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The MPLAD dilemma in times of corona

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Dr Apurva Jain, MPH candidate and Dr Feroz Ikbal, faculty, School of Health System Studies, Tata Institute of Social Sciences share their views on the government’s recent announcement of suspending the Member of Parliament Local Area Development (MPLAD) funds and how this amount could possibly be channelised to deal with the coronavirus pandemic

To rope in funds at this time of crisis, the central government of India recently announced suspension of the Member of Parliament Local Area Development (MPLAD) funds for a period of two years. The declaration invited mixed reactions from different communities- the politicians, the policymakers, the academicians and also the citizens of the country.

Introduced by the then Prime Minister, PV Narasimha Rao’s government in 1993-94, the grants under the funds have now reached an amount of Rs 5 crore from an initial of Rs 5 lakhs per member of parliament per year. Though the funds help to meet the local needs of the people in the constituency without much delay, they had lately drawn much criticism – lack of transparency, corruption, electoral propaganda and disrespecting the scope and guidelines by the government being some of the reasons.

The announcement of the withdrawal for two years has raised many eyebrows. The central government has put forth no plan or budget to explain how it intends to use an amount of Rs 7,900 crores, hence lacking transparency or any clarity. Arguments voice that channelising these funds into the consolidated fund is undemocratic. Secondly, some constituencies like Thiruvananthapuram have had their own COVID-management strategies by channelising these funds for COVID-containment response, while others have been doing quite well in terms of COVID containment without using the funds at all. For such constituencies, to give their entire funds to the consolidated fund is only a disincentive instead of an incentive. Further, there are cases of unfair distribution – as per a media report, Gujarat received a grant of Rs 662 crores by the central government, while Kerala received only Rs 157 crores for corona management even with the latter having a larger number of cases. This raises questions on the loss of equity, central autonomy and the presence of bias when left unexplained.

There is no doubt that the pandemic has only exposed the weak healthcare infrastructure of the country in a way, never before. The lack of arrangements for isolation and quarantine, few numbers of ventilators, weak community engagement, the skewed doctor: patient ratios or even the financial crunches to purchase or produce a sufficient number of personal protective equipment (PPE) or test kits – though always existed, have now come out to be much more relevant national issues, only after it has taken a toll on the normal functioning of 1.3 billion people and the national and global economy.

But the question still remains, was it a relevant COVID-19 tackling policy decision by the Central Government or to make up for the economy. The COVID databases have shown how all states have varying number of cases, deaths, number of hospitals, population in terms of number and even their own models of healthcare and corona-containment strategies. While we have Maharashtra and Delhi with an overwhelming number of cases, we have Goa and Manipur who have declared themselves as COVID free; we have other north-eastern states with comparatively lesser number of cases and we have the southern states with increasing numbers.

Epidemics are best controlled through local actions guided by local needs. Allowing each state and constituency to have their own strategy as per their needs while encouraging them to use their MPLAD funds for implementing the same would be a better strategy for the country. It allows for a decentralised management response where every constituency after a thorough assessment can draw a plan of action that augments their own area of weakness with respect to COVID management. In the short-term, this money can be used to engage more human resources for contact tracing to prevent community spread. With the latest panic over symptomless corona spread, the testing criteria may have to be increased and more people may have to be tested. Due to the limited capacity of the public sectors, the money could be utilised to buy the screening from private laboratories. Make-shift isolation and quarantine facilities as per the needs of the district, transport facilities to carry infected or potential carriers to the health facilities or even distributing sanitisers and soaps to the economically marginalised-customisation as per the demography and spread of the disease in the community.

The way forward

The health system of the country is in shambles. The pandemic is just another warning for our fading public healthcare sector.

It is widely accepted that the healthcare budget of our country that revolves around a meagre one per cent is far less than that of many other countries. The National Health Policy 2017 reaffirms the government’s commitment to increase the Central Government expenditure to 2.5 per cent of GDP by 2025 and state governments spending to more than eight per cent by 2020. However, the subsequent budgets do not reflect progress towards the same.

As per a report by The Centre for Policy Research (March 2018), only around six per cent of the 1.58 lakh sub centres and 12 per cent of the Primary Health Centers (PHCs) adh,ered to the norms of the IPHS while in the case of the Community Health Centers (CHCs), only 728 of the 5,600 follow basic standards. Not only this, we just have half of the required number of PHCs for a population of 1.3 billion. People turning to private care have to bear huge expenditure – 55 million people were pushed into poverty due to their spending on health, many choose to resort to poor health-seeking behaviours. It is thus mandatory to not only maintain, but also intensify the momentum to qualitatively and quantitatively enhance the health system even after the pandemic recedes.

Hence, in the long term, to overcome the minimum government expenditure on health and as an adjunct to the central and state funds, thought could be given to assign the MPLAD fund to build and equip durable health infrastructure in the country, the decision of which should be left on the local government as per thorough need assessment. The scope of the funds can then be changed to the upgrading of a selected sub-centre, Primary Healthy Centre (PHC) or Community Health Centre (CHC); starting new health and wellness centre, setting up telemedicine units, setting up small clinics or dispensaries, or in any other innovative way as visualised, as per local needs. All this should happen as an adjunct to the state and central health funds and never as a substitute for them. Thus, an amount of Rs 5 crores every year could hence go a long way in improving the health infrastructure collectively over time.

The concept of Member of Parliament Local Health Infrastructure Development (MPLHID) funds can be proposed to develop model sub-centres, PHCs or CHCs which comply with the Indian Public health Standard norms and National Quality Assurance Standards. It will not only help to regain the trust of the people, but also prepare our health system for future healthcare crisis. It takes no great calculation to ascertain that our healthcare delivery system is only a fraction of the requirement of any decent standard. The pandemic has made us realise that death does not distinguish amongst race, gender, or social status. Health can no longer be a matter to neglect.

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