Union Budget: Allocations for health sector an exercise in obfuscation; drinking water, sanitation, nutrition, vaccines clubbed under health

Published : February 02, 2021 10:43 IST

Outside the outpatient department at Patna Medical College and Hospital. A file picture. Photo: RANJEET KUMAR

When the Economic Survey (2020-21) expressed concern about India’s global ranking in quality and access to health care, its poor health outcomes compared with neighbouring countries, low hospitalisation rates reflective of lower access plus utilisation of health care and one of the highest rates of out of pocket expenditure in the world, it was expected that the Union Budget would reflect these concerns in terms of budgetary allocation on health. The Economic Survey said that the allocation as a percentage of the gross domestic product (GDP) should go up to anywhere between 2 and 3 per cent. The Union Budget does not seem to have been inspired by the counsel in the survey.

Finance Minister Nirmala Sitharaman declared the launch of a new scheme, Prime Minister’s Atmanirbhar Swasth Bharat Yojana, which would involve an expenditure of Rs.64,180 crore spread over six years, in order to “develop capacities of primary, secondary and tertiary health systems, strengthen national institutions, create new institutions to cater to the detection and cure of new and emerging diseases”. The scheme would support 17,788 rural and 11,024 urban health and wellness centres, set up integrated public health labs in all districts and 3,382 block public health units in 11 States, develop critical care hospital blocks in 612 districts and 12 central institutions, strengthen the National Centre for Disease Control, operationalise and strengthen public health units, and set up two mobile hospitals, 15 emergency operation hospital centres and four regional virology institutes.

“The Budget outlay for health and well being is Rs.2,23,846 crore in the Budget Estimates (2021-22), as against this year’s Budget Estimate (2020-21) of Rs.94,452 crore, an increase of 137 per cent,” said Nirmala Sitharaman in her Budget speech. This outlay was strangely in an annexure to the Budget speech. What the Finance Minister did not state was that this figure included allocations for the Jal Jeevan Mission (National Rural Drinking Water Mission) and sanitation amounting to Rs.60,030 crore; for nutrition, Rs.2,700 crore; for COVID-19 vaccines, Rs.35,000 crore; and Finance Commission grants to health, drinking water and sanitation, Rs.49,214 crore. The Budget Estimates for the Department of Health and Family Welfare, health research and AYUSH alone was Rs.76,902 crore, which was less than the Revised Estimates of Rs.82,445 crore, that is, the expenditure incurred in 2020-21.

The health budget was hailed as one which had seen the largest outlay till date. The disaggregated figures in the Annexure revealed that it was not so. Similarly, the allocation for vaccines was not part of the main expenditure budget but was part of the annexure to the Finance Minister’s speech. The proposed allocation for the new Swasth Bharat Yojana was not part of the present expenditure budget.

There was an increase in the Budget for the National Health Mission by Rs.1,576 crore but a reduction in the Rashtriya Swasthya Bima Yojana by Rs.28 crore. It has been argued that the health expenditure in 2020-21 was stepped up to meet the exigencies of COVID-19. There was seen, therefore, a visible jump in the BE for 2020-21 and the RE for the same period. There was an increase of Rs.14,961 crore, which was presumably spent on COVID management.

Notwithstanding the fact that the Union Budget has allocated significantly for vaccine development, there remains little doubt that as much or more attention needed to be paid to boosting health infrastructure, human resources, disease surveillance, epidemiology, etc., especially in the public sector. The rollout and progress of the PM Atmanirbhar Swasth Bharat Yojana will be keenly watched. The rationale behind the specific allocation for vaccines is not clear, neither has it been made apparent what percentage of the population will be covered under the allocation. And, above all, whether the vaccines will be given free to the Indian populace.

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