Budget’s missed healthcare opportunity

The Covid pandemic has amply demonstrated the health sector’s direct and indirect intersectoral impacts and its devastating power in creating disruption. It was, therefore, not surprising to see its imprint on the Economic Survey.

Given the learnings of the pandemic, it was reasonable to expect a “health-centred” budget. That was not to be. The budget’s main focus is on increasing capital expenditures for expanding the economic infrastructure under the PM Gati Shakti scheme. TV discussions centred around the GDP, as if a 7.7 per cent or an 8.2 per cent recovery holds any meaning for the millions who have been impoverished by the pandemic-induced income losses, hunger, sickness and trauma.

Inequalities have widened. An estimated Rs 70,000 crore have been spent by the people out-of-pocket in this short time for medical treatment that the government ought to have provided. Spending at a time when earnings were down, pushed millions below the poverty line and hunger has emerged as a major issue placing India low on the malnutrition and hunger index rankings. Children have lost two years of schooling that in real terms will be three, as they have lost what they had learnt when they last went to school.

The budget allocation for the post-Covid year is a princely amount of Rs 83,000 crore, up by 16.4 per cent over last year’s Rs 71,268 crore. The budget for the flagship National Health Mission that funds all health initiatives in partnership with the states has been increased by 7.4 per cent from Rs 36,576 crore to Rs 37,000 crore. It is under the NHM that all disease control programmes and reproductive and child health programmes including immunisations — they pertain to ailments that cost little to treat, but are life and death for the large masses of the poor — are implemented. Covid resulted in an over 30 per cent shortfall of coverage under all these programmes giving rise to fears of drug-resistant HIV and tuberculosis and left lakhs of children unprotected from vaccine-preventable diseases. These programmes required a much bigger boost alongside strategies to ensure they are insulated from another viral outbreak. But do we care?

Instead, the obsession is with digitisation. How does a digitised health record help a patient in ICU? What India’s health system requires are strong policies that enhance the availability of doctors and nurses and access to drugs and diagnostics.

Another announcement by the FM was establishing 23 telehealth centres of excellence for mental health. Why a special mention in the speech when the mental health budgetary allocation was increased only nominally — from Rs 597 crore to Rs 610 crore? Mental health impacts over 6-8 per cent of our population and is a major unaddressed epidemic, estimated to cost the economy $1.03 trillion and accounting for 2,443 disability-adjusted life years per 1 lakh population — equal to cardiovascular diseases and more than stroke or COPD. Addressing this requires the implementation of the Mental Health Act through an infusion of substantial money, ideas and imagination. We have a severe shortage of trained human resources, drugs are expensive and services are scarce and unavailable in most parts of the country.

The budget outlays for public hospitals has increased by 30 per cent — from Rs 7,000 crore to Rs 10,000 crore — though the much-needed investment for strengthening the surveillance system has a nominal 16.4 per cent increase. The flagship Ayushman Bharat health insurance scheme (PMJAY) continues to be grossly underfunded at Rs 6,412 crore — the same as last year. But then it had, quite strangely, spent only Rs 3,199 crore despite the huge medical needs people faced on account of the pandemic. An important takeaway ought to have been greater investment in health research. It has seen a miserable 3.92 per cent increase from Rs 2,663 crore to Rs 3,200 crore. It is out of this inadequate budget that the network of laboratories are expected to be built till such time additional money is mobilised from the World Bank or ADB.

This year, the health budget was required to build the required resilience so that we never go through the disruptions we have witnessed. Sadly, it contained neither a vision nor a direction towards bridging the glaring gaps in the health system. Despite all the evidence and data, year after year, we only lament the poor health budgets that have been stuck at about 1.5 per cent of the GDP.

At the end of World War II, England had a flattened infrastructure, a wrecked economy and a tired people. Yet, the political leadership had the courage to announce a National Health Service — universal free health care to all — on grounds that “Social insurance fully developed may provide income security; it is an attack upon want. But want is only one of the five giants on the road to reconstruction and in some ways the easiest to attack. The others are disease, ignorance, squalor and idleness.” Given that India too needs a massive building up of its economy to ensure a minimum quality of life for all its people, we need to envision a transformative change by attacking inequality, disease and ignorance by investing in health, education, nutrition and employment to ensure equal opportunities. Covid gave us that opportunity. It’s a pity we missed seizing it.

Author: K. Sujatha Rao. This column first appeared in the print edition on February 2, 2022 under the title ‘The missing focus on health’. The writer is former Union Health Secretary.

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