The usual case for health spending is that it raises productivity among people already in the measured economy. For a country trying to bring hundreds of millions more into productive life, that is too narrow. Illness changes household risk-taking: who migrates, who stays in school, who starts a business, who can leave unpaid care work. Health is infrastructure for participation, not a welfare add-on.

The deeper error is conflating money with systems. Financing builds facilities and fills posts. It does not create continuity, responsibility, or relationships across levels of care. Many states already spend enough, given cost advantages and labour slack. The scarce inputs are political capital (who has authority), regulatory capital (how incentives are aligned), and organizational capital (coordination, learning, accountability). Primary care fails without defined populations, risk stratification, and journeys that hold together. Digital tools do not substitute for that architecture.