The Union Budget for 2022-23 has reportedly disappointed many health experts and observers. The two main areas that received extra attention in the Budget have been tele-mental health centres and the National Digital Health Ecosystem (NDHE). The NDHE is expected to digitise health records and create expanded and easily accessible health facilities for the people.
Allocation for the health sector
Regarding broad allocations to the health sector in FY 2022-23, the health ministry’s share has been increased by only less than `1,000 crore. It was `82,290 crore in the revised estimate for FY22 and in the coming FY23, the allocation is `83,000 crore. Health research has been allocated `3,200 crore which is up from the revised allocation of `3,080 in ongoing FY22. Additionally, the FM allocated `690 crore for future pandemic preparedness as part of the Prime Minister’s Ayushman Bharat Health Infrastructure Mission Bio-security Preparedness and for strengthening pandemic research. Moreover, the transfer to states via centrally sponsored schemes in FY 23 has been reduced to `47,634 crore. The allocation in this head in FY 22 was `50,591 crore. The vaccine budget has been drastically reduced to `5,000 crore in the coming FY 23 from the revised estimate of `39,000 crore in FY 22.
Some questions raised by experts
Sailaja Chandra, former Health Secretary, Government of India pointed out (Indian Express, February 5,2022) that big ticket items in the Budget like digitally managed health ecosystem and provisions for mental health rely on the power of technology. This bypasses the need to undertake physical visits to doctors, carry prescriptions, and wait in queues. This system could be a game changer only if the facility, doctors, patients, and the health system worked in tandem. Chanda also mentioned that when it comes to the success of Covid-19 vaccination, it should be noted that the COWIN platform was simple and slick.
She also pointed out that when one would consider the management of hospital beds or their availability, the story could be different. She mentioned that out of the 19 lakh beds in India, 62% were in the private sector. Among these, nearly 95% were operated by small hospitals and nursing homes. The latter sector has been the first point of call for most citizens seeking medical care. She questioned whether the digitised system would encompass both private and public sectors – including the smaller hospitals and nursing homes.
Health system of the country widened economic inequality during the pandemic
It is being pointed out by observers that in the Covid-19 pandemic, a section of people was financially ruined. K Sujatha Rao, former Health Secretary, Government of India, mentioned (Indian Express, 2 February) that inequalities have widened. An estimated `70,000 crore had been spent by the people out of their pockets in that short time for medical treatment. People spent that amount when incomes of most were down and many were pushed below the poverty line. Secondly, Rao also pointed out that during the pandemic, several important maladies like drug resistant HIV and tuberculosis experienced about 30% shortfall in coverage. The Budget could address those issues and help prevent those diseases.
Thirdly, a very important matter mentioned in the Budget has been establishing 23 telehealth centres of excellence for mental health. But in this sector, only `13 crore has been increased from the allocation of `597 in FY 22. Mental health impacts over 6-8% of the population. This has been a major unaddressed epidemic, estimated to cost the economy $1.03 trillion and accounting for 2,443 disability-adjusted life years per one lakh of the country’s population. Rao mentioned that India has a severe shortage of trained human resources, drugs were expensive and services were scarce and unavailable in most parts of the country.
It is true that a single budget cannot change the entire health infrastructure of a country like India. In this regard, K Srinath Reddy, a cardiologist and epidemiologist and President, Public Health Foundation of India, has opined that after several decades of low government expenditure on health, the Covid pandemic has created a social consensus on the need to strengthen our health system. Actually, the need of the hour is to develop the general health system of the country but the Budget seemed indifferent to that need.