Opinion: Budget Report 2021- Health Sector falls prey to numbers game 

THD NewsDesk, New Delhi: After the year long nightmare that was the pandemic, all eyes were on how health sector allocation fares in Budget 2021. Well, it did not fail to turn eyeballs, but perhaps not in a manner we expected it to. 

Finance Minister Nirmala Sitharaman has said that the coronavirus pandemic “is the dawn of a new era, one in which India is poised to be a land of new hope”. As per the ‘historical’ announcements, 64,180 crore will be allocated for the new national health programme, Atmanirbhar Swasth Bharat Yojana – over the next six years. 

The program funds will be dedicated to developing primary, secondary and tertiary healthcare in the country. This will be in addition to the National Health Mission, and help support both urban and rural health centres. It is also looking at establishing 12 central institutions while strengthening the National Center for Disease Control, and expansion of the health information portal to all states and UTs to connect all health labs. 

Sitharaman announced Rs 2,83,846 lakh crores for the health and wellness sector which will also include Rs 35,000 crores for COVID-19 vaccines. She added that she is committed to spending more if needed. This money will be used for the development and distribution of the vaccines. The budget has been claimed to have a 137 percent increase in the health allocations from the previous FY.

No Big-ticket plans for Investing in robust public healthcare delivery systems 

In September 2018, the current government had launched the health insurance policy- Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to cover health insurance through PPP model. But, was it viable to ensure universal public health care via adopting the PPP model? The answer lies in the failure of PMJAY. Private health services would not lead to a complementary relationship between efficiency, equity and social justice. Two years after the implementation of the AB-PMJAY, cases of blatant corruption and gross negligence showcase the failure of privatization in the healthcare sector, and hence, the wastage of public funds via adopting the PPP model.   

The V-shaped recovery in the number of claims, under health insurance policy AB-PMJAY, highlighted in the Indian Economic Survey 2020-21 is projected as the revival of normalcy in Indian healthcare services. This further propagates the significance of health insurance under the PPP model rather than advocating the role of public health care in universalizing health care under Sustainable Development Goal- 3. As it states: “access to medical services were classified as essential services during the lockdown, care-seeking exhibited a V-shaped behavior during the lockdown and unlock phases with the pre-Covid-19 levels being reached in December 2020…we can observe a steep fall in claims under the overall general medicine category for PMJAY in the March-April 2020 period… Further, recovery in private sector hospitals is much better than the public empaneled healthcare provider

Come the extraordinary requirement during the covid pandemic, and the Private sector was absent from situation control. In a situation when the under prepared public healthcare was busy tackling the pandemic situation, private hospitals either refrained from or charged exorbitantly for their services. That led to the collapse of an already compromised health service. 

Out of total 3.5% of GDP, Indian health care expenditure (lowest), private expenditure is highest at 73% at global level and the share of public health care expenditure is lowest at 27%. Conversely, the higher role of private health expenditure can also be explained by the out-of-pocket health expenditure in India, which is also highest at global level 62%. According to the Survey, an increase in public health expenditure from the current levels in India to 3% of GDP can reduce the OOP expenditure from 60% currently to about 30%, which can free up substantial funds for Indian Households to spend on other needs.

All this meant that people were looking forward to big investments in healthcare. But the figures coming out of budget speech signal the opposite.  According to the documents, between budget estimates of Budget 2020 and Budget 2021, there is only a paltry increase of 10.5%, when the on ground requirements are desperately larger. There are additional funds for COVID-19 vaccinations, and in all likelihood, just like the previous year, the allocation will be upwardly revised according to need. However, when the threat of the pandemic is still around, shifting responsibility on states shows lack of intent.

But then what about the much talked about 137% increase?

A look at the budget numbers shows that it is mostly the result of bookkeeping rather than any actual increase in the health sector. Indeed, a new centrally sponsored scheme, PM Atma Nirbhar Swasthya Bharat Yojana, has been announced with an outlay of about INR 64,180 crores over six years, which plans to develop the capacities of primary, secondary, and tertiary care systems. 

However, if we pay attention to the numbers, there is a section called ‘Health and Wellbeing’, where Water and Sanitation allocation is predominant. No surprise there, as the Govt is relying heavily on potable water as a national issue. Apart from the Central fund for vaccination drive (INR 35,000 crores) and the Finance Commission Grants to the health sector (INR 13,192 crores), the fund distribution looks disappointing. 

Health and Wellbeing – Expenditure

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Centre has passed on the baton of public health to states, and only time will tell how they will manage the largest vaccination drive in recorded history while maintaining Non COVID-19 services with a crumbling infrastructure. If we had to take one and only one lesson from Pandemic, it had to be this- Investment in Public Health can’t be delayed anymore. Budget 2021 was a serious let-down in this regard.