’Budget 2024 erases healthcare from national priority’

The Union budget for 2024-25 is surprisingly silent on health, said Prof K Srinath Reddy, a leading public health expert and former president of the Public Health Foundation of India (PHFI) on Wednesday. 

While infrastructure and employment are undoubtedly vital for India’s development, he said, it was as if the budget wished to erase any impression that either the Indian economy or the health system is suffering from long covid.

Reddy said the main lesson from the pandemic is that a sub-optimally resourced and underperforming health system is a banana peel on which the national economy can keep slipping. 

He said that the healthcare sector had been hoping for greater investment in the development of a multi-layered, multi-skilled health workforce, not only to address the many unmet needs of the domestic health system but also because the government has ambitiously proclaimed that India will meet global health needs through initiatives like Heal In India and Heal By India. 

“Strangely, those proclaimed initiatives have disappeared from our policy pronouncements after the end of India’s G-20 presidency,” he said. However, Reddy commended the emphasis on tribal health. 

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Edited excerpts from an interview:

How do you see the budget allocation for healthcare?

In real terms, when adjusted for inflation, the allocations for the health ministry budget overall, as well as for the National Health Mission (NHM) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) programmes, have declined. We need to compare the budgetary estimate (BE) of the 2024-25 budget with the BE of 2023-24. Comparing BE for this financial year with the revised estimate (RE) of last year would be incorrect as RE reflects the inability of the health system to spend the allocated money (for a variety of reasons) and not a reduction in programme needs. We should allocate money as per programme needs, while improving efficiency of absorption and utilization through a variety of health system strengthening measures. Allocations to AYUSH and health research have gone up, which is appropriate.

What differences do you find in the interim and full budgets?

The interim budget prominently headlined health through various new initiatives: a new immunization programme for girls and young women with Human Papillomavirus (HPV) vaccine to protect against cervical cancer; extension of PMJAY benefits to ASHA workers and Anganwadi workers; and U-WIN digital programme to support implementation and improve coverage of the universal immunization programme.

In contrast, the main budget speech of the finance minister was surprisingly silent on health, with infrastructure and employment as the major thrust areas for Vikasit Bharat. While those sectors are undoubtedly vital for India’s development, it was as if the main budget speech wished to erase any impression that either the Indian economy or the health system are suffering from long covid.

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Do you think, government’s priority has been changed after declaring some of the key healthcare initiatives in the interim budget?

It is not clear that it is so. The cervical cancer programme will be financed from NHM budget. Expansion of the PMJAY programme - to include ASHA workers, Anganwadi workers (as stated in the interim budget) and elderly persons (a more recent announcement) -- has to be accommodated under the funds allocated for that programme. So, the earlier pledges may be kept, albeit with limited budgetary allocations which do not match programme ambitions.

Is there anything positive in the healthcare budget?

The emphasis on tribal health focused attention on a much-neglected area of public health. In the vast Indian population, virtually all major health indicators are the worst among the tribal groups. It is essential that their health needs are prioritized, though it is unclear as to how effectively that can be achieved when the NHM is hobbled by a minuscule rise in funding. 

What was your expectation?

I was hoping that the lessons of the covid pandemic were well learnt -- especially that a sub-optimally resourced and underperforming health system is a banana peel on which the national economy can keep slipping. I was expecting higher allocations for NHM and PMJAY. I was also hoping for greater investment in the development of a multi-layered, multi-skilled health workforce, not only to address many unmet needs of our health system but also because we have ambitiously proclaimed that we will meet global needs for assuredly high quality but eminently affordable healthcare through Heal In India and Heal By India programmes. Strangely, those proclaimed initiatives have disappeared from our policy pronouncements after the end of India’s G-20 presidency. I hope they are still considered important, so that more resources - public and private- can be streamed into the development of a larger, more skilled and better distributed health workforce.