Budget 2020: Focus on better medical care, boost to education

Health and family welfare was allocated ₹67,484 crore in the union budget 2020, a 3.8% increase over last year’s budgetary outlay of ₹64,999 crore.

Although there was no budgetary increase for the Narendra Modi government’s flagship health insurance scheme, Ayushman Bharat-Pradhan Mantri Jan Arogya Yojna (AB-PMJAY), it got the biggest share of the health allocation, receiving ₹6,429 crore for 2020-21.

“We have a holistic vision of healthcare that translates into wellness of the citizen. Mission Indradhanush has been expanded to cover 12 such diseases, including five new vaccines. Fit India movement is a vital part of the fight against non-communicable diseases coming out of lifestyle issues. A very focused safe water (Jal Jeevan Mission) and comprehensive sanitation programme (Swachch Bharat Mission) have been launched to support the health vision. That would reduce the disease burden on the poor,” finance minister Niramala Sitharaman in her budget speech.

The finance minister underlined the need to strengthen medical infrastructure and build human resources to improve the quality of medical colleges, especially at the district level, and increase the number of empanelled hospitals under the Ayushman Bharat scheme in tier-2 and tier-3 cities.

Around 20,000 hospitals are empanelled with AB-PMJAY, with the majority being in metropolises and state capitals.

“Budget 2020 has sharpened the focus on skilling and upgradation of medical human resources. Under the National Board of Examinations, large hospitals with sufficient capacity will be encouraged to train resident doctors in super-speciality courses. Bridge course for nurses and paramedics for equivalence with foreign courses will be designed by health ministry and Skill Development together with professional bodies,” said Union health minister Harshvardhan.

There is a significant increase – from ₹4,733 crore in 2019-20 to ₹6,020 crore this year -- for the Pradhan Mantri Swasthya Suraksha Yojna, which is the central scheme that deals with tertiary care hospitals, including new All India Institute of Medical Sciences (AIIMS) or AIIMS-like hospitals, and medical education.

“The budget estimates for the department of health and family welfare show an appreciable increase of 3.75%, while there has been a 10% hike in the allocation for the department for health research. This indicates the government’s strong focus on the health sector,” said Harshvardhan.

Policy think tank Niti Aayog’s proposal to allow private entities to run medical colleges attached to district hospitals under the public private partnership (PPP) model found mention in the finance minister’s speech.

Following the National Health Policy document, Sitharaman stressed the need for public-private partnerships to help build hospitals and sustain health infrastructure in underserved areas.

Apart from running medical colleges, the PPP model will also be used to create more hospitals in tier-2 and tier-3 cities to be empanelled under the Ayushman Bharat scheme.“112 aspirational districts to get priority,” she said.

“Proceeds from taxes on medical devices would be used for development of hospitals... The government will provide viability gap funding (VGF) for the process,” said Sitharaman.

Using VGF to set up hospitals in 112 aspirational districts has been welcomed by industry. “It will help create robust health infrastructure especially in areas where Ayushman Bharat benefits have not reached yet especially to the weaker section. We hope to see more investments in primary care and digital health to achieve the goal of Health for All,” said H Sudarshan Ballal, president, NATHEALTH, a healthcare industry body.

Sudarshan Jain, secretary general, Indian Pharmaceutical Alliance, said, “While the incentives in terms of using taxes on medical devices to build the health care ecosystem and additional hospitals in tier 2 and 3 are commendable, other initiatives, such as the New Export Incentive Scheme, are needed to really give India a competitive edge in the global health care market.”

The central allocation for crucial programmes such as the National Health Mission ( ₹34,290 crore to ₹34,115 crore) and National AIDS Control Programme ( ₹2,956 crore to ₹2,900 crore) remained almost the same.

The government-run Jan Aushadhi stores that sell generic medicines at cheaper than market rates will be expanded to every district in the next four years, with improved number of medicines and surgical items, said the finance minister.

Dr K Hari Prasad, President, Apollo Group Hospitals, told news agency IANS that after many years, health care received significant importance in the budget. “Swachch Bharat, clean drinking water, improved nutrition for women & children, Fit India movement and wellness centres are great initiatives promoting wellness and are welcome,” he said.