An important aspect of health budget that we must keep in consideration while analyzing recent allocations relates to the fact that health budgeting in the present phase of India’s development is not about marginal increases. In fact marginal increases sometimes mean near stagnation after accounting for the inflationary factor. This apart, as India has one of the lowest public spending on health as a proportion of GNP, we have to consider the phased increase per year in this so that we can achieve at least the minimum international norm in the near future. The need for this is officially accepted and roadmaps have been drawn up for this, but the country has been unable to adhere to these.
It is in this wider context that the allocations made for 2023-24 as well as the revisions made in the previous financial year 2022-23 should be seen.
Regarding the Department of Health and Family Welfare, the original allocation (called Budget Estimate or BE) last year ( 2022-23) was INR 83,000 crore in 2022-23 ( one crore=10 million) and it is 86,175 crore this year, only a marginal rise and in fact hardly a rise after accounting for inflation. What is more, it should be noted that there was a cut last year to INR 76,370 crore ( or a cut of around INR 6,600 crore) while preparing the revised estimate (RE) last year.
Regarding the Department of Health Research, the original allocation or B.E. last year was INR 3200 crore last year, and this year (2023-24) this has been actually reduced to INR 2980 crore. What is more, last year while preparing RE there was a cut from INR 3200 crore to INR 2775 crore.
Coming now to some core schemes, the allocation for the National Health Mission was INR 37,159 crore in 2022-23, but this has been reduced to INR 36,785 crore in 2023-24. What is more the allocation last year was cut from INR 37,159 crore to INR 33,707 crore while preparing revised estimate, a cut of nearly INR 3400 crore.
In the case of another core scheme, the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), the BE last year has been more or less maintained this year, but last year there was a very drastic cut—the BE of INR 4176 crore was cut to only INR 1885 crore.
Coming to Central Sector Schemes, the BE of Pradhan Mantri Swasthya Suraksha Yojana was first cut from BE of INR 10,000 crore to RE of INR 8,269 crore in 2022-23 and has been further reduced to a very less allocation of INR 3,365 crore in 2023-24.
In the case of National AIDS and STD Control Program, the BE of last year has been more or less maintained this year, but in 2022-23 there was a very big cut from BE of INR 3027 crore to RE of INR 2182 crore.
Under the Department of Health and Family Welfare there is a Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) central sector scheme also. Last year ( 2022-23) its BE of INR 978 crore was reduced very drastically to INR 281 crore. This year also the BE remains much below the BE of the previous year at INR 645 crore. Under the Department of Health Research there is another PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) for bio-security preparedness and strengthening pandemic research. Despite the obvious importance of this subject, its budget was cut from BE of INR 690 crore last year to RE of 378 crore last year. This has been further reduced to INR 324 crore in the B.E. of 2023-24.
Health sector disaster preparedness and response and human resource development for emergency medical services is clearly a very important issue. Its budget has reduced from INR 130 crore to INR 128 crore this year, and what is more it faced a severe cut in the RE last year to just INR 75 crore.
Setting up of nation-wide network of laboratories for managing epidemics and national calamities is certainly important. However its budget was cut from INR 82 crore last year to INR 70 crore and this year its allocation has been reduced further to INR 60 crore.
Development of infrastructure for promotion of health research is important, but its budget was slashed from INR 80 crore to INR 67 crore last year. Development of tools/support to prevent outbreaks of epidemics is obviously very important, but the already small budget last year of INR 15 crore has been cut to INR 10 crore this year.
Clearly the health of the budget of health sector ( in the union budget) is not good at all and the government must start thinking in terms of corrective action including mid-term increases right now.
Bharat Dogra is Honorary Convener, Campaign to Save Earth Now. His recent books include Planet in Peril, A Day in 2071 and Protecting Earth for Children.