14 Wednesday
February 2018
Dear Health Policy Makers of India.

Dear people in the Government, Health Ministry, Finance Ministry, Niti Aayog. We are very glad that you have woken up to the fact that India is seriously lagging behind in health care, medical infrastructure, and doctor: public ratio and that you intend to do something about it. Unfortunately for us, you have decided to use short cut solutions to very critical problems and the result will be a nightmare if any of these are implemented. Shortsighted knee jerk decisions may be the norm for you, but we, the people of India have to face the brunt and we request you to please STOP! Reconsider! Speak to the experts! Involve informed people in the decision making so that we don’t land in a mess every time you take path breaking decisions.

The proposed National Medical Commission Bill is one such Pandora’s box. Whoever came up with such an innovative piece of garbled logic? Yes, we have an acute shortage of Doctors in India. What would any sane person’s answer to that be? Increase the number of seats in existing medical colleges by 10% so that by the end of 5 years we would have 10% more qualified doctors available. Make investment in Medical Education a priority for the government , improve the quality of education being provided in Private Medical and Paramedical Colleges, raise the bar so that more competent, qualified doctors, nurses, technicians and midwives join the ranks of medical professionals to serve the people of India. No! The idea proposed in this bill is to give a 6 month course to AYUSH (Ayurveda, Homeopathy and Unani) so that they will also be called Doctors, and India’s Doctor: Public ratio will improve!!! This is beyond ridiculous! First, you are insulting the alternative medicine fields by telling them their knowledge and education isn’t of any value. Secondly, you are bypassing the NEET and EXIT exams which all Doctors have to undergo, the first to get into medical college and the second to get out of medical college to start saving lives. Both these exams are mandatory, and whole heartedly welcomed by the medical fraternity. But to have people who have taken neither these exams, nor gone through the training and education in medical college, be given a “Doctor” tag is scary, thoughtless and utterly ridiculous concept. Would you want your parent or child to be treated by such a bridge course person? Then how dare you suggest such a thing for the people of India??? We are not garbage for experimentation…. We are the ones whose interests you are supposed to protect in the hallowed halls of Parliament and the Government Offices! Shame on anyone who discusses such a course! Please strike it off from the NMC.

The next point is giving Private Medical Colleges a free hand, allowing them to increase the number of seats irrespective of their teacher : student and patient: student ratio and allowing them to charge any fees they deem fit! What were you smoking when you wrote this piece of legislation?? Private Medical Colleges have been under the scanner of the MCI (Medical Council of India) for not meeting the standards of medical education, not having enough full time teachers, for showing ghost teachers on their rolls who visit only for MCI inspections, for not having enough patients for their students to learn from and now with the NMC you are giving them a free hand!!! This is what happens when you have non doctors take medical decisions. You are factually so off the mark, you make the whole enterprise a joke. Kindly sit with a few doctors and understand the importance of improving quality of medical education in private medical colleges, because at the present time, some of them are selling degrees without imparting the needed education , and the poor kids who come out of them find it very difficult to treat patients in the real world without harming them. To add insult to injury, you have removed the cap on fees so now the medical colleges which were charging 5-15 lakhs per year, will be able to charge 20-30 lakhs per year, making it prohibitive for middle class families. You have also removed the cap on number of NRI seats. So, with this bill, you are making Medical education quality uncontrolled, raising the fee, and opening them to be sold to the highest bidders, especially NRIs, and thus making it more difficult for normal people to send their children to medical college. Phew! Who are you all working for , the private college lobby or the students of India?

The medical fraternity has been quiet all along. You introduced compulsory rural postings for one year extra, no one raised a voice. You made that year of rural posting a waste by not providing adequate infrastructure for our young medical graduates, we never said a thing. You discriminate against doctors for all policy making, because we are soft targets, we keep quiet. Where is the compulsory posting for all law graduates to help clear up the crores of pending cases in Indian Judiciary? Where are the laws for Criminal Negligence by Judges for wrong decisions, for Political parties for reneging on their written election manifesto.Please read this line carefully. We doctors are NOT keeping quiet about the NMC.

In the health budget our Finance Minister made an announcement of providing 10crore families with Rs 5lakh insurance cover per person, without providing the budgetary funding of their insurance premium! He changed the education cess of 3% to a new Health and education cess of 4%, claiming the Rs 11,000 crores raised in fresh taxes would cover the cost needed. A sum of 2lakh crores is needed to cover the cost of this insurance premium. That money is simply not there for health in India. Another announcement made was 24 New Medical Colleges will be made this year and a sum of Rs 1200 crores allocated for the same. Have you seen a 500 bedded hospital and medical college be ready in 50 crores? A sum of Rs 1200 crores also announced to create 1.5 lakh wellness centres across India, the amount allocated is Rs 80,000 per centre. Can you envision a centre ready in 80 thousand rupees?

Public Health care in India is in a very poor condition. About 30 years ago, the only healthcare available even to the middle class was Government Hospitals. With Private investments, State of the art health care facilities are now available in India, but at a significant cost. India is becoming a centre for medical tourism from the Middle East, Africa, and neighboring countries. This is the time for Government of India to prioritize health care spending, increase the budgetary allocation from 1.5% to 8-10% for the next few years so that amends can be made and affordable quality health care can be made available to the people of India. Roads and infrastructure budget this year is 1.52 lakh crores while the health budget is 56,000crores.

It is becoming very apparent that our health is not your primary concern. We urge you to please change the NMC and health budget to make sense.

Jai Hind.
Dr.Sarika Verma
ENT Surgeon & Allergy Specialist

02 Friday
February 2018
Dissecting the Health Budget 2018

I heard Mr Arun Jaitley read out the budget yesterday and was quite surprised this morning when this Budget is being touted as the next big thing in Indian HealthCare and a Landmark budget health wise!!! That’s really out of the blue because the only thing that the Finance minister has given more than a significant importance this year is Infrastructure. The Steel, Cement, Steel, Road making contractors must be rubbing their hands in glee. Please read this clearly, Infrastructure spend planned is 5.97 lakh crore for FY19, up by 21 percent. The 30,000 km of roads being called Bharatmala is so much more important than the health of Indian citizens.

The total budget of the health ministry stands at Rs 52,800 crore. Yes, you got that right. The Government of India spends 1.2 % of its GDP on its people’s healthcare, and they are claiming that THIS budget is pro-poor and pro-people!!!

Just to give you a perspective, most developed Nations like the UK spend 14-17% of their GDP on healthcare, and our not so wealthy neighbors like Bangladesh and Sri Lanka have a health spend in the range of 6-8%

Ministry/Department/Scheme Name 2017-18 2018-19
   In Rs.Crores   Rs.Crores
Health & Family Welfare 47,353 52,800
CSS+CS in Health 34,657 39,199
of which    
PMSSY 3,975  3,825
National AIDS and STD Control programmme 2,000 2,100
National Rural Health Mission 21,189 24,280
National Urban Health Mission 752 875
Human Resources for Health & Medical Education 4,025 4,225
Tertiary care programme 725 750
RSBY 1,000 2,000

The devil, as they say, lies in the details. Let us go through the health budget point by point.

As part of the Ayushman Bharat programme aimed at making path breaking interventions to address health holistically, in primary, secondary and tertiary care system covering both prevention and health promotion. Last month, the Niti Aayog had suggested a bridge course in medicine to convert AYUSH doctors to Allopaths. That would be as effective as a bridge course for Cats to become Tigers. There is a reason why Doctors need a more than average intelligence, difficult entrance exams and a 5.5 years course to become trained to heal patients. It would be a disservice to Indian people to be treated by half baked doctors. The law makers themselves go to AIIMS to be treated by the best brains in the country, but they don’t mind all of us to be treated by bridge course doctors. 3 lakh doctors had gone on a strike protesting against this on 2nd January 2018 and this law is going to come up in the Parliament soon.

In order to enhance accessibility of quality medical education, creation of 24 new government medical colleges and hospitals by upgrading existing district hospitals in the country. A grand amount of Rs 200 crore has been kept aside for this! Considering that a new medical college costs at least Rs 100 crore to set up, this whole announcement sounds farcial doesn’t it?

Rs.1200 Crores allocated for a network of 1.5 lakh health and wellness centres for providing comprehensive health care including for NCD’s and maternal and child health services. These centres will also provide free essential drugs and diagnostic services. Doesn’t this sound absolutely wonderful? Only thing is, it’s simply not possible. This budget allocates Rs 80,000 yes that’s right, 80 thousand rupees for each centre!!! The cheapest primary health centre made till date in India are the prefabricated Mohalla Clinics made by the Delhi Government on a shoe string budget of Rs 20 lakhs. So, these Rs 1200 crores will be enough for only 6000 Mohalla Clinics or Wellness Centres as the Centre wants to call them, Not the 1.5 lakh centres that the Finance Minister would like us to believe.

The National Health Mission has actually seen a decline in allocation – while Rs 30801.56 crore was spent on NHM in 2017-18, this year’s allocation is Rs 30129.61 crore. A dip of 672 crores.

Rs.600 crores allocated to provide nutritional support to all TB patients at the rate of Rs.500 per month for the duration of their treatment. That comes to 16 Rs per day, not enough to cover the cost of 2 glasses of milk!! So you see, such announcements will have no impact on the ground whatsoever. Are they made just for sounding concerned?

Healthcare emerged as the buzzword of the 2018-19 Budget, mainly due to the announcement of the Rs 5-lakh healthcare insurance each for 10 crore families+ , but the sector didn’t get mega allocations. If we calculate a lower than market premium of 1%, the cost for a 5 lakh cover for 1 person is Rs 5000. For 10 crore families, or 40 crore people that would be 2 lakh crore! There is simply no provision of this amount in the budget. So, it is BIG ANNOUNCEMENTS, BIG TALK and ZERO ACTION.

Don’t we all remember how on 8th November 2016, we were told that Demonetisation was a big step against black money, terrorist activities and fake currency notes?We now know that there has been no reduction in black money and terrorism post de-mon, fake currency notes were found in circulation even before the 50 days were up! The net gain in tax payers is 84 lakh new tax payers.So 125 crore people stood in queues for 50 days to add 0.67 % tax payers!!

This whole BIG health budget is just another JUMLA on the lines of the 15 lakhs which had to come to our accounts from Swiss Banks, and the fabled Acchey Din which conveniently keep moving from 2014 to 2019 to 2022! Ladies and Gentlemen, please take this budget for what it is. All the sops are given to the corporate sector and all the eye wash to the rest of us. The health and education cess rises from 3 to 4 % making everything more expensive, while we get No advantage of the falling fuel prices all over the world!

Sorry Mr Finance Minister, you cannot fool all the people, all the time.

Jai Hind.
Dr.Sarika Verma
ENT Surgeon & AAP Volunteeer.