After Covid, everyone expects health to get big hike in Budget but govt is being cautious

Modi govt may have to strike a fine balance between health finance and economic reality even as the pandemic has tested the capacity of Indian health system.

A health worker collects swab samples for the RT-PCR Covid test, at Najafgarh in New Delhi on 20 November 2020 | Representational image | ANI

New Delhi: On 1 February 2020, when Finance Minister Nirmala Sitharaman announced a 3.75 per cent raise in the budget for his ministry, Health Minister Harsh Vardhan had described the jump as an “appreciable increase”. It was not hyperbole in the face of a slowing economy and cuts for several sectors but was seen as an appreciable rise.

A year later, when health has been the overwhelming issue on everyone’s mind — from the Covid-19 numbers and beds in the beginning of the pandemic to vaccines now — there is expectation among the public of a more notable hike in the health budget this time.

As a percentage of GDP, last year’s outlay of Rs 69,000 crore was just 1.25 per cent of India’s total financial commitment — and just half of the target of 2.5 per cent the country has set for itself for a very long time now.

Regardless of whether that target is met or not, in terms of percentage rise, this year could see the highest year-on-year jump in the health budget (allocation), given the heavy financial commitments the pandemic needed.

In 2019, the health budget went up by 17 per cent. A year before that, it went up just 5 per cent. So going by past trends, even a 20 per cent (Rs 13,800 crore) hike would be massive.

However, the Narendra Modi government is circumspect about the economic situation, and the states’ participation — the funding pattern is in a 60:40 ratio between the Centre and the states.

“We are not expecting a big thing (in terms of hike). It is true that this year highlighted health but the economy suffered too. Revenue has been hit. When you don’t have the space to manoeuvre, you cannot do so no matter how hard you try,” said a government source.

“Moreover for the kind of increase that is being speculated, states would also need to be prepared to cough out their share,” the source said.

With every facet of the Indian healthcare system tested during the pandemic, its least discussed aspect has been the sheer financial burden — from provisioning for additional beds in the early days, to allocating resources for testing, contact tracing and quarantine, upgrading laboratories to equip them with the capacity to do molecular testing and now to procurement and disbursement of vaccines.

According to health ministry officials, who didn’t wish to be named, an estimate of the costs has not even been drawn up.

Here’s a look at some changes that might be considered in the health budget.

Urban HWCs

While India’s pandemic story has largely been good, one aspect where the country came up short was contact tracing, especially the lack of a dedicated health workforce like the Accredited Social Health Activists (ASHAs) that left cities like Delhi, Mumbai and Pune grappling with the coronavirus for far longer than others.

Whether the plan to set up urban health and wellness centres (HWCs) finds a mention in FM Sitharaman’s upcoming budget will be something to watch out for.

Each urban HWC is envisaged to cater to a population of 15,000-20,000 with five ASHAs and Auxiliary Nurse Midwives (ANMs) each, apart from doctors, nurses and paramedics. These are different from both the HWCs being set up under Ayushman Bharat.

National Digital Health Mission

Prime Minister Narendra Modi’s Independence Day announcement of the National Digital Health Mission (NDHM) is all set for a countrywide rollout. It is possible that the NDHM too will find mention in the budget with some assessment of the experience with the National Digital Health ID so far and the government’s vision of it going forward.

The NDHM aims to create a digital health ecosystem, complete with a personal health ID for every Indian, identifiers for doctors and health facilities and personal health records. All of this will be accessible through an app or a website, but “ownership” of these health records will remain with the individual. Only when a person grants access will a doctor or any other individual be able to see these records, that too for a limited period.

Vaccinations under Ayushman Bharat

Even as the Covid-19 vaccination programme is off to a start, albeit not as smooth as the government would have hoped for, one tricky question in the coming days is going to be about the funding for the vaccines.

For the first priority group of 3 crore healthcare and frontline workers, PM Modi has already announced that the Centre would procure all the vaccines and supply them to the state free of cost.

This model may not be sustainable for all the 30 crore people who come in the priority groups, including people with comorbidities and those aged above 50 years.

All eyes will be on the Union Budget to see if it presents clarity on the road ahead.

Moreover, with Health Secretary Rajesh Bhushan’s assertion that the government may not be looking at vaccinating all Indians just yet, it would be interesting to see what other options the government might explore to widen vaccination coverage.

One option could be to cover Covid-19 vaccinations under the Pradhan Mantri Jan Arogya Yojana (PMJAY), the tertiary care arm of the Modi government’s flagship health programme Ayushman Bharat.

Launched by Modi in 2018, PMJAY aims to prevent impoverishment because of catastrophic health expenses by providing an annual health cover of Rs 5 lakh per family to all 10.74 families listed according to “deprivations” in the Socio-Economic Caste Census 2011.

To include Covid vaccination under the coverage list could widen the vaccination net as and when the vaccine becomes available in the private sector, which is expected sometime in the second half of the year, according to senior health officials.

“That is one recommendation (of covering vaccinations under PMJAY). But it is for the government to accept it or otherwise,” said a senior health ministry official, who did not wish to be named.