It was surprising that there was hardly any mention of healthcare in the Union Budget presented by Finance Minister Nirmala Sitharaman. No significant announcements pertaining to this crucial sector were made. People had expected that this time, this sector would at lease see an increase in public health spending.
The only silver lining was that the Budget outlay for healthcare saw a 19 per cent rise — from Rs 52,800 crore in 2018-2019 fiscal to Rs 62,659.12 crore in the 2019-2020 fiscal. The Finance Minister just made a passing reference, stating that “according to the vision presented in the interim Budget, a healthy society would remain an area of attention for the Government.” However, Sitharaman did emphasise on the ‘Swachh Bharat’ mission and the aim to make India open-defecation free by October 2, 2019.
Issues such as mounting disease burden, the need to boost preventive healthcare and improving access to affordable and quality care were completely missed out by Modi 2.0, despite it getting a huge mandate from the people. This is highly discouraging. While the Government’s flagship health insurance scheme, Ayushman Bharat, was listed as a key focus area and received an allocation of Rs 6,400 crore, it is not clear as to how the Government will expand its scope to achieve wider penetration. Issues of public health importance such as zoonotic diseases and anti-microbial resistance were completely left out.
Only recently, the country was a witness to the Muzaffarpur crisis, where reportedly around 137 children lost their lives due to acute encephalitis syndrome (AES). Surprisingly, there was no mention of any budget allocation for future preventive measures to check the disease as also others. Moreover, the National Health Policy of increasing public health spending to 2.5 per cent of the Gross Domestic Product (GDP) by 2025 has hardly gained momentum.
The marginal increase in allocation for healthcare, too, is not enough. Unlike last time, when allocation for the National Rural Health Mission (NRHM) fell, this it was increased to Rs 27,039 crore. The 7.11 per cent raise, however, may not be enough to better rural health infrastructure. The Government’s own Economic Survey said rural health infra was crying for care. Allocation for the National Urban Health Mission has gone up to Rs 950 crore from Rs 875 crore previously. This marginal rise will not suffice to handle the crisis faced by this sector.
The importance that this Government accords to tertiary care was also reflected in the Budget. The allocation to these programmes saw an increase of 60 per cent from the previous year’s revised estimates. Interestingly, while primary care needs the most attention, tertiary care is getting the most. Healthcare in rural areas remains a prime concern. Sixty per cent of primary health centres (PHCs) in India have only one doctor while about five per cent have none, according to the Economic Survey 2018-19, tabled in the Parliament on July 4.
The Budget allocated for national programmes such as the National Mental Health Programme, National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, National Programme for Health Care of the Elderly and National Programme for Control of Blindness largely remained the same as last year. It is noteworthy that there is no budget for emergent care to be reimbursed in the private sector in case of non-availability of beds in the Government sector. The Government needs to revisit the issue of mandatory universal health insurance.
‘Health is wealth’ is a popular saying and we must understand its significance. A strong healthcare focus is the foundation for not only the growth of the economy but also in improving standards of living. Considering the country’s wobbling health infrastructure, the health sector deserved better representation. Further, the multitude of problems that is affecting the system should have been appropriately addressed.
Overall, it was heartening to see an increased focus on ‘Swachh Bharat’, water, hygiene and sanitation. These will go a long way in reducing preventable water and food-borne diseases.
Another important department in the health sector is the Department of Health Research. Its allocation has gone up to Rs 1,900 crore (2019-20 BE), an increase of nine per cent, as compared to last year’s revised estimates.
I welcome the Government’s move to set up an electronic fund-raising programme for social enterprises and voluntary organisations. This will go a long way in building capital and extend life-saving programmes to a larger section of the population. – The Pioneer