People’s health is determined by the air they breathe, the food and water they consume, their environmental hygiene, access to and safety of the roads they travel on, the education they receive, and the work they do. Budget allocations that influence these determinants have as much impact on population health as that allocated for healthcare provision. The recently announced Union Budget for 2021-22 puts a clear emphasis on the need for a healthy India (Swasth Bharat). This is a welcome shift towards health promotion. The criticism that these allocations cannot be treated as health budget is unfounded.
Each rupee spent on disease prevention and control yields the best return on investment. Allocations towards expanding pneumococcal vaccine to all, vaccinating against Covid-19, strengthening surveillance for both communicable and noncommunicable diseases and control programs took precedence in this year’s budget. Increased allocation to building resilience against future pandemics, natural disasters due to climate change, and mass population displacements is a welcome development. Covid-19 exposed the fragility of health systems in ensuring timely access to drugs and vaccines. Allocations aimed at self-reliance (productivity linked incentives, national research fund, national institutes of virology etc.,) in development, production, and supplyof resources (drugs, vaccines, devices, disposables, diagnostics etc.,) for healthwill enable more resilience in Indian health system.
The Department of Health Research has received a boost through a 27 percent rise over the last year’s budget allocation. Virology, research and biosafety are among areas that will benefit from the increased allocations. The government has announced funding towards four new national virology institutes, nine new laboratories for studies on highly infectious pathogens and a national institution to coordinate research and surveillance on animal and human infections.
The emphasis on strengthening comprehensive primary healthcare (CPHC) is reflected in allocations towards health & wellness centers. Various programs under the National Health Mission (NHM) will ultimately have to dovetail into the CPHC system to bring more efficiency in service delivery. Strong CPHC systems not only reduce the burden on expensive hospital-based care (HBC), but also ensure continuity of care needed for some communicable and most non-communicable diseases. The budget gives special emphasis on improving access to CPHC for urban populations, especially for slum dwellers and migrant populations. The policy announcement on Allied Health Professionals will also enable team-based, technology-enabled CPHC delivery system to be more effective.
Certain otherpoints in the budget will likely have an indirect impact on health systems. The policy decision on enhancing FDI limits to 74% in the insurance sector will give a fillip to the fledgling private health insurance sector. Announcements on gig workers and informal labor are aimed at improving financial protection against catastrophic and impoverishing health expenses to unprotected sections of the population (the so called ‘missing-middle’). The creation of Development Finance Institutes (DFI) may improve access to social capital for investment in healthcare infrastructure. Private Equity (PE) funded corporate hospitals that focus on high returns on investments over very short time may not be the right solution for creating healthcare infrastructure. Public trust in these models is rapidly diminishing on account of both affordability and ethics.
The country’s economy and population health are intricately intertwined. A healthy population is more productive and contributes to economic growth. Similarly, economic growth lifts millions of people above poverty, enabling them to afford their health expenses. Hence, the budget allocations and the policy announcements aimed at giving a push to the economy, will lead to better health.
The budget for this year, therefor, seems to be in the right direction to improve people’s health and move our health system to move closer to realizing SDG goals.
Dr Krishna Reddy Nallamalla
Regional Director (South Asia), ACCESS Health International