The Ministry of Health and Family Welfare (MoHFW) has demanded up to ₹1.17 lakh crore from the Centre to fulfill its obligation to spend 2.5 per cent of the country’s Gross Domestic Product (GDP) on health. However, the Ministry is slated to receive only about ₹65,000 crore, 44 per cent short of what it has demanded, in the upcoming 2020-21 Budget allocations.

According to the latest report of the High Level Group on Health Sector, submitted to the 15th Finance Commission, healthcare expenditure by the Centre and States combined has hovered around 1.25-1.30 per cent of the GDP in 2018-19 and 2019-20. Interim Budget allocation in 2019-20 stood at ₹61,398.12 crore as compared to 2018-19 revised estimates of ₹54,302.50 crore.

The National Health Mission (NHM), which receives the lion’s share of the MoHFW outlay, will also as a consequence be under-funded, said a senior official from MoHFW. “We had demanded ₹62,000 crore for only the NHM; however, we have been tentatively sanctioned ₹29,000 crore, a marginal increase over ₹27,889 crore received last year,” said the official.

NHM funds

As far as the absorption capacity and utilisation of NHM funds by States is concerned, another official said that it stands at 86 per cent. “Sufficient money should be pumped in for health so that the absorption capacity increases. If States are unsure of how much they will get, then how are they to plan usage?,” asked the official.

Under-allocation of their respective share in the State health budgets further compounds the issue. The National Health Policy advocates that States spend 8 per cent of their budget on health. But on an average, according to statistics released by the Reserve Bank of India in September last year, it stands at 4.7 per cent on an average, with outliers like Delhi which spends 12.5 per cent and Puducherry which spends 8.3 per cent as ratio to aggregate expenditure. The High Level Group report has also recommended moving Health from the States list to the Concurrent list.

PM-JAY

The government’s another pet scheme -- Pradhan Mantri Jan Arogya Yojana (PM-JAY) -- which provides cashless health insurance cover of up to five lakh rupees annually to poor families, had been allocated ₹6,400 crore in 2019-20. Because of under-utilisation (up to ₹2,300 crore utilised till date), officials were asked to revise their estimates downwards for the current financial year to ₹5,200 crore. “Pending salaries under the Central Government Health Scheme were paid from diverted funds,” said the official.

The official also said that a marginal increase in the budget means that preventive screening for non-communicable diseases and geriatric-care will take a hit.

By 2022, the Centre plans to build 1.5 lakh health and wellness centres (HWCs), which will be the first point of care.

According to MoHFW, 27,000 HWCs have been made functional over the last three years. “We will increase this to 40,000 HWCs by March 2020, but these are structures that were existing and had to be refurbished. Building each HWC costs close to ₹20 lakh. The further target of building close to 50,000 HWCs in 2020-21, and 2021-22 is a humongous task,” said the official.

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