By- Jan Swasthya Abhiyan

The state health budget for Rajasthan for the fiscal year 2019-20 presented by the Chief Minister, Sh. Ashok Gehlot, on 10th July was high on rhetoric but had very little to offer in real terms. Going by the figures, the overall allocation for medical, health and family welfare for this fiscal year is around 13038.60 crores, as compared to 12163.41 crores in the last year, indicating an increase of about 875.19 crores which implies an increase of just about 7.2%. In fact, if we do a deeper analysis taking inflation into account this rise can only be taken as a customary mount which is utterly negligible and would barely mean anything in terms of increase in per capita expenditure on health or its share in state’s GDP. On the downside, what is really problematic and alarming is the fact that  while the allocation for medical, health and family welfare last year constituted about 6.16% of the total budget allocations for the state, this year this share has gone down to 5.97% ! This reduction, which may seem miniscule in terms of percentage, is a considerable cut down and has a deeper connotation which should concern everyone. This slash indicates a clear undermining of health as a priority of the government and a total denial of the very need for intensifying health budgets so as to strengthen an already severely undernourished public health care system.

The CM announced that the state would come up with ‘Janta Clinics’, apparently something on the lines of much talked about ‘Mohalla Clinics’ started by the Kejriwal Government in Delhi, however, he did not specify any budget allocations for the same. With no clarity about the budgetary provisions for its operationalisation, this announcement sounds more like a hollow promise than anything significant, barely giving much hope that the project would see day of the light anytime soon.

Also, to one’s surprise, there was not even a single mention or reference of the much awaited Right to Health Act in the entire budget speech of the CM, this being one of the major promises made by the Congress in its 2018 state election manifesto, which now is a policy document. This raises serious questions on the intent of the government to even bring about this act, despite the fact that there were repeated assurances and some serious mention of it in different public addresses by the Chief Minister as well as the Health Minister in recent past. It may be noted that JSA Rajasthan had early this year submitted a draft of the bill to the government following which there were a couple of rounds of consultations to further build up on it and to present the bill at the soonest at the legislative assembly, but not much progress has been made so far.

There’s a huge slash noticed in the budget of Bhamashah Swasthya Bima Yojana, the health insurance scheme initiated by the Vasundhara Raje government in the year 2015,from 1491 crores announced last year to just about 631 crores announced this year.This might be an indication that the state may soon merge the scheme with centre’s Pradhan Mantri Swasthya Bima Yojana (PMJAY) which would have centre and state contribution in 60:40 ratio. This merger was also hinted at by the Health Minister, Raghu Sharma, in one of his statements given to media last month.

The free medicines and free diagnostics schemes, both started by the Congress during its last tenure in power in the state, were expected to receive huge boosts this fiscal year.However, the budgets for both the schemes have almost remained the same.In fact, the estimated budget for free medicines scheme this year is slightly less as compared to previous year, with an allocation of 557.09 crores last year to 556.43 crores announced this year. The budget for free diagnostic scheme saw a slight increase from 185.39 crores announced last year to about 222.16 crores this fiscal, however the increase is quite insignificant.Given that the government has announced increase in the number of free medicines and free diagnostics provisioned free under these schemes, the budget allocations this year should have been increased generously to meet expenses which would be incurred in delivering additional drugs and diagnostic services. In the dearth of adequate funds, both the schemes are more likely to suffer than to revive from the sheer neglect that took a toll on the schemes in last five years during the tenure of the last government.   

 Overall, the health budget announced this fiscal is no different than the budgets previously announced and brings about nothing significant to look forward to in terms of health systems strengthening. The budget lacks focus and commitment, does not align with the promises made in the manifesto and yet again leaves public health sector starving for adequate resources. As such, there’s little hope that the state health infrastructure and public health services would see any vital improvement in the near future.