Patterns of Public Health Expenditures in India : Analysis of State and Central Health Budgets in pre and post-NRHM period...
Public Financing of Health: Goals… <ul><li>National Health Policy (2002) </li></ul><ul><ul><li>Increase Health Expenditure...
Structure of Health Budget PLAN NON PLAN CENTRALLY SPONSORED SCHEMES State Funds EXTERNALLY AIDED PROJECTS REVENUE EXPENDI...
<ul><li>Line-item budget (lack of flexibility) </li></ul><ul><li>“ Doctrine of Lapse” </li></ul><ul><li>DDO (limits of fin...
<ul><li>Off-budget transactions (issue of accountability and transparency) </li></ul><ul><li>Merger of Expenditure with Au...
Inter-State Analysis of Health Budget
Central Health Budget
State Health Budget
Growth Rates of State Health Expenditure
Growth Rate of State Budget Expenditure  YEAR 2000-01 TO 2007-08 2000-01 TO 2004-05 2005-06 TO 2007-08 Andhra Pradesh 7.8 ...
Growth Rate of Capital Expenditure  YEAR 2000-01 TO 2007-08 2000-01 TO 2004-05 2005-06 TO 2007-08 Andhra Pradesh 2.4 -23.0...
Utilization of State Health Budgets - Revenue Budget for All States    Budgetary Allocation Expenditure Expenditure agains...
Fund Flow under NRHM
Expenditure Under NRHM
Fund Flow under RCH Flexi Pool
Fund Flow under Mission Flexi-pool
Peculiar problem under Mission Flexi-pool <ul><li>Complete grant under Mission Flexible Pool is treated as  Recurring Gran...
Bottle-necks in absorbing funds <ul><li>High expenditure cycle (civil works, procurement) </li></ul><ul><li>Lack of prepar...
Public Health Financing: the way forward <ul><li>Shift from line-item budgeting to block budgeting/grants, especially at f...
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Patterns of public health expenditure in India: Analysis of state and central health budgets in pre and post National Rural Health Mission period - Gautam Chakraborty

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Patterns of public health expenditure in India: Analysis of state and central health budgets in pre and post National Rural Health Mission period - Gautam Chakraborty

  1. 1. Patterns of Public Health Expenditures in India : Analysis of State and Central Health Budgets in pre and post-NRHM period Gautam Chakraborty (Advisor – Healthcare Financing) Arun B Nair (Consultant – Health Economist) National Health Systems Resource Centre (NHSRC) National Rural Health Mission (NRHM) Ministry of Health & Family Welfare Government of India
  2. 2. Public Financing of Health: Goals… <ul><li>National Health Policy (2002) </li></ul><ul><ul><li>Increase Health Expenditure by Govt. as % of GDP from the existing 0.9% to 2.0% by 2010. </li></ul></ul><ul><ul><li>Increase share of Central grants to constitute at least 25% of total health spending by 2010. </li></ul></ul><ul><ul><li>Increase State Sector Health spending from 5.5% to 7% of the budget by 2005 (and further increase to 8% by 2010). </li></ul></ul><ul><li>National Rural Health Mission (2005) </li></ul><ul><ul><li>“… Government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP.” </li></ul></ul><ul><ul><li>“ The States are expected to raise their contribution to Public Health Budget by minimum 10% p.a. …” </li></ul></ul>
  3. 3. Structure of Health Budget PLAN NON PLAN CENTRALLY SPONSORED SCHEMES State Funds EXTERNALLY AIDED PROJECTS REVENUE EXPENDITURE CAPITAL EXPENDITURE LOAN ACCOUNT EXPENDITURE “ SOCIETY” ROUTE (NRHM & RCH-II Flexi-pools; NACP-III) 2210 2211 4210 4211 6210 6211 “ TREASURY” ROUTE
  4. 4. <ul><li>Line-item budget (lack of flexibility) </li></ul><ul><li>“ Doctrine of Lapse” </li></ul><ul><li>DDO (limits of financial powers) </li></ul><ul><li>Separation of Expenditure with Authorization & Payment </li></ul>Treasury Route: Challenges 11/30/2010 NHSRC (Gautam Chakraborty)
  5. 5. <ul><li>Off-budget transactions (issue of accountability and transparency) </li></ul><ul><li>Merger of Expenditure with Authorization & Payment </li></ul><ul><li>This needs: </li></ul><ul><li>Accountability – more active participation of non-government members in the “Society” </li></ul><ul><li>Transparency – Concurrent Audits, FMRs in public domain (along with HMIS) </li></ul>Society Route 11/30/2010 NHSRC (Gautam Chakraborty)
  6. 6. Inter-State Analysis of Health Budget
  7. 7. Central Health Budget
  8. 8. State Health Budget
  9. 9. Growth Rates of State Health Expenditure
  10. 10. Growth Rate of State Budget Expenditure YEAR 2000-01 TO 2007-08 2000-01 TO 2004-05 2005-06 TO 2007-08 Andhra Pradesh 7.8 2.4 14.2 Assam 15.2 3.4 35.6 Bihar 3.6 -9.2 9.1 Chhattisgarh 26.3 27.7 22.3 Gujarat 4.5 1.1 7.1 Haryana 8.5 5.5 7.8 Jharkhand 12.5 3.1 -0.3 Karnataka 8.0 0.8 16.9 Kerala 9.3 5.8 12.5 Madhya Pradesh 5.3 0.8 9.6 Maharashtra 7.6 3.9 10.1 Orissa 8.1 6.4 20.9 Punjab 3.7 -1.0 6.8 Rajasthan 7.1 3.6 9.3 Tamil Nadu 7.1 2.6 8.3 Uttar Pradesh 14.5 8.7 13.8 West Bengal 4.2 -1.2 9.5 All States 8.4 3.9 12.0
  11. 11. Growth Rate of Capital Expenditure YEAR 2000-01 TO 2007-08 2000-01 TO 2004-05 2005-06 TO 2007-08 Andhra Pradesh 2.4 -23.0 76.8 Assam -15.1 5.7 -48.1 Bihar 3.2 12.0 -1.2 Chhattisgarh 53.1 58.7 43.9 Goa 19.6 11.5 7.7 Gujarat 14.9 1.0 38.1 Haryana 23.8 8.8 33.8 Jharkhand 35.1 23.9 42.6 Karnataka 10.7 11.8 -12.9 Kerala 20.6 7.3 29.0 Madhya Pradesh 20.6 7.3 29.0 Maharashtra 11.3 17.5 2.0 Orissa -0.3 -40.3 14.3 Punjab 34.8 15.8 87.8 Rajasthan 17.2 3.1 14.1 Tamil Nadu 24.2 11.5 -9.2 Uttar Pradesh 39.8 29.9 30.6 West Bengal 2.5 -14.2 22.7 All States 20.6 9.2 26.4
  12. 12. Utilization of State Health Budgets - Revenue Budget for All States   Budgetary Allocation Expenditure Expenditure against BE Year Plan Non-Plan Total Plan Non-Plan Total Plan Non-Plan Total 2001-02 580734 1158995 1739729 569354 1021032 1590386 98.0 88.1 91.4 2002-03 574250 1229544 1803794 445706 1188433 1634138 77.6 96.7 90.6 2003-04 612482 1277234 1889716 476471 1240646 1717116 77.8 97.1 90.9 2004-05 615964 1352247 1968210 520495 1325118 1845613 84.5 98.0 93.8 2005-06 711486 1544442 2256076 531541 1499013 2030554 74.7 97.1 90.0 2006-07 748863 1828648 2577512 574739 1645766 2220505 76.7 90.0 86.1 2007-08 752725 2012141 2764866 758091 2017951 2776043 100.7 100.3 100.4                     Utilization of State Health Budgets - Capital Budget for All States Year Budgetary Allocation Expenditure Expenditure against BE Plan Non-Plan Total Plan Non-Plan Total Plan Non-Plan Total 2001-02 176974 522 177496 70318 1976 72294 39.7 378.5 40.7 2002-03 98994 465 99459 74822 399 75221 75.6 85.8 75.6 2003-04 123594 205 123799 106125 291 106416 85.9 142.0 86.0 2004-05 127745 828 128573 113309 2763 116072 88.7 333.7 90.3 2005-06 209499 1386 210884 172169 398 172567 82.2 28.7 81.8 2006-07 316819 2675 319494 314906 2061 316967 99.4 77.0 99.2 2007-08 360648 2785 363433 377910 2738 380648 104.8 98.3 104.7
  13. 13. Fund Flow under NRHM
  14. 14. Expenditure Under NRHM
  15. 15. Fund Flow under RCH Flexi Pool
  16. 16. Fund Flow under Mission Flexi-pool
  17. 17. Peculiar problem under Mission Flexi-pool <ul><li>Complete grant under Mission Flexible Pool is treated as Recurring Grant (for which UC is due immediately after close of FY). This does not take into cognizance: </li></ul><ul><ul><li>7 tier structure of fund flow: Centre  State  District  Block (CHC)  PHC  Sub-Centre  VHSC. </li></ul></ul><ul><ul><li>Annual committed grants ( Untied Grants, AMG & Corpus Grants to RKS) to VHSC, SC, PHC, CHC & Distt. Hospitals which are to be used over the whole year. </li></ul></ul><ul><ul><li>Civil work component under which funds are advanced to PWD, etc.. </li></ul></ul><ul><ul><li>Procurement component under which funds are advanced to procurement agencies. </li></ul></ul>
  18. 18. Bottle-necks in absorbing funds <ul><li>High expenditure cycle (civil works, procurement) </li></ul><ul><li>Lack of preparation for expenditure (trainings, social protection schemes) </li></ul><ul><li>Average advances outstanding </li></ul><ul><li>Average cash reserves </li></ul><ul><li>Limits in financial decentralization </li></ul><ul><li>Skills of book keeping and accounting </li></ul><ul><li>Penetration of banking and e-commerce </li></ul>
  19. 19. Public Health Financing: the way forward <ul><li>Shift from line-item budgeting to block budgeting/grants, especially at facility level </li></ul><ul><li>Creating 2 channels of funding – (i) for items with expenditure cycle below 1-month, (ii) for items with expenditure cycle 3-months and above </li></ul><ul><li>“ Purchasing” of care even within public health system </li></ul><ul><li>Differential Financing (by levels, facilities, patients / beneficiaries) </li></ul><ul><li>Creation of “District Health Funds” for innovations and other needs </li></ul><ul><li>Shifting focus of audits from “compliance to guidelines” to transparency and accountability </li></ul>
  20. 20. THANK YOU

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