Though the Finance Minister referred to the Omicron variant of COVID-19 and the need to maintain caution, the clear signal that emerged from the Budget is that COVID-19 is no longer perceived to be a major threat and that the post-COVID-19 phase of development must focus on capital-intensive infrastructure projects. The commitment to primary healthcare that was strongly articulated in the Budget of 2021 was much more muted this year.
Definition of health
The Finance Minister expanded the conventional definition of health in her presentation of the Budget of 2021, when she included water, sanitation, nutrition and air pollution control. The Economic Survey, released a day before this year’s Budget, reported that expenditure on health reached 2.1% of GDP with an annual increment of 0.4% in the last two years. This suggests that we are on track to reach the government’s target of 2.5% by 2025. Recent increases represent both the redefined accounting categories and the COVID-19-related attention to augmented health services. Whether the health sector by itself will display a budgetary momentum of increased allocations was a feature of interest before the Finance Minister rose to present this year.
Supply of tap water to 38 million more homes will be welcome and so will the provision of housing under the Pradhan Mantri Awas Yojana and initiatives for pollution control which include expansion of zero emission public transport services, incentives to reduce crop stubble burning and battery-swapping policy. These along with expansion of digital classroom support to schools across the country will promote the social determinants of health.
Need for higher investment
For the health programmes themselves, there has been less than anticipated increase. The National Health Mission received a 7.4% increase over the money expended last year. With a large need to strengthen both rural and urban primary care, this is disappointing. There is a need to galvanise the Urban Health Mission which has moved slowly thus far. A number of rural and urban Health and Wellness Centres need to be established and activated with staff, equipment and supplies. While some of it will come from the infrastructure mission, the requirement of trained human resources calls for higher investment.
The allocation for the Pradhan Mantri Jan Arogya Yojana (PMJAY) stays unchanged at ₹6,412 crore. The expenditure last year was ₹3,199 crore. This represents a 100% increase. The scheme fell short of utilising its allocated budget for the past two years because of reduction in non-COVID-19 care under its payments and also because of the limited number of accredited hospitals in Tier-2 and Tier-3 urban locations and rural areas. It does not also cover the cost of outpatient care and medicines outside a hospital setting. Unless these limitations are overcome, mainly private sector hospitals in well-developed urban locations will be able to utilise it.
The Health Infrastructure Mission has got an allocation of ₹5,156 crore. Since its launch in October last year, it has spent ₹900 crore. Since the mission has projected an expenditure of ₹64,120 crore over six years, the allocation seems to fall 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 a 35.1% increase, keeping in with the promise of an AIIMS in every State and upgrading of several medical college hospitals.
AYUSH has been given a 14.5% increase, while the Department of Health Research sees an increase of only 3.9%. This is surprising, given the impetus given to continuing need for COVID-19 research and development of new vaccines. There is also a need for health systems and implementation research to support effective delivery of national health programmes that span communicable diseases, maternal and child health, nutrition, non-communicable diseases and mental health. Development and evaluation of appropriate and affordable health technologies too would be in keeping with the spirit of Atmanirbhar.
The Digital Health Mission has an allocation of ₹200 crore. Given the potential and promised services under that mission, the allocation appears sub-optimal. However, there is a welcome initiative to establish 23 Telehealth centres to provide support for mental health services across the country. The National Institute of Mental Health and Neurosciences (NIMHANS) at 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 must extend even to those who are not digitally enabled. That requires strengthened primary care services everywhere.
Vaccines for COVID-19 received an allocation of ₹5,000 crore as against ₹39,000 crore the previous year. This suggests that the government believes that all the eligible persons who need to be vaccinated through public funding will receive the vaccines in the current financial year and that there would be no major threat which would call for large-scale investments in new vaccine procurement. Since the government has granted market licensing to Covishield and Covaxin, the policy indicates that the private sector would be the principal source for providing additional vaccines to those who may seek it. If there is a resurgence of COVID-19 due to a new threatening variant, a special package may be needed. At present, that does not appear to be highly probable.
To end on an appreciative note, the Finance Minister deserves plaudits 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 employment and the earning capacity of the person who provides such support usually diminishes at that age.
K. Srinath Reddy is President, Public Health Foundation of India (PHFI), and Sakthivel Selvaraj is Director, Health Economics Unit, PHFI
