The number appears impressive—a staggering 137 per cent increase in the allocation for health and wellness.
“The budget outlay for health and well being is Rs 2,23,846 crore in budget estimates (2021-22), as against this year's (2020-2021) budget estimate of Rs 94,452 crores, an increase of 137 per cent,” finance minister Nirmala Sitharaman said in her budget speech.
A closer look at the budget document reveals that in the last year (2020-2021), the health ministry's budget estimate was Rs 65,011.80 crore, and the health ministry ended up spending Rs 78,866 crore. This year's budget estimate, for the health ministry stands at Rs 71,268 crores.
So where was this 137 per cent increase? The increase is seen if, as the finance minister did, one added up the money allocated for other departments such as drinking water, sanitation, nutrition and the Ayush ministry as well.
The money allocated for drinking water and sanitation had gone up from Rs 21,518 crore in 2020-2021 to Rs 60,030; for nutrition, it had actually come down from Rs 3,700 crore estimated last year to Rs 2,700 crore this year. While this does suggest an effort to look at health as an outcome of several variables, such as access to drinking water and sanitation, it cannot be taken as an increase in the budgetary commitment that public health experts have been demanding from the government.
“The allocation for drinking water and sanitation is good, but it can not be added as an increase to show the rise in the health budget. The money allocated for COVID-19 vaccination (Rs 35,000 crore) also is only a one-time investment. We are still far from the goal of 2.5 per cent of GDP as the health budget,” says Dipa Sinha, assistant professor (economics), school of liberal studies, Ambedkar University.
The outlay of Rs 64,180 crore under the PM Atma Nirbhar Swastha Bharat Yojna, mentioned in the minister's speech, was to be spread over six years, implying that each year would still be only about an additional Rs 10,000 crores approximately, Sinha added.
The central government has said that this money would be used to support health and wellness centres, setting up of integrated public health laboratories, establishing critical care hospital blocks, strengthening the National Centre for Disease Control, and expanding integrated health information portal.
“With an outlay of Rs 64,180 crore over six years, the scheme will develop capacities of primary, secondary and tertiary care, health care systems, develop institutions for detection and cure of new and emerging diseases, and strengthen the existing National Health Mission independent of it," union health minister Dr Harsh Vardhan said.
“The scheme will strengthen 17,000 rural and 11,000 urban health and wellness centres, set up integrated public health labs in all districts and 3,382 block public health units in 11 states, establish critical care hospital blocks in 602 districts and 12 central institutions”, the minister added. The NCDC, he said, would now have five regional branches, and 20 metropolitan health surveillance units.
“The experiences of the country’s year-long fight with COVID have shaped the union budget. This will give a tremendous boost to India’s health infrastructure,” Vardhan said.
The government was planning to expand the integrated health information portal to all states/UTs to connect all public health labs, operationalize 17 new public health units and strengthen of 33 existing public health units at points of entry (32 airports, 11 seaports and 7 land crossings), set up 15 health emergency operation centers and two mobile hospitals, set up a National Institution for One Health regional research platform for the WHO South-East Asia region office, as well as nine bio-safety Level III laboratories and four regional institutes on the lines of National Institute of Virology, Pune, Vardhan told the media. He also said that the government would roll-out the pneumococcal vaccine across the country. The vaccine roll-out was limited to five states currently, and with a countrywide roll-out, it would be able to avert over 50,000 deaths annually.
Among the various allocations in this year's budget, the central government's Ayushman Bharat-PMJAY seems to have not progressed much – while the budget estimate for the scheme (2020-2021) stood at Rs 6400 crore, the revised estimates indicate that only about half of the money allocated was spent. This year, too, the budget for the scheme is estimated to be Rs 6400 crore. The allocation for the department of health research, under which bodies such as ICMR fall, has also not seen a significant rise from the Rs 2,100 crore estimates of last year (revised estimates indicate that the department spent double the amount at Rs 4,062 crores), this year's estimate has risen marginally to Rs 2663 crores.
According to the government, India's health budget as part of a percentage of its GDP stands at 1.8 per cent. Though the budget has risen from 1.2 per cent from the year 2014-15, it is still not close to the 2.5 per cent that public health experts have been demanding for several years now.
