“Suggestions of activists should be sought in Budget”

Samuel John, executive director, National Centre for Advocacy Studies

An analysis of the Union Budget would bring to the fore the differences in rhetoric in the Budget speech and real allocations, particularly with reference to the rural poor and the marginalised, says Samuel John, executive director, National Centre for Advocacy Studies (Pune), and a member of the Centre for Budget Accountability (New Delhi). John has been actively involved in advocacy capacity building, research and various campaigns at the national and international level for more than twenty years. He is a member of the the working group on Governance and Planning Commission of Indi and the founder of Bodhigram India, an organisation working at the grassroots and Infochange, an business initiative committed to social justice. In an interview with Rita Dutta, John underscores the need to demystify the budget to use it as a tool for monitoring the expenditure.

What is your opinion about the various interpretations of the Union Budget vis-a-vis healthcare? Is it a healthy trend to have such divergent views?
It is necessary to interpret the Budget so as to demystify it. Why are only economists supposed to understand and analyse the Budget and not the common man? As the Budget is introduced to please the vested interests of corporate and politicians, the language of the Budget is deliberately made incomprehensible to the common man. In the developed countries, a simplified version of the Budget is available to the common man.

In India, the politicians and bureaucrats highlight only the new schemes, estimates and the increased expenditure in the field of healthcare in the Budget. They completely shield the fact that allotment of funds have gone down when one compares with the inflation and the per capita income. Though World Health Organisation recommends that five per cent of the GDP should be spent on health, the expenditure of the central and state government has come down from 1.25 per cent in (1993-94) to only 0.9 per cent (1999-2000) of the GDP on health.

The Budget is an exercise to please the urban middle class and the corporate leaders, while the poor gets a dose of rhetoric. In the absence of adequate budgetary allocation and careful spending to fulfil policy priorities, mere policy rhetoric leads to ‘policy mirages.’ ‘Policy mirage’ is the tactic used by the new policy-makers to provide false and distant hopes, without corresponding financial allocation or policy implementation.

In India, while the Budget estimates are hyped, there is no transparency and accountability as to what happens to the funds that are allocated. The target achieved should be available to the public, as it is with the developed countries. But unfortunately it is not so. It’s the health activists who bring to light how the allotment of funds have decreased or how the new schemes are launched at the cost of scrapping old schemes. Did the government point out that the Balwadi nutrition programme witnessed continuous slashing of grants over the last six years till no more allocation was made in the year 2002-03?

In what way can understanding the Budget help?
Understanding the Budget can be used as a tool of advocacy and policy monitoring of the government. It can be used to make the government more accountable for its promises and expenditure. We want the government to seek the opinion of activists in healthcare before finalising the Budget.

What is your opinion of the so called "feel-good" Budget 2003 which would supposedly give a boost to the healthcare sector?
The Union Budget 2003 is a budget of many ifs and buts. If the poor people have enough money and skill to take a healthcare policy from GIC, then we can dream of healthcare for all the poor. If there are enough hospitals in rural areas, then all the poor can get hospitalised within minutes. If the poor had Rs 20,000-Rs 30,000 then they can be easily reimbursed after the money is paid to the private hospitals.

The "feel good" factor is a delusion. Capital outlay on medical and public health was reduced from Rs 47.71 crore in the last Budget estimates to Rs 37.10 crore this year. Instead of increasing the outreach of the public healthcare systems, the Budget further encourages the privatisation of healthcare. The proposed tax benefits for financial institutions for providing long-term capital expenditure to the private hospitals would further decrease the accessibility and affordability of healthcare to the poor.

Instead of ensuring the timely accessibility and affordability of basic amenities and medicines that can be the cure of most of the diseases of the poor, the present budget seeks to further privatise the already unregulated private healthcare systems. The marketisation of healthcare would further delay the right to healthcare to the poorest sections.

But the government has announced the rural health insurance scheme for the poor!
The health insurance scheme is an unviable proposition. In a country where more than 45 per cent of the people who earn less than Rs 1.5 day for a family of five and Rs 2 per day of a family of seven will be entitled to reimbursement of hospitalisation expenses up to Rs 30,000 and cover for less than Rs 50 a day, how can the government expect that they would first spend thousands of rupees for the hospital expenses and then get re-imbursed. Most of the poor fall sick due to malnutrition, lack of clean water and sanitation.

What has been the experience of health activists with the government so far vis-a-vis Budget?
The government makes a pretense that it is open to suggestions. Take the instance of Andhra Pradesh government, which pretended that the opinion of health activists was important. They involved us in various stages of the draft of the Budget, but what was finalised was completely different from the draft shown to us. Same is the case with the National Health Policy, 2002 for which I was asked to make suggestions for the draft and write the introduction. But when the policy came out, my suggestions were not retained. This is how the government uses the NGOs to gain legitimacy.

Recently, the Centre for Enquiry into Health and Allied Theme (Cehat) organised a campaign in Mumbai to demand larger allocations for health in the state budget. A three-day hunger strike was organised with the participation of various people’s organisations and a memorandum was submitted to the government.

So what are health activists doing so that their voices are heard?
From next year, the Centre for Budget Accountability (New Delhi), which is a conclave of health activists, is going to make a pre-budget memorandum to the government for increase in allotment of funds in the healthcare sector. There have to be proper healthcare schemes for the poor. There have to be accountability and transparency in budget expenditure. We want to create a public debate on what is beneficial for the people.