Budget 2021: Allocation won't cover 300-million target for vaccination

While I am still looking at the numbers in detail, as the devil is in the detail, one can say the idea of combining the health system in terms of health services, as well as looking at nutrition, sanitation, water, and pollution (which are the determinants of health systems) is not a bad idea. It fits in well with the sustainable development goal number 3, which is looking after health and wellness. 

But, we have to look at what health is getting by itself, in terms of the health ministry. There are two elements here — one, there is modest growth in the allocation for the National Health Mission (NHM) and second, the Rs 64,180-crore scheme which is to be operated over six years. Centrally funded schemes will also call for states' contribution. Therefore, here one needs to see how much will be from the Centre and how much by states. 

It is going in for some additional health and wellness centres under the scheme, both rural and urban. The interesting part here is that health and wellness centres are also part of the NHM. 

Furthermore, the scheme focuses on epidemic prevention, surveillance, and response. There is focus on strengthening the surveillance system at the block, district and metropolitan levels, as well as strengthening the National Centre for Disease Control and its branches. The government plans to prepare district level critical care units. 

All of the above is looking like it is a Covid-19 stimulated response, which is not bad as this will strengthen the health care system in terms of its preparedness. The northeastern states, too, have received focus, which is a step in the right direction. 

One aspect which is missing, however, is the focus on the health workforce — increasing both numbers and skills. When we increase health care infrastructure, unless one has adequate personnel, one cannot deliver. It is not clear as to what is going to be done to ensure the supply of trained manpower, especially in critical care. 

The 15th Finance Commission Report, which was also submitted to Parliament today, has some clear cut mentions about health care manpower. It talks of strengthening primary health care and district hospitals, and also of training allied health care professionals. Therefore, it is bringing in complementarity to what the Budget is saying. If both of these are taken together and the Centre and states act upon it, we will have more substantial inputs into health systems strengthening. 

On the allocation for Covid-19 vaccines, Rs 35,000 crore is probably for purchase and administration of vaccines. One also needs to see here if the purchase is for domestic purposes, or also includes international friendly shipments as part of Covid-19 diplomacy. However, the finance minister has said that we will spend more on vaccines, if the utilisation is more. We need to wait and see if the allocation rises, and if the additional money comes from the Budget or the PM CARES Fund. 

The allocation for vaccines will not cover the remaining 270 million of the total 300 million target that the government has. There is yet no clarity on how this fund will be raised, how much states will contribute, and how much the new vaccines will cost. The finance minister has left it cryptic by saying that we will give more if required. 

We also have to look at state spending — one-third of the health care spending comes from the Centre, while two-thirds comes from the states. Assuming that the Centre is spending more given the pandemic, state budgets also will need to step up. 

The PM-Jan Aarogya Yojana (PMJAY) has not been given much, as last year the funds were not utilised due to the Covid-19 pandemic. Tier-2 and tier 3 cities also lacked the health infrastructure needed to use these funds appropriately. One area that the government could have looked at in the PMJAY was out-patient care and paying for medicines as this would have significantly reduced out-of-pocket expenditure. 

The author is president, Public Health Foundation of India (PHFI), former head of the department of cardiology at All India Institute of Medical Sciences (AIIMS), and Padma Bhushan awardee

While I am still looking at the numbers in detail, as the devil is in the detail, one can say the idea of combining the health system in terms of health services, as well as looking at nutrition, sanitation, water, and pollution (which are the determinants of health systems) is not a bad idea. It fits in well with the sustainable development goal number 3, which is looking after health and wellness. 

But, we have to look at what health is getting by itself, in terms of the health ministry. There are two elements here — one, there is modest growth in the allocation for the National Health Mission (NHM) and second, the Rs 64,180-crore scheme which is to be operated over six years. Centrally funded schemes will also call for states' contribution. Therefore, here one needs to see how much will be from the Centre and how much by states. 

It is going in for some additional health and wellness centres under the scheme, both rural and urban. The interesting part here is that health and wellness centres are also part of the NHM. 

Furthermore, the scheme focuses on epidemic prevention, surveillance, and response. There is focus on strengthening the surveillance system at the block, district and metropolitan levels, as well as strengthening the National Centre for Disease Control and its branches. The government plans to prepare district level critical care units. 

All of the above is looking like it is a Covid-19 stimulated response, which is not bad as this will strengthen the health care system in terms of its preparedness. The northeastern states, too, have received focus, which is a step in the right direction. 

One aspect which is missing, however, is the focus on the health workforce — increasing both numbers and skills. When we increase health care infrastructure, unless one has adequate personnel, one cannot deliver. It is not clear as to what is going to be done to ensure the supply of trained manpower, especially in critical care. 

The 15th Finance Commission Report, which was also submitted to Parliament today, has some clear cut mentions about health care manpower. It talks of strengthening primary health care and district hospitals, and also of training allied health care professionals. Therefore, it is bringing in complementarity to what the Budget is saying. If both of these are taken together and the Centre and states act upon it, we will have more substantial inputs into health systems strengthening. 

On the allocation for Covid-19 vaccines, Rs 35,000 crore is probably for purchase and administration of vaccines. One also needs to see here if the purchase is for domestic purposes, or also includes international friendly shipments as part of Covid-19 diplomacy. However, the finance minister has said that we will spend more on vaccines, if the utilisation is more. We need to wait and see if the allocation rises, and if the additional money comes from the Budget or the PM CARES Fund. 

The allocation for vaccines will not cover the remaining 270 million of the total 300 million target that the government has. There is yet no clarity on how this fund will be raised, how much states will contribute, and how much the new vaccines will cost. The finance minister has left it cryptic by saying that we will give more if required. 

We also have to look at state spending — one-third of the health care spending comes from the Centre, while two-thirds comes from the states. Assuming that the Centre is spending more given the pandemic, state budgets also will need to step up. 

The PM-Jan Aarogya Yojana (PMJAY) has not been given much, as last year the funds were not utilised due to the Covid-19 pandemic. Tier-2 and tier 3 cities also lacked the health infrastructure needed to use these funds appropriately. One area that the government could have looked at in the PMJAY was out-patient care and paying for medicines as this would have significantly reduced out-of-pocket expenditure. 

The author is president, Public Health Foundation of India (PHFI), former head of the department of cardiology at All India Institute of Medical Sciences (AIIMS), and Padma Bhushan awardee