Mr Vajpayee, you made a promise

Sadly, the commitment isn8217;t reflected in your Finance Minister8217;s Budget, even after your government bestowed the Bharat Ratna upon Amartya Sen, the man who8217;s been telling us that 8220;illness is 8230; one of the most widespread causes of human deprivation and economic insecurity in India8221;. You don8217;t have to be an Amartya Sen to figure out why, for in a society where the majority of the working population comprises daily wage earners, if the bread-winner of the family falls ill, his dependents not only have to dip into their meagre resources to cure him, but also be denied his piffling take-home. So, an illness in the family is really an invitation to lifelong indebtedness and greater deprivation for the resourceless majority.

But has your government absorbed the wisdom of the man you8217;ve just honoured? It won8217;t take even someone who8217;s IQ-challenged much time to figure out from the Budget that the old official paradigm continues to order our priorities, even though Health For All By 2000 remains your government8217;s stated objective. So much so that even as the rest of the world moves towards the elimination of leprosy 8212; a cause championed by the Mahatma 8212; by the year 2000, India has asked for more time from the international community, along with Brazil, Guinea, Madagascar, Mozambique and Nepal. What we need is light at the end of this tunnel, but your government has only a sooty pot to offer.

Successive health ministers have been telling us that India spends 6 percent of its GDP on healthcare. What they omit to point out is that the State 8212; the Centre together with the state governments 8212; contributes a mere 21 percent of this expenditure. The rest is borne by the people. Which places us behind Pakistan, where the State8217;s share is 53 percent, and even Bangladesh 33 percent. Even the 21 per cent doesn8217;t reach the intended beneficiaries in most instances, what with primary health centres 8212; the base of our public health-care delivery system 8212; being mere buildings that make no material difference to anyone8217;s life. Since the 8217;70s, in fact, the State has been slowing down its involvement in people8217;s health, which is why two-thirds of our doctors are employed in the private sector, and, by extension, in urban areas. And your Finance Minister8217;s turn-of-the-millennium Budget doesn8217;t change all that. Actually, it8217;s a classic case of refusing to learn.

We8217;ve known for a long time that there8217;s something wrong with the way the government prioritises its health budget, and despite this being no secret, your Finance Minister has done nothing to change the way we view health. The Delhi-driven family welfare budget continues to corner a hefty proportion of the meagre resources available, despite the advice of experts Amartya Sen and the Swaminathan Committee included against it. Their logic isn8217;t hard to grasp. If the focus is on public health, social security and empowerment of women, then the two principal factors driving our population towards the billion mark would cease to exist: namely, the urge of parents to safeguard against the premature deaths of their children and thereby protect their old-age safety net, and, of course, our national obsession with male children. Not surprisingly, the Swaminathan Committee had made a strong case for the abolition of the Ministry of Family Welfare, so that public health finally gets the importance it must have in anation where 48 percent of all deaths are premature. Yet, it8217;s primary health that continues to get short shrift.

The 1999-2000 Expenditure Budget, in fact, reads like a summary of all the things that have gone wrong with the way governments have been preparing health budgets. Public Health accounts for a mere Rs 768.25 crore of the Rs 1,969.5 crore allocated to Health, and of this, Rs 672 crore is reserved for the eight national disease control and elimination programmes. This, by the way, is less than the money to be spent in the coming fiscal year on just nine Central Government health institutions in New Delhi!

But the story gets curioser and curioser, as you compare the 1998-99 budget estimates with the revised estimates for the same year, and find a Rs 135 crore gap in public health. Of this difference, Rs 122 crore is accounted for by the two programmes for the control of malaria and TB 8212; one has been accounting for 2-3 million cases every year for over a decade and the other is responsible for 500,000 deaths. In other words, Rs 122 crore, enough to finance a non-communicable disease prevention programme which we badly need, given the evidence pointing towards an upsurge in cardio-vascular disease, diabetes and cancer, has lapsed and will never go to the people. Even in the family welfare budget, of the Rs 758 crore for the much-touted Reproductive and Child Health programme, Rs 145 crore has remained unspent, and so has Rs 61 crore from the allocation for Area Projects, which targets the country8217;s most backward districts. At this rate, Health For All By 2000 will look like a joke, not a commitment we made tothe world in 1983.