In his budget speech on February 17th, Chief Minister Basavaraj Bommai stated that quality of life in Bengaluru would improve “by ensuring seamless mobility, developing roads, prevention of floods by developing storm water drains and designing scientific and efficient waste management systems.”
While such physical infrastructure is undoubtedly important for the well-being of a city, social infrastructure such as housing and health are equally crucial for improving the standard of living.
In Part 1 of this series, we looked at the gaps in budget allocations to BMTC and education. In Part 2, we will look at how the budget focuses on other social aspects, such as health and housing.
Chief Minister Bommai stressed that the budget this year was a surplus budget, meaning that the revenue had exceeded income in the previous year. Much of this surplus, however, appears to be going into more physical infrastructure even in the healthcare sector.
Healthcare inequity in the city
Researchers and activists have pointed out the lack of equity in healthcare systems in Bengaluru several times. The urban poor have to navigate lack of access to public healthcare as well as caste and gender based discrimination.
A 2021 report on health care inequity in urban India noted that in Bengaluru around 30% of even the poorest citizens were forced to seek private health care and pay out of pocket expenditure. The report further points out that private healthcare costs are ten-fold higher than public healthcare. This leads the urban poor to delay or forgo health services, especially for chronic conditions requiring long-term care, the report noted.
Budget allocations for health
Overall, the government appears to have slightly increased expenditure on health and medical services in Bengaluru from Rs 4,438 lakhs in 2020-21 to an estimated Rs 5,534 lakhs in 2022-23, according to the budget estimates released by the finance department. However, much of this appears to have been budgeted for salaries and infrastructure.
In the light of the COVID-19 pandemic, the government has allocated Rs 10 crore for the establishment of an Epidemic Preparedness Centre in Bengaluru. Such a centre has been proposed since 2022 to better identify future epidemics. The state government met with private pharmaceutical companies like Bharath Biotech to discuss it further one week before the budget. However, it is still not clear how the centre will function and where the Rs 10 crore will be used.
Bommai also reiterated the government’s goal of establishing Namma Clinics in 243 wards in the city and 27 smart virtual clinics in 2022-23. The Chief Minister also claimed that “50 dialysis beds and 300-bed super speciality facilities are established.” To improve the health administration system, it is proposed to reconstitute the Mahanagara health administration as ‘Bengaluru Health Systems’. It is not clear why this revamp is needed or how much it will cost.
Namma Clinics- an eyewash
Akhila Vasan, a researcher and member of the Karnataka Janaarogya Chaluvali (KJC), is not impressed with these plans. She is particularly critical of the Namma Clinics scheme. “What is this Namma Clinic? We already have municipal run Public Health Centres. Why not improve these?” she asks.
However, the state government in a media statement had mentioned that currently there was one PHC for every 50,000 people, but every ward in Bengaluru will have a Namma Clinic and each clinic will cater to 15,000-20,000 people. The maths doesn’t quite add up, as the average population per ward in the city is currently around 42,000, meaning one Namma Clinic cannot cater to more than half the population of a ward.
Akhila points out that Namma Clinics do not solve the basic problem of accessibility for poorer citizens. The clinics function from 9.30 am to 4 pm, every day.
“For years we have been asking for PHCs or clinics to run from 5 pm to 10 pm in the evening,” she says. “Poor people cannot be expected to leave their work during the day and go to a clinic,” she adds. “The whole thing is an eyewash. It is a political gimmick to copy AAP’s mohalla clinic.”
Akhila points out that the government has not addressed the larger issue of a shortage of doctors and nurses in the state. “All these new beds and clinics…where are the doctors?”she asks.
This shortage has already affected the Namma Clinics plan. Each clinic is supposed to be staffed with one doctor, one nurse, one lab technician and one group ‘D’ officer. As of now, 108 Namma Clinics have been established in the city, and the remaining have been sanctioned at the cost of Rs 180 crore, according to the CM’s budget speech. One of the reasons for the delay in the remaining clinics is because of the lack of doctors, according to media reports.
Where are the doctors?
Indeed, there seems to be no plans in the budget to invest in medical human resources.
The state government slightly increased expenditure on health and medical services in Bengaluru from Rs 4, 438 lakhs in 2020-21 to an estimated Rs 5, 534 lakhs in 2022-23.
However, much of this appears to have gone in salaries for existing staff and some capital or infrastructural expenditure. The government has also estimated spending Rs 6, 000 crore on two new super-speciality hospitals in Bengaluru and two in other cities in the state.
However, media reports have repeatedly pointed out that poor pay and temporary contracts dissuaded doctors and nurses from joining government institutions. Akhila alleges that instead of addressing this issue, the government is empanelling private hospitals to provide crucial healthcare services where they cannot control patient charges. “They are also allowing government doctors to run private practices, instead of offering them better pay,” she adds.
The situation is worse as we go down the medical staff hierarchy. Nurses are severely underpaid in both government and private sectors. Government nurses earn an average of Rs 32,000 per month as permanent staff and Rs 16,000 as contract staff, Akhila points out.
Despite being vital grassroots health workers, who carry out maternal health and immunisation programmes, including COVID-19 vaccinations, ASHA workers are paid an honorarium of Rs 6, 000 and incentives ranging from Rs 500-1,000 for tasks such as complete immunisation of children in their ward.
The budget makes no mention of increasing salaries or allocating financial resources for hiring more nurses. Indeed, the state budget estimates show no spending on nurses and other health workers, such as midwives, from 2020-2022 and a mere Rs 1.5 lakhs has been estimated for training for the year 2022-23.
ASHA workers have got an increase of Rs 1,000 in their honorarium. “Thousand rupees is nothing even in a rural area, let alone a city like Bengaluru,” scoffs Akhila.
In a strange move, the Chief Minister promised aid to mutts and other religious organisations providing charitable services. “Religious organisations don’t need any support in this country. They get enough from private citizens and entities,” points out Akhila. The government needs to invest its resources in public healthcare.