Union Budget 2023: Public Health System Longs For A Respite

India has 5 million more people than China, as reported by the Bloomberg quoting World Population Review in January 2023. The country has successfully crossed many stumbling blocks since its independence and is currently dubbed as the fifth largest economies of the world. There are many sectors where substantial progress is documented, yet multiple challenges stare at us, and aspirations of many young and old, not fully met yet.

Budget Reflects National Policy and Perspective

Country’s national budget is an affirmative reflection of the government’s road-map and policy directions which it plans to pursue.  In the context of the ongoing pandemic era, it is time to re-visit the spectrum of public health and the future directions this sector ought to take in order to address the critical concerns of people.  So far, India's planned approach to the health policy has largely focused on addressing on the urgent and pressing health problems with only select solutions, which were usually addressed by missing out on multisectoral involvement with other key sectors. Therefore, such an approach by and large resulted in compromising on the global health and developmental targets. Nevertheless, the country has gradually begun focusing on addressing its endgame health issues. Public health and development experts are expecting substantial reflections of the government’s positive intent in addressing crucial end-game goals through the ensuing national budget 2023-24 at this critical juncture.  

Much Needed Impetus to Nutrition – Policy Re-Orientation  

Making substantial budgetary provisions is one of the political tools that demonstrate government’s commitment; however, some public health initiatives such as nutrition interventions instead need some crucial policy shifts along with closer field management. It is also recommended that the child-health and nutrition services need to be shifted from the long-running ICDS programme and be well merged with the ‘health’ outreach and extension. This should ideally be reflected through empowered policy instruments.  Such a strategic shift shall logically augment better monitoring and a broader view of the child-health interventions.  

There is an urgent need to foster a more responsive and dynamic management of SAM (severe acute malnutrition) and MAM (moderate acute malnutrition) children at a village/community health, wherein scientific monitoring of cases is akin to how the country addressed ‘Polio cases’ under the National Polio Eradication Programme. 

India also needs to strengthen ‘closer to ground’ monitoring of anemia free initiative with effective implementation of weekly distribution of IFA (iron folic acid) tablets, especially to adolescents with a strategic focus on girls.

Concerted efforts are required at the field level in order to inculcate substantive nutrition education – incorporated from the primary level - through the formal and non-formal education streams.  It is emerging crystal clear that more than the additional budget requirements, stronger monitoring mechanisms and clear policy directions would reinforce the nutrition interventions.

Pandemic Era: Lessons for Systems Strengthening for Mental Health

 The COVID-19 pandemic has added heightened stress on the overall health systems, while it has further worsened the already ongoing epidemic of mental health issues in various countries, including in India. It is noteworthy that India has committed to a more socially-inclusive model for mental health care. A case in point is the recent policies and legislations in the past few years; however, the matching budgets have still been kept rather low. As per the available data, the central government needs to provide for over 940 billion Indian rupees, whereas the current expenditure still lurks around only 10 billion rupees. Therefore, to fulfill its commitment made under the Mental Healthcare Act 2017, including in making provisions for psycho-social treatment under the national health insurance, PM Jan Arogya Yojana, the national government should be making affirmative reflections in the budget and the national plans.

Socially-inclusive investment in the area of mental health will accrue a positive impact on overall economic productivity, including the ability of the workers. Therefore, multi-sectoral partnership and inter-ministerial collaboration between the human resource development, youth affairs, and labour ministry would yield much needed results.

Reaching the Unreached: Tribal Health Must Be Prioritized in the Budget

A sizeable number of tribal people live in far flung, least accessed and vulnerable areas of the country. This segment of population live with a 1·6 times lesser number of primary and secondary public health centers for every hundred thousand people as compared to other rural and non-tribal areas. It includes lack of access to the nutrition related information and supplies, including monitoring. Considerable health infrastructure investment is required in order to address the health needs of tribal populace in the country. Unfortunately, the substantive health outcomes of this population group continue to suffer while the country is celebrating its 75^th year of independence. The ensuing national budget should ideally be reviewing the health systems with regard to tribal health.

It will not be out of place to emphasize, yet again, that with the recently gathered lessons from the COVID-19 pandemic, the commitments made to the global health goals and in order to keep the momentum in health reforms, it is pivotal to give serious consideration to enhancing allocations to health sector. This is especially so to ensure achieving the universal health coverage (UHC) goals, which calls for according high priority to the hard-to-reach, vulnerable, socially-excluded and weaker sections.

(The author is Senior Consulting Adviser (Strategic Communication & Programmes), UN System in Asia and the Pacific)