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Journalism of Courage
As the threat of COVID-19 has receded, the Union Budget of 2023-24 clearly signals a shift of emphasis to economic growth, with a fillip to infrastructure. The re-focus is understandable as this is the last budget before the 2024 election. However, health has to remain prominently on the radar of financial planners, both to protect and promote the productive potential of what will soon be designated the world’s largest population and to prevent a derailment of economic growth by unattended public health imperatives. Does the Union Budget reflect continued policy commitment to improve people’s health overall and enhance the provision and quality of health services to vulnerable sections of the population?
Announcement of a mission to eliminate Sickle Cell anaemia by 2047, coming early in the Budget speech, signalled the commitment to prioritise health needs of vulnerable populations. This inherited disorder of haemoglobin alters the shape of blood cells and results in anaemia and other adverse health consequences. Screening, counselling and care are needed to reduce the incidence and complications of Sickle Cell disease in tribal populations in whom it manifests at high rates. This is a much needed initiative.
There is intent to open 157 new nursing colleges, in conjunction with 157 recently commissioned medical colleges. While this initiative to increase the health workforce is welcome, it should be accompanied by doubling the number of accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs) to address the expanded mandate of comprehensive primary health care which now also includes non-communicable diseases and mental health disorders. Will that task be left to the state governments? There was no mention of the Public Health and Health Management cadres announced last year by the government. Without Central financial support, these will not take off in most states.
A new programme will be launched for scaling up research into pharmaceuticals. While India is already reputed to be the pharmacy of the world for production of generic medicines, we must now move fast on the path of discovery for developing new pharmaceutical agents. The pandemic has shown clearly that we cannot depend on profit-hungry, multi-national pharmaceutical firms for assured supply of essential vaccines, therapeutics and diagnostics, even as most of the world looks to India for meeting such global needs. Besides enhancing India’s capacity for pharmaceutical innovation and manufacture, the Budget should have also provided resources for strengthening the capacity of our drug regulatory agencies to ensure quality and safety of our pharmaceutical products.
The laboratories of the Indian Council of Medical Research (ICMR) will now be opened up for private sector research groups to participate in joint research with public sector scientists. The successful collaboration between ICMR and Bharat Biotech for the production of Covaxin has opened the path to joint research initiatives that can use the extensive facilities available at the many ICMR institutes across the country.
The overall allocation for health has gone up only marginally, from ₹ 83, 000 crore to ₹ 86,175 crore. This is less than what an inflation-adjusted figure would require to keep the allocation at the earlier level. Within the four major health programmes that are covered under Ayushman Bharat, the National Health Mission (NHM) has seen an increase of only 0.78 per cent, though the expanded mandate of comprehensive primary healthcare and the need to scale up the urban health component of NHM call for more funds.
Increases of 12.3 per cent in the Pradhan Mantri Jan Arogya Yojana (PMJAY) and of 70.6 per cent in the Digital Health Mission are appropriate. For the Health Infrastructure Mission, there has been a reduction in the Central component, which brings down the overall allocation from ₹5154 crore in 2022-23 to ₹4845 crore in 2023-24. This is perhaps because the activities of this component have only just begun and the previous year’s allocation was not fully utilised.
The Department of Health Research has seen a reduction from ₹ 3200 crore to ₹ 2980 crore. Is it because the private sector partners are now expected to bring money into joint projects with ICMR? During COVID-19, the Department of Biotechnology stepped up support for epidemiological and clinical research. Will that continue? Establishment of three multi-disciplinary Centres of Excellence in Artificial Intelligence (AI) will give a fillip to health data analytics, driving development of diagnostic and management algorithms relevant to our population.
The drive for improving the nutritional quality of our diets is evident through the Global Millets Programme which has been initiated in the Year of Millets (2023). Support for cooperatives in agriculture, fishery and dairy sectors will also improve access to nutritionally-appropriate diets, apart from benefiting the farmers. Similarly, investment in green energy technologies, education, youth skilling, empowerment of women’s self help groups, digital communication (especially 5G) and non-polluting transport services will have multiplier benefits for health. The Union Budget does blend investments for health that extend beyond healthcare.
(Prof K. Srinath Reddy is a cardiologist, epidemiologist and Distinguished Professor of Public Health, PHFI)
