New Delhi: On February 1, while presenting the Union Budget for the financial year 2022-23, Finance Minister Nirmala Sitharaman made some key announcements in the healthcare sector. This includes the roll-out of an open platform for the National Digital Health Ecosystem and the launch of the National Tele-Mental Health Programme. National Digital Health Ecosystem will consist of digital registries of health providers and health facilities, unique health identity, consent framework and universal access to health facilities. On the other hand, National Tele-Mental Health Programme will include a network of 23 tele-mental health centres of excellence with the National Institute of Mental Health and Neuro-Sciences (NIMHAS) being the nodal centre and the International Institute of Information Technology (IIIT) Bangalore providing technical support. Apart from these two announcements in the budget speech, the Ministry of Health and Family Welfare (MoHFW) has received an allocation of Rs. 86,200.65 crore (Budget estimate – BE) for 2022-23 which is a mere 0.23 per cent higher than the revised estimate of Rs. 86,000.65 crore in 2021-22. The current budget allocation is 6.82 per cent higher than the actual spending of Rs. 80,693.92 crore for the financial year 2020-21.
Talking to NDTV Dr Naresh Trehan, Chairman, CII Council on Health said that the increase in health budget is “not significant” because we are so under-funded for healthcare.
Sharing his disappointment on the little to nothing increase in healthcare spending, Dr Dilip Kamat, Senior Medical Administrator, Amrita Hospital, Kochi said,
In pure monetary terms, there is no major outlay to the healthcare sector per se. The allocation as a percentage of the GDP doesn’t appear to have changed. The focus has continued to remain on aligning various other sectors to achieve public health goals. The development of public health infrastructure and the development of skilled healthcare professionals to meet the healthcare needs of the growing population of India didn’t find a mention in the budget. This is disappointing in a way as these were badly exposed during the COVID-19 pandemic, especially during the second wave.
Dr Rachana Parikh, Senior Program Officer, Mental Health, PATH – South Asia also believes that in the wake of the third COVID wave and future variants, there should have been an increase in allocation for health. Dr Parikh said,
Increased allocations would have added the necessary impetus in enhancing the resilience of the health systems. It would have helped to instill more confidence in the healthcare services as they will cater to the increased health and mental health needs of the people in the wake of the pandemic and overcome for the opportunities lost during the pandemic. We also need to map and provide for the people with long COVID symptoms.
The Economic Survey 2020-21 had strongly recommended an increase in public spending on healthcare services from 1 per cent to 2.5-3 percent of GDP, as envisaged in the National Health Policy 2017. The latest Economic Survey of 2021-22 noted an increase in health expenditure to 2.1 per cent of GDP in 2021-22 against 1.8 per cent in 2020-21 in and 1.3 per cent in 2019-20. Expenditure on ‘Health’ includes expenditure on ‘Medical and Public Health’, ‘Family Welfare’ and ‘Water Supply and Sanitation’.
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A Look At The Budget Allocated To Ministry Of Health And Family Welfare
A breakdown of the budget allocated solely to the MoHFW shows that the largest chunk of the allocated sum goes to the National Health Mission (NHM) which covers health system strengthening in rural and urban areas. The NHM envisages achievement of universal access to equitable, affordable and quality health care services that are accountable and responsive to people’s needs. This year Rs. 37,000.23 crore or 42.92 per cent of the MoHFW allocation is for NHM.
Budgetary allocation to the National Health Mission saw a 7.41 per cent rise when compared to RE of Rs. 34,447.14 crore in 2021-22 and a mere 0.21 per cent rise from the actual spending in 2020-21.
As per an analysis by the NGO Population Foundation of India, the marginal increase in the budget for NHM, the government’s flagship health programme, will put the burden of financing the programme on the states. While the relatively developed states have greater resources to invest in the health needs of the population, the lack of support from the centre will put the less developed states at a significant disadvantage.
Allocation under Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) which comprises setting up of new AIIMS (All India Institute of Medical Sciences) and upgradation of existing Government Medical Colleges has been increased to Rs. 10,000 crore from Rs. 7,400 crore (RE) in 2021-22 and Rs. 7,000 crore in 2020-21.
Budget for National AIDS (Acquired Immunodeficiency Syndrome) and STD (Sexually Transmitted Diseases) Control programme has seen an increment of 11.61 per cent – Rs. 2,622.75 crore (BE) from Rs. 2349.73 crore which was the revised estimate for 2021-22. However, if we compare it to the actual money spent in 2020-21 that is Rs. 2,815.45 crore, there has been a drop of 6.84 per cent.
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The money allocated to the National Digital Health Mission (NHM) has seen a whopping 166 per cent rise. In 2021-22, Rs. 30 crore was estimated which was later revised to Rs. 75 crore. And this year, a budget of Rs. 200 crore has been estimated for the mission.
NHM provides for creating a National Digital Health Eco-System that supports universal health coverage through the provision of a wide range of data and information and infrastructure services, reads the budget document.
In a press statement, Dr Prathap C. Reddy, Chairman, Apollo Hospitals Group lauded the new National Digital Health Eco-System and said,
The budget keeps us on track on enabling universal health accessibility with the proposed National Digital Health Ecosystem. With digital registries of health providers and health facilities, unique health identity for each individual will help in providing universal access to health facilities.
Dr Trehan adds,
The national health registry will definitely help because that itself will let us know where the whole healthcare delivery system, the support system is adequate and where it is not. It will help hugely in planning and integrating the whole system.
Budget under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) has more than doubled from Rs. 3,199 crore (RE) in 2021-22 to Rs. 6,412 (BE) in 2022-23.
After over 21 per cent cut in allocation last year, Family Welfare Schemes saw a huge jump in allocation this year. The Family Welfare Schemes provide for Swastha Nagrik Abhiyan (SNA), population research centres, health surveys and research studies, procurement of contraceptives for social marketing and free distribution, among others. It saw an over 58 per cent increase in the budgetary allocation from Rs. 306.13 crore (RE) in 2021-22 to Rs. 484.35 crore (BE) in 2022-23.
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Talking about the same, Ms Muttreja said,
The Economic Survey attributed the fall in fertility rates to the increased use of contraceptives, especially modern methods. Going forward, there is a strong need to expand the basket of contraceptive choices, to include long-acting reversible contraceptives such as implants in the public-health system, and strengthen the quality of care to meet the sexual and reproductive health needs of India’s large young population.
While we talk about health, it is important to remember that India saw a disastrous second COVID wave from April to June 2020 that unfolded the reality of the country’s healthcare infrastructure. Currently, we are in the midst of the third wave. Amid this, India COVID -19 Emergency Response and Health System Preparedness Package (Phase-II) is completely missing in this year’s budget. Also, the budget allocated to Pradhan Mantri Garib Kalyan Package – Insurance Scheme for Health Care Workers fighting COVID-19 has been reduced from Rs. 813.60 crore to Rs. 226 crore. Talking about the same, K Sujatha Rao, Former Union Health Secretary said,
Ignoring health is at our peril. We have just seen what a devastating impact on all sectors of the economy and how comprehensively the pandemic has disrupted our lives. If the government wants to bury its head in the sand and not want to see or hear then what can one say. How could a situation have been worse than what we have seen and been through?
However, the government has decided to focus on one of the fallouts of the pandemic that is accentuated mental health problems. For the same, National Tele-Mental Health Programme will be implemented by NIHMANS and IIIT-B. In the budget document, no separate allocation is specified for the tele-mental health programmed.
Under Tertiary Care Programmes, National Mental Health Programme has been allocated a budget of Rs. 40 crore, a 27.5 per cent higher spend from Rs. 29 crore in 2021-22. Along with this, Rs. 560 crore have been allocated to NIMHANS compared to Rs. 528.49 crore allocated in the previous year. Every year budget is allocated to NIMHANS for providing services, training and research functions in the field of mental health and neurosciences. No allocation has been specified for the new tele-mental health programme.
Talking about the rollout of the programme, Dr Pratima Murthy, Director of NIMHANS said,
Centres of Excellence are either institutions or departments of psychiatry in different colleges that have been upgraded to cater to the needs. 23 centres of excellence already exist. We will set up tele-mental health unit in each of the state and union territories. In the last five years, National Mental Health Programme, which was started in the 1980s, has been expanded to over 700 districts. We will also be simultaneously looking at strengthening the district mental health programmes and involving community workers. Unlike other diseases, many psychotic disorders are chronic disorders and they need follow up and care. The treatment gap is very high for mental disorders and this is an opportunity to at least start off with making some service available to a lot of people and prioritising those who need to move up in more intensive services and providing them.
Dr Murthy informed that generally, there is an Interactive Voice Response System (IVRS) number where people call in and depending upon the origin of the call, it will be transferred to the specific state.
Based on the needs of the caller, the trained counsellor will intervene and if needed, they will escalate it to a mental health professional. It is about creating an ecosystem to help people with mental disorders, she said.
Dr Murthy also noted the inequitable distribution of mental health resources across states and said that if trained mental health counsellors engage with district mental health programmes, they will be able to create a system of care.
When asked about the digital divide, Dr Murthy said, the programme is about tele-consultation and over 73 per cent of the people in the country have a mobile phone. The challenge will be in transitioning the programme to video consultations.
Dr Parikh believes the focus on digital health is timely. In the mental health domain, considering the low number of psychiatrists and psychologists, it is a good way to provide increased access to specialist care.
Under MoHFW, the budget allocated to the Department of Health Research reported a 3.91 per cent rise from Rs. 3,080 crore (RE) IN 2021-22 to Rs. 3200.65 crore (BE) IN 2022-23. This is likely to give a boost to research.
Health and well-being was one of the six key pillars of Union Budget 2021, signalling the importance of health, especially amid the COVID-19 pandemic. However, this year’s budget doesn’t show improved attention towards health. Avani Kapur, Fellow, Centre for Policy Research and Director, Accountability Initiative said,
The worrying part is that the COVID-19 pandemic has shown the state healthcare infrastructure which wasn’t strong enough to respond to the crisis. There is no question that we need to invest in health. National Health Mission which is one of the largest schemes has often been underfunded.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, that is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.
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