Lok Sabha Question No. 150 (STARRED), answered on 2022-12-16
Subject: Health Expenditure in Terms of GDP Percentage
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sumalatha Ambareesh, Jual Oram

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA STARRED QUESTION NO. 150 TO BE ANSWERED ON THE 16 TH  DECEMBER, 2022

## HEALTH EXPENDITURE IN TERMS OF GDP PERCENTAGE

## *150. SHRIMATI SUMALATHA AMBAREESH: SHRI JUAL ORAM:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the Government has taken note that the National Health Policy, 2017 and 15th Finance Commission envisaged to increase Government's health expenditure to 2.5 percent of GDP by 2025 and if so, the details thereof along with necessary steps taken by the Government in this regard and if not, the reasons therefor;
- (b)  the  details  of  the  combined  health  spending  ratio  by  both  Union  and  State Governments to GDP during each of the last eight years from FY 2015 to 2022 along with the break-up of the proportion of spending by Union Government, year-wise;
- (c) whether the Government also proposes to increase the State's expenditure in health sector to  address  its  shortcomings  and  if so, the details  thereof  indicating the  action taken by the Government in this regard; and
- (d) the steps taken or proposed to be taken by the Government towards ensuring good healthcare facilities to all citizens of the country?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (DR MANSUKH MANDAVIYA)

- (a) to (  d) A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 150* FOR 16 TH  DECEMBER, 2022

(a) The budget allocation for Department of Health & Family Welfare (DoHFW) has increased by 75.3% from Rs. 47,353 Crores in 2017-18 (BE) to Rs. 83,000 crores in 2022-23 (BE). The allocations of the DoHFW are supplemented by the allocation under the 15th Finance Commission health grants through local bodies, under which grants to the tune of Rs 70,051 crores through local governments are recommended to strengthen  the  primary  health  infrastructure  and  facilities  in  both  rural  and  urban areas.

(b) As per the available data from NHA reports, the data on the health indicators is given in the table below:

(In Rs. crore)

|          | Government Health Expenditure   |   Share of Union (%) |   Share of State (%) |
|----------|---------------------------------|----------------------|----------------------|
| 2015- 16 | 1,61,863                        |                 35.6 |                 64.4 |
| 2016- 17 | 1,88,010                        |                 31.4 |                 68.6 |
| 2017- 18 | 2,31,104                        |                 40.8 |                 59.2 |
| 2018- 19 | 2,42,219                        |                 34.3 |                 65.7 |

Source: National Health Accounts Estimates for India

(c) As public health & hospitals is a State subject, effort to increase the overall investment in health in the country entails concomitant increase in health budgets of the States. As per the National Health Policy, 2017, public investment in health is envisioned to reach 2.5% of GDP by 2025. DoHFW has taken up with States to prioritize allocation to health sector and enhance their health budgets at least 10% every year to reach the goal as envisaged.  DoHFW is making continuous efforts to increase allocation in health budget. DoHFW has taken up with States to prioritize allocation  to  health  sector  and  enhance  their  health  budgets  to  reach  the  goal  as envisaged in the National Health Policy, 2017.

(d) The  Government  has  taken  the following initiatives to ensuring  good healthcare facilities to all citizen of the country:

The  Government  has  launched  four  mission  mode  projects,  namely  PMAyushman  Bharat  Health  Infrastructure  Mission  (PM-ABHIM),  Ayushman  Bharat Health  &  Wellness  Centres  (ABHWCs),  Pradhan  Mantri  Jan  Arogya  Yojana (PMJAY) and Ayushman Bharat Digital Mission (ABDM). Other notable initiatives which have contributed to this increase in health expenditure include schemes viz., National  Health  Mission  (NHM),  setting  up  of  new  AIIMS  and  upgrading  of Government medical colleges under the Pradhan Mantri Swasthya Suraksha Yojna (PMSSY), support to States/UTs for setting up of new medical colleges as well as for increasing  UG  and  PG  medical  seats,  provision  of  free  drugs  and  free  diagnostic facilities at Primary Health Centres (PHCs)/ Community Health Centres (CHCs) and district hospital level, substantial increase in availability of government ambulances, etc.  The  Fifteenth  Finance  Commission  has  also  recommended  health  grants aggregating  to    Rs.  70,051  crore  to  local  government  for  addressing  the  gaps  in primary health infrastructure in rural and urban areas.

Under NHM, the flagship programme of the government, many steps have been taken towards supporting the State Government in providing accessible & affordable healthcare to people. Financial and technical support are provided to States/UTs to provide  accessible,  affordable  and  quality  healthcare,  especially  to  the  poor  and vulnerable  sections  of  the  population,  in  both  urban  and  rural  areas.  The  NHM provides  support  for  improvement  in  health  infrastructure,  availability  of  adequate human resources to man health facilities, to improve availability and accessibility to quality  health  care  especially  for  the  underserved  and  marginalized  groups  in  rural areas. Major initiatives for which States are being supported include Janani Shishu Suraksha Karyakram (JSSK), Rashtriya Bal Swasthya Karyakram (RBSK), Rashtriya Kishor Swasthya Karyakram (RKSK), implementation of NHM Free Drugs and Free Diagnostics Service Initiatives, PM National Dialysis Programme and implementation of National Quality Assurance Framework.

Under the PM-ABHIM, focus is on developing capacities of health system and institutions  across  the  continuum  of  care  at  all  levels  viz.  primary,  secondary  and tertiary and on preparing health systems in responding effectively to the current and future pandemics and disasters. PM-ABHIM is a Centrally Sponsored Scheme with some Central Sector Components with an outlay of Rs. 64,180 crore.

Under Ayushman Bharat Health & Wellness Centres (AB-HWCs), a comprehensive  need-based  healthcare  services  covering  maternal  and  child  health services  and  non-communicable diseases,  including  free  essential  drugs,  diagnostic services  and  tele  consultation  services  are  being  provided  to  all  citizens  of  the country.    The  HWCs  are  strengthening  existing  Sub  Health  Centres  (SHCs)  and

Primary  Health  Centres  (PHCs).  A  total  number  of  1,31,150  HWCs  have  already been operationalized.

The Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) - a centrally sponsored scheme provides health coverage upto Rs. 5 lakh per family per year  for  secondary  and  tertiary  care  hospitalization  to  over  10.74  crore  poor  and vulnerable families (approx. 50 crore beneficiaries).   More than 20 crore Ayushman cards have been verified and approximately 4.11 crore hospital admission amounting to  Rs.  47,911  crores  have  been  authorized  through  a  network  of  approximately 26,130 empanelled public and private health care providers.

Ayushman  Bharat  Digital  Mission  (ABDM)  has  been  announced  on  27 th September,  2021  with  the  aim  to  develop  the  backbone  necessary  to  support  the integrated digital health infrastructure of the country. It will bridge the existing gap amongst different stakeholders of Healthcare ecosystem through digital highways. A total  27,46,56,356  Ayushman  Bharat  Health  Account  (ABHA)  have  already  been created. Under ABDM more than 1.72 lakh Health Facilities and 1,03,886 Healthcare Professionals are registered.

For providing affordable and  accessible Mental  Healthcare facilities, the Government  is  implementing  National  Mental  Health  Programme  (NMHP)  in  the country. The District Mental Health Programme (DMHP) component of the NMHP has been sanctioned for implementation in 704 districts for which support is provided to  States/UTs  through  the  NHM.  Facilities  made  available  under  DMHP  at  the Community  Health  Centre  and  Primary  Health  Centre  levels,  include  outpatient services,  assessment,  counselling/  psycho-social  interventions,  continuing  care  and support to persons with severe mental disorders, drugs, outreach services, ambulance services, etc.

Further,  Tele  Mental  Health  Assistance  and  Networking  Across  States  (TeleMANAS)  was  launched  on  10.10.2022  with  the  aim  to  provide  free  tele-mental health services all over the country round the clock, particularly to under-served areas and people remotely located. The programme includes a network of 23 tele-mental health centres of excellence, with NIMHANS  being the nodal centre and International Institute of Information Technology-Bangalore (IIITB) providing technology support.