June 15, 2014
LF Govt Takes Bold Decisions Despite Resource Crunch

Rahul Sinha

Health scheme for the poor; mustard oil and red lentil to be distributed through PDS DESPITE its miniscule financial resources, the Left Front government of Tripura has once again taken bold steps in the interest of the poor, common people of the state. In a path breaking move, the state government has decided to launch the Tripura Health Assistance Scheme for the poor to facilitate better medical treatment for the poorer sections of the society; in another move, it has decided to distribute mustard oil and red lentil (masur daal) to all the families in the state through the public distribution system (PDS). These decisions were taken in the meeting of the state cabinet held on June 4. After the cabinet meeting, Tripura chief minister Manik Sarkar briefed the press about these decisions in a press conference held in the Civil Secretariat. While India has one of the most privatised healthcare systems in the world, accounting for 80 percent of outpatient care and 60 percent of inpatient care. An estimated eight crore people are being pushed below the poverty line every year because of the forced expenditure on healthcare. A large part, about 70 percent, of out-of-pocket payments goes towards the purchase of medicines. Only a small proportion of medicines are provided free of cost, while over 80 percent of medicines are directly purchased by patients. The financial allocation by the central and state governments to the health sector should be increased to at least five percent of the GDP, as recommended by the World Health Organisation. But India for too long has been having one of the lowest levels of public expenditure on healthcare in the world. Both the common minimum programme of UPA-1 and the eleventh five year plan promised an increase in the public health expenditure to two to three percent of GDP, but currently the public health expenditure in the country stands at a mere 1.2 percent of GDP. There is a massive gap between the five year plan projections and actual allocation. The eleventh plan had projected that allocation to the health sector would be increased to two percent of GDP (0.87 percent of GDP by the centre and 1.13 percent of GDP by states). In contrast, it stood at a mere one percent of GDP --- 0.32 percent of GDP by the centre and 0.68 percent by the states --- at the end of the eleventh plan period in 2011-2012. In this sorry state of affairs all over the country, Tripura has a record of continuous effort at maximising the public intervention in the health sector. Almost 95 percent of the state’s population comes to the government hospitals for treatment and preventive healthcare. Other than two medical colleges of the state and a government state referral hospital in Agartala, the state has a network of community health centres (CHCs) and primary health centres (PHCs) spread all over. These CHCs and PHCs cater to the basic and primary health needs of the people. In the government hospitals, registration, bed and diet are free for all. Most of the investigations are free for all. Even for the costly and critical investigations, BPL (below poverty line) people are not charged while the charge in case of the APL (above poverty line) population is far less than the market rate. The government has opened a generic medicine store in the Agartala Government Medical College which provides low cost generic drugs to the patients. In a nutshell, the government expenditure on the health sector is much higher in proportion than the national average. The recent decision of the Left Front government to launch the Tripura Health Assistance Scheme for the poor is well in tune with these steps. Giving details of the scheme, chief minister Manik Sarkar said the modern day lifestyle has exposed us to a number of critical diseases whose treatments are very costly and the poor people can ill afford them. We are yet to create all the necessary infrastructure and provide equipped manpower for treatment of these diseases inside the state, which will require some more time. A number of people suffering from illnesses have to go outside the state. But a number of poor people can’t go outside for treatment because of their economic condition. Though, apart from government employees, those who are referred outside get some assistance from the chief minister’s relief fund, that is far from being adequate. After examining all these aspects, the chief minister said, the state government decided to start this scheme. Under this scheme patients from families with an yearly income not exceeding Rs 1.50 lakh will get government help of up to Rs 1.25 lakh if they are referred by the standing medical board of the state for treatment in the government enlisted hospitals outside the state. The scheme covers a broad category of seven diseases --- cancer, cardiovascular surgery, neurological surgery, renal surgery, neo-natal diseases, polychroma and eye diseases. Under these broad categories there will be sub categories of diseases when the detailed guidelines are made public. If a patient is referred outside, 10,000 rupees out of the envisaged 1.25 lakh rupees shall be given for travelling expenses. If the referred hospital is a private one, the government shall pay up to 1.15 lakh rupees of the medical bill; the rest if any shall have to be borne by the concerned family. If any patient of this income group is treated in the state referral hospitals in the state capital, they too shall have access to the facilities of this scheme, the chief minister added. He said at present, on an average, 1,800 patients go outside the state for treatment. If the number of government employees is excluded, the number is likely to come down. But it was thought that once this scheme got going, the number of such patients might go up to 3,000 per year when the people of poorer sections see that with some amount of money of their own they would be able to avail this opportunity. This will require an extra expenditure of Rs 37.50 crore from government exchequer per annum. About the second decision regarding the PDS, the chief minister said for a very long time the Left front government has been repeatedly urging the central government that the sky-rocketing prices of essential commodities could be kept under control if 14 or 15 essential commodities like pulses, edible oil, sugar etc are distributed at a subsidised rate through ration shops, apart from providing 35 kg of foodgrains to all the families at a price of two rupees per kg. But the centre did nothing in this regard. As for the new central government, it has just assumed office and we don’t know what they would do. If they take some positive steps in this regard, that will be good, but we in our limited financial capacity have thought over it and after thorough examination of all the related aspects have decided to distribute one litre of mustard oil and two kg of masur daal (red lentil) at subsidised rates to all the 9.65 lakh ration card holders irrespective of the APL-BPL division every month. It was estimated that this decision would cost the government an additional amount of Rs 40.53 crore annually. The mustard oil will be available at a price of Rs 15 less than the price in the open market; in case of masur daal, the price will be Rs 10 less per kg than the market price. The chief minister further said the decision of the earlier government to stop supplying sugar through the PDS has put us under pressure. However, the Left Front government then decided to buy sugar from the mill owners at competitive rates, by inviting tender, and distribute the commodity at the same price as was being charged from the consumers through ration shops with some subsidy from the centre. Thus the Left Front government itself has been to bearing some amount of subsidy for this scheme. Sarkar further said the central government had appreciated this step and termed it as an example, saying the other states too could emulate what Tripura had done successfully. He said in case of oil and pulses too we will follow the same process, procure the commodities at competitive prices by inviting tenders and distribute them through the PDS at subsidised rates. The oil will be available in one and half litre pouches and daal will also be sold in sealed packets of half or one kg so that any scope of adulteration could be killed. It is worth mentioning here that while the much touted food security act of the UPA-2 government did not see the light of the day and the PDS all over the country is being pushed to the brinks of disaster, the Left Front government of Tripura has been from August 2012 itself distributing 35 kg of rice to 2.95 lakh BPL and Antodoya families and at least 22 kg of rice to 1,61,787 enlisted BPL families (out of which 9,886 families get 35 kg) at a rate of 6.15 rupees per kg. This scheme costs the government an amount close to Rs 44 crore annually. The APL families get 22 kg of rice at 10.35 rupees per kg, apart from sugar, salt, atta and kerosene oil at subsidised prices. The CPI(M)’s Tripura state committee secretary Bijan Dhar hailed the decisions of the government. He said these decisions were reflective of the pro-people, alternative policy trajectory of the CPI(M) and the Left, which is completely in opposition to the neo-liberal policies being pursued in the rest of the country. He said these are positive steps for the welfare of the people which any government should take. This example should be emulated and implemented at the all-India level which requires increased governmental intervention and public spending. However, for that purpose, a complete reversal of the neo-liberal and pro-rich approach of the ruling classes is a prerequisite.