Union health minister Mansukh Mandaviya arrives at Parliament on a bicycle during ongoing Budget Session. Photo: PTI/Arun Sharma
New Delhi: A day after the Union Budget 2022-23 was presented that indicated a 7% decrease in health sector allocation as compared to last year’s Budget, civil society groups on February 2 issued a statement “condemning” this move.
Jan Swasthya Abhiyan, which is a network of about 100 small and big civil society groups working on health across India, appealed to the Parliament to “reject cuts, and unitedly call for increased allocations for health”, especially in the aftermath of COVID-19.
The Abhiyan has come down heavily on the inadequate allocation to the National Health Mission (NHM). The NHM is an umbrella programme for the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM) and caters to the health needs of the majority of the Indian population. The Wire Science reported on Tuesday that the NHM received Rs 37,000 crore this year as compared to Rs 34,447.14 crore last year (revised estimate).
Analysing the past two Budgets, the JSA says the NHM’s actual expenditure in 2021-22 was Rs 37,080 crore. Now, for 2022-23, the programme has just Rs 37,000 crore to spend. It includes Rs 7,500 crore for infrastructure development (some of which is under public-private partnership mode), leaving only Rs 30,000 crore for primary and secondary care.
“It was essential that the government had taken 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,” the JSA, which has chapters in 22 states, said. There are well-documented reports that childhood immunisation, tuberculosis elimination and malaria elimination were adversely hit due to COVID-19 disruptions.
Though the government has been successful in vaccinating a big chunk of the population against COVID-19, much of the success is to be attributed to ASHA workers and ANMs (Auxiliary Nurse Midwives) who have not been paid their due. “The NHM budget cut is going to considerably affect the compensation to ASHAs and ANMs,” it said.
The JSA also questioned the rationale behind increasing the outlay to Pradhan Mantri Jan Arogya Yojana (PMJAY) ever since it was conceived in 2018, especially when it has been able to spend only half of what was allocated. The budget estimate for 2021-22 for the scheme was Rs 6,400 crore. However, the allocation was revised through the year to just Rs 3,199 crore. PMJAY’s actual spending in 2019-20 was also Rs 3,200 crore, as The Wire Science reported.
“(Moreover)It has been clearly seen during the COVID-19 pandemic Pradhan Mantri Jan Arogya Yojana (PMJAY) abysmally failed in providing access to healthcare services to the poor and deprived sections during COVID-19. During COVID-19, a significant drop in insurance claims was seen,” the JSA said, demanding the scheme be scrapped altogether and resources be diverted to strengthen the public health system rather than putting them in an insurance scheme that clearly seems to be underperforming.
Even the programmes that address child nutrition and malnutrition hardly got a fillip in this Budget. The allocations for Saksham Anganwadi and POSHAN 2.0 have increased marginally by about 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 required adequate attention,” the statement said.
The statement also points out that the government didn’t do enough for women’s healthcare, in particular, when much of its message is to indicate that it cares for them. The SAMBAL scheme of the government is to ensure safety. It has components like One Stop Centre for rape victims, women’s helpline, widow homes etc. But the outlay for the scheme decreased from Rs 587 crore in the 2021-22 Budget to Rs 562 crore in the 2022-23 Budget. The SAMARTHYA scheme, which is for women’s healthcare and empowerment, saw a meagre increase of Rs 100 crore.
If ‘health’ as a subject found attention in Union finance minister Nirmala Sitharaman’s speech yesterday, it was about establishing a National Tele Mental Health Programme. “But the ongoing National Mental Health Programme of the country saw a small allocation of Rs 40 crore,” the JSA said.
The JSA questioned a rather high increase in outlay for the digital health mission “when at ground zero health services are grossly inadequate. What sense does it make to prioritise digital health records of doubtful value, compared to a provision of actual health services.”
Other than pointing out inadequate allocations in various domains of health, the statement also flayed the lack of transparency in the Budget documents. The Abhiyan gives a particular reference to NHM in this regard. “All the schemes and programs under the NHM, including National Rural Health Mission (NRHM) and its sub-components have been rolled into one head in this Budget. This does not allow us to understand the trends in allocation on key programs like NUHM, immunisation, various disease control programs,” it said. In other words, if one wants to know what amount of money has been given to childhood immunisation in the Budget, one would not be able to.
Another example they cite is of the PM-CARES Fund as one does not know what amount of money has been spent on healthcare-related to COVID-19. “All funds related to PM-CARES must be brought under democratic accountability and dissemination of public data should be made a priority,” the JSA said.