The push for an insurance-based health model in India has come at a huge cost for preventive public health schemes. According to experts, the Centre’s contribution towards the National Health Mission (NHM) has consistently declined over the years; from 60 per cent in 2014-15, it has dipped to about 50 per cent in the 2019-20 Interim Budget, they point out.

Of the ₹31,274 crore allocated in the 2014-15 health budget, the NHM had received ₹18,609 crore (61 per cent). In 2019-20, of the ₹63,298 crore (total budget), it was allocated ₹31,745 crore (50 per cent). However, this year, the NHM has taken the maximum beating. Compared to last year, there has been a five per cent decline: from 55 per cent in 2018-19 (₹30,683 crore of ₹56,045 crore) it is down to 50 per cent in 2019-20 (₹31,745 crore of ₹63,298 crore).

“The share in the Budget has been continuously declining over time; however, the maximum decline of 5 per cent was seen in 2018-19,” stated Avani Kapur, a Fellow at the Centre for Policy Research and Director of the Accountability Initiative.

While the Pradhan Mantri Jan Arogya Yojana (PM-JAY) has received ₹6,400 crore (nearly one- tenth of the total health budget which stands at ₹63,298.12 crore) — the largest share of the pie in health budget — experts say that it is at the cost of allocation to other schemes.

Worrying numbers
  • Allocation to National Health Mission reduced from 55 per cent of the total health budget in 2018-19 to 50 per cent in 2019-20
  • Budget allocation for non-communicable diseases faced a cut of up to 28.63 per cent
  • The revised estimates of the ‘Reproductive and Child Health filexipool’ in NHM are down 30 per cent in 2018-19 compared to the previous year; the allocation has further dipped in 2019-20

A close scrutiny of the Budget documents indicate that budget allocation for non-communicable diseases decreased from ₹1,004.67 crore in 2018-19 to ₹717 crore in 2019-20, a 28.63 per cent cut.

‘Reductions harsh’

Further, the revised estimates of Reproductive and Child Health filexipool in NHM, which looks after routine immunisation, pulse polio programme and maternal health, have reduced from ₹7,545.07 crore in 2017-18 to ₹5,253.51 crore in 2018-19, a 30 per cent decrease. This despite utilisation of up to ₹7640.24 crore in actual figures of 2017-18. The current year's allocation, at ₹5,253.46 crore, is even lesser.

Furthermore, while ₹3,066.80 crore was spent in 2017-18 to build infrastructure and procure equipment under the head capital expenditure, the allocation has been reduced by 43 per cent to ₹1,750.90 crore. For example, under the head Establishing New Medical Colleges (upgrading district hospitals), there is a decline of nearly 40 per cent over the expenditure in 2017-18, a statement released by Jan Swasthya Abhiyan (JSA) said. While ₹3,300 crore was spent in 2017-18 actuals, the current allocation stands at ₹2,000 crore.

“These reductions are especially harsh in the context of the government’s recent announcement of providing funds and land for setting up private hospitals in Tier-2 and Tier-3 cities,” said JSA.

Experts say that it is striking that the Centre’s spending on health stands at merely 0.31 per cent of the GDP, which is much lesser than what was spent a decade back. The National Health Policy 2017 talks about increasing public spending to 2.5 per cent of the GDP by 2025, but this would remain a far cry if the Centre’s allocations towards health are not increased considerably by at least 30 per cent annually.

“During the earlier period, sustained focus on public sector provisioning helped India improve access to select essential services and this helped us come close to achieving a number of Millennium Development Goals,” said Indranil Mukhopadhyaya, Associate Professor, School of Government and Public Policy in OP Jindal Global University, Haryana.

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