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Gap Between Allocations for Health and Outcomes in States
Context:
The effectiveness of Union Budget health allocations relies on State-level factors, especially for Centrally Sponsored Schemes (CSS), as States share costs and handle implementation, making their fiscal capacity and operational frameworks vital.
Health Budget Allocations and Outcomes in India:
State-Level Dependency: Union Budget allocations for health are highly dependent on State-level factors due to shared costs and implementation responsibilities under Centrally Sponsored Schemes (CSS).
Major Centrally Sponsored Schemes (CSS):
- Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM): Aims to improve healthcare infrastructure, including health and wellness centres, block-level health units, and critical care hospitals.
- Human Resources for Health and Medical Education (HRHME): Focuses on increasing medical personnel by upgrading district hospitals and establishing new medical colleges.
Low Fund Utilisation:
- PM-ABHIM: Only 29% of budgeted funds were utilised in 2022-23, with only 50% utilisation expected for 2023-24.
- HRHME: Fund utilisation was around 25% for both 2022-23 and 2023-24.
Challenges Impacting Fund Utilisation:
- Execution Complexity: Only 45% of the 15th Finance Commission’s health grants were utilised between 2021-2024.
- Program Integration: Merging district-level public health labs requires extensive planning.
- Construction Delays: Strict procedures in constructing health units and hospitals cause delays in fund absorption.
Faculty and Specialist Shortages:
- AIIMS & State Medical Colleges: Over 40% vacancy in teaching faculty, severely impacting healthcare services.
- Rural Health Centres: High specialist vacancy rates add strain to healthcare infrastructure.
- Fiscal Space for States: States will face recurring costs for new infrastructure post-2025-26, requiring enhanced financial planning and resource allocation.
Recommendations for Improvement:
- Enhanced Budget Planning: States must prioritise health spending efficiently.
- Revenue Generation: Improve tax collection and explore public-private partnerships.
- Expenditure Management: Implement transparent procurement and cost control practices to maximise the impact of health budgets.
Key Health Initiatives:
- PM-ABHIM: Improves rural and urban health infrastructure, establishes critical care blocks, and focuses on disease surveillance.
- National Health Mission (NHM): Aims to strengthen healthcare delivery across States.
- Ayushman Bharat and PM Jan Arogya Yojana (AB-PMJAY): Provides health coverage and insurance for low-income families.
Challenges to Health Equity:
- Global Challenges: Pandemics like COVID-19 and climate change disproportionately affect marginalised groups.
- India-Specific Challenges: Healthcare access disparities exist due to India’s large population, with marginalised communities (e.g., Scheduled Castes and Tribes) suffering higher child mortality and anaemia rates.
- Non-communicable diseases (NCDs) cause 60% of deaths, exacerbated by doctor shortages and high out-of-pocket healthcare expenses.
Suggestions for Equitable Healthcare:
- Comprehensive Approach: Address socioeconomic determinants of health and integrate health literacy into NHM.
- Government Interventions: Expand Ayushman Bharat to reduce healthcare disparities.
- Public-Private Collaboration: Partner with NGOs and private sector for preventive healthcare education and infrastructure development.
- International Support: Collaborate with WHO and global institutions to strengthen healthcare systems.
- Innovation in Healthcare: Use digital health and technology for better diagnostics and treatment.
- Increased Health Budget: The Fifteenth Finance Commission recommends increasing public health expenditure to 2.5% of GDP by 2025.
- Communication and Local Collaboration: Engage local organisations for community-specific health programs.
- Open communication between policymakers and grassroots organisations is key to improving health equity.
Way Forward:
- Enhanced Budget Planning: States must efficiently allocate funds for health infrastructure and recurring costs.
- Strengthen Revenue Generation: Explore new revenue sources, including improved tax collection.
- Optimising Expenditure: Implement better financial management practices, such as transparent procurement and cost control measures.