Budget falls short of meeting equitable health for all

The allocation of Rs 48,853 crores for the Ministry of Health and Family Welfare (MoHFW)in this year’s budget indicates a 27 per cent increase in overall Health allocation, which is welcome. This increase is higher than the budgeted allocation for the last year and the year before, the figures being 15 per cent and 8 per cent respectively. 

However, most of the increase comes from transfers to states/ union territories, which comprises 55 per cent of the Health budget. This reflects the government’s continued efforts to increase the role of states in health and reduce that of the MoHFW at the centre. It is reassuring to see the government’s commitment to ‘Health for All’ in the Economic Survey and the Union Budget tabled in the Parliament by the Finance Minister. 

The budget announces targeting elimination of Kala-Azar and filariasis by 2017, leprosy by 2018, measles by 2020 and tuberculosis by 2025. The other announcements to ensure adequate availability of specialist doctors and to strengthen secondary and tertiary levels of health care by creating additional post graduate seats and structural transformation of the Regulatory Framework of Medical Education and Practice in India were much needed. 

While all this is welcome, the budget allocation for health is not adequate to provide accessible, affordable and equitable quality health care to all. The Union Government’s allocation for health sector as a share of GDP has seen a marginal increase from 0.26 percent in 2016-17 (BE) to 0.30 per cent in 2017-18 (BE). This falls short of meeting the long standing demand (articulated in the Draft National Health Policy, 2015) of increasing the total allocation for health sector to at least 2.5 percent of GDP. 

While the allocation for National Rural Health Mission has been increased, the allocation for National Urban Health Mission has declined from Rs. 950 crore in 2016-17 (BE) to Rs. 752 core in 2017-18 (BE). This is of concern as the health care needs in urban areas have increased with growing urbanisation and migration. 

Similarly, budget allocation for Reproductive and Child Health (RCH) Flexi pool has gone down to Rs. 5,966 crore in 2017-18 (BE) from Rs. 7,775 crore in 2016-17 (BE). It not clear how the Union Budget for 2017-18 will split health spending across various programmes and how much will be available for the family planning programme. The latter is almost fully funded by the Central government and has received very little attention compared to other health programmes in the recent past. Family Welfare, which includes the budget for family planning constituted only 4 to 5 per cent in the past few years. 

One would have to wait to see if its share has seen any significant rise in the present budget so that the country can meet its FP2020 commitment. As per the estimation of the Government of India, if the current unmet need for family planning could be fulfilled within the next five years, India can avert 35,000 maternal deaths and 1.2 million infant deaths. 

If safe abortion services are coupled with an increase in family planning, the savings made to the country could be to the tune of Rs 6,500 crores. An ongoing study of the Population Foundation of India on “Cost of Inaction” reveals that given the current level of intervention, the goal of Total Fertility Rate becoming 2.1 will be achieved only in 2031 rather than in 2017 or 2022, as envisaged earlier. 

This would mean enormous cost in terms of MMR, IMR, health of the family as also provisioning of education health and basic amenities to the incremental population. Also, investing in health is critical for achieving the economic development goals of the government.