India’s union budget 2023–24 and health care allocation

‘Union Finance Minister Smt. @nsitharaman, in her opening remarks at the Joint Health-Finance Ministers’ Meeting of #G20 in Gandhinagar, stated that the Joint Finance and Health Task Force #JFHTF has achieved significant progress in delivering outcomes on all the three priorities: FEVR (Framework for Economic Vulnerabilities and Risks) Report, Report on Mapping Pandemic Response Financing Options and Gaps; and Report on Best Practices on Finance Health Institutional Arrangements during Covid-19. The Union Finance Minister highlighted that the Task Force under #G20India Presidency has adopted a multi-year work plan for the first time and has also invited selected key regional organisations, thereby enhancing the voice of low-income countries’.– Ministry of Finance, Union Government of India, 19 August 2023[1]

Dear Editor,

Mehta et al.[2] analysed India’s Union Budget 2023–24 and assessed its health care allocation data when they found there was much to be desired in their commentary published in the October 2023 issue of the journal. The authors present several facts and figures from the official documents and then lament about a reduction in the allocation in this sector when adjusted for inflation therein. This dismal rate of allocation is not going to improve the health of its people, as per their estimate and I agree with the overall viewpoint of the writers. They recount a slew of unfulfilled promises when we are entering an upcoming election year and the scheduled general election is also on the horizon. Also, they suggest potential solutions and I disagree precisely on this point while virtually appreciating all the other statements.

The authors underscore the value of public-private partnership (PPP) in our times – fraught with several conflicts – when many priorities compete for financial attention. They – like several large powerful players of our times[3] – enumerate its potential benefits, and I agree with its wider intent. However, in my experience, there are certain drawbacks also where the authors did not venture. The authors state that private investment will enhance accountability and transparency. Nevertheless, the fact of the matter is that the Right to Information Act is not applicable to private entities,[4] despite pushback by the administration.

In my experience, the moment an investment or service goes to a private bidder, it becomes a Herculean task to know anything about it. How will the opaque functioning of the system enhance accountability (as the writers suggest in their imagination), I wonder. Whether this exercise will increase responsiveness, as the authors genuinely emphasise in the article, I am confused. The terms and conditions of most of the PPP are not available in the public domain, to the best of my knowledge, where the contract has been going on in our time.

As regards the Ayushman Bharat Yojana (PM-JAY scheme) is concerned; the authors (correctly) state that its implementation has faced several challenges. Nonetheless, they suggest a new approach that involves PPP. But a recent report by the Comptroller and Auditor General of India states corruption therein.[5] How will (more) PPP (further) reduce the chances of this challenge; I want to know from my enlightened colleagues. During COVID-19, several private hospitals encashed the opportunity to mint money and build fortunes through unfair means. Stories of the hapless patients abound in our collective memory.[6,7] When the government shirked away its responsibility to vaccinate the population in its early stages, private players left no stone unturned to build their fortunes out of the biggest catastrophe of our lifetime.[8]

Among unfulfilled promises, the authors state that the prevalence of anaemia in Indian women and the stunting of school-going age children are causes of concern. In addition, to combat these challenges, we need funding. Although that is an agreeable point,[9] the reality is more complicated. Anaemia in Indian women has a patriarchal origin. When they are rated as second-class citizens next to their male counterparts, their nutrition status at the baseline is bound to be insufficient. On the other hand, one of the causes of stunting in school-going age children is diarrhoea.[10] This condition is because of the lack of availability of safe drinking water, which is one of the important factors.

While no large funds are needed to provide primary/basic education – including health care education – to masses including mothers to teach hygienic precautions, taking care of sick, dehydrated babies with intra venous (IV) drugs and fluids is a costly affair.[11] A poor country like ours having per capita income at the lower end of the list[12] should adopt the former approach over the second one. The US, with the highest per capita spending on health care, is not a stellar player in the field when it is assessed on such vital indicators. It has one of the lowest life-expectancy among its peers.[13] That data indicates massive wastage of resources. Therefore, while we would avoid making mistakes of the outlier developed economies, public resources need to be aggregated for equitable utilization. An increase in budgetary allocation alone does not automatically lead to improved health status of its people, as per worldwide experience, and other factors are at play that we need to realise and dissect.

China with its expansionist ambition is a constant threat to its neighbours.[14] International diplomacy demands that we would settle our disputes amicably, but repeated skirmishes at Galwan Valley, escalated since May 2020[15] and at other sites in cahoots with Pakistan require us to remain vigilant at borders. Sadly, the ration of soldiers comes at a cost, but that is an unavoidable yet hard truth. Along with directly confronting us, China lent money to our neighbour Sri Lanka, which some believe to be its leveraging point in its naval ambitions. The largest player in Asia sharing borders with us is constantly in search of allies in the South China Sea and beyond, and India too has been responding with disparate treaties and making alliances with several friendly nations. Geopolitics and diplomatic engagement should come to the rescue, as armed warfare benefits none.

In Utopia, all the challenges get resolved by dialogue but in the real world, many times power play of weapons decides our destiny. When choosing between books for children and guns for soldiers, hope and propriety demand to go for the former. Nonetheless, the world we inhabit today is far ugly, messy, war–torn, and often forces us to make wrong choices.

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Conflicts of interest

There are no conflicts of interest.