When you need objects that you want to look bigger, use a magnifying lens. The Treasury Secretary cleverly did so to forecast a 137% increase in health and wellbeing by connecting healthcare, nutrition, water, sanitation and the environment. It is perfectly appropriate to look at health outside of health as well, both from a public health perspective and in line with the Sustainable Development Goals. However, those seeking a large increase in the Department of Health’s program budget will have unfulfilled expectations.

The nation has been awakened to the realities of ongoing neglect and underfunding of the healthcare sector by the pandemic. The economic and social hardship caused by the rapid and widespread transmission of Covid-19 viruses and the strict lockdown made clear the links between health and the economy. A societal consensus has been established to strengthen health systems to prevent preventable deaths, promote wellbeing, and provide timely and affordable health care.

Has the Union budget met its expectations by mobilizing and allocating significant resources? The financial allocation for the upcoming fiscal year, which includes the core health sector, including health and family welfare, health research and AYUSH, is set £76,902 crore against the allocation of £69,233 crore, a modest 11% increase. However, if the expenditure estimates revised last year are taken into account, the result is a decrease of 10%. As a result, the centrally funded programs (NHM and Ayushman Bharat) will see an 8% decrease in allocation over the next fiscal year from the revised estimates of recent years. Even if the challenges of the pandemic are met, more support must continue to be given to key health programs that serve as tools for universal health insurance.

The National Health Mission is expected to see a relatively modest increase of only 4% over the revised estimates of the previous year over the next budget year. The Pradhan Mantri Jan Arogya Yojana (PMJAY) has received £6,400 crore in budget estimates with similar amounts allocated last year. However, the utilization compared to the allocation of the last few years was less than 50%. This highlights three challenges: two caused by covid-19, with a significant decrease in use on barriers to access to hospital services during lockdown, a large decrease in use of non-covid-19 packages, and inadequate availability Eligible hospitals in is due to smaller towns and cities. Admission to hospital stays through the PMJAY program for Covid-19 care accounted for 4% of all hospital stays from April to December 2020. Aside from investing in public health infrastructure and staffing to accredit more hospitals to deliver on PMJAY’s promise, the program needs to expand coverage to outpatient care as well as essential diagnoses and medications.

The urgency for increased vaccination against covid across the country has been reflected in budget allocations £35,000 crore this year. This will free states to focus on strengthening the supply chain and delivering vaccines to the frontline facilities. The allocation of Covid-19 vaccines takes place on the initiative of the central government, which has been issuing since January 2021 £360 crore in vaccines for healthcare workers and frontline workers.

The readiness for future pandemics must be based on the strengthening and agility of the infrastructure. The budget allocation for communicable disease surveillance and strengthening health surveillance infrastructure was roughly fixed £12,000 crore. The long-neglected health infrastructure for disease surveillance has now received a significant boost. Although Covid is a communicable disease, its worst effects are manifested in patients with non-communicable diseases – diabetes, high blood pressure, cardiovascular disease, obesity, and chronic respiratory diseases. Therefore, referral only to strengthen communicable disease surveillance is not an optimal solution. A more robust and coordinated response to the syndeme is needed, rather than a pronounced bias focusing only on infectious diseases.

A new centrally sponsored program, PM Ayushman Bharat Swasth Yojana, has been proposed to complement the NHM. It is proposed to add more rural and urban health and wellness centers, expand disease surveillance at the block, district and metropolitan levels, and strengthen the National Disease Control Center and its five regional branches. While the surveillance system appears to have been triggered by the pandemic, it needs broad-based support to cover a wide range of risk factors, pathogens and diseases. The proposal to strengthen One Health surveillance, which links microbial migration routes from wild animals to veterinary and human populations, came at the right time.

Despite the emphasis on building health infrastructure, little was said about building the health workforce required to make good use of it and competently deliver the required services. Is that up to the states? Perhaps the recommendations of the 15th Health Finance Commission are an important source of funding for states to study and increase government health spending. The Commission’s recently published recommendations propose strengthening rural and urban basic services, channeling funds to local authorities, supporting the training of Allied medical professionals, improving intensive care services and prioritizing allocation to north-eastern mountain states. A template is now emerging for comprehensive, networked, and ongoing care for public health services, from health and wellness centers and local bodies to district and medical university hospitals. This should be used through increased allocations, which should follow both in the state budget and in the central budget. The incentive given by the coincidence of the pandemic, the fusion of health and well-being in the Union budget into a shared commitment to the promotion and protection of health in all dimensions, and the advocacy of the Funding Commission for Primary Healthcare and Allied Health Workers should be provided through the Pandemic to be sustained.

A significant increase in public health funding is critical to reducing household expenses. This is a yardstick by which our progress toward universal health coverage will be measured. While a holistic approach to health and wellbeing is welcomed, the need for increased public funding for health should not be forgotten. Now over to the state budgets!

Dr. Sakthivel Selvaraj contributed to this column.

K. Srinath Reddy is President of the Public Health Foundation of India.

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