Nearly 45,000 mothers in India still die due to causes related to childbirth every year. Although maternal healthcare has come a long way, showing noticeable improvement from the past decade, it is critical to understand that most of the deaths occurring are preventable.
Lack of effective utilisation of funds in maternal, newborn and child health (MNCH) interventions is a major bottleneck.
With the Union budget round the corner, it is significant that the overall spending on health should be increased to provide universal access to healthcare. To ensure quality of maternal healthcare, infrastructure and human resources should be accorded greater priority in fund allocations.
The government should focus on five key areas this Union budget for quality maternal healthcare:
Increase in overall public spending on health
The allocations for the National Health Mission constituted nearly 65% of total funds for the Ministry of Health & Family Welfare (MoHFW) in 2012-13, but it has decreased to around 50% in 2016-17 (BE).
Public spending on health at present is merely 1.3% of the GDP, which is inadequate. The overall spending on health should be increased to provide improved healthcare, reduce out of pocket expenditure (OOP) and develop quality of care. The trends in allocations/expenditure of funds should be uniform across states.
The table below shows that the allocations for the Ministry of Health & Family Welfare (MoHFW) remained stagnant at 0.25% of GDP since 2012-13.
Improve fund utilisation in MNCH interventions
Lack of effective utilisation of funds in maternal, newborn and child health (MNCH) interventions is a major bottleneck. There should be focus on strengthening the service delivery mechanisms with community involvement. This will lead to better utilisation of funds.
Use of technology should be encouraged, leading to better transparency, less corruption and improved outcomes. Strengthening the Public Financial Management System (PFMS) and putting it in the public domain is thus important. PFMS helps in efficient fund management and providing the status of fund utilisation online on a real-time basis.
Address human resources and infrastructure shortages
There is a need to focus on strengthening the health system. This includes recruitment of human resources, provisioning for adequate infrastructure and availability of generic medicines and diagnostics.
According to the Indian Public Health Standards for Primary Health Centres (PHCs) and Community Health Centres (CHCs), there should be four specialists in each CHC—a surgeon, a gynecologist, an anaesthetist (can be on-call) and a pediatrician in order to provide care in emergencies such as obstructed labour, postpartum hemorrhage, fetal distress and eclampsia.
In terms of human resources, there are stark shortages as far as obstetricians and gynaecologists at CHCs are concerned. At the all-India level, the shortages in this category of human resources are 76%. In most states there is nearly 70-90% shortage of obstetricians and gynaecologists at the CHCs. Almost all the states fall way short in the availability of specialists such as surgeons, obstetricians and gynaecologists, physicians and paediatricians.
Union government must bridge the gap in state budgets
Although more healthcare delivery responsibilities are being transferred to state governments, the role of the Union government for provision of adequate budgets remains important. The Union government needs to ensure that the health sector does not suffer in the states which are unable to prioritise it.
Though the National Rural Health Mission (NRHM) guidelines promote the involvement of the community in planning, implementation and monitoring processes, this is not being put in practice adequately.
The NRHM official Vision and Mission document contains the structure of civil society involvement in various committees and forums, also stating that at least 5% of NRHM funds should be allocated for community activities. Hence, there is a need to promote community-based planning and monitoring.
Thought the present government is proactive in its approach and has implemented multiple policies for the benefits of masses, a far greater push is required for healthcare.