(2)Urban Health Division Ministry of Health & Family Welfare, Government of India. Health of the Urban Poor in India Key Results from the National Family Health Survey, 2005 - 06
NFHS 3(05-06)(10) Incrementalismin Addressing Challenges of Slums: Lessons from Urban Health Practice in IndiaKey Note AddressInternational Conference on Urban HealthOctober, 23, 2009Siddharth AgarwalUrban Health Resource Centre (UHRC), India
Analysis of health budget 2012-2013
WHAT IS BUDGET ?• It is the detailed plan expressed in quantitative terms, that specifies how resources will be acquired & used during a specified period of time.• WHAT IS UNION BUDGET ?• The union budget of India, referred to as annual Financial Statement in Article 112 of constitution of India, is the annual budget of the Republic of India, presented each year on the last working day of February by the Finance Minister of India in Parliament.• The budget has to be passed by the parliament house before it come into effect on April 1, the start of Indias financial year. The Union Budget 2012-13 presented by Mr.Pranab Mukherjee on March 16, the Financial Minister of India on16th March 2012.• The budget implemented on 1st April 2012.
HEALTH BUDGET• Allocation for National Rural Health Mission (NRHM) proposed to be increased from ` 181.15 bn in FY12 to ` 208.22 bn in FY13.• Scope of Accredited Social Health Activist– ‘ASHA’• National Urban Health Mission is being launched.• Pradhan Mantri Swasthya Suraksha Yojana• New integrated vaccine unit to be set up in Chennai.• Budgetary allocation for rural drinking water and sanitation increased from ` 110 bn to ` 140 bn, representing an increase of over 27%.
• Preventive health checkup deduction up to 5000 Rs. allowed• 5 year extension to the 200 percent R&D tax deduction up to 2017• Fund allocation for the health sector recorded a paltry 14% increase in 2012-13 to Rs 30,477 from Rs 26,760 crore• duty of 6% on iodine• Basic customs duty on probiotics will be reduced from 10% to 5%.
HEALTH BUDGET FINANCIALS 2010-2011 2011-2012 2011-2012 2012- 2013 Actuals Budget estimates Revised Budget estimates estimate sMinistry of health and 20726 26760 24315 30477family welfareDepartment of health and 19362 23560 21577 27127family welfareDepartment of AYUSH 849 900 650 990 Department of health 515 600 588 660 research Department of AIDS ---- 1700 1500 1700 control
NATIONAL RURAL HEALTHMISSION • Inaugurated on April 12,2005 • Correct the deficiencies of the health system. • Focus on 18 states- northern and eastern(Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, J&K, Manipur, Mizoram, Meghalaya, MP, Nagaland, Odisha, Rajasthan, Sikkim, Tripura, Uttaranchal, UP) • Intended for 2005-2012 now extended to 2017.
AIM• ASHA(Accredited Social Health Activist) To provide accessible, affordable, accountable, effective and reliable primary health care through creation of ASHA.Reduction in Infant mortality rate(IMR)Reduction in maternal mortality rate(MMR)Universal access to public health services like women’s health , child health, water , immunization, sanitation and hygiene and nutrition.Prevention and control of communicable and non- communicable diseases.Revitalise local health conditions and main stream AYUSH.
Components of NRHMASHA• Resident of the village• One ASHA per one thousand population• Chosen by Panchayat• Bridge between ANM & village• Receiving performance based compensation.
Responsibilities of ASHA• To create awareness• Counselling• Encouragement• Accompany the pregnant women requiring treatment and admission to the nearest PHCs• Primary medical care• Providers of DOTS
STRENGTHENING SUB-CENTRES • Each sub-centre will have an Untied Fund for local action @ Rs. 10,000 per annum. • Supply of essential drugs, both allopathic and AYUSH, to the Sub- centers. STRENGTHENING PRIMARY HEALTH CENTRES • Adequate and regular supply of essential quality drugs.. • Provision of 24 hour service in 50% PHCs by addressing shortage of doctor.
STRENGTHENING CHCs FOR FIRST REFERRAL CARE• Operationalizing 3222 existing Community Health Centers (30-50 beds) as 24 Hour First Referral Units.• It includes medicine doctors, surgeon, gynaecologist, anaesthetist.• Developing standards of services and costs in hospital care.DISTRICT HEALTH PLAN• Health Plans would form the core unit of action proposed in areas like water supply, sanitation, hygiene and nutrition.• District becomes core unit of planning, budgeting and implementation.• District Health Mission.
CONVERGING SANITATION AND HYGIENE UNDER NRHM-• Total Sanitation Campaign.STRENGTHENING DISEASE CONTROL PROGRAMMES-• National Disease Control Program.• New Initiatives would be launched for control of Non Communicable Diseases.• Supply of generic drugs.• Provision of a mobile medical unit
REORIENTING HEALTH/MEDICAL EDUCATION TO SUPPORT RURAL HEALTH ISSUES-• While district and tertiary hospitals are necessarily located in urban centres, they form an integral part of the referral care chain serving the needs of the rural people.• Medical and Para-medical education.• National Institution for Public Health Management etc.
The Central government has planned to develop a new scheme of National Urban Health Mission (NUHM) in order to highlight the health challenges in towns and citiesProvisional Census 2011 data showed that for the first time since Independence, the absolute increase in population was more in urban areas that in rural areas.At present, rural population in India is 68.84 per cent (down from 72.19 per cent in 2001 Census) as against 31.16 per cent urban population.Of the 370 million urban dwellers, over 100 million are estimated to live in slums and face multiple health challenges on the fronts of sanitation, communicable and non communicable diseases.
As per sensus 2011 ,37.7 crore people live in urban areas. Urbanization in India 1951 - 2026 Percentage to total populationUrban Population (in million) India has been urbanizing rapidly in recent decades. It is estimated that the urban population will nearly double to reach 534 million by 2026.
Health challenges in urban India Smaller the city – bigger the problem NFHS 3(05-06)
Health challenges in urban India (Cont..)Poor supply of Funds: 77% Public Subsidy for Curative Care Goes to Richest 3 QuintilesResearch and knowledge/information gapsPoor community awareness and weak community capacity to demand and access health carePoor family support systemPoor Environmental Conditions
GOAL Improving the efficiency of public health system in the cities bystrengthening, revamping and rationalizing urban primary healthstructure.• Provision for a need based contractual human resource, equipment and drugs.• Partnership with non-government providers for filling up of the health delivery gaps.• Promotion of access to improved health care at household level through community based groups : Mahila Arogya Samitis.
• Strengthening public health through preventive and promotive action.• Increased access to health care through risk pooling and community health insurance models.• All the services delivered under the urban health delivery system are based on identification of the target groups (slum dweller and other vulnerable groups); preferably through distribution of Family/ Individual Health Suraksha Cards.
Scope, Coverage and Durationof the Mission • The Mission would be covering 430 cities, i.e. all cities with population one lakh and above. • The duration of the Mission would be for the remaining period of the 11th Plan (2008-2012). • The initial focus would be on the urban slums then it will be extended to the whole urban population .
Community Level Urban Social Health Activist (USHA)USHA would remain in charge of each area and serve as an effective and demand–generating link between the health facility and the urban slum populations. The USHA would preferably be a woman resident of the slumMahila Arogya Samiti (MAS) Act as community based peer education group, involved in community monitoring and referral. The MAS may consist of 20-100 households (HH) with an elected Chairperson and a Treasurer, supported by an USHA
Budgetary Provisions• The NUHM would commence as a 100% centrally sponsored Scheme in the first year of its implementation during the XIth Plan period.
PRADHAN MANTRISWASTHYA SURAKSHA YOJNA 6 New AIIMS started by government. S. NO. AIIMSPHASE 1 1. PATNA, BIHAR 2. RAIPUR, CHATTISGARH 3. BHOPAL, MADHYA PRADESH 4. BHUBANESHWAR, ODISHA 5. JODHPUR, RAJASTHAN 6. RISHIKESH, UTTRANCHAL S. N AIIMS 1. LOCATION NOT SELECTED, U.P PHASE 2 2. RAIGANJ, WEST BENGAL
decided to strengthen 13 existing Medical College-• An outlay of Rs. 120 crore has been approved for upgradation of each medical college institution.• the Government of India is investing Rs. 100 crore for each institution and the State Government’s share is Rs. 20 crore.• The estimated cost for setting up each institute is Rs. 332 crore.
Upgradation of 13 medical institutes under PMSSYS. No. State Name Of Institution1st Phase1. Andhra Pradesh (1) Nizam Institute Of Medical Sciences,hyderabad. (2) Sri Venkatshwara Institute Of Medical Sciences,tirupati2. Gujrat B .J.Medical College, Ahmedabad3. Jammu –Kashmir (1) Govt. Medical College, Jammu (2) Govt. Medical College,srinagar4. Jharakhand (1) Rajendra Institute Of Medical Sciences,ranchi5 Karnataka (1) Govt. Medical College ,Banglore6. Kerala Govt. Medical College,thiruvananthpuram7. Maharashtra Grants Medical College,mumbai8. Tamil Nadu Govt. Mohan Kumarmangalam Medical College,salem9. Uttar Pradesh (1) Sanjay Gandhi Postgraduate Institue Of Medical Science, Lucknow (2) Institute Of Medical Sciences, Banaras Hindu University, Varanasi10. West Bengal Kolkata Medical College,kolkata
2NDPHASE1 HARYANA PANDIT B.D. SHARMA POST GRADUATE INSTITUTE OF MEDICAL , ROHTAK2 HIMACHAL DR. RAJENDRA PRASAD GOVT. MEDICAL COLLEGE, TANDA PRADESH3 MAHARASHTRA GOVT. MEDICAL COLLEGE,NAGPUR4 PUNJAB GOVT. MEDICAL COLLEGE,AMRITSAR5 TAMIL Nadu GOVT. MEDICAL COLLEGE,AMRITSAR6 Uttar pardesh JAWAHARLAL NEHRUGOVT. MEDICAL COLLEGE OF AMU,ALIGARH.
NEW INTEGRATED VACCINE UNIT• India will up a state-owned unit to build a 5.9 billion rupees integrated vaccine complex project in the southern state of Tamil Nadu.• HLL Biotech Limited.• build in the Kanchipuram district.• produce vaccines for DPT, hepatitis B, BCG, measles, Rabies, Japanese encephalitis and haemophilus influenza B, known as Hib.
IMPACTS OF HEALTH BUDGET• The Budget has focused towards improving healthcare services at the rural as well as urban region.• The increased NRHM outlay is expected to further improve access to healthcare in the rural areas.• Under the PMSSY scheme, the Government aims at setting up eight AIIMS-like institutions and up gradation of existing Government medical colleges.
• Drug prices may rise due to excise duty hike• Undergoing a preventive health check-up will help a consumer save tax up to Rs 5,000• Boost for probiotics product industry• The healthcare service in the urban region is also expected to increase with the launch of NUHM. Enhanced rate of deduction linked to capital expenditure is expected to increase investments in hospitals in the coming years.• These measures are expected to have a marginally positive impact on the healthcare sector.
RELATED ARTICLES•NAGPUR: Though there was a delay in work in the initial phase,the GMCand Hospital (GMCH), which is being upgraded as thestate-of-the-art medical college under the PMSSY, now seems tobe moving at the right pace. The project is about to enter thesecond phase.(rajaram powar, TIMES 7sep2012)•National Vaccine Policy: For industry, not peoples healthThe new National Vaccine Policy Draft 2011openly favoursindustry. It provides for advance market commitments for newvaccines.(Jacob Puliye is a member of the National Technical AdvisoryGroup on Immunisation and of the Working Group on Food andDrug Regulation in the 12th Five-Year Plan. inEPW November 5,2011)