It is disappointing that the budget gives no push towards universal healthcare

The COVID pandemic has exposed inequities in healthcare. Failure of public healthcare system to care for the poor and middle income sections of society was clearly evident. Economically well off sections could get treatment from private sector which minted money in this crisis. The corporate hospitals cared a hoot about government’s regulations. It was therefore needed that budget on health should have given direction towards ensuring comprehensive universal healthcare.

An outlay of Rs 223846 crore rupees on health in the budget for the year 2021-22 appears very encouraging. This is said to be a 137% increase from the previous budget of 94452 crore. However a detailed review of this raises some questions.

There is a marginal increase in the allocation to department of Health and Family Welfare from Rs 65012 crore in last budget to Rs 71269 crore, a meagre 10% increase. This may well be only to meet the increase in the cost due to inflation.

Out of Rs. 2.24 lakh crore, Rs 64180 crore is allocated to the PM Atma Nirbhar Swasth Bharat Yojna. This has to be spent over 6 years. So it is not an annual budgetary increase on health, but rather only a jugglery with the figures.

Department of Drinking Water and Sanitation gets a substantial increase from Rs 21518 to Rs 60030 crore. Water supply is not directly related to the Ministry of Health only. There are several ministries and departments like the rural and urban development ministries involved in this. To add this amount to the health budget amounts to fooling the country. Moreover this too is to be spent in 5 years’ time and is not an annual increase.

Most worrying factor in the budget is reduction in the spending on nutrition from Rs 3700 to Rs 2700 crore. This is at a time when India is at 102nd position in hunger index out of 117 countries, worse even than our neighbouring south Asian countries.

In her budget speech, the Finance Minister did not address the issue of health problems faced by the migratory people during the lockdown period. Neither did she take cognizance of loss of jobs and livelihood during lockdown which adversely effected people’s health.

Government had committed that it will spend 2.5% of the GDP on health. If that is to be done there has to be increase in spending to Rs 3.5 lakh crore as against present announced to Rs 2.24 lakh crore.

There is no clear indication as to how the money on healthcare will be spent. Whether the government will be spending this money on its own or it will be a transferred to the private/ corporate sector. The decision to allow 74% FDI on insurance is a pointer to the government’s intention to pass on money to the private sector instead of direct expenditure.

There is no mention of regulating the drug prices, an issue which is so important for the people who have to spend from their pocket to get the healthcare.

There is no plan to increase the number of doctors in the government sector. It is unfortunate that at present large number of vacancies are filled on contract basis with a very meagre salary.

There is no mention to strengthen the ASHA and Aganwadi schemes whose workers have done so much work as frontline workers during COVID. The apathy towards MGNREGA will lead to further joblessness and add to health crisis among the poor.

Various studies have concluded that to ensure comprehensive primary healthcare, there is a need to enhance public health spending on health to minimum of 5% of the GDP. As per the National Health Accounts (NHA) Estimate for 2014-15, the Government Health Expenditure (GHE) per person per year is just Rs.1108. This is in contrast to the Out of Pocket Expenditure (OPE) of Rs. 2394 which comes out to be 63% of total health expenditure which is Rs. 3286 per person. Even this expenditure is not homogenous. This is not likely to change with this budget.

More than 40 per cent of the population has to borrow or sell assets for treatment. This is totally against the principles of equity and justice. Already marginalised sections like Dalits, Muslims and other socio-economically weaker groups are worst affected.

Flaws in planning and implementation of the policies have been pointed out by the Comptroller and Auditor General of India (CAG) in 2017. The audit pointed towards inadequate funding, under-spending of available financial resources, delays in transfer of funds, diversion of allocated programme funds, limited capacity to spend due to shortages in infrastructure and human resources among other issues.

The budget has completely failed to meet the expectations for a direction towards comprehensive universal healthcare; rather there seems to be a hidden agenda of corporate push in the healthcare.

(IPA Service)

(Views are personal)