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Despite Pandemic, Health Budget Sees Little Real Increase

Water and sanitation outlays included in the health budget; nutrition outlay actually down.

Budget 2021-22: Healthcare
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New Delhi: Finance Minister Nirmala Sitharaman announced a new healthcare scheme--the Pradhan Mantri Atma Nirbhar Swasth Bharat Yojana--with a Rs 64,180-crore ($8.7 billion) outlay. The Centre's allocation to the health ministry for 2020-21 was Rs 67,112 crore ($9.18 billion). This new scheme appears to make a 100% increase in the entire health allocation.

However, Sitharaman also said that this would be operationalised over six years. And the detailed budget document does not have any mention of this scheme for 2021-22. So it is unclear how much of this money would make its way into any health spending this year.

The government also announced an unprecedented outlay for healthcare, Rs 2,23,846 crore ($30.6 billion), which the finance minister said is an increase of 137% over the 2020-21 budget.

However, although conventionally the outlay on healthcare has referred to the outlay to the health ministry alone, the government this time has presented the healthcare budget in a more intersectional manner: It has combined many existing heads in some way related to healthcare even if not managed by the health ministry. In other words, no new budget-heads of money have been created for healthcare, but already existing ones have been added up, which gives this increased figure of 137%.

The increased allocations are arrived at by adding the following budget heads: health ministry, AYUSH ministry, department of drinking water and sanitation, allocations by the finance commission for health, water and sanitation, and a new allocation of money for COVID-19 vaccination.


Source: Union Budget

How much did the health ministry itself get?

The actual allocation to India's health ministry alone is not striking, despite the ongoing pandemic.

In budget 2020-21, India's health ministry was allocated Rs 67,112 crore ($9.18 billion) just as the COVID-19 pandemic in India was taking off. Revised estimates--or the money estimated to have been spent--for the current financial year are Rs 82,928 crore ($11.4 billion).

For 2021-22, India's health ministry has been allotted Rs 73,931.77 crore ($10.12 billion). This is up 10.16% from the budget estimate for 2020-21, but down 10.84% from the revised estimate for the current financial year.

"The budget for the health ministry does not reflect that the COVID-19 pandemic has been happening since last year," said Avani Kapur, director of the Accountability Initiative.

She said that people lost access to routine health services, which must be made up for, and more allocations to deal with new health issues. The budget fails to reflect any of this.

"Just about a 10% increase in health allocations this year, in a country that has always been under-spending on health, is not good enough. On the other hand, given that there has been a pandemic, it would have been totally justified for the government to spend more on health this year," said Kapur.

How much allocation for nutrition?

New data from the first phase of the National Family and Health Survey, 2019-20 in December 2020 showed that nutrition levels in India had fallen. Under-nutrition, wasting and stunting levels among children have shown a rise in a majority of states for which data were released, and this could reverse decades of work India has done to address this issue, as we reported. A quarter of children surveyed in 18 of 22 states were stunted, according to the same government data.

The budget today could have, but fails to, show a larger allocation for nutrition services.

"Overall, I do not see from the budget that allocations have been aligned with the seriousness of the nutrition challenge that India faces," said Purnima Menon at the International Food Policy Research Institute. She said there have been no substantial changes to allocation for nutrition services within this new budget, "which is also problematic because the ICDS [Integrated Child Development Services] was still not reaching too many children even in earlier years".

Over the last few years, the government has already been under-spending its given allocations for nutrition, and then not increasing its allocations substantially in future years, said Dipa Sinha, faculty at Ambedkar University, Delhi. "We know from revised budget estimates over the last few years that many women are not getting the maternity entitlements to address their nutrition and that take-home ration in anganwadis is happening at low levels. The budget numbers itself show this shortfall," said Sinha.

To compound this already bleak situation, the new government data on nutrition and the stress of the pandemic have meant that "one can be sure that nutrition levels this year will be even worse around the country".

"This should have been the year to pump money into nutrition for children and households," said Sinha.

The nutrition budget is handled by the ministry of women and child development (which looks into nutrition for new mothers and children) and the ministry of human resources development (which looks into mid-day meals for school-going children). Neither is handled by the health ministry.

The announcement of "Mission Poshan 2.0", which will merge two existing nutrition programmes, will see an intensified strategy to improve nutritional outcomes in 112 aspirational districts. This has been allocated Rs 20,105 crore.

Prior to this, nutrition has been covered along with other components related to maternal, child and adolescent health, under the "Umbrella Integrated Child Development Services". This has now been removed from the budget. In previous budgets, this head was allotted Rs 28,557 crore (2020-21), Rs 27,584.37 crore (2019-20) and Rs 23,088.28 crore (2018-19).

This indicates that the allocation to nutrition for 2021-22, Rs 20,105 crore, is less than the allocation in the previous three years.

The mid-day meal scheme that caters to the nutrition needs of school-going children, has been allotted just Rs 500 crore more for 2021-22 (Rs 11,500 crore) compared to the current financial year (Rs 11,000 crore). Around 116 million children rely on mid-day meals, according to government data.

How will vaccination be funded?

Among special allocations for COVID-19, the government has announced today that Rs 35,000 ($4.7 billion) would be allocated for COVID-19 vaccines. This is nearly half of the entire health ministry's allocation.

Rs 11,756 crore has been ear-marked for COVID-19 to the health ministry, from its overall budget. Rs 360 crore has also been marked for the process of vaccinating healthcare workers.

"I was hoping the government would pump in money to fill vacancies across the board, so that there are more boots on the ground, healthcare workers who will be able to address vaccination," said Oommen C. Kurian, head of the health initiative at Observer Research Foundation.

He said that the Rs 35,000 crore allotted to the COVID-19 vaccine seems to be for buying the actual vaccine shots, and not for the healthcare workers or the entire infrastructure needed to perform the process of vaccination.

"These health workers will be the army we need to beat the pandemic this year. It is a pity that they are under-paid and hired temporarily. The pandemic has shown that the public sector will have to bear the burden of healthcare. This budget could have addressed this better," said Kurian.

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