Opinion

Indian Health Budget 2021-22

Bahubali size or innovative accounting

Dr Ranga Reddy Burri

President, Infection Control Academy of India Honorary Professor, University of Hyderabad On February 1, 2021, when the Finance

Minister announced a new budget and all news channels and pundits were screaming about an unprecedented outlay for healthcare of Rs 2,23 lakh crore, I was elated and felt relieved that our government had finally departed from the previous tradition of sub 1 per cent of GDP allocation for a vital segment like healthcare. Alas, the jubilation didn’t live long. Having kept my calm when I doublechecked – healthcare budget 2021-22, I found the innovative accountancy done by the team finance under the captaincy of Nirmala Sitaraman, Minister of Finance and Corporate Affairs. Good things first

Launch of yet another healthcare scheme—the Pradhan Mantri Atma Nirbhar Swasth Bharat Yojana—with Rs 64,180-crore outlay spread over the next six years was welcome. The scheme is to yet be launched to develop capacities in the healthcare system for over six years. It will address the much-needed capacity development to address one of the three major issues plaguing public health, which is understaffed and under-skilled human resources. However, it is unclear from the budget document how much of this money would make its way into any health spending this year. Hope clarity will emerge soon. A special allocation of Rs 35,000 crores promised for COVID-19 vaccines. This is substantial and reflects the government's commitment to deal with the ongoing pandemic. The vaccine is one major tool to control the pandemic such as never before allocation of this size is justified. Innovative accounting and real allocations

The government proclaims an unprecedented increase of 137 per cent in outlay for healthcare in budget FY‘22, pegged at Rs 2,23 lakh crore, which seems more optics than reality. Historically, the allocation for healthcare is referred to as allocation to the health ministry alone, the government this time has presented the healthcare

budget more innovatively. In an attempt to show 'Bahubali' size allocation, the finance minister combined many existing heads in some way related to healthcare even if not managed by the health ministry. It is evident, no new budget-heads of money have been created for healthcare, only existing ones have been added up, which gives this inflated figure of Rs 2,23 lakh crore. The increased allocations have been arrived at by adding the budget heads like one-time allocation for COVID vaccination, health ministry, AYUSH ministry, department of drinking water and sanitation and allocations by the finance committee for health, water and sanitation.

That leaves the real allocation for 202122, the Ministry of Health and Family Welfare got only 73,931 crore which is 10.16 per cent more than the budget estimate for 2020-21, but 10.84 per cent less than the revised estimate for the FY‘21.

This kind of innovative accounting doesn’t bode well for improving the ailing public health with multidimensional issues like infrastructure deficiency, inadequate staffing, high out of pocket expenditure etc. If we had to get out of chronic issues like poor availability of health services, less than satisfactory outcomes and move towards universal preventive healthcare, we need transparency first! Such allocations with just about a 10 per cent real increase are not aligned with the seriousness of the global public health challenges. We need to recognise how a healthcare crisis can get transformed into an economic and social crisis.

We wish the government spending on health which remained frozen at around 1 per cent of GDP for close to 15 years and continuing will be streamlined sometime soon. We earnestly request the finance minister, the real allocation be increased to at least 2-3 per cent of GDP over the next three years and make a good beginning this year itself with modifications to the budget presented on February 1, 2021.