The government’s spending on health and health education and research is abysmally low, a Parliamentary Committee observed last week. The states, despite their increased tax pool since last year, have also not increased their health budgets, the committee noted. Currently, the total government budget on health stands to just 1.2% of the total Gross Domestic Product.

As per the 12th Five Year Plan (2012-13 to 2016-17), the Planning Commission had approved raising of government expenditure to 2.5% of the GDP, and a total outlay of Rs 2.68 crore for the entire department of Health and Family Welfare. However, the total budget allocation made by the Union government in the five years is 1.25 cores, which works out to a “measly 46.5%” of the funding originally envisaged, the Committee said.

The Public Health Expenditure would need to increase by 147% to reach 2.5% of the GDP, the committee led by Samajwadi Party MP, Ramgopal Yadav said.

The government “owes an explanation” for the huge gap between the envisaged budgetary allocations and the funds made available, the committee said, noting the high out-of-pocket expenditure account for about 58% of the total health expenditure (as per the 2014 National Sample Survey data).

The abysmal States of the nation

Despite increasing the share of the tax-pool to the states in 2015-16, the states did not increase their health budgets, the health ministry officials told the Committee. The transfer of taxes to the states was increased from 32% to 42%, as per the 14th Finance Commission’s recommendation.

“The increased tax pool is in the form of untied funds, and the states can use it as they want. But, instead government uses it [to] build highways [and] other large infrastructure projects as opposed to spending on health and education,” said Ravi Duggal, country coordinator for the International Budget Partnership, which networks with organisations working on public budgeting.

The only states to have invested more in health after the increase in tax-pool are Sikkim, Mizoram, Goa, Meghalaya, Himachal Pradesh, Jammu & Kashmir and Kerala. The bigger states such as Bihar, Jharkhand, Uttar Pradesh, Odisha and Madhya Pradesh have not invested enough for health, stated the report.

The Committee also noted considerable delay in the transfer of Central Grants to the State Health Society of up to 142 days, with about 9.5% of the funds lying in the State Treasury for a period between 90 to 180 days.

In the rural settings, there was an increase in the shortfall of doctors, specialists and surgeons as compared to the requirement for the existing infrastructure, the Committee noted. There is a shortfall of 83.4% of surgeons, 76.3% of obstetricians & gynaecologists, 83.0% of physicians and 82.1% of paediatricians in the rural areas, which compels people to travel to the nearest city on bumpy roads entailing high cost of transport and challenging journeys, the committee said.

As far as health research goes, the Committee observed that the Department of Health Research had projected a requirement of Rs 1,689.43 crores, but the actual allocation for 2016-17 is Rs 750 crores. The committee lent its Parliamentary support for enhancement of funds to the tune of Rs 300 crores to the Department of Health Research for financial year 2016-17.