The missing focus on health
The Covid pandemic has amply demonstrated the direct and indirect cross-sector impacts of the health sector and its devastating power to create disruption. It was therefore not surprising to see his mark on the Economic Survey.
Given the lessons of the pandemic, it was reasonable to expect a “health-focused” budget. It shouldn’t be. The main objective of the budget is to increase capital expenditure to develop economic infrastructure under the PM Gati Shakti program. The televised discussions focused on GDP, as if a 7.7% or 8.2% recovery made sense for the millions of people who have been impoverished by income losses, hunger, disease and pandemic-induced trauma.
Inequalities have widened. It is estimated that Rs 70,000 crore was spent by the people in this short period of time on medical care that the government should have provided. Spending at a time when incomes were falling pushed millions below the poverty line and hunger became a major problem putting India at the bottom of the Malnutrition and Hunger Index rankings. Children have lost two years of schooling which, in real terms, will be three, because they have lost what they learned the last time they went to school.
The budget allocation for the post-Covid year is a princely amount of Rs 83,000 crore, up 16.4% from last year’s Rs 71,268 crore. The budget of the Flagship National Health Mission which funds all health initiatives in partnership with the states has been increased by 7.4% from Rs 36,576 crore to Rs 37,000 crore. It is under the NHM that all disease control programs and reproductive and child health programs, including vaccinations – they deal with diseases that cost little to treat, but are life or death for the great masses. poor – are implemented. Covid has led to a coverage gap of over 30% across all these programs, raising fears of drug-resistant HIV and TB and leaving thousands of children unprotected against vaccine-preventable diseases . These programs have needed a much bigger boost alongside strategies to ensure they are isolated from another viral outbreak. But do we care?
Instead, the obsession is with digitization. How does a digitized health record help a critical care patient? What India’s healthcare system needs are strong policies that improve the availability of doctors and nurses and access to medicines and diagnostics.
Another FM announcement was the creation of 23 telehealth centers of excellence for mental health. Why a special mention in the speech when the budget allocation for mental health has only been increased nominally – from Rs 597 crore to Rs 610 crore? Mental health affects over 6-8% of our population and is a major untreated epidemic, costing the economy an estimated $1.03 trillion and accounting for 2,443 disability-adjusted life years per 1 lakh of the population, equivalent to cardiovascular disease and more than stroke or COPD. . To remedy this, the Mental Health Act must be implemented with a substantial injection of money, ideas and imagination. We have a severe shortage of qualified human resources, medicines are expensive, and services are scarce and unavailable in most parts of the country.
Public hospital budget expenditure has increased by 30% – from Rs 7,000 crore to Rs 10,000 crore – although the much needed investment to strengthen the surveillance system has a nominal increase of 16.4%. The flagship Ayushman Bharat Health Insurance Scheme (PMJAY) continues to be grossly underfunded at Rs 6,412 crore – the same as last year. But then he had, strangely enough, only spent Rs 3,199 crore despite the huge medical needs people were facing due to the pandemic. An important takeaway should have been a greater investment in health research. It saw a miserable increase of 3.92% from Rs 2,663 crore to Rs 3,200 crore. It is on this insufficient budget that the laboratory network should be built until additional funds are mobilized from the World Bank or AfDB.
This year, the health budget was needed to build the resilience required so that we never go through the disruptions we have witnessed. Unfortunately, it contained no vision or direction to address glaring gaps in the health care system. Despite all the evidence and data, year after year we only lament bad health budgets that have been stuck at around 1.5% of GDP.
When World War II ended, England had a flattened infrastructure, a shattered economy and a weary people. Yet political leaders had the courage to announce a national health service – universal, free health care for all – on the grounds that “fully developed social insurance can provide income security; it is an attack on need. But need is only one of five giants on the road to reconstruction, and in some ways the easiest to attack. The others are disease, ignorance, misery and idleness. Since India also needs a massive boost to its economy to ensure a minimum quality of life for all its people, we must envision transformative change by tackling inequality, disease and ignorance by investing in health, education, nutrition and employment to ensure equal opportunities. Covid gave us that opportunity. It’s a shame we failed to catch it.
(The author is the former Union Health Secretary)