The Unmet Health Challenge

Context: Despite the emphasis on Health in budget, the actual allocations are disappointing.

Economic Survey 2020-21 on Health

• Recommended increase in health spending to 5-3% of GDP (currently at 1.5%).
• Emphasises on public service for reducing out-of-pocket expenditure.
• There is not much difference between the outcomes of public private healthcare services
• Calls for strengthening the National Health Mission 2005-06 (to strengthen public service) and Ayushman Bharat (to provide social security by financing private sector with public funds.)
• Made a pitch for greater regulations private healthcare.

Provisions in Budget 2021-22 related to the health sector

• “Health and well-being” as one of the pillars of the budget: With healthcare, water and sanitation and nutrition as the key components. (137 % increase in allocations)
• Introduced new schemes:
  • Pradhan Mantri Atma Nirbhar Swasthya Yojana:
    • To support 29,000 health and wellness centres.
    • For the creation of public health laboratories and critical care hospital blocks and virology institutes.
  • Poshan 2.0: combining Supplementary Nutrition Programme and Poshan project.
• Emphasised on the Concept of “One Health”.
• Increased allocations for various health departments: 6 % increase for the Department of Health and Family Welfare (H&FW) (including NHM and Ayushman Bharat).

 Critical analysis of financial allocations to health services:

• Emphasis was on one-time allocations: Core health service and research ministries (H&FW and AYUSH) received only an 11 % increase while the Finance Commission has granted huge one-time allocations for COVID-19 vaccination.
• Decrease in budgetary allocation for Health services: only 2.21 % down from 2.27 % last year.
  • It should be around 10 % to realise the targets set by High-Level Expert Group on Universal Health Coverage: which are -
    • 114 % increase in sub-centres and primary health centres,
    • 179 % increase in community health centres and
    • 230 % increase in sub-district and district hospitals. 
• Overemphasis on water and sanitation at the cost of healthcare and nutrition (decreased by 27%): Water and sanitation received a 179 % increase (Swachh Bharat and Jal Jeevan Mission)