What can one say of a Budget that is in denial of the devastation that Covid -19 caused millions of people — not just in terms of loss of life, but in terms of jobs, fall in family incomes and living standards, stress, and for many, continued ailments?
Last year, the budget for health was not inspiring. But then it was understandable given the shock the economy had taken. But this year, the economy has been looking up somewhat and so one did expect that the government would finally invest in the human capital — health and education. Unfortunately, this did not happen.
Status quo Budget
The health budget 2023-24 is a status quo budget. The Budget Estimate (BE) of the Health Department last year was ₹ 83,000 crore with ₹5,632 crore for capital. That has since been revised to ₹76,370 crore with a capital outlay of ₹ 3,582 crore. Against that, the 2023-24 Budget allocation is ₹ 86,175 crore, of which ₹ 5,300 crore is for capital. Thus, in real terms, the budget is lesser than last year’s BE allocation. That said, there is an increase for all government-owned hospitals such as AIIMS and PGI Chandigarh from ₹ 13,345 crore BE of last year, revised to ₹15,828 crore, and now ₹22,209 crore.
Likewise, telehealth for mental health, National AIDS Control Organisation and NCDC also see slight increases or restoration of the budget to last year’s BE level. Likewise, the PM-ABHIM for infrastructure of primary health care institutions, has also been allocated at last year’s budget level — ₹3670 crore against a RE of ₹1,639 crore that is half of what was allocated last year.
Most disease control programmes are, however, implemented in States with funding support from the GoI. It is indeed disappointing to see that the allocation this year is ₹ 36,785 crore against a Revised Estimate (RE) of ₹33,707 crore. This clearly means there is no frontal attack on disease containment, even as the country is reeling under a dual disease burden. For example, under the TB programme, performance fell by over 25 per cent. Making that up itself would require additional resources and effort if TB has to be eliminated by 2025 as declared by the government three years ago.
Renewed commitment
In this grim scenario, the renewed commitment to promoting health research is a positive. But in financial allocations, allocation of ₹2,980 crore against a RE of ₹2,775 crore for health research is disappointing. It was, however, heartening to see the government’s intention to invest in AI, skilling of human resources, incentivising public and private research institutions to take up research in collaboration with the ICMR and establishing the accompanying infrastructure.
The Covid pandemic brought out three fault lines — one, the inadequacy of tertiary hospitals to handle disasters like Covid, with the situation more adverse in the northern states of Bihar and UP where many lives were unnecessarily lost for want of access to care; two, the near absence of any financial risk protection for the middle classes, progressively worsening for those lower in the income gradient. One estimate showed that people incurred nearly ₹70,000 crore out of pocket expense for Covid treatment during Phase I and II. This at a time when the people were already facing fall in incomes at the family level has meant several on the border line being pushed into penury. Clearly, the role of the PMJAY, the government’s health insurance programme, was marginal. Instead of stepping it up, the budget allocation continues to be same — up from ₹6,427 crore to ₹6,789 crore. And three, the near collapse of the primary health system except in some of the southern States. All these three fault lines needed money, a serious reflection and restrategising policy with intent to improve. Instead, we got 157 nursing colleges to be built alongside government medical colleges, an old concept circulating in the ministry.
Another area that requires urgent attention is revamping the surveillance system. Though the NDCD saw a small increase in budget, it is inadequate. Besides, along the lines proposed by the Finance Minister for the financial sector, a review and revamp of all health laws to create a better environment to function and clear lines of accountability. Both these issues did not require much funding but are fundamental to improving the overall governance of the health sector. That even this ‘doable’ did not find mention in 2023 budget was disheartening, leaving the question hanging “what more needs to happen for us to acknowledge the criticality of good health and wellbeing as a foundational requirement for the progress of this nation.”
The author is Former Union Health Secretary, GOI