The outbreak of COVID-19 pandemic caught the country and the States ill-prepared to deal effectively with health emergencies. The 15th Finance Commission's report has brought to light the hard reality that the combined expenditure of the Ministry of Health & Family Welfare and the States together has been abysmally low and was less than one per cent of the country's GDP in 2018-19. The Commission has recommended that the public health expenditure of the Central government and the States together should be increased in a progressive manner to reach 2.5 per cent of GDP by 2025. A key recommendation for improvement of Health infrastructure and service delivery is channelizing the grants through the local governments of rural and urban bodies. The Commission has taken a cue from Kerala to arrive at the conclusion that in the efforts to achieve the ideal of universal health, the rural and urban local bodies can play a key role in the delivery of primary healthcare services especially at the "cutting-edge" level. Kerala has established itself as an example where local governments and the staff of public Health institutions effectively deliver healthcare at the local level in a collaborative framework, states the Commission in its report for 2021-26. The Commission has earmarked Rs 70,051 crore out of the grants for local governments for the Health sector at the rural and urban local body levels over the period of five years. The Central government has envisaged the creation of 1,50,000 Health and Wellness Centres (HWC) by transforming the existing sub centres and Primary Health Centres as the basic pillar of 'Ayushman Bharat' to deliver comprehensive primary healthcare. The Finance Commission has proposed to provide support for the necessary infrastructure to convert the rural PHCs and sub centres into HWCs so that they are equipped and staffed by an appropriately trained primary Healthcare team, comprising multipurpose workers. In addition to conversion of the existing PHCs and sub-centres, building of the new Health infrastructure and strengthening of Health intelligence service are critical to equip the States to handle future epidemics.
The States also need to bridge the wide human-resource gap in this sector. Assam, for instance, has a shortfall of 12,513 doctors, nurses, and other personnel in the existing Healthcare facilities. This gap is projected to widen to 23,567 in the State if the new facilities are built in accordance with population norms. Assam currently has 23,804 allopathic doctors, 2792 government Ayurvedic doctors, 2718 AYUSH registered practitioners, 1376 doctors at the Primary Health Centres. Only one allopathic doctor is available against a population of 1311, one AYUSH practitioner against 14328 population, one government doctor against 5131 population while one doctor at PHC caters to a population of 22679 in the State. Mismatch in building the Health infrastructure and human resource development will only drag the Health systems down and make it weaker in the event of outbreak of epidemics in the future. The shortfall in Community Health Centres in the State is 32 per cent and in respect of the Primary Health Centres, it is 27 per cent as against the requirement. According to the Rural Health Survey, 2018-19, there is ashortfall 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 in the country, notes the Commission. 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 Community Health Centre in the rural areas, the report states which show how ill prepared the country is if its has to deal with a pandemic situation. Strengthening of surveillance will require targeted investments to enhance integrated public Health laboratory infrastructure and functions, strengthening epidemic intelligence service by developing and deploying district surveillance teams, real-time surveillance and reporting time and strengthening inter-agency coordination for disease preparedness andresponse. The States have gained practical experiences and also successfully experimented the surveillance strategies during the COVID-19 pandemic which will be useful in achieving these goals set by the Finance Commission. The current expenditure on primary health is 53 per cent of the total expenditure on Health. The Commission has recommended that the Health spending by the States should be increased to more than 8 per cent of their Budget by 2022 to enhance their spending on health. The gap in existing facilities and requirement in the State is too wide to be narrowed down to one-upmanship over establishment of new medical colleges or building a new Health facility. There can be no room for any complacency till the States and the country bridge the gaps and are equipped fully to handle a health emergency like COVID-19 pandemic without disruption in the economy and minimising the loss of lives.