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 The new estimate of $25 billion for a three-year extension of the
flagship health program, down from an initial figure of about $33
billion, comes as Prime Minister Narendra Modi pushes a
multi-pronged agenda to revamp health services.
Planned reforms include streamlining spending and bureaucracy,
slashing prices of life-saving drugs and medical devices, and
nudging companies such as PepsiCo to make more healthy products.
To extend the National Health Mission to 2020, a think-tank led by
Modi and the finance ministry in March told health officials to
rework the original proposal with "realistic" budget expectations
and to incorporate lessons from neighbors such as Nepal and
Bangladesh, the documents show.
In response, the health ministry has resubmitted a plan with lower
cost estimates and a list of targets to be achieved by 2020,
including strengthening health infrastructure and reducing tobacco
use.
The finance ministry, which will review the plan for approval this
month, did not respond to a request for comment. The federal
think-tank, NITI Aayog, declined to comment.
India's National Health Mission is one of the world's largest public
health programs. It provides free drugs and treatment to millions of
rural poor and helped to eradicate polio.
But the public health system is in a shambles and India ranks poorly
on key indicators - more than a million children die every year
before reaching the age of five.
After focusing on maternal and child health for years, the program
will broaden priorities to tackle a growing burden of
non-communicable diseases such as cancer, heart disease and
diabetes, according to the documents.
The ministry has proposed increasing spending to treat such ailments
from about $150 million this year to $1.5 billion in 2019-20,
according to the new proposal which includes spending contributions
from states.
The annual funding for strengthening the health system, including
ramping up infrastructure and the work force, will more than double
to about $3 billion in 2019-20, the documents show.
The new funding estimates are in line with a goal of raising health
spending to 2.5 percent of gross domestic product by 2025, from 1.15
percent, a health ministry official said.
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CRITICISM, REVAMP
The NITI Aayog was at first against the continuation of the National
Health Mission, according to a record of government meetings
reviewed by Reuters.
During a March meeting to discuss the proposal, the NITI Aayog's
health adviser said the program needed a "course correction" and
needed to improve standards.
The adviser, Alok Kumar, also pointed out that despite investment in
the program, public facilities were not attracting enough patients,
documents showed.
Because rural hospitals in India are often dilapidated and suffer
from a shortage of doctors, it is not uncommon for people to shun
them and travel long distances in search of quality healthcare.
In the reworked plan, the ministry has prioritized out-patient
departments, and aims to reduce premature mortality from cancer or
heart ailments by a tenth and cut tobacco use by 7 percent by 2020,
the documents showed.
Kumar pointed out in the March meeting that Bangladesh and Nepal had
performed "better with even lower resources". Kumar declined to
comment.
Data from World Health Organization shows that Nepal, for example,
had an under-five mortality ratio of 35.8 per 1,000 births, compared
with India's ratio of 47.7.
Health officials acknowledged in the meeting that results had yet to
achieve levels of neighboring countries.
(Editing by Tom Lasseter and Robert Birsel)
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