By Srinath Reddy
“Health leaps out of science and draws nourishment from the totality of society” was the profound observation of Swedish economist Gunnar Myrdal who won the Nobel Prize in 1974. This was to convey that the advancement of scientific knowledge for disease prevention and healthcare, as well as social conditions for protecting and promoting health, are both essential for improving the health of populations and persons. When the finance minister talks of increased investment in agriculture, food security, education and skilling, housing, water sanitation, and green technologies and lays special emphasis on recognising vulnerabilities and reducing inequalities, the benefits which will accrue for health must be acknowledged. At the same time, the investments in the delivery of health programmes and capacity building in the health sector will be examined closely for their ability to impact the delivery of needed health services.
As the threat of Covid-19 has receded, there is an understandable shift of emphasis to economic growth, with a fillip to infrastructure. However, health has to remain prominently on the radar of financial planners, both to protect and promote the productive potential of what will soon be recognised as the world’s largest population and to prevent a derailment of economic growth by unattended public health imperatives. How does the budget reflect a continued commitment to the improvement of people’s health overall and enhance the provision and quality of health services to vulnerable sections of the population?
The announcement of a mission to eliminate sickle cell anaemia by 2047, coming early in the budget speech, signalled the commitment to prioritise health needs of vulnerable populations. This inherited disorder of haemoglobin alters the shape of blood cells and results in anaemia and other adverse health consequences. Screening, counseling, and care are needed to reduce the incidence and complications of sickle cell disease in tribal populations where it manifests at high rates. This is a much-needed initiative.
There is intent to open 157 new nursing colleges, in conjunction with 157 recently commissioned medical colleges. While this initiative to increase the health workforce is welcome, it should be accompanied by doubling the number of accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs) to address the expanded mandate of comprehensive primary health care, which now also includes non-communicable diseases and mental health disorders. Will that task be left to the state governments? There was no mention of the Public Health and Health Management cadres announced last year by the government. Without central financial support, these will not take off in most states.
A new programme will be launched for research into pharmaceuticals. While India is already reputed to be the pharmacy of the world for the production of generic medicines, we must now race ahead on the path of innovation and discovery for developing new pharmaceutical agents. Covid-19 pandemic has shown clearly that we cannot depend on profit-hungry multi-national pharmaceutical firms for assured supply of essential vaccines, therapeutics, and diagnostics, even as most of the world looks to India for meeting such global needs in the spirit of solidarity. Besides enhancing India’s capacity for pharmaceutical innovation and manufacture, the budget should have also provided for strengthening the capacity of our drug regulatory agencies, which have recently been under scrutiny for quality concerns of some exported medicines.
The laboratories of the Indian Council of Medical Research (ICMR) will now be opened up for private-sector research groups to participate in joint research with public-sector scientists. The successful collaboration between ICMR and Bharat Biotech for the production of Covaxin has opened the path to joint research initiatives that can use the extensive facilities at the many ICMR institutes across the country.
The overall allocation for health has gone up only marginally, from Rs 83,000 crore to Rs86,175 crore. This increase is less than what an inflation-adjusted figure would require to keep the allocation at the earlier level. Within the four major health programmes that are covered under Ayushman Bharat, the National Health Mission (NHM) has seen an increase of only 0.78%, though the expanded mandate of comprehensive primary healthcare and the need to scale up the urban health component of NHM call for more funds.
Increases of 12.3% in the Pradhan Mantri Jan Arogya Yojana (PMJAY) and of 70.6% in the Digital Health Mission are appropriate. For the Health Infrastructure Mission, there has been a reduction in the central component, which brings down the overall allocation from Rs 5,154 crore in 2022-23 to Rs 4,845 crore in 2023-24. This is perhaps because the activities of this component have only just begun to be scaled up and the previous year’s allocation was not fully utilised.
The Department of Health Research has seen a reduction from Rs 3,200 crore to Rs 2,980 crore. Is it because the private sector partners are now expected to bring in money into joint projects with ICMR or because the department of biotechnology has been providing increasingly strong support to both clinical and epidemiological research, in addition to basic research, as evident during the Covid pandemic? Establishment of three multi-disciplinary Centres of Excellence in Artificial Intelligence (AI) will give a fillip to health data analytics, driving development of diagnostic and management algorithms relevant to our population.
The drive for improving the nutritional quality of our diets is evident through the Global Millets Programme, which has been initiated in the Year of Millets (2023). Support for cooperatives in agriculture, fishery, and dairy sectors will also improve access to nutritionally appropriate diets, apart from benefiting the farmers. Similarly, investment in green energy technologies, education, youth skilling, empowerment of women’s self-help groups, digital communication (especially 5G), and non-polluting transport services will have multiplier benefits for health.
The writer is a Distinguished Professor at PHFI
