Author:
Publication: Humanscape
Date: December 2000
AIDS may continue to
be the flavour of the month/year internationally. But does that justify
the fact that several Indian states allocate a much larger percentage of
their health budget to HIV/AIDS than to other far more widespread diseases
such as malaria and tuberculosis?
According to the report
`Financing of Disease Control Programmes in India' by Sunil Nandraj and
Ravi Duggal of CEHAT, February 1996, the National AIDS Control Programme
was a new entrant in the list of national disease control programmes and
no baseline studies have yet been conducted to calculate the prevalence
and incidence of the disease.
The National Family Health
Survey (NFHS), carried out by the International Institute for Population
Sciences (IIPS) in 1995, lists malaria as the most prevalent disease, afflicting
3,324 per 100,000 population (in three months). Then comes blindness
(partial or complete): 3,001 per 100,000; tuberculosis: 467 per 100,000;
and physical impairment: 639 per 100,000. Despite the various national
programmes for these diseases in our country, neither morbidity nor mortality
have declined. On the contrary, there has been a resurgence of malaria,
TB and gastro-enteritis, while basic health care services that need to
be developed for an integrated approach, with the common man in focus,
are simply not present, the study states.
According to NACO, by
December 31, 1999, India had 92,312 HIV-positive persons, from 3.5 million
screened, with a seropositivity rate of 25.84 per 1,000. The study
states that AIDS control is rapidly increasing its share in the budget.
In Andhra Pradesh, during 1992-93, it was around 10.21 per cent; in 1994-95,
the figure went up to 24.45 per cent in proportion to the overall disease
programme. This trend is seen across most of the states that are
incurring expenditure on AIDS programmes.
According to the study,
the State was not spending more than 3.5 per cent of its resources on the
health sector. The budgeted expenditure for 1994-95 was 2.63 per
cent of the total government expenditure, which is the lowest ever.
In terms of proportion to GDP (Gross Domestic Product), the expenditure
on health has been a meagre 1 per cent, woefully short of the World Health
Organisation's recommendation of 5 per cent.
The severity of the malaria
threat can be gauged from the NFHS which recorded a three-month incidence
of 3,324 per 100,000 people -- that's over 3 per cent of the population
affected within a three-month period. When multiplied by four, we
get a whopping 1,205 million cases of symptomatic malaria every year.
Post-1993, the situation has worsened in states such as Rajasthan, Assam,
Maharashtra and Orissa. In spite of this, the expenditure on malaria
has been a mere 6-7 per cent of the total health expenditure in various
states.
Likewise, the expenditure
on TB control is paltry compared to the incidence and number of deaths
from TB throughout the country. On an average, states spend only
2 per cent on TB as a proportion of total health expenditure; and this
too is declining. About 1.5 per cent of India's total population
is estimated to be suffering from radiologically-active TB; some 500,000
lakh deaths occur every year, most of them children aged below 15 years.
Estimates suggest that by the end of the year 2000, India will have at
least 20 million active TB patients, one-fifth of whom will be infectious.
Leprosy control is the
second-largest disease control programme in our country, after malaria.
There are an estimated 4.2 million people affected by leprosy in India.
This importance given
to AIDS is at the expense of other diseases that, though equally fatal,
are more easily curable, unlike AIDS. Also accounting for the high
priority given to HIV/AIDS is the international attention it receives.
This has been the problem in India right from the First Plan where priority
was given to a disease programme based on the agenda of international agencies,
the report adds.
(The study analysed expenditures
on major diseases such as malaria, TB, leprosy, blindness and AIDS by various
state governments. The data was compiled over a period of six years,
between 1989-90 and 1994-1995.)
Central government expenditure
on Disease Control Programme (Rs in crores)
Year
Malaria TB Leprosy
Blindness AIDS
1992-93
78.76 29
35 20
69.8
1993-94
91.85 37.5 60.70
25 72.14
1994-95
92 46
94 40
72.6
1995-96
130.81 46 72
63 69.98
1996-97
144.01 52.07 74
75 141
1997-98
183.06 80 79
70 124.5
1998-99
221.09 72 79
75 111
1999-00
199.77 95 82
84 140
00-01
249.99 125 74
110 145
These are revised estimates
from the budget which have been compiled by Nilanjana Roy, senior research
assistant, CEHAT
