Mens sana in corpore sano is the timeless phrase that the Roman poet Juvenal coined—a healthy mind in a healthy body. Every government’s topmost priority is to enable its citizens to maintain a healthy mind in a healthy body. We can hardly expect the people at the grassroots to think business successfully unless they can stop worrying about health care spending.
Among all the achievements from which the current government may collect brownie points, there would be two that shine the most: Atmanirbhar Bharat and Ayushman Bharat. These two together take the development challenges by the horns.
Indeed the strength of a government lies in the efficacy of it policies in taking development challenges head-on and resolving them. And health is one of the major issues that have negatively and hugely impacted earlier poverty alleviation and development programmes. A look at a few sets of data clarifies the point here. The per capita expenditure on health care has increased from Rs 61 in 2009-10 to Rs 1,677 in 2017-18! If we factor in healthcare inflation at 7 per cent, we can well imagine the galloping cost of household healthcare expenditure and its consequent impact at the lowest strata of the economic pyramid.
The government has remained concerned about it.
In 14.4 per cent of households, the annual expenditure on healthcare exceeds per capita overall expenditure. The situation is dire. On the other hand, given the tough battle that the government had to fight to meet its budgetary allocation for so many other sectors, it couldn’t find enough resources to address the issues of health care. The National Health Profile 2019 admitted that spending 1.28 per cent of the GDP on healthcare was not enough to meet the demand.
In this context, the Pradhan Mantri Jan Arogya Yojana, popularly referred to as Ayushman Bharat scheme, must rate as a policy masterstroke to address the issues related to healthcare that have remained the bane of development efforts. Aimed at the poor, covering nearly 50 crore people, it provides healthcare coverage of Rs 5 lakh per family per year.
The strategy here is simple. Instead of focusing on creating physical infrastructure, which takes time, it gives the poor immediate access to the existing infrastructure by providing them with medical insurance. Put into effect in September 2018, the scheme should merit as one of the jewels of this government led by the Honorable Prime Minister Narendra Modi. This scheme unshackles the poor from the compulsion of out-of-pocket expenditure in medical emergencies, frees them from the compulsion of spending while already bankrupt and selling whatever asset they have, to meet the cost.
The other jewel is the Atmanirbhar Bharat. While healthcare cost has tended to undermine the poverty alleviation programmes, lack of continued employment generation mechanism has hamstrung attempts to give the poor an adequate income. The failed attempts to break the vicious cycle of poverty and create the virtuous cycle of prosperity and well-being have been blamed on policy-makers’ failure to be innovative. With this programme, the analysts are seeing a new positive direction in creating jobs.
Atmanirbhar Bharat focuses on providing greater ease of market play for micro, small and medium enterprises or MSMEs. Keeping in mind that this sector is the largest employment generator in the country, stressing on self-reliance, efficiency and equity and with such a long rope given to MSMEs, a quick turnaround is foretold and the lost jobs will be regained as soon as the demand starts picking up.
What needs to be noted here is that the Atmanirbhar Bharat programme focuses on ease of doing business. The government has taken note of the fact that MSMEs cannot raise or deploy resources as easily as a large unit can. Similarly, market access is relatively more difficult for this sector. Yet, this is the sector that creates the greatest chunk of employment, also having a substantial contribution to the export earnings of the country. The nimbleness in addressing market needs is also a great trait of this sector. It would be relevant to remember in this context that this was the sector that turned us from a country that hardly made any personal protective equipment or PPE to one that now manufactures enough for local demand and exports.
Other interesting figures can be read with such successes. Most of the jobs created in the last three years were by MSMEs. And of all the jobs created, more than 70 per cent were in the micro-units.
Realizing the potential of this sector, the Atmanirbhar Bharat paves the path for MSMEs towards opportunity by creating access to both market and funds. MSMEs are now expected to ramp up production and create further net employment. This, in other words, is an answer to the curse of unemployment.
On this note, it might be worth mentioning that, with government support, microfinance will also have an important role to play. The new-unemployed, with little or no capital to invest, need finance to start a business. Microfinance institutions (MFIs), with their experience in the sector, already have the core processes and may be the key facilitators for these self-employed. The fact that MFIs don’t just provide credit but also train their customers in the productive use of money will be a great differentiator in the journey.
These two projects together could yield the solution to the poverty alleviation question. While the first takes care of the healthcare needs of the poor, the other seeks to generate employment and thereby put them on the prosperity cycle.
This is the reason why I am optimistic and look forward to a healthy country with economic independence in its truest sense.