Funds unspent by States distend to 29% in 5 years: Study

Chennai: Despite health crises in India growing per year, the National Health Mission (NHM) funds unspent by States over five years upto 2016, increased by 29 per cent, according to a recent audit by the Comptroller and Auditor General (CAG) of India.

CAG has also reported delayed transfers and misallocation of these funds.

The NHM, launched in 2005, is India’s largest health programme aimed at providing universal access to healthcare. One of its primary missions is to improve maternal and child health and control communicable and non-communicable diseases.

NHM also disburses funds to State health societies to help strengthen local health systems, institutions and capabilities. Rural health centres in India are short of human resources and infrastructure, as Indiaspend reported on 30 January.

Sub-centres were 20 per cent short of human resources, 29 per cent of them did not have regular water supply, 26 per cent lacked electricity supply and 11 per cent were not connected by all-weather roads.

India ranks lower than neighbouring Bangladesh and even sub-Saharan Sudan and Equatorial Guinea on healthcare access, we reported on 23 May. And it spends 1.4 per cent of its gross domestic product (GDP) on health, the least among BRICS nations.

The amount unspent by State health societies went up from Rs 73.75 billion ($1.44 billion) in 2011-12 to Rs 95.09 billion ($1.43 billion) in 2015-16.

State treasuries delayed the transfer of Rs 50.37 billion ($806 million) and Rs 40.16 billion ($ 606 million) released in 2014-15 and 2015-16 to State health societies. The transfer that is supposed to take 15 days took between 50 to 271 days, the report stated.

In six states — Andhra Pradesh, Gujarat, Jammu and Kashmir, Rajasthan, Telangana and Tripura — Rs 360 million was diverted to other schemes, such as the Mukhyamantri Shubh Lakshmi Yojana (Chief Minister’s scheme for baby girls) and the Sukhibhava Scheme (assistance for institutional deliveries) in Telangana, etc.

Eighteen States spent only 32 per cent of allocation which was already 36 per cent short, the report said.

In 18 states, against a requirement of Rs 1.33 billion, reflected in the 2013-16 state programme implementation plans, only 64 per cent was allocated. But States were not able to utilise even the allocated amount, with no more than 32 per cent or Rs 430 million spent, it stated.

NHM is funded by both the Central government and the States, with the Centre providing 60 per cent. The Ministry of Health and Family Welfare used to release funds directly to the State health societies till 2013-14. The money is now sent to State governments, which then move it to the societies.

The State-level societies in turn, disburse the funds to district health societies for further release to blocks. From here, the money goes to various implementing units such as community and primary health centres and sub-centres and village health sanitation nutrition committees.

NHM funds are released in five parts: NRHM Reproductive and Child Health (RCH) Flexipool, National Urban Health Mission (NUHM) Flexipool and Flexipool for Communicable Diseases and Non-communicable Diseases, including injury and trauma and infrastructure maintenance.

State health societies had spent only Rs 1.0618 trillion ($20.7 billion) of the Rs 1.1093 trillion ($17.1 billion) available during 2011-16. In some States the unspent balance ranged between 40 per cent to 76 per cent, the report stated.

According to data, India still accounts for 17 per cent of global burden of maternal deaths, non-communicable diseases made for 61 per cent of deaths in 2016, communicable diseases like leprosy and malaria are yet to be controlled and 55 million Indians slipped into poverty in 2011-12 because of health catastrophes they could not afford.