While the budget promotes the social determinants of health, there is less than projected growth for health programs.
Although the Finance Minister mentioned the Omicron version of COVID-19 and the need to take precautions, the clear indication from the budget is that COVID-19 is no longer considered a major threat and that the post-COVID-19 phase of development should focus on capital-intensive infrastructure projects. The commitment to primary healthcare, which was strongly articulated in the 2021 budget, was far more muted this year.
definition of health
The Finance Minister expanded the traditional definition of health in his presentation of the Budget for 2021, when he included water, sanitation, nutrition and air pollution control. The Economic Survey, released a day ahead of this year’s budget, reported that spending on health has reached 2.1% of GDP, with an annual growth of 0.4% over the past two years. This shows that we are on track to reach the government’s target of 2.5% by 2025. The recent growth represents both a redefined accounting category and a COVID-19-related focus on enhanced health services. Whether the health sector itself would exhibit a budgetary trajectory of increased allocation was a feature of interest before the finance minister presented it this year.
38 million more homes would be welcomed with tap water supply and so would the provision of housing under the Pradhan Mantri Awas Yojana and initiatives for pollution control including expansion of zero-emission public transport services, reducing crop stubble burning and battery-swapping incentives are included. Policy. These will promote the expansion of digital classroom support in schools across the country as well as the social determinants of health.
need more investment
There has been less growth than expected for the health programs themselves. The National Health Mission received an increase of 7.4% over the funds spent last year. With the great need to strengthen primary care, both rural and urban, this is disheartening. There is a need to accelerate the Urban Health Mission, which has so far progressed slowly. There is a need to establish and activate several rural and urban health and wellness centers with staff, equipment and supplies. While some of this will come from the infrastructure mission, the need for trained manpower demands higher investment.
The allocation for the Pradhan Mantri Jan Arogya Yojana (PMJAY) remains unchanged at ₹6,412 crore. Last year the expenditure was ₹3,199 crore. This represents a 100% increase. The scheme failed to utilize its allocated budget for the last two years because of the shortfall in non-COVID-19 care under its payment as well as recognition in Tier-2 and Tier-3 urban locations and rural areas. The scheme also failed due to the limited number of hospitals received. , It also does not cover the cost of outpatient care and medications outside the hospital setting. Unless these limitations are overcome, private sector hospitals, mainly in developed urban locations, will be able to use it.
Health Infrastructure Mission has got an allocation of Rs 5,156 crore. Since its launch in October last year, it has spent Rs 900 crore. Since the mission has estimated an expenditure of Rs 64,120 crore over six years, the allocation seems short of ambition. Perhaps, next year’s budget will show catch-up growth. The Pradhan Mantri Swasthya Suraksha Yojana, which focuses on expansion of tertiary care facilities, has been allocated an increase of 35.1% in keeping with the promise of AIIMS in every state and the promise of upgrading several medical college hospitals.
AYUSH is given an increase of 14.5%, while the Department of Health Research sees an increase of only 3.9%. Given the ongoing need for COVID-19 research and development of new vaccines, this is surprising. There is also a need for health systems and implementation research to support the effective delivery of national health programs that span communicable diseases, maternal and child health, nutrition, non-communicable diseases and mental health. The development and evaluation of appropriate and affordable health technologies will also be in line with the spirit of Atmanirbhar.
200 crore has been allocated for Digital Health Mission. Given the potential and promised services under that mission, the allocation appears to be sub-optimal. However, it is a welcome initiative to set up 23 telehealth centers to provide support for mental health services across the country. The National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru will coordinate these services. The International Institute of Information Technology (IIIT) in that city will provide technical support. While this is a much needed initiative, mental health services should also extend to those who are not digitally enabled. This requires robust primary care services everywhere.
The COVID-19 vaccines received an allocation of ₹5,000 crore against ₹39,000 crore last year. This shows that the government believes that all eligible individuals who need vaccination through public funding will receive the vaccines in the current financial year and that there will be no major risk that large-scale purchases of new vaccines will occur. Will demand investment. Since the government has granted market licenses to Covishield and Covaxin, the policy indicates that the private sector will be a major source of providing additional vaccines to those who may seek it. If the new dangerous variant causes a resurgence of COVID-19, a special package may be needed. At the moment it doesn’t seem very likely.
To end on a laudable note, the Finance Minister deserves praise for providing tax relief to differently-abled persons whose parents or guardians have crossed the age of 60 years. This takes into account the fact that the employment and earning capacity of the person providing such assistance usually declines at that age.
Of. Srinath Reddy is the President of the Public Health Foundation of India (PHFI), and Sakthivel Selvaraj is the Director, Health Economics Unit, PHFI.
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