Event Report
Mannat Ghumman
IMPRI #PolicyWebTalk recently organised an insightful 6-day panel discussion on the prospects of the Union Budget. Held from July 24th to July 29th, 2024, this event was part of the IMPRI 5th Annual Series of Thematic Deliberations and Analysis of Interim Union Budget 2024-25. On July 25th, 2024, the Center for Human Dignity and Development (CHDD), IMPRI Impact and Policy Research Institute, New Delhi, hosted a discussion on “Population, Health, and Union Budget 2024-25.”
The panel featured a distinguished lineup of experts. The Chair and Moderator for the event was Dr Manorama Bakshi, Director and Head of Healthcare and Advocacy at Consocia Advisory, Founder and Director of the Trilok Raj Foundation (TRF), and Visiting Senior Fellow at IMPRI. The panellists included Prof. Sanghmitra Sheel Acharya, Mr Abhijit Mukhopadhyay, Ms Urvashi Prasad, Dr Shoba Suri, and Prof. Pradeep K. Panda. Each expert brought unique insights and perspectives, enriching the discussion with in-depth analyses and forward-looking views.
The recent lecture on “Population, Health, and Union Budget 2024-25,” chaired and moderated by Dr. Manorama Bakshi, Director and Head of Healthcare and Advocacy at Consocia Advisory, Founder and Director of the Trilok Raj Foundation (TRF), and Visiting Senior Fellow at IMPRI, provided an in-depth analysis of the Union Budget’s implications for healthcare in India. Dr. Bakshi opened the session with insightful remarks, underscoring the importance of the healthcare sector in realizing the goals outlined in the Viksit Bharat vision. Her introduction set a comprehensive framework for the discussion on the budget’s role in shaping the future of healthcare in the country.
Dr. Bakshi’s presentation highlighted key allocations in the healthcare budget. The Department of Health Research received ₹9,958 crore, marking a significant 12.93% increase from previous allocations. This increase reflects the government’s commitment to advancing health research and innovation. The Department of Health and Family Welfare was allocated ₹33,301.73 crore, aimed at strengthening the department’s capacity to address public health challenges more effectively.
Significant changes and initiatives were also discussed. The budget includes exemptions on duties for X-ray tube flat panel detectors, which is expected to promote domestic manufacturing and reduce costs for medical facilities. Another notable aspect is the increase in funding for vaccination programs, particularly targeting the reduction of cervical disease mortality among young girls. This initiative represents a proactive measure by the government to address critical public health concerns.
Dr. Bakshi also touched upon the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). While the scheme continues to support a large portion of the population, the anticipated extension to elderly individuals has not yet been implemented, raising questions about future inclusions.
Prof. Pradeep K. Panda, Professor and Dean at the School of Public Health, Asian Institute of Public Health (AIPH) University, Bhubaneswar, provided a comprehensive analysis of the Union Budget 2024-25 during his recent lecture. Prof. Panda commended the post-election budget for its emphasis on fiscal consolidation and its focus on future challenges such as COVID-19. He noted that the government has adjusted its fiscal deficit target to 4.5% of GDP by the fiscal year 2026, a reduction from the previously set 5.1% target. This adjustment is crucial for maintaining macroeconomic stability and attracting investment. He highlighted the balanced approach between growth-enhancing capital expenditure and welfare-enhancing revenue expenditure, which reflects the government’s commitment to addressing both immediate and long-term economic needs.
However, Prof. Panda also pointed out some disappointments in the budget. He criticized the lack of structural reforms, which he believes could impede long-term growth. Additionally, he raised concerns about the disproportionate allocation of resources to states like Bihar and Andhra Pradesh, arguing that this allocation may undermine the principles of cooperative federalism. Turning to the health sector, Prof. Panda expressed dissatisfaction with the allocation of funds. The budget for the health sector in 2024-25 stands at ₹90,009.58 crore, which represents a 12% increase from the previous year but remains only 0.28% of GDP, up from 0.27% the previous year. He advocated for a more substantial increase, suggesting that health sector allocations should reach 0.5% of GDP and gradually rise to 1% in the future. Prof. Panda highlighted persistent issues such as under-expenditure and shortages in human resources for health, which continue to plague India’s healthcare system.
He provided specific examples of discrepancies between budget allocations and actual spending. For instance, the Prime Minister’s Ayushman Bharat Health Infrastructure Mission (PMABHIM) received a budget estimate of ₹4,200 crore in 2023-24, yet only half of this amount was spent. Similarly, the Prime Minister Swasthya Suraksha Yojana (PMSSY), which focuses on establishing new AIIMS and upgrading medical colleges, saw expenditures of less than half of the allocated amount. Even though the allocation for the National AIDS Control Program was better, with ₹7,200 crore allocated for 2023-24, spending still fell short of the budget estimate.
Dr. Shobha Suri, Senior Fellow at the Health Initiative of Observer Research Foundation (ORF), New Delhi, provided valuable insights into how the Union Budget 2024-25 addresses issues related to women, children, and nutrition at the grassroots level. Dr. Suri began by acknowledging the context set by the previous speakers and expressed her gratitude for the opportunity to contribute to the discussion. She emphasized the importance of understanding how budget allocations translate into tangible improvements, particularly in areas critical to women’s and children’s health.
Highlighting the broader goals of the budget, Dr. Suri noted that while there has been an increased focus on health, the overall allocation remains relatively low. She pointed out that the World Health Organization recommends that governments allocate at least 5% of their gross national income (GNI) to healthcare. In contrast, the current budget allocation does not meet this guideline, which is crucial for ensuring sustainable and comprehensive healthcare. Dr. Suri addressed specific budget allocations and their impact on programs related to maternal and child health, nutrition, and public health. She observed that while there is a nominal increase in the overall health budget, many key programs have either seen reduced allocations or remained stagnant. For instance, programs such as Saksham Anganwadi and Poshan 2.0, which are vital for combating malnutrition and supporting early childhood care, have experienced a decrease in funding. This is concerning given that India faces significant malnutrition challenges, particularly in South Asia.
The budget for programs related to human resources for health and medical education has also been reduced, which could impact the quality of healthcare services and training for healthcare professionals. Dr. Suri underscored that despite the nominal increase in overall health allocations, crucial issues like the obesity epidemic, rising non-communicable diseases (NCDs), and mental health challenges are not adequately addressed. On the topic of nutrition, Dr. Suri expressed concern over the lack of significant increase in funding for programs essential for combating malnutrition, such as the midday meal scheme and Anganwadi worker honorariums. She emphasized that while the finance minister’s extension of the PM Garib Kalyan Yojana is a positive step, it may not fully address the underlying issues affecting women’s and children’s health.
Dr. Suri also discussed the synergies needed between various health programs and their impact at the grassroots level. She highlighted the importance of enhancing infrastructure and human resources, especially in rural and marginalized communities. Improving antenatal care, immunization, and nutritional support programs are essential for better maternal and child health outcomes. She stressed the need for robust implementation and monitoring of health programs to ensure that allocated funds are effectively utilized. Behavioral change communication and awareness campaigns are crucial for addressing issues like anemia and promoting better health-seeking behaviors among women and children.
Mr. Abhijit Mukhopadhyay, Consulting Economist at The Secretariat, highlighted several critical aspects of the Union Budget 2024-25, particularly concerning its impact on healthcare, employment, and capital investment. Despite the reported 30% increase in the healthcare budget, Mr. Mukhopadhyay pointed out that the actual percentage increase from the 2023-24 budget is only around 12.7%. When compared to previous estimates, the effective increase is even lower, approximately 0.4% or less than 1%. This modest rise in funding is troubling given the growing demands and needs in the healthcare sector. Additionally, actual spending frequently falls short of allocated budgets, indicating significant inefficiencies in fund utilization.
In terms of employment, the healthcare sector is projected to create around 5 lakh jobs annually. However, the distribution of these roles remains uneven, particularly among ASHA (Accredited Social Health Activist) workers, who are often overloaded with responsibilities. In some areas, an ASHA worker might handle too many individuals, while in others, the workload is lighter. This disparity suggests a need for more equitable distribution and enhanced efficiency in human resource management. Capital investment in healthcare infrastructure has not seen substantial growth. Significant programs, such as Ayushman Bharat and other health infrastructure missions, have either faced cuts or received minimal increases in funding. Although there has been some increase in allocations for reproductive and child health, many flagship programs have not benefitted from significant financial boosts.
Mr. Mukhopadhyay also stressed the importance of rigorous impact assessments for healthcare programs. He noted that many schemes suffer from poor implementation and underutilization of funds. Effective impact assessments could reveal program inefficiencies and guide better resource allocation. The demographic shift towards an older population presents additional challenges. By 2036, those aged 60 and above are expected to make up 15% of the population, and this figure could rise to 20% by 2050. This shift underscores the need for policies that address the healthcare needs of the elderly, including potentially offering free healthcare services. Recent policy changes allowing health insurance for those over 65 are promising but require effective implementation.
Finally, Mr. Mukhopadhyay compared India’s healthcare spending as a percentage of GDP with other countries, noting that India’s expenditure of 3.3% in 2020-21 is lower than in many other nations. He emphasized the need for increased healthcare spending to keep pace with population growth and rising healthcare demands. Investing more in health infrastructure and human resources, as well as ensuring better integration of various healthcare schemes, could significantly enhance the effectiveness of healthcare delivery in India.
Prof. Sanghmitra Sheel Acharya, Professor at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University (JNU), New Delhi, discussed the key elements of the Union Budget for the financial year 2024 in her presentation. She began by noting that the total estimated expenditure for the fiscal year is approximately ₹48,12,512 crores. The budget’s primary focus includes energy security and infrastructure development, alongside significant allocations for social sector schemes such as the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) and the Pradhan Mantri Awas Yojana (PMAY). These schemes have seen a notable net gain of around ₹17,500 crores. In terms of social sector expenditure, the total allocation is approximately ₹1.27 lakh crores, with subsidies for food, fertilizer, and petroleum estimated at ₹3.71 lakh crores. Despite these allocations, Prof. Acharya expressed concern over the relatively lower allocation for the social sector compared to previous years, suggesting that the increases were not substantial enough.
A critical point in the discussion was the allocation for healthcare. The Union Budget has earmarked ₹8,656 crores for the Health and Family Welfare Department and ₹3,300 crores for research. Although there has been an improvement in the allocation for flagship schemes like Ayushman Bharat and the Pradhan Mantri Jan Arogya Yojana (PMJAY), there has been no increase in the budget for the National Digital Health Mission (Ayushman Bharat Digital Mission), which remains at ₹200 crores. The National Health Mission (NHM) has received an allocation of approximately ₹36,000 crores, and the Indian Council of Medical Research (ICMR) has seen its funding raised from ₹95 crores to ₹2732 crores. However, allocations for autonomous bodies, such as the All India Institute of Medical Sciences (AIIMS), have not seen substantial increases.
Prof. Acharya also highlighted the exemption of duties on cancer drugs and the need for continued focus on addressing critical health issues. The budget reflects a significant boost in funding for healthcare and Ayush, but challenges remain in adequately addressing health emergencies and needs, particularly with the increasing incidence of cancer and other major health concerns.
In conclusion, the lecture on “Population, Health, and the Union Budget 2024-25” offered a detailed examination of the budget’s implications for healthcare in India. Dr. Manorama Bakshi, Prof. Pradeep K. Panda, Dr. Shobha Suri, Mr. Abhijit Mukhopadhyay, and Prof. Sanghmitra Sheel Acharya collectively highlighted the budget’s increased allocations and various initiatives aimed at improving healthcare outcomes. However, they also pointed out significant gaps and inefficiencies, such as inadequate increases in funding, uneven distribution of resources, and under-expenditure on critical programs. While the budget demonstrates a commitment to healthcare advancement, addressing these challenges effectively is crucial for translating financial allocations into tangible improvements in health outcomes for all segments of the population.
Acknowledgement: Written by Mannat Ghumman, Research Intern at IMPRI.
