Health Budget: Time to look forward, learning lessons from the past

India has been able to fully vaccinate 50 percent of its population within a year of the start of its vaccination. But its public health expenditure as a share of the gross domestic product is one of the lowest among its peers in the developing world. COVID-19 provides an opportunity to change that, and we hope the upcoming budget takes a big step in that direction.

The Hon’ble finance minister’s 2021-22 budget speech understandably started on a somber note. In her words, “the preparation of this Budget was undertaken in circumstances like never before….we could not have imagined that the global economy, already in throes of a slowdown, would be pushed into an unprecedented contraction.”

As she prepares to deliver her next budget speech, much of what she said is still relevant today. Public memory is short, but only two months after the last budget, India experienced a devastating COVID-19 wave fueled by the delta variant. It showed how inadequately prepared the country was nearly a year after one of the strictest lockdowns in the world in March 2020. The global economy is yet to recover from the shock of the pandemic, and India is no exception.

| Budget 2022: What’s in store for Life Sciences Sector?

At the same time, the country rolled out one of the world's largest vaccination programs reaching one billion doses by end-October. It has dealt relatively well with the latest surge of the Omicron variant, ramping up testing and preventing the chaotic scenes of the last pandemic wave. As the world moves from the pandemic to an endemic phase of the COVID-19 emergency, the upcoming budget is a good time to refocus priorities, restructure expenditure, and reframe outcomes.

In terms of priorities, one of the main focuses should be on maintaining preparedness for further disruption in the short run while strengthening the health system to face the medium and long-term challenges. Globally, the last two years have demonstrated the need for an efficient and well-resourced public health system and the important role that health workers play in the fight against COVID-19. Fighting the pandemic requires improving the coverage and quality of the public health infrastructure, upgrading skills for healthcare personnel, and increasing public expenditure on health. While every budget mentions these as priorities, it is time to get serious about putting the money where the intention is.

On the financing side, India’s response to the COVID-19 emergency has been both reactive and proactive. Much of the health budget for 2020-21 was repurposed for the pandemic response, possibly at the expense of the National Health Mission (NHM). The Emergency COVID Response Package (ECRP), financed partly by the World Bank and Asian Development Bank, enabled the government to quickly procure goods and services needed for pandemic response. In addition, Budget 2021-22 made a provision of Rs.35,000 crores to fund the vaccination campaign. The vaccination campaign has been a bright spot in India’s COVID-19 response.

Even with the ongoing uncertainty, Budget 2022-23 provides an opportunity to take a strategic view of the Indian government’s health expenditure and its intended outcomes. One immediate objective is to strengthen the NHM. After more than a decade the NHM’s implementation structure has remained more or less the same. It is time to re-think how the NHM can better serve the demands on the health system in a post-COVID-19 world.

Also Read | Rising input and logistics costs could weigh on pharma market: Kiran M Shaw

In the last budget, the finance minister announced a new scheme Atmanirbhar Swastha Bharat Yojana (PM-ASBY) with an allocation of nearly 65,000 crores over six years. On the face of it, there is significant overlap between PM-ASBY and NHM, potentially creating duplication of effort, deterioration in expenditure quality, and low, if any, impact on outcomes. The proliferation of schemes should be avoided as much as possible. Now is the time for consolidation rather than fragmentation and Budget 2022-23 needs to send a clear signal about the government’s intention to consolidate response efforts.

On the positive side, India’s COVID-19 vaccination campaign has also shown what a well-functioning digital health delivery and management system can achieve in a short period. India’s Co-Win vaccination portal is an example of an end-to-end digital infrastructure that can be used for other disease control priorities like tuberculosis. Data analytics and new digital tools like artificial intelligence and machine learning can help target health services – both preventive and curative – more effectively. What is needed is a strategic vision and financing of a digital health ecosystem that will leverage the dynamism of India’s entrepreneurs to serve the needs of those who most need health services.