Pre Budget Expectations Dr Shakti Gupta

The budget document is basic policy paper of the government and in some sense provides a mirror of government’s priorities. However, one basic question remains as to how to translate these policies into implementable plans and how to make sure that the government is able to deliver the planned development. Many times we focus on priorities and policies without giving due consideration to ground level realities and the policy pronouncements remain rhetoric. 

Union Budget and the Health Sector Meeting the healthcare needs of population perhaps goes beyond the budget allocations. Given the growing complexities and challenges the health sector faces, reforms in this sector are inevitable. Reforms in health sector generally focus on making the health systems responsive through higher allocations and strengthening financial systems, ensuring local participation and public-private partnerships, and autonomy of health facilities. 

Health Sector and the Immediate Need One of the areas that need immediate attention in implementing the vision envisaged in the National Health Policy (NHP) is reforming existing institutional structure of the health care delivery system. The experience and number of studies suggest that the present structure has become dysfunctional as it has grown in size without giving due consideration to developing appropriate management structures to handle a large number of employees, fragmented the health care delivery system by creating operating islands without any mechanism of coordination and information sharing across departments and various offices involved in implementing the programmes, the structure is with broken hierarchy without any one assuming responsibility of performance or management of key resources, the system has remained less developed in terms of management systems (financial, personnel, logistics etc.) to implement programmes effectively and with greater degree of transparency.
 Immediate Need  for  Institutional Mechanisms The health sector reform strategies should take into considerations that appropriate institutional structures are inevitable for the growth and development of the health sector. Some broad suggestions in this direction are as follows: 
1.         Public Health Commission :  In order to address the Centre-State relationships in health effectively, the Government of India should set-up a Public Health Commission. The implementation of all central sponsored programmes (including family welfare programme) should be brought under the control of this commission. The MoHFW should play an active role of financing the programmes of this Commission .
 2.         Reforming the Medical Council of India :  The role of MCI over the years has got restricted to medical education. There has been no review of the functioning of the MCI. There has been dilution in its role to control the growing undesirable practices in the private health care sector. Some options are: divide the MCI into two parts: Medical Education Council of India and Medical Standards Council of India, or Create new Medical Standards Board, which should be responsible for setting standards for acceptable medical practice in the country.
 3.         Health Sector Regulation Monitoring Committee :  With the increasing private sector and liberalisation of insurance sector, regulations need to be strengthened. It is very important that in respect of Health Care Sector the Government may be urged to frame some sort of regulation for Hospitals, Practitioners, Nursing Homes, Labs, Drug Stores etc. There is need to set-up Health Sector Regulation Monitoring Committee which should have responsibility of ensuring that regulation get implemented and keep on examining various issues pertaining development of appropriate regulations on continuous basis.
4.         Indian Health Administration Service : The health sector needs much better management cadres and, for this, the creation of an Indian National Health Administration Service on the lines of the IAS and the IPS is urgently required.
5.         Health