Published on: May 28, 2015

The Lancet Volume 385 of May 23, 2015 carries an article by Dinesh C. Sharma about health spending in India, which makes us wonder whether we have forgotten our kitchen table wisdom that health is more important than wealth.

India’s health spending has always been one of the lowest in the world. Compared to 15-17% of GDP spent by the U.S. government on health and compared to 5%, which is the lowest among most civilized countries, India stands out with its abysmally low health spending of less than 1.2%. During the last decade, health spending had slowly crawled up from 1.1% to nearly 1.2%, but the newly declared health policy has slashed it by 15%.

One of the major achievements in the last decade was the spending by the Government of India through the National Rural Health Mission (NRHM) to improve health services, particularly with a focus on infant and maternal mortality. The availability of medicines had improved in government hospitals, including primary health centres. For the first time, diabetics and hypertensives from the poorer strata of the society were getting essential medicines free. There were plenty of imperfections, but certainly there was a trend towards improvement. The proposed cut in health spending by 15% does seem tragic. According to the government, under a new tax-sharing formula, states will get more funds and they will spend more on health. But the Lancet quotes experts who expect that the maximum that the state may get out of such tax-sharing is 0.7% of GDP, while some states will actually lose out. The National AIDS Control Program, which had succeeded in keeping prevalence below 1% and in improving ART also now stands under threat.

The impact on palliative care access is predictable. Though the government of India had framed the National Program of Palliative Care (NPPC) in 2012, it had been able to provide only about 2% of the originally proposed budget for the purpose. Now, even that stands threatened.