Roads plus health care

Build highways, but don't ignore medical infrastructure

The pictures of thousands of migrant labourers walking back home have shaken the nation’s conscience, but they also show well-built four-lane highways in different parts of the country. This is a testament to the good work that Road Transport and Highways Minister Nitin Gadkari has done over the last six years. The state of highways has improved substantially over the last few years, and India now has relatively good rural connectivity because of the Pradhan Mantri Gram Sadak Yojana, which has connected most villages with all-weather roads. However, with a financially strangled National Highways Authority of India, and a general resource crunch in the government, Mr Gadkari’s doubling down on even more highways and expressways raises some questions. 

India now has the second-largest road network in the world, but the country certainly compares poorly on the amount of public resources given to health care. Though the government has acted swiftly in producing more Personal Protective Equipment (PPE) kits, masks (in early April, India was dependent on imports), and ventilators, Covid-19 has shown the limitations of the country’s medical infrastructure — the relative shortage of hospital beds, doctors, and nurses, and other public health infrastructure. The pandemic has shown that private hospitals are not a substitute. In any case, government hospitals are uniformly crowded, making it clear that the capacity needs to be expanded. In other words, this is a felt need. The assumption behind the government’s health insurance programme, launched in 2018, was that it would stoke demand, which will create supply of medical infrastructure. This may or may not happen, and even if it does, some of the new capacity is almost certain to be private beds, which already constitute half the total. What is needed is a renewed focus on public health infrastructure, including a beefing up of primary health centres and community health centres. Hence, the government should increase expenditure in the health care sector and not necessarily on more highways, and especially the really expensive expressways.

This is not to suggest that India should not be spending on building roads, but it cannot neglect health care anymore. It is surprising that the government intends to spend Rs 15 trillion on roads over the next two years, but the central and state government expenditure on health was budgeted at a mere Rs 3.24 trillion or 1.6 per cent of gross domestic product in 2019-20. There is thus a clear case for splitting the funds being collected through the road cess on petrol and diesel into two, and half the money given to the health care sector. A recent report of the Comptroller and Auditor General of India noted that the funds collected on account of road cess are being diverted to meet the government’s other obligations. Instead of indulging in such diversions, the government should redefine the purpose of the road cess with half the incremental inflow going for public health. To be sure, this is not an optimal solution, and allocation to health care should be more transparent and permanent. Till that happens, the government, which spends an abysmally low amount on health care, would do well to look at this option.