Need a Booster Dose

This year’s Economic Survey makes a few recommendations to revitalise India’s ailing health system. Three recommendations are noteworthy. First, it recommends enhancement of public spending on health as envisaged in the National Health Policy from the current expenditure of 1 per cent to 2.53 per cent of GDP to drastically cutdown in the out of pocket expenditure from 65 per cent to 30 per cent. Second, it recommends further expansion of National Health Mission (NHM) along with Ayushman Bharat to mitigate the health inequity. Third, it recommends setting up of a national level health regulator to regulate the private healthcare providers, which ride on the regulatory vacuum and financially exploit the patents and their families. It is important to keep these recommendations in mind to look at the budget allocations.

From a public health perspective, one needs to look into the allocation of other ministries like Ministry of Jalshakti, Department of Pharmaceuticals, Ministry of Women and Child Development, etc., to assess the implications on health. This year taking into account allocations of water, national nutrition mission, Finance Commission Allocation on water, sanitation and health and COVID-19 vaccine along with the allocation of Health Ministry the total allocation rose to Rs 2,23,846 crore. Among them the most notable allocation is the Rs 50,000 crore under the Jal Jeevan Mission (JJM), which saw a hike of Rs 38,540 crore. JJM is the project to provide Functional Household Tap Connection to every rural household by 2024.

Another important allocation mentioned in the speech but not finding any reference in the Health Ministry allocation is Rs 30,000 crore for COVID-19 vaccines. Considering the vaccine production capacity existing in the country this amount is enough to provide free vaccines to the whole population.

The allocation to the Health Ministry saw only a moderate hike this year from Rs 69,234 crore (2020-21) to Rs 76,902 crore (2021-22), an increase of Rs 7,668 crore. This is roughly 0.35% of GDP. This level of allocation is far below to achieve the target set by the NHP along with the allocation form States. Though there is an increase in the overall allocation it is less than the revised allocation of Rs 78,866 crore carried out in 2020-21 due to COVID-19 outbreak.

The notable increase is in the National Heath Mission, which obtained Rs 3, 175 crore extra allocation this year. This increase expected to play a positive role in public sector health delivery in the country. Similarly the Pradhan Mantri Jan Arogya Yojana (PMJAY) is maintained at Rs 6,400 crore as in the year 2020-21. In the revised allocation in 2020-21 the allocated amount was reduced to Rs 3,100 crore, though it maintained the same level of allocation. Under this scheme the eligible family is to get Rs 5 lakh health coverage. However, the utility of the scheme is very limited. The Parliamentary Standing Committee on Health in its 123rd Report remarked “The Committee is quite apprehensive that lack of awareness especially in the rural areas may be major reason for ignorance about healthcare benefits under the AB-PMJAY scheme. As a result of such ignorance many entitled beneficiaries still remain outside the ambit of the scheme. The Committee, therefore, recommends, especially in the remotest and rural areas, to utilise the existing community healthcare workforce, community leaders, gram panchayat etc in disseminating information about the scheme.”

Thus, the Budget allocations shows some good intentions but needs much more pro-active government intervention in terms of financial allocation to extend affordable and quality healthcare to people.