The overall and health budget of 2024–25 does not offer anything significantly different from what has been committed in previous budgets, asserts Ravi Duggal.
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THE Union finance minister, Nirmala Sitharaman, introduces us to four pillars for whom the 2024–25 interim budget is designed: the poor, women, youth and farmers.
However, the budgetary allocations do not reflect this commitment.
For instance, the expenditure on the Mahatma Gandhi National Rural Employment Guarantee Act scheme (MGNREGA), which was ₹90,806 crore in 2022–23, is down to an allocation of ₹86,000 crore.
The allocation for Mission Shakti, for the empowerment of women, which was ₹3,144 crore in the previous year’s budget, remains almost the same at ₹3,146 crore, which is actually a huge decline if we factor in inflation.
Food subsidy, which was ₹2,72,802 crore in 2022–23, is 25 percent less at ₹2,05,250 crore in 2024–25. Similarly, Samagra Shiksha, which was ₹37,453 crore in 2023–24, is almost the same at ₹37,500 crore.
The allocation for Capacity Building and Skill Development in 2024–25 is exactly the same as the previous year at ₹538 crore.
Nirmala Sitharaman introduces us to four pillars for whom the 2024–25 interim budget is designed: the poor, women, youth and farmers.
So this is the priority for the four pillars. These facts appear even more stark considering that these pillars are the ruling party’s election targets in the forthcoming general elections.
Also read: Uncovering the political economy of the 2023-24 budget
Overall, the budget speech was nothing but an eulogy to the Prime Minister’s decadal performance. It was only about what has been achieved for different sectors and sections of the population over the last 10 years and how this would be taken forward in the next five years. There was nothing about the budget for fiscal year 2024–25.
What was evident from the speech was the approach to welfare over the last ten years. The shift to targeted direct benefit transfers reflects a mai-baap or a paternalistic approach to welfare.
There is no mention of economic and social rights to which India is a signatory at the global level. For each social sector, it is only about targeted schemes either as programmes or as direct benefit transfers to gain electoral leverage.
Thus, health, education, nutrition, empowerment of women and youth, livelihood, agriculture and farmers welfare, water and sanitation, access to cooking gas, and the welfare of Scheduled Caste, Scheduled Tribe, Other Backward Caste and minority communities, etc., are all covered under targeted schemes to appease the electorate.
There is no effort in the direction of establishing rights to healthcare, education, employment, social security, etc.
The Union health budget
While health is a state subject, the National Health Policy, 2017 makes a commitment that at least 2.5 percent of the Gross Domestic Product (GDP) should be allocated to health by the Union and state governments with the former’s share at 40 percent. This should be achieved by 2024–25.
Thus, given the estimated GDP of ₹3,27,72,000 crore, the health allocation of both the Union and states at 2.5 percent should be ₹8,19,000 crore and the contribution of the Union government at 40 percent should have been ₹3,27,718 crore.
Also read: Rajasthan’s Right to Health Care Act: Promises and pitfalls
The 2024–25 budget for all three departments of health totals ₹94,371 crore, which includes grants to states and Union territories. As per the health policy commitment, there is a shortfall to the extent of 3.5 times in the Union’s allocation to health.
This shows that healthcare is not a priority for this government and the little allocations it makes, for instance via schemes such as Pradhan Mantri Jan Arogya Yojana (PMJAY), medical education, Central Government Health Scheme (CGHS) and various public–private partnerships benefit the private health sector where public resources get transferred to private healthcare through insurance, subsidies, outsourcing, human resources, etc.
Further, from the previous year’s allocation of ₹92,803 crore, the increase in the health budget is a mere 1.6 percent, which does not even compensate for the inflation of 5–6 percent.
Then again, from the ₹94,371 crore health budget, ₹50,237 crore or 53 percent has been transferred as grants to states and Union territories and this amount gets reflected in state and Union territory accounts.
The shift to targeted direct benefit transfers reflects a mai-baap or a paternalistic approach to welfare.
So, on a net basis, the Union’s own health budget is ₹45,467 crore or only 0.95 percent of the total budget. If we include grants, it constitutes 1.98 percent of the budget or 0.29 percent of the GDP.
From the Union’s own budget, allocations are mainly for All India Institute of Medical Sciences, Delhi and other Union government hospitals, the National Institute of Mental Health and Neuro-Sciences, the National HIV-AIDS and sexually transmitted disease control programme, CGHS and the Union’s establishment.
Interestingly, CGHS, which is a social security benefit for serving and retired Union government employees, judiciary and members of Parliament, is a whopping ₹6,100 crore and is surprisingly included in the Union health ministry’s budget.
Also read: Five years of the HIV/AIDS Act, 2017: An assessment— Part 2
The CGHS spending of ₹6,100 crore in 2024–25 is a good example of discrimination in access to healthcare benefits from public resources. Privileged employees and parliamentarians get benefits of ₹16,052 per capita in sharp contrast to the general health budget for common citizens, which is estimated at a mere ₹2,400 per capita nationally.
The grants given by the Union are mainly for the various schemes under the National Health Mission which is ₹33,167 crore and for Union schemes such as PMJAY (₹7,500 crore), HIV-AIDS (₹3,049 crore), human resources for health and medical education (₹5,016 crore), and Ayushman Bharat Health Infrastructure Mission (₹4,108 crore).
Privileged employees and parliamentarians get benefits of ₹16,052 per capita in sharp contrast to the general health budget for common citizens, which is estimated at a mere ₹2,400 per capita nationally.
In addition to the above, in 2023–24, state governments together budgeted ₹323,934 crore or ₹2,281 per capita, including grants from the Union, for healthcare.
So clearly state governments do spend much more proportionately than the Union government but even state health budgets are far short of the required 60 percent of 2.5 percent of the GDP as mandated by the National Health Policy.
To conclude, the overall and health budget of 2024–25 does not offer anything significantly different from what has been committed in previous budgets.
Though the Union finance minister in her speech did mention upscaling of government hospitals to medical colleges, maternal and child health, immunisation, anganwadi and nutrition programmes, there is no evidence of these having been provided in the budget document.
I guess one will have to wait and see whether the post-election full budget is any different.
