New Govt must double public health spending

Dr Arun Mitra
To ensure empowerment of vulnerable groups women, children, young people, persons with disabilities, older persons, refugees, internally displaced persons and migrants and to protect human rights the 2030 Agenda for Sustainable Development was launched by a UN Summit in New York on 25-27 September 2015 which has 193 countries as signatories. It envisages “a world of universal respect for human rights and human dignity, the rule of law, justice, equality and non-discrimination”. The Agenda has 17 Sustainable Development Goals (SDG), and 169 targets which seek to eradicate poverty, promote human rights and achieve gender equality. The agenda became effective from 1st January 2016.
The UNO has defined sustainable development as that meets the needs of the present without compromising the ability of future generations to meet their own needs. To achieve sustainable development it is important to have economic growth social inclusion and environmental protection. The Sustainable Development Goals (SDGs) are not legally binding, nevertheless, countries are expected to take ownership and establish a national framework for achieving the 17 Goals. Implementation and success will rely on countries’ own sustainable development policies, plans and programmes.
The Goal No 3 of the Sustainable Development Goal (SDGs) solely focuses on health, which is “to ensure healthy lives and promote well-being for all age groups”.
SDG-3 comprises 13 targets. These include No Poverty, Zero Hunger, Good Health and Well-Being for people, Quality Education, Gender Equality, Clean Water and Sanitation, Affordable and Clean Energy, Decent Work and Economic Growth, Industry, Innovation and Infrastructure, Reduced Inequalities, Sustainable Cities and Communities, Responsible Consumption and Production, Climate Action, Life below Water, Life on Land, Peace, Justice and Strong Institutions, Partnerships for the Goals.
Targets to be achieved by 2030 include maternal mortality ratio to less than 70 per 100,000 live births, end preventable deaths of new-borns and children under 5 years of age, reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births, end the epidemics of AIDS, Tuberculosis, Malaria and neglected tropical diseases and combat Hepatitis, water-borne diseases and other communicable diseases, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being, strengthen the prevention and treatment of substance abuse, halve the number of global deaths and injuries from road traffic accidents, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes, achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination.
WHO has estimated cost of reaching global health targets by 2030. A study conducted by the Lancet Global Health shows that investments to expand services towards universal health coverage and the other SDG health targets could prevent 97 million premature deaths globally between now and 2030, and add as much as 8.4 years of life expectancy in some countries. While most countries can afford the investments needed, the poorest 67 low- and middle-income countries that face the greatest challenges in terms of expanding health services will need assistance to reach the targets. “Universal health coverage is ultimately a political choice. It is the responsibility of every country and national government to pursue it,” says Dr Tedros Adhanom Ghebreyesus, the Director-General of WHO.
To meet the SDG target would require up to US$ 371 billion or US$ 58 per person by 2030. This would require health spending as a proportion of gross domestic product from an average of 5.6 per cent to 7.5 per cent. The global average for health spending as a proportion of GDP is 9.9 per cent. Although higher spending does not necessarily translate to improved health, making the right investments at the right time can.
For India it is a big challenge to meet the SDG goals on health. Our public health spending is around 1.1 per cent only. This is too low an expenditure on health. Our Maternal Mortality Rate is 130 per 100000 live births. To bring it down to 70 requires political will. India’s under 5 mortality rate was 43 in 2015. It has to be brought down to 25 and the Infant mortality rate has to be brought down to 12 from 34 in 2016.
According to SDG Index and Dashboards Report 2018 India’s ranking in SDG is 112. In comparison other South Asian countries barring Pakistan are better in their performance. Their rankings are Pakistan 126, Sri Lanka 89, Nepal 102, Bangladesh 111, Bhutan 83, China 54. In SDG on health India ranks at 143 out of 188 countries.
The Government’s recently announced health scheme Ayushman Bharat is based on involving insurance sector. The global experience shows that health has improved by direct spending by the state. There is need to immediately increase the public health spending to 2.5 per cent of GDP and increase is to 5 per cent to be able to meet the SDG requirements on health. (IPA)


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