In the last few years, the state governments across the country failed in dealing with the public health crisis. Be it the 2019 Bihar encephalitis outbreak or the incompetence of the states like Maharashtra, Punjab and Chattishgarh in dealing with the Coronavirus pandemic, the state governments have repeatedly failed despite the fact that health is a state subject, and therefore, the state governments are supposed to be better prepared to deal with it rather than the union government. Therefore, health needs to be transferred from the state list subject to the concurrent list.
The Union government, despite having less financial resources at its disposal, has better technical capabilities than the state governments as far as public health is concerned. Indian Council of Medical Research (ICMR), the body that is leading India’s Coronavirus response, is under the Union Ministry of Health and Family Welfare, and despite having a budget of around 5,000 crore rupees, it led the innovation in vaccine (indigenous Bharat Biotech vaccine is produced in collaboration with ICMR) development as well as coming up with protocols, testing methodology and other infrastructure that proved critical in the fight against the Coronavirus.
Moreover, the Union government is already spending a lot of money for universal health insurance (Ayushman Bharat Yojna) and, more importantly, coming up with digital infrastructure (National Digital Health Mission) that would prove crucial in expanding the public healthcare system and would bring the cost of healthcare substantially down.
Many people, inside as well as outside the government, are already raising the issue even before the country was hit by the Coronavirus. “With Union government initiatives in health, should health be in the state list?” wrote Bibek Debroy, Chairman of the Prime Minister – Economic Advisory Council and constitutional scholar, in an article published in Livemint in 2019.
Moreover, in January 2020, a high-level group (HLG) formed by the Finance Commission to look after the health sector argued that health needs to be transferred to the Concurrent list. “This is very strange,” T Sundararaman, former executive director of National Health Systems Resource Centre, said.
“Some of the states have been doing really well with or without the Centre’s support. Some have refused to accept central schemes in toto or otherwise according to their requirement. While we have been pitching for decentralisation of power and fund allocation, this is exactly a step in opposite direction,” he added.
There had been enough debates about the rationality of the health being transferred to the Concurrent list. India needs a relook at the subjects that are under the three different lists – Union, state and Concurrent. While subjects like labour need to be fully devolved to the state’s list from the concurrent list, health needs to be brought into the concurrent list.
The failure of the states like Chattishgarh, Punjab and Maharashtra in dealing with the Coronavirus, and even before that, Bihar’s failure to deal with encephalitis outbreak suggests that most of the states have not developed critical infrastructure to deal with a public health crisis and they need technical know-how from the institutions like ICMR and AIIMS to deal with such crisis and, therefore, health needs to be brought into the concurrent list.