Civil society groups criticize budgetary allocations for the health sector

Union Health Minister Mansukh Mandaviya arrives at Parliament on a bicycle during the ongoing budget session. Photo: PTI/Arun Sharma

New Delhi: A day after the presentation of the Union budget 2022-23 which indicated a 7% decrease in the allocation to the health sector compared to last year’s budget, civil society groups published the 2 February a statement “condemning” this decision.

Jan Swasthya Abhiyan, which is a network of around 100 large and small civil society groups working on health across India, called on parliament to ‘reject the cuts and call unitedly for increased allocations for health”, especially in the aftermath of COVID-19.

The Abhiyan strongly criticized the inadequate allocation to the National Health Mission (NHM). The NHM is an umbrella program for the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM) and serves the health needs of the majority of the Indian population. The science of yarn reported on Tuesday that the NHM had received Rs 37,000 crore this year compared to Rs 34,447.14 crore last year (revised estimate).

Analyzing the last two budgets, the JSA indicates that the actual expenditure of the NHM in 2021-22 was Rs 37,080 crore. Now, for 2022-2023, the program has only Rs 37,000 crore to spend. It includes Rs 7,500 crore for infrastructure development (some of which is in public-private partnership mode), leaving only Rs 30,000 crore for primary and secondary care.

“It was essential for the government to make special efforts to ensure safe motherhood, universal immunization and expand various disease control programs to make up for losses during the pandemic, but this major need was ignored,” the JSA said. , which has chapters. in 22 states, said. There are well-documented reports that childhood immunization, TB elimination, and malaria elimination have been negatively impacted due to COVID-19-related disruptions.

Although the government has been successful in vaccinating a large portion of the population against COVID-19, much of the success must be attributed to ASHA workers and ANMs (Auxiliary Nurse Midwives) who were not paid. “The NHM budget cut is going to significantly affect the compensation of ASHAs and ANMs,” he said.

The JSA has also questioned the justification for Pradhan Mantri Jan Arogya Yojana (PMJAY)’s increased spending since its conception in 2018, especially when it was only able to spend half of what was allocated to it. The budget estimate for 2021-2022 for the program was Rs 6,400 crore. However, the allowance was revised during the year to just Rs 3,199 crore. PMJAY’s actual expenditure in 2019-20 was also Rs 3,200 crore as The science of yarn reported.

“(Furthermore) It has been clearly seen during the COVID-19 pandemic that Pradhan Mantri Jan Arogya Yojana (PMJAY) has failed miserably in providing access to health services to poor and disadvantaged sections during COVID-19. During COVID-19, a significant decline in insurance claims has been observed,” the JSA said, demanding that the scheme be completely abandoned and that resources be diverted to strengthening the public health system rather than placing them in an insurance scheme that seems clearly underperforming.

Even programs that address child nutrition and malnutrition have had little boost in this budget. Allocations for Saksham Anganwadi and POSHAN 2.0 increased slightly by around Rs 150 crore. This program 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 girls has been affected and required adequate attention,” the statement said.

The statement also highlights that the government has not done enough for women’s health, in particular, when much of its message is to indicate that it cares about them. The government’s SAMBAL plan is to provide security. It has components like the One Stop Center for Rape Victims, Women’s Helpline, Widows Homes, etc. But spending on the program has increased from Rs 587 crore in the 2021-22 budget to Rs 562 crore in the 2022-23 budget. The SAMARTHYA scheme, which is all about health care and empowerment of women, saw a meager increase of Rs 100 crore.

If ‘health’ as ​​a subject captured the spotlight in Union Finance Minister Nirmala Sitharaman’s speech yesterday, it was to establish a national tele-mental health programme. “But the country’s ongoing national mental health program saw a small allocation of Rs 40 crore,” the JSA said.

The JSA questioned a fairly high increase in spending for the digital health mission “while health services are utterly inadequate. What sense does it make to prioritize digital health records of dubious value, over the provision of real health services. »

Apart from pointing out inadequate allocations in various areas of health, the statement also castigated the lack of transparency in budget documents. The Abhiyan makes special reference to NHM in this regard. “All schemes and programs under the NHM, including the National Rural Health Mission (NRHM) and its sub-components, have been consolidated into one head in this budget. This does not allow us to understand allocation trends on key programs like NUHM, immunization, various disease control programs,” he said. In other words, if we want to know how much money has been allocated for childhood vaccination in the budget, we cannot.

Another example they cite is the PM-CARES Fund as it is unclear how much money has been spent on COVID-19 related health care. “All funds related to PM-CARES must be placed under democratic accountability and the release of public data must be a priority,” the JSA said.

James V. Hayes