By Dr Arun Mitra
Much was expected from the budget presented by the Finance Minister Smt. Nirmala Sitharaman on February 1 2023. As this was the last budget of the present government before the upcoming elections to the parliament next year, people had high hopes of relief in various sectors including health. Thumping the chest by the BJP members and its allies in NDA apart the allocation to health in the budget has completely belied people’s aspirations. This is apparently because health and education are not taken as assets by the governments in power in our country.
It is in this context to utter dismay that there is a decrease in allocation to health sector in the budget presented by the FM. In the budget presented last year out of 39.45 lakh crores rupees of total budget the health was allocated Rs.86606/- crores that is 2.19 % of the budget. But this year health has been allocated Rs.88956/- crores out of the total budget of 45 lakh crores rupees which means 1.97 % of the budget. There is a decrease of 0.22% despite high inflation during this period.
Budgetary allocation to the National Health Mission (NHM) has seen a meagre 0.21% rise. The Budget for National AIDS (Acquired Immunodeficiency Syndrome) and STD (Sexually Transmitted Diseases) Control Programme has seen an increment of 11.61 per cent – Rs. 2,622.75 crore (BE) from Rs. 2349.73 crore which was the revised estimate for 2021-22. However, if we compare it to the actual money spent in 2020-21 on National AIDS (Acquired Immunodeficiency Syndrome) and STD (Sexually Transmitted Diseases) Control programme there has been a drop of 6.84 per cent.
The whole exercise is to promote the digital agenda instead of the infrastructure and employment of doctors and paramedical staff in the rural health centres. It is beyond comprehension how without actual ground level infrastructural development digitalization is going to help.
The WHO has pointed out time and again that to meet the health needs it is important that the public health spending should be 5% of the GDP. But unfortunately the public health expenditure in our country has been much lower for several years. According to Oxfam’s “Commitment to reducing inequality report 2020” India ranks 154th in health spending, 5th from the bottom. It was therefore expected that the government would be serious in budgetary allocation towards health. But it was not to be.
‘Oxfam India’s Inequality Report 2021: India’s Unequal Healthcare Story’ further points out that growing socio-economic inequalities in India are disproportionately affecting health outcomes of marginalized groups due to the absence of Universal Health Coverage (UHC). The report shows the general category performs better than SCs and STs; Hindus perform better than Muslims; the rich perform better than the poor; men are better off than women; and the urban population is better off than the rural population on various health indicators.
The budget nowhere indicates increase in allocation for the emoluments of the doctors and paramedical staff. Services of the front line health workers, ASHA, Aanganwadi etc. have not been given due recognition. They have not been given the status of a worker in this budget.
The allocation to Poshan Abhiyan was reduced last year from Rs.3700 crore to Rs.2700 crore. This is affecting nutrition of the marginalized sections. The allocation for MGNREGA is cut from Rs 89,400 crore to Rs.60,000 crores. Further, rural development allocation has been reduced from Rs 2,43,317 crore in the revised estimate to Rs 2,38,204 crore of the total budget expenditure, it is getting 5% and that shows the low priority of the government for the rural sector. Poor allocation to the rural sector and MGNREGA will reduce the purchasing capacity of the people thus affecting their nutrition. With under nutrition it would be naïve to expect better health indicators among the people.
There is talk of increasing nursing colleges. But unless this is accompanied with job employment for them they will be left to work in the private sector at very low wages or migrate to other countries for better opportunities.
The Community Health Centres (CHCs) which are the first referral centres and are supposed to have a surgeon, an obstetrician-gynaecologist, a paediatrician, a physician and an anaesthetist. But there is over 80 % shortfall in surgeons and paediatricians, and an over 70 % shortfall in physicians and obstetrician-gynaecologists. There is no plan or direction to fill these vacancies despite the fact that the number of doctors coming out every year has increased but because of lack of infrastructural facilities in the rural areas most of them opt for the private sector or migrate to other countries.
There is emphasis on Public Private Partnership (PPP) mode in the health sector through which money will be shelved to the private players.
The whole exercise of budgetary allocation is not going to improve health services in the country and shows no sign of universal health care. There is a need to increase the budgetary allocation to 10% of the revenue budget if the health services have to be made inclusive for all sections of the society. (IPA Service)