People across all walks of life eagerly await India’s annual budget every year. The pre-budget economic survey presents the current state of the economy and other social indicators and offers a peep into the budget. While a major portion of the budget deals with current operations and ongoing policy implementations, certain allocations point to a new policy and strategic priorities.

Major health policy decisions have already been announced over the last five years as part of National Health Policy 2017 and as a response to the experience with the Covid-19 pandemic under the broad policy umbrella of Ayushman Bharat. These include operationalizing 150,000 health and wellness clinics (HWC) to strengthen comprehensive primary health care systems, providing financial protection to 100 million poor families across the country (PMJAY), strengthening public health infrastructure based on the lessons learned from the ongoing pandemic (Ayushman Bharat Health Infrastructure Mission), and leveraging digital health to transform health systems (Ayushman Bharat Digital Mission). In addition, there were major reforms to address health workforce issues, namely the constitution of the National Medical Council (NMC) in place of the Medical Council of India (MCI), legislation on allied health professionals, and plans to strengthen cadres of public health, health management, and medical education. All these are in various stages of implementation and are not constrained by budgetary allocation.

Given the fact that the major health policies are already in the implementation phase of the policy cycle, we did not see any major announcements in this year’s budget except for additional new nursing colleges, pharma research, and sickle cell anemia elimination. There is a significant policy announcement on the opening up of ICMR institutions for partnerships with private sector stakeholders.

However, certain budget announcements pertaining to non-health sectors will have a greater bearing on the health of the people than those for health. The continuing emphasis on the provision of safe drinking water and toilets to every household, last-mile digital communications connectivity, and clean energy will have a significant impact on public health status. Higher taxation on tobacco products is a welcome move. Policy thrust on millets and organic foods will have a long-term impact on the incidence of certain diseases. These examples make a point that population health is as much influenced by social, economic, commercial, and environmental determinants as the state of health systems.

More than budgetary allocation, what ails India’s health system is the poor quality of healthcare services, low moral and ethical standards, and insufficient professional competencies in the areas of healthcare, health information, health insurance, and public health management. A significant portion of the meager health budgets remains unutilized by many states. Low-value care (unnecessary consultations, tests, and procedures) amounts to 20 percent of health expenditures even in high-income countries. We do not have estimates of low-value care in India.

In addition, we need higher budgetary allocation for ensuring an assurance of quality in the healthcare services provided. Currently, few healthcare providers have quality accreditation to assure a decent quality of care to people. While current policies are aimed at improving access to care and reducing the financial hardships of poor people in accessing essential healthcare, we need policies to ensure adequate quality of care so as to reduce the incidence of preventable deaths. Poor quality of care is the reason behind two-thirds of all preventable deaths.

In summary, what we need is an efficient implementation of ongoing major health policies, bringing efficiency in health financial management, building needed competencies in the health workforce, and assuring the quality of care people receive. The budget should reflect policies and strategies for the above in the future.

Dr. Krishna Reddy Nallamalla

Photo Credits:  The Week

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