COVID-19 Exposed How Inadequate India's Healthcare Spending Is, Will Budget 2022 Change It?

In early 2020 when COVID-19 began spreading across India. One of the biggest challenges the country faced was the shortage of hospital beds, including critical care and ventilator beds.

While it can be argued that the scale of hospitalisations from COVID-19 was something that even the most developed countries in the world could not anticipate or handle, there is no denying that over the years India's healthcare spending has not been anywhere close to where it should have been.

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India is among the countries with the lowest public healthcare budget in the world. The public healthcare system in the country, including that of the state and central government, is close to 1.3% of GDP compared to 5% by China and Russia, 8% by South Africa, and over 9% by Brazil.

This meant that the critical grassroots-level infrastructure that had to be built over many years and decades did not happen, and when COVID-19 hit the country had no time to create it overnight.

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Things showed a positive change in the previous budget where the allocation for the health sector was increased by 137%, to Rs 2.23 lakh crore, which is around 1.8% of the GDP.

Even this was way below the 2-3% per cent many were hoping and the 2.5% of the GDP, target set by the National Health Policy 2017 for 2025.

"Over the years, our investment in the health care sector has been very low. It is also much below what has been envisaged in the National Health Policy in 2017 which suggested that the spending should be at least 2.5 per cent of the GDP. The government urgently needs to increase the health budget by twice the current amount," Sanghamitra Singh, Senior Manager, Knowledge Management and Partnerships at Population Foundation of India told Indiatimes.

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Due to the limited allocation, the rural healthcare infrastructure has been largely neglected and will take a long time for it to change.

"There is a huge urban-rural divide in India when it comes to healthcare infrastructure. Almost all the big hospitals and specialist doctors in India are concentrated in a handful of big cities. Even now access to primary health facilities is a big challenge in many villages. This in many cases can aggravate the situation by the time when they find proper medical care, which is not something that many can afford to pay for," Sanghamitra said.

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Another key area, which requires attention and more resources is mental health. India's growing mental health crisis is well documented.

National Mental Health Survey 2016 found that close to 14% of India¡¯s population required active mental health interventions.

Every year, about 2,00,000 Indians take their lives. Roughly 56 million Indians suffer from depression, and 38 million suffer from some anxiety disorder.

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The pandemic years have only worsened this ballooning crisis. Apart from the stigma around mental health, one of the major factors that have resulted in the current situation is poor human resource availability.

"One of the strategies to address the mental health crisis is to take preventive measures. This includes creating awareness among people to seek help at the early stages. But it requires a huge human resource investment. There is a huge gap in the availability of human resources in mental health. We have less than one psychiatrist for every 100,000 population, whereas the ideal number is at least 3, as per the mental health act. There is also a lack of infrastructure and awareness. All these stem from the lack of proper budgetary allocation," she said.

Another area that needs urgent attention is the health requirements of young Indians.

India¡¯s large young population presents a huge opportunity for the country. But to capitalise on it, it is imperative that we acknowledge distinctions within this heterogenous segment of the population. For instance, the needs of adolescents are distinct from those of youth (aged between 15 and 24 years), whose concerns often centre around employment and economic stability. Adolescents, on the other hand, are in their formative years and are far more impressionable and vulnerable.

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At 253 million, India has the largest adolescent population in the world, with one in every five Indians belonging to this category. By 2024, around 127 million adolescents would have turned 18, and will begin contributing to nation-building as consumers, members of the workforce, and future leaders. Investments in the health and education of this group are crucial to the future development of our country.

Adolescents, especially from marginalised communities, face numerous challenges to their physical and mental health due to a lack of access to information, guidance and services. The COVID-19 pandemic has exacerbated these challenges. School closures, absence of interactions with peers, mobility restrictions, loss of parents and social networks, growing household responsibilities and violence experienced by adolescents may have lifelong effects. With delayed educational and employment opportunities, many are feeling helplessness, anxiety and fear.

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The National Family Health Survey (NFHS 5) 2019-21 reveals that anaemia is a major health concern among adolescents and is more prominent among girls. Anaemia levels among girls aged 15-19 years increased from 54% in 2015-16 to 59% in 2019-21 and in the case of adolescent boys, they increased from 29% to 31% between the same period.

"There is a growing concern about the nutritional state of women and girls. It is important to awareness among communities about this," she said.

Sanghamitra said that India needs to urgently increase the health budget and focus on where it is being spent.

"There is a need to focus on the health budget a lot more than we have been doing, especially in the context of the pandemic. A lot of progress we made over the years stands threatened today due to the pandemic. There should be more allocation for the health sector in the budget. And within this, there should be an increased focus on vulnerable groups, including adolescence. Mental health is also an emerging issue, we definitely need to allocate more resources here. More focus should also be there in ensuring that young people have access to sexual and reproductive health and family planning services. The health budget also should look at issues with a gender lens and that can only be done by greater investment in social and behavioral communication strategies."

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