"The Budget lays a futuristic 'Amrit Kaal' for women, youth and marginalised communities..." said Union Finance Minister, Nirmala Sitharaman in her speech on Wednesday, 1 February.
But, where does health factor in the 'Amrit Kaal'?
"There were definitely high expectations of the Union Budget from the health sector," public health & policy expert, Dr Chandrakant Lahariya, tells FIT a day later. However, experts have since voiced their disappointment with the budget allocation for health.
Health Budget 2023: What's New?
Before we get into what was missing, here's a quick run down of what budget 2023 said, as far as health is concerned.
The total allocation for the department of health and family welfare this year is Rs 89,155 crore, which is just about 0.34 per cent higher than last year’s allocation of Rs 86,200 crore.
This also includes a Rs 2980 crore budget estimate for the department of health research — which is slightly more than the 2022-23 revised estimate of Rs 2775 crore, but still less than last year’s estimate of Rs 3,200 crore.
Speaking to FIT, Dr Sarit Kumar Rout, Health Economist, and Additional Professor at Indian Institute of Public Health, Bhubaneswar (IIPHB), said that the higher allocations for National Digital Mission is a good move, adding, "this will eventually lead to electronic health records, tracking the patient history and clinical records."
"Another important declaration is the sickle cell anaemia mission which will help tribal population largely."Dr Sarit Kumar Rout, Health Economicst, and Additional Professor at Indian Institute of Public Health, Bhubaneshwar (IIPHB)
According to Dr Lahariya, though, the initiative announced to eliminate sickle cell disease and anaemia by 2047 is useful, "but it’s very far away."
"India’s health sector needs intervention now," he adds.
"There are a lot of things that need to be done in the health sector, and anything that the Government wants to do is a welcome step. Having said that, there are not many initiatives that have been proposed this time in the Union Budget."Dr Chandrakant Lahariya
What Was Lacking?
"Critical areas of Pandemic Preparedness, Antimicrobial resistance (AMR), Mental Health, as well as focus required for infrastructure development have remained wanting in the budget," says Himanshu Sikka, Lead – Health, Nutrition & WASH, IPE Global, an international development consultancy firm.
However, according to Dr Lahariya, the Union Budget is not about announcing health initiatives.
"Union budget is more about allocation of funds, and increasing allocations to the health sector. And that is where it is lacking."Dr Chandrakant Lahariya
Lack of funds
Experts point out that the funds allocated to the health sector make up just 2 percent of overall Central Government expenditure meant for 2023-24.
"Allocations to health research has also reduced to Rs 2980 Crore in 2023-24BE from Rs 3200 Crore in 2022-23 BE," points out Dr Sarit Kumar Rout, Additional Professor, IIPHB.
Why is this not enough?
According to Dr Chandrakant Lahariya, higher allocations towards the health sector is important to meet two key goals.
The 'pandemic years' showed us many weaknesses in India’s healthcare system, and filling these gaps to prepare for the future can only be done through improved financial allocation for health services.
Secondly, experts also point to flagship programmes that were announced in last year's budget that still need to be implemented well, which also need funds.
Incomplete initiatives
"The budget has limited focus on fast pacing the implementation of some of the flagship schemes announced in previous budgets," says Himanshu Sikka.
For instance, the budgetary allocations for schemes under Ayushman Bharat umbrella, remain pretty much stagnant. "This is concerning as in previous years as well actual expenditure has remained way below the budgeted expenditure," adds Sikka.
While allocation to the Ayushman Bharat Health Infrastructure Mission in last year’s budget was something like Rs 4800 Crore, it was revised in this budget to around Rs 2000 Crore.
"Programmes that were announced have not been rolled out to the extent that they could, an are seeing limited success. So it's important to see that already rolled out programmes are sufficiently funded, and well implemented on the ground."Dr Chandrakant Lahariya
Public health could see a setback
"The national Health Mission is the key public health program, but the Centre neglects it, and this year the Centre's contribution actually shows a decline from Rs 37800 crores is 2022-23 to Rs 36785 crores," Dr Ravi Duggal, an Independent Researcher and Health Activist, tells FIT.
On the other hand, he says, the programmes proposed in the budget 'to strengthen public-private partnership', could end up weakening public health further.
"We see significant increases in budgets of technology driven and infrastructure related allocations such as Pradhan Mantri Jan Arogya Yojana (PMJAY) that promote private sector partnerships or privatization, which actually could further weaken the public health system."Dr Ravi Duggal
PMJAY is a problematic budget item. It receives a huge allocation, but spending is usually half of that each year. For instance, in 2021-22 the budget was Rs 7500 Crores, but actual spending was only Rs 3116 Crores. And we know from NITI Aayog data that 78 percent of the PMJAY funds flow into private hospitals," he adds.
'Need Intervention Now': Health Beyond the Pandemic
In the last three years, health became the epicentre of our lives and discourses thanks to the COVID pandemic, but now that COVID-19 has become endemic in India, experts fear health concerns will once again take a back seat.
"If not now, then in the years that will follow, health will be even a lower priority. So our opportunity to invest in health and the healthcare sector is now, and not in the future."Dr Chandrakant Lahariya
"India Public spending on health has been one of the lowest in the world, this is just 1.3 percent of GDP now as per the NHA India report, given the pandemic threats not over, anyone would expect overall higher allocations to health especially strengthening public health systems," says Dr Sarit Kumar Rout, Additional Professor, IIPHB.
"A balanced approach focusing on infrastructure, growth and social development would have been ideal," he adds.
"We need more funds for the primary healthcare facilities, and peripheral healthcare facilities," says Dr Chandrakant Lahariya.
Dr Ravi Duggal agrees, saying:
"Instead of the Rs 620 per capita, the Centre's health budget should have at least doubled to Rs 1,250 per capita with primary healthcare getting two-thirds share."Dr Ravi Duggal
According to Dr Duggal, some other initiatives in the future that can help the regular citizen are,
More teaching hospitals at district level so that tertiary care is available to people closer to their place of residence.
Make moves to fill the huge vacancies in positions of doctors, specialists and nurses in both district hospitals and Community Health Centres.
Assuring that free medicines and diagnostics are available in all public facilities, as this would help reduce substantially out of pocket expenditures.
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