Two waves of the Covid-19 pandemic have exposed the health insecurity that persists in India. Rebuilding a robust people-centric health system and improving health security could have been key pillars in the post-pandemic recovery strategy.
Defying popular expectation, allocations to Ministry of Health and AYUSH have been reduced in real terms in Budget 2022-23 by 7 per cent, compared with the Revised Estimate of 2021-22. As a percentage of GDP, the Centre’s allocation has declined from 0.38 per cent to 0.35 per cent between 2021-22 RE and 2022-23 BE. Thus, priority towards health in the total budget has also declined from 2.35 per cent to 2.26 per cent.
The National Health Mission is the key programme through which the Centre intervenes in improving primary and secondary care on maternal and child health; disease control and non-communicable diseases. Much of these services have suffered during the lockdown.
However, since 2018-19, NHM allocations have declined in real terms. This means, essential services like safe deliveries, vaccination for children, ongoing treatment of TB, etc., cannot be provided anymore with the current limited resources. NHM money also goes into remunerations for frontline health workers (ASHAs), mostly women. Cuts in NHM budget means reduced budget for paying these workers, who have been demanding minimum wages for a long time.
The mention of National Tele Mental Health Program is a recognition of mental health challenges that have been exposed during the pandemic, even though there is no money allotted. The National Mental Health Programs (NMHP) has received a measly allocation of ₹40 crores– which continues to be the same since 2019-20. Allotted budget remains largely underspent in the absence of adequate priority support for the mental health, while service remains thin.
One of the biggest beneficiaries of the Budget has been Ayushman Bharat Digital Mission – which received almost seven times increase in allocation. The Centre’s fascination to create electronic health records in the middle of a pandemic, while neglecting the actual public healthcare delivery system is problematic. In the absence of a regulatory framework, safety and security of personal information remains a concern as ‘function creep’ is sort of sine-qua-non in the sector.
(The writer is a Health Economist and Associate Professor at OP Jindal Global University, Sonipat. Views are personal.)