Union Budget and health sector – Some thoughts

The Union Finance Minister, Nirmala Sitharaman, presented the general budget for the FY 2020-21 in the Lok Sabha on February 1, 2020 allotting 2.27% share of the total budget (Rs 30.42 trillion) to the health sector. The budget allocation to the health sec- tor for the FY 2020-21 is Rs. 69,000 crore, which is Rs. 6340.88 crore more than the last year’s budget estimates. This is an increase of around 10.12% compared to the proposed budget of Rs 62,659.12 crore during the FY 2019-20, which is negligible, considering the consumer price index inflation was 7.5% in December 2019. More than half the increase will go to offsetting inflation.

Though the Finance Minister allotted the highest amount for the health sector in 2020-21 fiscal than the previous financial years, announcing that the budget 2020-21 is woven around three prominent themes – Aspirational India, Economic Development and Caring Society, which includes health as one of the fundamental pillars, in addition to education and better jobs, there was no significant announcement pertaining to health- care in the budget. She didn’t announce any new major health scheme in the budget. She has focused on expansion of many previously announced health schemes and their fruitful implementation. This is one of the best aspects of this budget. It is better to implement previously announced schemes properly than announcing any new major scheme.

Of the total health sector outlay of 2020-21 fiscal, the budget allocates Rs 6,400 crore – the same as in the previous budget, for the Centre’s flagship health insurance scheme Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB- PMJAY) though it needed to be scaled up. Besides allocating Rs 6,400 crore for the scheme, the FM announced in the budget that the AB-PMJAY scheme would be expanded by setting up more hospitals under public-private-partnership (PPP) mode in Tier-II and Tier- III cities in the aspirational districts that don’t have empanelled hospitals under the AB-PMJAY. The Government will provide viability gap funding for the process. Proceeds from taxes on medical devices would be used for development of hospitals. At present, there are more than 20,000 empanelled hospitals (both government and private) under the AB-PMJAY in India. Once there are Ayushman-empanelled hospitals in those aspirational districts, the poor people of India will be definitely benefited getting universal healthcare. These will bring better, affordable and efficient advanced healthcare delivery to the doorsteps of the people residing in the remote areas of India and will save many lives. Moreover, it will provide large-scale employment opportunities to the youth.

This apart, the FM also announced in the budget that the generic medicine retail outlets, Jan Aushadhi Kendras, would be expanded to all the hospitals in every district, offering 2,000 medicines and 300 surgical items by 2024 under Ayushman Bharat. This will help the poor people of India to get medicines and surgical items at affordable rates.

The National Rural Health Mission, the biggest component of the health budget, was allocated Rs 27,039 crore – the same as the previous budget and, in fact, less than the 2019-20 revised estimates of Rs 27,833.6 crore. A host of health schemes are bundled under NRHM. Considering the need of more funds for primary healthcare, which caters to the rural population, the allocation should have been increased. Of course, the Central Government initiated a programme for transforming 1.5 lakh sub-centres and PHCs into Ayushman Bharat health and wellness centres in 2018 to bring the health- care system closer to the rural people by 2022 as per the National Health Policy, 2017.

The allocation towards the schemes dealing with communicable diseases remained unchanged at Rs 2,178 crore. The allocation should have been increased. A National Sample Survey Organization report last year said that communicable diseases (viz., malaria, diarrheal diseases, encephalitis, tuberculosis, etc.) were responsible for more illnesses among Indians than any other ailments. India has the highest burden of tuberculosis (TB). TB kills an estimated 480,000 Indians every year and more than 1,400 every day. India has also more than a million missing cases of TB that are not notified and most remain either undiagnosed or unaccountably and inadequately diagnosed and treated. Therefore, the FM announced in the budget that the TB eradication programme would be expanded. Setting a target of 2025, the FM said in the budget, ‘TB Harega Desh Jeetega’. The Government’s decision to expand the TB eradication programme would mean better cure and higher treatment completion rates and overall better performance status.

The FM announced in the budget that India has a holistic vision for healthcare that translates into wellness of the citizen. Mission Indradhanush would be expanded to cover 12 diseases, including five new vaccines. Considering the changing scenario of dis- ease burden in India from communicable to non-communicable dis- eases (NCDs), the FM announced FIT India movement in her budget to fight against NCDs coming out of lifestyle issues. A much focused safe water availability (Jal Jeevan Mission) and comprehensive sanitation programme (Swachh Bharat Mission) have been launched to support the holistic health vision. The FM proposed Rs 3.60 lakh crore for Jal Jeevan Mission and Rs 12,300 crore for open defecation free (ODF) campaign and in order to sustain the ODF behaviour in 2020-21 budget. These are some wellness measures in the budget.

The Ministry of Ayush has been allocated Rs 2122.08 crore for the 2020-21 fiscal. An allocation of Rs 2,100 crore has been made to the Department of Health Research in the budget. It will help in medical and bio-technical researches. Usage of new machines and artificial intelligence in detecting and preventing the diseases, which will arise from medical and bio-technical re- searches, will be a great help for the healthcare practitioners.

In India there is a shortage of qualified medical doctors, both general practitioners and specialists. Therefore, to address the issue, the FM proposed in her budget to attach a medical college to a district hospital in PPP mode, in the first phase, in those aspirational districts where they don’t have empanelled hospitals under the AB-PMJAY. The details of the scheme will be worked out soon by the Government. The move to attach medical colleges to district hospitals in PPP mode will help in addressing the challenges related to availability of healthcare professionals in hospitals, improve access to healthcare and bridge the demand-supply gap. The FM also proposed a special bridge course to be designed to fill up the short- age health professionals. She re- quested the large hospitals to offer DNB/SNB courses to increase specialist doctors.

While India has been plagued by multiple health issues and stressed health infrastructure, the healthcare personnel expected more allocations for the health sector which is not seen in this budget. There is an urgent need to address multiple issues that are plaguing the healthcare system of India. We request the Government to consider increasing public spending on the healthcare system of India.

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