The Finance Minister could well be regarded as a true blue public health advocate. For several decades, the public health community has argued against healthcare being viewed predominantly as illness care.

The Finance Minister has seized on these arguments to present a broader package of health and wellness programmes in her Budget.

This package also enabled her to smartly claim a 137 per cent increase in allocation for health! Those who expected a big boost to the existing programmes of the Health Ministry were due for disappointment, as the increase is only 9.6 per cent. Inclusive of the Departments of Health Research and AYUSH, which see larger increments, the allocation to the Ministry rises only by 11 per cent. Covid-19 vaccines get ₹35,000 crore. A new centrally sponsored scheme, Pradhan Mantri Atmanirbhar Swasth Bharat Yojana (PMASBY), gets ₹64,180 crore over the next six years

Water and sanitation see a three-fold increase in allocation. The budgeted expenditure on nutrition sees a decrease in the allocation, though it is higher than the amount actually utilised last year. The Covid-19 pandemic response curtailed several nutrition related programmes last year, with closure of Anganwadi Centres and suspension of Mid-Day Meal programmes. Given these reasons, the underspending should not have led to a reduced allocation.

Mission Poshan-2

Merger of existing nutrition programmes into Mission Poshan-2, with an intensified strategy to improve nutrition outcomes in 112 Aspirational Districts, is welcome but needs to backed up with adequate resourcing and efficiency in delivery.

The Pradhan Mantri Jan Arogya Yojana (PMJAY) has an allocation with no increase from last year. This was because the utilisation was less than 50 per cent in the last financial year. The need to upgrade and expand public sector hospital capacity across the country, to enable greater utilisation of PMJAY funded services, is a clear message which the Central and State governments should not ignore. Further, PMJAY should link seamlessly with the National Health Mission (NHM) and fund the provision of out-patient care and essential medicines.

The NHM itself has seen a very modest rise from last year’s allocation but an actual decline in relation to last year’s revised estimates. The urban health mission component of the NHM still awaits a determined push and the comprehensive primary care component of Ayushman Bharat needs higher investment in human resources, equipment, diagnostics and drugs. The Budget seems to have pushed them on to the agendas of the States and into the newly minted Swasth Bharat Yojana. (PMASBY).

The PMASBY, a centrally sponsored scheme, will be co-funded by the Centre and the States, with initially higher funding from the Centre. The annual spend on this by the Centre is unclear in terms of both the budgetary allocation this year or the locus of control in the Health Ministry or elsewhere in the government. The scheme clearly owes its provenance to the challenges posed by the pandemic and aims to gear up preparedness for prevention, surveillance and response to future epidemics. It speaks of “support for 17,788 rural and 11,024 urban health and wellness centers”.

Disease surveillance will be strengthened at block, district and metropolitan levels, with improved surveillance at all international entry points. The National Centre for Disease Control and its five regional branches will be strengthened. Public health labs in all districts and 3,382 block public health units in 11 States will bolster monitoring capacity, while critical care units in 602 districts and 12 central institutes will help to strengthen case management. Strengthening of epidemiological surveillance and response systems is very much needed but should not be limited to infectious diseases, as adverse clinical outcomes are greatly influenced by co-morbidities of non-communicable diseases.

The simultaneous arrival of the allocations made by the Fifteenth Finance Commission is a blessing for the health sector, as it provides both resources and direction. It calls on States to increase health financing to more than 8 per cent of their budgets by 2022, while providing support to urban and rural primary healthcare, block level public health units and diagnostic infrastructure in primary care. These measures will greatly help to strengthen the health system, apart from democratising it with the greater engagement of local bodies. The wide angle view of health provided by the Budget and the resource backed reforms proposed by the Finance Commission can accelerate our journey towards an efficient and equitable health system.

The writer, a cardiologist and epidemiologist, is President, Public Health Foundation of India (PHFI). The views expressed are personal

comment COMMENT NOW