The Economic Survey reported that India’s expenditure on health (Centre and states included) increased to 2.1% of GDP in 2021-22, up from previous years (1.8% in 2020-21 and 1.4% in 2019-20). The rise is explained by increase in health expenditure during Covid as well as the decision to include expenditure on nutrition, water supply, sanitation and air pollution control under an expanded definition of health. In the current Budget, important social determinants of health (such as drinking water, housing and education) have been addressed. Tap water would be provided to 38 million more households, while provision of housing would be increased under the PM Awas Yojana. Digital classrooms will extend to schools along the country. Increased investment in emission-free public transport, battery-swapping facilities and incentives to reduce crop burning will help to address air pollution.
Within the health sector itself, the increases have been less than expected. With an allocation of 37,000 crore, the National Health Mission received an increase of 7% over last year’s expenditure. The need to galvanise the slow-paced urban health mission and strengthen rural primary healthcare across the country calls for higher allocations. Health workforce expansion in primary care is especially urgent in view of the plan to expand services through health and wellness centres. Allocation for the Pradhan Mantri Jan Arogya Yojana (PMJAY) is static at 6,412 crore, as the allocations remained substantially under-utilised in the past two years.
Total allocation for the health infrastructure mission is 5,156 crore, which is surprising since the scheme is designed to spend 64,180 crore over a six-year period and spent only 900 crore since its launch in October last year. AYUSH gets a 14.5% increase, while Swasthya Suraksha Yojana, which focuses on expansion of tertiary care infrastructure, gets a 35.1% increase. The department of health research has been allocated 3,200.65 crore, which represents a rise of 3.9 %. Given the need for strong impetus to scale up research in both communicable, non-communicable and nutrition-related disorders as relevant to the Indian context and also extend health systems research into implementation and evaluation research related to national health programmes, this is less than anticipated.
Mental health services will receive telehealth support through 23 digital centres to be coordinated by the National Institute of Mental Health and Neurosciences (NIMHANS) with support from IIIT Bengaluru. While this is a welcome initiative that will enable mental health related consultations for digitally adept individuals, it needs to be supplemented by primary care and community-based initiatives that can reach those not able to access digital services.
Covid vaccines have a limited allocation of Rs 5,000 crore. This may indicate that the government feels that public funding for vaccine procurement and delivery will no longer be needed by April 2022. The grant of market licences to Covishield and Covaxin suggests that individuals will need to purchase the vaccines from the private sector. We will wait to see if the government will come up with another special package if there is a serious resurgence of Covid due to a more virulent variant and new vaccines arrive. I hope that will not be needed. Overall, the Budget has not provided the much-needed boost to primary healthcare. We still wait to see how recommendations of the Fifteenth Commission for funding rural and urban bodies directly for primary health services will be implemented. It appears that the focus has shifted from health, as Covid appears to be under control.
The author is President of Public Health Foundation of India. Views are personal.