The result is a Band-Aid budget, which postpones the real healing for another time
Given that this is the last full budget before the general elections of May 2024, Finance Minister Nirmala Seetharaman perhaps decided to play safe rather than attempt bold reforms in a key sector like healthcare. The result is a Band-Aid budget, which postpones the real healing for another time.
To be fair, Union Budget 2023-24 does attempt to look beyond COVID, while tracking it in the rear-view mirror. It continues the trends of marginal increase in the allocation for healthcare, from 1.4 per cent of GDP in FY 19 to 2.1 per cent of GDP in FY 2023, but it still falls short of the promised 2.5 per cent. Of course, a 3.4 per cent hike over the previous year’s allocation seems minuscule but realistically speaking, nothing was going to match last year’s massive COVID-related hike of 16.59 per cent.
The Finance Minister also had to balance COVID-related spends while allocating more funds to other health concerns. Hence the proposal to set up a mission to eliminate sickle cell anaemia by 2047 is a welcome step. However, there has to be clarity on how this will be achieved, as previous such missions, like the elimination of TB by 2025, need to be brought back on track.
The most welcome facet of the Union Budget 2023-24 is that it finally recognises the pivotal role, and huge shortage, of nursing and allied staff in the country. As per the budget proposal, Rs 33 crore will be allocated to set up 157 new nursing colleges. Since these will be co-located within existing medical colleges, some of the infrastructure is already in place so one hopes that we see a speedy implementation of this proposal. This represents a 67 per cent increase in allocation as compared to last year’s budget (Rs 20 crore).
But setting up nursing colleges is the first step. Can we ensure the quality of nurses being trained in these colleges? Our medical colleges already have a shortage of teaching staff. We should not focus on quantity and lose sight of quality.
Secondly, can we create attractive enough career paths for the nurses who graduate from these newly minted nursing colleges? In addition, how can we ensure we retain them within the country? Or are we simply creating nursing resources for export, to better remunerative and more satisfying opportunities across the world?
Thirdly, how can we upskill the existing staff, especially as the budget continues the digital push? With the announcement of three centres of excellence for artificial intelligence, digital health is one key area where AI can play a huge role in improving patient outcomes as well as increasing efficiency. However, this must go hand in hand with the implementation of the proposal to introduce the National Data Governance policy, to enable access to anonymised data, so that there are enough safeguards to ensure security of patient data and confidentiality.
Another major announcement in the budget was the proposal to set up ‘dedicated multidisciplinary courses for medical devices …. to ensure skilled manpower for futuristic medical tech and high end manufacturing and research.’ While the skilling initiative is appreciated, medical device companies were disappointed, to say the least, that the budget did nothing to encourage the local manufacturing of medical devices. Recommendations like increasing customs duty on cheaper imports, reducing GST and monitoring trade margins were not implemented. Medical device leaders are warning that imports of medical devices, especially from China, are increasing and remind us of the grave situation we faced as a country, during the COVID pandemic, when supply chains were disrupted. While the government encouraged many entrepreneurs to step up to the cause and start making medical devices, many of these units are reportedly not able to sustain against cheaper imports. Investors are losing interest and funding is drying up, leading many smaller units to shut shop.
While many schemes got a haircut, flagship initiative Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) got a 12 per cent increase, with the allocation of Rs 7,200 crore this year. The government is obviously hoping to expand the scheme but whether this increased allocation will encourage more participation from private healthcare providers is the big question. Hospital managements remain upset that many of their long-standing recommendations, (rationalising of embedded indirect taxes like GST, for instance), remain unaddressed.
Increased collaboration between the public and private sector stakeholders, be they healthcare facilities or medical/nursing colleges, is the only logical way to speedily expand access to infrastructure and resources. But for that to happen, there needs to be trust between the stakeholders. And sadly, that’s in short supply these days.
VIVEKA ROYCHOWDHURY Editor
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