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Union Budget 2017-18: A Look at the Health Sector
Pallavi Gupta / Pallavi Gupta
The total budget for the financial year 2017-18 is Rs. 21,46,735 crore, which is 8.5 per cent more than last year’s budget estimate (BE) of Rs. 19,78,060 crore. However, compared to the revised estimate (RE) for 2016-17 (Rs. 20,14,407 crore), the increase is lower, at 6.5 per cent. The increase in budget is not commensurate with the net tax revenue, which has been increasing at the rate of 17 per cent per annum for the last two consecutive years, as per Finance Minister Arun Jaitley's Budget speech.
The total allocation for the Department of Health and Family Welfare (DoHFW) (Rs. 47,353 crore) is 2.2 per cent of the total budget envelope for the year, which is slightly higher than last year’s revised estimate of 1.9 per cent. In terms of proportion of GDP, the allocation for DoHFW is only 0.28 per cent, which is marginally higher than last year’s allocation of 0.25 per cent of GDP. Public health expenditure in India is approximately 1.3 per cent of GDP, which itself is much lower than the recommended figure of 2.5 per cent (draft National Health Policy 2015). The Central government’s share of merely 0.28 per cent in 2017-18 continues to signal the low priority accorded to the Health sector.
However, overall allocation for DoHFW in 2017-18 is 23.5 per cent more than 2016-17 (RE). Maximum increase is observed in the areas of ‘Human Resources for Health and Medical Education’ and ‘Pardhan Mantri Swasthya Suraksha Yojana’. Allocation for ‘Human Resources for Health and Medical Education’ has been increased to Rs. 4,025 crore, an increase of 168 per cent compared to 2016-17 (RE) (Rs. 1,500 crore). As per the Budget document, this amount is to be transferred to the states for improving and increasing human resources for health, including upgradation of district hospitals to teaching hospitals.
Allocation for Pardhan Mantri Swasthya Suraksha Yojana which is also aimed at tertiary healthcare services and medical education is Rs. 3,975 crore, almost double the amount as compared to 2016-17 (RE) (Rs. 1,953 crore). Increase in both these areas is a welcome step considering the huge gap in the availability of health service providers. The two AIIMS announced by the Finance Minister to be built in Jharkhand and Gujarat, and the 5,000 additional post graduate seats would be funded from these two budget heads.
However, the thrust on tertiary care should not compromise with primary healthcare, in the absence of which the burden on tertiary care is only going to increase further. Hence, the increase in tertiary care services and human resources has to be accompanied by a Human Resources for Health (HRH) policy that ensures that vacant posts in rural and tribal parts of the country are suitably filled. The announcement of transforming 1.5 lakh health sub-centres into Health and Wellness Centres (details awaited of what these transformed centres will entail) is not going to mean much unless there is dedicated staff deployed at these Centres. As per the rural health statistics 2014-15, more than 18,000 posts of ANMs are vacant in the sub-centres as of 31 March 2015. Another important component, the National Rural Health Mission has been allocated (Rs. 21,189 crore) a mere 8.87 per cent more than 2016-17 (RE) (Rs. 19,462 crore). Within NRHM, ‘Health System Strengthening’ sees a substantial increase of 52 per cent as against 2016-17 (RE) (Rs. 8,383 crore). At the same time the allocation for RCH Flexipool (including routine immunisation, pulse polio immunisation etc) has been reduced by 24 per cent compared to 2016-17 (RE) while there is no allocation against HRH.
Will the allocation of Rs. 1,000 crore, a 38 per cent increase over 2016-17 (RE) for the National Health Protection Scheme (new nomenclature for Rashtriya Swasthya Bima Yojana) provide the promised insurance cover of Rs. 1 lakh per enrolled family and a top-up of Rs. 30,000 for senior citizens? How will the increased allocation for health system strengthening actually roll out and what improvements will it bring? To find answers to questions like these, we will have to wait for the Ministry of Health and Family Welfare’s plan to put its share of our money to use.
Written by Pallavi Gupta, Programme Coordinator-Health.
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