India’s lacklustre health budget “may have affected how far people were shielded from the COVID-19 outbreak” according to the latest “Commitment to Reducing Inequality Index 2020” published by Oxfam.
India’s total government spending on health equated to four percent of the overall government budget, according to the report. This is just a quarter of the recommended spending levels suggested by the charity, and just a third of the percentage set aside by the poorest country in the world, Burundi.
“Its health budget is the fourth lowest in the world. Just half of its population have access to even the most essential health services,” the report said. The average spending on healthcare in total for high income nations is listed by the report as 18.6 percent. For lower-to-middle income nations such as India, the average spending was 5.1 percent.
The issue of inadequate healthcare budgets has been raised on numerous occasions in the past by Health Issues India: “Among the main takeaways of the 2020 Union Budget for healthcare is a Rs 69,000 crore budget for the health sector for the 2020-21 period. This marks an increase compared to last year’s Union Budget, which saw Rs 62,659.12 crore allocated… described at the time as “a marginal hike”.”
Experts weighed in on the budget and made the observation that India is still failing to reach its intended target of 2.5 percent of GDP — itself a target far below the average of other countries in the same economic bracket as India. “Overall, it is a lacklustre budget,” said Vikram Vuppala, founder and chief executive officer of NephroPlus. “There is no clarity on how the government is specifically increasing its commitment to invest in healthcare to 2.5 percent of GDP. Even 2.5 per cent is too low if compared with BRICS countries.”
The report underlines the fact that weak investment into healthcare, coupled with insubstantial labour rights and security — with the report noting 75 percent of Indian jobs lack security — has led to increased economic fallout resulting from the COVID-19 pandemic. India placed eighth from the bottom with regards to economic security during the pandemic, with only India and Haiti ranking in the bottom ten outside of Africa.
“Most workers earn less than half of the minimum wage; 71 percent do not have any written job contract and 54 percent do not get paid leave. Only about ten percent of the workforce in India is formal, with safe working conditions and social security,” the report noted.
These factors may have been a primary mechanism by which the disease was allowed to spread. At the onset of the pandemic, following the announcement of lockdown measures, scores of day labourers and migrant workers fled the cities and attempted to return to their homes in towns and villages. This led to the creation of considerable crowds, as well as faltering transport infrastructure. A large number simply attempted to walk — often hundreds of miles — back to their native villages. Many failed in their attempts to leave, and have been effectively rendered homeless and without jobs.
“Hunger will kill us before any disease does.” were the words of one man affected by the mass exodus from the cities. Most among the crowds had no form of PPE. This, combined with the close proximity of the thousands affected created a perfect situation for the virus to spread. COVID-19 could then have been spread from these individuals back to their villages and allow for community transmission.
A lack of a substantial health budget has created a situation in India where a host of conditions are all but uncontrollable. This has been exacerbated by a number of other factors. The broad spectrum of different diseases occurring in India do not aid the situation. A dual burden of disease exists in India, with infectious diseases still rampant while noncommunicable conditions such as heart disease and cancer have risen to become India’s most common causes of death.
Likewise, India’s health budget is stretched across a vast geographic area. It is needed to cater to megacities hosting tens of millions of individuals across wealthy apartments to impoverished and densely packed slums. It is also required in rural regions and remote villages, often existing with little to no healthcare infrastructure at all.
The reality is India’s health budget caters to the second most populous country in the world. The budget is spread across more than a million people, with vastly different circumstances occurring for each of them. COVID-19’s death toll, and its economic fallout has exposed gaping weaknesses in the healthcare system’s infrastructure. If things are to improve, the budget must accommodate the cost of improvement.