Strengthening primary healthcare augurs well

National Health Mission gets a 9.6% increment, despite the pressing need to strengthen both rural and urban primary care

Conventionally, the union budget provides annual financial allocations to the Ministry of Health and Family Welfare (MoHFW). The low levels of public financing for health in the budgets have been bemoaned for decades. This year, the Finance Minister sprang a surprise by announcing a 137 per cent increase for 'health and wellness' in the Union Budget for 2021-22. She did so by broadening the definition of health to include not only the healthcare services but also the determinants of health like nutrition, water, sanitation and pollution control. This fits in well with the public health definition of healthcare as extending to protection and promotion of health apart from care of illness. It also resonates with the Sustainable Development Goals which call for 'health and wellbeing for all, at all ages'.

Though grouped together, the areas are spread across several ministries. The programmes of the health ministry itself do not get a high rise. The National Health Mission gets a 9.6 per cent increment, despite the pressing need to strengthen both rural and urban primary care apart from upgrading district hospitals. The Pradhan Mantri Jan Arogya Yojana, which slipped into the slow lane during Covid-19 and also faced difficulty in accrediting eligible hospitals in many smaller towns, stayed at last year's level. AYUSH and ICMR fared a little better. Nutrition programmes, which were impeded by the pandemic, saw a lower allocation. Water and sanitation saw a three-fold rise. Pollution control and public transport received strong support. An allocation of Rs 35,000 crore was accompanied by a promise for more if needed.

Though the existing health programmes were not blessed with larger allocations, a new centrally sponsored health programme was announced, with a funding of Rs 64,180 crore over six years. The PM AtmanirbharSwasth Bharat Yojana will support 17,788 rural and 11, 024 urban Health and Wellness Centres, establish public health labs in all districts and 3,382 block public health units in 11 States.

Clearly catalysed by the pandemic, the scheme will strengthen the National Centre for Disease Control and its 5 regional branches, establish critical care hospital blocks in 602 districts and 12 central institutions. It will strengthen infectious disease surveillance at all monitored entry points into the country. It will set up a national institution for One Health microbial surveillance across wildlife, veterinary and human populations, establish four new regional institutes of virology and nine advanced microbial laboratories at Level 111 biosafety.

Complementary to the health budget, the 15th Finance Commission, which released its recommendations on Centre-State sharing of tax revenues for the next five years, specifically allocated funds for strengthening urban and rural primary healthcare, training of allied healthcare workforce and establishment of critical care hospitals. It recommended the establishment of an All India Medical and Health Service and better regulation of the private sector. The funds for primary healthcare would flow through local bodies, democratising the health system.

While the budget and the Finance Commission recommendations have been greatly influenced by the pandemic, the broader vision of health and the emphasis on strengthening of primary health care as well as hospitals and laboratories in the public sector augur well for the strengthening of India's health services.

(The author, a cardiologist and epidemiologist, is president of Public Health Foundation of India (PHFI). He is the author of 'Make Health in India: Reaching a Billion Plus'. He advises the Andhra Pradesh government on public health)