Rajasthan moves to Universal Health care - Budget 2021-22

 The chief minister of Rajasthan announced that Right to Health enactment would be passed in the state, when he presented the first ever health oriented budget of Rajasthan. He made announcement of providing 100 % insurance cover to the people of Rajasthan, as a step towards Universal Health Coverage. He made important announcements for the extension of free drug distribution and free diagnostics schemes. Rajasthan model of Public Health was mentioned in the speech, which is a welcome step to boost much neglected preventive and promotive care in the country. Principally, Rajsthan has taken all the right steps towards the achievement of Sustainable Development  Goal – 3, which is Health.

Health and Education are the two most important pillars of human development. A healthy and educated society is a harmonious and happy society.  Good governance ensures equal accessibility of health and education to everyone in the society, and that becomes one of the most important indicators of equity. Investment in health brings long term benefits.  These are simple facts, known to development economists for a long time.

It took a pandemic to impart political will to bring back focus on health in the country. Total allocation to medical and Health in Rajasthan’s budget is 53,02,71.34 lakhs. Health is a state subject and some part of allocation to health, comes from central fund allocations to programs and schemes. Ayurveda Department will get an allocation of 11,54,37.90 lakhs allocation, with the center’s share in it as 4369.54 lakhs. Medical and Health Department received an allocation of  10,37,155.06 lakhs, out of which 1,65,701.28 lakhs will be center’s share. Medical education gets an allocation of 44,68,35.60 lakhs out of which 68434.80 lakhs is center’s contribution.

Department	State	Center	Total
Directorate Family Planning	66668.99	57804.02	124473.01
Directorate Medical and Health	720172.21	0.09	720172.30
Mobile Medical Unit	1565.47	-	1565.47
NRHM	80303.01	107897.01	188200.01
Food Safety	68	-	68
Medicine and Drugs	2676.10	.17	2676.27
Medical Colleges	378400.80	68434.80	446835.60
Ayurveda	111068.36	4369.54	115437.90
Yunani and Homeopathic	8329.43	-	8329.43

Apparently, allocation to NRHM has been reduced, but it might increase in the revised estimates, as central fund allocation is pronounced. Major increase in allocation has been for Jan Swasthya Bima Yojna, medical education and free drug distribution scheme.

Scheme	Budgeted Allocation in Lakhs – 2020-21	Budgeted Allocation in Lakhs-2021-22	Increased Allocations	Percentage change
Free Drug Distribution scheme	60185.61	70118.56	9932.95	16.50%
Free Diagnostic scheme	25453.2	25513.16	59.96	0.24%
Jan swasthya Bima Yojna	49150.82	146339.89	97189.07	197.74%
Rajasthan Medical Education	21600	27000.01	5400.01	25.00%
National Ayush Mission	155655	168700.00	13045	8.38%
NRHM	250692	188200.01	-62492	-24.93%
NUHM	5910	6500	590	9.98%
EMRI	12900	13000.00	100	0.78%

 Enhancing demand for healthcare

Universal health coverage of Rs. 5 lakh insurance cover provided to every family, a facility for cashless IPD treatment, is an announcement which is welcome. It will be provided free of cost to those covered under Ayushman Bharat, and small and marginal farmers. For the rest of the people it will be available at a premium of Rs. 850 annually. It will prove to be a major factor in increasing demand for healthcare services. It is yet to be made clear whether this scheme could be incorporated as a scheme of group insurance or not, generally subscribed by private and semi-government organisations. Rajasthan Government Health Scheme on the lines of CGHS has been announced by the Chief Minister for Pensioners, MLAs and Government Officials. Mukhyamantri Nishulk Jaanch Yojna will be extended to 61 PHCs (from 15), 95 CHCs (from 37) and 109 subdistrict hospitals (from 56 ), and 133 district hospitals (from 56), through a hub and spoke model.

Supporting Healthcare on supply side

The supply side will be enhanced by the increasing empanelment of health care service providers in the private sector.  Several announcements were made to increase capacity of hospitals and opening of new hospitals. Increase of 1000 beds in hospitals at Kota, Bhilwara, Sikar, Bharatpur, Pali, Churu and Barmer has been announced. 30 new PHCs will be established and 50 PHCs will be upgraded to CHCs. Model CHCs will be established in every assembly constituency. MLA Fund of 2 crores will be utilised for that purpose. At every district headquarter, medical college will be established. Every district will have its own nursing college. Building for 40 PHCs and 25 CHCs will be constructed with expenditure of 206 cr.

Institute of tropical medicine and virology and Institute of Cardiology will be established in Jaipur for health response to all communicable diseases, preventive as well as curative and cardiac problems under one roof. Post graduate institute of Maternity and Neonatology and Regional Cancer Institute will be established in Jodhpur. For alternate medicine Ayurvedic, Unani and Homeopathic hospitals will be established at every block headquarter. Post MBBS diploma in 8 specialities will be offered at all district hospitals. That will ensure the availability of 400 more specialists every year. Special cadre for specialist doctors will be introduced to better utilize their services particularly in the far off areas. For a better management of medical colleges and public hospitals, a Health Management Cadre will be introduced.

New Jeevan Rakshak Yojna will be launched to provide free emergency care to those who suffer from road injuries without having any need for identity check. 100 crores will be provided for dedicated Road Safety Fund. Primary Trauma Center will be established at 40 CHCs. Directorate of Food Safety will look after the quality of food products.  Rajasthan Ayush Niti 2021 will be made to boost ayurved based health services and ayurved based medical tourism. International center for excellence in Panchakarma will be established in Jodhpur for the purpose.  

Public Health

Rajasthan Model of Public Health has been supported by announcements made about 12000 health and wellness centers to be established, by upgrading PHCs and sub-centres. Primary health services of 12 types will be made available at these centres. HWCs will become primary functional units for Public Health. For that 11000 Community Health Officers are being recruited. Public Health Colleges will be established at divisional head quarter.

A Community Health Officer is supposed to collect the data of a population of 3000-5000 and transfer it to a centralised database. He should be capable of analysing this data, prepare epidemiological reports, understand socio-economic parameters affecting the health of the people, understand the ecology of his area, and make intelligent suggestions for targeted policy and programmatic initiatives. Unfortunately, the community health officers being recruited by the government are not skilled in all the above mentioned areas. They need to be educated, and will have to be provided better skills. Public Health Colleges should do that work.

Challenges

While the announcements made are in the right direction, robust implementation would be the key. Healthcare sector has an asymmetric distribution of information, which gives rise to cartelization, inefficient markets and suboptimal allocation of resources. Studies have found that insurance schemes like RSBY have not been able to deliver on a high cost-benefit ratio. Government hospitals are overcrowded and inefficient and private healthcare service is suboptimal. Private insurance markets, world over, are riddled with the problems of middlemen, increasing the overall costs.  Challenges are just too many, and a lot of political will would be required to deliver on the promises made. 

But, it is definitely a right step in the right direction.