SPMG II MTEF Report 2015-16 - Department of Health & Family Welfare - Final

MTEF for Department of Health and Family Welfare– 2015-16
Strengthening Performance Management in Government Phase–II 0
December 2014
333
Strengthening Performance Management in Government
Phase–II
Medium Term Expenditure Framework
Bottom Up Budgeting Report 2015-16
Department of Public Health & Family Welfare
Strengthening Performance Management in II
Deloitte Touche Tohmatsu India Private Limited
December 2014

December 2014
Table of Contents
1. Executive Summary..........................................................................................................6
1.1 Project background ...................................................................................................... 6
1.2 MTEF Process ............................................................................................................. 6
1.3 Bottom up Budgeting .................................................................................................... 7
1.4 Top Down Estimation ................................................................................................. 11
1.5 Reconciliation ............................................................................................................ 11
1.6 Way Forward ............................................................................................................. 12
2. Background.....................................................................................................................13
2.1 SPMG Project ............................................................................................................ 13
2.2 Medium Term Expenditure Framework ........................................................................ 14
3. Bottom Up Budgeting....................................................................................................15
3.1 Sector Overview......................................................................................................... 16
3.2 Department Review.................................................................................................... 30
3.3 Scheme Review......................................................................................................... 34
3.4 Scheme Prioritization.................................................................................................. 38
3.5 Expenditure Review ................................................................................................... 42
3.6 Trend Projections ....................................................................................................... 48
4. Top Down Estimation.....................................................................................................53
5. Reconciliation.................................................................................................................54
6. Way Forward ...................................................................................................................55
7. Annexures:......................................................................................................................56
Annexure 1. Allocation of funds across plan schemes during the period from 2009-10 to 2014-
15 (BE) (Rs. In Crores) - 70 schemes ................................................................................... 56
Annexure 2. Allocation of State Plan funds across the schemes during the period from 2009-10
to 2014-15 (BE) (Rs. In Crores) - 42 schemes ....................................................................... 58
Annexure 3. Mapping of all plan schemes with Departmental objectives............................... 60
Annexure 4. Distribution of Non-Plan expenditure of DoHFW by object (Rs. in crore) ............ 62
Annexure 5. Distribution of Plan expenditure of DoHFW by object (Rs. in crore) ................... 62
Annexure 6. Revenue expenditure of DoHFW by objects (Rs. in crore) ................................ 63
Annexure 7. Capital expenditure of DoHFW by objects (Rs. in crore) ................................... 64
Annexure 8. Projected expenditure of DoHFW by schemes (Rs. in crore)............................. 64
Annexure 9. Projected total expenditure for DoHFW by object (Rs. in crore)......................... 66
Annexure 10. Projected Plan expenditure of DoHFW by schemes (Rs. in crores).................. 67
Annexure 11. Projected Plan expenditure of DoHFW by objects (in crores) .......................... 70

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Annexure 12. Projected Non-Plan expenditure of DoHFW by Schemes (Rs. in crore) ........... 70
Annexure 13. Projected Non-Plan expenditure of DoHFW by Objects (Rs. in crore) .............. 73

MTEF for Department of Health and Family Welfare – 2015-16
December 2014
List of Tables
Table 1 : Trend Projections for DoHFW (Rs. in crore) .................................................................... 10
Table 2: Top down estimates for DoHFW for FY 2015-16 (in crores) .............................................. 11
Table 3: Projected resource and expenditure growth of DoHFW (in Rs. Crore) ............................... 11
Table 4: Number of Diarrheal cases and deaths during 2010-11 .................................................... 26
Table 5: Identified Cataract cases and achievements 2007-08 to 2009-10...................................... 26
Table 6: Case detection and treatment of Leprosy cases in MP 2010-11 ........................................ 26
Table 7: Status of Malaria in MP .................................................................................................. 26
Table 8: Case detection and Treatment success rate of TB cases.................................................. 27
Table 9: Health Infrastructure in MP ............................................................................................. 27
Table 10: Human Resources for Health – December 2013 ............................................................ 27
Table 11: Objectives of the Department ........................................................................................ 32
Table 12: Scheme prioritization summary - all plan schemes of DoHFW ......................................... 38
Table 13: Scheme prioritization summary - all state plan schemes of DoHFW................................. 39
Table 14: Scheme prioritization summary - all active schemes of DOHFW...................................... 40
Table 15: Description of the Demand Numbers under DoHFW ....................................................... 42
Table 16: Government expenditure by sector (Rs. in crore) ........................................................... 42
Table 17: Trends in expenditure of DoHFW (Rs. in crore) .............................................................. 43
Table 18 : Revenue & capital-wise expenditure trends of DoHFW by demand numbers (Rs. in crore)
.................................................................................................................................................. 44
Table 19 : Plan and Non-Plan expenditure trend of DoHFW by demand numbers (Rs. in crore) ....... 45
Table 20: Expenditure by DoHFW (Rs. in crore)............................................................................ 46
Table 21: Assumptions for Trend Based Projections ..................................................................... 48
Table 22: Percentage distribution of total expenditure by object ..................................................... 49
Table 23: Percentage distribution of plan expenditure by object ..................................................... 50
Table 24: Percentage distribution of non-plan expenditure by object .............................................. 51
Table 25: Plan and Non-Plan Expenditure projections of DoHFW (Rs. in crore) .............................. 52
Table 26: Top down estimates for DoHFW for FY 2015-16 ............................................................ 53
Table 27: Projected resource and expenditure growth of DoHFW (in Rs. Crore).............................. 54

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Acronyms
Acronym Definition
AAGR Annual Average GrowthRate
ACA AdditionalCentralAssistance
ALOS Average Lengthof Stay
BCC Behavior ChangeCommunication
BE BudgetEstimates
BGTRR BhopalGasTragedyReliefandRehabilitation
BMI Body MassIndex
BOR Bed OccupancyRate
BTR Bed TurnoverRate
CBR CrudeBirth Rate
CDR CrudeDeath Rate
CP CentralPlan
CSS Centrallysponsoredschemes
D. No DemandNumber
DFID Departmentfor InternationalDevelopment
DME Directorateof MedicalEducation
DoHFW Departmentof HealthandFamilyWelfare
DoL Departmentof Labour
DWCD Departmentfor WomenandChildDevelopment
EAPs ExternallyAided Projects
GIA Grants-in-Aid
GoI Governmentof India
GoMP Governmentof MadhyaPradesh
GPI GenderParity Index
GSDP GrossState Domestic Product
ICT Informationand CommunicationTechnology
IMR Infant MortalityRate
MCR MiscellaneousCapitalReceipts
MIS ManagedInternetService
MP MadhyaPradesh
MPSACS MadhyaPradeshState AIDs ControlSociety
MTEF Medium-Term ExpenditureFramework
NRHM NationalRuralHealth Mission
OBC OtherBackwardClasses
OBE OnBudget Expenditure
RE Revised Estimates
SC ScheduledCaste
SCP SpecialComponentPlan
SOs SchemeOutputs
SP State Plan
SPC State PlanningCommission
SPMG Strengthening Public FinancialManagementinGovernment
ST ScheduledTribe
ST ScheduledTribes
TFR TotalFertilityRate
TGE TotalGovernmentExpenditure
UNICEF UnitedNationsInternationalChildren'sEmergencyFund

December 2014
Disclaimer
This documentis strictly private and confidential and has been prepared by Deloitte Touché Tohmatsu India
Private Limited (“DTTIPL”) specifically for the Directorate of Institutional Finance, Government of Madhya
Pradesh (“DIF”) for the purposes specified herein. The information and observations contained in this
document are intended solely for the use and reliance of DIF and are not to be used, circulated, quoted or
otherwise referred to for any other purpose or relied upon without the express prior written permission of
DTTIPL in each instance.
Deloitte has not verified independently all of the information contained in this report and the work performed
by Deloitte is not in the nature of audit or investigation.
This document is limited to the matters expressly set forth herein and no comment is implied or may be
inferred beyond matters expressly stated herein.
It is hereby clarified that in no event DTTIPL shall be responsible for any unauthorized use of this document,
or be liable for any loss or damage,whether direct,indirect,or consequential,thatmay be suffered or incurred
by any party.

December 2014
1. Executive Summary
1.1 Project background
Government of Madhya Pradesh (GoMP) seeks to further strengthen the fiscal performance of the
State through fiscal reforms. Through the Phase II of the DFID funded Strengthening Performance
Management in Government project, GoMP intends to bring about systemic reforms in public financial
management. GoMP has engaged Deloitte Touche Tohmatsu India Private Limited as Long Term
Consultants for strengthening Public Financial Management in Madhya Pradesh. The project
commenced on 1st March 2013.
In most of the states, Medium Term Expenditure Frameworks (MTEFs) have been attempted with
limited success. Most of them are attempted on pilot basis by line departments to access budgetary
support provided by international funding agencies. GoMP is attempting to go beyond these kinds of
attempts. During second phase of SPMG, starting March 2013, MTEF is being implement ed in 15
departments in a phased manner.
The following is the scope of work of MTEFs:
 Review of MTEF methodology
 Update MTEF Manual prepared under SPMG I
 Conduct workshop to validate and finalize MTEF Methodology
 Support select departments in preparation of MTEF for 3 budget cycles
The present report is prepared for the Department of Health and Family Welfare (DoHFW) for the year
2015-16.
The report is organized into following sections:
Section 1: Executive Summary
Section 2: Background of the SPMG Project
Section 3: Bottom Up Budgeting
Section 4: Way Forward
Section 5: Annexures
The present section provides a detailed summary of MTEF for DoHFW for the year 2015-16.
1.2 MTEF Process
Medium Term Expenditure Framework provides estimates for multi-year expenditure requirements and
makes the budget more strategic and performance oriented. The preparation of MTEF for DoHFW,
involved following steps:
 Bottom up budgeting
 Top down budgeting
 Reconciliation and Reprioritization
The current report focuses on the bottom up budgeting of MTEF for DoHFW. Top down estimates for
DoHFW have been carried out and a separate report has been prepared and submitted to Finance
Department for suggestions. Post approval of the top down methodology by the Finance Department,
the multi-year budget ceilings arrived through the approved methodology would be reconciled with the
bottom up resource requirements.

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1.3 Bottom up Budgeting
The ‘bottom up’ estimates are arrived through a set of sequential steps as elucidated below:
Step 1: Sector Review – evaluation and identification of the performance and problems of the sector in
terms of various quantifiable indicators used by the department
Step 2: Scheme Review – identification, prioritization and mapping of primary and secondary
objectives of the department with the schemes and preparation of prioritization matrix
Step 3: Scheme Prioritization – segregation of schemes with zero and non-zero (active) budget
allocation, grouping of schemes based on primary objectives. Subsequently, prioritization according to
sources of funds through application of prioritization principle
Step 4: Expenditure Review – analysis of the flow of resources for various schemes at object head
level during past 5 / 6 years
Step 5: Expenditure Projections – projection of the expenditure on the basis of past trend and as per
the Medium Term Fiscal Policy Statement presented under the Fiscal Responsibility and Budget
Management (FRBM) Act for 2014-15
1.3.1 Sector Review
A review has been undertaken for Health Sector, as DoHFW primarily focuses on improving the
performance of this sector. The key observations are given below:
A. Demographic Issues:
1. In absolute terms, the population of the state is growing at a faster rate. The decadal growth rate of
the population in MP is higher than the all India average002E
2. Larger segment of the population are people within the age group of 15-49 years followed by the
population within the age group of 0-14. Therefore, adequate provision needs to be made for them
in order to address the health and other related issues of these groups.
3. The life expectancy is low in the state as a whole. The life expectancy of females is more
compared to males. This needs more attention on chronic diseases and geriatric care
4. A large proportion of populations are adults. Therefore there is a need for expanding the
awareness generation activities, especially related to sexual and reproductive health in order to
prevent them from various sexual infectious diseases.
B. Key Issues related to CBR, CDR, IMR and MMR:
1. Desire to have more children due to high infant mortality, and low coverage of family planning
services are two major factors responsible for high birth rate in the state.
2. The CDR of Madhya Pradesh is relatively high compared to national average. This is mostly due to
lack of quality of care and appropriate infrastructure in the government health care facilities.
3. Lack of proper attention to provide ANC, PNC and immunization services are the key factors that
contribute to higher Infant deaths, thus contributing to IMR and MMR
4. Low institutional deliveries that stems from the lack of trained manpower and timeliness of handling
the complicated delivery cases are the major causes of high MMR.
5. Lack of inter sectoral coordination is also one of the most important factors for high infant and
maternal deaths
C. Key Issues related to Family Welfare activities:
1. The TFR of Madhya Pradesh is significantly high compared to national average. This is mostly due
to inadequate attention on family welfare activities in the state. This has ultimately led to high
population growth in the state
2. A major chuck of the population in the state is tribal. Various awareness activities coupled with
better education in tribal dominated areas would help mitigating the problem to a large extent
3. The unmet need for family planning need to be addressed on a priority basis

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4. There is a high need for increasing awareness of the tribal population on the temporary methods of
family planning.
D. Key Issue related to maternal and child care:
1. The ANC activities in the state, especially in remote and tribal dominated areas, are extremely
poor. It is therefore necessary that appropriate policy measures are initiated to cover the all
pregnant mothers for ANC care. This would help in reducing the maternal mortality to a large extent
2. Childhood immunization plays a most important role in reducing the IMR. It is therefore necessary
that special provisions are made to increase the immunization coverage so that the majority of child
populations are completely immunized as per the government norm.
3. The institutional deliveries need to be increased in order to reduce the complications during child
birth
4. The Post Natal Care is abysmally low and need to be improved in order to reduce the
complications arising immediately after the delivery
5. The major reason for all these are the negligence of the department to carry out their activities
properly / lack of proper coordination between DoHFW and NRHM
E. Key Issues related to nutritional status:
1. Poor nutritional status of the children.
2. Low awareness of the population on the effect of appropriate nutrition on the future health of the
children and adults
3. Increasing number of stunted and wasted children
4. Lack of awareness of the population on the importance of appropriate diet during pregnancy
5. Low awareness of the reproductive age group on appropriate diet leading to low BMI and
overweight
F. Key issues related to other diseases:
1. High prevalence of diarrheal diseases and the consequent deaths
2. High prevalence of leprosy in the state due to low case detection
3. High incidence of malaria and other vector borne diseases
4. High prevalence of Tuberculosis and drug resistance
The status of some of the selected key indicators is given in Sector Review section of the report.
1.3.2 Scheme Review
Scheme review has been undertaken to identify the major schemes that are being implemented by
DoHFW for improving health status of the population. The main objective of scheme review is to
identify important schemes accounting for more than 90 per cent of the department budget.
Following observations are made through scheme review:
 Out of a total of 70 plan schemes, 8 schemes accounted for more than 90 per cent of the plan
budget.
 Out of 34 state plan schemes, 7 schemes garner more than 90 per cent of the state plan budget
 Out of the total 34 state plan schemes of DoHFW, there are 9 schemes that have zero budget
allocation in the last 4 years (Inactive schemes) and 25 schemes are active schemes.
1.3.3 Scheme Prioritization
All plan schemes of DoHFW for the financial year 2014-15 are mapped with the department’s primary
and secondary objectives.
 Plan schemes that are considered for mapping are Central Sector Schemes (CS), Centrally
Sponsored Schemes (CSS), Externally Aided Projects (EAPs) and State Plan Schemes (SPs)
 Based on scheme guidelines and nature of scheme, each scheme is mapped with the objectives
(Primary & Secondary) of the department

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o Primary objective refers to the key objective for which the scheme has been specifically
designed
o Secondary objective refers to any additional objective met by scheme (if any), other than the
primary objective
Following are the results of scheme prioritization of all state plan schemes:
 There are 16 schemes with single objective. Rest 54 schemes have multiple objectives.
 Six schemes have Human Resources for Health (HRH) as primary objective. This objective is
associated with the secondary objective such as Institutional strengthening (5 schemes) and quality
(4 schemes). Most of the schemes have more than two objectives. However, for the present report
only primary and secondary objectives are taken into consideration.
 Out of total 28 schemes associated with institutional strengthening, 3 of them have institutional
strengthening as their sole objective, 17 are combined with access and 8 with quality.
 Out of 16 schemes whose objective is prevention and control of different diseases, 6 have access
and 7 have quality as additional objectives.
1.3.4 Expenditure Review
Expenditure review has been undertaken for analyzing the past trend of expenditure based on actuals
till 2012-13, revised estimates (RE) for 2013-14 and budget estimates (BE) for 2014-15. Following are
the observations based expenditure trend analysis, for the period 2009-10 to 2014-15:
 During 2009-10 the expenditure by DoHFW was around 2.6 per cent of the total state budget.
There is a steady increase in expenditure over past 6 years.
 As per revised estimate of 2013-14 the expenditure is around 3.35 per cent of the total government
budget and as per budget estimate 2014-15 the expenditure is around 4.24 percent of the total
government expenditure.
 Expenditure on health as percentage of GSDP shows slight fluctuation during 2009-10 and
2011-12. From 2012-13 onwards the expenditure shows a consistent trend (i.e. grown from 0.69
per cent of GSDP to 1.03 percent of GSDP).
1.3.5 Trend Based Expenditure Projections
Trend based projection is the process of arriving at expenditure projections for the Medium term (3
years) on the basis of past expenditure trends of the department. For DoHFW, trend projections are
made for the period 2015-16 to 2017-18 in consultation with the finance division of DoHFW. The
assumptions and methodology for arriving at trend projections for the department is presented below.
The assumptions used for trend projections are presented below:
Assumptions
Object Heads Object description Assumptions
11 Salary, Allowances As per FRBM statement – 27.52% of 2013-14 RE for 2014-15.
Growth rate of 15 per cent for 2015-17 onwards.
12 Wages AAGR 15 per cent (As discussed with department)
14 Reward, Award Honours AAGR of 7 per cent (Equivalent to Inflation / Price Indices)
19 Salary of contractual employees AAGR of 12 per cent increase over the year 2013-14
21 TravelAllowance AAGR of 12 per cent
22 Office Expenditure AAGR of 12 per cent
23 Purchase Vehicles AAGR 7 per cent (only maintenance cost included)
24 Examination & Training 12 per cent over the previous year.
31 Payment for professional
services
12 per cent per annum
33 Maintenance Work AAGR + 7 per cent Inflation (variesdepending on AAGR)

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Object Heads Object description Assumptions
34 Materials & Supplies AAGR of 5 + 7 Percent over the period 2013-14
35 Advertisement & Broadcasting Increase by 7 percent over the previous year
41 Scholarship & Fellowship AAGR + 7 per cent Inflation
42 Grant-in-Aid AAGR for 2013-14 RE Calculated and the growth rate is used for
projection. If no growth rate is observed, the grant amount is kept
constant for the projected period.
43 Contribution Kept constant during the projection period
44 Subsidy As per the AAGR
51 Other Charges Kept constant during the projection period
53 Payment of Decree Kept constant during the projection period
63 Machines Assuming that the machine will last for 10 years, a maintenance cost
of 10 per cent of the total cost is assumed
64 Large Construction Work No specific method. If the construction was started in recent past the
same growth rate is continued for the year 2015-16 onwards. In case
the construction work was started at some earlier point of time AAGR
is taken as the base for projection.
Methodology
The methodology for arriving at trend projections for the years 2015-16 to 2017-18 is presented below:
 First, object wise projections of plan as well as non-plan expenditure are made in order to
arrive at object level estimations. The projected scheme level expenditures (by plan and non-
plan) are arrived at by summing up of the object level expenditures for each individual scheme.
 Second: The object wise expenditure trends for the past 6 years are used to arrive at
appropriate growth rates. The growth rates, thus arrived, are used for object wise projections.
The figures are then discussed with the department and the final projection estimates are
made1. The base year used for the projection is 2013-14 RE.
Trend projections for the period 2015-16 to 2017-18 based on the above methodology are presented in
Table 1. It may be pointed out that off budget schemes that existed before 2013-14 are now merged with
on budget schemes and form a part of the demand for grants presented in Assembly. The plan for the off
budget expenditure was made by the societies2.
Table 1 : Trend Projections for DoHFW (Rs. in crore)
Expenditure
RE BE Projections
2013-14 2014-15 2015-16 2016-17 2017-18
Plan 1226.66 2448.02 2834.30 3163.16 3553.69
Non-Plan 1757.26 2380.36 2604.31 2966.12 3379.89
Off budget 1508.03 0.00 0.00 0.00 0.00
Total 4491.95 4828.38 5438.61 6129.28 6933.58
Growth rate 0.07 0.13 0.13 0.13
1 It may be noted that for the projection of some of the items, the department officials were not in opinion of taking the trend growth rate as
they expected that for some of the schemes the growth rate of expenditure will be higher/lower in the future years. Therefore, instead of
taking trend growth rates we have taken the growth rate as given by finance section of DoHFW. This has been discussed and agreed during
the validation discussions.
2 The off budget funds are directly transferred to the departments through the independent societies formed by them. For the health sector
two independent societies are NRHM and MP State Aids Control Society (MPSACS). The off budget money is directly transferred to the
account of the societies formed by the departments and not channelized through the state treasury. State does not take any direct
responsibility on this fund management. At present (from the financial year 2014-15), the government has removed the concept of ‘off
budget’ and merged them with the on budget (i.e., the budget channelized through state treasury). The off budget money are now spent on
the state government schemes existing in the department. The government has also introduced some additional schemes.

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1.4 Top Down Estimation
The top down estimates for DoHFW for Financial Years 2015-16, 2016-17 and 2017-18 are arrived at
based on top down estimation methodology that is submitted separately to the finance department. The
results are presented in Table 2. As per the top down estimates the resources that are likely to be
available to the DoHFW for State Plan Schemes are Rs.341 crores, Rs.391 crores and Rs.448 crores
for the FYs 2015-16, 2016-17 and 2017-18 respectively. In case of surplus (as in the present case) the
plan funds will be allocated to the State Plan Schemes across each objective based on the application
of Scheme Prioritization Framework after making any provision for any additional matching contribution
to the CSS (if required). If the DoHFW receives a lower plan expenditure ceiling compared to its plan
requirements arrived based on their past expenditure trends, then the funds allocation would be
reduced, by allocating lesser resources to the low priority State Plan Schemes, arrived at using
Scheme Prioritization Framework.
Table 2: Top down estimates for DoHFW for FY 2015-16 (in crores)
2011-12
(A)
2012-13
(A)
2013-14
(RE)
2014-15
(BE)
Projections
2015-16 2016-17 2017-18
a. State Plan Sch. in DoHFW 279 678 265 226 341 391 448
b. CSS in DoHFW 9 16 366 1397 1537 1690 1859
c. CS in DoHFW 309 346 479 624 750 940 1179
d. EAPs in DoHFW 0 26 53 81 96 118 139
e. CFC in DoHFW 11 30 63 111 125 152 179
f. NABARD (General) 5 10 2 10 11 12 13
g. On- Budget resources
(sum of a to g) 613 1107 1227 2448 2859 3303 3818
h. Budgetary Plan Resource
Envelope for DoHFW 613 1107 1227 24483 2859 3303 3818
1.5 Reconciliation
The bottom-up estimates arrived at based on trend projections and top down estimates derived from
top down estimation methodology for DoHFW for FY 2015-16 are presented in Table 3. These
projections have been carried out assuming the department intends to continue with the current
schemes and progress at the current rate.
Table 3: Projected resource and expenditure growth of DoHFW (in Rs. Crore)
2015-16 2016-17 2017-18
I. PLAN EXPENDITURE
I. A. Top Down
Resource Envelope for DoHFW computed through top
down estimates 2859 3303 3818
I. B. Bottom Up
Trend Scenario based on the actual data and assumptions
accepted by the department 2834.30 3163.16 3553.69
Trend deficit (+)/ surplus (-) with respect to resource
envelope (-)24.7 (-)139.84 (-)264.31
II. NON PLAN EXPENDITURE 2604.31 2966.12 3379.89
It is pertinent to note that the top down ceilings are indicated to the line departments by the State
Planning Commission in consultation with Finance Department before they prepare their budget
proposals for the next year budget cycle. Therefore, if the DoHFW receives a lower plan expenditure
3 The Budgetary Plan Resource Envelope for DoHFW for FY 2014-15 includes off budget expenditure as well. From FY 2014-15 off budget
expenditure of the department is routed via treasury mode making it on-budget.

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ceiling compared to its plan requirements arrived based on their past expenditure then the funds
allocation would have to be reduced from the low priority State Plan Schemes arrived at based on the
application of Scheme Prioritization Framework.
1.6 Way Forward
In taking forward the MTEF and for institutionalization of MTEFs, the following actions are proposed:
 The bottom up resource estimates and the top down estimates will be reconciled during budget
discussions.
 Post obtaining the resource gap from top down and bottom-up estimates, the principle of
prioritization will be used to allocate resources to different schemes.

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2.Background
2.1 SPMG Project
The Government of Madhya Pradesh (GoMP) seeks to further strengthen the fiscal performance of the
State through fiscal reforms. Some of the reforms have been initiated under the Department for
International Development (DFID), United Kingdom funded Strengthening Performance Management in
Government Phase I (SPMG) project. Through the Phase II of this project, the Government intends to
bring about systemic reforms in public financial management. This is expected to assist GoMP to
effectively implement policies for higher growth and attract private investment, strengthen
accountability for effective public service delivery and respond to challenges of environment
sustainability.
GoMP has engaged Deloitte Touché Tohmatsu India Private Limited as Long Term Consultants for
strengthening Public Financial Management in Madhya Pradesh. Deloitte has commenced work on 1st
March 2013.
2.1.1 Scope of Work
Scope of work of Deloitte include tasks that are aimed at effective implementation of systemic reforms
in public financial management (PFM) and establishing Project Development Facility (PDF) in
Department of Finance (DoF) for development and operationalization of PPP (Public Private
Partnership) projects in different sectors. Various tasks under PFM include institutionalizat ion of
government wide monitoring and evaluation system, reforms aimed at enhancing tax revenue of state,
broadening MTEF usage in more departments incorporating elements of performance budgeting, value
for money audit for select departments, institutional strengthening of Directorate of Institutional Finance
(DIF) and provide program management support for SPMG II project.
2.1.2 Budget and Expenditure Management
During the Inception phase, the broad approach agreed towards preparation of MTEF has been
finalized. The overview of the approach that has been agreed for implementing MTEF is provided in the
figure below:
Based on review of the existing methodology, issues have been identified in implementing MTEF. The
identified issues along with existing methodology have been shared with all 15 departments during the
MTEF workshop held on 2nd August 2013. MTEF action plan and MTEF guideline was discussed and
agreed upon during the workshop.
Based on the agreed MTEF action plan and methodology, support is being provided during the 1st year
of the project (i.e., 2013-14) for DoHFW. In the 2nd year of the project (i.e., 2014-15), selected
departments are being provided support in implementing MTEF. During the 3rd year of the project

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(2015-16), all the 15 departments are expected to be in a position to prepare MTEF for 2015-16 on
their own with limited support from the expert team.
2.2 Medium Term Expenditure Framework
2.2.1 Introduction
Medium Term Expenditure Framework (MTEF) is a modern process of planning and budgeting that
links the objectives and expenditure of the department with the respective outputs over a medium term,
preferably for 3 years. The process entails a detailed analysis of schemes and their objectives and
linking them with appropriate outputs / outcomes, thus making the budgetary process more realistic,
accountable and transparent, and outcome based. Thus, in implicit terms, the MTEF can be called as a
process of outcome informed budgeting, which is rolled over a period of 3 years, with the current year
being the most recent budget.
2.2.2 Objectives of MTEF
Medium Term Expenditure Framework (MTEF) is defined as a budgetary framework over a medium
term (3 year) planning horizon.
The main objectives of the MTEF are:
 Create a predictable and consistent State policy and budget framework
 Departments estimate the budgetary resource required over a three-year period to achieve
explicit strategic objectives
 Foster development of budget estimates based on priorities of GoMP that are backed by
proper costing of schemes and sub-schemes i.e. at the level of outputs and activities.
 Improved budget discipline through effective financial management and accountability, so that
budget execution is consistent with budgetary appropriations.
 Develop a comprehensive, integrated budget that captures all public expenditures in an
integrated format, where investment and recurrent budgets are comprehensively covered.
2.2.3 Methodology
MTEF is a tool to enhance efficiency and effectiveness in Budget management. Adoption of MTEF is
deemed an efficient way of linking Strategic Plans and Budgets. A sound MTEF serves as a tool for
economic and financial management, accountability and also serves as a mechanism to bring in
outcome orientation in departments.
Preparation of MTEF involves the following 3 steps:
 Top Down Budgeting - Top Down Resource Estimation
 Bottom Up Budgeting - Bottom-Up Resource Estimation
 Reconciliation and Reprioritization
Top down estimation has been presented in a separate report submitted to Finance and Planning
Departments for their suggestions and approval. In the current report, bottom up budgeting as may be
applicable to DoHFW is presented in next section for arriving at resource requirement for the
department for the period 2015-16 to 2017-18.

December 2014
3.Bottom Up Budgeting
Bottom up budgeting is the process through which resource requirements of the department are arrived
at based on past trends in expenditure and attainment of objectives of the department.
This entails assessment of the sector in terms of status of key indicators to identify issues of concern,
followed by overview of department objectives and review of schemes that are currently being
implemented.
A conceptual framework is used to logically link the issues of the sector, objectives of the department
with the schemes being implemented. This process leads to identification of resource requirements,
driven by outputs to be achieved by the department. Further, over and above current interventions,
additional interventions would also be identified to address sector issues.
The sequential steps involved in arriving at bottom up estimation for DoHFW are as follows:
(i). Sector Review
(ii). Department Review
(iii). Scheme Review
(iv). Expenditure Review
(v). Trend Projection
The above steps are followed in arriving at resource requirements for DoHFW for the period 2015-16 to
2017-18, which are presented in the subsequent sections.

December 2014
3.1 Sector Overview
DoHFW of MP has as it major objective of improving status of key health parameters of the State. The
sector performance is assessed through a detailed analysis of various performance indicators over the
years. The analysis provides us an insight into the underlying reasons for the observed trends and help
in identifying the issues plaguing the health sector. A brief overview of the structure of health sector
and department in MP is provided in the next sub-section.
3.1.1 Health Status in Madhya Pradesh
Key demographic and health Indicators
Demographic characteristics of the population are key determinants of health status. This is measured
by using key indicators as given below:
(A) Demographic Indicators:
The demographic indicators related to health are: total population and its growth rate, population by
gender, population by age, life expectancy etc. The status of Madhya Pradesh in terms of the above
indicators is given below:
Growth Rate: In absolute terms the total population of India as well as Madhya Pradesh has increased
over the decades. Figure 1 shows the decadal growth rate of the population.
Figure 1: Decadal growth rate population – India and MP (1911-2011)
Figure 2 depicts the distribution of population by age. It is observed that a large portion of the
population (38.6 per cent males and 38.5 per cent females) falls within the age group 5-14, indicating
that the population is skewed towards the younger age groups. This warrants the health system to give
more emphasis on child health – as they form the basis of human capital and overall economic growth
of the state.

December 2014
Figure 2: Percentage distribution of total population of Madhya Pradesh by age groups4
Figure 3 depicts the population by sex across different age groups. It is observed that the percentage
of male population till the age group 50-54 is more compared to their female counterparts. The sex
ratio of the state during 2011 is 930 as against the national average 940.
Figure 3: Percentage distribution of population by age and sex
The population within the age group of 15-49 (i.e., reproductive age group) is the major target group as
far as the maternal and adolescent health care services are concerned. Out of total population, nearly
35 million of the total population falls under this age group. Out of 35.19 million, nearly 49 per cent are
females. This puts huge burden on the health system, as provision of health infrastructure (i.e.,
manpower and buildings) is basic responsibility of the state. Is it also observed that there is a high need
for providing pre as well as post-delivery care to this segment of the population (Figure 4)
4 As the age wise distribution of male and female population was not available, the percentage figures of 2001 census has been used

December 2014
Figure 4: Number of males and females (reproductive age group 15-49 emphasized) in Madhya Pradesh – Figures in
millions
(B) Health Indicators
Vital Health Statistics – India and MP
Among the major statistics that are used to assess the health status of population, and alternatively
reflects the performance of health sector are: Crude Death Rate (CDR), Crude birth Rate, Infant
Mortality Rate (IMR), Maternal Mortality Ratio (MMR) and Total Fertility Rate5.
(a) Crude Death Rate (CDR): Crude death rate (CDR) of males and females of India along with MP
and other comparable states is depicted in Figure 5 and Figure 6. It is evident from the figures that the
CDR for males is more than the females – thus implying higher life expectancy of females compared to
their male counterparts. The CDR for MP for males has declined from 9.2 to 9.1 per thousand during
the year from 2005 to 2011. The CDR for females has declined from 8.6 to 7.5 during the same period.
A comparison of CDR with the all India average indicates that CDR is slightly higher for MP for both the
sexes. A comparison across the states indicates that CDR is highest for Orissa compared to other
states.
Figure 5: Crude death rate (Male) - India, MP along with comparable states 2005-2011
(Source: Census, 2011)
5(a) Crude Death Rate (CDR) is number of deaths during the year divided by midyear population and multiplied by 1000
(b) Infant Mortality Rate (IMR) is the ratio of infant deaths to live births during the year multiplied by 1000
(c ) Total Fertility Rate (TFR) is the number of live births during a year per 1000 female population aged 15-49 years at the midpoint of the
same year (d) Maternal Mortality Ratio (MMR) is the number of maternal deaths in the age group 15-49 years per one 100,000 live birth.
Source: Sample Registration System (SRS) : www.censusindia.gov.in

December 2014
Figure 6: Crude death rate (Female) - India, MP along with comparable states 2005-2011
(b) Crude Birth Rate (CBR)6
Crude birth rate is another key indicator of health and linked to aspects such as provision of family
planning, child immunization at appropriate age etc. In terms of CBR, the status of the state is slightly
higher than the national average. This is mostly due to more number of births in rural as well as urban
areas Figure 7.
Figure 7: Crude Birth Rate – India and Madhya Pradesh
(Source: Census of India 2011, Annual Health Survey 2011-12)
(c) Infant mortality rate (IMR)
The infant mortality rate for Madhya Pradesh along with all India average and comparable states is
shown in Figure 8 and Figure 9. It may be highlighted that the IMR for females is much higher than
their male counterpart. Same trend is observed for the country as well as across the states. As far as
the status of the indicator is concerned, the IMR in MP for male children has come down from 72 to 57
during 2005 and 2011. For female children it has come down from 79 to 62 per 1000 live births. This is
much higher than the national average during the same period.
A comparison across the states indicates that Orissa has the highest infant mortality followed by
Madhya Pradesh and Rajasthan. The status is slightly better for Chhattisgarh and Jharkhand which
were the part of Madhya Pradesh and Bihar during the earlier part of this decade. This is exceptionally
a serious issue and needs urgent intervention
6 CBR = (N / TP) x 1000 where N represents the number of births in a specific time period, and TP is the total population during this period-
usually a year.
24.8
26.4
19.8
25.0
27.3
20.4
0.0
20.0
40.0
Total Rural Urban
Crude birth rate - India and MP
India MP

December 2014
Figure 8: Infant mortality rate (male) - India, MP along with comparable states 2005-2011
Figure 9: Infant mortality rate (female) - India, MP along with comparable states 2005-2011
(Source: NSSO, Census, 2011)
(d) Maternal Mortality Ratio (MMR)
The MMR for MP along with all India average and comparable states is depicted in Figure 10. It may
be noted that the MMR is much higher in MP compared to national average. At the national level, the
MMR has declined from 398 per 100,000 live births during 2005 to 212 during 2011. In MP the MMR
appears to be high. As the figures indicate, it has fallen from 441 in 2005 to 269 during 2011. Though
the rate of decline is higher than the national average, in absolute terms the figure is much higher.
Orissa, Bihar and Rajasthan have brought down their MMR substantially during the same period.
Figure 10: Maternal Mortality Ratio (MMR) - India, MP along with comparable states 1997-98 to 2007-09
398
441
346
531
508
327
407
424
400
501
301
379
358
371
445
254
335
303
312
388
212
269
258
261
318
0
100
200
300
400
500
600
India Madhya Pradesh Orissa Bihar Rajasthan
1997-98 1999-01 2001-03 2004-06 2007-09
(
Source: Census, 2011)

December 2014
(C)Family Welfare Indicators
(e)Total Fertility Rate (TFR)7: The TFR of Madhya Pradesh along with all India average and
comparable states is shown in Figure 11.
Figure 11: Total Fertility Rate (TFR) - India, MP along with comparable states 2005-2011
(Source: Census 2011)
It is observed that the TFR in MP is substantially higher compared to national average and other
comparable states (Orissa, and Jharkhand). The TFR for Bihar is highest followed by Rajasthan,
Madhya Pradesh, Jharkhand and Chhattisgarh. Orissa has the lowest TFR. The TFR of India has
declined from 2.9 to 2.4 per women, whereas, the TFR for MP has declined from 3.6 to 3.1, thus
indicating at least 3-4 children per women during their reproductive age. High TFR is the major reason
for growth of population in India.
(f) Status of Family Planning
Following few sections of the report is heavily dependent on the data from National Family Health
Survey (NFHS-1, 1992-93), NFHS-2 (1998-99) and NFHS-3 (2005-2006). It is observed that the major
contributing factor to high TFR is the lack of use of modern family planning methods. This is evident
from Figure 12 and Figure 13.
Figure 12: Status of Family Planning (currently married women, age 15–49) in India (%) – NFHS1, 2 and 3
40.7
48.2
56.3
36.5
42.8
48.5
27.4
34.1
37.3
3.5
1.9
1.0
1.9
1.6
1.7
1.2
2.1
3.1
2.4
3.1
5.2
0
20
40
60
NFHS1 NFHS2 NFHS3
Any method (%) Any modern method (%) a. Female sterilization (%)
b. Male sterilization (%) c. IUD (%) d. Pill (%)
e. Condom (%)
7 Total Fertility Rate may be defined as average number of children that would be born to a woman if she experiences the
current fertility pattern throughout her reproductive span (15-49 years). The total fertility rate is a more direct measure of the
level of fertility than the birth rate, since it refers to births per woman. This indicator shows the potential for population change in
a country. A TFR of 2.1 i.e., two children per women is considered the replacement rate for a population, resulting in relative
stability in terms of total population numbers. Rates above two children per woman indicate population growing in size and
whose median age is declining. Rates below two children per woman indicate population decreasing in size and growing older.

December 2014
Figure 13: Status of Family Planning (currently married women, age 15–49) in MP (%) – NFHS1, 2 and 3
As far as family planning is concerned, for all India, the percentage of eligible couples using any family
planning method has increased from 40.7 per cent to 56.3 per cent during the reference period.
Madhya Pradesh also has shown similar progress as far as overall figure is concerned. Therefore the
percentage of eligible couples using any modern method of family planning is well comparable with the
national average.
(D) Indicators on Maternal Health
(i) Maternal Health – ANC care
The status of Ante Natal Care (ANC -care during the pregnancy) is presented in Figure 14 and Figure
15. During NFHS-1 data on ANC for MP is not available for the state. Therefore, we have made a
comparison based on the data obtained from NFHS-2 and 3 only. Only 27.1 per cent of the pregnant
mothers in MP had 3 ANC visits (complete ANC checkup) during 1998-99. There is substantial
improvement in ANC care (44.2 per cent) during 2005-06 (NFHS-3).
These figures are substantially lower compared to national average (Figure 14). Similar observation is
made when we compare the state figures with national average. As far as the consumption of IFA
tablets, births attended by trained personnel, institutional delivery and Post Natal Care (PNC)
concerned there is substantial improvement in the status of the state. However, the figures are not
comparable with national figures.
Figure 14: Maternity care for the deliveries (for births within last 3 years of survey) % - India

December 2014
Figure 15: Maternity care for the deliveries (for births within last 3 years of survey) % - MP
(E) Indicators on Child Health
(i) Immunization and Vitamin-A supplementation
In so far as the health status of children is concerned the status of Madhya Pradesh lags behind in
several aspects. Out of total children only 22.6 per cent of the children within age group of 12-23
months were fully immunized in the state as against the national average of 42 per cent (NFHS-2). As
per NFHS-3, the situation is substantially improved but still lies below the national average of 43.5 per
cent (Figure 16 and Figure 17).
During NFHS-2 the children between 12-23 months who received BCG vaccination is around 62 per
cent, received 3 polio doses is around 57 percent, received 3 DPT doses is around 36 per cent and
received measles vaccine is around 34 per cent. These figures lie much below the national average
which is around 72 per cent for BCG, 63 per cent for polio, 55 per cent for DPT and 51 per cent for
measles respectively.
Figure 16: Status of child immunization (%) – All India

December 2014
Figure 17: Status of child immunization (%) – Madhya Pradesh
As per NFHS-3 results there seems to be substantial improvement in number of children who received
various vaccinations (BCG, Polio, DPT and Measles). These numbers are substantially below the
national average.
No doubt, substantial improvements are being made to increase the coverage of fully immunized
children. The figures still lie below the national average (Source: NFHS 1, 2 and 3; Annual Health
Survey 2011-12)
(F) Issues related Nutritional Status
(i) Child Feeding Practices and Nutritional status
As per the norm prescribed by the Government of India every newborn child should be breast fed
within 1 hour of their birth. As far as such practice is concerned the status of MP appears to be poor
compared to national average (Source: NFHS-2 and 3). Similarly, exclusive breast feeding till 5th month
and practice of breast feeding along with semi solid or solid food is comparatively lower for the state
compared to national average.
As a result, the percentage of stunted8 and wasted9 and underweight (<3 years) children has remained
as high as 46.5, 39.5 and 57.9 per cent respectively (Figure 18).
8 Stunted: Low height for age. This is caused by long-term insufficient nutrient intake and frequent infections. Stunting generally occurs
before age two, and effects are largely irreversible. These include delayed motor development, impaired cognitive function and poor school
performance
9 Wasted: Low weight for height. This is a strong predictor of mortality among children under five. It is usually the result of acute significant
food shortage and/or disease.

December 2014
Figure 18: Child feeding practices and nutritional status of children below 3 years (%) – India and MP
The nutritional status of the women and men within the reproductive age group is usually measured by
Body Mass Index (BMI10) and Overweight. As per NFHS-2, in MP the percentage of women with
<normal BMI are around 35.2 per cent as against the national average of 32.2 per cent.
As per NFHS 3, in MP the women with less than normal BMI is around 40 percent and men with less
than normal BMI is around 37 per cent. The figures are still higher than the national average Figure 19.
Figure 19: Nutritional status of men and women within reproductive age (15-49) – India and MP
0
32.2
33.0
0
0
28.1
0
10.6
14.8
0
0.0
12.1
0
5
10
15
20
25
30
35
NFHS1 NFHS2 NFHS3
India
Women with < normal BMI
Men with < normal BMI
Women with overweight
Men with overweight
(G) Status of other diseases
10 Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women. The formula for
calculation of BMI = (Weight in Kilograms/ (Height in meters)2
BMI below 18.5 – Underweight, BMI from 18.5 - 24.9 Normal Weight, BMI from 25 - 29.9 Overweight, BMI from 30 - 34.9 Obese, BMI from
35 - 38.9 Very Obese, BMI 39 and above Morbidly Obese
0
35.2
40.1
0
0
36.3
0
6.8
8.6
0
0.0
5.4
0
10
20
30
40
50
NFHS1 NFHS2 NFHS3
MP
Women with < normal BMI
Men with < normal BMI
Women with overweight
Men with overweight
9.5
16.0
23.4
0
0
46.3
0
0.0
55.8
0
51.0
44.9
0
19.7
22.9
51.5
42.7
40.4
0
20
40
60
NFHS1 NFHS2 NFHS3
India
<3 years breast fed within one hour of
birth
0-5 months exclusively breast fed
6-9 months with breast milk and semi
solid food
< 3 years stunted
0
8.9
14.9
0
0
21.6
0
0.0
51.9
0
55.1
46.5
0
25.2
39.5
0.0
50.8
57.9
0
10
20
30
40
50
60
70
NFHS1 NFHS2 NFHS3
MP
<3 years breast fed within one hour of birth
0-5 months exclusively breast fed
6-9 months with breast milk and semi solid
food
< 3 years stunted

December 2014
(i) Diarrhea
Table 4: Number of Diarrheal cases and deaths during 2010-11
Number of Cases and Deaths Due to Acute Diarrheal Diseases in Madhya Pradesh 2010-2011
State
Male Female Total Reference
PeriodCases Deaths Cases Deaths Cases Deaths
MP 153655 56 137050 36 290705 92 Dec.’11
India 5300955 731 4930094 538 10231049 1269
Source: Indiastat.com
Table 4 gives the details of the identified diarrheal cases and deaths during 2010-11. Out of total 1269
deaths due to diarrheal diseases in India, MP contributed around 7.2 per cent to it. This appears to be
to be markedly higher. This may be due to bad hygienic conditions and inadequate attention of the
health authorities during the outbreak of the disease and the preparedness of the health authorities to
tackle the condition in time.
(ii) Cataract
Table 5 gives the achievement of the state in identification and successful operation of cataract cases
in the state as well as the country. During 2007-08 out of 3.5 lacks identified cataract cases, 92.23 per
cent of the cases were successfully operated. Similarly out of 3.8 and 4.1 lakh cases who were
identified during 2008-09 and 2009-10, 83.6 and 90.8 per cent of the cases were successfully
operated. The achievement of Madhya Pradesh is lower than the national average.
Table 5: Identified Cataract cases and achievements 2007-08 to 2009-10
2007-08 2008-09 2009-10
Target Achievement
%
Achieve Target Achievement
%
Achieve Target Achievement
%
Achieve
MP 350000 322822 92.23 450000 376143 83.59 450000 408518 90.78
India 5000000 5404406 108.09 6000000 5810336 96.84 6000000 5906016 98.43
(Source: Indiastat.com)
(iii) Leprosy
Table 6 depicts the number of new leprosy cases detected, treated and under treatment for the year
2010-11. As could be observed from the table, out of total population of 72.6 million, a total of 5708
cases were newly detected. A total of 5631 cases completed their treatment and 4391 cases are on the
record and undergoing the treatment for the disease. This gives a prevalence of 0.6 cases per 10,000
people which is slightly lower than the national average of 0.69 per 10,000 persons.
Table 6: Case detection and treatment of Leprosy cases in MP 2010-11
State Provisional Total New
Cases
Cases
Discharged
Cases on
Record
Prevalence Rate /
10,000
Population
(Census 2011)
Detected as Cured Under
Treatment
Rate/10,000
MP 72597565 5708 5631 4391 0.6
India 1210193422 126800 132105 83041 0.69
(iv) Malaria
As can be seen from Table 7, during 2011-12 and 2012-13 (figures are up to December 2012) the total
number of malaria cases detected works out to be 91,851 and 45,200. The deaths due to malaria were
71, which is nearly 0.07 per cent of the total deaths due to malaria during 2011. A comparison with the
national figures indicates that only 0.03 per cent of the malaria cases were died during the same
period. The status of MP is extremely poor in this case.
Table 7: Status of Malaria in MP
Number of Malaria Cases and Deaths in Madhya Pradesh (2011 and 2012)
State 2011 2012*

December 2014
Cases Death Cases
Madhya Pradesh 91851 71 45200
India 1310656 430 736875
(v) Tuberculosis
Table 8 depicts the scenario of Tuberculosis cases in the state. As could be seen from the table, during
2008, out of total registered TB cases in India, 5.4 per cent of them were from Madhya Pradesh.
Similarly during 2009 and 2010, out of total registered TB cases in the country, 5.4 and 5.7 per cent
were from Madhya Pradesh. This indicates high prevalence of TB in the state.
Table 8: Case detection and Treatment success rate of TB cases
State 2008 2009 2010
No. of
Patients
Registered
No. of
Patients
Treated
TSR No. of
Patients
Registered
No. of
Patients
Treated
TSR No. of
Patients
Registered
No. of
Patients
Treated
TSR
MP 80929 67866 84% 83276 70921 85% 87823 75864 86%
India 1517333 1299296 86% 1533309 1320387 86% 1522147 1310324 86%
(TSR: Treatment success rate, Source: Indiastat.com)
(G) Health Infrastructure:
Table 9: Health Infrastructure in MP
Type of hospital Sanctioned
bed
(general)
Sanctioned
Bed (SCP)
Sanctioned Bed
(TSP)
Total
Beds
Total Hospitals / Health care
Delivery centres*
District Hospital 6100 (21) 4900 (18) 2400 (11) 13400 50
Civil Hospitals 1649 (25) 1622 (30) 260 (3) 3631 58
CHCs 9960 332
PHCs 6936 1156
SCs 284 8765
Civil Dispensary (U) 92
Urban FW Centre 96
Urban Health Centre
(HP)
83
TB Hospital 07
TB Sanitarium 02
Chest Centre 01
Poly Clinic 06
Regional Diagnostic
Centers
11
Trauma Centre 07
34211 10666
* Excludes the tertiary level health care institutions and medical college hospitals and institutions related to them.
(December 2013)
Table 9 shows the status of the MP in terms of health infrastructure. As table indicates, there are nearly
10,666 health care institutions in the state and total beds available at various levels (excluding tertiary
and medical colleges) are 34211. The bed population ratio works out to be 1:2122 as against all India
average of 9 beds per 10,000 populations, which is abysmally lower than the national average.
(H) Human Resources for Health
Table 10: Human Resources for Health – December 2013
Type Type of appointment Sanctioned Working Vacancies
Specialists Regular 3057 1251 1916
Medical officer Regular 4265 2789 1476

December 2014
Type Type of appointment Sanctioned Working Vacancies
RCH (PG) 108
RCH (MBBS) 326
Total Doctors 7322 4474 3392
(Source: Annual Administrative Report, 2013)
The information about the number of allopathic doctors presently working in the state is given in Table
10. It is observed that against the total sanctioned posts only 61 per cent of the posts are filled and
rest of them are vacant. The doctor population ratio (allopathic doctors) works out to be 1:16227 which
is lower than the national average of 1:13531
3.1.2 Summary of the Issues related to Health Sector
A. Demographic Issues:
1. In absolute terms, the population of the state is growing at a faster rate. The decadal growth rate of
the population in MP is higher than the all India average.
2. Larger segment of the population are people within the age group of 15-49 years followed by the
population within the age group of 0-14. Therefore, adequate provision needs to be made for them
in order to address the health and other related issues of these groups.
3. The life expectancy is low in the state as a whole. The life expectancy of females is more
compared to males. This needs more attention on chronic diseases and geriatric care
4. A large proportion of populations are adults. Therefore there is a need for expanding the
awareness generation activities, especially related to sexual and reproductive health in order to
prevent them from various sexual infectious diseases.
B. Key Issues related to CBR, CDR, IMR and MMR:
1. Desire to have more children due to high infant mortality, and low coverage of family planning
services are two major factors responsible for high birth rate in the state.
2. The CDR of Madhya Pradesh is relatively high compared to national average. This is mostly due to
lack of quality of care and appropriate infrastructure in the government health care facilities.
3. Lack of proper attention to provide ANC, PNC and immunization services are the key factors that
contribute to higher Infant deaths, thus contributing to IMR and MMR
4. Low institutional deliveries that stems from the lack of trained manpower and timeliness of handling
the complicated delivery cases are the major causes of high MMR.
5. Lack of inter sectoral coordination is also one of the most important factors for high infant and
maternal deaths
C. Key Issues related to Family Welfare activities:
1. The TFR of Madhya Pradesh is significantly high compared to national average. This is mostly due
to inadequate attention on family welfare activities in the state. This has ultimately led to high
population growth in the state
2. A major chuck of the population in the state is tribal. Various awareness activities coupled with
better education in tribal dominated areas would help mitigating the problem to a large extent
3. The unmet need for family planning need to be addressed on a priority basis
4. There is a high need for increasing awareness of the tribal population on the temporary methods of
family planning.
D. Key Issue related to maternal and child care:
1. The ANC activities in the state, especially in remote and tribal dominated areas, are extremely
poor. It is therefore necessary that appropriate policy measures are initiated to cover the all
pregnant mothers for ANC care. This would help in reducing the maternal mortality to a large extent
2. Childhood immunization plays a most important role in reducing the IMR. It is therefore necessary
that special provisions are made to increase the immunization coverage so that the majority of child
populations are completely immunized as per the government norm.
3. The institutional deliveries need to be increased in order to reduce the complications during child
birth

December 2014
4. The Post Natal Care is abysmally low and need to be improved in order to reduce the
complications arising immediately after the delivery
5. The major reason for all these are the negligence of the department to carry out their activities
properly / lack of proper coordination between DoHFW and NRHM
E. Key Issues related to nutritional status:
1. Poor nutritional status of the children.
2. Low awareness of the population on the effect of appropriate nutrition on the future health of the
children and adults
3. Increasing number of stunted and wasted children
4. Lack of awareness of the population on the importance of appropriate diet during pregnancy
5. Low awareness of the reproductive age group on appropriate diet leading to low BMI and
overweight
F. Key issues related to other diseases:
1. High prevalence of diarrheal diseases and the consequent deaths
2. High prevalence of leprosy in the state due to low case detection
3. High incidence of malaria and other vector borne diseases
4. High prevalence of Tuberculosis and drug resistance

December 2014
3.2 Department Review
3.2.1 Structure of Health Department in MP
The Health Department consists of several Directorates. Apart from DoHFW there are other
directorates: Directorate of Medical Education (DME), Directorate of Ayush, National Rural Health
Mission (NRHM), Madhya Pradesh State Aids Control Society (MPSACS), and Directorate of Food and
Drug Control.
The Principal Secretary is assisted by Secretaries / Commissioners, who are responsible for each of
these Directorates/Societies. As the present document deals with the Department of Health and Family
Welfare only, the structure of the department is presented in detail. The commissioner of health is
responsible for overall management of DoHFW. He is assisted by 5 Directors. At present the
nomenclature of the Directors depend on the responsibility bestowed on them. The Director of Health
Services is directly responsible for the health care delivery activities by DoHFW at the state level.
He/she is assisted by several officials. The health care activities at the district level are looked after by
Chief District Medical officers of respective districts. They are directly responsible for the
implementation of health programs at the district level. At the block level there are Community Health
Centers (CHC) and Primary Health Centers (PHC) are the lowest level health care institutions of the
public sector. Below PHCs, there are Sub Centers (SCs) which serves 7-10 villages at the grass root
level. Block Medical officers and Medical officers are directly responsible for the health care delivery at
the CHC and PHC level. The SCs are managed by health workers.
Apart from the above, the health care in the state is also managed by other line departments:
Department of Labor, Public relations Department, Department of Tribal welfare (TSP), Department of
Women and Child Development etc. A detailed list of all the departments and the demand numbers
through which the budget is allocated is presented in subsequent sections of the report.
The organogram of DoHFW as well as NRHM is presented in Figure 20 and Figure 21.

MTEF for School Education Department - 2014-15
December 2014
Figure 20: Structure of DoHFW in Madhya Pradesh

December 2014
Figure 21: Structure of National Rural Health Mission (NRHM) in Madhya Pradesh
3.2.2 Objectives of the Department
In this section we make a detailed review of the Department of Health and Family Welfare (DoHFW) in
order to get inputs that would help understand the roles and responsibilities of the department. This
would help us to bring a link concerning the objectives of DoHFW with the overall objective of the
health sector. It may be recalled that the health sector consists of several directorates and societies
and each of them have their own roles and responsibilities. In this report we focus on the roles and
responsibilities of DoHFW. Based on the mandate of the department and consultations with the
department officials, following six objectives (not in order of priority) are identified as the key objectives
of DoHFW presented in Table 11 below:
Table 11: Objectives of the Department
Sr. no
Objectives of the
Department
Description
1 Access
• Access has been taken as the secondary objective for most of the schemes. All the
schemes that aim at increasing the access to the health services are included within
this. As Institutional strengthening aims at increasing access to health care, both the
objectives goes together.
• Services such as emergency ambulance services, mobile health clinic etc.
• Additional sub health centers,
2 Awareness Generation
• Information Education and Communication (IEC) activities related to different health
programs: i.e., disease control programs and family welfare programs etc.
• Teenager reproductive health programs, information and broadcasting
3
Human Resources for
Health (HRH)
• The main objective is to fill up existing posts, creation of new posts of
specialists/doctors and other supportive staff necessary to provide the health care
and manage the existing infrastructure. Moreover this also includes timely release of
the salaries and other allowances to the regular staff recruited by DoHFW.
4
Institutional
Strengthening
• Strengthening and maintenance of physical infrastructure at state, district, block
levels and below. This is done through the construction / renovation / expansion / up-
gradation of the existing physical infrastructure on behalf of the DoHFW as well as

December 2014
Sr. no
Objectives of the
Department
Description
management of the same.
• This also includes administrative/ governance reforms, modernization of hospitals,
monitoring and evaluation etc.
5 Prevention and control
• National Health Programs: Control of communicable and non-communicable diseases
• Immunization activities for the children and pregnant mothers
• Old age health care program
• Prevention of adulteration of foods and drugs
• Programs related to iodine deficiency, HIV, Anemia etc.
6 Quality
• Drug Control, Establishment of radiation safety unit
• The secondary objective for most of the schemes with Institutional strengthening and
HRH as primary objective.

December 2014
3.3 Scheme Review
3.3.1 Introduction
In order to meet the objectives of the department, DoHFW has been implementing several schemes.
There are a total of 102 schemes implemented by the department. The schemes are classified into two
categories – plan schemes and non-plan schemes. However, there are certain schemes which are
funded by multiple sources which have both ‘plan’ and ‘non-plan’ component. The expenditure under
the non-plan schemes is usually non-negotiable as it involves salaries and wages which are usually
increased every year as per the rules laid in FRBM. The planned schemes are sourced from different
agencies: Centrally Sponsored Schemes (CSS), Externally Aided Projects (EAP) and Centrally Funded
Schemes (CP) and State Plan Schemes (SP). Scheme review involves the analysis of important
schemes that are currently being implemented by DoHFW and account for 90 percent or more of the
plan expenditure.
3.3.2 Scheme Analysis
A detailed analysis of the plan schemes with specific emphasis on state plan schemes that are being
implemented by DoHFW is being undertaken to identify those that account for the major proportion (90
per cent or more) of total plan budget in general and the state plan budget in particular.. The analysis is
used to examine the possibility of prioritization and preparation of the scheme prioritization matrix.
Plan Schemes and Expenditure (Total plan)
In this section we have analyzed all plan schemes. The analysis would help in prioritizing the plan
schemes. The scheme analysis has been undertaken through following approach:
i. Sorting all the planned schemes that are being implemented by the department in descending
order on the basis of expenditure incurred under the schemes during the most recent year i.e.,
2014-15 BE.
ii. Detailed analysis of schemes that account for 90 percent or more of plan expenditure
iii. Separate the state plan schemes from total plan schemes and follow the similar procedure as
described above
It may be noted that for the initial analysis of all the planned schemes, the following sources of fund are
considered:
(a) Foreign Assisted Projects ( For general / ST and SC population)
(b) Funds from Central Finance Commission (For general / ST and SC population)
(c) Funds from NABARD (For general / ST and SC population)
(d) State Plan Funds (For general / ST and SC population)
(e) Centrally Sponsored Schemes (For general / ST and SC population)
(f) Central Plan Funds (For general / ST and SC population)
As could be observed from Annexure 1, only 8 schemes account for 92.2 per cent of the entire planned
budget out of a total of 70 planned schemes. The name of the schemes along with their respective
shares in the total budget is presented in Figure 22 below.

December 2014
Figure 22: Name and percentage distribution of the plan schemes consuming more than 90 per-cent of the plan budget
Following inferences could be made from the above figure.
1. National Rural Health Mission (NRHM) accounts for more than half of the plan budget. This
indicates the emphasis of the government on rural health care. When we link the sources of
funding with the expenditure, it is observed that the major source of funding is Government of India
and a small portion of state’s share towards the program.
2. Nearly one fourth of the sub centers in the state are operated from rented houses or buildings that
are extremely poor. Therefore the government’s second priority is renovation of existing sub
centers and construction of modernized sub centers that can handle complicated deliveries and
provide appropriate maternal and child health care and immunization services.
3. Excessive load on the existing infrastructure is one of the key features of the public hospitals of the
state – leading to high bed occupancy and turnover. This affects the quality of care to a large
extent. In order to maintain an acceptable quality standard in the government hospitals, attempts
are in the process to renovate/expand the existing infrastructure and modernize them to fulfill the
increasing needs.
4. Part of the plan expenditure is intended to meet the recurrent expenses such as salaries and
wages. These are basically expenses which are non-plan in nature.
Plan Schemes and Expenditure (State Plan)
State plan expenditures are the expenses that are exclusively met by the state and are under the
control of the state authorities. State can make appropriations and re-appropriation of this fund. As
could be observed from Annexure 2, out of 34 state plan schemes 7 schemes consume more than 90
per cent of the state plan budget. This is depicted in Figure 23. Out of the total budget allocated under
state plan 44.34 per cent of the total amount is allocated for elevation / up gradation of the existing
hospitals. As is evident from the figure, more than 90 per cent of the state plan expenditure is devoted
for construction / renovation / modernization of the hospitals / health centers. Details of expenditure
made from the state plan budget are presented in Annexure 2.

December 2014
Figure 23: Name and percentage distribution of the state plan schemes consuming 93.4 per cent of the state plan budget
Following conclusions could be drawn from the plan expenditure and schemes given in Figure 23:
1. A chunk of the expenditure is devoted towards the elevation / up-gradation of the major
hospitals located at district or major cities of the state.
2. Attempts are also in the progress to construct new PHC/CHC/SCs. This gives an indication
that the current emphasis of the government is mostly on the access of the population for the
health facilities.
3. It is also observed that modernization of the existing health facilities is also another focused
area of the department. This would help the rural people to avail the modern facilities at their
respective areas.
4. More than 90 per cent of the state plan funds are on the activities that are capital intensive.
As mentioned above there are more than 85 per cent of the plan schemes which can be rationalized.
Thus, there is a huge scope for rationalization of schemes by merging the schemes aiming at similar
objectives. For example, the major objective of bulk of the schemes is to reduce maternal and infant
mortality. The schemes aiming at similar objectives can be merged together in order to reduce the
number of schemes. There is also possibility of grouping the schemes that account for 10 per cent of
the plan budget but many in number. This would help the state government to minimize the number of
schemes and ease the process of linking scheme objectives with their respective outputs.
Thus, the two possible ways suggested for streamlining the bottom 10 percent and top 90 percent of
plan expenditure is:
 Convergence – Merging up of the schemes with similar objectives that come under top 90 per
cent of plan expenditure
 Grouping - within schemes in bottom 10 per cent of plan expenditure
However, the limiting factor in this exercise is that the state does not have much leverage on the
schemes that are implemented through NRHM as it acts as an independent society. It is hoped that the

December 2014
removal of off budget schemes by the government might bring some changes in the management of
funds. Therefore, rationalization among the State Plan (SP) schemes could be explored. The finance
department along with the DoHFW has a major role to play in this decision making process.
3.3.3 Mapping of schemes with objectives
All the planned schemes are mapped with the 6 objectives of the department mentioned in previous
section. For the purpose of mapping following exercise were carried out:
1. The scheme guidelines and their details are reviewed on the basis of the documents of
Government of India and state government. Further, detailed discussions where held with the
finance section officials of DoHFW and NRHM.
2. It was observed that there are several schemes aiming at multiple objectives of the
department. Keeping in view of the limitations of our methodology, maximum of two objectives
per scheme have been taken into consideration. This is presented in Annexure 3.
3. The objectives are mapped with the schemes on the basis of priority. (Most important objective
is taken first, followed by the next and so on.)
3.3.4 Scheme Prioritization Matrix
A separate note on the methodology followed for the preparation of scheme prioritization matrix have
already been submitted to the Directorate of Institutional Finance and a workshop on this topic was
conducted on 23rd May 2014 in the presence of the department officials. In brief, a scheme prioritization
matrix is a matrix of the objectives of the department mapped with schemes. A schematic presentation
of the process is presented below:

December 2014
3.4 Scheme Prioritization
3.4.1 Introduction
As mentioned in the previous section, there are 70 plan schemes and 6 objectives of DoHFW. Based
on the departmental objectives, the scheme prioritization matrix is prepared. First all the plan schemes
are enlisted and mapped with the objectives. All the state plan schemes are segregated and are taken
up for prioritization. As a next step, the schemes are further segregated into active and inactive
schemes (inactive schemes are those schemes which have no allocation of funds since past 4 years).
The details are given in sub sequent sections.
3.4.2 Mapping of the existing schemes with objectives of the
department
All plan schemes for the financial year of DoHFW are mapped with the department’s primary and
secondary objectives.
 Plan schemes that are considered for mapping are Central Sector Schemes (CS), Centrally
Sponsored Schemes (CSS), Externally Aided Projects (EAPs) and State Plan Schemes (SPs)
 Based on scheme guidelines and nature of scheme, each scheme is mapped with the objectives
(Primary & Secondary) of the department
o Primary objective refers to the key objective for which the scheme has been specifically
designed
o Secondary objective refers to any additional objective met by scheme (if any), other than the
primary objective
Please refer to Annexure 3 for details.
As is evident from the Annexure 3, there are currently 70 plan schemes in DoHFW (2014-15). A
summary of mapping of all these plan schemes with the corresponding primary and secondary
objectives that they aim at is provided in Table 12.
Table 12: Scheme prioritization summary - all plan schemes of DoHFW
Primary
Objective
Secondary Objective Only
primary
objective
Tota
l(Number of Schemes)
Access Awarenes
s
Generatio
n
HRH Institutional
Strengthenin
g
Prevention
and Control
Quality
Access 1 2 2 5
Awareness
Generation
1 2 3
HRH 5 4 6 15
Institutional
Strengthening
17 8 3 28
Prevention and
control
6 1 7 2 16
Quality 2 1 3
Grand Total 23 0 0 10 0 21 16 70
A summary of the mapping of the schemes with their corresponding objectives suggests the following:
 There are 16 schemes with single objectives. Rest 54 schemes have some or other objective
combined with them.

December 2014
 Six schemes have HRH as primary objective. This objective is associated with the secondary
objectives such as Institutional strengthening for 5 schemes and quality in 4 schemes. Most of the
schemes have more than two objectives. However, for the present report only primary and
secondary objectives are taken into consideration.
 Out of total 28 schemes associated with institutional strengthening, 3 of them have institutional
strengthening as the sole objective, 17 are combined with access and 8 with quality.
 Out of 16 schemes whose objective is prevention and control of different diseases, 6 are combined
with access and 7 with quality.
3.4.3 Segregation of schemes based on Source of Funds (SoFs)
All the plan schemes mapped to the corresponding primary and secondary objectives in the previous
step are further segregated on the basis of their source of funds, i.e., CS, CSS, EAP, SP and others.
It is observed that out of the total 70 plan schemes of DoHFW, 34 plan schemes are exclusively funded
by the State. A summary of mapping of all these 34 state plan schemes of DoHFW along with the
corresponding primary and secondary objectives is provided in Table 13 below:
Table 13: Scheme prioritization summary - all state plan schemes of DoHFW
Primary
Objective
Secondary Objective Only
primary
objective
Total
(Number of Schemes)
Access Awareness
Generation
HRH Institutional
Strengthening
Prevention
and Control
Quality
Access 1 1 2 4
Awareness
Generation
1 1
HRH 3 3 1 7
Institutional
Strengthening
7 5 3 15
Prevention and
control
4 4
Quality 2 1 3
Grand Total 7 0 0 6 0 13 8 34
It is evident from Table 13 that the emphasis of the state plan is mostly been on Strengthening of
Health Infrastructure - which helps in meeting the key objective of the DoHFW. Provision of adequate
manpower, especially in rural in-accessible places, appears to be the next priority of the state plan
schemes as 7 of them aim at this objective. The details of the mapping of schemes are as follows:
 Out of total 34 schemes 8 schemes have only primary objectives and rest of them are associated
with some or other objective as given in the table.
 Three schemes have Institutional Strengthening and 2 schemes have access as their sole
objectives. No secondary objective is associated with these 5 schemes. This implies that provision
of adequate infrastructure, especially at the grass root levels is one of the key objectives of state
plan schemes.
 Among other objectives, HRH, prevention and control of diseases and access appear to be in the
priority areas of DoHFW.

December 2014
3.4.4 Segregation of schemes based on zero & non-zero budget
allocation (active schemes)
All the state plan schemes identified in the previous step have then been segregated into zero & non-
zero budget allocation
All state plan schemes are segregated into two categories. These are:
 Category 1 (Inactive Schemes) – Schemes with zero budget allocation in the last 4 years
 Category 2 (Active Schemes) – All schemes other than those in Category 1
Schemes only in Category 2 are considered for prioritization exercise.
It can be observed from Table 14 that out of the total 34 state plan schemes of DoHFW, there are 9
schemes that have zero budget allocation in the last 4 years (Inactive schemes) and 25 schemes are
active schemes. A summary of mapping of all these 25 active state plan schemes of DOHFW with the
corresponding primary and secondary objectives is provided in Table 14.
Table 14: Scheme prioritization summary - all active schemes of DOHFW
Primary Objective Secondary Objective Only
primary
objectiv
e
Tota
l(Number of Schemes)
Access Awarenes
s
Generatio
n
HRH Institutional
Strengthenin
g
Preventio
n and
Control
Quality
Access 1 2 3
Awareness Generation 0
HRH 2 2 1 5
Institutional
Strengthening
6 3 2 11
Prevention and control 3 3
Quality 2 1 3
Grand Total 6 0 0 5 0 8 6 25
As mentioned above the emphasis of the state plan schemes has mostly been on building of basic
health infrastructure, strengthening of existing hospitals and dispensaries i.e., their renovation and new
constructions. As mentioned in Sector Review, there are nearly 50 per cent of the posts lying vacant in
the state. The results of scheme mapping and prioritization matrix indicate the same, with 5 live state
plan schemes giving adequate attention on HRH. Objectives of access, quality and prevention of
communicable and non-communicable diseases appear to get the same weightage as each of these
objectives has 3 schemes each.
3.4.5 Grouping of schemes based on primary objective
This needs to be done by the department during the budget discussion.
Plan schemes that have a common primary objective have to be clubbed together into a group in order
to enable the department to carry out prioritization exercise between schemes within each group.
This prioritization of objectives is expected to guide allocation of additional resources available annually
and further serve as a bridge between Five Year Plan & annual budgeting exercise and will lead to:
 Strengthen existing schemes and
 Help in planning new interventions

December 2014
3.4.6 Segregation for each group based on Source of Funds (SoFs)
Schemes within each group are segregated on the basis of source of funds.
 Central Sector Schemes
 Centrally Sponsored Schemes
 Externally Aided Program / Schemes
 State Plan Schemes
 Others
Since, State Government does not have much leverage in GoI schemes (CSS/ CS) and makes
provisions for the same on priority basis, only State Plan schemes are considered for the prioritization
exercise.
3.4.7 Prioritisation for each group based on SoFs
This will be done after consultation with the department.
 First priority is to be given to high priority State Plan Schemes (as mentioned in Five Year Plan
document, Annual Plan)
 Second priority is to be given to schemes catering to more than one objectives
 Within this, top priority is to be given to those schemes which meet objectives having indicators and
have significant gap between national and state values
 Third Priority is to be given to schemes catering to single objective
 Within this, top priority is to be given to those schemes which meet objectives having indicators and
have a significant gap between national and state values
 Fourth Priority is to be given to the schemes catering to single objective and low priority (residual
schemes)

December 2014
3.5 Expenditure Review
3.5.1 Introduction
In this section an analysis of the expenditure by DoHFW in Madhya Pradesh during the past 6 years is
undertaken.
Section 3.5.2 provides a review of allocation of the entire state budget across the 11 Developmental
Heads / Sectors over past 6 years i.e., (from 2009-10 to 2014-15 BE). This is undertaken because
each of the departments of GoMP is classified and aligned to one of the developmental heads.
Post review of the sector wise expenditure of the state, analysis of DoHFW expenditure across the
demand numbers is presented in section 3.5.3. Expenditure of DoHFW is spread across 9 demand
numbers. These demand numbers are presented in Table 15.
Table 15: Description of the Demand Numbers under DoHFW
Demand No. Demand Title
19 Department of Health and Family Welfare
41 Tribal Welfare Department (TSP)
64 Special component plan for Scheduled Castes (SCP)
18 Department of Labor (Employees State Insurance Schemes) (ESIS)
55 Department of Women and Child Development (DWCD)
32 Department of Public Relations
38 Department of AYUSH
73 Department of Medical Education (DME)
72 Bhopal Gas Tragedy Relief and Rehabilitation
(Source: Demand for Grants, GoMP)
A detailed analysis of three demand numbers i.e., demand number 19 (DoHFW), 41 (TSP under
DoHFW), and demand number 64 (SCP under DoHFW), that are specific to the department are
presented in section 3.5.4.
Expenditure analysis over past 6 years of DoHFW has been undertaken across these 3 demand
numbers for the following categories of expenditure:
 Non plan and Plan
 Revenue and Capital
3.5.2 Sector expenditure
Government expenditure at the aggregate level is classified under different developmental heads. The
past expenditure of Government of Madhya Pradesh under different development heads for the years
2009-10 to 2014-15 is presented in Table 16.
Table 16: Government expenditure by sector (Rs. in crore)
Sectors
Accounts Accounts Accounts Accounts RE BE
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
Agriculture and Allied Services 2903.33 4243.93 5525.84 6677.01 7447.13 10172.68
Rural Development 2699.93 3562.62 3896.59 5192.04 5528.60 12044.00
Irrigation & Flood Control 2649.63 4043.94 3971.82 4489.07 5482.64 5313.67
Energy 7228.88 5538.34 18196.91 8583.37 9316.16 7904.21
Industry & Minerals 374.20 419.79 1396.69 2610.12 1357.16 2134.06
Transport 2515.56 2660.11 2620.29 3393.56 3882.57 3554.62
Science, Technology & Environment 54.10 54.64 50.69 92.33 144.37 220.31

December 2014
Sectors
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
General Economic Services 143.97 204.22 213.64 230.54 431.23 568.16
General Services 12178.05 14850.32 16397.80 17954.71 21237.61 24676.00
Social Services 14341.09 19067.90 22035.90 26126.34 32941.79 45209.10
Others 2552.69 2883.19 3206.83 4570.91 1389.87 2076.01
Total Expenditure 47641.43 57529.00 77513.00 79920.00 89159.10 113872.82
(Source: Report of the Account General; Annual Financial Statement 2014-15, GoMP)
The expenditure of the State Government on Agriculture Sector has increased from 2903.33 crores
during 2009-2010 to 6677.01 crores in 2012-13. Though the figures for the year 2013-14RE and 2014-
15 BE are indicative, it is imperative that a substantial amount of government fund is allocated for
Agriculture during this period. The expenditure trend shows a higher emphasis on the rural economy.
This is depicted through more than two fold increase in allocated expenditure during 2014-15
compared to 2013-14. The expenditure on General Economic Services shows a steady growth over the
reference period and a similar trend is observed in the case of social services as well. The expenditure
figure for the year 2014-15 (BE) is substantially higher compared to 2013-14 because the entire off
budget items have now been shown as on budget during 2014-15.
3.5.3 DoHFW expenditure across demand numbers
The expenditure trend in DoHFW with respect to the total Government expenditure is presented in
Table 17.
Table 17: Trends in expenditure of DoHFW (Rs. in crore)
Expenditure by DoHFW
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
Total DoHFW Expenditure 1231.78 1498.88 1914.83 2500.42 2983.92 4828.38
Total Government Expenditure 47641.43 57529 77513 79920 89159.1 113872.82
DoHFW Expenditure as % of
Government Expenditure
2.59 2.61 2.47 3.13 3.35 4.24
GSDP 194427.26 271681 315387 361874 409877 466976
DoHFW Expenditure as % of GSDP 0.63 0.55 0.61 0.69 0.73 1.03
(Source: Report of the Account General; Annual Financial Statement 2014-15, GoMP)
Table 17 presents the DoHFW expenditure as percentage of total government expenditure. During
2009-10 the expenditure by DoHFW was around 2.6 per cent of the total state budget. There is a
steady increase in expenditure over past 6 years. As per revised estimate of 2013-14 the expenditure
is around 3.35 per cent of the total government budget and as per budget estimate 2014-15 the
expenditure is around 4.24 percent of the total government expenditure. Expenditure on health as
percentage of GSDP shows slight fluctuation during 2009-10 and 2011-12. From 2012-13 onwards the
expenditure shows a consistent trend (i.e. grown from 0.69 per cent of GSDP to 1.03 percent of
GSDP). It may be noted that the expenditure by DoHFW in the above table is not the total expenditure
on health sector. The expenditure will be substantially higher if all the demand numbers contributing to
health are taken into consideration. Therefore, the figures presented in the table need to be interpreted
with due precaution.
3.5.4 DoHFW expenditure – Capital and Revenue
Between 2009-10 and 2014-15, the total expenditure of DoHFW increased substantially. This has been
as result of increase in total expenditure primarily under demand number 19 as can be seen from Table
18.

December 2014
Demand number wise analysis of capital and revenue expenditure indicates the following:
 Under demand number 19 (the major demand number for DoHFW), the revenue expenditure
constitutes around 97-98 per cent of the budget. The capital expenditure is around 2-3 per cent.
 Under demand number 41 (TSP component of health), the revenue expenditure has increased
from 75 per cent to 91 per cent during the reference period (2009-10 to 2014-15). During the initial
years i.e. 2009-10 the capital expenditure was slightly more than 25 per cent. This has declined to
nearly 10 per cent during 2014-15. Higher capital expenditure under TSP indicates higher
emphasis on the infrastructure component in Tribal areas of the state.
 The scenario under demand number 64 is almost similar to demand number 41. The revenue
expenditure during 2009-10 to 2014-15 has increased from 77 to 86 per cent with slight fluctuations
in between. The capital expenditure during this period has declined from nearly 23 per cent to 14
per cent, with highest peak of 46 per cent during 2011-12. This also implies the expansion of health
infrastructure in Schedule and backward class communities.
 Taking all the three demand numbers (19, 41, 64) together, the revenue expenditure of the
department has remained between 95 to 97 per cent of the expenditure by DoHFW
However, in absolute terms the capital expenditure under the above demand numbers has increased to
a large extent. Same is the case with the revenue expenditure.
Table 18 : Revenue & capital-wise expenditure trends of DoHFW by demand numbers (Rs. in crore)
Demand
Number
Revenue &
Capital
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
19 Capital 31.02 22.40 21.55 60.58 86.12 95.25
Revenue 1135.89 1391.25 1724.60 2044.32 2591.90 4014.97
Total for 19 1166.92 1413.65 1746.15 2104.89 2678.02 4110.22
As % of TE 94.73 94.31 91.19 84.18 89.75 85.13
41 Capital 8.24 10.41 30.39 31.93 27.35 36.00
Revenue 24.14 35.10 59.02 205.14 151.37 358.71
Total for 41 32.38 45.52 89.41 237.07 178.72 394.71
As % of TE 2.63 3.04 4.67 9.48 5.99 8.17
64 Capital 7.35 10.44 37.34 37.71 19.55 46.35
Revenue 25.13 29.28 41.94 120.75 107.63 277.10
Total for 64 32.48 39.72 79.27 158.46 127.18 323.45
As % of TE 2.64 2.65 4.14 6.34 4.26 6.70
Total Capital 46.61 43.25 89.28 130.22 133.02 177.60
Revenue 1185.17 1455.64 1825.55 2370.20 2850.90 4650.78
Total for All 1231.78 1498.88 1914.83 2500.42 2983.92 4828.38
As % of TE 100.00 100.00 100.00 100.00 100.00 100.00
(Source: Demand for Grants, GoMP)
3.5.5 DoHFW expenditure – non plan and plan
A detailed analysis of the expenditure of the department on the basis of plan and non-plan expenditure
has been undertaken. The results are presented in Table 19. As is already known, the expenditure
under demand number 41 and 64 are plan expenditures. As far as the expenditure under demand
number 19 and total expenditure (i.e., 19, 41, 64) by DoHFW is concerned following observations are
made:
 Under demand number 19 (the major demand number for DoHFW), the Non-Plan expenditure has
come down from 71.3 during 2009-10 to 57.9 during 2014-15. The plan expenditure has increased
from 28.7 per cent to 42.1 per cent during the same period. The highest growth of plan expenditure

SPMG II MTEF Report 2015-16 - Department of Health & Family Welfare - Final

SPMG II MTEF Report 2015-16 - Department of Health & Family Welfare - Final

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