In the Union Budget for FY 2022-23, the Ministry of Health and Family Welfare (MOHFW) has received an allocation of ₹86,200 crore (BE). This amount is almost similar to ₹86,000 crore (RE) allocated in FY 2021-22 and around 7 per cent more than ₹80,693 crore actual expenditure in FY 2020-21. The Ministry of AYUSH has received an allocation of ₹3,050 crore, which is almost similar to BE in FY 2021-22 but 15 per cent increase over RE. In terms of new health initiatives, an open platform for rolling out the National Digital Health Ecosystem and a ‘National Tele-Mental Health Programme’ with the aim of delivering mental health counselling and care services, have been announced.

In the demands for grant, the MoHFW has received an allocation of ₹5,845 crore under the Pradhan Mantri Ayushmann Bharat Health infrastructure Mission (PMABHIM), which was announced in the last Budget as Pradhan Mantri AtmaNirbhar Swasth Bharat Yojana (PMANSBY) and launched as PM-ABHIM in Sept 2021. This allocation has been marked for a few Central sector schemes (CSS) and Centrally-sponsored schemes under the department of health and family welfare as well as ₹690 crore for bio-security preparedness and strengthening pandemic research as well as for One Health under the department of health research. Another key increase in allocation has been for National Digital Health Mission (NDHM) which has received ₹200 crore. There is a nearly 70 per cent increase in capital expenditure from ₹3,813 crore (RE 2021-22) to ₹5,632 crore (BE 2022-23).

One of the noticeable points is that during the FY 2021-22, majority of key programs, i.e. national rural health mission, national urban health mission, Pradhan Mantri Jan Arogya Yojana, had witnessed a reduction in Budget allocation during the revised estimates.

Another noticeable change in the health budget 2022-23 is that many component-wise subheadings under the national health mission (NHM) have been merged, except the budget sub-headings for tertiary care programs and human resources for health and medical education. Nearly 75 per cent of the total allocation for NHM in the Budget has been kept under two broader headings of (a) flexible pool for Reproductive and child health, health systems strengthening, national health programs as well as NUHM and (b) infrastructure maintenance.

Focus on strengthening ‘One Health’, disease surveillance, increase in capital expenditure for health and human resources in medical education are some of the high points for the health sector. The tele-mental health programme apparently emanates from the right diagnosis of increased burden of mental health issues; however, it has not received additional allocation. More investment for health, specially in areas such as management of post-long Covid is clearly a missed opportunity. Then, the financial allocation, when adjusted for GDP growth, inflation and population growth, would essentially mean actual decline in allocation for the health sector.

This was the first Union Budget after the devastating second wave of Covid-19, which had exposed the limitations of India’s healthcare system. It is also a Budget where getting economic recovery on track is a key focus (rightfully so). For every dollar (or Rupee) spent on health, there is an estimated nine-fold return on the investment. Therefore, in preparing for a post-pandemic period, more allocation for health is a realistic expectation. The Finance Minister started her Budget speech on a high note of expressing empathy to those who faced the adverse health and economic impact of the pandemic. However, when speech ended and the detailed Budget documents became available, on an objective assessment of the financial allocations or potentially impactful initiatives for the health sector, one gets a feeling that the FM could have done more for health.

The author is a medical doctor and trained epidemiologist and health systems specialist. He tweets at @DrLahariya.

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