Budget’s missed healthcare opportunity

HEALTH/ ECONOMY

• GS-2: Government policies and interventions for development in Health sectors and issues arising out of their design and implementation.
• GS-3: Budgeting

Budget’s missed healthcare opportunity

Context: The Covid pandemic has amply demonstrated the health sector’s direct and indirect intersectoral impacts.

• Given the learnings of the pandemic, it was reasonable to expect a “health-centred” budget but it was not the case.
• The budget’s main focus is on increasing capital expenditures for expanding the economic infrastructure under the PM Gati Shakti scheme.

Pandemic induced Poverty and Hunger

• An estimated Rs 70,000 crore have been spent by the people out-of-pocket in this short time for medical treatment that the government ought to have provided. 
• Spending at a time when earnings were down, pushed millions below the poverty line.
• As a result, hunger has emerged as a major issue placing India low on the malnutrition and hunger index rankings. 

How did Budget deal with Healthcare Sector?

• Low Proportion of GDP: The budget allocation for 2022-23 is Rs 83,000 crore, up by 16.4 per cent over last year’s Rs 71,268 crore. Health budget have been stuck at about 1.5 per cent of the GDP.
  • On average, OECD countries are estimated to have spent 8.8% of GDP on health care in 2018.
• Marginal Increase for NHM: The budget for the flagship National Health Mission that funds all health initiatives in partnership with the states has been increased from Rs 36,576 crore to Rs 37,000 crore.
• Symbolic Focus on mental health: Government announced establishing 23 telehealth centres of excellence for mental health. However, the mental health budgetary allocation was increased only nominally — from Rs 597 crore to Rs 610 crore
  • Mental health impacts over 6-8% of our population and is a major unaddressed epidemic, estimated to cost the economy $1.03 trillion and accounting for 2,443 disability-adjusted life years per 1 lakh population — equal to cardiovascular diseases and more than stroke or COPD.
• Budget outlays for public hospitals has increased by 30%— from Rs 7,000 crore to Rs 10,000 crore — though the much-needed investment for strengthening the surveillance system has a nominal 16.4% increase.
• Underfunding of Health Insurance: The flagship Ayushman Bharat health insurance scheme (PMJAY) continues to be grossly underfunded at Rs 6,412 crore — the same as last year. 
• Investment in health research: It has seen a miserable 3.92 per cent increase from Rs 2,663 crore to Rs 3,200 crore.

Why NHM needed much larger boost in funding?

• It is under the NHM that all disease control programmes and reproductive and child health programmes including immunisations are implemented.
• These programmes pertain to ailments that cost little to treat, but are life and death for the large masses of the poor
• Covid resulted in an over 30% shortfall of coverage under all these programmes giving rise to fears of drug-resistant HIV and tuberculosis and left lakhs of children unprotected from vaccine-preventable diseases.
• These programmes required a much bigger boost alongside strategies to ensure they are insulated from another viral outbreak. 

Criticisms of Government’s Healthcare Budget

• The government policy focus has been on digitisation of health system instead of enhance the availability of doctors and nurses and access to drugs and diagnostics.
• Addressing mental healthcare problem requires the implementation of the Mental Health Act through an infusion of substantial money, ideas and imagination so as to address the issues of 
  • shortage of trained human resources
  • expensive drugs and services are scarce 
  • unavailability of services in most parts of the country.
• PMJAY had, quite strangely, spent only Rs 3,199 crore (out of Rs 6,412 crore)  despite the huge medical needs people faced on account of the pandemic. Therefore, there is a need to focus on implementation.
• This year, the health budget was required to build the required resilience so that India never goes through the disruptions that it witnessed. Sadly, it contained neither a vision nor a direction towards bridging the glaring gaps in the health system.

Conclusion

Given that India too needs a massive building up of its economy to ensure a minimum quality of life for all its people, we need to envision a transformative change by attacking inequality, disease and ignorance by investing in health, education, nutrition and employment to ensure equal opportunities.

UNION BUDGET 2022-23

Connecting the dots

• Mental Healthcare: Issues & solutions
• Pradhan Mantri Jan Arogya Yojana