Indian Union Budget 2021-22: One of the major highlights of the budget has been health care taking the centre-stage. Or as India’s highly regarded medical scientist Gagandeep Kang, professor at the Christian Medical College, Vellore puts it: “Health is finally on an upward trajectory.” For a nation that is having to still cope with the second highest viral caseload after the United states and for several years the central government spending on healthcare has been roughly about 1 per cent of the GDP, this shift is critical and long overdue. It is therefore with good reason that the finance minister Nirmala Sitharaman’s statement that the “budget outlay for health and wellbeing is (pegged at) Rs 2,23,846 crore in BE (budget estimate) 2021-22 as against this year (2020-21) BE of Rs 94,452 crore, an increase of 137 per cent,” was applauded by most, including health care experts. “The 137 per cent increase in healthcare spending is a step in the right direction. This is all the more crucial given that this is happening from a largely static base over several years,” says Professor Kang.
To her, the direction of fund flow is as important, if not more, than the quantum of funds allocated. “Healthcare is not only about infrastructure but also about access and quality of care–which is determined by the people who will run the health centres, their skills and the range of services that will be delivered as close to the population or further up the referral chain,” she says. Speaking to Financial Express Online, she also pointed out that “while in terms of absolute numbers, the funds allocated may seem huge but even in an Asian context, it is still a far cry from per capita investments that even India’s neighbours (such as Bhutan and Sri Lanka) have been making—nonetheless health is finally on an upward trajectory.”
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Look closely at the budget speech and papers and on the important component of Rs 64,180 crore over a six year period that is to “develop capacities of primary, secondary and tertiary care health systems, strengthen existing national institutions and create new institutions, to cater to detection and cure of new and emerging diseases”. It then goes on to give details on the number of rural and urban health and wellness centres to be supported, the public health labs and block health units that are to be set up, setting up of the health emergency operation centres and mobile hospitals and a few other details.
The key point that experts like Professor Kang and others have for long pointed out is that while building infrastructure is crucial, it is the amount of detail and attention laid on the people who will staff and run that infrastructure, is what that really matters.
What may be also worth noting is that the budget outlay for health and wellbeing of Rs 2,23,846 crore also includes expenditure on drinking water, sanitation and nutrition, which is not strictly health care though one could argue that poor water quality and lack of sanitation leads to many acute illnesses. Mention of this is important in the context of what analysts have pointed out. Manoj Garg, director, Investments, White Oak Capital and one who has looked at Indian health care sector for a long time, says, “excluding COVID vaccinations, water and sanitation expenditure, the remaining healthcare budget has seen a modest increase of 11 per cent (versus 137 per cent for the overall healthcare budget).” He also points out that “the budgeted expenditure for Ayushman Bharat Scheme has been kept unchanged at Rs 6400 crore. The increase in healthcare budget from Rs 94,500 crore to Rs 2.23 lakh crore is driven in large part by the budgetary allocations for COVID vaccinations (Rs 35,000 crore, accounting for 27 per cent of the increase) and an increase in water and sanitation costs (Rs 74,500 crore, accounting for 58 per cent of the increase).”