By Dhurjati Mukherjee
India’s large population—about 30–35% of whom live at or near the poverty line—needs strong healthcare prioritisation. However, governments have long neglected this sector, leaving many rural and underprivileged health centers without sufficient staff or basic equipment like operational x-ray machines. A thorough examination of the recent Budget is necessary to determine if the government adequately addresses the essential needs of the population.
Prior to budget, the Jan Swasthya Abhiyan (JSA) stated the Centre’s health spending had stagnated at 0.29% of the GDP. It noted the central health outlay must rise at least 1% of the GDP for the country’s total public health spending, including that of states, to reach 2.5%. requires the health allocation to increase to about Rs 350,000 crore from roughly Rs 100,000 crore in 2025-26. “We’re asking for at least a doubling of the Centre’s outlay for health to something like Rs 200,000 crore for 2026-27”, said Indranil Mukhopadhyay, a health economist and JSA co-convenor.
At same time, note that economist and social activist, John Drèze has pointed out that India’s public expenditure on health stood at just 1.3% of the GDP, lower than 1.9% of sub; Saharan Africa, 2% in West Asia and North Africa, 2.8% in East Asia, 4.1% in Latin America and 8% in the European Union.
A dedicated Rs 10,000 crore five-year programme has been allotted in the budget to the bio-pharma sector to develop the country as a global manufacturing hub through Biopharma SHAKTI, which is welcome. Additionally, there’s a proposal to set up NIMHANS-II at Ranchi designed specifically for mental health and trauma care. But why just one? The government is placing particular emphasis on Ayurveda, planning to establish three All India Institutes and upgrade Ayurveda pharmacies. This initiative, it’s hoped shall benefit the public.
While the reduction in prices for 17 cancer drugs and import cuts on treatments for rare diseases, alongside the promotion of medical tourism, may represent progress, these measures do not sufficiently address the needs of the general population, particularly those in lower-income segments who continue to face barriers to adequate healthcare and must often travel significant distances for specialized services. In a populous country such as India, there is a clear need to focus on rural and underdeveloped districts. Expectations existed that plans would be announced to establish 50 to 100 specialty hospitals within the next three to five years; however, no such initiatives were mentioned by Sitharaman. Furthermore, it is notable that the Health Mission’s allocation of Rs 39,390 crore for strengthening primary healthcare, maternal and child health services, and disease control programmes appears insufficient to meet the actual demand in a nation of this size.
However, the Rs 1.06 lakh crore allocation in the budget allocation, reflecting a 6% increase over the revised estimates of the current fiscal, may sound optimistic but such increase doesn’t have any meaning when considered with inflationary conditions. Health economists have calculated that the increase is in fact a decline in the government’s share of health expenditure from a stagnant 0.28% of India GDP over the past five years to an estimated 0.27%. Is this adequate keeping in view the needs of the impoverished and marginalised sections, deprived of affordable healthcare?
It is indeed tragic that India’s low spending on public health have, over the past two decades or so, has been acknowledged by successive governments, but very little has been done by way of increasing allocation. Even in its 2017, the National Health Policy documents, set a goal of raising government health expenditure from 1.15% to 2.5% of the GDP by 2025. But all this has remained false promises that the present government has not bothered to keep, even when most countries of the world, including African nations, spend much more on health.
Let us now delve deep into the subject of the situation by referring to two examples. A study that analysed around 128 RTI responses, 440 judgments and 50 laws and regulations revealed a worrying lack of clarity as to how institutions decide matters, the transparency procedures they follow, causing distress to patients and doctors. Although many years have passed since the National Medical Commission was established, it has yet to set up the National Medical Register. Similarly, there is no central record of all registered and operational healthcare facilities in the country.
When it comes to medical negligence, judgements analysed over the last three decades till 2023 applied inconsistent standards of evidence and failed to clarify what evidence was relied upon with nearly 60% of decisions not mentioning any medical evidence. In some cases, commissions not only insisted on independent expert opinion but also rejected claims as complainants failed to arrange for a medical expert for themselves.
The unclear, inconsistent, and opaque regulatory mechanisms do little to resolve patient grievances. There is need for more active and independent role of state medical councils, proper data management and transparency in operations of hospitals, both government and private, to help patients’ redress their grievances.
Another example appears more appalling. India records one of the highest numbers of deaths globally, yet the country still does not know what most people die of, a gap most pronounced in North India and even the national capital. A nationwide study published in Scientific Report found that only around 22.5% of deaths in the country are medically certified, leaving nearly four out of five deaths without a doctor-confirmed cause in official records. North India has the poorest medical certification of deaths, averaging just 13% while Delhi’s rate has remained stagnant at around 57-59% for years. Public health experts warn that unreliable cause of death data means governments are effectively planning health policy without knowing which diseases are killing people.
Deaths from heart diseases, strike, cancer, diabetes, infectious diseases etc. cannot be currently tracked, distorting disease burden estimates and skewing health spending. Large parts of North and East India continue to report single digit or low double digit certification rates, pulling down national averages and leaving millions of deaths each year without medical explanation.
While poorly performing states have fewer physicians, the strongest detriment is whether hospitals report deaths. In low-performing states, only about half of registered hospitals submit cause of death data, compared with over 90% reporting in high-performance states and UTs. Researchers warn that unless medical certification becomes enforceable, particularly in the defaulting states, India will continue to underestimate the actual causes of death and the interventions needed.
In such a scenario, it was expected that the Budget would substantially increase allocation and help in setting up at least one centrally funded hospital in each district, to start with the backward ones. But no such measures have been announced so far. Amends do need to be made. —INFA
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