Ideal spending on health care should be at least 2.5-3 percent of the Gross Domestic Product (GDP)
n her Budget speech on February 1, Minister of Finance Nirmala Sitharaman announced that India will build an open platform for the national health ecosystem, which will contain digital registries of health providers and facilities, unique health identities, consent framework and unique access to health facilities.
Another notable announcement was the National Tele Mental Health Programme, which includes building a network of 23 tele-centres for mental health counselling and care, with the National Institute of Mental Health and Neurosciences (Nimhans) in Bengaluru being the nodal centre, and the International Institute of Information Technology-Bangalore (IIITB) providing technology support.
That apart, the Budget speech did not announce any specific provisions for the health care sector, for which experts have been stating, for many years now and particularly in the wake of the Covid-19 pandemic
, the ideal spending on health care should be at least 2.5-3 percent of the Gross Domestic Product (GDP).
“Usually, Budget figures are announced in the Speech. This time, they departed from this tradition. The actual allocation to the health ministry has gone up only marginally,” says K Srinath Reddy, president, Public Health Foundation of India (PHFI). The Budget Estimates last year for the Ministry of Health and Family Welfare (MoHFW) stood at Rs 71,269 crore, which were revised to Rs 82,921 crore. The Budget Estimates for the MoHFW this year are Rs 83,000 crore. This is only for the Union health ministry and does not include other allocations towards Ayush, health research, and so on.
Reddy adds that there has been some focus on the social determinants of health, like water, sanitation and housing
. The finance minister announced that 8.7 crore households have been covered under the ‘Har Ghar, Nal Se Jal’ programme to provide direct tap-water access, and Rs60,000 has been allocated to cover 3.8 crore households in FY23.
“I was underwhelmed by the Budget,” says Meena Ganesh, MD, co-founder and chairperson of Portea Medical, a home health care company. “Over the last couple of years, the government has spent a lot on vaccination and Covid-19 management, but the fact of the matter is that the fundamental health care system for the country needs significant higher investment, be it for taking care of people with chronic diseases or for elders. I did not see any specific mention of that.”
According to her, while the focus on mental health
is a step in the right direction, one needs to wait and watch how this will be implemented in a way that it goes beyond cities to the corners of the country, because there are challenges around providing teleconsultation access to people, and ensuring they are comfortable and willing to speak over a digital health helpline. “It is not just money for clinical purposes, but also helping people get comfortable with opening up about their mental health issues,” she says.
Last year, the government had announced a five-year-plan to improve health infrastructure
and strengthen health surveillance, and they might have chosen not to reiterate it this time, says Hitesh Sharma, tax partner and life science sector leader, EY India, adding that the actual overall health spends by the central government has only gone up marginally. From an overall (not just for MoHFW) budgeted and revised estimate of Rs 74,602 crore and Rs 85,915 crore last year to a budgeted estimate of Rs 86,606 crore this year. “The only thing I saw as an aberration from last year was the vaccination spends. From a Rs 35,000 crore budgeted estimate and Rs 39,000 crore revised estimate, it has been reduced to Rs 5,000 crore,” says Sharma. One can interpret this in three ways, according to him. One, perhaps according to the government, Covid-19 is to become endemic
; two, they might want everyone to incur their own costs; or three, the Centre might want the states to focus more on this, since health, after all, is a state subject.
Reddy too believes that with the ongoing progress of Covid vaccinations and precautionary doses, the government might have considered the reduced allocations sufficient. “In Covid times, they have come up with special packages. So they may feel that right now it is difficult to anticipate requirement, and they may reserve the right to make special allocations if there is a further problem,” he says. “I think right now, the assumption seems to be that Budgetary need for vaccination is not that high and they seem to be going slow on that.”
Reddy, however, believes that the National Health Mission
should have got a lot more focus. The Budget estimates have only seen a marginal increase, from Rs37,130 crore last year to Rs37,800 crore this year. “The Budget needed particular focus on how to improve urban health, apart from rural health, which still needs a lot of strengthening. Urban primary health care has not been given a boost, and urban primary health care mission has been largely unaddressed as a priority,” he says.
According to Ganesh, while the Budget is more of just an indication of the intent to create a digital health ecosystem, how the government will actually get health workers to be part of it and get patients to share their health records is yet to be seen, because digitisation is a “very large transformation exercise”, she says.
The consent framework that Sitharaman mentioned, Ganesh explains, will be the most fundamental building block of this digital ecosystem. “For the first time, we are looking at patients owning their data, rather than hospitals and health care workers owning patients’ health records. For the first time we are saying the patients will have control in terms of tracking and sharing their records, as and when they think it is appropriate,” she says.
Sharma believes that one of the biggest things missing in the Budget was support for creation of health care infrastructure by the private sector, like providing incentives or focusing on innovations. “Vaccines have only taught us that innovation is a must, because we do not know how things will move. But they [the government] really did not think of research, innovation or infrastructure for private sector in the Budget. The industry has been asking for it, and that was a miss.”