Budget 2024: With an economic focus, the health sector is marginalized

As the World Health Organization cautions that the virus has not completely disappeared, the worst of the COVID-19 pandemic has passed, but the Union Budget has predictably turned its attention to factors that might spur economic growth, such jobs and infrastructure. It was also envisaged that as population health became recognized as an essential investment for both safeguarding and promoting economic growth, more money would be allocated to improving our health systems. It appears that this hope has only been partially realized.

Transitional Declarations

The Finance Minister had stated in the Interim Budget that the government intended to “encourage” girls to get vaccinated against HPV in order to prevent cervical cancer, establish a U-WIN program to increase the coverage of the routine immunization program, and add Anganwadi and ASHA workers to the Pradhan Mantri Jan Arogya Yojana (PMJAY) health insurance program. Concerns over the importance of health on the national agenda have been raised by the fact that these were not explained in detail or included as line items in the main budget that was presented on June 23.

Comparisons of Budgets
Comparing the Revised and Budgetary Estimates

When calculating an increase in program allocations between budgets, the budgetary estimate (BE) for this year must be compared to the BE for the previous year, not to the revised estimate (RE) for the previous year, which is also included in the budget. The real expenditure, or RE, shows that the program was unable to use the funds effectively and does not reflect the true need. When comparing the BE for health in this year's budget to the RE from the previous year, it appears that there was an almost 12% rise, which is an inaccurate approximation of the actual amount the program will receive.

True Comparability

Merely examining the BEs of 2023–24 and 2024–25, we observe increases of 1.4% for PMJAY, 1.16% for the National Health Mission (NHM), and 1.98% for the Health Ministry as a whole. These increases are disappointingly small in light of the need to improve the impact and reach of these two Ayushman Bharat flagship projects. NHM is in charge of overseeing a large number of our national initiatives and is also in charge of bolstering district hospitals and primary care in both urban and rural areas. A stronger NHM is necessary due to the threat of tuberculosis, for which India has set an aspirational elimination date of 2025, as well as the rapidly increasing rates of non-communicable diseases. Additionally, the need for universal child immunization cannot be overstated.

Lost Chances
Employee Development

The need to invest in creating a sizable, multi-layered, multi-skilled workforce was not addressed, despite the inclusion of more medical colleges. The vigorous push for creating jobs and developing skills has to acknowledge that the health industry, particularly for young people, is an area of enormous need and opportunity.

Cost and Purchasing of Drugs

The removal of customs taxes on three anti-cancer medications is commendable. For many other medications, price limits are nevertheless necessary. With its unmatched ability to negotiate costs, pooled procurement can significantly lower the cost of pharmaceuticals purchased by both public and private healthcare organizations recognized by government-funded health insurance programs. The Budget did not seize the chance to create these kinds of systems.

Agriculture That Is Climate-Resilient

At a time when global warming is projected to have a significant impact on the quantity and quality of staple crops, budgetary commitments to climate-resilient agriculture are much appreciated. In addition to ensuring food security, diversifying agriculture to include climate-resilient crops will also be environmentally friendly because it will require less energy, water, pesticides, and greenhouse emissions.

An Extensive Analysis of Health Budget Distribution
Total Budget for the Health Ministry

With the sector's substantial needs, the Health Ministry's overall budget increase of just 1.98% is insufficient. This small rise lessens the actual impact of the increase because it does not take inflation and the expanding population into account.

Mission of National Health (NHM)

NHM experienced a pitiful rise of 1.16%. NHM is essential for the infrastructure of both rural and urban health. Considering that NHM is involved in the fight against non-communicable illnesses, TB, and childhood immunizations, this is very troubling. The slight increase is not commensurate with the urgency of increasing access to these vital health services.

Mantri Pradhan PMJAY, or Jan Arogya Yojana

The PMJAY program, which aims to give the poor access to health insurance, witnessed a 1.4% increase. This is insufficient to broaden the program to include all senior citizens and improve inclusion. There are concerns over the possibility of attaining universal health coverage by 2030 due to the little increase.

Investment in the Health Sector Is Critical

Investing in the health sector promotes both economic growth and the provision of better healthcare services. People who are in better health are more productive, and sustainable development requires strong health systems. This interdependence does not appear to be adequately captured by the existing fiscal allocations.

• Jobs and Skill Development in the Health Sector: The health sector has a lot of room to grow in terms of employment, particularly for young people. The issue of youth unemployment and the requirement for a competent workforce could both be addressed by funding healthcare professionals' training and skill development. Regretfully, the existing budget does not sufficiently acknowledge or utilize this potential.
• Taking Care of Non-Communicable Diseases: With the prevalence of non-communicable diseases like diabetes, hypertension, and cancer on the rise, a well-resourced healthcare system that can offer complete care is required. Improving NHM and other health initiatives is essential to controlling chronic illnesses and halting their worsening.
• India has established an ambitious goal to eradicate tuberculosis by the year 2025. Significant investments in healthcare infrastructure, diagnostics, and treatment are necessary to achieve this goal. To achieve this crucial goal, NHM's current budgeted increase is insufficient.
• 2030 Universal Health Coverage: It is a noble objective to aim for 2030 universal health coverage. Nevertheless, it necessitates a significant outlay of cash and careful planning. The current budget's meager increases betray little faith in the government's dedication to this goal.

In summary

The Union Budget has marginalised health in favour of economic expansion through employment and infrastructure. The population's expanding health demands cannot be met by the slight increases in funding for important health programs like PMJAY and NHM. The underfunding of health infrastructure and the lost possibilities in workforce development, medication pricing, and procurement underscore the need for a more thorough and comprehensive approach to health budgeting. In order to create a robust and inclusive healthcare system that serves all Indians, significant financial commitments must be made in light of the fact that health is a key factor in economic growth.