Last year was a challenging year for the state of Kerala, when it faced a Nipah outbreak in Kozhikode and then the worst floods in a century. Kerala’s new budget – announced in 2019 – will have to factor in the learnings from these two major events.
The Nipah outbreak in early May in Kozhikode was a stark reminder of the virus’ fatality and the precautions required to be taken for infection control purposes in healthcare settings.
The outbreak infected 23 people. Only two could be saved.
Also read: How Kerala Passed the Tough Nipah Test
Barely a month after the outbreak, Nipah was declared over. Soon after, however, the floods came. Wreaking havoc in most parts of Kerala, they led to considerable loss of life and livelihoods. After the floods subsided, the health department was put on alert to look out for the spread of communicable diseases resulting from the aftermath of the deluge.
Budgetary allocations of the state
It is against this background that Kerala – while still trying to rebuild after the floods – presented its new budget.
The budget allocations for public health have seen a marginal increase from last year’s figures. But spending on health has seen an overall increased every year.
Some of the spending areas allocated in this budget include the upgradation of primary health centres to family health centres. With the increasing burden of communicable diseases, the state has decided to invest more on surveillance and public health measures.
Against this backdrop of increased focus on public health after the Nipah outbreak and the floods, concerted efforts are being made to increase health spending and focus more on disease detection and reduction.
This increased focus led to the conceptualisation and inauguration of a virology institute in the state, which became operational in the first week of February.
State schemes versus Ayushaman Bharat?
Last year, the central government made a grand announcement about the National Health Protection Scheme, now known as the Pradhan Mantri Jan Arogya Yojana (PMJAY). Meanwhile, around the same time, some states were wondering what would happen to their own schemes which had wider reach and were already being implemented in the state, albeit under different names.
For example, Kerala’s Comprehensive Health Insurance Scheme (CHIS) claims to covers 40.96 Lakh families and has reportedly managed to cover almost 50% of the state’s population.
Over the years, different government schemes have tried to improve upon the CHIS and top it with higher insurance covers. From CHIS it became CHIS-Plus followed by newer schemes being announced by the Centre in subsequent years, adding to the existing schemes being run by the state government.
Under these circumstances, the Kerala state government decided to float its own scheme – called the Comprehensive Health Care scheme – announced during the 2019-20 Budget.
While the name was changed, state finance minister Thomas Issac emphasised that no beneficiary would be left out and that every effort would be made to include them according to the list of eligible beneficiaries. In his Budget speech on January 31, he also mentioned this scheme could not take off because the Centre had come up with its own scheme (AB- PMJAY).
Also read: Explainer: Nipah Virus in Kerala and What the Government Is Doing About It
Over the past three years there have been numerous changes made to the original Rashtriya Swasthya Bhima Yojana health insurance scheme (RSBY) in Kerala. The state rolled out the Karunya Benevolent scheme (2011-12) which provides monetary help for treatment sought in public as well as private hospitals.
But as the central government announced the arrival of Ayushman Bharat, it was up to the state governments to decide whether they wanted to continue with their own schemes or wanted to join PMJAY.
Kerala signed an MOU to join PMJAY in November 2018. The state’s finance minister who had voiced his concerns about funding and allocations for the ambitious PMJAY scheme, once again reiterated his concerns about the premium amount to be coughed up by the state and the number of beneficiaries who would be covered.
Also read: In the Wake of Ayushman Bharat Come Sops for Private Hospitals
In the budget for the year 2019-2020, Thomas Issac presented a new scheme which would be fully funded by the lottery revenue from the state lottery department to provide for insurance covers for the new scheme. The scheme will use the funds from the Centre allotted to Ayushman Bharat and combine it with the state’s lottery revenue to include those who have been excluded from the Centre’s scheme and make it more comprehensive.
This would mean that the new scheme will merge with the old Karunya Benevolent scheme and be called Comprehensive Health Security Scheme(CHSS). This scheme will roll out during the month of May 2019.
We await to see if the scheme will receive the promised financial funding from the Centre and whether the state will be able to seamlessly balance between their needs and the supply of funds from the Centre.
The scheme is also bound to be reviewed post-2019 Lok Sabha elections, as some states like Karnataka – who shifted from being BJP-ruled to coming under Congress rule – have mentioned their willingness to withdraw from the Ayushman Bharat scheme and to re-introduce their old state specific schemes.
Jisha Jayashree is a PhD candidate at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University. Her PhD looks at the role of the private sector in Ayurvedic education in Kerala.