When the much anticipated budget 2021 was rolled out earlier this month, the country seemed to rejoice at the increased allocation of '137%' to healthcare which on the surface looked promising enough to take care of all the necessary expenditures. Dig deeper and it is becomes blatantly clear-- not much has really changed.

Healthcare budget: What seems problematic?

1. The Ministry of Health and Family Welfare was allotted a sum of Rs. 73,937.77 crores, but this is a 5.4 percent increase from the previous year after adjusting for inflation. India’s public health expenditure has been low when compared to most other countries.
2. The National Health Policy 2017 envisages to increase the central government spending on health to 2.5 percent of GDP by 2025. This would require a substantial increase in government expenditure on health in the subsequent years.
3. The expenditure on National Mental Health Programme should be increased to accommodate the rising mental distress among people in the wake of the pandemic.
4. To maintain and subsequently increase the establishment of telemedicine services that have taken roots during the lockdown, an increased expenditure on telemedicine would be desirable.
5. An increased expenditure on HwC would aid in providing improved and accessible comprehensive primary healthcare.
6. The amount dedicated to PMJAY though low according to its coverage has been left unabsorbed for the past two years.

The economic survey 2021-22 relayed how the recent pandemic highlighted the importance of the health sector and also cited that such a health crisis could get transformed into an economic and social crisis. This, with the catchy title of the chapter ‘Healthcare takes centre stage, finally’ gave good grounds to several healthcare professionals and experts to anticipate that India’s health budget would finally move beyond its trademark ‘one point something percent.’ And so did it sound to the layman when the honourable finance minister voiced the number ‘137’ while speaking about health in her speech. Though it appears to be rosy, the reality would be revealed only when the numbers are further broken down and viewed under the allocated headings.

Total outlay: 137% increase

The 2.23 lakh crore earmarked in the name of ‘health and well-being’ includes the expenditure not only by the ministry of health and family welfare but also ministry of AYUSH, department of drinking water and sanitation, nutrition and on COVID vaccination.

The unwrapping of the fancy 2.23 lakh crore healthcare package leaves behind a naked Rs. 73,931.77 crore as the actual amount spent on health, a 10.1 percent increase from the previous fiscal year which when adjusted to inflation stands at barely 5.4.

NHM allocation: 9.5% increase

The National Health Mission is India’s attempt to provide affordable healthcare solutions for the most common communicable and non-communicable diseases. It consists of four units – National Urban Health Mission, National Rural Health Mission, Tertiary Care Programs and Human Resources for health and medical education.

Like the last year, about 50 percent of the ministry’s budget is allocated to the NHM, the sum being 9.5% more than the last year. However, the question that arises is, is this allocation for India’s chief health mission enough?

National Mental Health Programme: 0% increase

The National Mental Health Programme has been allocated an amount of Rs. 40 crore, a zero percent increase from last year. This is despite the severe derangement of mental health that has accompanied the pandemic. There has been no attempt made to accommodate relief of mental health issues that have stemmed out of the pandemic.

A large chunk of the funds for mental health viz Rs. 117.44 crore is allocated to just two national mental health institutes centralising the funds in a way. Secondly, though the pandemic has increased the use of telemedicine, the allocation has not increased compared to the past year.

Furthermore, according to government reports, the average non-recurring and recurring cost for one health and wellness centre is approximately Rs. 10 lakh and Rs. 7.3 lakh respectively. Considering the recurring cost of the already established 58,999 health and wellness centres and construction of the remaining from the 1.5 lakh centres, the dedicated amount would be far less than sufficient.

Ayushman Bharat Yojana: Allocation unchanged

PMJAY, the safety net scheme provides insurance to 50 crore families for inpatient care. According to the average hospitalisation rate in India of 37 per 1000, an allocation of Rs. 6400 crore from the past three years accounts for Rs. 3,459 per individual per inpatient episode.

The problem that arises here is that the amount in spite of being minimal, is still left underutilised for the past two years.

PM Atma Nirbhar Swasth Bharat Initiative

An additional mention of an allocation of Rs. 64,180 crore over the next six years for upgradation of the healthcare infrastructure through a flagship programme PM Atma Nirbhar Swasth Bharat Initiative has been made. However, its expenditure over this year seems uncertain.

COVID-19 vaccination

The decision that made headlines-- the Finance Minister announced that Rs. 35000 crores was set aside for supporting the largest vaccination drive to inoculate healthcare and frontline workers, and high-risk groups in the country.

Though, it becomes much clear that though the pandemic has brought with it a strong realisation of the need for health infrastructure and human resources in the country, the healthcare budget of 2021-2022 does not seem to reflect the same.

The National Health Policy envisages increasing the healthcare budget to 2.5 percent of the GDP by 2025. But the truth remains that it has increased by merely 0.20 percent points in the past four years. Keeping this in mind, the possibility of an increase of one percent in the next three years thus by far remains questionable. All in all, the healthcare budget does not seem to have got the boost that it truly deserves.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

Dr. Apurva Jain is a dentist and an aspiring public health professional. She can be reached at apujain94@gmail.com