show me the money

Promoting yoga as a preventive health strategy is ok – if health budgets increase too

The health financing system in India defies the global trend. Out of every four rupees spent on health, only one comes from the government.

In his address on International Yoga Day last month, Prime Minister Narendra Modi asked everyone to think of yoga as “health assurance at zero budget”.

The prime minister also pitched the idea that countries with low health budgets should invest in yoga for preventive health measures as that would save them a lot of money.

During Modi’s 25-minute speech, India lost 62 children. The majority of these young lives could have been saved with investments in primary healthcare.

One in every five children who dies before reaching its fifth birthday is born in India. Similarly, millions of pregnant women in India do not receive basic healthcare while giving birth, with thousands of them dying in childbirth. Life expectancy in neighbouring Sri Lanka and Bangladesh is greater than that in India.

Health allocations

The benefits of yoga are well established, particularly in promoting health and well-being. But when yoga is invoked as a health assurance while, in reality, millions are denied the right to live a healthy life, projecting yoga as an alternative appears to be a cruel joke.

The prime minister's compulsion to find health assurance in yoga reiterates his government’s obsession with reducing the national health budget. During the ruling BJP-led National Democratic Alliance’s first budget in 2015-’16, budgetary allocation to health was cut to a historic low. Though there were some notional increases in the budget of 2016-’17, when adjusted for prices, the allocation was actually lower than that in 2014-’15.

The Union government allocations on health have not been able to keep pace with the rise in prices, even though stagflation has given way to a sober rise in prices recently. As a result, the Union government’s expenditure on health as a percentage of the country’s income – a globally acknowledged indicator to assess government commitment – is on a downward slope.

Cuts in the Union budget have been justified on the understanding that under the 14th Finance Commission more funds will be devolved to states directly as centralised planning is abandoned.

So, now the buck stops at states. The evidence so far suggest that states have lost rather than gained under this new fiscal arrangement. Health departments in states have not gained as much from the expanded tax kitty, as they have lost from the withdrawal of central plan funds.

During 2010-’11 to 2014-’15, when the Union government spending on health care declined, spending by states actually grew close to double-digit rates at 9.9%. The effects of this new fiscal arrangement might halt this much required expansion of healthcare services by states as they may face a new fiscal crisis.

State spending not enough

Public spending on health in India is among the lowest in the world when compared in terms of share in Gross Domestic Product and per capita spending. States should spend more on health, as health is a state subject. But it is unrealistic to expect that states alone will be in a position to step up public spending on health adequately to take it up to 2.5% of the Gross Domestic Product, as promised in several policy documents over last two decades.

The Centre not only complements spending by states, it also signals crucial policy directions for states to follow, as it did through the National Rural Health Mission. Not only did spending by states increase in tandem with the Centre, considerable expansion of rural healthcare infrastructure and services took place through the national mission.

National health missions stalling

Unfortunately, recent cuts in the Union budget will have perilous effects on the quality of health services delivered through government facilities. Progress on implementation of the National Health Mission has been halted across states. Salaries of doctors and nurses are overdue, National Health Mission staff are protesting indefinite delays in payment in several states, new mothers are being denied financial assistance after delivery, and crucial life-saving medicines and commodities are in short supply.

There is an unwritten embargo against any new intervention under the National Health Mission. Some of the health outcome impacts could be long term. For instance, budgetary cuts are impacting antenatal care and supplemental nutrition programs for a generation of children who are likely to face stunting and growth issues and a lifetime of illnesses.

Health for all

Worldwide, governments acknowledge their responsibility to pay for the healthcare needs of their citizens, and have have taken several paths to this goal of assuring health for all.

Most countries either provide care directly through public-funded health systems or through social insurance or a combination of the two. High income households often top up their healthcare needs through out-of-pocket payments or insurance mechanisms. As a result, the vast majority of people are protected from the financial consequences of seeking healthcare in developed and many developing countries.

But the health financing system in India defies the global trend. Out of every four rupees spent on health, only one comes from the government, and most healthcare expenses are borne by households.

Around 5.5 crore people are pushed to poverty just to meet the healthcare expenses of their near and dear ones. Many more die untimely deaths, or get delayed treatment because they can’t afford to pay for healthcare.

Compared to most developing nations and even some of our neighbours like Sri Lanka, Thailand and Malaysia or even our partners in BRICS, our record on public spending on health is abysmal

Note: National Health Accounts estimates being conducted currently might provide a refined estimate and bring India’s public spending on health down to near one percent of GDP.
Note: National Health Accounts estimates being conducted currently might provide a refined estimate and bring India’s public spending on health down to near one percent of GDP.

India’s health and development indicators hold the key to a healthier world. India is rapidly urbanising, social support systems are fading away, diseases related to work and lifestyle are on the rise. A recent National Sample Survey report shows the increasing burden of non-communicable diseases.

Needless to say, yoga has considerable potential when it is part of a holistic, integrated and comprehensive health system.

One of the immediate requirements for building that kind of system is to take up scientific research on yoga, to assess its effectiveness and limitations in an objective manner and apply that refined knowledge to the larger health sciences.

In 2015-’16 the total budgetary allocation to yoga research was merely Rs 42.5 crore. But while hype was created around World Yoga Day, allocations to yoga research were silently cut further to Rs 26 crore in the revised estimates.

Observing all this, it’s difficult not to wonder that the rhetoric around yoga is being invoked to allow the state to abdicate its responsibilities when it comes to health.

Indranil Mukhopadhyay and Nandita Bhan work with the Public Health Foundation of India. Views expressed here are personal.

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