A hospital in Alluri Sitarama Raju district, Andhra Pradesh. File
| Photo Credit: Special Arrangement

With the worst of the COVID-19 pandemic behind us (though the World Health Organization warns that the virus has still not vanished), the Union Budget expectedly shifted focus to levers of economic growth such as infrastructure and employment. It was also hoped that the recognition of population health as a vital investment for accelerating as well as protecting economic growth would see continued investment in strengthening our health systems. In the Interim Budget, the Finance Minister had announced the government’s plans to “encourage” HPV vaccination to girls (to prevent cervical cancer), create a U-WIN programme for improving coverage of the routine immunisation programme, and include ASHA workers and Anganwadi workers as beneficiaries of the Pradhan Mantri Jan Arogya Yojana (PMJAY) health insurance programme. These have not been elaborated or presented as line items in the main Budget presented on June 23.

Comparisons

An increase in programme allocations from Budget to Budget must be calculated by comparing the budgetary estimate (BE) of this year with the BE of last year and not with the revised estimate (RE) for last year, which also features in the Budget. RE is the money actually spent, and indicates inability of the programme to efficiently spend the money, and not the actual need. A comparison of the BE for health in this year’s Budget with the RE of last year suggests that there was an increase of nearly 12%, which is an erroneous estimate of what the programme will actually get as a raise.

By comparing only the BEs of 2023-24 and 2025-25, we note an increase of only 1.98% for the overall Health Ministry budget, 1.16% for the National Health Mission (NHM), and 1.4% for PMJAY. Given the need to expand coverage and enhance the impact of these two flagship programmes of Ayushman Bharat, these increases are disappointingly modest. Many of our national programmes are steered by NHM, which is also responsible for strengthening rural and urban primary care as well as the district hospitals. Apart from the need to make child immunisation universal, the danger of tuberculosis (for which India has set an aspirational elimination date of 2025) and the rapidly rising rates of non-communicable diseases require a better resourced and structurally strengthened NHM.

The goal of having every Indian protected by universal health coverage (our target for 2030) cannot be realised if even the government-funded PMJAY programme is unable to become more inclusive. The recent announcement that it will be extended to cover all elderly persons appears untenable if the programme has a minimal budgetary increase.

A missed opportunity

While an increase in new medical colleges was mentioned, the need to invest in building a large multi-layered, multi-skilled workforce was not acknowledged. The energetic thrust for employment generation and skill-building must recognise that the health sector represents an area of great need and opportunity, especially for young persons.

It is laudable that customs duties have been waived on three anti-cancer drugs. Price controls are also needed for many other drugs. Pooled procurement, with monopsonic power of price negotiation, can markedly reduce the prices of drugs procured not only by public sector institutions, but also by private healthcare institutions which are accredited to government-funded health insurance schemes. The Budget missed an opportunity to establish such mechanisms.

Investment in climate-resilient agriculture is a welcome budgetary commitment, at a juncture where the quantity and quality of staple crops are likely to be severely affected by global warming. Diversification of agriculture to climate-resilient crops will not only provide nutrition security, but will also be climate smart in reducing the use of water, pesticide, energy and release of greenhouse gases.

K. Srinath Reddy, honorary distinguished professor at the Public Health Foundation of India

A hospital in Alluri Sitarama Raju district, Andhra Pradesh. File
| Photo Credit: Special Arrangement

With the worst of the COVID-19 pandemic behind us (though the World Health Organization warns that the virus has still not vanished), the Union Budget expectedly shifted focus to levers of economic growth such as infrastructure and employment. It was also hoped that the recognition of population health as a vital investment for accelerating as well as protecting economic growth would see continued investment in strengthening our health systems. In the Interim Budget, the Finance Minister had announced the government’s plans to “encourage” HPV vaccination to girls (to prevent cervical cancer), create a U-WIN programme for improving coverage of the routine immunisation programme, and include ASHA workers and Anganwadi workers as beneficiaries of the Pradhan Mantri Jan Arogya Yojana (PMJAY) health insurance programme. These have not been elaborated or presented as line items in the main Budget presented on June 23.

Comparisons

An increase in programme allocations from Budget to Budget must be calculated by comparing the budgetary estimate (BE) of this year with the BE of last year and not with the revised estimate (RE) for last year, which also features in the Budget. RE is the money actually spent, and indicates inability of the programme to efficiently spend the money, and not the actual need. A comparison of the BE for health in this year’s Budget with the RE of last year suggests that there was an increase of nearly 12%, which is an erroneous estimate of what the programme will actually get as a raise.

By comparing only the BEs of 2023-24 and 2025-25, we note an increase of only 1.98% for the overall Health Ministry budget, 1.16% for the National Health Mission (NHM), and 1.4% for PMJAY. Given the need to expand coverage and enhance the impact of these two flagship programmes of Ayushman Bharat, these increases are disappointingly modest. Many of our national programmes are steered by NHM, which is also responsible for strengthening rural and urban primary care as well as the district hospitals. Apart from the need to make child immunisation universal, the danger of tuberculosis (for which India has set an aspirational elimination date of 2025) and the rapidly rising rates of non-communicable diseases require a better resourced and structurally strengthened NHM.

The goal of having every Indian protected by universal health coverage (our target for 2030) cannot be realised if even the government-funded PMJAY programme is unable to become more inclusive. The recent announcement that it will be extended to cover all elderly persons appears untenable if the programme has a minimal budgetary increase.

A missed opportunity

While an increase in new medical colleges was mentioned, the need to invest in building a large multi-layered, multi-skilled workforce was not acknowledged. The energetic thrust for employment generation and skill-building must recognise that the health sector represents an area of great need and opportunity, especially for young persons.

It is laudable that customs duties have been waived on three anti-cancer drugs. Price controls are also needed for many other drugs. Pooled procurement, with monopsonic power of price negotiation, can markedly reduce the prices of drugs procured not only by public sector institutions, but also by private healthcare institutions which are accredited to government-funded health insurance schemes. The Budget missed an opportunity to establish such mechanisms.

Investment in climate-resilient agriculture is a welcome budgetary commitment, at a juncture where the quantity and quality of staple crops are likely to be severely affected by global warming. Diversification of agriculture to climate-resilient crops will not only provide nutrition security, but will also be climate smart in reducing the use of water, pesticide, energy and release of greenhouse gases.

K. Srinath Reddy, honorary distinguished professor at the Public Health Foundation of India

Watch | Interim Budget 2024 | What’s in it for health sector?

| Video Credit:
Richard Kujur

Health cover under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana will be extended to all Accredited Social Health Activist (ASHA) and anganwadi workers and helpers said Finance Minister Nirmala Sitharaman on Thursday, while announcing the interim Union Budget 2024-25.

While a full budget for 2024-25 will be announced after the new government is formed following the Lok Sabha elections later this year the budget allocation saw an increase from ₹89,155 crore in 2023-24 to ₹90,658.63 crore for the Ministry of Health and Family Welfare while Ayush Ministry also saw a hike from ₹3,647.50 crore to ₹3,712.49 crore.

Budget 2024 live | Interim budget leaves tax structure untouched; FM details Centre’s achievements

For the health sector, the Minister added that India will be bringing in the services of the newly designed U-WIN platform for managing immunisation and intensified efforts of Mission Indradhanush.

“This is to be rolled out expeditiously throughout the country,” the Minister said during her nigh hour long speech.

The other major addition in the sector includes utilising the existing hospital infrastructure under various departments to offer medical seats to students and encouraging HPV vaccination for girls in the age group of 9 to 14 years for prevention of cervical cancer.

The government also proposed to combine various schemes for maternal and childcare and bring them under one comprehensive programme for synergy.

The Minister added that, as part of the Skill India Mission, youth are being trained through various world-class institutes including 15 newly constructed All India Institute of Medical Sciences.

“Several youth have the ambition to get qualified as doctors. They aim to serve our people through improved healthcare services. Our Government plans to set up more medical colleges by utilizing the existing hospital infrastructure under various departments. A committee for this purpose will be set-up to examine the issues and make relevant recommendations,” the Minister said.

The Minister added that geopolitically, global affairs are becoming more challenging with wars and conflicts.

“Globalisation is being redefined with reshoring and friend-shoring, disruption and fragmentation of supply chains, and competition for critical minerals and technologies. A new world order is emerging after the COVID-19 pandemic,” the Minister said. The budget also announced upgradation of Anganwadi centres under ‘Saksham Anganwadi’ and Poshan 2.0 will be expedited to improve nutrition delivery, early childhood care, and development.

The sectors that saw increased allocation of funds in the last 2023-24 budget included Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, CGHS pensioners, and the National AIDS and STD programme. This year continued with that trend although allocation for development of nursing services did witness a drop.

Finance Minister Nirmala Sitharaman on Wednesday, February 1, presented the last full budget of the Narendra Modi government before the 2024 general elections. The Minister announced a range of new initiatives, revised income tax slabs and customs duty, and sops for agriculture and energy transition.

The Union Budget 2023-24 document also listed the new allocations for core welfare schemes that drive socio-economic development. Here’s a roundup of how the budgetary allocations for some of the key schemes have changed-

MGNREGS: The government slashed the budget for its flagship rural employment scheme, the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) by nearly 32% compared to the ₹89,400 revised estimate for the scheme in the current year.

Also read | Explained | The funding and demand for MGNREGA

The Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) was passed in 2005 and aimed at enhancing the livelihood security of households in rural areas. Under it, the MGNREGS is a demand-driven scheme that guarantees 100 days of unskilled work per year for every rural household that wants it, covering all districts in the country except those with a 100% urban population.

Food Subsidies: The Centre has allocated a little above ₹2 lakh crore for the food subsidy under the National Food Security Act (NFSA)- this includes funds for the Food Corporation of India, funds for decentralised procurement of grains by State agencies, and other logistical costs. Starting from January 1, 2023, the Centre had decided to provide 5 kg of free foodgrains per month to the 81.35 crore beneficiaries of the NFSA for one year starting from January 2023, rather than charging them a subsidised amount of ₹3 a kg of rice, ₹2 a kg of wheat and ₹1 a kg of coarse cereal as is usually done.

It was announced in December that the government was terminating the Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY), which had provided an additional 5 kg of free grains every month to NFSA beneficiaries after being launched as an emergency measure in response to the COVID-19 pandemic in April 2020 and received multiple extensions since. In a normal year, without COVID disruptions, the Centre’s food subsidy bill on account of the NFSA amounted to around ₹2 lakh crore, similar to the newly-announced allocation, but the PMGKAY had effectively doubled that sum for the past two years.

Jal Jeevan Mission: The Centre increased its budgetary allocation for the Jal Jeevan Mission (JJM) or the National Rural Drinking Water Mission by about 27% to ₹70,000 crore from the current year’s revised estimates of ₹55,000. The Jal Jeevan Mission aims to provide safe and adequate drinking water through individual household tap connections by 2024 to all households in rural India.

The Jal Shakti Ministry tweeted last week that the government had provided 11 crore rural households with a tap water connection under the JJM scheme. Data from the Ministry’s dashboard suggest that 56% of the targeted 19.3 crore households had been covered.

The scheme has a total financial outlay of about ₹3.60 lakh crore, with the Centre funding 50% of the cost with States and Union Territories, except for Union Territories without a legislature, where it foots the entire bill, and northeastern and Himalayan States and Union Territories with legislatures, where it funds 90% of the bill.

Ayushman Bharat-PMJAY: The budget for the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) — the national public health insurance fund, saw an increase of about 12% at ₹7,200 crore compared to the ₹6,000 crore revised estimates for the current year.

The Ayushman Bharat PM-JAY is a health insurance scheme launched in 2018, aiming to provide a health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization. It aims to over 10.74 crore poor and vulnerable families (or 50 crore beneficiaries) from the bottom 40% of the Indian population. Union Health Minister Mansukh Mandaviya had said in December 2022, that 4.5 crore people had so far been empanelled under the scheme.

PM-Kisan: The allocation for the Prime Minister’s Kisan Samman Nidhi (PM-KISAN) scheme was the lowest in five years and remained the same as the revised estimates for the current year at ₹60,000 crore. PM-Kisan is a flagship Central scheme launched in 2019 for cash transfers ₹6,000 per year to eligible farmer families in three instalments of ₹2,000 each.

Finance Minister Nirmala Sitharaman informed while presenting the Union Budget on Wednesday that the government has made cash transfers totalling ₹2.2 lakh crore to around 11 crore farmers under the PM-Kisan scheme.

PM-POSHAN: The government has allocated a budget of ₹11,600 crore to the Pradhan Mantri Poshan Shakti Nirman, or the rebranded version of the mid-day meal scheme for 2023-24. This is down 9.37% from the current year’s revised estimates of ₹12,800.

In 2021, while renaming the mid-day meal scheme to give hot cooked meals to 11.8 crore government school students from Class 1 to 8, the Centre had also decided to extend the scheme to 24 lakh children studying in balvatikas, the pre-primary section of government schools from 2022-23.

National Education Mission: A total of ₹38,965 crore was allocated to the National Education Mission for 2023-24, up 19.44% from the ₹32,612 crore revised estimates for the current year. The Mission is the umbrella scheme integrating major education-related schemes so education can be provided holistically and without segmentation from pre-primary to class 12. It includes the Sarva Shiksha Abhiyan under the Right to Education and schemes for secondary and higher education as well those for teacher training and adult education.

PMAY: The Centre allocated ₹79,590 crore to the Pradhan Mantri Awas Yojana (PMAY), up 3.19% from the current year’s revised estimates and 66% from the budget estimates. The PMAY aims at constructing houses in both urban and rural areas. PMAY-Gramin (rural) was initiated in November 2016 with a target of completing 2.7 crore houses and PMAY-Urban was initiated in June 2015 with a target of constructing 1.2 crore homes.

National Social Assistance Program: The budget allotted ₹9,636 to the National Social Assistance Program (NSAP), which provides monthly pension assistance to the elderly, widows, and persons with disabilities.

Development of Scheduled Tribes and Scheduled Castes: The budget allocated ₹4,295 crore and ₹9,409 crore to the umbrella programs for the development of Scheduled Tribe and Scheduled Caste communities respectively. While the ST development allocation saw a nearly 10% increase, the SC programme funding rose by close to 22%, compared to the current year’s revised estimates.

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