State budget and health sector

Dr Dharmakanta Kumbhakar

(The writer can be reached at drkdharmakanta1@gmail.com)

Finance Minister Ajanta Neog presented the budget for the FY 2021-22 in the State Assembly on July 16, 2021. With an announcement that the Government has not allowed fund constraints for COVID-19 management and the vaccination drive being converted to a mass movement with people's participation, the minister allocated Rs 7004.35 crore for the expenditure on the health sector in the budget which is Rs 877.35 crore more than the last year's budget allocation. This is an increase of around 14.32% compared to the budget allocation of Rs 6127 crore during FY 2020-21. This year the COVID-19 pandemic allowed the Finance Minister to be an outlier and allocate more money to the health sector than what had been done earlier. But it seems she wasted it. A good budgetary allocation to the health sector this year was anticipated given the pandemic situation. Despite the pandemic, the health sector, however, saw little real increase in the allocation. There was a dire need for a bigger budget allocation than what she has allocated to the health sector to cope up with the pandemic.

At the beginning of the budget speech, the minister thanked thousands of health workers- doctors, nurses, paramedics, laboratory technicians, ambulance drivers, ASHA workers, other frontline workers- for their selfless services during the pandemic. But the budget failed to allocate funding for ensuring minimum wage and insurance for all the frontline health workers, especially Anganwadi and ASHA workers.

The minister didn't announce any new major health scheme in this budget like in previous years' budget. She focused on the completion of the previously announced health schemes and their fruitful implementation. This is one of the best aspects of this budget. It is better to complete and implement previously announced schemes than to announce any new major scheme. The minister mentioned that under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PMJAY), around 27 lakh families will continue to avail of cashless treatment across 1350 procedures. She also announced that the scheme under the Assam Cancer Care Foundation for cancer awareness, cancer prevention, early diagnosis and detection of cancer, improved and affordable cancer treatment, and better palliative and end-of-life care for cancer patients in the State will continue and all funds necessary will be provided in due course. She expected that the cancer hospitals at Dibrugarh, Barpeta, Tezpur, Lakhimpur, Mangaldoi, Kokrajhar and Jorhat under the Foundation will become functional during the current financial year while cancer hospitals in Guwahati, Silchar and Diphu are targeted during next year. If it happens, the existing gap between the demand for treatment and the available number of beds and facilities for cancer care will decrease in Assam. This will be good for Assam, which is witnessing an alarming rise in the number of cancer patients in recent years.

Neog assured in the budget that the Government will provide affordable and quality healthcare to all the citizens in Assam. The majority of Assam's total population resides in rural areas. The public healthcare system in rural Assam comprises mostly sub-centres, health and wellness centres (HWCs) and primary health centres (PHCs). Many people in the rural setup still lack access to basic healthcare. Closing these gaps has gained new urgency, especially during the COVID-19 pandemic. The pandemic has put the spotlight on the state of these sub-centres, HWCs and PHCs in rural areas and highlighted their significance in early detection of cases and providing quick help to patients before health conditions become more severe. The minister informed that at present, Assam has 1005 PHCs and 4693 sub-centres out of which 2344 are HWCs. Presently, PHCs have doctors, sub-centres have ANMs and HWCs have community health officers. She announced in the budget that in the coming days, the Government will provide the basic healthcare facilities including the services of a doctor in 1000 sub-centres/HWCs to make them Buniyadi Swasthya Kendra where free medical consultation, diagnostic tests, medical treatment of primary diseases including diabetes, hypertension, asthma and communicable diseases shall be provided. The implementation of this announcement will help to overcome the twin challenges of rising non-communicable and infectious diseases in rural Assam. Proper implementation of this announcement will bring better, affordable and efficient healthcare delivery to the doorsteps of the people residing in the remote areas of Assam and will save many lives. It will also strengthen the primary healthcare system of Assam.

It is proposed in the budget to upgrade subdivisional civil hospitals in Biswanath, Charaideo, Majuli, West Karbi Anglong and South Salmara to district hospitals and to establish a 100-bedded maternal and child wing at the S.K. Roy Civil Hospital in Hailakandi. These good initiatives will improve the quality of healthcare services at the public institutions providing secondary-level services and maternal and child healthcare.

In the budget, Neog announced that the academic session with 100 MBBS students in the North Lakhimpur Medical College would be operationalized in 2021 and the construction works of the Dhubri, Nagaon, Nalbari, Tinsukia, Kokrajhar, Charaideo, Karimganj and Biswanath Chariali medical colleges are advancing smoothly. She has announced that five new medical colleges in Golaghat, Dhemaji, Marigaon, Bongaigaon and Tamulpur would be established and allocated Rs 16 crore for each project. The Government is also planning to start new medical colleges at Guwahati and Goalpara soon. The establishment of new medical colleges plays a vital role in healthcare initiatives for citizens providing the latest healthcare services and reducing the demand-supply gap. Currently, we have 1000 MBBS and 711 PG seats in Assam. This will substantially increase when all the medical colleges will start functioning. The proposal is excellent if the State Government can provide sufficient faculty and infrastructure in these new medical colleges. It is seen that most of the faculties of medical colleges of Assam have opted either for voluntary retirement or resignation. To stop this, the Government must adopt some policies for the faculties like fair and transparent transfer policy, higher salary, better accommodation, etc. One hopes the Government will take the necessary steps in this regard. The functioning of new medical colleges will also change the picture of Assam's tertiary public healthcare delivery system.

The Finance Minister has proposed in the budget to upgrade the blood bank at the Gauhati Medical College and to establish two new blood banks with component separation unit (CSU) facilities at the North Lakhimpur Medical College and Nagaon Medical College. This will help in the transfusion of safe blood to needy ones and will reduce death due to scarcity of blood and its component. During the COVID-19 first wave, the blood banks of Assam with facilities of CSU played a vital role in the case of convalescent plasma therapy.

Continuation of the scheme of providing Rs 12,000 wage compensation to the female tea garden workers during pregnancy and motherhood will help them to look after themselves and their unborn babies better without compromising the livelihood of their families.

This will also help in reducing maternal mortality and infant mortality in the community. Moreover, the continuation of the scheme of providing free rice under the Affordable Nutrition & Nourishment Assistance Scheme to all the National Food Security Act beneficiaries, Poshan Abhiyan and the new scheme of providing free food to poor urban people under the Anna Nischito Asonia and pipe drinking water connection in tea garden labour lines will improve the health status of the beneficiaries.

While Assam has been plagued by multiple health issues and stressed health infrastructure, the healthcare personnel expected more allocations for the health sector which is not seen in this budget. There is an urgent need to address multiple issues that are plaguing the healthcare system of Assam.