There’s nothing much to cheer for the health sector in the Budget. The National Health Mission is left out from the list of flagship schemes! Moreover, share of health in Union Budget comes down to less than 2 per cent.
In nominal terms there is some increase in the total allocation of Ministry of Health and AYUSH taken together. Allocation has increased from Rs 92,802.5 crore (2023-24 Budget Estimate) to ₹94,671 crore (2024-25 BE), an increase of ₹1,869 crore in nominal terms. If we adjust for the effect of inflation this means a decrease of 0.67 per cent in real terms. Moreover, in real terms this is 7.4 per cent less than what was actually spent in 2020-21. This means, the care that could be provided in 2020-21 cannot be ensured now, given that allocations have declined while prices have skyrocketed.
This also means that as per cent of GDP, Union government allocation to health has declined from 0.37 per cent to 0.29 per cent between 2020-21 Actual Expenditure and 2024-25 BE. It seems the priority accorded to the health sector in the Union Budget has also declined. Share of health in the total Union Government budget has declined from 2.26 per cent to 1.96 per cent in this period.
But if we dissect the budget a bit and try to identify which schemes and programmes have received cuts and which have not, it becomes apparent who are the Kauravas and who are the Pandavas in the eye of the Government. Schemes which contribute to strengthening the public system and protecting the health of most vulnerable sections of the society, like the National Health Mission, Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), schemes on nutrition, health research received severe cuts- despite doing good work during hard times.
In contrast, schemes to promote commercial interests - like the Pradhan Mantri Jan Arogya Yojana (PMJAY), the Digital Health Mission, are being rewarded with higher allocations - despite failures. The National Health Mission is the key programme through which the Government intervenes in improving primary and secondary on maternal and child health, disease control programs and non-communicable diseases. Much of these services have suffered during the lockdown. However, since 2020-21, NHM allocations had been declining in real terms. We see a marginal increase in NHM allocation in this budget, but much less than what prevailed in 2020-21. This means that essential services like safe deliveries, vaccination for children, treatment of TB provided earlier cannot be provided anymore with current limited resources.
NHM money also goes into paying remunerations for frontline health workers like ASHAs, mostly women - who received global recognition for their stellar role during the pandemic. Cuts in NHM budget means reduced budget for paying these workers, who have been demanding minimum wages for a long time. It is important to note that some of the most critical programmes related to non-communicable diseases and climate change and human health are being delivered through NHM and paltry allocations under these schemes are major causes of concern.
PMJAY seems like the spoiled child of the current government- even though it fails to deliver continuously, known to largely benefit the private sector and exclude the most marginalised, it is rewarded with higher allocations. In the 2022-23 budget ₹6,400 crores was allocated, almost all the money was spent (₹6,185 crore)! Allocation has been further increased to ₹7,300 crore! PMJAY eating up larger share of budget remains a cause of concern.
The Economic Survey, published a day back, puts considerable emphasis on Mental health. This is definitely welcome. However, the Survey should also recognise paltry public spending on the existing National Mental Health Programs (NMHP). The various Union Government funded mental health institutions continue to face neglect. Furthermore, even these allotted funds remain largely under spent. In absence of adequate support for the mental health programme on the ground telemental health initiatives remain limited to better off sections of the society. Even after many years of its inception of NMHP there remain huge gaps in human resources.
A completely unregulated and commercially driven healthcare industry finds multiple ways to fleece the patients and in this process push healthcare towards further super-specialization and tertiarisation.
Indranil Mukhopadhyay, School of Government and Public Policy, OP Jindal Global University