Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.

How the Budget can push India’s health system transformation


From UPSC perspective, the following things are important :

Prelims level: National Health Authority

Mains level: Paper 2- Health system transformation


After decades of low government expenditure on health, the Covid pandemic created a societal consensus on the need to strengthen our health system.

Steps to strengthen our health system

  • The Fifteenth Finance Commission recommended greater investment in rural and urban primary care, a nationwide disease surveillance system extending from the block-level to national institutes, a larger health workforce and the augmentation of critical care capacity of hospitals.
  • The Union budget of 2021 reflected these priorities in a proposed Pradhan Mantri Aatmanirbhar Swasth Bharat Yojana (PMASBY) to be made operational over six years, with a budget of Rs 64,180 crore.
  • Broader vision of health: The Finance Minister also projected a broader vision of health beyond healthcare by merging allocations to water, sanitation, nutrition and air pollution control with the health budget.
  • Under the Ayushman Bharat umbrella the Digital Health Mission was launched in September 2021.
  • The Health Infrastructure Mission, launched in October 2021, was a renamed and augmented version of the PMASBY.
  • These missions join the two other components of Ayushman Bharat launched in 2018.
  • The Comprehensive Primary Health Care (CPHC) component is nested in the National Health Mission (NHM) while the Pradhan Mantri Jan Arogya Yojana (PMJAY) is steered by the National Health Authority (NHA).

Way forward

  • While much of the following needs to be done by the states, the Centre should incentivise and support such efforts by the states.
  • Link synergically: Primary healthcare services under the CPHC and linkage with water, sanitation, nutrition and pollution control programmes will strengthen the capacity of the health system for health promotion and disease prevention.
  • The budget of 2022 must not only fund these missions adequately but indicate how they will link synergically while functioning under different administrative agencies.
  • Allocate more funds: The NHM received only a 9.6 per cent increase in the 2021 budget.
  • PMJAY did not see an increase in allocation last year, because its utilisation for non-Covid care declined sharply in the previous year.
  •  More importantly, limiting cost coverage to hospitalised care reduces the PMJAY’s capacity to significantly lower out-of-pocket expenditure (OOPE) on health, which is driven mostly by outpatient care and expenditure on medicines.
  • Focus on Digital Heath Mission: The Digital Health Mission can enhance efficiency of the health systems in a variety of ways.
  • These include better data collection and analysis, improved medical and health records, efficient supply chain management, tele-health services, support for health workforce training, implementation of health insurance programmes, real time monitoring and sharper evaluation of health programme performance along with effective multi-sectoral coordination.
  • Improve the skill and number of healthcare workers:  We need to increase the numbers and improve the skills of all categories of healthcare providers.
  • While training specialist doctors could take time, the training of frontline workers like Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) can be done in a shorter time.
  • Upgrade district hospitals: District hospitals need to be upgraded, with greater investment in infrastructure, equipment and staffing.
  • In underserved regions, such district hospitals should be upgraded to become training centres for students of medical, nursing and allied health professional courses.


The expanded ambit of health, as defined in last year’s budget, must continue for aligning other sectors to public health objectives. The Union budget of 2022 can add further momentum to our health system transformation.

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