Like in the rest of the world, India’s health infrastructure came under considerable strain in 2020, with 10.6 million Covid cases (so far) and perhaps over a million requiring hospitalisation. With India having less than one bed per thousand people and one doctor for a population of 1,456 (Economic Survey 2019-20) against the WHO norm of 1:1000, it is apparent that physical infrastructure, as well as the quality and quantity of human capital needs upgradation. This calls for a reordering of priorities in the Budget as a whole by stepping up health outlays (at ₹67,000 crore out of the Budget size of ₹30.4 lakh crore in 2020-21, it works out to just over 2 per cent), and relooking at allocations within the health Budget itself. Even if the Budget were to set aside about ₹10,000 crore towards the Covid vaccination push to innoculate more than 300 million people, this should not come at the cost of existing outlays on health. With Covid cases on the decline, the Centre and States should wait and watch before offering free vaccinations across the board. The health Budget should be seen as a growth-boosting vehicle, with allocations being doubled to at least 5 per cent of the total Budget. The ₹15,000 crore allocation towards health infrastructure in the Atmanirbhar package, announced in May, marked the right step forward and should be sustained.

Viewing health and pharma as a single sector, the focus areas should be: beefing up decentralised health ‘wellness’ centres under the aegis of Ayushman Bharat programme (Pradhan Mantri Jan Aarogya Yojana) so that mass vaccination programmes, besides routine healthcare situations, can proceed without any hitch; ramping up the Ayushman Bharat’s coverage; stepping up investments in research to develop indigenous solutions in terms of vaccines and medicines; and ramping up self-reliance in bulk drugs.

Ayushman Bharat has expanded its footprint and it is just as well that the Centre is considering a data integration exercise to cover larger populations, as reported in this newspaper. Since September 2018, over one crore people have received treatment with an outgo of close to ₹15,000 crore. However, its outlays too need to be raised from current levels of ₹6,400 crore. A greater variety of packages needs to be devised to ensure that patients do not slip through the cracks. Although the Economic Survey 2019-20 claims that out of pocket expenses have fallen as a proportion of total health expenditure to less than 60 per cent, it is important that the role of PM-JAY in plugging catastrophic expenditure be ascertained. However, an over-reliance on insurance and PPP can have its pitfalls. An investment in medical colleges, beyond a few islands of excellence such as the AIIMS, can bring down costs and ramp up quality of health services. The Centre could focus on medical education, infrastructure and research in an expanded health Budget.

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