This big amount is brought forward to veil the real allocation to health sector. The outlay includes the budgets for Jal Jeevan Mission (Urban), Swachch Bharat Mission, Clean Air programme and many more. Ministry of Health and Family Welfare got only Rs 73,931 crore while the Ministry of MSME only Rs 15,699 crore, as against about 69 and 8 thousand crore respectively for the present fiscal.

Union Finance Minister Nirmala Sitharaman while presenting the budget said that the total COVID-19 support measures amounted to 13 per cent of GDP and total support measures by government and RBI amounted to Rs 27.1 lakh crore. Those were, but emergency measures. The country actually needed strengthening of healthcare system that needed substantial increase in budget allocation without which saving lives would prove to be a nightmare.

The budget was prepared on six pillars of Aatmanirbhar Yojna in addition to the National Health Mission. It was good to announce in this fashion but we needed much more to strengthen the whole healthcare system comprehensively. The Aatmanirbhar Health Yojna with an outlay of Rs 64,180 crore that too over six years is too small a relief. It was claimed that the scheme would strengthen the National Centre for Disease Control. Besides this, the government would also set up 15 Health Emergency Centres.

A low budget allocation for healthcare reflects government neglect of the sector. National Health Accounts show that 66 per cent of spending on healthcare was being done by the states. India ranks 179th out of 189 countries in prioritization accorded to health in its consolidated government budgets of the centre and the states. Such level of prioritization of health in India has been similar to donor-dependent countries such as Haiti and Sudan, and well short of its peers in development.

It may be mentioned that the National Health Policy 2017 had stated that an increase from one per cent to 2.5-3 per cent of GDP can decrease the Out-Of-Pocket Expenditures from 65 per cent to 30 percent of overall healthcare spend. It must also be noted that a bulk of the healthcare in India is provided by the private sector.

Increased prioritization of healthcare was needed in the budget because it crucially impacts how much protection citizens get against financial hardships due to out-of-pocket payments made by them.

Economic survey 2020-21 has categorically said that better healthcare infrastructure was no insurance against communicable disease. It was just an indication what the government have been thinking about improving healthcare infrastructure.

Despite improvement in healthcare access and quality, India’s score is just about 41.2 per cent, as quoted in the latest Economic Survey. India continues to underperform in comparison to even other Low and Lower Middle Income countries. On quality and access of healthcare, India ranked 145th out of 180 countries. Only few sub-Saharan countries, some pacific islands, Nepal, and Pakistan were ranked below India. On account of poor health outcomes India still needs to improve in MMR and IMR metrics.

Low access and utilization have been the major problem. At 3-4 per cent, the hospitalization rates in India are among the lowest in the world. The average for middle income countries is 8-9 per cent and 13-17 per cent for OECD countries.

There is also low level of human resources for health. Aggregate human resources for health density in India is just close to the lower threshold of 23 per 10,000 of population. To achieve the SDG targets this should be 44.5, according to WHO. Moreover, distribution of health workforce across the states is lop-sided. Large proportion of deaths in India is due to poor quality of healthcare than due to insufficient access. This proportion is significantly higher than neighbouring and many other countries.

To save livelihood we needed much more for MSMEs than what has been announced. Major announcements for this sector are collateral free loans for businesses, setting up of a fund of funds for MSMEs, PM Garib Kalyan Yojana, and subordinate debt for MSMEs, disallowing global tenders of up to Rs 200 crore and change in definition of MSMEs. All of them are not sufficient for revival of the MSMEs as we have already seen how the similar provisions under Aatmanirbhar packages failed to revive the sector, which used to be providing largest number of employment after agriculture.

MSMEs need easy access to finance, which has not been possible due to various reasons including policy hurdles and unwillingness of bankers to provide them loans. Guarantee of collateral free loans is not working despite the Rs 3 lakh crore relief packages announced earlier. There are many pending cases for debt resolutions and crores of rupees are yet to be paid to them by the government for their goods and services. The MSMEs needed timely payment and easy access to finance, but both are almost ignored. A special framework for debt resolution has been announced, but it would be too early to comment on its success or failure.

The proposal for certain changes to benefit MSMEs are there, but they are indirect approaches, such as increasing duty from 10 per cent to 15 percent on steel screws and plastic builder wares. Some reliefs are also given on imports by MSMEs and customs duties are raised on certain goods. The sector needed direct interventions to enable them to survive in the present scenario, but unfortunately the budget cannot give such a push, and therefore, saving livelihoods and providing jobs will remain a daunting task. (IPA Service)