Health as well being

It is hard to argue against Finance Minister Nirmala Sitharaman’s stated rationale for merging allocations for water, sanitation, nutrition, and even the Central Roads and Infrastructure Fund into the umbrella head of ‘Health and Wellbeing’. Indeed, policy documents have long advocated inclusion of precisely such social determinants to enlarge the definition of ‘Health’ not just as curative but also preventive and holistic. The creation of Primary, Secondary and Tertiary Healthcare systems integrated with municipalities, sanitation systems and nutritional programmes is precisely the approach that would have arrested the grim spectre of 2,000 Indians dying every day of a totally preventable disease such as diarrhoea. Never was the stark absence of a functional healthcare system felt more acutely than during the Covid-19 pandemic.

In this context, Sitharaman’s assertion of an 137 per cent increase in Budget outlay for health is welcome but it needs clarity in parts especially because there is a decline in the spending on nutrition. Of the various heads, the rise in the allocation to the Department of Health and Family Welfare is about 9.6 per cent from ₹65,011.80 crore in 2020-21 to ₹71,268.77 crore. The Ayush Ministry outlay is up from ₹2,122 crore to ₹2,970 crore. The allocation to Drinking Water and Sanitation has been stepped up by 178 per cent from ₹21,518 crore to ₹60,030 crore and a grant of ₹35,000 crore has been provided in the Transfer to States head in the Expenditure Budget statement. The case for a holistic view of Health rests on an allocation of ₹20,105 crore to what has been christened as Saksham Anganwadi and Poshan-2 programme.

However, Saksham Anganwadi and Poshan-2 requires closer scrutiny in the light of the revelation by the National Family Health Survey (NFHS-5) of a staggering rise in child malnutrition and stunting in India. It appears to be a rejig of numbers by taking out schemes from the Umbrella ICDS, the Centre’s flagship nutrition programme, thus far under the Ministry of Women and Child Welfare. Till the last fiscal, the Umbrella ICDS included six heads — Anganwadi Services (₹20,532 crore), National Nutrition Mission (₹3,700 crore), PM Matru Vandana Yojna (₹2,500 crore), Scheme for Adolescent Girls (₹1,500 crore), National Creche Scheme (₹75 crore) and Child Protection Services (₹1,500 crore). The refashioning of the Umbrella ICDS (₹28,557.38 crore) as Saksham Anganwadi and Poshan-2 (₹20,105 crore) amounts to a cut in nutrition of about ₹5,000 crore after clubbing PM Matru Vandana Yojna (₹2,500 crore) with Mission Shakti and refashioning of Child Protection Services into Mission Vatsalya (₹900 crore) and the rest of components being cut. It would also help if the Centre clarifies where the PM Atmanirbhar Swastha Bharat Yojna has been provisioned considering it does not reflect in the statement of Budget estimates nor in the Health Ministry documents. Indeed, striving for a holistic vision for healthcare is a commendable enterprise. The next step should be towards achieving it with vigour.