With assurances of completion of earlier announced health schemes this year, Karnataka Chief Minister Basavaraj Bommai on Friday, 17 February, presented a budget that gave a push to the health sector in a big way.
While a majority of the announcements were praised by health experts, they also expressed concern over its implementation and pointed out a few areas where the state has failed to focus.
Mane Mane Arogya
The Karnataka government, with a focus on preventive care, has decided to organise health camps in villages throughout the local PHCs for comprehensive health testing of the rural masses.
With a catchline of “Mane Mane Arogya” (Rough translation: Health in every household), the state expects the scheme to help detect critical diseases at the early stages. It is also aimed at delivering medicines to the doorsteps of those suffering from chronic diseases.
However, public health activist Dr Silvia Karpagam expressed concern over this concept and said health camps being held twice a year were a cause for concern.
She argued, “Comprehensive healthcare cannot function in a camp mode, and, as has been seen right from when the Vajpayee Arogyashree scheme was introduced, these camps are just a smokescreen to shift patients to large corporate hospitals in the city.”
Expressing concern, Karpagam said patients are screened and told they have one or the other communicable or noncommunicable disease, and “then asked to go to a tertiary hospital for further management”.
“The further a patient moves from home, the more the out-of-pocket expenditure. This further leads to cherry-picking of patients, exclusion of those with complicated or serious illness, and also to fragmented care,” she explained.
While the state government announced more Jan Aushadi Kendras for the availability of generic medicines, experts argued that they should undergo rigorous quality control and also ensure the availability of all essential drugs.
Cancer detection and screening
Bommai proposed to allocate ₹12.50 crore for conducting community-based testing activities for the initial testing and treatment of TB patients with the help of handheld X-ray machines in all districts.
Extensive testing and screening camps will also be held to ensure cancer detection at an early stage.
Experts pointed out that handheld X-ray machines alone might not be very accurate for the screening of TB cases, and some could be missed.
“It is important to have other screening facilities like those for sputum examination and biopsy of lymph nodes,” said Karpagam.
She added that the government should commit to better treatment options, which include nutrition for those diagnosed with TB.
The state government, under the “Jeevasudhe” scheme, also allocated ₹12 crore for organising cancer detection camps.
The experts argued that once cancer gets detected, the patients would be referred to tertiary hospitals.
“Going by the current situation, it means referral to private tertiary centres in the city. The Kidwai hospital is underfunded and under-resourced. There should have been a commitment to upgrade this hospital and also make district hospitals self-sufficient in the management of cancer with the referral of complicated cases to Kidwai,” the experts argued.
However, noted epidemiologist and public health expert Dr Giridhara R Babu said: “The government’s efforts to improve tuberculosis screening are crucial for preventing and treating diseases. The increased access to cardiovascular disease and cancer screening and treatment facilities will help in early detection and treatment.”
Maternal and child health
The state government announced the establishment of a Mother and Child Hospital in Savanur and also decided to commence IVF clinics at an expenditure of ₹6 crore. This was praised by health experts.
Dr Gopikrishna D, a paediatrician and obstetrician, told South First, “It was much-needed. IVF facilities at government setups — especially in four medical science institutes in Bengaluru, Hubballi, Mysuru, and Kalaburgi — are a very good move by the government. The maternal hospital in Savanur was also a much-needed one.”
Babu concurred: “The government’s plan to develop women’s wellness centres and mother and child hospitals will improve maternal and child health.”
However, Prasanna Saligram of the Bengaluru-based Jan Swasthya Abhiyan (People’s Health Movement) called said, “IVF clinic? Big joke”. “They are just playing to the gallery,” he added.
Anaemia and malnutrition
While the Central government announced it was looking to eliminate sickle-cell anaemia, the Karnataka chief minister said that a new scheme would be implemented to fight anaemia in the state with a multi-dimensional intervention.
₹100 crore was being provided for the intended tests, treatment, public awareness and training under this scheme to eradicate anaemia and malnutrition among neonates, children, adolescents, pregnant women and lactating mothers and women of reproductive age (15-49 years).
Bringing the focus on how both the Central and the state governments failed to address the underlying social or cultural conditions, Saligram told South First, “Fixation on the ‘elimination’ of diseases from the Union and state governments without addressing any of the underlying social or cultural conditions will do no good. This budget has no mention of how they will address the human-resource challenges.”
Praising the move, Babu said efforts to fight anaemia were crucial for the prevention and treating this condition.
While the midday meal scheme (including the Mathrupurna scheme) was also linked to the nutrition of children, Karpagam said that it did not meet the quality or quantity standards prescribed under the National Food Security Act.
Therefore, unless it was upgraded to be more diverse and balanced, and include iron-rich and Vitamin A-rich foods, this scheme would not meet its purpose, she explained.
She also lamented that there was no mention in the budget of eggs in the midday meal scheme in spite of repeated demands from groups such as Ahara Namma Hakku, doctors, and nutritionists.
However, she appreciated the fact that supplementary nutrition would be introduced for all adolescent girls who were not in school.
Focus on public health
Babu praised the budget announcements on improving public health services in Karnataka.
He said, “This is an important step towards adopting a public health approach. Establishing 100 community health centres and upgrading existing health centres will increase access to quality health care services in rural and urban areas.”
Manipal Hospitals Chairman Dr Sudarshan Ballal also praised the government’s effort in starting community centres, critical-care units, cancer detection, an organ transplant retrieval unit in NIMHANS, and the strengthening of taluka hospitals.
He said: “It will benefit our population immensely. Overall, many aspects of the budget are praiseworthy, but, as always, we will have to see how well they are implemented.”
On the approval given to establish 438 “Namma Clinics” in urban areas and 128 Women’s Wellness Centres, the experts felt that though it was a good move and would increase access to quality healthcare services in rural and urban areas, the government should have ensured that they were all started early.
Those that have started are already facing hurdles, and that needs to be addressed, they said.
Of the 438 Namma Clinics, 272 are functioning. Also, of the 128 women wellness centres, 53 have been completed.
Babu said that though Bengaluru Health Systems is a novel concept, it needs financial commitment from the BBMP for the health of Bengalureans.
He also felt the government could have allocated more resources towards the public health cadre, promoting healthy lifestyles and increasing access to screening and preventive services for NCDs.
New facilities coming up
Community Health Centres in Khanapura, Anekal, Shirahatti, Sringeri, Yelandur, Nelamangala and Hoskote taluks, where there are no taluk hospitals, will be upgraded to 100-bedded hospitals.
Dialysis for kidney patients has been increased from 60,000 cycles to 1 lakh cycles per day.
Other facilities in the pipeline are:
- 50-bedded critical care blocks in the hospitals of Kolar, Bagalkote, Yadgiri, Gadag, Chikkamagaluru, Ramangara, Vijayanagara, and Doddaballapura
- 100-bedded critical care blocks in Tumakuru and Bengaluru will be established under PM-ABHIM to provide tertiary care
- Efforts are being made to promote brain health along with NIMHANS.
- Establishment of an AIIMS-model hospital in Raichur and a super-speciality hospital in Kumta.
- Establishment of 129 taluk laboratories, district laboratories in all districts, and state-level referral laboratory in Bengaluru.