Dear Pranab Babu,

If octogenarians were the only people rating your Budget, you would surely have fared far better than you did with some of the pundits appearing in television panel discussions who have given you four or five out of 10. Your understanding and concern for our elderly, especially the very senior citizens, is indeed touching, and reflected in the measures you just announced: tax exemption limit raised to `5 lakhs a year, and old age pension up from `200 to `500 for those over 80.
G

iven these thoughtful gestures, I am surprised that you were not a little more expansive on the one subject that obsesses the elderly — healthcare. Come to think of it, in a country where the vast majority of the population have to pay for their own medical treatment and where healthcare costs drive tens of thousands into debt, this is not just a “senior citizen” issue. It concerns us all. It is critical to a future where over 70 per cent of India will be of working age by 2025.
But healthcare was probably the shortest part of your Budget speech. Don’t misunderstand me. I cheered when you said that you have hiked funds for the healthcare sector by 20 per cent (to `26,760 crores) and that there is `2,738 crores for medical education, training and research to deal with the acute shortage of healthcare professionals in the country. I cheered again when you told us that the government-sponsored Rashtriya Swasthya Beema Yojana (national health insurance scheme) targeting families below the poverty line is now being extended to Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) beneficiaries and henceforth will also cover unorganised sector workers in hazardous mining and associated industries like slate and slate pencil, dolomite, mica, asbestos etc.
After all that talk about India’s demographic dividend, I had hoped that you would come up with some big, new ideas for a healthier India. I am not a hospital administrator or an economist. But like many middle-class Indians who listened to your speech, I wonder why you proposed a five per cent tax on all services provided by hospitals with 25 or more beds that have central air-conditioning; and was even more bewildered by extension of the levy on all diagnostic tests of all kinds. Surely, a health check-up is not an elitist idea.
You may argue that an air-conditioned hospital is a big city phenomenon. So, for the time being, let us keep aside the metrowallah’s gripe. But I was talking to healthcare entrepreneurs who have set up hospitals in small-town India and they are disappointed. This Budget does little to cheer people like Dr Ashwin Naik, co-founder and chief executive officer of the Vaatsalya Group, which runs hospitals in towns like Hubli, Bijapur, Hassan, Mysore, Shimoga, Gulbarga etc. You have exempted all government hospitals from this levy, no doubt, because of concerns for the aam aadmi who is mentioned with increasing frequency in official documents. The long-standing demand for treatment of healthcare as infrastructure has been overlooked — once again, as Hari Bhartia, president of the Confederation of the Indian Industry pointed out.
Your government has good intentions and though some TV pundits have been berating your decision to double the salaries of Anganwadi workers and helpers, I think it is an important step, just as your special incentives to improve education and to grow food items like maize can help fight malnutrition. All of them are parts of the social infrastructure necessary for a healthier India, but are not sufficient.
If I may humbly point out, there are two critical “I” words if we are to improve our healthcare. One is “intent” and the other is “implementation”. All the money in the world will not a healthier India make if there is no implementation of schemes. And nothing gets implemented if there are no minimal standards and no monitoring on a continuous basis.
Pranab babu, did you know that in this great country of ours with over a billion people, there are only 56 hospitals that have been accredited by the National Accreditation Board for Hospitals and Healthcare Providers? It is good to know that now there is more money for government health programmes and some steps are being taken to get a reality check. One example from the National Rural Health Mission’s website — a report by officials who visited the Colonel Ganj community health centre (CHC) in Uttar Pradesh’s Gonda district last December said: “It is a 30-bedded CHC. However, no blood storage centre was there. Surgeon, anesthetist, opthlmologist were available. However, there is no gynaecologist. Sole female medical officer posted in the CHC is also on training for ultrasonography. So services of anesthetist not used optimally”. Sounds familiar?

Patralekha Chatterjee writes on development issues in India and emerging economies and can be reached at patralekha.chatterjee@gmail.com