NEW DELHI: A prominent coalition of 350 organizations and individuals has issued a strong demand for the union government to at least double the health budget this year, highlighting concerning trends in public healthcare funding during the post-pandemic period.
Alarming Decline in Health Expenditure
The network's statement, released on Wednesday, reveals that government spending on health has continued to decline both as a percentage of GDP and in terms of its share in total expenditure. This comes despite the National Health Policy's commitment to achieve public spending of 2.5% of GDP on healthcare.
"Government spending has remained alarmingly low at just 1.15% of GDP," the statement noted, emphasizing the significant gap between policy promises and actual allocations.
Expert Perspectives on Healthcare Underfunding
Ravi Duggal, a sociologist, health researcher and activist, explained the financial implications of the government's own commitments: "The National Health Policy of 2017 stated that 40% of public expenditure should be the Union government's responsibility. This translates to 1% of GDP or approximately Rs. 350,000 crore at today's prices. That's what we expect the Union budget to commit."
Development economist and social activist Jean Dreze provided a broader international context, stating: "India is one of the world champions of public under-spending in healthcare. For decades, public expenditure on healthcare has hovered around 1% of GDP, compared with an average of 3% in developing countries today."
International Comparisons Reveal Stark Contrasts
The network presented compelling data showing how India's health spending compares unfavorably with other regions:
- India spends just 1.3% of GDP on health, with only 39% of health expenditure coming from public sources
- Sub-Saharan Africa allocates 2% of GDP to health, with 41% public contribution
- East Asia and Pacific region spends 2.8% of GDP, with 55% public funding
- European Union leads with 8% of GDP allocated to health, with 77% from public sources
A statement from Jan Swasthya Abhiyan provided additional context: "Public spending on health in India continues to be abysmally low compared to many countries. For instance, Bhutan's per capita spending on health was 2.5 times more than India's, while Sri Lanka's was three times in 2021. All other BRICS nations spent per person 14-15 times more on health than India does."
Structural Issues in Health Funding
Indranil, Co-convener of the JSA National Secretariat, highlighted systemic problems in health financing: "Union government spending on health has continuously declined in real terms, making it impossible for the NHP 2017 goal to be realised by 2025. At least two-thirds of the Union Health Budget should be transferred to states, given that the states bear two-thirds of the total burden of public health expenditure."
He further emphasized the need for "greater proportion of untied or flexible funding for states to enable them to plan and execute their priorities on health."
Consequences of Underfunding Public Health
Jean Dreze elaborated on the long-term impacts of healthcare underinvestment: "The result of this accumulated under-investment is a huge deficit in public health facilities. Universal health care cannot be achieved without a serious effort to address this deficit and transform healthcare standards in the public sector."
He added a sobering perspective: "Even if India were to achieve the target of 2.5% for public spending on health, it would be among low-income countries that spend the least."
Specific Program Cuts and Policy Directions
Richa Chintan, also Co-convener of the JSA National Secretariat, pointed to concerning trends in specific health programs: "The harshest cuts are hitting programmes that strengthen the public system—National Health Mission (NHM), Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), nutrition, and research—despite their value in hard times."
She provided specific data: "NHM funds have declined in real terms by 5.5% on average. Even within limited allocations, the thrust continues towards private partnerships and insurance-based models such as PMJAY."
Historical Context and Regional Trends
The network presented historical data showing minimal improvement in India's health spending over the past decade:
- India increased health spending from 1.2% of GDP in 2010 to just 1.3% in 2022
- During the same period, Latin America and Caribbean increased from 3.8% to 4.1%
- Europe and Central Asia maintained higher levels, moving from 3.8% to 4.2%
- The European Union showed consistent high investment, from 8.1% to 8%
The collective demand from the network of 350 organizations represents a growing consensus among health experts and activists that substantial increases in public health funding are essential for India to address its healthcare challenges and work toward universal health coverage.
