With a focus on job creation, infrastructure, economic slowdown and ease of living, Union Budget 2019 has shown little concern towards an ever deteriorating public health system. There has been only a marginal increase in allocations for the health ministry, leaving a sector that has long been reeling under lack of infrastructure a bit disappointed.Today, India’s second woman finance minister Nirmala Sitharaman presented her maiden budget, calling it, “a ten year vision with a five-year target.” She maintained, “it is a budget for rural India, youth and women, with an emphasis on ease of living.” However, she did not utter the word public health in her budget speech even once. She talked about making India “pollution free with green mother earth and blue skies,” but failed to lay a roadmap for making it a reality.
Against the backdrop of the Bihar tragedy, which highlighted the funding requirements in public healthcare space that has been struggling with infrastructure crisis, lack of human resources and inadequate facilities the sector had huge expectations from the government. Especially after the BJP had upped the health narrative during the election campaign and showed political will towards improving universal health coverage by launching Ayushman Bharat.
As highlighted by Health Issues India recently, apart from inadequate funds, the lack of utilisation of available funds and efficiency of funding are two issues plaguing the sector. Government needs to ensure that red tapism is dealt with an iron hand to make health delivery more effective.
The budget fine print elaborated on the expenditure for the Health Ministry and marginally increased spending from Rs 54,302.50 cr in 2018-19 to Rs 62,659.12 cr in 2019-20. However, it is far below the industry expectations of increasing spending levels to 2.5 percent of the GDP to slowly move towards global average of four percent of the GDP — an increase that has previously been promised by the government on numerous occasions and which the Modi government plans to enact by 2025. The budget for the National Health Mission (NHM) also saw a small surge from Rs 31,187 cr in 2018-19 to Rs 33,651 cr in 2019-2020. The NHM is a part of the ministry which works to strengthen healthcare infrastructure and boost faltering performance on key health indicators in the country.
India is battling human resource deficits of eighty percent with staff crunches at various levels, including specialists, nurses and even junior medical staff, with a doctor-patient gap pegged at one doctor for over 11,000 patients. There were expectations that the government would take extra measures for human resource management, but funds for upgradation / strengthening of nursing services and upgrading district hospitals were slashed. Conversely, spending for the upgradation of state government medical colleges scheme, strengthening government medical colleges scheme and central government health Institutions scheme have been hiked.
Ayushman Bharat received the largest share of the health budget with Rs 6,400 cr being allocated to provide insurance cover of Rs 5 lakh to 10 crore underprivileged Indians. Experts have deemed this inadequate. Naseer Salim, Managing Partner at Flexi Capita, told NDTV, “Ayushman Bharat has been a flagship scheme of the central government but it has been battling a huge fund crunch. Right now it is only providing Rs 40 per family.” Salim’s judgement is a clear indication that, for the scheme to be successful, it requires more funds. Such concerns have been raised since Ayushman Bharat was announced in last year’s Budget and reiterated by economists and healthcare experts in the months since. Funding concerns are especially salient now that the government plans to expand the outreach of Ayushman Bharat to cover 75 percent of Indians, as Union Health Minister Dr Harsh Vardhan announced earlier this year.
“The budget comes as an indication that it is taking a comprehensive approach in the healthcare and wellness segment, and I think it is aimed in the right direction. With the government’s continuous focus on the Ayushman Bharat scheme will further help in providing extensive medical care and reinforce the commitment to universal healthcare for all citizens,” said Amol Naikawadi, JMD of Indus Health Plus. “Apart from this, the announcement to boost Artificial Intelligence will strengthen the usage of technology in the field of healthcare and it will intensify the quality in healthcare with accessibility and affordability,”
At the health conference conducted by Health Issues India, former special secretary for health, Meenakshi Ghosh stated, “the launch of the government’s health insurance scheme has diluted the primary healthcare sector and is seen to provide insurance without adequate support structure on the supply side.” The government has paid heed to the advice by shifting focus to setting up health and wellness centres. However, the target to build 1.5 lakh health and wellness centres to empower primary healthcare has been given a mere Rs 50 cr increase, taking the budget from Rs 199 cr in 2018-19 to Rs 249 cr in 2019-2020.
The government’s intentions to combat the water crisis and provide clean drinking water to every household by 2024 through the ‘Nal Se Jal’ scheme were reflected in the budget document. Rs 10,001 cr were allocated for National Rural Drinking Water Mission. The scheme comes under the ambit of the Jal Shakti Ministry, which has merged the ministries of Water Resources, River Development and Ganga Rejuvenation with the Drinking Water and Sanitation portfolio. Gajendra Singh Shekhawat took charge of this new ministry on May 31.
“Today’s #BudgetForNewIndia sets the stage for fulfilling our collective dreams of water for every citizen, ensuring electricity connectivity across India and boosting manufacturing especially in sunrise sectors. The Budget will enable India to become a more vibrant start-up hub”, Home Affairs Minister Amit Shah tweeted.
Since coming to power in 2014, the Modi government has focussed on big-ticket reforms, starting with Swachh Bharat Abhiyan to Ayushman Bharat. Where huge allocations were made to fulfil a vision, however, most of these schemes saw political will fizzling out over the years. Despite failing to meet the target of making India free of open defecation, Swachh Bharat Abhiyan’s funds have been slashed over the years. Even as Ayushman Bharat seeks more funds for better implementation, the focus has shifted to Drinking Water for All – admittedly understandable in a time of water scarcity. What is undeniable is that, in between all these ambitious, big-ticket reforms, steps to strengthen public health have taken a back seat.