In pandemic age, 137% increase in budget on health, well-being

India’s overall allocation for health and well being has soared by 137% in the financial year 2021-22 to Rs. 2.23 lakh crore compared to the budgeted spending in 2020-21 as the country seeks to boost the capacity of its health-care system to detect and cure new and emerging diseases in the aftermath of the Covid-19 pandemic.

The Budget unveiled by finance minister NIrmala Sitharaman features a new centrally sponsored initiative called the PM AtmaNirbhar Swasth Bharat Yojana, with an outlay of about Rs64,180 crores over six years. It set aside Rs.35,000 crore for Covid-19 vaccines.

The initiative is aimed at developing capacities of the primary, secondary, and tertiary care health systems, strengthen existing national institutions, and create new institutions, to detect and cure new diseases in the wake of the pandemic that has affected 10.7 million people and claimed more than 154,000 lives in the country . It will be in addition to the National Health Mission.

“…The Budget outlay for Health and Wellbeing is `2,23,846 crores in BE 2021-22 as against this year’s BE of `94,452 crores, an increase of 137 percent,” Sitharaman said.

Experts noted that the 137% increase includes many one-time allocations.

“The proposed investment of ₹64,200 crore over 6 years under the PM AtmaNirbhar Swasth Bharat Yojana is encouraging… excluding Covid vaccinations and water and sanitation expenditure, the remaining healthcare budget has seen a modest increase of 11% (vs. 137% for the overall healthcare budget)…,” said Manoj Garg, director of investments at White Oak Capital, in a statement.

The budgeted expenditure on the Ayushman Bharat health insurance scheme has been kept unchanged at ₹6,400 crore, Garg noted.

“The increase in the healthcare budget from ₹94,500 crore to ₹2.23 lakh crore is driven in large part by budgetary allocations for Covid vaccinations ( ₹35,000 crore, accounting for 27% of the increase) and an increase in water & sanitation costs ( ₹74,500 crore, accounting for 58% of the increase),” he added.

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This year’s budget proposal rests on six pillars, of which health and well-being is one of the key pillars. The government’s three focus areas in the health segment mentioned by the finance minister were preventive, curative and well-being.

Many inclusions in the budget this year have been made keeping in mind the coronavirus disease (Covid-19) pandemic, and to deal with such public health emergencies in future that includes setting aside ₹35,000 crore for Covid-19 vaccines, additional grants of ₹13,192 for health, ₹36,022 crore for water and sanitation, and strengthening disease surveillance initiatives by upgrading the National Centre for Disease Control (NCDC).

In order to better deal with infectious disease outbreaks, the government plans to set up integrated public health labs in all districts and 3,382 block public health units in 11 states, and establishing critical care hospital blocks in 602 districts and 12 central institutions.

The plan for strengthening of the NCDC will also include upgrading its five regional branches, and 20 metropolitan health surveillance units. There will be an expansion of the integrated health information portal to all states and Union territories to connect all public health labs; operationalisation of 17 new public health units and strengthening of 33 existing public health units at points of entry, that is at 32 airports, 11 seaports and seven land crossings.

“The budget provides a much-needed boost to health, nutrition sanitation and pollution control, all of which will contribute to improved health and wellbeing. Primary health care is receiving more support, with even the previously neglected urban component getting new health and wellness centres. The strengthening of disease surveillance system across the country and entry points to the country as well as the laboratory capacity in all districts is also needed for pandemic prevention and epidemic response,” said Dr K Srinath Reddy, founder, Public Health Foundation of India (PHFI).

For enhancing disease surveillance system, the government will also set up 15 health emergency operation centres and two mobile hospitals; along with a national institution for One Health, a regional research platform for the World Health Organisation’s South East Asia Region, and nine Bo-Safety Level (BSL)-3 laboratories and four regional National Institutes for Virology.

“Two or more vaccines are expected soon, and I allot ₹35,000 crore for Covid-19 vaccines in 2021-22, and committed to providing more funds, if required,” Sitharaman said.

The use of another key vaccine, pneumococcal vaccine, that saves children from potentially fatal health conditions such as pneumonia, meningitis, and sepsis will be expanded to other states. Currently, the vaccine is being used only in five states, and will now be rolled out in the entire country.

“It will avoid more than 50,000 child deaths annually in India,” said Sitharaman.

Since malnutrition is one of the primary concerns in India because of which many health-related indicators are still not improving, the government has proposed launching an improvised Mission Poshan 2.0, to strengthen nutritional content, delivery, outreach, and outcomes by merging the supplementary nutrition programme and the earlier Poshan Abhiyan.

An intensified approach is planned to improve nutritional outcomes across 112 aspirational districts.

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Another focus area is providing clean water, sanitation, and clean environment, as a prerequisite to achieving universal health. The Jal Jeevan Mission (urban), will be launched with the aim at universal water supply in all 4,378 urban local bodies with 28.6 million household tap connections that will be implemented over five years, with an outlay of Rs2,87,000 crores (Rs. 2.87 lakh crore).

“The overall allocation as compared to the previous year looks good as it has been clubbed under health and well being, but you cannot compare apples with oranges as there are many one-time allocations that won’t be repeated. This was a pandemic year and more than 10-11% was expected from the government. Let’s see how it is implemented, though, which will be a bigger struggle,” said a senior public health expert who did nto wish to be named.