What young India needs most – a budgetary priority
Young people in India need jobs. But they also urgently need access to appropriate family planning services. Greater investments in sexual and reproductive health ought to become integral to the Prime Minister’s big push for universal health coverage. The upcoming budget is an opportunity for the Government to increase allocations for family planning activities to at least ten per cent of the total budget of the National Health Mission (NHM). This will signal both intent and commitment to Ayushman Bharat.
India’s public health care system has moved a step further towards universal health coverage with the launch of the Prime Minister’s Jan Arogya Yojana (PM-JAY) under Ayushman Bharat that seeks to provide free health coverage to 500 million citizens. The central plank of PM-JAY is to bring comprehensive primary care closer to the doorsteps of the community through the setting up of Health and Wellness Centres (HWCs). Providing financial protection to the poor by covering in-patient costs of medical treatment is also a significant component towards providing comprehensive primary, secondary and tertiary care. However, budgetary allocations for health need to reflect greater alignment with India’s commitments to increase investments in health (National Health Policy 2017), family planning (India’s commitment to FP2020), the attainment of Sustainable Development Goal No. 3 (Ensure healthy lives and promote wellbeing for all at all ages), and above all the most ambitious PMJAY.
The share of allocations for NHM has declined from 60 per cent in 2012-13 to 57 per cent of the total health budget in 2018-19. Last year, the budgetary allocations for Reproductive and Child Health (RCH) Flexipool, a component of the NHM budget critical to the accomplishment of health outcomes under SDG3 such as reductions in child and maternal mortality, and ensuring universal access to sexual and reproductive health services (SRH) including family planning increased marginally by 15 per cent over 2017-18 allocations. However, budgets for family planning activities over the years have remained stagnant at 4 per cent of the NHM budgetary allocations. These allocations are inadequate to meet the unmet need for contraception of India’s youth (15-24 years) that constitutes 18 per cent of our population.
The allocations for procurement and distribution of contraceptives, which are exclusively provided as budgetary support from the Union government to the states, has been declining continuously over the years - from 3 per cent in 2013-14 to 1.5 per cent in 2018-19. This is far below the funds required to finance the country’s unmet need for family planning (13 per cent), the current demand for contraceptives particularly with the introduction in 2016 of three additional contraceptives in the public health system, and the much-needed improvements in quality of services.
The success of Ayushman Bharat, expected to become the world’s largest government-funded health care programme, will depend almost entirely on an increase in public expenditures on health accompanied by improvements in the efficiency of spending as well as in the quality of care provided to people. With two-thirds of our population below 35 years of age, it is imperative to push for greater investments in family planning to reap the benefits of the demographic dividend. The Population Foundation of India looks forward to a substantial increase in fiscal allocations for health and family welfare in the upcoming budget. This would signal the Government’s intention to fulfill the commitment made in the National Health Policy 2017 to increase public spending on health from 1.15 to 2.5 per cent of GDP by 2025. Above all, it would signal the Government’s commitment to the young people of India.