Union Budget 2021 India: Laboratory capacity will be expanded and One Health surveillance connectivity will be established across wildlife, veterinary and human populations.
Indian Union Budget 2021-22: Public health experts call for attention to both efficient and equitable healthcare systems beyond healthcare through action on social, economic, commercial and environmental determinants of health. Economists point out that critics of low public financing of health do not take into account expenditures on nutrition, water and sanitation, which directly contribute to health promotion and disease prevention. The FM drew upon these perspectives to present a combined Budget for health and wellbeing, taking a “holistic approach … to focus on strengthening three areas: preventive, curative and wellbeing.” Her proposition resonates with the SDG3 which calls for “health and wellbeing for all, at all ages.” Combining them helps to present a 137% increase, which appears impressive.
For strengthening healthcare systems, a new CSS, the PM Atmanirbhar Swasth Bharat, is proposed with an outlay of Rs 64,180 crore over six years. Will the states too contribute as in other CSS? This scheme will be funded and branded separately from the existing National Health Mission (NHM). It proposes to add more health and wellness centres (HWCs) inclusive of urban locations and establish critical care facilities in districts. While augmenting disease surveillance at block, district and metropolitan levels, it aims to strengthen the National Centre for Disease Control and its regional branches.
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Laboratory capacity will be expanded and One Health surveillance connectivity will be established across wildlife, veterinary and human populations.
Support for improving water, sanitation, reducing air pollution, is welcome. The increase in allocation to health, family welfare is a modest 9.6%, from Rs 65,012 crore to Rs 71,269 crore. The 137% increase adds Rs 35,000 crore for Covid-19 vaccine, a large increase for drinking water, sanitation, AYUSH and ICMR. While healthcare infra strengthening is mooted, health workforce expansion is not clearly spelt out. The Pradhan Mantri Jan Arogya Yojana, which underspent last year due to Covid-19 and inadequate availability of accredited hospitals in several areas, received less this year. It needs to extend its coverage to outpatient care, medicines and link with the NHM to provide comprehensive care.
The now released recommendations of the 15th Finance Commission, applicable to both central and state governments, are complementary. The Commission recommends Rs 70,051 crore for urban HWCs, conversion of rural sub-centres and primary health centres (PHCs) into HWCs, strengthening of PHCs, CHCs, block level public health units and diagnostic infrastructure in primary care. The Commission recommended Rs 15, 265 crore for critical care hospitals and Rs 13,296 crore for training of allied healthcare workforce. The Budget and the Finance Commission augur well for health. It is now for the states to respond by raising their health budgets and for the Centre to continue raising its health funding, both for universal healthcare and the determinants of health.
The author is President, Public Health Foundation of India