Indranil Mukhopadhyay

 ndranil 

The budget that misses out on health of the people 

Thaugh there is a nominal rise in allocation ,in real terms the hike is paltry. Schemes that aid the poor  have been neglected 

 The government continues to neglect the health sector.

    In nominal terms there is some increase in the total allocation of Ministry of Health and Ayush taken together compared to the previous budget. Allocation has increased from Rs. 94671 crore (2024..25BE) to 10,3851 crore 2025..26 Budget Estimate). Thaugh this looks a significant increase of Rs 9180 crores in nominal terms, if we adjust for  the effect of inflation in real means an increase of 3.04% in real terms .

       Moreover in real terms there is  4.7% less than what was actually spent in 2020..21. This means the care that could be provided into 2020..21 cannot be ensured  now, given that allocation have declined while prices have sky rocked.

         This also means that as percentage of GDP the government location to health has declined from 0.37% to 0.29 percent between 2020..21 Actual Expenditure and 2025.. 26 BE. It means priority  accorded to the health sector in the budget has also declined over this period with  its  share declining from 2.26% to 2.05% in this period .

   Skewed Priorities 

        Schemes which contributed to strengthening the public system and  protecting the health of most vulnerable sections of the society , like the National Health mission, Pradhanmantri Swasthya Suraksha Yojana(PMSSY), Schemes on nutrition , health research received severe cuts despite doing good work during hard times. In contrast schemes to promote commercial interests... like the Pradhan Mantri Jan Arogya Yojana(PMJAY),

the Digital Health Mission, are being rewarded with higher l

allocation despite failures.  

        National Health mission is the key program through which the government intervenes in improving primary and secondary on maternal and child Health disease control program and non communicable diseases. Much of these services have suffered during the lockdown. However since 2019 ..20, NHM allocations had been declining  in real terms. This means that essential services  like safe deliveries , vaccination  for children , treatment of TB provided earlier  cannot be provided  any more with current limited resources.

        NHM money also goes in to paying remunerations for frontline health workers like ASHAs, mostly women  , who received global recognition for their stellar role during the pandemic. Cuts in NHM budget means reduced budget for paying these workers ,who have been demanding  minimum wages for a long time. We need expand net work of  the  Health and Wellness Centres to  ensure quality comprehensive primary care. HWC  are part of  NHM budget. In the context of NHM the plight of HWCs also remains unclear.

    PMJAY seems like the blue eyed boy of the government  even thaugh it fails to deliver 

continuously , known to largely benefit the private sector and exclude the most marginalised, it is rewarded with higher allocation . 

    In the 2023..24 budget Rs 7200 crore was allocated and only Rs 6670 crore  could be spent . Allocation has been further increased by 24 percent compared to previous year to Rs 9406 crore.  PMJAY eating up larger share of budget remains a cause of concern while it fails to deliver.

       Blind obsession to promote  commercial interest needed in serious introspection. A large part of  the Dalits, Shedule Tribes and other marginalised section hardly recieve care from the private sector  under Government  Funded Insurance Schemes like PMJAY.

     Exemption of custom duty on imported medicines is well indeed but nothing more than a mere bandage. Custom duties form only a small part of the price of these patented medicines and the likely impact remain miniscule if at all the benefits are  passed on the customers . What is needed is issuing compulsory  license to Indian  firms so that cheap generic  alternative could be provided.

Indranil Mukhopadhyay

Richa Chintan | 03 Feb 2025

 Richa Chintan | 03 Feb 2025

Exemption of some drugs from BCD aimed to “provide relief to patients” suffering from cancer, rare diseases and other severe chronic diseases are a drop in the ocean of high costs.

One of the highlights of Union Budget 2025-26 was the announcement by Finance Minister Nirmala Sitharaman to exempt a list of lifesaving drugs from Basic Customs Duty (BCD). Apparently to “provide relief to patients” suffering from cancer, rare diseases and other severe chronic diseases.

However, this is nothing but an eyewash!

Let us take the example of Risdiplam, a drug to treat the rare disease, Spinal Muscular Atrophy. The price of Risdiplam is about Rs 6 lakh for a month or about Rs 72 lakh annually. Even if a BCD of 15% is removed, the price comes to about Rs 61 lakh annually. Risdiplam is produced by Swiss pharma major, Roche, which has a patent on the drug until 2035.

Had the government been a bit serious in providing relief to patients, it would have thought of allowing for generic manufacture of Risdiplam in the country and providing compulsory license for the production of such patented drugs. A case is already pending in the High Court of Kerala where evidence has been provided that the estimated cost-based price of the generic version of Risdiplam can be as low as Rs 3,024.

K M Gopakumar, legal advisor and senior researcher with Third World Network (TWN), notes that “The elimination of import duty elimination would not translate into enhanced access to medicines at an affordable price because these medicines are exorbitantly priced. Further, there is no evidence that benefit import duty elimination is passed on to patients.”

Similarly, the price of one 1,000 mg vial of Obinutuzumab, a patented drug for Chronic Lymphocytic Leukemia, is about Rs 4 lakh. The treatment cycles require about eight doses, the price of which comes to about Rs 32 lakh. After 15% BCD reduction, its price would be about Rs 27 lakh.

The announcement of Day Care Cancer Centres in all district hospitals is a welcome step. One only hopes that this comes into effect and not meets the fate of the health and wellness centres, where the announcement only meant a change in name and signboards with no real enhancement in services.

Allocations for Women and Child Development

The eyewash is not limited to the affordable availability of drugs to people.

The Finance Minister announced enhancement of cost norms for the nutritional support under the Saksham Anganwadi and POSHAN 2.0 programme. However, if we look at the allocations, there is a 2.7% decline under this programme over the last year’s Budget allocation in real terms, that is, accounting for inflation. For the Ministry of Women and Child Development, there is a decline of about 3% in real terms over the last year’s Budget allocation.

Continued Emphasis on PMJAY and Starving of NHM

As in the previous years, the Union government continues to emphasise an insurance-based model while starving crucial programmes, such as the National Health Mission (NHM). While there is a 29% jump in the allocations to PMJAY (Pradhan Mantri Jan Arogya Yojana), there is a meagre 6% increase in the nominal allocations to NHM.

The NHM, which works to strengthen the health system and pays attention to the preventive and primary health needs of the population includes crucial interventions at the primary level such as Flexible Pool for RCH (reproductive child health) & Health System Strengthening, National Health Programme and National Urban Health Mission, National Digital Health Mission, AYUSH Mission and also Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PMABHIM) – NHM component. If we look at the allocations for NHM in real terms, there is only 0.4% increase over the last year’s Budget.

It was also announced that gig workers would now be provided healthcare under PMJAY. But the evidence already suggests that schemes such as PMJAY, with over emphasis on tertiary care and in-patient care, are not appropriate or capable to cater to the health needs of the poor and marginalised.

Investment in Health: Disappointing

On the whole, the Budget, despite promises, shows that the government continues to neglect the public health system, which needs greater public investment.

Figure 2: Union government expenditure and allocations on Health as % of GDP



The Union government’s health expenditure as a proportion of the total income of the country (or GDP) continues to remain a meagre 0.29%. The priority to health in the total Budget continues to remain low at about 2%. Accounting for inflation, the allocations for health in Union Budget 2025-26 have increased only by a meagre 3% over the previous year’s Budget allocation.

In sum, the government has learnt no lessons from the COVID-19 crisis that a strong public health system is the need of the hour. Are we waiting for another such crisis to jolt us?

The writer is a researcher who writes on public health and economic issues. The views are personal.

National Health Mission continues to face neglect!

 National Health Mission continues to face neglect!

National Health Mission (NHM) is the key program through which the Union Government intervenes

in improving primary and secondary care on maternal and child health, disease control programs and

non-communicable diseases. Many of these services have suffered during the lockdown. However,

since 2019-20, NHM allocations have been declining in real terms. This means that essential services

like safe deliveries, vaccination for children, and treatment of TB provided earlier can no longer be

provided with limited resources.

NHM money also goes into paying remunerations for frontline health workers like ASHAs, mostly

women- who received global recognition for their stellar role during the pandemic. Cuts in the NHM

budget mean a reduced budget for paying these workers, who have been demanding minimum wages

for a long time. It is important to note that some of the most critical programs related to Non-

communicable diseases, climate change, and human health are being delivered through NHM, and

paltry allocations under these schemes are major causes of concern.

We need to expand the network of Health and Wellness Centers (HWCs) to ensure quality

comprehensive primary care. HWCs are part of the NHM budget. In the context of considerable budget

cuts for NHM, the plight of HWCs also remains unclear! We have also been demanding that the new

name – Arogya Mandir - given to HWCs should be withdrawn.

Anant phadke

 Thanks Anant for your insightful thoughts

 Milestones in People Health Movement MFC.ppt

, . Please see the attached Milestones of Peoples Health Movement presented at the MFC 50th Anniversary

Ekbal

____________________________________________________

Dr.B.Ekbal

Chairperson, Covid Expert Committee, Government of Kerala 

            Mobile:   94470 60912

            Land Phone:  0471-2590912  (Home)

Home Address: Kuzhuvalil House,

                       G.R.A.E 30 A,

                       Chilambil Lane, Gandhipuram, 

                       Srikariyam P.O., Thiruvananthapuram.695017

On Sun, 15 Dec 2024 at 20:45, V R Raman, National Convener PHRN <weareraman@phrnindia.org> wrote:

Thanks Anant for this note. 

Best, 

Raman

On Sun, 15 Dec, 2024, 20:13 Anant Phadke, <anant.phadke@gmail.com> wrote:

Dear all,

    About 100 activists attended this online meeting and about a dozen people spoke. At the end about 50 were there. As one of the co-founders, some of us were to share our ideas in about 5-7 minutes about the JSA's journey. Since many people who spoke before me had covered the initial period of the journey, I shared my ideas about a very brief overview of JSA. It is attached/pasted herewith. 

TY

SY

Anant Phadke   

24 Years of JSA- Looking Back, Looking Forward

Anant  Phadke

 

1)    In the year 2000, all of us i.e. health organizations working on issues of health care as well as social organizations working on issues of social determinants of health came together at the state and national level to form the National Coalition, Jan Swasthya Abhiyaan. This was done through a process of social mobilization across India in the form of Jathas, conventions etc. We belonged to very diverse socio-political backgrounds from different parts of India. We also contributed to the Global process of coming together of people’s health groups.

 This was big step forward.

2) Together we formed the 20 point People’s Health Charter from the rights based perspective. This JSA-charter included all the major policy-demands regarding radical improvements in health care and also in social determinants of health.

3) Taking note of the political economy of health-care, privatization, corporatization of health care under the rule of finance capital, we have been demanding radically strengthened Public Health Services along with it’s direct accountability to the people. Secondly we have been demanding regulation of private health care through a dedicated, transparent and accountable regulatory structure. This goes far beyond the defunct, bureaucratized CEA which has been enacted in some states. 

4) All the above demands that we have been making ask for changes in the government policies and are thus political demands. Secondly, like say the demand for education for all, these demands regarding Health Care for all represent all the common interests of all common people. Hence they have a different, special political potential compared to say the sectional demands of say farmers, or say transport workers or say agricultural workers etc.

5) The above are very positive features of our work. However we have remained largely an advocacy coalition. We have been People’s spokes persons on health care and social determinants of health. We have been presenting our demands, our criticisms, and concerns in various ways to influence public opinion. We have been raising awareness among people about these policy-changes. We have been using spaces available in the media, in the political spaces to influence certain bureaucrats, certain politicians. But we have not been able to launch a powerful mass movement which forces the government to change it’s policies.

We started with a big bang. However, we have remained primarily an advocacy coalition. Going beyond this, unless we have mass awareness programmes, mass signature campaigns, innovative forms of mass protests, our 20 point charter would continue to have very limited influence. We cannot merely say that this is the work of the pro-people political parties. They are not sufficiently clear about the need of such mass political health movement and do not have the strength to undertake this work. We have to take initiative and we have to ourselves contribute to the work of raising awareness of people around these political demands. Situation is becoming from bad to worse.  From the side of health-politics, we need to strengthen the mass political health work to add strength to the pro-people politics.

6)  Do we agree that we need to move forward beyond primarily awareness and advocacy work and try to build a powerful mass movement? Say around the demand of including health care in the fundamental rights in the constitution? If yes, what changes will have to be made within us? I think that we need to discuss this. While being proud of our work that we have done in last 24 years, we need to be aware of it’s limitations and decide to make progress. Otherwise we will continue to have a very limited influence and our slogan – Health care for All and Health for All would continue to be distant dream.    

***********

On Sun, 1 Dec 2024 at 23:18, Ameerkhan <ameer@sochara.org> wrote:

Dear JSA NCC members

Greetings from JSA Secretariat !

On this day of 01st December 2024 We are happy to share the poster marking the beginning of the 25th year of JSA. On the same day of December 2000 JSA friends and comrades gathered in Kolkata and began the journey as JSA and the struggle for Health for All is continuing. On this day we remember and thank all the founding members of JSA; seniors and current members and friends who continued to shoulder the responsibility of taking forward JSA's objective of Health for All.

In the coming days we plan to have a series of webinars and activities at the national level and at the state and district levels for the 25th year of JSA.

Thanks for all your support and cooperation.

with regards

Ameerkhan; Abhay;Richa;Indranil and Chhaya 

onbehlaf of the JSA national secretariat

--

You received this message because you are subscribed to the Google Groups "jsancc" group.

To unsubscribe from this group and stop receiving emails from it, send an email to jsaindiancc+unsubscribe@googlegroups.com.

To view this discussion visit https://groups.google.com/d/msgid/jsaindiancc/CAPtZ-OaA6D9s6GRx6SM6Oxv1kRoxmrr9shhFc%2Bx9f%2B%3DFp6mtxQ%40mail.gmail.com.

--

With Regards,

Sincerely Yours,

 

Anant

 

Anant and Sandhya Phadke,

8, Ameya Ashish Society, Kokan Express Hotel Lane,

Kothrud, Pune 411038

 

Please note our new landline number - 020 67620145

Mobile number - 9423531478, 

--

You received this message because you are subscribed to the Google Groups "mfccircle" group.

To unsubscribe from this group and stop receiving emails from it, send an email to mfccircle+unsubscribe@googlegroups.com.

To view this discussion visit https://groups.google.com/d/msgid/mfccircle/CALmZYKmh6mMUxuyiMFyc3L1zhFizN%3D6Lqx3QRwCQmbS8%2Bu8aZQ%40mail.gmail.com.

--

You received this message because you are subscribed to the Google Groups "jsancc" group.

To unsubscribe from this group and stop receiving emails from it, send an email to jsaindiancc+unsubscribe@googlegroups.com.

To view this discussion visit https://groups.google.com/d/msgid/jsaindiancc/CANOLUj-VH5cv-CetkFWskSc8heEShH43TwquAG5OAHOOuONX2w%40mail.gmail.com.

--

You received this message because you are subscribed to the Google Groups "jsancc" group.

To unsubscribe from this group and stop receiving emails from it, send an email to jsaindiancc+unsubscribe@googlegroups.com.

To view this discussion visit https://groups.google.com/d/msgid/jsaindiancc/CAJ4cKQTob%2BHzv-Yeom%2BmUXuwNWsXE1o4-g_Qxj9sSA_6vfjASQ%40mail.gmail.com.

दवाई

 दवाई

नीम के पत्ते... दो तोले 

 आंक के पत्ते.... तीन या चार 

लहसुन..... एक पोथा

 हींग.... (डली वाली) दो मासा 

कच्चा कुचला 3..4 टीकड़ी 

हमाम दस्ते में कूटना है,  उस हमाम दस्ते को फिर इस्तेमाल नहीं करना है फॉर एनी अदर परपज 

तेल.... 1 किलो 

सब कूटी गई सामग्री को सरसों के तेल में मंद आंच पर पका लें। फिर ठंडा करके छान के कांच की बोतल में रख लें

शिक्षा और स्वास्थ्य

 शिक्षा और स्वास्थ्य

रोहतक जिला पार्टी का 17 वाँ  सम्मेलन

 स्वास्थ्य और शिक्षा के बजट को लगातार कम किया जाने और स्वास्थ्य और शिक्षा के पब्लिक सेक्टर पर सरकार के भारी हमले का विरोध करता है। शिक्षा के हर स्तर की फीस बढ़ाई जा रही है। सरकारी अस्पतालों में  न पूरे डॉक्टर हैं ना पूरा स्टाफ है ना दवाई हैं ना जरूरी मशीन और औजार हैं। रोहतक जिले में जनसंख्या के हिसाब से सामुदायिक स्वास्थ्य केंद्र , प्राथमिक स्वास्थ्य केंद्र और उप स्वास्थ्य केंद्र ग्रामीण आबादी के हिसाब से खड़े तो किए हैं लेकिन बहुत  सी  कमियां हैं । इसी प्रकार रोहतक की शहरी जन संख्या के हिस्से 6 अर्बन प्राइमरी स्वास्थ्य केंद्र होने चाहिए लेकिन 4 ही हैं । सिविल अस्पताल रोहतक में भी डाक्टरों और स्टाफ की कमी है। इसके लिए रोहतक सिविल अस्पताल पर एक दिन का धरना भी दिया गया था। पीजीआईएमएस में भी फैकल्टी और सीनियर रेजिडेंट्स की 30 - 40 प्रतिशत की कमी है। इसके खिलाफ भी आवाज उठाई गई। ऐसा ही चलता रहा तो गरीब और मध्यवर्ग के लिए इलाज करवाना मुश्किल हो जाएगा । इलाज पर जेब से खर्च बढ़ रहा है। कम वित्तीय संसाधन दिए जा रहे हैं स्वास्थ्य पर जेब खर्च से किये खर्च के कारण काफी लोग गरीबों की रेखा के नीचे जाने को मजबूर हो रहे हैं।

नौकरियों में कटौती की जा रही हैं।  

शिक्षा के ढांचों को  अपनी नीतियों  से पहले तो खराब किया,  जरूरत के हिसाब से विस्तार नहीं किया। इसका दोष जान बूझकर अध्यापकों और बाकी स्टाफ पर लगा दिया । शिक्षा के सेलेब्स में भी सांप्रदायिक नजरिए से बदलाव की प्रक्रिया शुरू की है । कहीं ढांचा विकसित नहीं कहीं स्टाफ की कमी । 

प्राइवेट की भेंट दोनों क्षेत्रों का ढांचा चढ़ाया जा रहा है। इन दोनों के सरकारी ढांचे को बचाने के लिए बड़े स्तर पर संघर्ष की जरूरत है।  शिक्षा स्वास्थ्य और रोजगार के वास्तविक मुद्दों से ध्यान हटाने के लिए जात धर्म पर आम जन को उलझाया जा रहा है। कावड़ तो कभी कुंभ का मेला प्रस्तुत किए जा रहे हैं। निजीकरण के पक्ष में दलील यही दी जा रही है कि निजी सेवा प्रदाता  नए निवेश लगाएंगे तथा ज्यादा कुशलता से सेवाएं मुहैया करवाएंगे ।  

  नई शिक्षा नीति 2019 के दस्तावेज में वर्तमान शिक्षा व्यवस्था स्कूल ,कॉलेज, विश्वविद्यालय की खामियों को दर्शाया गया है। गुणवत्तापूर्ण शिक्षा की बात भी की जा रही है । मूलत शिक्षा का क्षेत्र ढांचाग़त समायोजन , समेकन, निजीकरण , केंद्रीकरण  के रुझानों से मुक्त नहीं हो पाया है । 

शिक्षा क्षेत्र****

*शिक्षा पर सकल घरेलू उत्पाद का 6% खर्च हो ।

*सार्वजनिक क्षेत्र को बढ़ावा मिले

*हर स्तर पर शिक्षकों के पद भरे जाएं 

*सार्वभौमिक नामांकन तथा गुणवत्तापूर्ण शिक्षा हमारा लक्ष्य हो 

*शिक्षा के मौलिक अधिकार को 3 से 18 वर्ष के आयु के सभी बच्चों के लिए मोहिया करवाया जाए।

स्वास्थ्य क्षेत्र****

1) सार्वजनिक स्वास्थ्य तंत्रका सशक्तिकरण। 

2) निजीकरण पर रोक और स्वास्थ्य सेवाओं का विस्तार।

3) जेंडर और स्वास्थ्य।

4) दवाइयों और जाँच सेवाओं की सबके लिए उपलब्धता।

5) स्वास्थ्य के सामजिक कारकों पर ध्यान देना।

लड़े हैं जीते हैं 

लड़ेंगे जीतेंगे

The National Family Health Survey 2019-21 (NFHS-5)

 Introduction

The National Family Health Survey 2019-21 (NFHS-5), the fifth in the NFHS series, provides information on population, health, and nutrition for India and each state/union territory (UT). Like NFHS-4, NFHS-5 also provides district-level estimates for many important indicators.

The contents of NFHS-5 are similar to NFHS-4 to allow comparisons over time. However, NFHS-5 includes some new topics, such as preschool education, disability, access to a toilet facility, death registration, bathing practices during menstruation, and methods and reasons for abortion. The scope of clinical, anthropometric, and biochemical testing (CAB) has also been expanded to include measurement of waist and hip circumferences, and the age range for the measurement of blood pressure and blood glucose has been expanded. However, HIV testing has been dropped. The NFHS-5 sample has been designed to provide national, state/union territory (UT), and district level estimates of various indicators covered in the survey. However, estimates of indicators of sexual behaviour; husband’s background and woman’s work; HIV/AIDS knowledge, attitudes and behaviour; and domestic violence are available only at the state/union territory (UT) and national level.

As in the earlier rounds, the Ministry of Health and Family Welfare, Government of India, designated the International Institute for Population Sciences, Mumbai, as the nodal agency to conduct NFHS-5. The main objective of each successive round of the NFHS has been to provide high-quality data on health and family welfare and emerging issues in this area. NFHS-5 data will be useful in setting benchmarks and examining the progress the health sector has made over time. Besides providing evidence for the effectiveness of ongoing programmes, the data from NFHS-5 help in identifying the need for new programmes with an area specific focus and identifying groups that are most in need of essential services.

Four Survey Schedules - Household, Woman’s, Man’s, and Biomarker - were canvassed in local languages using Computer Assisted Personal Interviewing (CAPI). In the Household Schedule, information was collected on all usual members of the household and visitors who stayed in the household the previous night, as well as socio-economic characteristics of the household; water, sanitation, and hygiene; health insurance coverage; disabilities; land ownership; number of deaths in the household in the three years preceding the survey; and the ownership and use of mosquito nets. The Woman’s Schedule covered a wide variety of topics, including the woman’s characteristics, marriage, fertility, contraception, children’s immunizations and healthcare, nutrition, reproductive health, sexual behaviour, HIV/AIDS, women’s empowerment, and domestic violence. The Man’s Schedule covered the man’s characteristics, marriage, his number of children, contraception, fertility preferences, nutrition, sexual behaviour, health issues, attitudes towards gender roles, and HIV/AIDS. The Biomarker Schedule covered measurements of height, weight, and haemoglobin levels for children; measurements of height, weight, waist and hip circumference, and haemoglobin levels for women age 15-49 years and men age 15-54 years; and blood pressure and random blood glucose levels for women and men age 15 years and over. In addition, women and men were requested to provide a few additional drops of blood from a finger prick for laboratory testing for HbA1c, malaria parasites, and Vitamin D3.

Readers should be cautious while interpreting and comparing the trends as some States/UTs may have smaller sample size. Moreover, at the time of survey, Ayushman Bharat AB-PMJAY and Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) were not fully rolled out and hence, their coverage may not have been factored in the results of indicator 12 (percentage of households with any usual member covered under a health insurance/financing scheme) and indicator 41 (percentage of mothers who received 4 or more antenatal care check-ups).

This fact sheet provides information on key indicators and trends for Haryana. Due to the Covid-19 situation and the imposition of lockdown, NFHS-5 fieldwork in phase 2 States/UTs was conducted in two parts. NFHS-5 fieldwork for Haryana was conducted from 12th January 2020 to 21st March 2020 prior to the lockdown and from 21st December 2020 to 30th April 2021 post lockdown by Society for Promotion of Youth and Masses (SPYM). Information was gathered from 18,229 households, 21,909 women, and 3,224 men. Fact sheets for each district in Haryana are also available separately.