New Delhi: Despite the Covid-19 pandemic having exposed the inadequacies in India’s healthcare systems, the sector is not getting sufficient fiscal attention, most public health specialists complain every year after the Union Budget.
But the Budget documents shared by the government this year revealed another inconvenient reality. The revised budget for the Union health ministry for the current financial year (2023-2024) is considerably less than the original budget estimated for the fiscal — reflecting how funds allocated for several key schemes were underutilised.
The proposed budget for the ministry — including the departments of health and family welfare and health research — for 2023-24 was Rs 89,155 crore. This was reduced to Rs 80,516 crore in the revised estimate (RE), the 2024-25 interim budget document revealed.
This is 9.6 percent less than the actual budget proposed for the current fiscal.
For 2024-25, the ministry has been allocated Rs 90,657 crore — which is 12.5 percent higher than the revised budget for the current fiscal.
The health budget as of now stands at just about 2.1 percent of the gross domestic product (GDP), up from 1.3 percent of the GDP in 2015-16.
Meanwhile, officials in the health ministry largely blamed states for underutilisation of the originally proposed funds for the year.
“Most of the ministry’s schemes are centrally sponsored with a Centre-state share of 60:40, but in many cases, states fail to utilise the schemes to the full due to capacity issues,” said a senior ministry official.
The official, who did not wish to be named, added that this problem was largely experienced in the case of a few particular states, without naming any state.
ThePrint reached Apurva Chandra, appointed as health secretary Saturday (he was holding the additional charge of health since last month), over calls and text messages but got no response. This report will be updated if and when a response is received.
Former health secretary Preeti Sudan maintained that there is no dearth of money for health schemes when there is a need.
“It may be an issue on the part of some states in utilisation of funds, but I don’t think there is an issue of availability of funds for health-related projects,” she told ThePrint.
Sudan also pointed out that for many infrastructure-related projects, there is a time lag in planning, fund allocation and implementation.
However, some health sector experts blame the lack of political commitment for under utilisation of health scheme funds.
“Building health facilities and creating these services, a functional medical college for example, are far more complex than building roads and bridges,” said a health systems expert with the World Health Organization-India, who did not wish to be named.
According to Oommen C. Kurian, senior fellow and head of health initiative at the Observer Research Foundation (ORF), the downward revisions in overall budget estimates for last year’s health allocations are not new, given the post-pandemic boost in the budget for health.
“It had happened in 2022 as well, on account of money assigned for Covid preparations being unspent due to lack of demand,“ he told ThePrint.
Kurian added that it’s a fact that the health sector has not yet seen a sustained increase in allocations and spending like drinking water is seeing now, and sanitation saw earlier.
ThePrint looks at the revised budget for the current financial year (2023-2024) and breaks down the scheme that saw major cuts.
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Key schemes see fund cuts
A closer look at the 2023-24 expenditure, suggests that estimates for several key schemes have been revised. This includes the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) for which Rs 3,365 crore was proposed for the year, but it has been revised to Rs 1,900 crore.
Under the scheme, the government aims to correct regional imbalances in the availability of affordable tertiary healthcare services and to augment facilities for quality medical education in the country.
PMSSY has two components — the setting up of the All India Institute of Medical Sciences (AIIMS) and the upgradation of existing government medical colleges.
According to the ministry, till July last year, 22 new AIIMS and 75 projects of upgradation of government colleges had been approved under the scheme in various phases.
Another scheme, which has seen significant revision in funds is Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM).
First launched during the 2021 Budget, the scheme aims to fill critical gaps in health infrastructure, surveillance and health research — spanning both the urban and rural areas so that the communities are independent in managing pandemics or health crises.
There are two components to the scheme — centrally sponsored components that include rural and urban health and wellness centres, block public health units, integrated public health labs and critical care hospital blocks.
The other component of the scheme planned to start 12 central institutions as training and mentoring sites with 150 bedded critical care hospital blocks, strengthening the National Centre for Disease Control (NCDC) and setting up a national institution for One Health, apart from four new National Institutes for Virology, among others.
However, the budget documents show that, while Rs 4,200 crore had been allocated for the centrally sponsored components of the scheme, it was later revised to Rs 1,900 crore. The budget for the second component was also revised to Rs 200 crore from Rs 645 crore.
The third scheme that saw the most drastic cut in funds was human resources for health and medical education under the National Health Mission. The project includes opening new medical and nursing colleges and increasing the number of seats in medicine.
The original budget allocated for this scheme was Rs 6,500 crore, which was revised to Rs 1,519 crore.
For the government’s flagship health insurance scheme, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY), too, the budget was revised to Rs 6,800 crore from Rs 7,200 crore. Under the scheme, the poorest 10 crore families across India are offered hospitalisation coverage of up to Rs 5 lakh.
The budget marked for the national AIDS and sexually transmitted disease control programme has also been revised to Rs 2,420 crore from Rs 3,079 crore.
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‘Schemes stuck in bureaucratic rigmarole’
According to the WHO-India health systems expert quoted earlier, often for such schemes there is not adequate push by the local MP or MLAs or state governments because of which the schemes remain stuck in bureaucratic rigmarole.
“Therefore much higher political resilience and accountability mechanism is required to ensure what has been proposed is followed through,” he stressed.
ORF’s Kurian pointed out that the PMSSY and PMABHIM’s latest allocations are marginally lower than last year’s budget estimates. “This seems to be on account of the revised estimates for last year being considerably lower than budget estimates, indicating low utilisation, which needs to be corrected,” he stressed.
“The interim budget focuses on preventive health, with U-WIN and HPV (Human Papillomavirus) vaccination, and potentially adds around 1.2 million health workers and their families into PMJAY, which are important steps towards universal health coverage,” Kurian added.
The U-WIN portal, which is similar to the Covid-19 vaccine management system Co-WIN, aims at documenting all vaccination and immunisation programmes in the country, including registration, follow-ups, and vaccination certificates.
However, according to him, the budget for the National Health Mission has plateaued, and it won’t improve unless human resource gaps are addressed.
“The government seems to have realised this, given the continuing focus on public-sector-led medical education in this budget as well. The plan to consolidate and enhance hospitals under non-health ministries and Public Sector Undertakings is perhaps the most significant announcement in this budget,” Kurian said.
The statement made by the finance minister in her Budget speech suggested that the government may convert existing health infrastructure outside the control of the health ministry, too, into medical colleges. The Centre had earlier already initiated a massive project to upgrade existing district hospitals into medical colleges.
Kurian explained that the move will add dozens, if not hundreds, of hospitals to public sector health education infrastructure. In parallel, more than 150 nursing colleges are also getting ready, he added.
This is an updated version of the story.
(Edited by Richa Mishra)
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