Healthy India's "Aatmanirbhar Swasth Bharat Yojana"

Overview
The government’s objective to strengthen the healthcare sector due to the prevailing pandemic situation is evident from its 137% expenditure hike for health & wellbeing in the Union Budget 2021. With a total budget allocation of Rs. 223,846 crore (US$ 30.70 billion), the government aims to fortify three areas—preventive health, curative health and well-being—to boost the developing healthcare sector. As India’s healthcare spending (as a percentage of its GDP) has been lower than other countries, the government has taken numerous initiatives in the last 3 years to improve healthcare infrastructure.

On February 23, 2021, Prime Minister Mr. Narendra Modi emphasised on the need to address the country’s health issues in a holistic manner and called for widespread adoption of a four-pronged strategy for a Healthy India; the strategy also includes implementation of the Pradhan Mantri Aatmanirbhar Swasth Bharat Yojana.

The Four-pronged Strategy for a Healthy India is as follows:

• Prevent illness and promote wellness comprising measures such as ‘Swachh Bharat Abhiyan’, yoga and timely care & treatment of pregnant women and children.
• Provide cheap and effective treatment to the poor and underprivileged.
• Increase the quality of health infrastructure and healthcare professionals.
• Work on a mission mode to overcome obstacles through Mission Indradhanush, which has been extended to the tribal and far-flung areas of the country.

Union Budget Allocation 2021-22
On February 1, 2021, the Union Finance Minister Mrs. Nirmala Sitharaman announced the Pradhan Mantri Aatmanirbhar Swasth Bharat Yojana (PMANSY)—a centrally sponsored scheme under the Union Budget 2021.

Key features of the PMANSY are as follows:

• Allocating Rs. 64,180 crore (US$ 8.80 billion) over six years to strengthen the existing ‘National Health Mission’ by developing capacities of primary, secondary & tertiary care and healthcare systems & institutions to detect and cure new & emerging diseases
• Extending support for health & wellness centres—the scheme will strengthen 17,788 rural and 11,024 urban health & wellness centres
• Setting up integrated public health labs in all districts and 3,382 block public health units in 11 states
• Establishing critical care hospital blocks in 602 districts and 12 central institutions
• Strengthening the NCDC (National Centre for Disease Control) to have five regional branches and 20 metropolitan health surveillance units
• Expanding access to integrated health information portal in all states/UTs
• Operationalising 17 new public health units. The scheme will also improve 33 existing public health units at points of entry—11 seaports, 32 airports and 7 land crossings
• Establishing 2 mobile hospitals and 15 health emergency operation centres
• Setting up a national institution for One Health (a regional research platform for the WHO in Southeast Asia), nine Bio-Safety Level III laboratories and four National Institutes for Virology in each region.

The government plans to launch ‘Mission Poshan 2.0’ to merge the supplementary nutrition programme with the ‘Poshan Abhiyan’ (Nutrition Mission) and improve nutritional outcomes across 112 aspirational districts. The Poshan Abhiyan was launched in 2018 to reduce malnourishment in a phased manner (via the life cycle concept) by adopting a synergised and result-oriented approach. The Poshan Abhiyan will ensure procedures for timely service delivery and robust monitoring as well as intervention infrastructure. The government has set a target to bring down stunting among children (aged 0-6 years), from 38.4% in 2018 to 25% by 2022.

The government announced allocation of Rs. 35,000 crore (US$ 4.80 billion) for Covid-19 vaccines in 2021-22. Additionally, it announced rolling out of the pneumococcal vaccine—a ‘Made in India’ product. At present, the vaccine is currently limited to five states; the government plans to roll it out across the country to avert >50,000 child deaths annually.

The government under the Department of Drinking & Water Sanitation plans to launch ‘Jal Jeevan Mission’ (Urban). It aims at comprehensive water supply in 4,378 urban local bodies with 2.86 crore household tap connections, along with liquid waste management in 500 AMRUT cities. The scheme will be implemented over five years, with an expenditure of Rs. 2,87,000 crore (~US$ 39 billion).

Budget 2021: Health & Wellbeing Expenditure

 Source: Expenditure Budget 2021-22 – Ministry of Finance

Government Initiatives in Progress
In February 2018, the Indian government announced the Ayushman Bharat Program (ABP), with two sections of health & wellness centres (HWCs), to distribute comprehensive primary healthcare (PHC) services to the entire population. The Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched in September 2018 to help enhance access to hospitalisation services at secondary and tertiary health facilities for the bottom 40% of the total population. The scheme plans to set up 150,000 HWCs by December 2022. The first HWC was launched on April 14, 2018, and by November 2020, 38,595 AB-HWCs (Ayushman Bharat-Health & Wellness Centres) were operational across 678 districts. AB-HWCs included 18,536 Primary Health Centres, 27,890 Sub-health Centres and 3,599 Urban Primary Health Centres. On January 16, 2021, the Prime Minister launched the first phase of the pan-India roll out of the COVID-19 vaccination. As of March 1, 2021, total beneficiaries of COVID-19 vaccination in India stood at 14,301,266, with 11,845,075 as the first-dose beneficiary and 2,456,191 as the second-dose beneficiary.

Conclusion
The government has proposed more than double expenditure in the healthcare sector under the Union Budget 2021-22, compared with the previous fiscal year. The increased outlay will help in rolling out the vaccination programme as well as reinforcing the delivery system and building better capability and capacity to combat any pandemic situations in future. And, the various government schemes will act as a robust supportive system to the burgeoning health & wellbeing sector.