Annual budget provides a window to understand policy intent and action. We tend to focus on the budgetary allocation to health to draw conclusions on government’s intent. However, health of people is influenced more by various social determinants than healthcare alone. Access to safe drinking water has more impact on diarrheal deaths than the status of healthcare provision. Similarly, literacy, women education, child nutrition, clean and green energy, cleanliness, per capita income, living conditions have greater effect on health status of people and account for nearly 70% of longevity gain. Hence, the budget has to be evaluated through a wider social prism than health systems’ alone.

Budgetary focus on potable tap water to every household, green energy and EV policies to reduce air pollution, improving access to education through digital platforms and TV channels to improve literacy, food subsidies to ensure access to adequate nutrition etc., will have greater impact on health status over medium to long term. Policies on onboarding informal labor will enable governments to expand social net and health financial cover. Focus on housing to urban low- and middle-income groups will reduce expense outflow on housing thereby making money available for health and education.

Digital technologies are disrupting social systems, including health systems in unimaginable ways. Last mile extension of digital payments through post-offices will enable direct health and other welfare benefit transfer so that the help reaches intended beneficiaries. Digital communication systems can be leveraged to make public health education more effective. Three-fold increased allocation to digital health mission that aims at adoption of standards-based interoperable digital health records will make health systems more efficient and effective. Digital health will enable dynamic disease surveillance to prevent and control epidemics and pandemics and in addition to providing more reliable data to policy makers. Hence, budgetary focus on digital technologies in general and digital health in particular has greater impact on health than that allocated to ministry of health.

Budgetary amount spent for Covid-19 response during 2021-22 was around Rs.3000 crores. There is no provision for emergency response to additional waves this year, possibly on account of confidence in vaccination of its population and in our ability to manufacture and supply newer antiviral drugs. However, there is an enhanced allocation to strengthening infrastructure in district, area, and community hospitals and public health infrastructure through Ayushman Bharat Health Infrastructure Mission (ABHIM) – ~Rs.979 cr versus Rs.315 cr last year, and PM Swasthya Suraksha Yojana (PM-SSY) – Rs.9410 cr compared to Rs.3250 cr previous year. PMSSY is designed to strengthen specialty services and increase intake medical students in states and districts through establishment of All India Institutes of Medical Sciences.

Considering the fact that PMJAY uptake is yet to ramp up, understandably there is no increase in budget allocation. The focus of the states is on taking steps to create awareness amongst beneficiaries so that the services can be more utilized as per the healthcare needs. Similarly, commissioning of health & wellness slowed down during the pandemic. Increase in allocation may be needed once the pace picks up as pandemic settles down. There is a greater need to improve operational efficiencies to improve healthcare provision. It is estimated that anywhere from 20% to 40% of allocated health budget remains unspent due to poor public health finance management. Procurement irregularities underlie perennial shortage of essential drugs in public healthcare system. Absenteeism adds to the chronic shortage of health workforce, especially in towns and villages. States should focus more on driving efficiencies in their healthcare operations in addition to strengthening infrastructure.

In summary, the budget provides a useful window to understand various policy directions that have impact on health of people. This year budget reflects a fine balance between sustainable long-term development to recover from and immediate social security to absorb the shock from the once in a century devastating pandemic. It also reflects the built-in resilience of Indian society through evolved through years of suffering. 

Dr Krishna Reddy Nallamalla
President, InOrder
Regional Director (South Asia), ACCESS Health International

Photo Credits: Quartz India

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