Advocacy group decries 'hyper-centralization' as States’ share of health funds plummets

By A Representative

In a major pre-budget mobilization, the Jan Swasthya Abhiyan (JSA), India’s leading public health advocacy network, has issued a sharp critique of the Union government’s health spending and demanded a doubling of the health budget for the upcoming 2026-27 fiscal year.

The network, which represents over 1,000 organizations, warned that the government is on the verge of defaulting on its own National Health Policy (NHP) 2017 commitment to raise public health expenditure to 2.5% of GDP by 2025. Despite the deadline passing, JSA data indicates that total government spending remains stuck below 1.5% of GDP, leaving the public health system chronically understaffed and ill-equipped.

The JSA's "Health for All Now!" charter highlights a troubling post-pandemic trend where the Union government's health allocation as a percentage of the total budget has actually declined from 2.26% in 2020-21 to 2.05% in 2025-26. Adjusting for inflation, the organization claims the 2025-26 health budget was effectively 4.7% lower than what was spent during the height of the pandemic in 2020-21.

This stagnation is stark when compared to regional neighbors; the report notes that Bhutan and Sri Lanka spend 2.5 to 3 times more per capita on health than India, while other BRICS nations outspend India by 14 to 15 times per person.

A central pillar of the JSA’s demand is the revitalization of the National Health Mission (NHM). While the NHM was once the primary vehicle for improving rural and urban health services, its funding has reportedly declined by an average of 5.5% in real terms during the current administration's second tenure. The JSA is calling for an immediate doubling of NHM funds to ensure dignified wages for ASHAs and other health workers, and to facilitate the expansion of services to tackle non-communicable diseases and climate-related health threats.

The advocacy group also raised alarms over the "hyper-centralization" of health resources. While state governments carry the primary burden of healthcare delivery, the share of the Union health budget transferred to states has plummeted from 75.9% in 2014-15 to just 43% in 2024-25. To rectify this, the JSA demands that at least two-thirds of the Union health budget be transferred to state governments as flexible funding.

Additionally, the report criticizes the use of the Health and Education Cess, alleging that instead of acting as a "top-up" for the sector, the INR 17,795 crores collected annually is being used to mask deeper cuts in the main budget.

Further demands include a total rollback of the insurance-based Pradhan Mantri Jan Arogya Yojana (PMJAY), which the JSA argues is inefficient and prone to irregularities, in favor of direct investment in public healthcare. The charter also calls for the immediate revamping of Central Pharma and Vaccine PSUs, such as Hindustan Antibiotics and IDPL, to bolster domestic production of medicines and Active Pharmaceutical Ingredients (APIs).

Ultimately, the JSA is urging the Union government to increase its health allocation to 5% of the total budget within the next two years to treat health as a basic human right rather than a discretionary expense.

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