During the last two years, as India along with rest of the world faced the onslaught of the pandemic, Union Government’s key focus remained on providing a safety-net to the vulnerable segments of society as well as providing a coherent response to the health consequences of the pandemic, says the Economic Survey. The Union Minister for Finance & Corporate Affairs, Smt. Nirmala Sitharaman tabled the Economic Survey 2021-22 in Parliament today.

The Economic Survey also highlights the ‘agile framework’ of policy noting that in “an uncertain environment, the agile framework responds by a assessing outcomes in short alternations and constantly adjusting incrementally” as “the flexibility of agile improves responsiveness and aids evolution, but it does not attempt to predict future outcomes”. The response of the Union Government to the global COVID19 pandemic has been agile, strategic and pre-emptive. 

India’s Health Response to COVID-19:

The Economic Survey states that India, the country with the second largest population and a large elderly population, adopted a multipronged approach to COVID19 response and management. These included:

Measures were taken to break the chain of transmission in terms of containment and buffer zones; perimeter control; contact tracing; isolation and testing of suspect cases and high risk contacts, and creation of quarantine facilities. Preventive strategy changed in response to the changing situation based on real-time data and evidence. Testing facility in the country has increased exponentially.  Tests for COVID-19 were made free in all Government Centers.  Rapid Antigen Test Kits for faster screening were introduced.  Manufacturing capacity of N-95 masks, ventilators, personal protective equipment kits, sanitizers were ramped up in a mission mode.  The Survey also highlights the massive infrastructure created for isolation beds, dedicated intensive care unit beds, and supply of medical oxygen. To meet the exponential rise in medical oxygen demand during second COVID surge, the Government engaged even Railways, Air force, Navy and Industry to work with ‘whole of government’ approach.

In fight against the corona virus, COVID vaccines emerged as the best shield against the disease to save lives and sustained livelihood.

COVID Vaccination Strategy:

The Economic Survey highlights that vaccination is not merely a health response but is critical for opening up the economy, particularly contact-intensive services.  Therefore, it should be treated for now as a macro-economic indicator. 

“The Liberalized Pricing and Accelerated, National COVID-19 Vaccination Strategy”, was implemented from 1^st May to 20^th June, 2021, observes the Survey.  From 3^rd January, 2022, COVID-19 vaccine coverage has been extended to age group of 15-18 years.  Further, from 10^th January, 2022, Health Care Workers, Frontline Workers and persons aged more than 60 years with co-morbidities have been made eligible to receive a precaution dose of COVID-19 vaccine, on completion of 9 months or 39 weeks from the date of administration of second dose.

The Economic Survey notes that Indian National COVID Vaccination Program, one of the world’s largest vaccination programs, has not only supported production of COVID-vaccines domestically, but it has also ensured free vaccines to its population, world’s second largest population.  Union Budget for 2021-22 allocated Rs. 35,000 crore for procurement of vaccines under the nationwide COVID-19 Vaccination Program.  From 16^th January, 2021 till 16^th January, 2022, a total of 156.76 crore doses of COVID-19 vaccines have been administered, 90.75 crore first dose and 65.58 crore second dose.  Vaccination at this scale and speed has enabled swift revival of livelihoods, the Survey underscores.

The Survey highlights that India is among the few countries producing COVID vaccines.  The country started with two made in India COVID vaccines.  In line with India’s vision of Atmanirbhar Bharat, India’s first domestic COVID-19 vaccine, Whole Virion Inactivated Corona Virus Vaccine (COVAXIN), was developed and manufactured by Bharat Biotech International Limited in collaboration with National Institute of Virology of Indian Counsel of Medical Research (ICMR).  The ICMR funded the clinical trials of COVISHIELD vaccine developed in collaboration with Oxford-AstraZeneca.  COVISHIELD and COVAXIN have been widely used vaccines in India.  Every month about 250-275 million doses of COVISHIELD and 50-60 million doses of COVAXIN have been produced.

Making it a technology driven vaccination program, Arogya Setu mobile app was launched to enable people to assess themselves the risk of their catching the COVID-19 infection. Co-WIN 2.0 (along with e-VIN), a unique digital platform, supported the real time vaccination activities viz. registration for vaccine, tracking COVID-19 vaccine status of every beneficiary, stocks of vaccine, storage, actual vaccination process, and generation of digital certificates, observes the Economic Survey.

Health Sector Expenditure:

The Economic Survey mentions that although the pandemic has affected almost all social services, yet the health sector was the worst hit.  Expenditure on health sector increased from Rs. 2.73 lakh crore in 2019-20 (pre-COVID -19) to Rs, 4.72 lakh crore in 2021-22 (BE), an increase of nearly 73%. 

The Survey further states that in addition to the National Health Mission, Union Budget 2021-22, announced Ayushman Bharat Health Infrastructure Mission, a new Centrally Sponsored Scheme, with an outlay of about Rs. 64,180 crore in next five years to develop capacities of primary, secondary and tertiary Health Care Systems, strengthen existing national institutions, and create new institutions to cater to detection and cure of new and emerging diseases.  Besides, Union Budget 2021-22 provided an outlay of Rs. 35,000 crore towards COVID-19 vaccination.

The National Health Policy, 2017 envisaged to increase Government’s health expenditure to 2.5% of GDP by 2025, reiterates the Economic Survey.  It says that in keeping with this objective, Central and State Government’s Budgeted expenditure on health sector reached 2.1% of GDP in 2021-22, against 1.3% in 2019-20.

National Family Health Survey-5 (NFHS-5):

As per latest the NFHS-5, social indicators such as Total Fertility Rate (TFR), Sex Ratio and health outcome indicators viz. Infant Mortality Rate, under-Five mortality rate, institutional birth rate have improved over year 2015-16, observes the Economic Survey.  According the Survey, NFHS-5 shows that not only services are reaching to the public, but the intended outcomes have also improved.

All child nutrition indicators have also improved at the all India level. Under-Five Mortality Rate (U5MR) has declined from 49.7 in 2015-16 to 41.9 in 2019-21.  IMR has declined from 40.7 per 1000 live births in 2015-16 to 35.2 per 1000 live births in 2019-21.  Stunting has declined from 38% in 2015-16 to 36% in 2019-21.  Wasting has also declined from 21% in 2015-16 to 19% in 2019-21.  And, underweight declined from 36% in 2015-16 to 32% in 2019-21. 

Latest NFHS-5 shows that TFR, an average number of children per women, has further come down to 2.0 in 2019-21 from 2.2 in 2015-16.  The Survey highlights that the TFR has even come down below the replacement level of fertility (2.1 children per women) in the country.

The Sex Ratio, number of females per 1000 males, in the total population has risen from 991 females in 2015-16 (NFHS-4) to 1020 in 2019-20 (NFHS-5).  More importantly, the sex ratio and birth female children per 1000 male children born in the last five years, has grown from 919 in 2015-16 to 929 in 2019-21. 

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During the last two years, as India along with rest of the world faced the onslaught of the pandemic, Union Government’s key focus remained on providing a safety-net to the vulnerable segments of society as well as providing a coherent response to the health consequences of the pandemic, says the Economic Survey. The Union Minister for Finance & Corporate Affairs, Smt. Nirmala Sitharaman tabled the Economic Survey 2021-22 in Parliament today.

The Economic Survey also highlights the ‘agile framework’ of policy noting that in “an uncertain environment, the agile framework responds by a assessing outcomes in short alternations and constantly adjusting incrementally” as “the flexibility of agile improves responsiveness and aids evolution, but it does not attempt to predict future outcomes”. The response of the Union Government to the global COVID19 pandemic has been agile, strategic and pre-emptive. 

India’s Health Response to COVID-19:

The Economic Survey states that India, the country with the second largest population and a large elderly population, adopted a multipronged approach to COVID19 response and management. These included:

Measures were taken to break the chain of transmission in terms of containment and buffer zones; perimeter control; contact tracing; isolation and testing of suspect cases and high risk contacts, and creation of quarantine facilities. Preventive strategy changed in response to the changing situation based on real-time data and evidence. Testing facility in the country has increased exponentially.  Tests for COVID-19 were made free in all Government Centers.  Rapid Antigen Test Kits for faster screening were introduced.  Manufacturing capacity of N-95 masks, ventilators, personal protective equipment kits, sanitizers were ramped up in a mission mode.  The Survey also highlights the massive infrastructure created for isolation beds, dedicated intensive care unit beds, and supply of medical oxygen. To meet the exponential rise in medical oxygen demand during second COVID surge, the Government engaged even Railways, Air force, Navy and Industry to work with ‘whole of government’ approach.

In fight against the corona virus, COVID vaccines emerged as the best shield against the disease to save lives and sustained livelihood.

COVID Vaccination Strategy:

The Economic Survey highlights that vaccination is not merely a health response but is critical for opening up the economy, particularly contact-intensive services.  Therefore, it should be treated for now as a macro-economic indicator. 

“The Liberalized Pricing and Accelerated, National COVID-19 Vaccination Strategy”, was implemented from 1^st May to 20^th June, 2021, observes the Survey.  From 3^rd January, 2022, COVID-19 vaccine coverage has been extended to age group of 15-18 years.  Further, from 10^th January, 2022, Health Care Workers, Frontline Workers and persons aged more than 60 years with co-morbidities have been made eligible to receive a precaution dose of COVID-19 vaccine, on completion of 9 months or 39 weeks from the date of administration of second dose.

The Economic Survey notes that Indian National COVID Vaccination Program, one of the world’s largest vaccination programs, has not only supported production of COVID-vaccines domestically, but it has also ensured free vaccines to its population, world’s second largest population.  Union Budget for 2021-22 allocated Rs. 35,000 crore for procurement of vaccines under the nationwide COVID-19 Vaccination Program.  From 16^th January, 2021 till 16^th January, 2022, a total of 156.76 crore doses of COVID-19 vaccines have been administered, 90.75 crore first dose and 65.58 crore second dose.  Vaccination at this scale and speed has enabled swift revival of livelihoods, the Survey underscores.

The Survey highlights that India is among the few countries producing COVID vaccines.  The country started with two made in India COVID vaccines.  In line with India’s vision of Atmanirbhar Bharat, India’s first domestic COVID-19 vaccine, Whole Virion Inactivated Corona Virus Vaccine (COVAXIN), was developed and manufactured by Bharat Biotech International Limited in collaboration with National Institute of Virology of Indian Counsel of Medical Research (ICMR).  The ICMR funded the clinical trials of COVISHIELD vaccine developed in collaboration with Oxford-AstraZeneca.  COVISHIELD and COVAXIN have been widely used vaccines in India.  Every month about 250-275 million doses of COVISHIELD and 50-60 million doses of COVAXIN have been produced.

Making it a technology driven vaccination program, Arogya Setu mobile app was launched to enable people to assess themselves the risk of their catching the COVID-19 infection. Co-WIN 2.0 (along with e-VIN), a unique digital platform, supported the real time vaccination activities viz. registration for vaccine, tracking COVID-19 vaccine status of every beneficiary, stocks of vaccine, storage, actual vaccination process, and generation of digital certificates, observes the Economic Survey.

Health Sector Expenditure:

The Economic Survey mentions that although the pandemic has affected almost all social services, yet the health sector was the worst hit.  Expenditure on health sector increased from Rs. 2.73 lakh crore in 2019-20 (pre-COVID -19) to Rs, 4.72 lakh crore in 2021-22 (BE), an increase of nearly 73%. 

The Survey further states that in addition to the National Health Mission, Union Budget 2021-22, announced Ayushman Bharat Health Infrastructure Mission, a new Centrally Sponsored Scheme, with an outlay of about Rs. 64,180 crore in next five years to develop capacities of primary, secondary and tertiary Health Care Systems, strengthen existing national institutions, and create new institutions to cater to detection and cure of new and emerging diseases.  Besides, Union Budget 2021-22 provided an outlay of Rs. 35,000 crore towards COVID-19 vaccination.

The National Health Policy, 2017 envisaged to increase Government’s health expenditure to 2.5% of GDP by 2025, reiterates the Economic Survey.  It says that in keeping with this objective, Central and State Government’s Budgeted expenditure on health sector reached 2.1% of GDP in 2021-22, against 1.3% in 2019-20.

National Family Health Survey-5 (NFHS-5):

As per latest the NFHS-5, social indicators such as Total Fertility Rate (TFR), Sex Ratio and health outcome indicators viz. Infant Mortality Rate, under-Five mortality rate, institutional birth rate have improved over year 2015-16, observes the Economic Survey.  According the Survey, NFHS-5 shows that not only services are reaching to the public, but the intended outcomes have also improved.

All child nutrition indicators have also improved at the all India level. Under-Five Mortality Rate (U5MR) has declined from 49.7 in 2015-16 to 41.9 in 2019-21.  IMR has declined from 40.7 per 1000 live births in 2015-16 to 35.2 per 1000 live births in 2019-21.  Stunting has declined from 38% in 2015-16 to 36% in 2019-21.  Wasting has also declined from 21% in 2015-16 to 19% in 2019-21.  And, underweight declined from 36% in 2015-16 to 32% in 2019-21. 

Latest NFHS-5 shows that TFR, an average number of children per women, has further come down to 2.0 in 2019-21 from 2.2 in 2015-16.  The Survey highlights that the TFR has even come down below the replacement level of fertility (2.1 children per women) in the country.

The Sex Ratio, number of females per 1000 males, in the total population has risen from 991 females in 2015-16 (NFHS-4) to 1020 in 2019-20 (NFHS-5).  More importantly, the sex ratio and birth female children per 1000 male children born in the last five years, has grown from 919 in 2015-16 to 929 in 2019-21. 

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