By Sarit Kumar Rout
Announcing the budget, the Finance Minister underscored skilling allied health professionals and care providers to respond to the increasing burden of non-communicable diseases (NCDs) and the growing elderly population, both of which require care and empathy. Around 63% of all deaths in India are caused due to NCDs, resulting in substantial economic burden from healthcare cost and productive losses linked to premature mortality. This needs a responsive health system to design intervention at the primary and secondary care to address underlying constraints. The role of allied health professionals — physiotherapists, nutritionists, laboratory technicians, and rehabilitation specialists — is key to bridge the existing service delivery gap in primary and secondary care. The declaration to train one lakh allied health professionals through a mix of public and private institutions signals a commitment to build a healthy population.
Moreover, the growing elderly population from 100 million in 2011 to 230 million in 2036 has profound socio-economic implications. The proposal to create 1.5 lakh caregivers is impressive in many ways as India is uniquely placed to leverage the demographic dividend with a higher share of younger population who can be trained to look after the elderly. Along with this, the Biopharma SHAKTI initiative, with an allocation of `10,000cr for a period of five years will transform India from a low cost pharmacy to a hub of biopharmaceutical manufacturing.
Despite the stated intentions, the allocations are not notable. Total allocations to health including health research, witnessed a 7% rise in FY27BE compared with FY26BE. Allocations to health and family welfare has risen from 95,957cr in FY26BE to 1,01,709cr in FY27BE — an increase of around 6%. Similarly, allocation to health research has increased to 4,821cr in FY27BE compared to 3,900cr in FY26BE. The increase in allocations in health research will help build an ecosystem to conduct high profile and context specific research for evidence-based policymaking. However, a balanced approach spanning disease specific (biological research) and health system research involving both government and private organizations is essential to maximize impact on population health.
Despite increase in nominal terms, the share of health in the total allocations for FY27BE remains insignificant, and continues to hover around 2%, the same observed 7 years ago. The National Health Mission has received an allocation `39,390cr and has not changed much in the last seven years except the pandemic years. The National Urban Health Mission, which was added as a sub-component of NHM in 2013 in order to meet the growing health care needs of the rising urban population, has not witnessed any commensurate expansion of funding. As cities grow with increasing migration of population, urban health requires more funding to develop and design adaptive health systems to meet growing challenges.
Pradhan Mantri Ayushman Bharat Health Infrastructure Mission, announced to develop capacities of health systems and institutions across the continuum of care at all levels, has faced several implementation constraints leading to substantial underutilization of resources. In FY27BE, total allocation has been 4,760cr, similar to what was allocated in FY26BE. Similarly, the National Digital Health Mission witnessed a marginal rise from 340cr in FY26BE to 350cr in FY27BE. Allocation to PMJAY is proposed at 9,500cr in FY27BE, a component that has drawn enough attention due to steady population coverage and hospital admissions over the years. While PMJAY has been addressing hospitalization component, an integrated care model combining primary care with secondary and tertiary care through PMJAY would reduce avoidable hospitalizations and hence efficiency of spending. As an expression of policy intent, the budget needs to articulate such integration in order to improve efficiency of public investment.
The writer is Professor of Health Economics and Financing at Indian Institute of Public Health Bhubaneswar, an institution under the aegis of PHFI New Delhi
