Health infrastructure and local bodies

Primary healthcare system in the country is poised for a radical change with the Central government releasing the healthsector grants to the urban and rural local bodies as recommended by the 15th Finance Commission. Timely and judicious utilisation of fund by the local bodies will be critical for plugging the gap in the primary healthcare sector that was laid bare by the COVID-19 pandemic. The Department of Expenditure, Ministry of Finance has released an amount of Rs 8,453.92 crore for the local bodies of 19 states including an amount of Rs 272 crore for Assam while the maximum amount of Rs 1,116 crore has been released to Bihar. Of the total grant of Rs 70,051 crore recommended by the Finance Commission, Rs 43,928 crore is meant for the rural local bodies and Rs 26,123 crore for the urban local bodies. The grants are meant to support the PRIs (Panchayati Raj Institutions) and the urban local bodies for setting up diagnostic infrastructure in the primary healthcare facilities, block-level public health units, construction of buildings for the sub centres, PHCs (Primary Health Centres), CHCs (Community Health Centres) running from rented houses, conversion of PHCs and Sub Centres into health and wellness centres in the rural areas and also to support the urban health and wellness centres.

The rationale behind the Finance Commission's emphasis on the involvement of the local bodies in building the infrastructure in the public health delivery system is rooted in the decentralised system of implementation of healthcare programmes of the NRHM (National Rural Health Mission) though involvement the local governments and 12th Five-Year Plan focusing on strengthening the initiatives for greater involvement of these local government institutions right from the village to the district levels in the public health delivery system under their jurisdictions. Health and sanitation, including hospitals, primary health centres and dispensaries and family welfare are listed at serial numbers 23 and 24 of the Eleventh Schedule for panchayats, and public health, sanitation conservancy and solid waste management at serial number 6 of the Twelfth Schedule for municipalities. This led the FC to reach the articulate its view that strengthening the local governments in terms of resources, health infrastructure and capacity building can enable them to play a catalytic role in health care delivery, including in crisis times. The commission emphasised the need for putting primary health care at the centre of efforts to improve health and well-being and insisted that "there is clear international evidence that quality primary health care reduces total healthcare costs and improves efficiency by reducing hospital admissions." While recommending a substantial grant to strengthen the Health sector, the Commission expected concurrent efforts by the states to enhance their spending on health and recommended in its report 2021-26 that the health spending by the states should be increased to more than 8 per cent of their budget and ensuring that primary health expenditure is increased to two-thirds of the total health expenditure of the budget by 2022. Investment in primary healthcare, including prevention and health promotion, provides better health and developmental outcomes at a much lower cost and reduce the need for costlier, complex care by preventing illness and promoting general health, adds the report. The FC has made it mandatory for the states to form a committee under the Chief Secretary and comprising officials of the state departments of Health, Panchayat Raj and Urban Affairs and select representatives from all the three tiers of rural and urban local bodies for utilising the Health sector grants for local bodies. The state government and local governments will have to ensure synergy in planning and execution of the primary Health sector projects to be undertaken with FC grants.

Building capacity of the PRIs and urban local bodies in supervising and managing the healthcare projects will be an urgent necessity for the state health departments. Shortfall of human resources will also have to factored in such planning to project future needs of primary health infrastructure. Based on the findings of the Rural Health Survey, 2018-19, the Commission's report for 2021-26 brought to light that shortfall of human resources in the Health sector. There is a shortfall of 85.6 per cent of surgeons, 75 per cent of obstetricians and gynaecologists, 87.2 per cent of physicians and 79.9 per cent of paediatricians. Overall, there is a shortfall of 81.8 per cent specialists at the CHCs, 23 per cent in terms of nursing staff at PHCs and 10 per cent in CHCs in the rural areas. The survey also revealed a shortfall of 22% in PHCs and 21% in CHCs in urban areas; and such shortfall still remains a critical human resource management challenge in the Health sector in India. As of now, timely utilisation of the Health sector grants released to the local bodies for building the required infrastructure will go a long way towards building India's resilience against the prevailing COVID-19 pandemic and future pandemics and epidemics in the country.