The health sector was allocated Rs. 89,155 crores (excluding the Transfers to States by the Ministry of Finance) in the 2023-24 union budget. Notably, this allocation was an increase of approximately 13% over Rs. 79,145 crores allocated in the 2022-23 union budget. Of the allocated Rs. 89,155 crore, Department of Health and Family Welfare gets Rs. 86,175 crore and Department of Health Research would receive Rs. 2,980 crores. However, one can observe a significant reduction in the share of health in the aggregate Union budget, which was 3.6% in 2021-22, fell to 2.7% in 2022-23 and further went down to 2.4% in 2023-24.
Also, there is 15% decline in the revised estimate (Rs 91,900 Crores) of the Union health budget (including the Transfers to States) for 2022-23 compared with the budgeted amount (Rs 1,07,433 crores) for that year. Including the Transfers to States, Rs.1,06,654 crores have been allocated to health for 2023-24 (i.e., Rs. 89,200 Crs for Ministry of Health and Family Welfare, Rs.3,600 Crores for Ministry of Ayush and Rs. 13,900 Crores for Ministry of Finance for Transfers to States). This indicates a slight decrease from last year’s budgeted allocation of roughly Rs 1,07,433 crores.
Union health budget as a percentage of GDP is also declining over a period (0.56% in 2021-22, 0.42% in 2022-23 and 0.35% in 2023-24). Economic Survey 2023-24 says the central and state governments combined budgeted expenditure on the health sector was 2.1% of the GDP in 2022-23 whereas the revised estimate for the year 2021-22 was 2.2% of the GDP and it was 1.6% 2020-21 (actual figures). However, the share of expenditure on health in the total expenditure on social services increased from 21% in 2018-19 to 26% in 2022-23. The National Health Policy, 2017, recommended raising public health spending to 2.5% of the GDP by 2025, which seems difficult in the current scenario.
In 2023-24 The AYUSH ministry received Rs. 3,647 Crore compared to Rs.2,845 Crore in 2022-23 (28% increase). For establishing 22 new All India Institute of Medical Sciences (AIIMS), the Health Ministry set aside Rs. 6,835 crores. The Union Budget 2023-24 also includes provision for setting up of 157 new nursing colleges in co-location with the current medical colleges.
This will, in the long run improve the nurses to population ratio. (Bharat currently has 1.7 nurses per 1,000 people as against the WHO norm of 3 nurses per 1,000 people). Union Government has announced in 2023-24 Budget its plans to launch a mission of eliminating sickle cell anaemia by 2047. Once launched, the initiative will allow for universal screening of 7 crore people between 0 and 40 years in affected tribal areas.
For the healthcare sector, the budget announcements indicate research and innovation, use of technology, skill development and medical education as the priority areas. The budget announcements also indicate – setting up centers of excellence (CoE) to promote research and innovation in pharma, multidisciplinary courses for medical devices to create skilled manpower for medical technology, collaborative research and innovation by joint participation of public and private sectors as the focus areas. In line with this the allocation for the Indian Council of Medical Research (ICMR) in the Union Budget has gone up from INR 2,116.73 crores to INR 2,359.58 crores.
The budget for the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) is INR 3,365 crores in 2023-24 and an additional amount of Rs.6,835 Crores has been allocated for the setting up of new AIIMS. This amounts to a total of Rs.10,200 Crores, which is 23% more than revised estimates for 2022-23 (Rs.8,270 Crores).
The Union Budget has allocated for autonomous bodies INR 17,322.55 crores in 2023-24. This is a rise from INR 10,348.17 crores in 2022-23. The allocation for National Digital Health Mission has been increased from Rs.140 crore in 2022-23 to Rs.341.02 Crores in 2023-24.
Budget allocation for Ayushman Bharat is Rs.7,200 Crores in 2023-24, 12 percent higher than Rs.6,412 Crores allotted in 2022-23.
Overall, it can be said that though there has been an increase in the amount of budgetary allocation, as a percentage of the GDP or aggregate of Union Budget healthcare allocation the share of health sector has been declining over the years. It is also evident that raising the public health spending to 2.5% of GDP by 2025 appears to be a distant dream rather than a near reality. While digital health initiatives have the potential for the country to address the gaps in physical infrastructure in health, we have a long way to go with regard to preventive healthcare and health insurance.
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