Increase healthcare spend: Govt funding of public health needs more forward-thinking

Against the backdrop of the Covid-19 pandemic, finance minister Nirmala Sitharaman highlighting a 137% increase in spending over FY21 on ‘health and well-being’ in her Budget speech on Monday was sure to grab headlines. But, get down to the brass tacks, and the actual allocation to the health and welfare ministry, the nodal arm of the Centre for public health, is a small increase over that budgeted for FY21.

FY22’s Rs 2.24 lakh crore ‘health and well-being’ allocation comprises Rs 71,269 crore for health and family welfare, Rs 2,663 crore for health research, Rs 2,970 crore for Ayush, Rs 35,000 crore for Covid-19 vaccination, Rs 60,030 crore drinking water & sanitation, Rs 2,700 crore for nutrition, and Rs 49,214 crore as Finance Commission XV grants to states for water & sanitation and health. Bear in mind, drinking water & sanitation is under the Jal Shakti ministry, and the nutrition programmes of the Centre are herded by the ministry of women and child welfare.

To be sure, health and clean water-sanitation-nutrition have significant intersectionality. But, the government’s goal of spending 2.5% of the GDP on health by 2025 has to be about increased direct expenditure on healthcare infrastructure and human resources also.

India’s Covid-19 experience wasn’t even close to that of some Western nations—even so, the pandemic showed how inadequate our public health infrastructure is. Both Delhi and Mumbai, the political and financial capital of the country, came dangerously close to running out of healthcare infrastructure during their respective Covid-19 hospitalisation peaks.

So, the FY22 allocation for health and family welfare being merely 10% higher than the FY21 budget estimate—and more starkly, 11% below the revised estimate for that year—should give the government reason to introspect and correct course. In a year that saw the Indian Council of Medical Research oversee the management of the Covid-19 response in the country, the revised estimate of the department of health research expenditure was nearly twice the budgeted figure.

So, a 25% increase in allocation for the coming fiscal over the budgeted expenditure for the current one is inadequate. The country’s pandemic/epidemic preparedness can’t be scaled up at the eleventh hour; it has to be achieved through sustained investment in health research and public health. While states have been shouldering more than 60% of the public health expenditure, the spending to bolster capacity varies sharply between states. Given the pandemic’s economic impact, the Centre will have to step in to bolster healthcare capacity in the laggard states.

The provision for Covid-19 vaccine would have been enough to cover nearly half the population at Rs 500 for a two-dose regime. But, such pricing is unlikely to be available beyond the initial few months; so, the finance minister did well to clarify that the Centre is ready to commit further funds. The big jump in the allocation for drinking water is a sound investment in a healthy future. The Centre needs to bring similar forward-thinking to other areas of health too, particularly nutrition, where the allocation has actually been slashed by Rs 1,000 crore, and the PM Jan Aarogya Yojana, which lessens the out-of-pocket burden on the masses, where the allocation has been maintained at FY21 levels.