Karnataka's budget displays a strong focus on healthcare, said industry experts. Read to know what's in store for the health sector.
Siddaramaiah presented the Karnataka budget on 7 July. (Twitter)
While the Siddaramaiah-led government on Friday, 7 July, showed an increase in absolute monetary allocation in the health budget (from ₹11,151 crore to ₹14,950 crore), it’s concerning that the allocation actually dropped from 5 percent to 4 percent by ratio.
While Karnataka’s healthcare budget showcases a win-win scenario, with some positive initiatives, experts pointed out that there are several initiatives that have not been touched upon — and a few of the ones announced need to be relooked at.
Noted epidemiologist and public health expert Dr Giridhara R Babu told South First, “The Karnataka budget displays a strong healthcare focus. Despite increased absolute funding, a lower percentage allocation to health signals a need for reassessment. This suggests a need to reconsider priorities to maintain, if not increase, the proportion of funding for the health sector.”
Meanwhile, Dr Satyanarayana Mysore, a noted pulmonologist, and Head of the Department of Sleep Medicine at the Manipal Hospitals in Bengaluru, opined, “This budget has many win-win situations. However, a few measures need to be relooked at.”
One significant aspect of the health budget is the allocation of ₹92 crore to strengthen dialysis services across district and taluk hospitals. By introducing “single-use dialysers” and increasing the number of dialysis centres, the government aims to enhance the quality and accessibility of this life-saving treatment.
This initiative is commendable as it directly benefits patients suffering from kidney-related conditions, ensuring they receive the care they deserve without financial burden.
Representative pic of single use dialyzer (wikimedia Common)
Chief Minister Siddaramaiah announced, additionally, that the number of dialysis centres in the state would be increased from the existing 173 to 219.
This is a welcome move, said many, particularly nephrologists and dialysis patients.
Speaking to South First, Dr Arvind Canchi, Consultant Nephrologist and Transplant Physician at Trustwell Hospitals, Bengaluru, said, “As far as Nephrology goes, the use of single-use dialysis in all the taluks and districts is very welcoming, basically because we have had episodes of HCV infections within government and district hospitals due to the reuse of dialysers. Single-use dialysers will mitigate that. Also, an additional 46 centres in the state is a good move.”
However, Canchi also expressed concern and hope that all these dialysis centres will be manned by nephrologists rather than technicians, especially considering every patient’s well-being, day-to-day care, and how each patient is responding to dialysis.
“There have been instances where technicians are manning the dialysis centres as the nephrologists have not been recruited. Due to the Public-Private Partnership model, the private entity doesn’t hire the nephrologists in a bid to cut costs. I hope the government looks into it,” he said.
A dialysis unit in a government hospital. (Wikimedia Commons)
Of a similar opinion, Dr Sylvia Karpagam, public health activist and food and nutrition advocate, said that the implementation of dialysis units has been a long-standing promise by the government and it is crucial that this commitment is taken seriously. Many patients, particularly at the district level, face challenges in accessing regular dialysis services.
She added, “However, it is important to note that dialysis should not be treated as a standalone service. District facilities must have the capacity to meet tertiary-level needs. Handing over dialysis services to private players and district hospitals to private medical colleges should be avoided to ensure equitable access to quality care.”
Another noteworthy provision in the budget is the allocation of ₹70 crore to upgrade 23 primary health centres (PHCs) to community health centres (CHCs). By providing these centres with the necessary equipment and human resources, the government aims to improve healthcare services and ensure that people living in remote areas have access to quality medical care.
However, focusing predominantly on capital expenditure may not yield the desired healthcare improvement.
“The emphasis should be on bolstering human resources — increasing doctors, Auxiliary Nursing Midwives (ANMs), and benefits for ASHAs — for a more impactful and resilient healthcare system in rural areas,” opined Dr Babu.
The state government also announced rolling out comprehensive preventive health camps in eight districts across four divisions of the state — on a pilot basis — for identification of diabetes and high blood pressure patients, and to deliver required medicines to their doorsteps.
Camp-based methods for screening eyesight, tuberculosis, and other diseases were also announced.
Health officials at a blood check camp, testing for malaria and other vector-borne diseases. (Supplied)
Lauding the announcement of health camps, Canchi said, “This is a very important move as both diabetes and hypertension are those lifestyle diseases that lead to so many other conditions, like chronic kidney disease, heart-related diseases, heart attacks, strokes, eye problems, and so on. So it is important to diagnose these problems early and by delivering medication to the doorsteps of these patients, we can ensure control of these diseases so that complications do not occur.”
Adding to this, Babu said that the optimal strategy to mitigate the growing burden of NCDs and their complications would be to invest in robust preventative health measures.
Early screening and detection programmes for persons with hypertension and type-2 diabetes can facilitate timely intervention, preventing the development of renal failure and reducing the subsequent demand for dialysis.
“This would not only alleviate some of the pressure on dialysis centres, but also save many individuals from the distress and challenges associated with dialysis and kidney disease,” he said.
Dr Babu reasoned that, while the investment in dialysis services is undoubtedly a significant move, an integrated approach to healthcare is vital. The government should prioritise and allocate resources to early screening, detection, and management of hypertension and diabetes, as well as other NCDs.
However, Dr Sylvia Karpagam expressed concern that adopting a health camp-based approach for various medical procedures, including sterilisation, tuberculosis management, and eye surgeries, may lead to fragmented care and a lack of oversight and regulation.
“It also opens doors for private players to provide contractual services in a fragmented manner. To avoid these pitfalls, it is important to provide essential services on a regular basis and prioritise continuity of care,” she said.
Expressing similar concerns, Dr Babu said that health camps for identifying diabetes and hypertension are crucial, but their expansion beyond the pilot stage and assured funding is required. Transitioning from a camp-based approach to a door-to-door strategy, and linking patients to health and wellness centres, can offer broader coverage and ongoing care, he opined.
Dr Babu added that the absence of dedicated financial resources in this budget for this ambitious programme is a concern.
The budget allocation of ₹25 crore for a comprehensive programme to address anaemia and malnutrition is a praiseworthy effort. By focusing on comprehensive screening, treatment, awareness creation, and capacity building of health workers, the programme aims to tackle the root causes of these health challenges.
Early identification and intervention, particularly among vulnerable groups such as neonates, children, and pregnant women, will have a significant impact on reducing the prevalence of anaemia and malnutrition, ultimately improving the overall health of the population.
The Centre is contemplating reducing haemoglobin cut-offs, which will change anaemia numbers. (iStock)
However, experts said it is necessary to design specific strategies that encompass a wide range of approaches. Dr Sylvia Karpagam pointed out that these strategies should include promoting the consumption of iron-rich foods, such as red meat and organ meats.
She said, “Additionally, efforts should be made to resist the Union government’s approach to fortification and reducing haemoglobin cut-offs, as these may have adverse clinical consequences for individuals with anaemia.”
Meanwhile, Dr Babu said that while the intention is commendable, resources and seriousness in handling this issue is not evident.
“It’s crucial to remember that this is a complex issue needing systematic investment. A truly impactful approach should consider nutrition across all life stages and involve investments in education, access to quality food, and addressing root causes like poverty and food insecurity. Cultural factors influencing nutrition should also be considered,” he said.
Siddaramaiah, while presenting the budget, announced ₹25 crore for the “Brain Health Initiative” in collaboration with NIMHANS. This initiative was the brainchild of the previous BJP government.
“This is a significant step in mental healthcare. Its extension throughout the state is commendable. However, it would be beneficial to integrate this initiative with broader NCD screening and management at the primary healthcare level, enhancing overall health outcomes and optimising resources,” opined Dr Babu.
However, Dr Mysore said that NIMHANS would have benefitted if it were done on the lines of what Sri Jayadeva Institute of Cardiovascular Sciences and Research is doing in having its own regional centres in at least two to three districts.
The state government has also decided to provide two hand-held X-ray machines per district, costing ₹20 lakh each, to eight districts across the state on pilot basis.
Dr Babu said that while community check-ups and portable X-ray machines are helpful for initial tuberculosis screening, a comprehensive TB strategy should also involve capacity building, community partnerships, and participation of private practitioners. TB diagnosis is a complex process and needs a multi-faceted approach for effective management.
For the first time, the Karnataka Digital Health Society will be established in order to implement the Ayushman Bharat Digital Mission Scheme and all other digital initiatives of the Health Department.
“This is quite important as we are looking at more and more paperwork in most hospitals, including private and government hospitals. If we could translate this into more electronic medical records and keep the data of the patients digitally, it will be easier for epidemiologists, as well as other scientists, to analyse and focus on changes in disease patterns, etiologies of diseases, and treatment patterns that may change. It may also help in looking into incidence, prevalence, and thus cause prevention of diseases,” Canchi said.
Meanwhile, Dr Babu explained that instead of isolated efforts, it would be strategic to integrate the envisioned Karnataka Health Technology initiatives with the National Digital Health Mission (NDHM).
“There should be a clear strategy. It should include aligning data standards, promoting the use of NDHM’s Health ID, maintaining up-to-date registrations of doctors and health facilities, adopting telemedicine services, ensuring data privacy, and aligning state-level policies with national guidelines. This would ensure seamless communication between state and national health data systems, maximizing their collective impact,” he added.
Meanwhile, Dr Mysore said that Ayushman Bharat Scheme should be relooked at, taking into account inflation and other expenses. Only if the rates are realistic will it be welcomed by all private institutions.
While a new medical college has been announced in Kanakapura, the state government has decided to earmark ₹450 crore for the ongoing construction works of medical colleges and hospitals belonging to these colleges, also pending work of 450-bed hospitals in Gadag, Koppal, Karwar, and Kodagu districts will be completed on priority.
Dr Babu said that the allocation of resources for ongoing construction shows a significant investment in infrastructure. However, the effective utilisation of these resources is as crucial for welfare of healthcare professionals, improving quality, staff training, maintenance, and patient care quality for a well-rounded healthcare system.
Dr Sylvia added that to provide stability and continuity in healthcare services, contractual staff, including allied staff such as Group D workers, mortuary workers, ambulance drivers, lab technicians, and pharmacists, should be made permanent employees.
Meanwhile, Dr Mysore also said that “starting new medical colleges will only ensure that, in the next 10 years, we will only have too much of surplus young medical graduates who will not have prospects of PG facilities. Instead of that, existing medical colleges under government and scalable models across private could be enhanced.”
15 CT and 6 MRI scanning centres to come up in all district hospitals in the state
₹155 crore to be spent to operationalise super speciality hospitals and burn care centres in Mysuru, Kalaburagi, and Belagavi districts
The nation’s first public hospital for organ transplants to be established at NIMHANS
Fibro scan for detection of cirrhosis and cancer patients suffering from non-alcoholic fatty liver disease
New 200-bedded Mother and Child Hospital in Gulbarga Institute of Medical Sciences (GIMS), Kalaburagi
RGUHS will start state-of-the-art skill labs, research centres, and indoor sorts facilities in Belagavi, Kalaburagi, Hubballi, Davanagere, Dakshina Kannada, and Mysuru districts
Establish colleges of allied health sciences in Kalaburagi and Mysuru districts
Kidwai Memorial Institute of Oncology in its regional units at Kalaburagi and Mysuru to be upgraded
A medical college in Chitradurga to be operational soon
Centralised blood bank management system in Bengaluru Medical College and Research Institute
In memory of Dr Puneet Rajkumar, Automated External Defibrillators (AED) will be installed in all district hospitals and taluk hospitals to aid in the prevention of sudden cardiac deaths
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