Budget 2024: Big announcements, little clarity

Nirmala Sitharaman. Pic/PTI

Even as Finance Minister Nirmala Sitaraman said the government "will encourage vaccination for girls in the age group of 9 to 14 years for the prevention of cervical cancer", there is very little clarity on whether this would now be a part of the national immunisation programme. Last month, the health ministry, dispelling reports of human papillomavirus (HPV) vaccine rollout in the second quarter this year, said in a statement, "Such reports are not true. The Ministry is yet to decide on the rollout of HPV vaccination."

HPV is a sexually transmitted infection that is responsible for almost all cases of cervical cancer. It was only last year that India's first quadrivalent HPV vaccine, targeting the four prevalent cancer-causing HPV types - 16, 18, 6, and 11 - became available in the private market. Developed and manufactured by the Pune-based Serum Institute of India (SII), the vaccine costs Rs 2,000.

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Meanwhile, the estimated budget for health is Rs 89,155 crore - an increase by 12.6 per cent compared to the revised estimates for 2022-23. "Budget estimates are further brought down like it happened last year and the previous year, so we can expect the number to further go down. Health has been clearly deprioritised even after we have seen during COVID what a collapse of health systems can do," said Dr Soumitra Ghosh, health researcher from Mumbai's Tata Institute of Social Sciences (TISS) School of Health Systems Studies. "The spending on health needs to go from 1 per cent of the GDP to 2.5 per cent. The government itself has committed to do so by 2025 in the national health policy of 2017," he said.

Insurance for health workers

For Accredited Social Health Activist (ASHA) and anganwadi workers - who play a key role in immunisation efforts and look after the health of new mothers and children - the government has extended its flagship Ayushman Bharat insurance scheme. The move will impact more than 30 lakh individuals.

Manisha Pawar - an ASHA worker in Shahpur near Mumbai - said the move comes as a relief to her as she does not hold a ration card required to avail benefits under the scheme. "I have to borrow money from others in times of emergency," she said, adding that the larger question of better pay for ASHA workers has been ignored.

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However, Shubha Shamim, state secretary of the anganwadi workers' action committee, said the announcement doesn't hold much significance as many ASHA and anganwadi workers already hold an Ayushman Bharat card. "It has been five years since the Centre increased honorarium. We were expecting some mention," she added.

Dr Ghosh pointed out that the move will increase enrollment of the ASHA and anganwadi workers. "But enrollment does not lead to utilisation of the scheme. There aren't as many empanelled hospitals as required for this scheme to work smoothly. Hospitals frequently refuse to admit someone who wants to avail of benefits under Ayushman Bharat," he said.

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