The Health Budget announced earlier today is grossly inadequate, especially in light of the COVID pandemic, and falls well short of the goals of the National Health Policy, 2017, writes RAVI DUGGAL.

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WITH GDP [Gross Domestic Product] increase projected at over 9 per cent for 2021-22 and 8.5 per cent for 2022-23, as well as buoyant tax collections, especially through the GST [Goods and Services Tax], to which the poor contribute a huge proportion of their income, a huge surge in the magnitude of allocations for healthcare was expected from today’s Union Budget. Yet again, however, the Centre has failed the people of the country at a time when the COVID-19 pandemic continues unabated and the demand for healthcare has grown significantly. In 2020-21, the government did make some effort at upping the budget estimate of Rs. 69,234 crores with an actual spending of Rs 82,820 crores: an increase of Rs. 13,563 crores to factor in COVID-19 related expenditures, which was Rs. 11,940 crores (Rs. 8205 under the National Health Mission [NHM]).

Also read: Deception in the Health Budget 2021-22

Declining spending on National Health Mission

The following Table gives the trends for the last eight years of spending for Health, specifically the NHM, by the Union Government. What the numbers tell is that growth during the COVID years has been flat, and the allocation for 2022-23 over the previous revised estimate [RE] has been a mere 0.67 per cent increase. If we factor inflation of over 5 per cent, then what we see is a real significant decline in the proposed healthcare budget.

Table: Union Government Health Budget and Expenditures 2015-2023 (in crore rupees)

Year	Total Health Budget	Percentage of total budget	Percentage of GDP	NHM budget	NHM budget as percentage of of Total Health Budget
2015-16	35189	1.97	0.26	20213	57.44
2016-17	40241	2.04	0.26	22870	56.83
2017-18	54645	2.55	0.32	32000	58.56
2018-19	56236	2.43	0.3	31502	56.02
2019-20	66042	2.46	0.32	35155	53.23
2020-21	82820	2.35	0.37	37478	45.25
2020-21 budgeted estimate [BE]	69234	2.28	0.31	34105	49.26
2020-21 RE	85250	2.47	0.44	42872	50.29
2021-22 BE	76902	2.21	0.33	37159	48.32
2021-22 RE	88665	2.35	0.38	34747	39.19
2022-23 BE	89250	2.26	0.35	37800	42.35

The NHM, which is a flagship health program, saw a decline in real terms from Rs. 37,478 crores in 2020-21 to Rs. 37,800 nominal allocations. As a percentage of the health budget, NHM is witnessing a declining trend – from 58 per cent at its peak in 2018 to 39 per cent in 2021-22. NHM is the core program for reaching primary healthcare to the public and the foundation of the public health system, but has been grossly neglected in terms of budgetary commitments.

Also read: Covid-19 Impact: Huge Decline in People Accessing Health Services

Inadequate health budget

Another key program of the Union Ministry of Health is the Pradhan Mantri Swasthya Suraksha Yojana which focuses on strengthening tertiary care, that is, the new AIIMS [All India Institute of Medical Sciences] hospitals in states and upgradation of a few government medical colleges. In the context of the pandemic, this is an important capital investment, and the 2022-23 budget sees a large increase to Rs. 10,000 crores from Rs. 7,000 crores in the previous year. While this increase and strengthening of health infrastructure is welcome, it should not be diverted into a public private partnership initiative as proposed by the NITI Aayog.

Growth of health spending during the COVID years has been flat, and the allocation for 2022-23 over the previous revised estimate has been a mere 0.67 per cent increase. If we factor inflation of over 5 per cent, then what we see is a real significant decline in the proposed healthcare budget.

Similarly, the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission also aims at strengthening the health infrastructure from the level of Primary Health Centre to the District Hospital, and has received a booster from Rs. 900 crores in the current year (RE) to a substantial Rs. 5,156 crores in the proposed 2022-23 budget. This has emerged out of the COVID context and is a good beginning to strengthen the basic health infrastructure, but given the large size of the country and the poor conditions of the public health system, this will need much more resources.

So overall the core health budget of the Centre remains grossly inadequate at a mere 2.26 per cent of the total budget and 0.35 per cent of the GDP. The National Health Policy, 2017 has mandated 2.5 to 3 per cent of GDP for health, of which 40 per cent or at least 1 per cent of the GDP is the responsibility of the Union Government. The health budget completely fails to meet this mandate; to fulfil it, the budget allocations would have to be increased three-fold.

Also read: Economic Survey 2021-22: Glossing Over Travails of a Pandemic-hit Economy

COVID-related budget indicates laxity, lack of transparency

Finally, as regards COVID-related expenditure, while it was Rs. 11,940 crores in 2020-21 and the RE for 2021-22 stands at Rs. 16,545 crores, there is only an insignificant allocation of Rs. 226 crores (which is the insurance cover for health workers) for this in 2022-23. Is the government assuming that with the third COVID wave ebbing, it signals the end of the pandemic? Similar optimism was shown by this government last year, before the second wave devastated the nation.

The National Health Policy 2017 has mandated 2.5 to 3 per cent of GDP for health, of which 40 per cent or at least 1 per cent of the GDP is the responsibility of the Union Government. The health budget completely fails to meet this mandate; to fulfil it, the budget allocations would have to be increased three-fold.

Notably, in November last year, the Asian Development Bank published a press release as per which it approved a loan of $1.5 billion and the Asian Infrastructure Investment Bank, another $500 million, for COVID-19 vaccinations and related expenditures, but this allocation does not find a place in the proposed budget.

Apart from this, we know very little about expenditure on COVID-19 treatment and vaccinations. A Right to Information application revealed that up to December 20, 2021 the government had spent Rs. 19,675.46 crores to procure COVID vaccines for the states, and according to government data, as of January 31, 2022, 164.59 crore doses had been delivered, with about 65% of the adult population having received both doses. Further, there is no information available on the PM CARES [Prime Minister’s Citizen Assistance and Relief in Emergency Situations] Fund, which was specifically created for managing COVID-19. What is known is that by May 2020, it had collected Rs. 9,677.9 crores as donations, and had allocated Rs. 3,100 crores for COVID-related expenditures. Since then, neither its income nor expenditure is available in public domain.

In November 2021, the Asian Development Bank approved a loan of $1.5 billion and the Asian Infrastructure Investment Bank, another $500 million, for COVID-19 vaccinations and related expenditures, but this allocation does not find a place in the proposed budget.

Also read: PM CARES Fund: Why we should lift the veil, to demand accountability

To conclude, we have not seen the last of COVID-19, but the Health budget as well as allocations for COVID-19 continue to be anaemic and have failed the people of this country in reaching basic healthcare to them.

There is no information available on the PM CARES Fund, which was specifically created for managing COVID-19. What is known is that by May 2020, it had collected Rs. 9,677.9 crores as donations, and had allocated Rs. 3,100 crores for COVID-related expenditures. Since then, neither its income nor expenditure is available in public domain.

(Ravi is a Sociologist, Health Researcher and Activist associated with the Peoples Health Movement. He is the former Country Coordinator at the International Budget Partnership. The views expressed are personal.)