Friday is budget day in India

India’s Past or India’s Future?

Friday is budget day in India and the papers and news channels are full of debates about where the Government should be spending it’s money.  A budget provides a clear picture of the priorities of any Government. It is the time when the Government has to put aside the rhetoric and  – to misquote Jerry Maguire  – it is time to ’show us the money’.

So is the country with the highest number of children dying anywhere in the world investing enough in public health? 

Health spending as a percentage of GDP is a useful indicator for us to start answering this question. The World Health Organisation (WHO) stated that the global average public health spend is 5% of GDP. Canada currently spends 7%, Spain 6%, South Africa  is at 3%, Sri Lanka 2% and India is trailing near the bottom spending just 1.1% ( both states and the centre combined). It’s incredible to think that this is only just above Sweden’s aid budget which currently at 0.99% of GDP!

What about if we look at health spending per person? According to the WHO in 2009 Canada spends $3763 per person, South Africa about $715, Malaysia $544, Sri Lanka $171 and India…$86.

It is no wonder that more than 70% of all health care in India is paid for by people from their own pocket. But this is putting an increasingly heavy burden on the poor. A recent front page in the The Times of India estimated that in 2004-05, an additional 39 million people were pushed into poverty due to out-of-pocket payments.

Despite these statistics there is progress and India has some excellent schemes such as the NRHM in place but good schemes are not enough unless matched by effective implementation and budget.

Economic growth is certainly helping in India but even neighbours with slower economic growth are making faster progress on cutting child mortality. It is time for urgent action to change this.

So why spend money on health?  Because every child has the right to survive no matter the community or caste to which they are born.  Because when health improves, people have smaller families and a government has more resources per person. Because recent research evidence shows a 5% point reduction in child mortality rates is associated with a 1% point increase in economic growth over the following decade.  Because thousands of parents will lie awake tonight across India having lost a child to preventable illnesses and disease. And quite frankly because the Indian Government promised to spend 2-3% on health and still haven’t delivered.

The question facing the Minister of Finance and the Government of India is whether the high levels of child and maternal mortality are part of India’s past or India’s future. The Government will give an answer to this question on Friday in the budget.