Jan Swasthya Abhiyan press statement on Union Health Budget 2022-23(draft)
Business as usual : As if there was, is no Covid-epidemic!
No falls flat, fails to allocate funds for COVID care!
Health budget stagnant despite COVID crisis, National Health Mission neglected !
Given the unprecedented human calamity that the country faced during the first two waves of COVID-19 pandemic, and inadequate health facilities to protect lives of people linked with the under-resourced public health system, it was expected that the Union government would present a significantly increased Health budget for 2022-23and that it would take concrete measures to improve the dilapidated health system of India. But contrary to popular expectations, allocations to health and related programs reduced in real terms in the budget 2022-23 by 7% compared to Revised Estimate of 2021-22. Jan Swasthya Abhiyan (JSA) condemns the inadequacies cut in the Union Health Budget in the strongest possible terms and appeals to the Parliament to reject cuts, and unitedly call for increased allocations for health!
Oppose cuts in overall allocations for Health, instead ensure major increase!
If we look at the Union Health Ministry’s total budget (including Ministry of AYUSH), the allocations have been increased from Rs 88,665 crores (2021-22 Revised Estimate) to Rs 89,251crores (2022-23 BE), that is a meagre increase of Rs 586 crores only. If we adjust for the effect of inflation this means a decline of 7% in real terms. As percent of GDP, Union government allocation to health has declined from 0.382% to 0.346% between 2021-22 RE and 2022-23 BE. This also means that the Union Government has reduced its priority towards the health sector - share of health in the total budget has declined from 2.35% to 2.26% compared to previous year. This is a far cry from even government’s own Niti Aayog’s recommendations.
Covid related provisions being rolled back?
As regards COVID-related expenditure, while it was Rs. 11,940 crores in 2020-21 and in the RE for 2021-22 this stands at Rs. 16,545 crores, there is only an insignificant allocation of Rs. 226 crores (which is the insurance cover for health workers) for COVID response in 2022-23. Is the government assuming that there is now no need to make provisions for care related to the COVID pandemic, even though cases continue across the country? Such misplaced optimism was shown by this government last year, before the second wave devastated the nation. We demand the entire range of public health measures, as well as expanding capacity of public health services through adequate, massive increase in Union government expenditure are ensured so that COVID-19 related care should be made freely available through public systems to the maximum extent possible.
Cuts in National Health Mission allocations are unacceptable!
During the pandemic, Primary healthcare services were especially affected and there was a need to increase the expenditure on programmes which strengthen basic health services in rural and urban areas. One of the most crucial flagship schemes which has been performing relatively better and contributed to improvements in health of mothers and children is the National Health Mission. However, since 2019-20, NHM allocations have declined in real terms. In the year 2020-21 actual expenditure on NHM was Rs. 37,080 crores, but now allocation for NHM in 2022-23 is only Rs. 37,000 crores which is not only a decline of 80 crores in nominal terms, in real terms this is actually a cut of INR 4106 crores. It includes Rs. 7500 crores for construction of new medical colleges, (which are being planned to be in the PPP mode to furtherthe privatization agenda) leaving only 30,000 crores for primary and secondary care through Public Health Services.This means that essential services provided under NHM in 2020-21 cannot be provided anymore with current limited resources. It was essential that the government takes up special efforts to ensure safe motherhood, universal vaccination and expand various disease control programs to catch up with the loss during the pandemic, but this major need has been ignored.
Pay Frontline Health workers their due!
Frontline health workers have played a critical role during the pandemic, braving multiple obstacles and even salary cuts and delayed payments and often losing lives. However, beyond tokenistic measures, there have been hardly any steps taken to improve compensation for these dedicated health workers! Even the provision to provide insurance coverage to health workers has been reduced from Rs. 813 crore in RE 2021-22, to Rs. 226 crores in 2022-23. It should furtherbe noted that much of the success of the vaccination that is being claimed is based on the untiring efforts from ASHAs and other frontline health workers, butthe NHM budget cut is going to affect the compensations to ASHAs and ANMs considerably.
Scrap wasteful and ineffective PMJAY!
It has been clearly seen during the Covid-19 pandemic that despite the public healthcare system being underfunded it played a significant role, while the private sector was completely ineffective in doing so. Not only there were innumerable cases where the private sector hospitals charged arbitrarily high prices, we also saw cases where the poor and weaker sections were denied healthcare services. The Pradhan Mantri Jan Arogya Yojana (PMJAY) abysmally failed in providing access to healthcare services to the poor and deprived sections during Covid-19. Moreover, during Covid-19, a significant drop in insurance claims was seen. When about 30,000 croes are needed to to give insurance cover of Rs. 5 lakh to 10 crore families for hospitalization, for the third consecutive year Amount allocated for PMJAY was allocation in Budget Estimates 2021-22 was Rs. a mere 6400 crore, and but as revealed by the Revised Estimates only half of this (Rs. 3199 crores) was actually projected to be utilised. Despite these massive failures, the government is continuing large and wasteful allocations for this scheme. It is significant to note that 75% of payments under PMJAY, up till February 2020 has been to the private sector which proves that schemes like PMJAY divert government money to the private sector. The government should immediately scrap this failed, ill-thought PMJAY and instead, use these resources to strengthen the public health system.
Allocations for Women’s Health and Protection have remained stagnant or reduced!
While cut in NHM allocations directly impacts the programmes on reproductive and child health care, there are other critical elements related to women’s health that got neglected under the current budget. In the Union budget 2022-23 there has been a decline in allocations for SAMBAL scheme from Rs. 587 crore in 2021-22 budget to Rs. 562 crore in 2022-23 budget. SAMBAL scheme includes components such as One Stop Centre, Mahila Police Volunteer, Women's Helpline/Swadhar/Ujjawala/Widow Homes etc.) which focus on women’s health and protection. Such a decline has serious repercussions in the times when crimes against women are on a rise.
Allocations for Saksham Anganwadi and POSHAN 2.0 have increased only marginally by Rs. 150 crore. This scheme includes important components such as Anganwadi Services, Poshan Abhiyan, Scheme for Adolescent Girls, National Creche Scheme. During the COVID-19 pandemic, the nutrition of women and young girls has been adversely affected and it requires adequate attention. SAMARTHYA scheme (Beti Bachao Beti Padhao, Creche, Pradhan Mantri Matru Vandana Yojana, Gender Budgeting/Research/ Skilling/ Training etc) has also got a meagre increase in allocations by about Rs. 100 crore.
Indian Council of Medical Research (ICMR) Budget has been cut!
The recent Covid crisis also raises questions on the extent of emphasis being laid on research in the health sector. The allocation for the Department of Health Research has been a meagre 3% of the total budget of health. In the year 2020-21 Actual expenditure on health research was 3.8% of health budget, which declined to 3.6% in the current budget. Furthermore, ICMR, which has led several research initiatives during the pandemic including vaccines, has received a cut. In the 2021-22 Budget ICMR had been allocated INR 2358 crores. This year allocation has been cut to INR 2198 crores- a 17% decline in real terms. This is going to affect funding of several health research institutes who depend on ICMR funding.
Mental Health continues to be neglected despite tall claims!
Though the Honourable Finance Minister has announced a special National Tele Mental Health Program, the existing National Mental Health Programs (NMHP) and various Union Government funded institutions continue to face neglect. The NMHP has received a measly allocation of INR 40 crores- which continues to be the same since 2019-20. This amounts to spending just 30 paise per person per year, for the National Mental Health Programme! Furthermore even these allotted funds remain largely underspent; Actual Expenditure in 2020-21 was just Rs. 20 crores. The budget for NIMHANS as an apex institute for mental health has been somewhat increased from Rs. 500 crores (2021-22) to Rs. 560 crores (2022-23), but in the larger context this is clearly insufficient, in absence of adequate support for the Mental health programme on the ground; even after many years of its inception there remain huge gaps of human resources. Trying to fill those major gaps in services just by relying on a tele-medicine program means that a large section of the society would continue to be deprived of quality mental health care.
Lopsided priorities: Ayushman Digital Mission receives 566% increase!
One of the biggest gains in expenditure has been received by the Ayushman Digital Health Mission - from meagre INR 30 crores allocated in the previous year, ABDM budget has increased to INR 200 crores for 2022-23, almost seven times increase in one year. This amounts to placing undue emphasis on ‘Health cards’ while neglecting actual ‘Health care’. Government’s fascination to create electronic health records in the middle of a pandemic, while neglecting the actual public healthcare delivery system, raises serious doubts about the main intentions of the program. It is highly likely that this scheme is going to benefit the big IT companies and commercial health insurance companies while the safety and security of personal information remain doubtful. When at ground zero health services are grossly inadequate, what sense does it make to prioritise digital health records of doubtful value, compared to provision of actual health services?
Lack of transparency and inconsistency in data presentation!
We would also like to note with serious concern that it has been a standard rouitine practice for the current government to continuously hide information related to budget. For instance, all the schemes and programs under NHM, including National Rural Health Mission (NRHM) and its sub-components have been rolled into one head in this budget. This do not allow us to understand the trends in allocation on key programs like NUHM, immunisation, various disease control programs! Prior to 2015-16 the detailed Financial Management Reports of NHMs with details of all subcomponents was available in public domain but since then have disappeared. We would like to demand that the government ensures more transparent dissemination of data!
To conclude, the Union Health budget 2022-23 falls flat because it has completely overlooked the lessons of the Covid-19 epidemic, fails to allocate much-needed huge increases in allocations for public health system strengthening, the major National Health Mission programme, COVID related provisions which remain a continuing requirement, protection and remuneration for health workers, services for women and children, Mental health programme, and essential Health research. It seems that to cover up these multifaceted failures, the presentation of data in the current health budget has been made deliberately opaque and difficult to compare with earlier years. Jan Swasthya Abhiyan calls upon people of this country as well as Parliament to oppose this betrayal and demand essential, much higher allocations for public health which are essential during the COVID pandemic and beyond, to ensure adequate healthcare for all of us.
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