Deception in the Health Budget 2021-22

There were huge expectations from the Health Budget but it finally turned out to be a damp squib, says RAVI DUGGAL.

Health and Family Welfare has got an allocation of Rs. 71269 crore for 2021-22 and if we include AYUSH and Health Research it adds up to Rs 76,902 crore and this is merely 2.21% of the Total Budget in contrast to 2.27% for Budget Estimates 2020-21 and 2.47% of 2020-21 Revised Estimates.

Clearly, no growth in healthcare spending is visible for the forthcoming fiscal year. The increase in revised estimates for 2020-21 are of course due to additional emergency allocations on account of Covid-19.

The Covid-19 Emergency Response allocation has only been made for 2020-21 and not for 2021-22 as under:

• National Centre for Disease Control: Rs. 95 crores
• Supplies for Covid-19 response:  Rs. 4724 crores
• Covid-19 expenses under NRHM:  Rs 6935 crores
• Covid vaccines for health and frontline workers: Rs 360 crores
• Covid support for Research: Rs 2100 crores

The above adds up allocations of Rs. 14,217 crore, but what will actually be spent would be known only next year.

Table 1 presents an overview of the budget as presented in the latest budget document and what it reveals is that while the budget estimate of 2020-21 was hiked by 23% in response to covid-19 in the 2021-22 allocation, we see a decline of 10.85% from the 2020-21 revised estimates. Covid-19 has certainly not gone away and hence this decline of allocation is indeed surprising in the main health budget.

Table 1: Union Government Health Budget 2019-20 to 2021-22 Rs crores. Source: Expenditure Budget 2021-22 Vol 2, Ministry of Finance, Govt of India, 2021.

However, there are two additional amounts for healthcare allocated in the 2021-22 budget under the Finance Ministry as special grants and that is Rs.35,000 crores earmarked for covid vaccines when needed and Rs. 13,192 crores as special grants for health by the 15th Finance Commission. But like the covid emergency response allocations in 2020-21 these are onetime special allocations and not an integral part of the health budget.

The Finance Minister also spoke about a new centrally sponsored scheme PM AtmaNirbhar Swasth Bharat Yojana to be launched with an outlay of about Rs 64,180 crores over 6 years as additional to the NHM budget and provided elaboration.

This will develop capacities of primary, secondary, and tertiary care Health Systems, strengthen existing national institutions, and create new institutions, to cater to detection and cure of new and emerging diseases. The main interventions under the scheme are:

a. Support for 17,788 rural and 11,024 urban Health and Wellness Centers;

b. Setting up integrated public health labs in all districts and 3382 block public health units in 11 states;

c. Establishing critical care hospital blocks in 602 districts and 12 central institutions;

d. Strengthening of the National Centre for Disease Control (NCDC), its 5 regional branches and 20 metropolitan health surveillance units;

e. Expansion of the Integrated Health Information Portal to all States and Union Territories to connect all public health labs;

f. Operationalisation of 17 new Public Health Units and strengthening of 33 existing Public Health Units at Points of Entry, that is at 32 Airports, 11 Seaports and 7 land crossings;

g. Setting up of 15 Health Emergency Operation Centers

h. Setting up of a national institution for One Health, a Regional Research Platform for WHO South East Asia Region, 9 Bio-Safety Level III laboratories and 4 regional National Institutes for Virology.                    

However, the budget document does not reflect this in any allocations and so it is as of now merely an announcement.

The 2021-22 Health Budget betrayed the expectation amongst citizens that the covid crises would push the government to make structural reforms in the public healthcare system and quickly set on path for the health budget to move closer towards the goal of 2.5% of the GDP.

We are still far away from it and there does not seem to be the political will to transform the lives and health of e people.

Let us wait and see what states have to offer when they present their budgets.

The article was originally published in The Leaflet.

(Ravi Duggal is a sociologist, health researcher and activist associated with the Peoples Health Movement. The views expressed are personal.)