money matters

Will India see a much-needed increase in health funding in 2017?

A Rajya Sabha committee has directed the health department to demand a substantially greater budget for health from the Finance Ministry.

Abysmal spending on health had “impinged” upon the effective delivery of health care services to the people, a Rajya Sabha Standing Committee has said in a recent report. The committee has called for the health department to make a strong case for more health funding to the Finance Ministry before it finalises the union budget for the coming year.

Th standing committee’s action taken report on health budget allocations recommendations made in April was released on December 14, in which it has asked for the health department to provide a roadmap to reverse the trend of low budgetary allocations to the health sector. The new recommendations were made a little more than a month before the Finance Minister Arun Jaitley presents the Union budget on February 1.

In the April report, the committee led by Samajwadi Party MP Ramgopal Yadav had called noted that the total budget allocation for health stands to just 1.2% of total GDP. India has one of the sparsest health budgets in the world, lower than Nepal, Sri Lanka, and many other developing countries.

As per the 12th Five-Year Plan for the years between 2012 and 2017, the Planning Commission had approved raising government expenditure to 2.5% of the GDP, which entails a massive 147% rise in public health expenditure. Currently the total budget allocation in five years works out to what the committee calls a “measly 46.5%”.

“The committee has taken the view that the financial allocation for the health department were grossly underfinanced,” said Ravi Duggal, country coordinator for the International Budget Partnership that networks with organisations working on public budgeting.

Government’s response

In reply to the committee, the government has stated that public health expenditure is based on “availability of financial resources” and it has to keep in mind the competing demands on the resources of the government and the “absorptive capacity” of the health sector – that is the capacity to effectively and efficiently spend the funds.

Health department officials said that the observations of the Parliamentary Standing Committee has been communicated to the finance department that makes budgetary allocations.

The committee also took note of the 2,423 pending utilisation certificates, which are essentially expenditure statements, for various grants given by the health department to the states. The utilisation certificates amount to Rs 3,186.88 crores and have been pending since 2005. Non-submission of the utilisation reports indicates lack of monitoring of corresponding projects and could also hamper the further release of funds to these projects. The government has stated that it has, from time to time, requested states to submit their utilisation reports and a team has visited some of the states to ensure effective implementation.

State spending on health

In 2015-’16, the share of the tax pool from the states had increased from 32% to 42%, as per the 14th Finance Commission’s recommendation. The Centre had cited the rise in the state tax pool for cutting Union health expenditure. The states, however, had not increased their health budgets correspondingly , the committee said in April.

The government had tried to address reduction in allocation of funds to the National Health Mission by imposing a condition requiring the states to raise their own share in healthcare spending by 15%.

“This is where the centre has passed on the buck to the states,” said Duggal. “There is something more that the governments should do in terms of pushing the state.”

The information provided by the government showed that, out of 36 states and union territories, 22 had increased their health budgets by 10% or more in comparison to the financial year 2015-’16. However, states such as Chandigarh, Daman and Diu, Karnataka, Maharashtra, Manipur and Sikkim had not shown any increase in their health budgets but have, in fact, shown a “negative trend” or a reduced increase in the budget.

The committee has recommended the union health department to keep a close watch on the states and also ensure the allocated funds get spent.

Laboratory capacity

The committee asked the government to increase laboratory capacity at district level to improve the quality of laboratory-based data for disease surveillance and disease outbreak investigations. Currently only 111 out of the envisaged 300 laboratories are functional.

The committee has also cautioned the government about its national polio programme. In April 2016, the government introduced the Inactivated Polio Vaccine programme and also planned to phase out the Oral Polio Vaccine. The department pointed to a global shortage of the new vaccine and how domestic manufacturers had not been able to fulfill the government’s requirement. The committee cautioned the department to “maintain strict surveillance” with respect to domestic production of the new vaccine as its shortage would jeopardise the hard earned success in elimination of polio in the country.

The committee has accepted some of the actions taken by the government. Addressing the steady increase of shortfall of doctors in the rural sector, the government has decided to reserve 50% of sears in post-graduate diploma courses for people who have served for more than three years in remote areas. Each year of service in a remote area will also account as 10% marks in entrance tests of post-graduate courses.

It also accepted the government’s efforts to boost immunisation rates and family planning, among other programmes. “Most of the work the centre has done were anyway under process, and not very radical,” said Duggal.

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India’s urban water crisis calls for an integrated approach

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Water challenges in urban India

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Distribution and water loss issues: Distribution challenges, such as water loss due to theft, pilferage, leaky pipes and faulty meter readings, result in unequal and unregulated distribution of water. In New Delhi, for example, water distribution loss was reported to be about 40% as per a study. In Mumbai, where most residents get only 2-5 hours of water supply per day, the non-revenue water loss is about 27% of the overall water supply. This strains the municipal body’s budget and impacts the improvement of distribution infrastructure. Factors such as difficult terrain and legal issues over buildings also affect water supply to many parts. According to a study, only 5% of piped water reaches slum areas in 42 Indian cities, including New Delhi. A 2011 study also found that 95% of households in slum areas in Mumbai’s Kaula Bunder district, in some seasons, use less than the WHO-recommended minimum of 50 litres per capita per day.

Water pollution and contamination: In India, almost 400,000 children die every year of diarrhea, primarily due to contaminated water. According to a 2017 report, 630 million people in the South East Asian countries, including India, use faeces-contaminated drinking water source, becoming susceptible to a range of diseases. Industrial waste is also a major cause for water contamination, particularly antibiotic ingredients released into rivers and soils by pharma companies. A Guardian report talks about pollution from drug companies, particularly those in India and China, resulting in the creation of drug-resistant superbugs. The report cites a study which indicates that by 2050, the total death toll worldwide due to infection by drug resistant bacteria could reach 10 million people.

A holistic approach to tackling water challenges

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Recycling and harvesting: Raw sewage water which is dumped into oceans damages the coastal eco-system. Instead, this could be used as a cheaper alternative to fresh water for industrial purposes. According to a 2011 World Bank report, 13% of total freshwater withdrawal in India is for industrial use. What’s more, the industrial demand for water is expected to grow at a rate of 4.2% per year till 2025. Much of this demand can be met by recycling and treating sewage water. In Mumbai for example, 3000 MLD of sewage water is released, almost 80% of fresh water availability. This can be purified and utilised for industrial needs. An example of recycled sewage water being used for industrial purpose is the 30 MLD waste water treatment facility at Gandhinagar and Anjar in Gujarat set up by Welspun India Ltd.

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Collaborative approach: Finally, a collaborative approach like the adoption of a public-private partnership model for water projects can help. There are already examples of best practices here. For example, in Netherlands, water companies are incorporated as private companies, with the local and national governments being majority shareholders. Involving citizens through social business models for decentralised water supply, treatment or storage installations like water ATMs, as also the appointment of water guardians who can report on various aspects of water supply and usage can help in efficient water management. Grass-root level organizations could be partnered with for programmes to spread awareness on water safety and conservation.

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This article was produced by the Scroll marketing team on behalf of BASF and not by the Scroll editorial team.