Interim Union Budget and health sector

Prof. (Dr.) Dharmakanta Kumbhakar

(The writer can be reached at drkdharmakanta@yahoo.com)

While a full budget for the FY 2024-25 will be announced after the new government is formed following the Lok Sabha election, Union Finance Minister Nirmala Sitharaman presented the interim Budget 2024-25 in the Lok Sabha on February 1, allocating 1.90 percent share of the total budget estimate (Rs 47,65,768 crore) to the health sector. The budget allocation to the health sector for FY 2024-25 is Rs 90,658.63 crore. This is an increase of around 1.69 percent compared to the budget estimates of Rs 89,155 crore and around 12.59 percent compared to the revised estimates of Rs 80,518 crore for the 2023-24 fiscal. Rs 3,712.49 crore has been allocated to the Ministry of Ayush separately in the budget which will also contribute to the health sector.

Of the total health sector outlay of 2024-25 fiscal, Rs 87,656.90 crore has been allocated to the Department of Health and Family Welfare. The allocation for the National Health Mission (NHM) has been increased to Rs 31967 crore from last year’s budgetary allocation of Rs 29,085.26 crore. A host of health schemes are bundled under NHM. Considering the need for more funds for public health care which caters to poor people, the allocation should have been increased.

The allocation towards the government’s flagship insurance scheme Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), under which nearly 12 crore families receive cashless hospitalisation benefit of up to Rs 5 lakh per family per annum,  is marginally raised to Rs 7,500 crore from last year’s budgetary allocation of Rs 7,200 crore. The scheme aims to reduce the out-of-pocket private expenditure on health that has been pushing several people into poverty.

In the budget speech for FY 2021-22, the FM had made the big announcement on the launch of a new Centrally-sponsored scheme ‘PM Atmanirbhar Swasth Bharat Yojana’, now renamed as ‘Pradhan Mantri Ayushman Bharat Health Infrastructure Mission’ (PMABHIM), with a total outlay of Rs 64,180 crore over a period of the 5 years from 2021-22 to 2025-26. This year, the FM has allocated Rs 4,107.68 crore for this scheme. The allocation will be utilised to support wellness centres, setting up of integrated public health laboratories, and critical care hospital blocks in districts with a population of more than 5 lakh. The scheme will change the health scenario in India if it is implemented in letter and spirit.

For the National Tele Mental Health Programme which was launched by the government in FY 2022-23 for better access to quality mental health counselling and care services, the budget allocation has been decreased to Rs 100 crore this year from last year’s budgetary allocation of Rs 133.3 crore. Significantly, Rs 250 crore has been allocated to the National Digital Health Mission in the budget, which was Rs 341.02 crore in FY 23-24. The FM launched the National Digital Health Mission in FY 2022-23 to bring the entire healthcare network under one umbrella to help the health care providers with better access to the public and vice-versa.

For the Department of Health Research which played a key role in the development of Covid-19 vaccine in India, Rs 3001.73 crore has been allocated. It will help in medical and biotechnical research. Usage of new machines and artificial intelligence in detecting and preventing diseases, which will arise from such researches, will be of great help for the healthcare practitioners.

In her brief budget speech, the FM said that several youths are ambitious to get qualified as doctors. They aim to serve people of India through improved healthcare services. Limited opportunities for medical education have led to aspirants going abroad for questionable quality training or being severely stressed by NEET examination preparation and results. Therefore, the government plans to set up more medical colleges by utilising the existing hospital infrastructure under various departments to boost the healthcare sector while meeting the aspirations of more students and a committee for this purpose will be set up to examine the issues and make relevant recommendations. Investment towards establishing new medical colleges is a progressive move in view of the severe shortage of doctors in India. This will definitely improve the doctor-patient ratio and will help make quality health care accessible to a larger population.  However, the current state of existing medical colleges must be evaluated for upgradation in terms of infrastructure development, recruitment of expert manpower and installation of a number of high-end equipment.

The  Finance Minister’s announcement to bring various schemes for maternal and child care under one comprehensive programme for synergy in implementation will lead to better outcomes in maternal and child health, addressing both preventive and curative aspects. The proposal for implementation of the newly designed U-WIN platform for managing immunization and intensified efforts of Mission Indradhanush to be rolled out expeditiously throughout the country will reduce the incidence of preventable diseases and improve public health. Upgradation of anganwadi centres under ‘Saksham Anganwadi and Poshan 2.0’, will expedite improved nutrition delivery, early childhood care and development. These are great moves by the government as these are going to boost women and childcare.

The FM also announced that the government will encourage vaccination for girls in the 9-14 year age group for prevention of cervical cancer. As per the WHO, cervical cancer ranks as the fourth most prevalent cancer among women, posing a significant challenge for the Indian population. Every year in India about 1, 20,000 women are diagnosed with cervical cancer and about 67,000 women die from the disease. Cervical cancer vaccines, such as HPV vaccines, play a crucial role in preventing the onset of this potentially life-threatening disease. Hence, this initiative is a great step towards raising awareness and taking preventive measures of cervical cancer in girls at an early age and promoting the health and well-being of young girls. If all girls aged between 9 to 14 years are vaccinated effectively the disease can be eliminated within one generation. However, the initiative of HPV vaccination needs to be extended to all age group women, especially the reproductive age group, as cervical cancer poses a significant threat to women across all age groups.

Additionally, the FM announced that healthcare cover under the Ayushman Bharat scheme will be extended to all ASHA workers and anganwadi workers and helpers. While it is possible that many of them may have already qualified under the provisions of AB-PMJAY or state insurance scheme, providing assured health cost coverage to these women is an appropriate recognition of their noble service.  The step will not only safeguard their well-being but also encourage them for dedicated service which will strengthens the foundation of our healthcare system as they are valuable promoters, facilitators and providers of health, nutrition and child development services at the frontlines of primary healthcare.

The budget is promising one in the health sector and it underscores the government’s forward-looking approach towards the health of women and children. However, there was a dire need to increase the health budget allocation. This amount of budget allocation doesn’t seem to enough to tide over the current challenges of upgradation of infrastructure and providing accessibility and affordability for quality healthcare in the country. Increased government spending on health sector is the only assured way to make health services affordable and prevent people from falling into poverty. Hopefully, this will be addressed in the general budget to be announced in July this year, under the new government.