Union Budget 2024-25 encourages vaccination against cervical cancer, provides insurance to frontline health workers

The Department of Health and Family Welfare was allocated Rs 87,656.90 crore in the interim Union Budget 2024-2025 tabled by Finance Minister Nirmala Sitharaman in Parliament on February 1, 2024.

This earmarked funding for the health ministry is a minor bump from the budget allocation in the Union Budget for 2023-2024 at Rs 86,175 crore.

Srinath Reddy, former president of the Public Health Foundation of India (PHFI), told Down to Earth (DTE): “As far as the actual increase in funding is concerned, it is marginal at one per cent. Compared to the revised estimates which is the spent amount, it is about 12 per cent. We have to look at why the amount spent was less than what was allocated. It may mean administrative inefficiencies, and health system weaknesses in absorptive capacity that may need rectification. We hope the regular budget after the elections increases the health budget while paying attention to greater utilisation.”

The National Health Policy 2017 outlined a health budget target of 2.5 per cent of the Gross Domestic Product (GDP) by 2025. With just a year left to reach the target, the health budget remains less than 2 per cent of the total expenditure estimated at Rs 47,65,768 crore for 2024-25.

In a first for the country’s frontline healthcare workers most of whom live Below the Poverty Line and work for low unfixed wages, varying according to the states, Sitharaman announced, “Healthcare cover under the Ayushman Bharat scheme will be extended to all ASHA workers, Anganwadi workers, and helpers.”

“The question remains how many of them already are entitled beneficiaries as they may have already been covered. How many additional workers will benefit remains to determined. However, the fact that there is an assurance is a welcome move,” Reddy said.

Dr. Pratheeba John, health financing specialist with the Health Systems Transformation Platform, a non-profit, told DTE, “This is a good initiative as the country’s frontline health workers are assured of their health with financial protection during times of illness. Moreover, social care workers who did not have health protection measures have been brought under the safety net for the first time. It also caters to the missing middle, healthcare workers who are not below the poverty line.”

The government’s flagship Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY) aims to provide health insurance to 120 million poor and 550 million vulnerable families. The scheme includes a health cover of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation. The beneficiaries are chosen based on the economic status and occupational criteria specified in the Socio-Economic Caste Census 2011 (SECC 2011).

The budget provided a boost to children’s nutrition and addressed strengthening Anganwadi centres under “Saksham Anganwadi and Poshan 2.0” which will provide improved nutrition delivery, early childhood care, and development.

“Early childhood development was not paid attention to earlier, because the original Integrated Child Development Services only concentrated on preschool children. This is the first scheme to cater to children 0-3 years old. However, over the years, early childhood development has been receiving more attention because physical growth and cognitive development are dependent on those years,” Reddy explained.

Sitharaman also emphasised that new medical colleges will be added to cater to the shortage of doctors. She said, “Several youths are ambitious to get qualified as doctors. They aim to serve our people through improved healthcare services.”

The minister added, “Our government plans to set up more medical colleges by utilising the existing hospital infrastructure under various departments. A committee for this purpose will be set up to examine the issues and make relevant recommendations.”

John explained that “the country is facing a shortage of medical officers and specialist doctors, especially in rural areas, which is compounded by the problem of out-migration. Setting up more medical colleges is a much-needed move, especially to bridge the gap in specific regions that face a shortage of specialists and to bring in more medical personnel to address the local healthcare needs; however, this requires efforts that are carefully crafted without compromising on the quality of education.”

Cervical cancer

The government also focused on the vaccination against cervical cancer. “Our government will encourage vaccination for girls in the age group of 9 to 14 years for the prevention of cervical cancer,” Sitharaman said.

Arvind Krishnamurthy, professor and head, of surgical oncology, at Cancer Institute, WIA (Chennai), told DTE, “It is not a mandate but it creates awareness amongst the population, asking them to voluntarily come for vaccination.”

There are, at present, two vaccines available in the country against the human papillomavirus (HPV) which causes cervical cancer, namely Merck’s Gardasil and Serum Institute of India’s Cervavac. In 2010, the government suspended all HPV vaccination projects after a post-license observational study in Andhra Pradesh and Gujarat reported six deaths weeks or months following HPV vaccination. The study was conducted by the immunisation departments of Andhra Pradesh and Gujarat, along with US-based not-for-profit, PATH.

Cervical cancer is the second most common type of cancer in India for women. “The cases have come down over the years as a result of good sexual hygiene and improved immunity, among other factors, including the simultaneous rise of breast cancer,” Krishnamurthy said.

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