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15th Finance Commission holds a meeting with World Bank
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For a better understanding of the contours of India’s Health Sector and in view of the Union Government’s need and intention for reprioritization of its health spending, the 15th Finance commission held a detailed meeting with representatives of the World Bank, Niti Aayog and member of the Commission’s High-level Group (HLG) on the health sector.

The  Chairman XVFC N.K Singh and all members and senior officials of the Commission were present at the meeting. The World Bank was represented by Dr. Junaid Ahmad, Country Director, Mr. Muhammad Ali Pate, Global Director, and other senior officials. Dr. Randeep Guleria, Director, AIIMS, Dr. VK Paul, Member Niti Aayog, Dr. Indu Bhushan, CEO, Ayushman Bharat also took part in the meeting.

The meeting started off with Dr. Junaid Ahmad stating that the World Bank has been engaged in India’s health sector for a long time. Recently, in the context of the pandemic, a billion-dollar loan has been given by World Bank to the Government of India. It has been engaged in helping State governments to strengthen service delivery through district hospitals. World Bank has recently successfully concluded a 20-year long partnership with the Government of India in the area of HIV. He stated that the States in India is going to be the anchor in the implementation of health programs. As States are so different from each other, the solutions for them will be custom made. Health, he said, was not just a social expenditure but also important for economic growth and development of the country. In this regard, he felt that the Finance Commission may like to look at health in three different ways: grants to enhance per capita spending, a block grant for capacity building, and performance incentives for certain health outcomes. Similarly, in the context of health, a pivotal role may be played by local bodies. Also, more than 60% of health demand in India is supplied by the private sector. Leveraging private clinics along with DBT may be used as a tool to increase engagement with the private sector. The importance of non-communicable diseases can’t be undermined. Another area that needs focus is infectious disease programs like tuberculosis.

Dr. Junaid Ahmad also stressed the importance of engagement with Centrally Sponsored schemes with the Government of India for implementation of these programs. He cited the example where the World Bank had engaged in the implementation of Samgra Shiksha Abhiyan with five States of India. Similarly, in the health sector, institutions like district hospitals, primary health centers, private providers, municipalities, social sector systems may be leveraged carefully. World Bank, he suggested, could play a role in designing and implementation of such programs while working closely with such institutions. Government’s programs needed to be converged with Finance Commission recommendations along with efforts of World Bank towards a common goal, he said.

A presentation made by World Bank Highlighted that :

Dr. Paul, member, Niti Aayog emphasized the importance of local bodies in the delivery of health care services. He also emphasized that 65% of public spending on health comes from State Governments while 35% come from the Union Government. There is an enhanced need to increase the overall expenditure on the health sector.

Dr. Guleria, Director, AIIMS, emphasized that public-private partnerships in the health sector should be encouraged. He also asked for an enhanced focus on the investigative infrastructure of health.

Dr. Indu Bhushan stressed the need to cover the ‘Missing Middle’ population in PM-JAY. He also stated that private hospitals need help as they are stressed with falling revenues and rising costs. He also emphasized that health should be a concurrent subject.

Chairman N.K. Singh recollected the Finance Minister’s intention to increase the budgetary outlay Ministry of Health in her announcement of the special package for the economy.

It may be recalled that India COVID-19 Emergency Response and Health Systems Preparedness Package (ER&HSP) was approved by Cabinet on 22nd April 2020 for Rs 15,000 Crores. This included mainly emergency response components such as development and operations of dedicated COVID facilities with isolation wards, ICUs, etc including the training of the health professionals, augmenting testing capacity, procurements of PPEs, N-95 masks, ventilators testing kits and drugs, conversion of railway coaches as COVID Care Centres, strengthening surveillance units, Untied funds to the Districts for the Emergency response, etc.

S.No.ComponentAmount in Crores
1Emergency COVID-19 Response7500
2Strengthening National and State Health Systems to support prevention and preparedness4150
3.Strengthening Pandemic Research and multi-sector, National Institutions and Platforms for One Health1400
4.Community Engagement and Risk Communication1050
5.Implementation, management, capacity building, monitoring and evaluation900
Chairman stated that the Fifteenth Finance Commission, for the first time, will devote an entire chapter on health financing. He also opined that the High-Level Committee on the Health sector constituted by Fifteenth Finance Commission and the World Bank will dove-tail their study and analysis to come up with suitable recommendations for the health sector. The Government of India’s spending on health through Centrally sponsored schemes will also be studied in detail by the Commission before it gave its recommendations to the Union government.
Tue, Jul 07, 2020, 07:48 PM
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