Much was expected from the budget presented by the Finance Minister Smt.Nirmala Sitharaman on 23rd July 2024. Since the government has lost majority in the Lok Sabha and is now dependent on others to continue to be in power, there was a hope that the budget will have some pro-people out look. But it turned out to be a damp squib. Health and education, the two key sectors for any nation’s development as well as for employment generation have been neglected in this budget.
Allocation to health is far from meeting the people’s health needs. This is only 89287 cores rupees out of a total budget of 48.21 lakh crore rupees. This means health has been allocated only 1.8% of the total budget. For our population of 140 crore, this comes to only Rs.638/- per person. It is a cruel joke with the people as we are among the lowest in the health indicators and our public health spending is also among the lowest in the world. The government’s claim that they have increased the health budget by 13% is a farce. The budget allotment on health was Rs.88956/- crore last year; it was later on revised to Rs.79221/- crore. They are calculating the increase from the revised budget not from the actual budget presented last year which comes out to be only 0.37% increase. If we go by the inflation then the budget on health has been actually reduced from last year’s budget. There is likelihood that this year too the budget will be further reduced after revision. This shows the government’s total apathy towards health of the people. It smacks of push towards further corporatisation of healthcare.
For good health it is imperative that good nourishment of the mother as well as the children is ensured. According to UNICEF Child Food poverty report 2024, 40% of our children suffer from severe food poverty and 36% with moderate to severe food poverty. Food poverty refers to accessibility to vegetables, fruits, grains, protein and dairy. Those fed two or fewer food groups are in severe child food poverty; those fed three or four food groups are counted in moderate child food poverty’ (1).
Ironically in child food poverty our rank is much below even from our south Asian neighbours with Pakistan at 38%, Bangladesh 20%, Nepal 8% children suffering from severe food poverty. The seven more worse off countries than us are Somalia (63 %), Guinea (54 %), Guinea-Bissau (53 %), Afghanistan (49 %), Sierra Leone (47%), Ethiopia (46 %) and Liberia (43 %).
India’s rank in the Global Hunger Index (GHI) is 111 out of 125 countries. It may be noted that the Ministry of Women and Child Development (MoWCD) has refused to acknowledge the GHI report calling it a “flawed measure of hunger that doesn’t reflect India’s true position”. The UNICEF report is in consonance with the GHI and it has corroborated the GHI report.
The government should have considered these factors while allotting the funds to health. On the contrary the funds allotted under the Saksham Anganwadi and Poshan have been reduced instead of being raised compared to the revised amount granted last year. Allocation to Mission Vatsalya which is meant for Child Protection, Services and Child, Welfare Services too have remained stagnant in the budget presented by the Finance Minister.
The public health expenditure in our country has been much lower than required for several years. According to Oxfam’s “Commitment to reducing inequality report 2020” India ranks 154th in health spending that is 5th from the bottom. It was therefore expected that the government would be serious in budgetary allocation towards health. But it was not to be.
The report further points out that growing socio-economic inequality in India is disproportionately affecting health outcomes of marginalized groups due to the absence of Universal Health Coverage (UHC).
The budget nowhere indicates increase in allocation for the emoluments of the doctors and paramedical staff. Services of the front line health workers, ASHA, Aanganwadi, Mid day meal workers etc. have not been given due recognition. They have not been given the status of a worker in this budget.
Nearly 70% of the healthcare provided in our country is in the private sector. Here the patients have to shelve money from their own pocket. As a result 5.5 crore people are pushed to poverty because of out of pocket expenditure on health every year. With the opening of hospitals by the corporate sector in several major cities of the country the burden of advanced healthcare has further increased on the patients.
The corporate sector has entered the diagnostics in a big way. The diagnostics industry in India is currently valued at $4 Bn. The share of the organized sector is almost 25% in this segment (15% in labs and 10% in radiology). The hospital industry in India, accounting for 80% of the total healthcare market, is witnessing a huge investor demand from both global as well as domestic investors (2).
The whole concept of the healthcare as a service sector and a responsibility of the government has shifted. This is reflected in the budget itself. The per capita public expenditure on health is lowest in India among the BRICS with Russia 61.25%, China 55.64%, South Africa 48.08%, Brazil 40.24% and lastly India 33.76% (3).
It is time that total approach to healthcare to the citizens be reviewed. The present emphasis on insurance based healthcare is virtually passing the people’s money to the private conglomerates. The government has to own the responsibility of providing healthcare services as per the requirement of each individual and the society irrespective of socio economic status.
Dr Arun Mitra is a Practicing ENT Surgeon in Ludhiana, Punjab. He is also the President of Indian Doctors for Peace and Development (IDPD) www.idpd.org
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