Health was one sector everyone was hoping the Budget 2022-23 would increase allocations for, given the unrelenting COVID-19 pandemic.
It has been repeatedly pointed out that public spending on healthcare has historically been low in the country.
There are only 10 countries in the world where government spending as a percentage of GDP is lower than India’s 1.3 percent.
Even the Economic Survey 2021-22 points out that India ranks 179th out of 189 countries in prioritisation accorded to health in its government budgets.
The National Health Policy 2017 envisioned increasing public health expenditure to 2.5 percent of GDP by 2025.
The Budget gives no indication that the doubling of public spending will happen over the next three years.
Despite the pandemic having exposed the inadequacies in our health infrastructure, and the shortage of human resources, the Government has shown little fiscal commitment towards strengthening health systems.
Also, allocations in the Budget fail to address the concerns of increasing inequality, rising livelihood insecurities, and mounting health risks exacerbated by the COVID-19 pandemic.
This year, the outlay for the Union Ministry of Health and Family Welfare stands at Rs 86,200 crore.
While the Economic Survey pegged the budget at 2.1 percent of the GDP, the figure included expenditure on water, sanitation, nutrition and air pollution control.
The actual allocations for health sector, however, were disappointing. The National Health Mission (NHM) has been the Government of India’s flagship health programme since 2005 and has played a crucial role in improving health outcomes in the country.
It envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people's needs.
It is disappointing to see the marginal increase in the NHM budget compared to the last financial year.
This places an additional of financing the programme on the states. While the relatively developed states have greater resources to invest in health, the lack of adequate fiscal support from the Centre will put the less developed states at a significant disadvantage.
Several disease-control programmes and reproductive and child health programmes were seriously disrupted by the COVID-19 pandemic.
By allocating an amount less than the actual spending on NHM in the year 2020-21, the government has let our citizens down at a time when people need support and compassion to tide over the crisis.
The rollout of the “Ayushman Bharat Digital Mission” is a major announcement in the Budget. This will consist, among other things, of digital registries of healthcare providers and health facilities, unique health identity, and a consent framework.
While digitisation is welcome, one wonders whether this will truly address the life-and-death issues and the increasing and impoverishment of people on account of the extremely high private out-of-pocket expenses they incur on medical treatment.
The pandemic highlighted the many inadequacies in our health systems and its lack of preparedness to handle large-scale health emergencies.
According to the National Health Accounts Estimates for India for 2016-17, government health expenditure constitutes only 32 percent of the total health expenditures in India, while 68 percent of households’ medical expenses is accounted for by private out-of-pocket expenditures.
This places an enormous financial burden on households and results in many families getting pushed into poverty.
The lack of commitment to strengthening the public health delivery system indicates that this will continue to be a problem.
The Finance Minister does not mention how the ongoing nutrition crisis will be tackled. The recently released National Family Health Survey-5 reveals that the country is undergoing a nutritional crisis, and more than half of India’s women and children are anemic.
And yet, the allocations for the National Programme of Mid-Day Meal in schools, now renamed as Pradhan Mantri Poshan Shakti Nirman, declined by 11 percent from Rs 11,500 crores in 2021-22 to Rs 10,233.75 crores in 2022-23.
The Finance Minister has announced that 23 telehealth centres of excellence for mental health will be established.
But despite this announcement, the mental health budgetary allocation was increased only nominally—from Rs 597 crore to Rs 610 crore. According to 2017 data released by the World Health Organisation, there are approximately 9,000 psychiatrists and 49 child psychiatrists in India.
This amounts to 0.75 psychiatrists per lakh population and 0.021 child psychiatrists per one lakh adolescents. The WHO pegs the desirable ratio at three psychiatrists per one lakh population.
Similarly, India has about 1.93 mental health care workers per one lakh population, while the global average stands at 6.6. The budget gives no hope that this situation would change anytime in the future.
The Economic Survey 2021-22 released a day before the Budget, reported that expenditure on health has reached 2.1 percent of the GDP.
This is misleading. As K Srinath Reddy and Sakthivel Selvaraj point out, the conventional definition of health has been expanded in the presentation of the Budget of 2021.
The Finance Minister has included within health the allocations for water, sanitation, nutrition and air pollution control.
While acknowledging the social determinants of health is welcome, it should not hide the low levels of spending on health per se, and on primary health care in particular.
The Budget was an opportunity to rise up to the challenge, address fundamental problems in our public health systems, and prioritize the provision of primary healthcare.
The low priority to health, reflected in the insufficient budgetary allocations in the annual Budget 2022-23 cannot be expected to push healthcare reforms and move us in the direction of universal health coverage.
(Poonam Muttreja is a public health expert and Executive Director of the Population Foundation of India.)
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