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The Budget-2021 Series: Pillar 1: Health & well-being

The following essay will attempt to examine the anatomy of health care system in India followed by provisions of Budget 2021 and its impact.


According to Plato, "State is individual writ large". Healthy India has to have healthy citizens. Having recognized, the Budget 2021 infuses the much-needed adrenaline (137% increase in allocation to health sector) in the tranquillized health system. Before, digesting Budget provisions, let us first briefly scan some of the tumors choking Indian health care. Primary and Community health, forms the backbone to achieve universal health coverage. In case of India, this ecosystem suffers from underdevelopment. The High-Level Expert Group on Universal Health Coverage in 2011 (HLEG-UHC) had estimated that by 2020, we would need a 114 per cent increase in sub-centers and primary health centers, 179 per cent increase in community health centers and a 230 per cent increase in sub-district and district hospitals. However, even after a decade, the progress on this front remains opiated. India has been under global spotlight for its poor performance regarding Nutrition. The Global Hunger Index 2020 ranks India in the bottom quartile (94th among 107 countries), faring worse than some of our neighbors (Nepal, Pakistan and Bangladesh). In addition, maternal and infant mortality rates are unencouraging. Furthermore, health care fragmentation is a serious concern. Poor referral networks hamper continuity of care. Rural-urban and gender divide (NFHS reports), inter-state disparities (NITI Aayog) and asymmetry of information (Economic survey 2020-2021: ES-21) further intoxicates the system. ES-21 exposes the fractures in health care financing (65% Out of pocket spending) and suggests doubling of public health care expenditure. Also, Environmental and Animal health doesn't receive adequate attention. The provisions under Budget 2021 are a part of series of reforms envisioned under the National Health Policy 2017 (NHP-17). The budget, primarily attempts to resuscitate preventive, curative and well-being aspects of health care. In order to strengthen health infrastructure Pradhan Mantri Atmanirbhar Swastha Bharat Yojana has been launched. Under this, expansion and consolidation of primary, secondary and tertiary systems have been envisaged. Moreover, strengthening disease surveillance by augmenting National Centre for Disease Control, by establishing public health labs equipped with bioinformatic tools, has been the priority. Additionally, the budget proposes to institutionalize the ONE HEALTH approach in collaboration with World Health Organization. The tradition to focus on well-being has been continued in 2021. Substantial funds have been allocated to improve access to clean water, sanitation and hygiene viz. Swachh Bharat Mission and Jal Jeevan Mission. However, the flagship initiative on Nutrition- POSHAN 2.0 has seen a reduction of 27% in budget allocation. Nonetheless, being a convergent and facilitating platform, it expects relevant stakeholders and ministries to add to the corpus. Notwithstanding, it is important to realize that Budget 2021 is no silver bullet. The journey of progressive reforms must continue until we achieve universal quality health coverage. There are certain crevices to be plastered. ES-21 has been vocal for flexible health system with an independent, impartial regulator. Moreover, it asserts for greater private sector investments in innovation which currently constitutes meagre 37% as against top 10 economies with mean 68%. Besides these, other systemic reforms suggested by HLEG-UHC and underlined in NHP-17 needs to be translated. According to Hippocrates, "Healing is a matter of time, but it is sometimes also a matter of opportunity". As Indian health system recovers from COVID-19 trauma, plethora of opportunities await. If not seized, the vision of Atmanirbhar India shall remain elusive.


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