India’s health expenditure programme is not just about COVID-19, just like spending after the 2004 tsunami couldn’t have focused only on disaster management, Expenditure Secretary T.V. Somanathan told The Hindu, launching a strong defence on criticism of the Budget 2021-22’s health sector allocations.
Responding to critiques about the Budget citing a 137% hike in allocations for health and well-being by including spending on water and sanitation, Mr. Somanathan said even the World Health Organisation (WHO) stressed that water and sanitation were crucial for basic healthcare.
“In a normal year, India doesn’t suffer from COVID-19. It suffers from diarrhoea, malaria and dengue, with diarrhoeal diseases accounting for most of our child deaths. Lack of sewage, stagnant water, non-disposal of solid and liquid waste, and absence of clean water, are very major problems in Indian health in a non-pandemic year,” he stated.
“Our health expenditure programme is not a COVID-19 expenditure program; the COVID-19 part is the ₹35,000 crore provided for vaccines. We are building health infrastructure for the future, not for 2020. In 2004, we had the tsunami, but you have not had a tsunami since. If you planned all your budgets on preventing a tsunami, everything that you would have spent since 2004 would have been wasted,” he explained.
The 137% hike mentioned in the Budget speech, was also not an ‘apples vs mangoes’ comparison, as it included last year’s water and sanitation spending along with healthcare expenditure, he pointed out.
While the ₹71,000 crore allocation for the health and family welfare ministry was 10% higher than 2020-21, Mr. Somanathan said that taking the ₹35,000 crore for the vaccine into account, reflected a 56% hike. Moreover, ₹13,192 crore had been granted to the States and local bodies for health on the Fifteenth Finance Commission’s recommendation.
“I heard someone say vaccine is not health. Maybe vaccine is space research, but I may be wrong. Then somebody questioned how can you count Finance Commission grants, but if the Commission gives a grant from Central revenues for health, in my book, that is health. It was not there last year,” he asserted.
“There is also a provision for the Ministry of Ayush, which is up 40% up, health research is up 25%, and drinking water is up 200%. It is not correct to assume that only doctors, nurses, and medicines are health. So I would submit that this is not a fair criticism,” he concluded.
Allocation for vaccines
The ₹35,000 crore allocation for vaccines could cover as many as 50 crore people at an estimated cost of ₹700 a person for administering both doses, but no decision had been made on the funding mechanism for vaccines beyond the three crore health workers in the first phase (whose cost the Centre is footing).
“Hypothetically, if the whole cost was covered, it will vaccinate 50 crore out of a population of 130 crore. That would take us to 53 crore vaccinations, and it is possible we may have reached herd immunity, or maybe we would not. That is why the Finance Minister said we are committed to providing more if it is required,” Mr. Somanathan said, stressing that vaccinating 50 crore people may take up to September.