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New Delhi: While allocation towards health in the union budget 2021-22 focussed on mitigating the impact of covid-19 pandemic, major public health schemes received insufficient funds.

Though the budget estimate 2021-22 for health and well-being is pegged at Rs.2,23,846 crore, translating an increase of 137%, the amount also includes budget for schemes from other ministries along with ministry of health and family welfare such as POSHAN Abhiyan under Women and Child Development ministry, Jal Jeevan Mission (Urban) under department of Water and Sanitation.

The allocation towards government’s flagship health insurance scheme launched in 2018, Ayushman Bharat-PM Jan Arogya Yojana (PM-JAY) remained unchanged at Rs. 6,400 crores this year in the finance Minister Nirmala Sitharaman’s union budget 2021-22 presented the in the parliament on Monday. The scheme aims to reduce the out-of-pocket private expenditure on health that has been pushing several people into poverty, especially during and after covid-19 pandemic.

Public health experts see the healthcare budget in particular in a negative balance. “Despite the much-touted emphasis on health, health ministry’s budget has increased only by 7000 crore from Budget Estimates of 2020-21 and declined by 9.8% from Revised Estimates of 2020-21," said Amitabh Behar, CEO, Oxfam India.

Of the health and well-being budget Rs. 35,000 crore will be spent on the producing and distributing the covid-19 vaccine. The budget allocation for the Department of Health and Family Welfare is Rs. 71,269 crores, an increase of 9.6% over the budget allocation (Rs. 65,012 crores) on Financial Year 2020-21. This is, however, lower than the revised estimates for financial year 2020-21 (Rs. 78,866 crores.)

Finance minister announced PM Aatma Nirbhar Swasth Bharat Yojana with an outlay of about 64,180 crore over 6 years. “The budgetary allocation for healthcare sector for 2021-22 will translate into 10% drop in the allocation, if compared to the revised estimated 2021. Nonetheless, the allocation translates to growth of 11%, if it is compared to the budget estimates for 2021," Kapil Banga, Assistant Vice President, ICRA Limited.

The current spending of India remains 1.6% of the GDP while the government’s own National Health Policy 2017 envisages increasing the health budget to 2.5%. Prime Minister Narendra Modi had earlier proposed to increase health spending to 2.5% of GDP by 2025 from the existing 1.15%, but health sector has always received minimal funding year on year.

“However, as the total allocation towards the healthcare sector has come down vis-a-vis RE for financial year 2021, this could translate into cutting of expenditure on other avenues within the sector. The continuing modest allocation towards the healthcare sector would make it challenging for the Government to meet its target of public sector healthcare investment of 2.5% of the GDP by 2025," said Banga.

Public health experts believe that the funds allocated towards covid-19 vaccination may fall short in achieving the target of vaccinating people against coronavirus. “Allocation of 35,000 crore for COVID vaccination might be insufficient to ensure free, universal and timely vaccination given that it would cost 52,000 crores. The allocation for National Health Mission, however, has witnessed a 4.4% increase," said Behar adding that despite frontline health workers such as Anganwadi and Asha workers being at the forefront of the COVID response, the Budget fails to allocate funding for ensuring minimum wage and insurance for all frontline health workers.

Public health bodies have started concerns regarding budgetary allocations towards overall health especially family welfare. Population Foundation of India, a NGO working towards women health pointed out that allocations for Central Sector and Centrally Sponsored Family Welfare schemes, which includes the budgets for procurement and distribution of contraceptives to states, is reduced by 35% from Rs. 600 crores in FY 2020-21 to Rs. 387.15 crores in FY 2021-22.

This is concerning, since to maintain the momentum of India’s commendable performance in moving towards population stabilisation, investments in this area are critical, the PFI said citing its study “The Cost of Inaction in Family Planning in India" that indicated India’s per capita GDP could rise an additional 13% by 2031 if family planning policies and investments were actively prioritised.

The budget of the National Health Mission has increased by 9.5% over the previous year from Rs. 33,400 crores to Rs. 36,575.5 crores in FY 2021-22. However, the National Urban Health Mission received only a Rs. 50 crore increase over the previous budget, from Rs. 950 crores to Rs. 1,000 crores.

“Given the increasing pressure of growth and migration on India’s cities, this amount is inadequate," said Poonam Muttreja, Executive Director, PFI said. “We must not lose our focus on maternal, child and adolescent health, including family planning. Prioritising social sector spending on women and young people’s health is central to all our futures. It will spur economic growth and recovery by ensuring a healthy population and ensure that the current health crisis does not increase existing gender disparities in access to affordable and quality healthcare," she said.

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