Context-

With the worst of the COVID-19 pandemic behind us (though the World Health Organization warns that the virus has still not vanished), the Union Budget expectedly shifted focus to levers of economic growth such as infrastructure and employment. However, it was also hoped that the recognition of population health as a vital investment for accelerating as well as protecting economic growth would see continued investment in strengthening our health systems. This hope seems to have been only partially fulfilled.

Interim Announcements

●       In the Interim Budget, the Finance Minister had announced the government’s plans to “encourage” HPV vaccination for girls (to prevent cervical cancer), create a U-WIN programme for improving coverage of the routine immunisation programme, and include ASHA workers and Anganwadi workers as beneficiaries of the Pradhan Mantri Jan Arogya Yojana (PMJAY) health insurance programme. These have not been elaborated or presented as line items in the main Budget presented on June 23, raising concerns about the prioritization of health in the national agenda.

Budget Comparisons

●       Budgetary Estimates vs. Revised Estimates

An increase in programme allocations from Budget to Budget must be calculated by comparing the budgetary estimate (BE) of this year with the BE of last year and not with the revised estimate (RE) for last year, which also features in the Budget. RE is the money actually spent, and indicates the inability of the programme to efficiently spend the money, and not the actual need. A comparison of the BE for health in this year’s Budget with the RE of last year suggests that there was an increase of nearly 12%, which is an erroneous estimate of what the programme will actually get as a raise.

●       Accurate Comparison

By comparing only the BEs of 2023-24 and 2024-25, we note an increase of only 1.98% for the overall Health Ministry budget, 1.16% for the National Health Mission (NHM), and 1.4% for PMJAY. Given the need to expand coverage and enhance the impact of these two flagship programmes of Ayushman Bharat, these increases are disappointingly modest. Many of our national programmes are steered by NHM, which is also responsible for strengthening rural and urban primary care as well as the district hospitals. Apart from the need to make child immunisation universal, the danger of tuberculosis (for which India has set an aspirational elimination date of 2025) and the rapidly rising rates of non-communicable diseases require a better resourced and structurally strengthened NHM.

Missed Opportunities

●       Workforce Development

While an increase in new medical colleges was mentioned, the need to invest in building a large multi-layered, multi-skilled workforce was not acknowledged. The energetic thrust for employment generation and skill-building must recognise that the health sector represents an area of great need and opportunity, especially for young persons.

●       Drug Pricing and Procurement

It is laudable that customs duties have been waived on three anti-cancer drugs. However, price controls are also needed for many other drugs. Pooled procurement, with monopsonic power of price negotiation, can markedly reduce the prices of drugs procured not only by public sector institutions but also by private healthcare institutions which are accredited to government-funded health insurance schemes. The Budget missed an opportunity to establish such mechanisms.

●       Climate-Resilient Agriculture

Investment in climate-resilient agriculture is a welcome budgetary commitment, at a juncture where the quantity and quality of staple crops are likely to be severely affected by global warming. Diversification of agriculture to climate-resilient crops will not only provide nutrition security but will also be climate smart in reducing the use of water, pesticide, energy, and release of greenhouse gases.

Detailed Breakdown of Health Budget Allocation

●       Overall Health Ministry Budget

The overall increase in the Health Ministry budget is just 1.98%, which is insufficient considering the extensive needs of the sector. This minor increment fails to account for inflation and the growing population, which dilutes the actual impact of the increase.

●       National Health Mission (NHM)

NHM, which is pivotal for both rural and urban health infrastructure, saw a meager increase of 1.16%. This is particularly concerning given NHM's role in tackling child immunisation, tuberculosis, and non-communicable diseases. The modest increase does not reflect the urgency of scaling up these essential health services.

●       Pradhan Mantri Jan Arogya Yojana (PMJAY)

PMJAY, aimed at providing health insurance coverage to the underprivileged, saw an increase of just 1.4%. This is inadequate for expanding the programme to cover all elderly persons and enhancing inclusivity. The minimal increase raises doubts about the feasibility of achieving universal health coverage by 2030.

The Importance of Health Sector Investment

Investing in the health sector is not merely about improving healthcare services but also about enhancing economic growth. Healthier populations are more productive, and robust health systems are essential for sustainable development. The current budgetary allocations do not seem to fully grasp this interconnectedness.

• Employment and Skill Development in Health Sector: The health sector holds significant potential for employment generation, especially for young people. Investing in training and skill development for healthcare workers could address both the need for a skilled workforce and the issue of youth unemployment. Unfortunately, this potential has not been adequately recognized or leveraged in the current budget.
• Addressing Non-Communicable Diseases : The rising rates of non-communicable diseases such as diabetes, hypertension, and cancer necessitate a well-resourced health system capable of providing comprehensive care. Strengthening NHM and other health programmes is crucial for managing these conditions and preventing their escalation.
• Tuberculosis Elimination by 2025: India has set an ambitious target to eliminate tuberculosis by 2025. Achieving this goal requires significant investment in healthcare infrastructure, diagnostics, and treatment. The current budgetary increase for NHM is insufficient to meet this critical objective.
• Universal Health Coverage by 2030 : The vision of universal health coverage by 2030 is a commendable goal. However, it demands substantial financial commitment and strategic planning. The current budget, with its minimal increases, does not inspire confidence in the government's commitment to this vision.

Conclusion

The Union Budget, while focusing on economic growth through infrastructure and employment, has placed health on the margins. The modest increases in allocations for key health programmes like NHM and PMJAY are inadequate to meet the growing health needs of the population. The missed opportunities in workforce development, drug pricing, and procurement, along with the insufficient investment in health infrastructure, highlight the need for a more robust and comprehensive approach to health budgeting. The recognition of health as a critical driver of economic growth must translate into substantial financial commitments to build a resilient and inclusive health system for all Indians.

Source - The Hindu