JUNE is the month of annual budget presentation. With the centre wholly focusing on squeezing provincial transfers to fund growing federal expense, both the provincial and federal budgets are slashing public spending. Not surprisingly, the health budgets — like education — are for the chop. This shows up in most health figures reported in the budget statements.
Beginning with the federal document, the budget set aside for health is around Rs13 billion. This is less than last year’s health allocations, according to opposition leaders and one local NGO working on budget tracking. The allocated budget will be spent on 32 new and 13 existing health projects. There is some money made available for the Sehat Insaf Card; the Ehsaas programme also aims to provide nutritious food to one million poor families.
Worryingly, some proposed taxes measures in the federal budget can have an adverse impact on people’s access – particularly children’s – to food. For example, taxing pasteurised milk will affect access. This is a country where stunting and malnutrition are widespread. Added taxes and an increase in the prices of food items will worsen matters. This strategy should be rethought.
If people spend more on food, they tend to spend less on health, which is a second-order priority. The federal excise duty on tobacco has also been raised with a view to increasing revenue generation. Yet there is no certainty that the additional money will be reserved exclusively for health. Another surprise was that the proposed health tax on cigarette packs and fizzy drinks has not figured in the budget. This was a huge missed opportunity. There is no explanation forthcoming as to why the much-talked-about health tax was dropped at the last minute.
The slashing of funds for health will reverse gains.
As for the Punjab budget, Rs279bn has been earmarked for health. Despite the Punjab government’s assertion that the health budget represents an increase of 20 per cent, one media report reveals that the money allocated is actually Rs5bn less than the caretaker government’s health appropriation. The latter will be spent on upgrading hospitals and funding the hepatitis and tuberculosis programmes, among other things.
Access to the Sehat card will also be expanded to 26 districts in the province. The health budgetary squeeze is already in evidence if we go by the press accounts of patients being refused free medicines and tests in some major hospitals, and the provincial health minister has said that the government should not be expected to provide free medicine on a long-term basis.
Meanwhile, in Balochistan, the provincial health budget is fixed at Rs34.18bn. The bulk of the amount will go towards creating more than 1,000 jobs, establishing 21 emergency and trauma centres and setting up the Bolan medical university.
Khyber Pakhtunkhwa has set aside Rs52bn for health in its provincial budget. The broader goal of the health appropriation is to provide free treatment to everyone in the province as part of universal health coverage. The Sehat card facility is envisaged to be extended to every family, with government servants also given the choice to join in the scheme. The big-ticket expense will involve improvements at the Peshawar Institute of Cardiology and the Khyber and Saidu Sharif teaching hospitals. There is additional money pledged for health safety programmes and cancer patients.
Unlike other provinces (that are ruled either by a PTI or PTI-affiliated government), Sindh has bucked the federally led austerity drive. This is evident in the enhanced allocation of Rs114.4bn, up by 19pc. The newly increased allocation will be used to complete 12 ongoing schemes. An additional Rs1bn has been set aside to deal with the outbreak of HIV in the province. This money should be used wisely, and proper infection-control measures need to be instituted to prevent the scourge from expanding.
The tuberculosis and malaria control programmes have also received budgetary allocations. The PPP spearheaded the 18th Amendment. So it has a moral duty to show that devolution in health has improved service delivery for the people.
From the figure released, it is apparent that there is a general trend towards squeezing the provincial and federal health budgets — this is most likely linked to the ongoing tussle over the increased transfers to the provinces in the wake of the 18th Amendment. The squeeze will adversely affect the provincial health budgets, which had seen a steady increase in the aftermath of the 18th Amendment that devolved many of the health functions to the provinces.
Pakistan’s health systems have suffered grievously from chronic under-investment. This year’s budget reverses some of the modest gains in health over the last decade.
The writer is the author of Patient Pakistan: Reforming and Fixing Healthcare for all in the 21st Century.
Published in Dawn, July 2nd, 2019