We congratulate the Union government on the budget presented on 1 February, 2017. The core thrusts of this year's budget are infrastructure, livelihood, higher education and youth. We welcome the government's attention on women and youth of the country, particularly the announcement of initiating in the 14 lakh Integrated Child Development Service (ICDS) centres across the country.
The allocation of ₹48,853 crores for the Ministry of Health and Family Welfare (MoHFW) in this year's budget indicates a 27% increase in overall health allocation, which is welcome. This increase is higher than the budgeted allocation for the last year and the year before, the figures being 15% and 8% respectively. However, most of the increase comes from transfers to states/Union territories, which comprises 55% of the health budget. This reflects the government's continued efforts to increase the role of states in health and reduce that of the MoHFW at the Centre.
The budget allocation is not adequate to provide accessible, affordable and equitable quality healthcare to all.
It is reassuring to see the government's commitment to "Health for All" in the Economic Survey and the Union budget tabled in Parliament by the Finance Minister. The budget announces a target of eliminating kala-azar and filariasis by 2017, leprosy by 2018, measles by 2020 and tuberculosis by 2025. The other much-needed announcements were to ensure adequate availability of specialist doctors, to strengthen secondary and tertiary levels of healthcare by creating additional postgraduate seats, and a structural transformation of the Regulatory Framework of Medical Education and Practice in India.
While all this is welcome, the budget allocation is not adequate to provide accessible, affordable and equitable quality healthcare to all. The Union government's allocation for the health sector as a share of GDP has seen a marginal increase from 0.26% in 2016-17 (BE) to 0.30% in 2017-18 (BE). This falls short of meeting the long-standing demand (articulated in the Draft National Health Policy, 2015) of increasing the total allocation for health sector to at least 2.5% of the GDP.
While the allocation for the National Rural Health Mission has been increased, that for the National Urban Health Mission has declined from ₹950 crore in 2016-17 (BE) to ₹752 crore in 2017-18 (BE). This is of concern as the healthcare needs in urban areas have increased with growing urbanisation and migration. Similarly, the budget allocation for Reproductive and Child Health (RCH) flexi pool has gone down to ₹5966 crore in 2017-18 (BE) from ₹7,775 crore in 2016-17 (BE).
It not clear how the Union Budget for 2017-18 will split health spending across various programmes and how much will be available for the family planning programme. The latter is almost fully funded by the Central government and has received very little attention compared to other health programmes in the recent past. Family welfare, which includes the budget for family planning constituted only 4 to 5% in the past few years. One will have to wait to see if its share has seen any significant rise in the present budget so that the country can meet its FP2020 commitment.
If the current unmet need for family planning could be fulfilled within the next five years, India can avert 35,000 maternal deaths and 1.2 million infant deaths.
The government envisages reducing the infant mortality rate (IMR) from 39 in 2014 to 28 by 2019 and maternal mortality rate (MMR) from 167 in 2011-13 to 100 by 2018-2020. Attention to family planning is crucial for India today. As per government estimates, if the current unmet need for family planning could be fulfilled within the next five years, India can avert 35,000 maternal deaths and 1.2 million infant deaths. If safe abortion services are coupled with an increase in family planning, the savings made to the country could be to the tune of ₹6500 crores. An ongoing study of the Population Foundation of India on "Cost of Inaction" reveals that given the current level of intervention, the goal of Total Fertility Rate becoming 2.1 will be achieved only in 2031 rather than in 2017 or 2022, as envisaged earlier. This would mean enormous cost in terms of MMR, IMR, health of the family as also provisioning of education health and basic amenities to the incremental population.
The increase in the MoHFW's budget for family welfare includes procurement of contraceptives. In FY 2017-18, ₹755 crore has been allocated to the Family Welfare Scheme of the central sector. This component provides assistance for the procurement and supply of contraceptives, strengthening national programme management for NRHM, funding to training and research institutions, IEC, and other activities of the central sector.This increase is barely enough to cover inflation. In 2015, the MoHFW added three new spacing methods of contraception to the family planning programme—the procurement, training and roll-out for these added methods would require additional investments. As new contraceptives are mainly supported by central procurement budgets, one wonders whether the demand can be adequately met.
Also, investing in health is critical for achieving the economic development goals of the government. The health sector, which drives domestic demand for healthcare, has the potential to provide new jobs. The lack of skilled workforce is stark in the health sector. Increased investment will also reduce the price of health services to the people and assist in sustaining the medium-term inflation target of 4%. An increased investment in health will increase levels of economic growth and political stability in the long run, reduce poverty and contribute to the general well-being of the population.