- The Union health ministry was unable to utilise 10% of the money allocated to it in the last financial year, 2023-24.
- The budget this year, for health and family welfare is down 3%. The decline is in keeping with consistent cuts in health spends by the government, despite claims made after the COVID-19 pandemic shook the system.
- The story of the new AIIMS claimed to have been set up also reveals wide discrepancies between talk around it and the status on the ground.
New Delhi: The Union health ministry could not utilise more than 10% of the money allocated to it in the last financial year, 2023-24. Since the second stint of the Modi government, which began in 2019-20, this is the highest proportion of money left unutilised by the ministry.
In real terms, the unspent amount comes to Rs 8550.21 crore. This is more than what finance minister Nirmala Sitharaman allocated as ‘establishment expenditure of all new 16 new AIIMS-like institutions’, for the current financial year 2024-25. The expenditure estimated for the purpose is Rs 6800 crore.
If we look at the last six years of the Narendra Modi government, the trend of underutilisation of funds allocated for health started from 2022-23.
In a budget document, the Budget Estimates (BE) for a head indicate money allocated, initially, during the presentation of budget. The revised estimates (REs) indicate a ‘revised’ amount allocated – a while after the budget announcement. The ‘revision’, done after some months, is based on the performance of the ministry and its future requirements for the remaining months of the particular financial year.
Starting from 2019-20, the Union health ministry’s REs for four consecutive years was higher than BEs. In other words, in those four years, the ministry got extra money allocated than what was initially budgeted for it.
But this trend reversed in 2022-23 and 2023-2024.
Indian health spend among lowest globally
This comes at a time when India’s allocated expenditure on health is already one of the lowest in the world. Despite the decline in out-of-pocket expenditure, health costs have been a factor in pushing thousands of people into poverty every year, something which even the government think-tank NITI Aayog confirms in a report.
“On one hand we say that the budgetary allocation for health, which directly impacts millions, is not enough and on the other we are not able to spend even what is allocated. This is serious,” Indranil Mukopadhyay, a health economist at OP Jindal University, said.
However, it must be noted that some share of this budget also includes centrally sponsored schemes , the cost for which are borne by central and state governments. the onus of utilisation of these lies on the state governments as well, and therefore the money spent as well.
“But the share of the state governments on health is continuously rising, indicating they need money for health. This does not sit with the fact that they are not utilising money,” Mukopadhyay said. “What is worth finding out is if the Union government is able to provide money to states on time,” he added.
At times, state governments delay the voicing of demands as well and this can also lead to a delay in the disbursal of funds from the Union government. However, that is not reason enough to withhold funds or leave them unutilised.
As far as budgetary allocations for the Union health ministry is concerned, it is divided into two parts – the department of health and family welfare and the department of health research. The latter includes the Indian Council of Medical Research. Most of the health schemes are covered under the former.
The department of health and family welfare has been allocated Rs 87,656 crore in the current financial year. On the face of it, this is a 13% increase from the previous year’s BE. However, when adjusted with inflation, the allocation actually decreases by a little over 3%
Also read: Ten Cr People Pushed into Poverty Every Year Due to Healthcare. Will The New Govt Act At Least Now?
Consistent decrease in health expenditure
The Modi government’s allocation to health has been declining continuously since 2022-23. The National Health Policy 2017, made by the same government, envisaged increasing the health budget every year so as to reach the target of spending 2.5% of the Gross Domestic Product on health by 2025. But this downward spiral appears to be taking the country in the opposite direction.
The current allocation translates into 0.29% of the GDP going towards health. This excludes funds going to water, sanitation and any other head that the finance ministry now clubs to show a total allocation for health.
No action to match tall talk
More than half of the health sub-head of the Economic Survey 2023-24, tabled a day before the budget was presented, was devoted to mental health. It spoke about how mental healthcare needs to become more important than ever before and also sought to give an impression that the government wanted to invest significantly in improving services in this sector.
However, budgetary allocations did not match the spirit of the Economic Survey. One of the main schemes to address the mental health needs of the country is the National Tele Mental Health Programme.
Its outlay for the current financial year has come down to Rs 90 crore. The partial reason for this could be the fact that against the allocation of more than Rs 133 crore last year, the programme could spend only Rs 65 crore.
In her interim budget speech in February this year, Sitharaman had announced 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, no budgetary details were spelt out. It was expected that in her full budget this time, she would spell out the details of this programme. But there was no mention of the HPV vaccine roll-out in the budget this time.
This time, she, though announced that the customs duty on three cancer drugs would be waived.
AIIMS claims versus facts
The Pardhan Mantri Swasthya Suraksha Yojana (PMSSY) has two components – the setting up of All India Institute of Medical Sciences (AIIMS) and the upgradation of existing government medical colleges and institutions.
White it is significant that the PMSSY budget has declined, a reading of the notes at the end of the relevant document tells us something even more significant: the status of the AIIMS.
Six AIIMS – Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur and Rishikesh – conceptualised during the last Vajpayee government are fully functional, it says.
But the budget document does not use the phrase “fully functional” for any of the 16 new AIIMS built during the 10 years of the Modi government. It says “16 AIIMS have been sanctioned/approved by the Cabinet in subsequent phases and out of which 11 AIIMS are functional.”
These are AIIMS at Gorakhpur, Rae Bareli, Nagpur, Kalyani, Mangalagiri, Bibinagar, Bathinda, Deoghar, Bilaspur (HP), Rajkot and Guwahati.
This is significant as The Wire had reported last year, on the basis of parliamentary replies furnished in 2023, that all the AIIMS conceptualised by the Modi government were either ‘partially functional’ or not functional at all. Not one of them were fully functional. The budget 2024-25 reiterates that status.
AIIMS at Vijaypur (Jammu), Madurai, Darbhanga, Awantipura (Kashmir) and Manethi (Haryana) are pending to be operational in the first place.
Another scheme – Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PMABHIM) – was launched by Modi in his constituency Varanasi in 2021-22 to focus on developing health systems so as to better respond to future pandemics.
It stipulates building more than 17,000 rural sub-health centres and more than 11,000 urban health centres. Apart from that, critical care blocks were supposed to be built at national state and district levels.
The total outlay proposed for this scheme to be spent over five years, up to 2025-2026, was Rs 64,000 crores.
However, in a parliament reply in December 2023, the government stated that the total allocation till financial year 2024 was only Rs 14,138.98 crores.
This year the scheme has been allocated Rs 3,756 crore because of under-performance last year. This takes the total expenditure till this financial year only to Rs 17,895 crore. So the government has only two more years left to exhaust the remaining outlay, Rs 46,105 crore of the scheme.
Health education spend falls
The other head which has seen a significant decline is the ‘human resources for health and medical education’ with an outlay of only Rs 1274.8 crore for this year. One reason for this could be that the scheme could spend only Rs 1519 crore against it budgetary allocation of Rs 6500 crore last year.
Similarly, the Biotechnology Research and Development department, which comes under the ministry of science, also saw a budget cut of Rs 500 crore. This may be due to the utilisation of less than half of the amount allocated last year.
The Indian Council Of Medical Research got a hike of Rs 300 crore this year.
