Pre-budget Statement New Delhi The foundation of a resilient public health system is built on primary care, which often takes a backseat against other national priorities. It takes a tragedy like the recent outbreak of acute encephalitis in Muzaffarpur that led to the death of 150 children, to demonstrate the critical need for higher investments in our public health system. India’s investments in primary health care continue to be inadequate, and our health systems falter when put to test. Unfortunately, our public health spending is extremely low at 1.18 per cent of the GDP. Of the already low amounts available for health, only 51 percent are invested in primary health care, according to the recent National Health Accounts Estimates for India. This is contrary to the National Health Policy 2017, which advocates for investing up to two-thirds or more resources for primary care. The recent Health Index Report 2019 of NITI Aayog also reveals huge inequity in health outcomes across states. Madhya Pradesh, Bihar, Jharkhand, Uttar Pradesh and Uttarakhand continue to lag in quality of care at public health facilities, registration of births, birth weight of infants, success in tuberculosis treatment and transfer of NHM funds from the State treasury to implementing units. States that are better on the health index have higher spending of their health care budgets. For instance, in Kerala, Tamil Nadu and Rajasthan close to 6 percent of the budgets are spent on health care as against 4 percent or less in other states. Population Foundation of India calls for the government to revisit its commitments towards improved health for all as it presents the Budget for 2019-20 in the current Parliament Session. The health budget needs to have substantial resources allocated towards providing quality primary health care within the National Health Mission as well as the newly initiated Health and Wellness Centres under Ayushman Bharat Scheme. There is also an urgent need to re-prioritize family planning on the nation’s development agenda, as the budgets for family planning have remained unchanged at 4 percent of the National Health Mission budgets since 2014-15. ‘Universal access to contraception’ is amongst the 19 priority targets of the Sustainable Development Goals (SDGs) that, as per the Post-2015 Consensus represent the best value for money, translating to $120 social, economic and environmental benefit for every $1 spent . Those savings can go towards infrastructure, health and education to help the government harness our demographic dividend.