New Delhi: In the interim budget presented for the year 2024-25, Union finance minister Nirmala Sitharaman pitched for a ‘Viksit Bharat’ by 2047. However, in that imagination of a ‘developed India’, the budget allocation for the department of health and family welfare and the department of health research, and key nutrition programmes have dipped for the FY 2024-25 as compared to FY 2023-24 budget estimates, when adjusted for inflation.
Both the two departments related to health come under Ministry of Health and Family Welfare, while nutrition schemes are managed by Ministry of Woman and Child Development.
Against the allocation of Rs 86,175 crores (according to budget estimates) for the department of health and family welfare for FY 2023-24, the allocation for 2024-25 stood at Rs 87,656 crore. While this seems to be an increase in absolute numbers, when adjusted for inflation at even 5%, this is a decline of 3.17%. Thus, in real terms, the budget for the health and family welfare department has gone down.
According to the National Health Policy, 2017, India needs to increase its budget for health every year so as to meet the target of spending 2.5% of the GDP on health by the year 2025.
PMSSY among worst hit
One of the key programmes that was hit was Pradhan Mantri Swasthya Suraksha Yojana under the department of health and family welfare. “The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) envisages the creation of tertiary healthcare capacity in medical education, research and clinical care, in the under-served areas of the country,” says the official document.
For FY 2024-25, the scheme has been allocated Rs 2,400 crore as against the budget estimate of Rs 3,365 crore for the last financial year. This essays a decline of 33% even without taking into account the inflation.
The scheme aims to upgrade existing medical colleges across India and build new AIIMS-like institutions. Six of these include the ones which were conceptualised during the last Atal Bihari Vajpayee-led government. Another 16 were conceptualised by the Narendra Modi-led NDA government which came to power in 2014.
This government constantly claims that establishment of new AIIMS-like institutions has been one of its biggest achievements but according to a parliamentary reply given last year, not one of the 16 institutes conceived from 2014 is fully functional yet. And, now even the budgetary allocation has been slashed.
There is a separate head in the budget document titled ‘Establishment Expenditure of New AIIMS’. “It provides for establishment expenditure of 22 new AIIMS located at different states,” the document says. Under this head too, the budget estimates for FY 2024-25 have declined to Rs 6,800 crore from Rs 6,835 crore (budget estimates) for the previous year.
The Indian Council of Medical Research (ICMR), which comes under the department of health research and is the most prominent research body for health and science, has been allocated Rs 2,432 crore for FY 2024-25 as against Rs 2,360 crore for last year. Again, while in absolute numbers, this seems to be an increase, but when adjusted for inflation for even 5%, it is a decline of 1.87%.
The allocation for National Aids and Sexually Transmitted Diseases (STDs) control programme also decreased to Rs 3,049 crore for FY 2024-25 – a decline of 1% as compared to previous year’s allocation but the shortfall is more than 5% when adjusted with inflation.
Ayushman Bharat
The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) was launched in 2021 after the massive second wave of the COVID-19 pandemic. The scheme was aimed at preparing for future pandemics. At the time of launch it aimed at spending Rs 64,000 crore over a span of five years. This also saw a decline in allocation as compared to budget estimates for last year. It has been allocated Rs 4,107 crore for FY 2024-25 as compared to Rs 4,200 crore last year.
“The measures under the PM ABHIM focus on developing capacities of health systems and institutions across the continuum of care at all levels, primary, secondary and tertiary, to prepare health systems in responding effectively to the current and future pandemics/disaster,” said the budget document.
The government has also launched a scheme to increase the number of branches of National Center for Disease Control (NCDC). Currently there is only one branch at Delhi. The NCDC was supposed to play an important role during the pandemic.
Under that head itself, the government had planned to control zoonotic diseases (diseases jumping from animals to humans), and strengthen efforts to reign in antibiotic resistance, technically known as antimicrobial resistance (AMR). India has the highest burden of AMR in the world. The allocation in this head too stood slashed from Rs 55.52 crore to Rs 52 crore.
One scheme, which saw an increase almost nearly adjusted with inflation was Pradhan Mantri Jan Arogya Yojana (PMJAY), of which the Ayushman Bharat scheme is a part. The Ayushman Bharat scheme provides an insurance cover of Rs 5 lakh per family per year for the hospitalisation expenses.
As of now, the PMJAY scheme has covered 40% families of India. The insurance premium is paid by the Central and the state governments as it is a centrally sponsored scheme. The scheme has been allocated Rs 7,500 crore for FY 2024-25 as against allocation of Rs 7,200 crore for FY 2023-24 (BE).
While the government touts the PMJAY as a landmark scheme, it receives criticism for not doing enough to create infrastructure and put money in hands of private healthcare providers. However, the government counters this by saying it has also built more than 1.5 lakh health and wellness centres. Last year, the Comptroller and Auditor General had found the scheme riddled with various forms of corruption at multiple levels causing not just loss to the exchequer but defeating the purpose of the scheme.
Nutrition
The finance minister stressed in her speech that Poshan 2.0 will be expedited for improved nutrition delivery, early childhood care and development.
Poshan 2.0 and Saksham Anganwadi scheme aims at “to develop practices that nurture health, wellness and immunity among malnutrition.” India is home to one of the highest number of malnourished children in the world.
The scheme has been allocated Rs 21,200 crore for FY 2024-25, an increase from Rs 20,554.31 crore (budget estimates) from previous financial year. However, when adjusted with inflation of 5%, this allocation is actually a decline of 1.77%.
Recently, India was ranked 111 out of 125 countries in the Global Hunger Index. The government rubbished the report though the report makers stood by it.
In her budget speech, the finance minister said that the government would ‘encourage’ girls in the age group of 9-14 years to take the HPV vaccine for the prevention of cervical cancer. However, she did not spell out whether the HPV vaccine – the jab against the cancer – would become a part of routine immunisation programme of the government given the fact that the government itself had said a few days ago that there were no immediate plans to introduce it in such a way in the later part of this year.
Anganwadi and ASHA workers
The minister also said a committee would be set up to open more medical colleges. However, no more details were given. It may be mentioned here that under the Pradhan Mantri Swasthya Suraksha Yojana, the government is already aiming at developing more colleges.
Sitharaman announced that the ASHA and Anganwadi workers would be extended the cover of Ayushman Bharat. The ASHAs, who are designated as activists, have been constantly demanding that they be given the status of workers so that they can get the cover of social security schemes which government workers get. Though that demand remains unmet, this may be the first instance of people employed by the government being extended the insurance cover of the Ayushman Bharat scheme. Union government employees are covered under the central government health scheme or CGHS, which unlike a health insurance scheme, gives upfront subsidised healthcare — both OPD and hospitalisation — to all its beneficiaries.
