One of the major highlights of the recently announced Budget was the emphasis on the healthcare sector in the country. The budget outlay for “health and well-being” for 2021-2022 is Rs 2,23,846 crore, said Union Finance Minister Nirmala Sitharaman as she presented the budget on February 1. Other announcements related to the health sector included a new centrally-sponsored scheme, the Pradhan Mantri Atmanirbhar Swasth Bharat Yojana, which would be launched at a cost of Rs 64,180 crores over six years. Additionally, Rs 35,000 crore has been allocated for the COVID-19 vaccine.
However, speaking to TNM, Dr J A Jayalal, President of the Indian Medical Association (IMA), said that although the healthcare allocation was said to be an increase of 137% over that of last year, the actual amount is much lesser. This is because, different ministries and departments (Health, AYUSH and Department of Drinking Water and Sanitation), allocations by the Finance Commission and for COVID-19 vaccination have been conflated under one heading: ‘Health and Wellbeing’ — one of the six pillars of Prime Minister Narendra Modi’s vision for Atmanirbhar Bharat.
Among this, the Health and Family Welfare Ministry has been allotted Rs 73,931 crore in the budget for the next financial year. This is a 10.16% increase from the budget estimate for the current financial year (RS 67,112 crore), but 10.84% less than the revised estimate (the amount actually spent by the ministry last year) of Rs 82,928 crore. This was at a time when the country was at the peak of the pandemic.
Expressing his dissatisfaction with the healthcare sector allocations, Dr Jayalal told TNM that it is much less than what is required. “Developed countries spend a lot more in the same sector, for the welfare of the people. The budget allocation for healthcare should be 5% of the country’s Gross Domestic Product (GDP),” he said.
According to a report by Reuters, for decades, India’s spending on healthcare has been a mere 1.3% of its GDP. In FY 2020-21, India’s healthcare spending was 1.8% of the GDP. Besides, according to the Economic Survey 2020-21, India has one of the highest levels of out-of-pocket expenditure (OOPE) in the world. It noted that the country could substantially decrease its OOPE expenditure on the overall healthcare from 60-65% to 30%, if it increased its public spending on healthcare to 2.5-3%.
Dr Jayalal also expressed his discontent over the fact that expert medical organisations were not consulted before allocating a budget of Rs 35,000 crore for the COVID-19 vaccine in the new budget. “Medical experts worked hard to develop the vaccines and were also among the first to get the jab. Besides, the money for the vaccines is set to come from the Prime Minister’s COVID-19 fund, and not the Union government,” he said.
Incidentally, according to Expenditure Secretary TV Somanathan, the cost of vaccination of frontline and healthcare workers in the current fiscal is being majorly borne by PM-CARES or the Citizen Assistance and Relief in Emergency Situations Fund, which was set up in Mach 2020 during the coronavirus pandemic. He said that while over Rs 2,200 crore has been contributed by the PM-CARES for the first phase of the vaccination drive, the rest will come from the Health Ministry.
The budget for the current fiscal year (2020-21) was set at a time when the pandemic had not hit the country. According to the Expenditure Secretary, since no allocation was made for the vaccination then, more than 82% of the expenditure for the vaccination for January to March will be borne by the Union government via the PM-CARES funds. The supplementary budget in September 2020 earmarked a COVID-19 relief of Rs 350 crore for the health sector.
Under the Pradhan Mantri Atmanirbhar Swasth Bharat Yojana, the Union government announced to set up wellness centres. “However, most of such centres that were announced in the past three years were not set up and 80% of the All India Institutes of Medical Sciences (AIIMS) institutions that were announced earlier were not set up. The AIIMS in Tamil Nadu has not been set up yet, even though the foundation stone was laid by Prime Minister Narendra Modi in 2019,” he said.
Incidentally, the allocation for nutrition is 29.6% less for the next financial year — Rs 20,105 crore — compared to Rs 28,557 crore in 2020-21 and Rs 27,584 crore in 2019-20. "The allocation for nutrition is meagre. However, there is a consolation that the previous allocations to the nutrition would continue, but there should be an increased emphasis on the micro and macronutrients especially during the pandemic,” he said.
Dr Jayalal also mentioned how the IMA is firmly opposed to the Union government’s announcement last year to integrate the health system, by combining the study of Ayurveda and allopathy. He explained that this was “a suicidal attempt by the government” in India, where about 90% of the people turn to allopathy for treatment.
"Health comprises many aspects such as water and nutrition. Although we welcome the allocation of funds for water in the budget, the government should also focus on the social development aspect of health as well,” said Dr Jayalal, adding, “We appeal to the Finance Minister to look into the healthcare sector seriously and increase the allocations."