Budget for Children in India 2008–2009 to 2013–2014

BUDGET FOR CHILDREN IN INDIA 2008–2009 to 2013–2014
01
BUDGET FOR
CHILDREN
INDIA
2008–2009 TO 2013–2014
Prepared by HAQ: Centre for Child Rights, New Delhi

A Study by:
HAQ: Centre for Child Rights
BUDGET
FOR
CHILDRENINDIA
2008–2009 TO 2013–2014

Printed and Published in 2015
ISBN Number: 978-93-83807-03-1
B 1/2, Malviya Nagar, Ground Floor
New Delhi-110017, India
Phone: 91-11-26677412/3599
Fax: 91-11-26674688
Email: info@haqcrc.org
Website: www.haqcrc.org
Credits
Research Team
Enakshi Ganguly Thukral
Farhana Yasmin
Kumar Shailabh
Supported by : FORD Foundation
Photographs : Pallab Seth (Cover), Premnath Thirumalaisamy (Pg 2), Pilar Pacheco (Pg 40)
Designed and Printed by : Aspire Design

iii
CONTENTS
TABLE OF
ABBREVIATIONS & ACRONYMS v
PREFACE vii
INTRODUCTION 3
CHILD HEALTH 20
ANNEXURE: Child Health 33
CHILD DEVELOPMENT 41
ANNEXURE: Child Development 55
CHILD EDUCATION 61
ANNEXURE: Child Education 78
CHILD PROTECTION 99
ANNEXURE: Child Protection 113

v
ABBREVIATIONS &
ACRONYMS
LIST OF
AE Actual Expenditure
AWC Anganwadi Centre
AWH Anganwadi Helper
AWW Anganwadi Worker
BfC Budget for Children
BE Budget Estimate
CAG Comptroller and Auditor General
CICL Chid in Conflict with Law
CNCP Child in Need of Care and Protection
CWC Child Welfare Committee
DDG Detailed Demand for Grants
DISE District Information System for Education
GDP Gross Domestic Product
ICDS Integrated Child Development Scheme
ICPS Integrated Child Protection Scheme
ICCW Indian Council for Child Welfare
IMR Infant Mortality Rate
JJ Juvenile Justice
JICL Juvenile in Conflict with Law

JJ Act Juvenile Justice (Care and Protection) Act, 2000
JJB Juvenile Justice Board
JWO Juvenile Welfare Officer
KSY Kishori Shakti Yojana
MCH Mother and Child Healthcare
MDM Mid–day Meal
MMR Maternal Mortality Rate
MoU Memorandum of Understanding
NBCC New Born Care Corner
NCLP National Child Labour Project
NCPCR National Commission for Protection of Child Rights
NCRB National Crime Record Bureau
NFHS National Family Health Survey
NGO Non-governmental Organisation
NUEPA National University for Educational Planning and Administration
NSSO National Sample Survey Organisation
PHC Primary Health Centre
RCH Reproductive and Child Health
RE Revised Expenditure
RTE Right to (Free and Compulsory) Education Act, 2009
SCNU Special Care New Born Unit
SHC School Health Clinics
SJPU Special Juvenile Police Unit
SNP Supplementary Nutrition Scheme
SSA Sarva Shiksha Abhiyan
UNICEF United Nations International Children’s Emergency Fund
NER Net Enrolment Ratio
CRC Convention on the Rights of Child
DFID Department for international Development

vii
PREFACE
It has been 14 years since HAQ first started questioning the State’s responsibilities and promises
towards children through budget analysis. Over these years, we have been constantly engaging with
the government functionaries through our budget analysis.
HAQ’s last trend analysis was published in the year 2009, which included the trend ananlysis from
2004–2005 to 2008–2009. Taking this work further, this time, we have analysed the government’s
commitments towards ensuring and securing the rights of the children for six years spanning from
2008–2009 to 2013–2014.
In the last years HAQ has worked with partners in the states of Andhra Pradesh, Himachal Pradesh,
Orissa, Uttar Pradesh, West Bengal, Delhi and Assam.
This study has been made possible with the support of Ford Foundation.
Enakshi Ganguly Thukral Bharti Ali
Co-Director Co-Director

1
Budget for Children in India
2008–2009 TO 2013–2014

3
CHAPTER ONE
INTRODUCTION
India has emerged to be second most populated country in the world. Child population in India
constitutes almost 39 per cent of the total India’s population. Every year estimated 26 million
children are born in India (Census 2011)1
They are all citizens of this country and their rights have
to be recognised and realised.Article 15 (3) of the Constitution has recognised the need for making
special provisions for children.
A budget of country is perhaps the most important reflec-
tion of its political priorities. That is why, come the last
working day of February, India’s Finance Minister presents
the Union Budget to the Parliament. The media devotes it-
self to analysing various aspects of the budget, speaking to
numerous experts, scrutinising whether it favours industry,
agriculture, and the middle class and so on. The opposition
invariably screams the budget is populist, anti-poor and
anti ‘common man.’ Indeed, a budget concretely expresses
a government’s intentions, policies, priorities, policies and
the choice of development pathways.
India ratified the UN Convention on the Rights of Child (UNCRC) two decades ago in 1992 which
mandates the signatory countries to ensure well-being of children. Apart from these international
commitments, India has developed various policy documents on child welfare. Even the Five Year
Plan documents have special mention about children, with a special section dedicated to child rights
since the Eleventh Plan. Apart from the policy documents, the government has numerous welfare
schemes/programmes for children. In this context, it is quite essential to analyse the government’s
efforts to meet the targets mentioned in its policy documents.
1 “Children in India 2012: A Statistical Approach”; Chapter 2; Ministry of Statistics and Programme Implementation; http://mospi.nic.in/
mospi_new/upload/Children_in_India_2012, pdf, accessed on 15.05.2013
Technically, budgets include the
government’s expenditure and revenue
proposals.
Economically and politically, it is the
most important document mirroring its
policy priorities and fiscal targets.
It is also a legal document passed by the
legislature and, like any law, needs the
chief executive’s assent.
Thus budgets have an economic,
political and technical basis.

4
As an important economic and political statement that signals its vision and future policy priorities,
the budget of any government must ensure adequate resourcing for the successful implementation
of the schemes and achievement of the set goals it has set for itself.
Along with allocation, it is imperative that the money has been spent efficiently and effectively, and
the outcomes achieved.
While budgets of a country affects everyone, its impact on the marginalised groups like children, the
poor, the disabled, and the excluded SCs, STs and minorities is much more. Children among them
are particularly vulnerable to government decisions about raising resources and spending.
Budgets can be a powerful tool for monitoring state performance and advancing human rights as they help in:
 Measuring government’s commitment to specific policy areas, and contrasting that commitment to other lower-
priority areas;
 Determining the trends in spending on programme areas, to ensure that programmes aimed at meeting human
rights commitments receive a growing share of the budget over time.
 Costing out the implications of policy proposals;
 Analysing the impact of budgetary choices on people;
 Assessing the adequacy of budgets relative to international or local conventions and commitments; and
 Identifying sources of new funding for proposed policies.
 Fundar, International Budget Project and International Human Rights Internship Program. Dignity Counts- A
Guide to using Budget Analysis to Advance Human Rights. 2004
Inasmuch as it expresses resolutions and intents for the forthcoming year, the budget analyses rarely
scrutinise the performance of the previous years. In the Indian situation, the budgetary outlays
(budget estimates) for a particular year are revised in the next fiscal year (revised estimates) and the
actual spending (actual expenditure) is available only after a gap of two years. Thus for instance in
2013–2014, we would get only the budget estimates (BE), the revised estimates (RE) for 2012–2013
and the actual expenditures (AE) for 2011–2012. Often, there is a difference between the BE, RE
and the AE. This difference is not just about fiscal planning, allocation and expenditure. In fact it is
a reflection of planning and execution of initiatives of the government for the realisation of rights
and entitlements of its citizens. In other words the results of any budget analysis is a score card of
the governance system of a country or a state.
Hence, budget analysis is a powerful tool for both the government to assess itself as well as for civil
society to monitor state performance and hold it accountable.

5
Budget for Children (BfC)
As with human rights in general, budget monitoring is an effective tool for monitoring the govern-
ments’ efforts towards ensuring rights of the children, including the future requirements by analys-
ing the money allocated and spent against the physical targets achieved in various schemes specific
to children.
Budget for Children was started by HAQ in 2000 with a decadal analysis, and since then we have
been analysing the budgets, both central and of several states since 2000.
The Government of India has been undertaking children’s budgeting since 2003 and has since 2008
included a special Expenditure Budget Statement on Schemes for the Welfare of Children.
In this study, we analyse the Union Budget from the point of view of children, for the six years end-
ing in 2013–2014. We seek to evaluate the budgetary provisions of the Government of India (GOI)
in ensuring the rights of children, scrutinising in detail the areas of health, development, education
and protection, using the GOI data bases. Our analyses in each sector mainly examines the current
outlay and the divergence of the actual expenditures from the respective allocations and where pos-
sible the underlying causalities for the under or over utilisation.
Thus, in broad terms, the BfC study attempts to analyse the financial priorities of the GoI with re-
spect to its declared commitments for the children. It seeks to understand and question the extent
to which promises made by the government have been translated into policies and programmes that
protect children’s rights, mainly through an analysis of the Union Budgets for a specific timeframe
and other government and academic review documents.
It has to be noted that the BfC is not a separate budget, but an exercise to disaggregate the allocations
for all programmes and schemes benefitting children across the nation. Child budget analyses can
be carried out for national, state, sectoral and departmental budgets.
Methodology
Data Source
Since 2007, budget related data for children is available in the Expenditure Budget Statement 22.
This information is also available in the Detailed Demands for Grants (DDGs) of the Different Min-
istries and Departments.
At HAQ we have chosen to base our analysis on the DDGs for the following reasons:
1. Statement 22 is a constantly evolving document with more and more departments/ ministries/
schemes and programmes being added in every year and hence the information in it is not
consistent over the years.

6
2. The figures in the Statement 22 and the DDGs do not tally. At the same time while Statement 22
only includes the major heads, the minor and sub-minor are available only in DDGs making it
possible to dig deeper into the data.
The methodology and analysis structure has been developed by HAQ in 2000 and has continued to
be the same.
The ministries and departments that run programmes are selected and the Child-related expense
heads in the detailed demands for grants under each of these departments and ministries are select-
ed. All three budget figures (Budget Estimate, Revised Estimate and Actual Expenditure) pertaining
to the selected heads were entered and tabulated for comparison and analysis.
For the purpose of calculating ‘percentage average’, instead of adding each year’s figures and then
taking out the average value of percentage figure, we have calculated this figure from the absolute
average values of total number of years.
Analysis structure
The CRC defines the four basic rights of a child as the rights to survival, Development, Protection
and Participation.
However, based on how the budget figure are available, we have divided the programmes and
schemes into four sectors specific to children–development, health, education and protection.
0
20
40
60
80
100
120
2008–09 2009–10 2010–11 2011–12 2012–13 2013–14 2014–15
10
16
21 19 18 18 19
49
84
109
101 96 94 91
4.45 3.88 4.06 4.51 4.76 4.64 4.52
No. of Minister/Demands No. of Schemes Share of Bfc
FIGURE 1.1 || Statement 22 (2008–09 to 2014–15)

7
Development With special focus on Early Childhood Care and Development, it includes those schemes which don’t fit in other
sectors but are meant for overall development of children.
Health This sector includes programmes and schemes related to the health care needs of children. Some schemes
such as ‘Medical Termination of Pregnancy (MTP)’,‘Sukhibhava’ etc. which aim at correcting maternal mortality
rate (MMR) do not benefit children directly but have been still taken under health sector as they positively impact
the infant mortality rates (IMR).
Education Here, we have included elementary and secondary education from the School Education Department. Some
schemes from the Higher Education Department and Technical Education Department are incorporated
under secondary education because these target children up to the age of 18 years. Educational schemes/
programmes run by departments other than the Education Department are also included here.
Protection This sector contains programmes and schemes aimed at specially disadvantaged groups of children, including
child labour, adoption, trafficked children, children who are physically or mentally challenged street children and
children in conflict with law.
The focus of analysis was identification of gaps at the following multiple levels:
 Between needs of the children to fulfill their rights and the commitments made by the state,
both national and international;
 Between the commitments made by the state and the actual programmes/schemes under the
various ministries and departments;
 Between the objectives of the programmes/schemes and the financial allocations towards them;
 Between the allocations and actual expenditures; and
 Between the outlays and the outcomes.
For preparing the final report, to begin with, the total allocation and expenditure for each individual
schemes/programmes was calculated. In the second stage, the sum total for all programmes in a
sector was made for each of the four sectors and then the total Budget for Children (BfC) was calcu-
lated. Then the sectoral totals and the BfC were compared with the total state budget.
In the third stage, the Need vs. Allocation analysis was done using the allocations against the quan-
titative and qualitative status of the children in the state. At this stage, secondary data and analysis
from different government and non-government reports and publications have been used.
In the fourth stage, the analysis of Allocation vs. spending was made on the basis of the data on
actual expenditure (AE) available from the Detailed Demands for Grants (DDGs) for the first three
years and comparing them with the budget and revised expenditure figures to gauge how well gov-
ernment money was being utilised for the children. This and the outlays vs. outcomes analysis are
also based on the other financial documents of the government such as the audit reports, the per-
formance budgets and the appropriation accounts.

8
Time Period of the Study
As said earlier, the study was carried out for six consecutive years, from 2008–2009 to 2013–2014.
The BE, RE and AE were analysed, the later only for the first four years, given the data availability.
Constraints and Limitations
 The biggest handicap in undertaking BfC analysis work has been the mismatch of data per-
taining to a particular scheme/programme in various budget documents. While the Detailed
Demand of Grants provide the allocation and expenditure details, the Appropriation Accounts2
provide the most important information regarding over spending and underspending and the
reasons for the same. On some occasions, it has been found that there is difference in figures of
Expenditure between the government’s Appropriation Account and what has been mentioned
in the Detailed Demand of Grants.
 The other major problem is faced in disaggregating resources only for children, as many
schemes are designed for both women and children. For example, Relief and Rehabilitation for
Rape Victims is a scheme which caters to the needs of both women and girl victims less than of
18 years. Similarly, it is not possible to disaggregate the exact allocation meant for children with
disability form those meant for disabled persons. In such cases, we have decided to err on the
side of excess and include the full amount in this analysis.
 A big roadblock is the lack of reliability of the socio-economic data as well as the government’s
own data on its achievements.
2 Appropriation Accounts means the accounts which indicate the expenditure (both Voted and Charged) of the government for each
financial year compared with the amounts of voted grants and charged appropriations for different purposes, as specified in the
Schedules appended to the Appropriation Act passed by Parliament. These Accounts are submitted to Parliament under Article 151 of the
Constitution and are intended to disclose:-
(a) that the moneys indicated therein as having been disbursed, were legally available for and applicable to the service or purpose to
which they had been applied or charged;
(b) that the expenditure conforms to the authority which governs it (exceptions being listed out in the Appendix, referred to in the
certificate mentioned in para 11.3.4(a));
(c) the effects of reappropriations ordered by the Ministry/Department.

9
Key Statistics on Children in India3
Indicator Status Source
Child population (0–18 years)
472 million
428 million
Census 2011
Census 2001
Children in the age group of 0–6 years
158.8 million
163.8 million
Census 2011
Census 2001
Child-sex Ratio
(number of females per 1000 males in the
age group of 0–6 year)
914
927
Census 2011
Census 2001
HEALTH
Infant Mortality rate
(Probability of dying before completing one
year of life)
42 (2012)
47 (2010)
Sample Registration System
Neo Natal Mortality Rate
(Probability of children dying before
completing four weeks of life)
33 (2010) Sample Registration System
Under Five Mortality Rate
(Probability of dying before reaching the
age of five years)
59 (2010) Sample Registration System
Fully immunized children
61% in the age group 12–23
months
Coverage Evaluation Survey, 2009
Maternal Mortality Ratio
(number of women aged 15–49 years
dying due to maternal causes per
1,00,000 live births)
178 (2010–12)
212 (2007–09)
Sample Registration System (SRS)
EDUCATION
Total Enrolment at primary level (Classes
I-V)
133.4 million (2009–10)
135.2 million (2010–11)
134.7 million
(2012–13)
‘The 3rd Year -The Right of Children to Free and
Compulsory Education Act, 2009’, Ministry of Human
Resource Development
Total Enrolment at upper primary level
(Classes VI–VIII)
54.4 million (2009–10)
57.8 million (2010–11)
64.9 million
(2012–13)
‘The 3rd Year—The Right of Children to Free and
Per centage of Girls to total enrolment at
primary level
48% (2009–10)
48% (2010–11)
48% (2012–13)
‘The 3rd Year —The Right of Children to Free and
Per centage of Girls to total enrolment at
upper primary level
48% (2009–10)
48% (2010–11)
49% (2012–13)
Gender Parity Index at primary level
(Ratio of girls to boys in primary,
education)
0.94 (2009–10)
0.94 (2010–11)
0.94 (2012–13)
Gender Parity Index at upper primary level
(Ratio of girls to boys in upper primary
education)
0.93 (2009–10)
0.94 (2010–11)
0.95 (2012–13)
3 India’s reply to the list of issues and questions in relation to the combined 3rd
and 4th
periodic reports of India.

10
Indicator Status Source
Annual Average drop-out rate (Primary)
9.1 (2009–10)
6.8 (2010–11)
5.6 (2012–13)
Number of States that have banned corpo-
ral punishment under Right to Education
Act, 2009
34
Per centage of schools with drinking water
facility
93 (2009–10)
93 (2010–11)
95 (2012–13)
Per centage of schools with toilet facility
82 (2009–10)
84 (2010–11)
Per centage of schools with ramp
47 (2009–10)
50 (2010–11)
56 (2012–13)
‘The 3rd Year -The Right of Children to Free and
PROTECTION
Murder of children
1597 (2012)
1451 (2011)
1408 (2010)
Crime in India 2010, 2011, 2012, National Crime
Records Bureau
Infanticide
81 (2012)
63 (2011)
100 (2010)
Records Bureau
Rape of children
8541 (2012)
7112 (2011)
5484 (2010)
Records Bureau
Kidnapping and abduction of children
18266 (2012)
15284 (2011)
10670 (2010)
Records Bureau
Foeticide of children
210 (2012)
132 (2011)
111 (2010)
Records Bureau
Exposure and abandonment of children
821 (2012)
700 (2011)
725 (2010)
Records Bureau
Procuration of Minor Girls
809 (2012)
862 (2011)
679 (2010)
Records Bureau
Buying of Girls for prostitution
15 (2012)
27 (2011)
78 (2010)
Records Bureau
Selling of Girls for prostitution
108 (2012)
113 (2011)
130 (2010)
Records Bureau

11
TABLE 1.1 || Share of BfC (BE) in Union Budget (Per cent)
Year BE RE AE
2008–2009 5.71 4.48 4.21
2009-2010 4.28 8.60 4.16
2010-2011 4.87 4.04 3.98
2011-2012 4.17 4.22 4.16
2012-2013 4.47 4.27 NA
2013-2014 4.51 NA NA
Average (BE) 4.59 -- --
TABLE 1.2 || Children’s Share in Union Budget
Year Share (in Per cent)
2000–2001 to 2006–2007 3.10
2004–2005 to 2008–2009 4.45
2008–2009 to 2013–2014 4.59
FIGURE 1.2 || Average Share of BfC (BE) in Union Budget
(2008–2009 to 2013–2014) (Per cent)
Budget for Children 2008–2009 to 2013–2014: An Overview
The share of children (2008–2009 to 2013–2014) has remained less than 5 per cent of the Union
Budget. (Figure 1.2).
What is more children’s share has decreased
from 2008–09 when it was close to 6 per cent
(Table 1.1 and Figure 1.3).
However, over the years, there has been an in-
crease in the share of budget for children. It is in
2005–2006 that the share of BfC broke through
4 per cent barrier for the first time, and even
touched 5.23 per cent share in 2005–2006.
Further, as per our previous analysis, we have
tracked down the trend of financing for chil-
dren in India since 2000–2001 till 2013–2014, which does show a positive increase but given the
increased focus on child rights, the government needs to put more emphasis in terms of financing
and safeguarding the rights of children (Table 1.2).
4.59
BfC in Union
Budget
95.41
Other than BfC in
Union Budget
0
1
2
3
4
5
6
5.71
4.28
4.87
4.17
4.47
4.51
2008–09 2009–10 2010–11 2011–12 2012–13 2013–14
FIGURE 1.3 || Share of BfC (BE) in Union Budget (2008–2009 to
2013–2014) (Per cent)

12
Allocation and Expenditure in Budget for Children (BfC) (BE,
RE and AE)
While the share of allocation for children within the overall Union Budget may have seen a fall since
2008–2009, the beginning of the study period, both the allocation and expenditure in real terms has
increased although there was a small fall in BE in 2011–2012. While in 2010–2011, the BE increased
by 23.33 per cent, AE increased by 11.81 per cent (Figure 1.4).
On an average, RE was
13.27 per cent more than
the BE over the years.
While in 2008–2009, the
RE was lower than the
BE, in 2009–2010, the
RE was over 100 per cent
higher than BE and fell
drastically the following
year (see Table 1.5), only
to be higher than BE
again the following year.
However, even more
important is whether
what is allocated in
spent and what the
trend of allocations and
expenditure been across
the three stages (BE, RE
and AE). In the earlier
years of BfC analysis it
has been seen that the
RE was almost always
lower than the BE and the AE
was lower than both BE and RE
(Table 1.3).
The available expenditure data
of four years show that almost
every year, the BfC (Figure 1.5)
with an average under spending
of almost 6 per cent over three
years. In 2008–2009, the under
spending was as high as 13.19
per cent (Figure 1.4).
BE RE AE
0
20000
40000
60000
80000
100000
2008-09 2009-10 2010-11
42888.2
43736
53941
52433
66634
75056
40323.1
87855
49142
55676
61095
37232.2
42667.5
47707
54307
0.00
0.00
0.00
2012-132011-12 2013-14
FIGURE 1.4 || BE, RE & AE In BfC ( 2008–2009 to 2013–2014) (` Crore)
–16
–14
–12
–10
–8
–6
–4
–2
0
2
4
6
2008–09
–13.19
–2.44
–11.56
3.57
2009–10 2010–11 2011–12
FIGURE 1.5 || Expenditure (AE) in BfC (2008–2009 to 2011–2012) (Per cent)
TABLE 1.3 || BE, RE & AE in BfC (` Crore)
Year BE RE AE
2008–2009 42888.17 40323.94 37232.40
2009–2010 43736.29 87855.47 42667.00
2010–2011 53941.49 49142.19 47707.24
2011–2012 52433.09 55676.92 54307.06
2012–2013 66634.75 61095.44 NA
2013–2014 75056.31 NA NA
Average (BE) 55781.68 58818.79 45478.42

13
In 2009–2010, AE experienced a significant under spending of 51.44 per cent against the increased
allocations at RE stage (Table 1.4). Such trends of under spending raise serious questions about the
implementation of children centric programmes and efforts being made towards ensuring the well
being of children of our country.
TABLE 1.4 || Allocation and Expenditure in BfC (` Crore)
Year BE RE AE AE-BE AE-BE (%) RE-BE RE-BE (%) AE-RE AE-RE (%)
2008–2009 42888.17 40323.94 37232.40 –5655.77 –13.19 –2564.23 –5.98 –3091.55 –7.67
2009–2010 43736.29 87855.47 42667.00 –1069.29 –2.44 44119.18 100.88 –45188.47 –51.44
2010–2011 53941.49 49142.19 47707.24 –6234.24 –11.56 –4799.30 –8.90 –1434.94 –2.92
2011–2012 52433.09 55676.92 54307.06 1873.97 3.57 3243.82 6.19 –1369.85 –2.46
2012–2013 66634.75 61095.44 NA NA NA –5539.30 –8.31 NA NA
2013–2014 75056.31 NA NA NA NA NA NA NA NA
Average (BE)
(uptill 2011–12)
48249.76
Average Expenditure
(up till 2011–12)
–5.74 -- -- --
Rate of Change in BfC and Union Budget
As we have seen that there has been 75 per cent increase in the allocation of children in actual
terms, the average rate of change in BfC during 2008–2009 to 2013–2014 was 12.45 per cent. On
the other hand the average rate of change in the Union Budget was 17.65 per cent during the same
time period.
In 2009–2010, while the BfC allocations rose by just 1.98 per cent against the previous year’s al-
locations, the Union Budget allocations shot up by a significant 35.95 per cent. Subsequently, in
2011–2012, the BfC allocation was reduced by 2.80 per cent and Union Budget allocation increased
by 13.44 per cent.
What is more the rate of change in the BE and RE within BfC do not follow the same trend. In the
year 2009–2010, allocation at RE stage were revised and increased by a huge 117.87 per cent against
previous year’s as against of only 1.98 per cent increase in BE. The very next year the RE showed a
negative growth rate while the BE increased by 22.33 per cent (Table 1.5).
TABLE 1.5 || Rate of Change in BfC and Union Budget (BE) (Per cent)
Year
BfC Union
BE RE AE BE RE AE
2008–2009 -- -- -- -- -- --
2009–2010 1.98 117.87 14.60 35.95 13.39 15.90
2010–2011 23.33 –44.06 11.81 8.61 19.09 16.87
2011–2012 –2.80 13.30 13.83 13.44 8.40 8.94
2012–2013 27.09 9.73 NA 18.54 8.50 NA
2013–2014 12.64 NA NA 11.70 NA NA
Average (BE) 12.45 24.21 13.41 17.65 12.34 13.90

14
Sectoral Share in Union Budget
Despite falling child health conditions in the coun-
try, Child Health, on an average, received a meager
0.65 per cent share in the total Union Budget, where-
as child education received the maximum share of
2.90 per cent in Union Budget. Child Development
received an average share of 0.65 per cent and child
protection continues to be on edge with the lowest
share of 0.05 per cent in the Union Budget during
the study period (Figure 1.6).
What is more, the share of allocation for health has
seen a decline over the years (Table 1.6).
TABLE 1.6 || Sectoral Budget (BE) within Union Budget and BfC (in per cent)
Health Development Education Protection
Year Union BfC Union BfC Union BfC Union BfC
2008–2009 0.87 15.25 0.86 15.12 3.91 68.46 0.07 1.17
2009–2010 0.65 15.20 0.68 15.98 2.92 68.13 0.03 0.69
2010–2011 0.66 13.54 0.93 19.20 3.22 66.22 0.05 1.05
2011–2012 0.61 14.67 0.94 22.51 2.57 61.60 0.05 1.22
2012–2013 0.63 14.07 1.18 26.49 2.61 58.46 0.04 0.98
2013–2014 0.58 12.79 1.17 26.02 2.72 60.29 0.04 0.90
Average 0.65 14.09 1.00 21.75 2.90 63.16 0.05 1.00
Sectoral Share in BfC
The trend of fund sharing among four sec-
tors within BfC almost follows the same
trend as it was in Union Budget. Child
education receives the maximum atten-
tion in terms of financial resource alloca-
tion as it bags the maximum average share
of 63.16 per cent within the BfC during
2008–09 to 2013–14. Despite the grow-
ing concern of child health and child pro-
tection, these two sectors continue to be
marginalised and thus, receive an average
share of 14.09 per cent and 1 per cent re-
spectively (Figure 1.7). It almost comes as
a surprise that how child protection has been ignored in terms of resource allocation especially
after launching the umbrella scheme of ICPS and even Eleventh and Twelfth Five Year Plans have
expressed the need of strengthen the child protection mechanisms in country.
0.65%
Health
95.41
Other than BfC
Sector
1.00
Development
0.05
Protection
Education
2.90
FIGURE 1.6 || Average Sectoral Share in Union Budget
(2008–2009 to 2013–2014) (Per cent)
1.00
Protection 14.09
Health
63.16
Education
21.75
Development
FIGURE 1.7 || Average Sectoral Share within BfC (2008–2009 to
2013–2014) (Per cent)

15
Rate of Change in Sectoral Allocations
While the Union Budget has seen an
erratic trend of allocation every year,
other sectors too have followed the
same pattern. While, Union Bud-
get has witnessed an average rate of
change of 17.65 per cent in alloca-
tions, only child development is the
sector to observe a positive trend
of allocations with an average rate
of change of 26.02 per cent. Child
health sector observed the poorest
average rate of change during the
study period (Table 1.7).
On the other hand, the rate of change in BfC has shown a positive trend during the study period,
but within BfC, the fund allocations have been very uneven with few sectors witnessing a negative
growth over the years. On an average, BfC observed an average rate of change of 12.45 per cent,
whereas child helath and child education observed an average rate of change of just 8.22 per cent
and 9.71 per cent respectively. Such trend of rate of change in allocations raises serious questions
about the funds distribution among sectors within the BfC (Table 1.7).
Sector-wise Expenditure Trend
While evaluating the effectiveness of any budget, expenditure plays a vital role because it reflects
the utilisation of financial resources laid down for any particular programme. If we look at the sec-
toral utilisation during these four years (for which the expenditure data is available), except child
development sector, other three sectors have experienced the under expenditure during 2008–2009
to 2011–2012. This fact becomes more compelling especially when the Union Budget expenditure
has witnessed over expenditure all through years, with an average over expenditure of 6.57 per cent.
Worst of all, protection sector continues to remain on the edge with a significant average under
expenditure of 51.25 per cent during the study period (Table 1.8).
TABLE 1.8 || Sectoral Expenditure and Union Budget & BfC Expenditure (Per cent)
Year Union BfC Health Development Education Protection
2008–2009 17.72 –13.19 –11.8 0.5 –15.9 –50
2009–2010 0.36 –2.44 –2.3 19 –6.9 –65.4
2010–2011 7.99 –11.56 –10 –0.2 –14.6 –51.1
2011–2012 3.71 3.57 –15.5 29.5 –0.4 –45.7
Average 6.57 –5.74 –10.07 13.53 –9.45 –51.25
TABLE 1.7 || Sectoral Rate of Change and Rate of Change in Union Budget and BfC
(Per cent)
Year Union BfC Health Development Education Protection
2009–2010 35.95 1.98 1.64 7.76 1.48 –39.44
2010–2011 8.61 23.33 9.89 48.18 19.87 86.04
2011–2012 13.44 –2.8 5.29 13.97 –9.56 13.19
2012–2013 18.54 27.09 21.9 49.58 20.6 1.76
2013–2014 11.7 12.64 2.4 10.62 16.15 4.32
Average 17.65 12.45 8.22 26.02 9.71 13.18

16
As Union Budget witnessed 6.57 per cent of average over expenditure over the years, on the other
hand, BfC observed an average under expenditure of 5.74 per cent during 2008–2009 to 2011–2012.
This under expenditure can further be explained in the light of secotral expenditure where, except
child development, rest of the sectors observed heavy underspending; thus finally contributing to
the heavy under expenditure in BfC (Table 1.8).
Flagship Schemes That Are Showing Massive Under
Spending (2008–2009 to 2011–2012)
TABLE 1.9 || Appropriation Account of Government of India (2008–2009 to 2011–2012) (` lakhs)
Year Scheme Total Grant Actual Expenditure
Excess (+)
Saving (–)
2008–2009
Routine Immunisation Programme 61500 28237.68 –33262.32
Manufacture of Sera/Vaccine–B.C.G.
Vaccine Laboratory, Guindy, Chennai
1200 431.03 –768.97
IEC–RCH Project 9067 4513.88 –4553.12
National Institute of Public Co-operation and Child
Development (NIPCCD)
2778.50 797.76 –1980.74
Rajiv Gandhi National Crèche Scheme for the
Children of Working Mothers
9610.00 8751.38 –858.62
Integrated Child Development Services (ICDS) 4220.00 1488.33 –2731.67
Sarva Shiksha Abhiyan—Establishment and Related
Expenditure
1978.00 1705.23 –272.77
ICPS 5000 0 –5000
Conditioned Cash Transfer Scheme for Girl Child
with insurance cover
900 595.16 –304.84
Central Adoption Resource Agency (CARA) 400 240 –160
2009–2010
1750 473.57 –1276.43
Routine Immunisation Programme 41421 26893 –14528.00
National Institute of Public Co-operation and Child
2416.00 2150.00 –266.00
Sarva Shiksha Abhiyan–Establishment and Related
Expenditure
2085.00 1632.68 –452.32
National Programme of Mid-day Meals in Schools
(National Component)
1500.00 52.69 –1447.31
Rashtriya Madhyamik Shiksha Abhiyan (RMSA) 98346.00 48927.87 –49418.13
Central Adoption Resource Agency (CARA) 380 158.38 –221.62
ICPS 1200 932.29 –267.02
1000 500 –500
National Commission for the Protection of Child
Rights (NCPCR)
700 510 –190

17
Year Scheme Total Grant Actual Expenditure
Excess (+)
Saving (–)
2010–2011
1725 1000.39 –724.61
Pulse Polio Immunisation Programme 103709 99059.38 –4649.62
Rajiv Gandhi Scheme for Empowerment of Adoles-
cent Girls (RGSEAG)
300 22.07 –277.93
Indira Gandhi Matritva Sahyog Yojana (CMB
Scheme)
200 32.25 –167.75
Expenditure
2636.00 2458.72 –177.28
National Programme of Mid-day Meals in Schools -
Cost of Food Grains
30000.00 15372.54 –14627.46
Sarva Shiksha Abhiyan–General Component 161175.55 12.54 –161163.01
Rashtriya Madhyamik Shiksha Abhiyan (RMSA) 152752.00 148196.76 –4555.24
National Means cum Merit Scholarship Scheme 8145.00 4978.57 –3166.43
National Commission for the Protection of Child
Rights (NCPCR)
950 550 –400
1000 183.02 –816.98
ICPS 2200 1828.73 –371.27
2011–2012
Manufacture of Sera/Vaccine–B.C.G. Vaccine
Laboratory, Guindy, Chennai
1940 904.45 –1035.55
Rajiv Gandhi National Crèche Scheme for the
Children of Working Mothers
7651.00 7383.5 –267.50
World Bank ICDS IV Project 7500.00 0 –7500.00
Expenditure
2891.00 2379.26 –511.74
National Programme of Mid-day Meals in Schools
(National Component)
1315.00 871.78 –443.22
1000 0 –1000
ICPS 3900 2352.67 –1547.33

18
Dependence on External Aid
Programmes and schemes for children have a substantial external aid component (EAC). During
2008–2009 to 2013–2014, an average of 5.30 per cent of total BfC financial resources were as a part
of external aid (Figure 1.8).
Talking of sectors, child health received the maximum share of external grants, whereas there was
no externally aided component for Child Protection. An average of 3.51 per cent of the child health
allocations within BfC was a part of External Aid (Figure 1.9).
Of all sectors in BfC,
health sector receives
the maximum share of
EAC with an average
share of 3.51 per cent
within BfC. The average
share of EAC in health
sector for children was
24.89 per cent. On the
other hand, EAC edu-
cation sector receives only 2.60 per cent in the total education budget.
In the child development sector, the most important contributor to external aid in this sector is the
World Bank through its contribution to ICDS in the form of Grant in Aid. EAC constitutes an aver-
age of 0.62 per cent of the total child development sector budget.
5.30
94.70
Share of EAC
Other than EAC
1.64
Education
94.70
Other than EAC
3.51
Health
0.15
Development
FIGURE 1.8 || Share of EAC within BfC (2008–2009
to 2013–2014) (Per cent)
FIGURE1.9 || Sectoral EAC Share within BfC (2008–2009 to
2013–2014) (Per cent)
0
1000
2000
3000
4000
5000
3698.03
3746.68
3891.01
4250.82
1440.91
700.50
3390.95
3854.57
3043.98
3944.22
1205.39
NA
3344.16
3772.08
2650.11
4224.33
NA
NA
2008–09 2009–10 2010–11 2012–132011–12 2013–14
FIGURE 1.10 || EAC in Child Budget (` crore)

19
Conclusion
Does the reducing share of financial resources for children within the over-all Union Budget reflect
a falling concern for them in the country? Given the poor outcomes of child health that an increas-
ing violence against children that the country is witnessing, how does the government rationalize
and explain the poor allocations and the high under spending on these sectors?
There is also a growing trend of moving towards the PPP (Public Private Partnership) model for ser-
vices for children, leading to abdication of state responsibility. With the enactment of the Company
(Corporate Social Responsibility policy) Rules, 2014, there is more money from the private sector
available for social services. This should not lead to replacement of government by private sec-
tor. Instead it should be part of the pool or resources available to the government to be used to
augment its own resources. Government must be accountable for utilisation of these resources.
What children need is a political will from the planner and the government. Without adequate re-
sources and accountable implementation of programmes and schemes, the promises being made,
the laws and policies enacted remain as mere platitude.

20
India’s health care system consists of a mix of
public and private sector providers of health
services. The total expenditure on health
care in India, taking both public, private and
household out-of-pocket (OOP) expenditure
was about 4.1 per cent of GDP in 2008–2009 (National Health Accounts [NHA] 2009), which is broad-
ly comparable to other developing countries, at similar levels of per capita income.
The public expenditure on health was only about 27 per cent of the total in 2008–2009 (NHA, 2009
and on Core Health (both plan and non-plan and taking the Centre and States together) was less
than 1 per cent of GDP in 2007–2008. It has increased to a mere 1.04 per cent during 2011–2012.4
The Approach Paper to the Eleventh Five Year Plan had said that accessibility to health care is a major
issue especially in areas where habitations are scattered and women & children continue to die en route
to hospitals. It further added that rural health care in most states is marked by absenteeism of doctors/
health providers, low levels of skills, shortage of medicines, inadequate supervision/monitoring and
callous attitudes. There are neither rewards for service providers nor punishments for defaulters.5
This was reiterated after five years in the Twelfth Five Year Plan document which once again admit-
ted that the health system suffers from the following weaknesses—availability of health services, quality
and affordability. It also acknowledges that these problems are likely to worsen in future and health
care costs are expected to rise.6
The Planning Commission has also observed that the health outcome
of the Eleventh Plan and of NRHM is constrained by lack of end-line data on most indicators.
Analysis of available data reveals that though there has been progress, except on child-sex ratio, the
goals have not been fully met. Despite efforts through the flagship of NRHM, wide disparity in at-
tainments across states outlines the need for contextual strategies.7
4 http://planningcommission.gov.in/plans/planrel/12thplan/pdf/12fyp_vol3.pdf (accessed on 21.04.2014).
5 http://planningcommission.nic.in/plans/planrel/app11th_24.pdf
6 ibid
7 http://planningcommission.gov.in/plans/planrel/12thplan/pdf/12fyp_vol3.pdf (accessed on 17.04.2014).
CHAPTER TWO
CHILD HEALTH
Health should be viewed as not merely the absence of disease
but as a state of complete physical, mental and social well-being.
Planning Commission. Twelfth Five Year Plan. Volume 3

21
Thus, the health status of children in India in terms of Infant mortality rate, Under 5 mortality rate
and morbidity remains a matter of concern. The National Population Policy 2000 identified adoles-
cents as an underserved group for which health needs and within this reproductive and sexual health
interventions are to be designed.
Most of the specific intervention related to health of children is under the Reproductive and Child
Health programme (RCH) II; and under the National Rural Health Mission (NRHM) programme.
This includes measures to address disease control through immunisation as well as those for treat-
ment and care.
 Census figures show a continued decline in child sex ratios (0-6 age group), from 927 girls per 1,000 boys in 2001 to 919
girls in 2011.8
 According to SRS bulletin 2012 India’s Infant mortality rate (IMR) is 42 per 1,000 lives.9
 At the National level, under-five mortality rate is estimated at 59 per 1,000 lives and it varies from 66 in rural areas to 38
in urban areas. Among the bigger States, it varies from 15 in Kerala to 83 in Assam.10
 India continues to lose more than 400,000 children to Pneumonia and Diarrhoea before their fifth birthday due to these
two preventable diseases.11
 India contributes to more than 20 per cent of the world’s child deaths, with approximately 1.73 million, children dying
annually before completing their fifth birthday (under 5 mortality rate)- most of them due to preventable causes.12
 India’s neo-natal mortality rate is 33 in 2010 and it ranges from 19 in urban areas to 36 in rural areas. This means at
nationally 33 infant dying before reaching 28 days of age, per 1,000 live births.13
 Early neo-natal mortality rate for the year 2010 has been estimated at 25 and ranges from 28 in rural areas to 15 in urban
areas, i.e., number of infant deaths less than seven days of life per 1,000 live births14
.
 Almost 47 per cent of girls in the age group of 11 to 19 years are underweight.
 Adolescents with correct knowledge of HIV/AIDS is 35 per cent in boys and 28 per cent in girls.15
Adolescent Health: The Gap no one Talks about!15
Adolescents constitute about 21 per cent of the population.16
However, it has been observed that
there is a lack of services that respond to their distinctive needs. In fact, when child health is referred
to, it is almost always interventions for that focus on the 0–6 year age group.
Adolescents ‘age out’ of pediatric health care and often remain unreached by programmes for adults.
Since they are neither infants nor adults and, although fall within the definition of ‘child’, without
specific health interventions designed for their needs, fall between the cracks.17
8 http://www.devinfolive.info/censusinfodashboard/ (accessed on 30.04.2014).
9 http://censusindia.gov.in/vital_statistics/SRS_Bulletins/SRS_Bulletin-September_2013.pdf (accessed on 21.04.2014).
10 http://www.censusindia.gov.in/vital_statistics/srs/Chap_4_-_2010.pdf (accessed on 21.04.2014).
11 International Vaccine Access Center (IVAC) Pneumonia and Diarrhoea Progress Report 2013. http://www.jhsph.edu/research/centers-
and-institutes/ivac/resources/IVAC-2013-Pneumonia-Diarrhea-Progress-Report.pdf (accessed on 30.04.2014).
12 UNICEF, the State of the World Children’s Report 2012: Children in an Urban World. (accessed on 21.04.2014).
15 http://www.deccanherald.com/content/141057/condition-adolescents-india-among-worst.html (accessed on 18.08.2014).
16 http://news.oneindia.in/india/india-launches-adolescent-health-programme-1372430.html.
17 Bharti Mehta, Amandeep Kaur, Vijay Kumar and Sumit Chawla, Manisha Malik and She Kharti. ‘Adolescent Reproductive and Sexual Health
in India: The Need to Focus’. http://www.journalyoungmed.com/articles/1/1/adolescent-reproductive.html (accessed on 18.08.2014).
Status of Child Health in India

22
Moreover, as has been pointed out by Gupta, Ramani and Soors, in India, components of adoles-
cent health are being looked after by separate ministries and departments. The Ministry of Health
and Family Welfare (MoHFW) focuses on delivering adolescent health services. The Adolescent
Education Programme (AEP) and sex education come under the Department of Education in the
Ministry of Human Resource Development (MoHRD), while its earlier version SAEP was admin-
istered by National AIDS Control Organization. The programme on nutrition and counseling of
adolescent girls—Kishori Shakti Yojana—is being looked after by the Ministry of Women and Child
Development (MoWCD) under its Integrated Child Development Scheme (ICDS). The National
Youth Policy 2003, of the Ministry of Youth Affairs and Sports (MoYAS) recognises adolescents
(15–19 years) as distinct from the youth (20–35 years age). Thus each ministry is looking after one
component of adolescent health.18
It is perhaps in recognition of this that the Government of India has launched a Programme called
the Rashtriya Kishor Swasthya Karyakram or the Adolescent Reproductive and Sexual Health
(ARSH) Programme under National Rural Health Mission as a part of RCH II. The special interven-
tions for adolescents was in anticipation of the following expected outcomes: delay age of marriage,
reduce incidence of teenage pregnancies, meet unmet contraceptive needs and reduce the number
of maternal deaths, reduce the incidence of sexually transmitted diseases and reduce the proportion
of HIV positive cases in the 10-19 years age group. However, included as part of the larger RCH II
initiative, there is no specific budget line for this programme.
Several of the initiatives addressing adolescents that fall within the other ministries have been
included in the section on education (The Adolescent Education Programme) and development
(Kishori Shakti Yojana).
Share of Health in Union Budget and BfC
Despite a 42 per cent increase in the actual allocations (BE) in children’s health initiatives, the pro-
portionate share of budget allocation for the health sector for children is a mere is 0.65 per cent
18 Mona Gupta, K. V. Ramani, Werner Soors ‘Adolescent Health in India: Still at Crossroads’. http://www.SciRP.org/journal/aasoci.
FIGURE 2.1 || Average Share of Child Health (BE) in Union
Budget (2008–2009 to 2013–2014) (Per cent)
FIGURE 2.2 || Average Share of Child Health (BE) within
BfC (2008–2009 to 2013–2014) (Per cent)
0.65
Child Health
99.35
Other than Child
Health
14.09
Child Health
85.91
Other than Child
Health

23
of the Union Budget during 2008–
2009 to 2013–2014 and within BfC,
it is 14.09 per cent (Figure 2.1 &
2.2).
What is of even greater concern is
that the share of allocations showsa
significant decline during the pe-
riod of our study (Figure 2.3 and
Table 2.1) both within the Union
Budget as well as within BfC. The
share of child health in the total
Union Budget has declined, from
0.87 per cent in 2008–2009 to 0.58
per cent in 2013–2014. And within
BfC, it reduced to 12.79 per cent in
2013–2014 from 15.25 per cent in 2008–2009. Given the government’s own recognition of the prob-
lems in the health system and its impact (as we saw above) this is difficult to explain.
0
2
4
6
8
10
12
14
16
18
15.20
2008–09 2009–10 2010–11 2011–12 2012–13 2013–14
15.25
0.87 0.65 0.66 0.61 0.63 0.58
13.54
14.67
14.07
12.79
FIGURE 2.3 || Share of Health (BE) in Union Budget & BfC (2008–2009 to 2013–2014)
( Per cent)
Health (BE) in Union Budget Health (BE) within BfC
Of every 100 rupee, an average of only 65 paise is provided for the health needs of the country’s children.
Over the years there has been a fall in share for the heath sector for children. How can this be explained?
TABLE 2.1 || Share of Health BE within Union Budget and BfC
Year Health BE
(` crore)
Union Budget BE
(` crore)
BfC BE (` crore) Share of Health (BE)
in Union Budget
(per cent)
Share of Health
BE within BfC (per
cent)
2008–2009 6539.80 750884 42888.17 0.87 15.25
2009–2010 6646.99 1020838 43736.29 0.65 15.20
2010–2011 7304.62 1108749 53941.49 0.66 13.54
2011–2012 7691.18 1257729 52433.09 0.61 14.67
2012–2013 9375.66 1490925 66634.75 0.63 14.07
2013–2014 9600.56 1665297 75056.31 0.58 12.79
Average 7859.80 1215737 55781.68 0.67 14.09
Rate of Change in Child Health Sector
The annual rate of change in the child health sector shows an erratic trend throughout the period of
study which is difficult to explain given the consistent need and indeed growing need for investment
in children in view of the constantly growing health challenges.
Child health observed an average rate of change of 8.22 per cent in terms of allocations during the
study period and has shown inconsistent and erratic trend of allocations. In 2009–2010, there was
a meagre 1.64 per cent increase in child health BE against 2008–2009 allocation and in 2010–2011,

24
BE rose to a significant 9.89 per cent against 2009–2010, and further, in the year 2012–2013, the al-
locations rose up by 21.90 per cent against previous year’s allocation.
It is also important to closely analyse the rate of change in child health allocations in comparison
with the Union Budget and BfC allocations rate of change. Comparing these three, while in 2009–
2010, BE for Union Budget increased by a significant 35.95 per cent against previous year, the BfC
BE increased by 1.98 per cent and the child Health BE increased by a mere 1.64 per cent against
previous year’s allocation. If we look at the annual rate of change of union budget, BfC and Child
Health budget, it gives a very erratic trend and allocations are not found to be in synchrony with
each other. Such inconsistency also indicates towards imbalanced approach towards planning for
child health (Table 2.2).
TABLE 2.2 || Rate of Change in Union Budget, BfC and Child Health Budget (Per cent)
Union BfC Child Health
Year BE RE AE BE RE AE BE RE AE
2008–2009 -- -- -- -- -- -- -- -- --
2009–2010 35.95 13.39 15.9 1.98 117.87 14.6 1.64 8.32 12.59
2010–2011 8.61 19.09 16.87 23.33 –44.06 11.81 9.89 6.22 1.17
2011–2012 13.44 8.4 8.94 –2.8 13.3 13.83 5.29 4.85 –1.07
2012–2013 18.54 8.5 NA 27.09 9.73 NA 21.90 0.13 NA
2013–2014 11.7 NA NA 12.64 NA NA 2.40 NA NA
Average (BE) 17.65 -- -- 12.45 -- -- 8.22 -- --
The inconsistent rate of change in allocations continued with allocations increasing by just 2.40 per
cent against previous year’s allocations. In this year, many schemes under RCH like Pulse Polio Pro-
gramme, Routine Immunisation Programme, Information, Education & Communication (IEC)—
RCH project etc. did not observe any allocations separately and were merged with RCH Flexi Pool
and yet a very small allocation was made that year.
Similarly there is a fall at RE stage the percentage showed a declining trend from 8.32 per cent of
increase in 2009–2010 over the previous year to only a 0.13 per cent increase in 2012–2013 over
2011–2012.
Allocation & Expenditure under Child Health Sector
While in actual terms the allocation (BE) for the child health sector has increased by 46.80 per cent
over the six years (Figure 2.4), its share in the overall Union Budget has reduced. It is only in the
last two years of our study i.e., in 2012–2013 that there has been a significant increase in allocation
(almost 22 per cent) (Figure 2.4).

25
This sudden increase in the rate of change in child health allocations in 2012–2013, can be attrib-
uted to higher allocations in few of the schemes under Reproductive and Child health like Infor-
mation, Education and Communication (IEC)—RCH Project, Training, Routine Immunisation
Programme etc. All these schemes have also seen a good amount of allocation for Special Com-
ponent Plan for Scheduled Caste and Schedule Tribes Area Sub Plan. Between 2008–2009 and
2009–2010 the increase in allocations was only 1.63 per cent which further rose up by 9.89 per cent
in 2010–2011.
The revised estimate has been lower than
the budget estimate during the five year pe-
riod of study except in 2009–2010 the allo-
cation at RE stage was slightly higher than
the BE stage. On an average RE has been 5.4
per cent less than the BE.
Over the years for which data is available,
less than 10.07 per cent of what was allo-
cated has been spent.
The actual expenditure (AE) was consis-
tently lower than the BE showing low utili-
sation of resources for health sector pro-
grammes despite requirement of better health services for children across the country (Figure 2.5
& Table 2.3). The AE has been also lower than the RE in all the years.
0
2000
4000
6000
8000
10000
2008–09 2009–10 2010–11 2012–132011–12 2013–14
6539.80
6646.99
7304.62
7691.18
9375.66
9600.56
6229.34
6747.85
7167.39
7515.13
7524.99
5770.81
6497.36
6573.25
6502.72
0.00
0.00
0.00
FIGURE 2.4 || BE, RE & AE in Child Health ( ` crore)
BE
RE
AE
FIGURE 2.5 || Expenditure (AE) in Child Health (2008–2009 to
2011–2012) (Per cent)
–18
–16
–14
–12
–10
–8
–6
–4
–2
0
2008–2009 2009–2010 2010–2011 2011–2012
Expenditure (AE)
–11.8
–2.3
–10.0
–15.5

26
TABLE 2.3 || Allocation and Expenditure in Health Sector (` crore)
2008–2009 6539.8 6229.34 5770.81 –769 –11.8 –310.5 –4.7 –458.5 –7.4
2009–2010 6646.99 6747.85 6497.36 –149.6 –2.3 100.9 1.5 –250.5 –3.7
2010–2011 7304.62 7167.39 6573.25 –731.4 –10 –137.2 –1.9 –594.1 –8.3
2011–2012 7691.18 7515.13 6502.72 –1188.5 –15.5 –176.1 –2.3 –1012.4 –13.5
2012–2013 9375.66 7524.99 NA NA NA –1850.7 –19.7 NA NA
Average
(2008-09 to
2011-12)
7045.648 -- 6336.035 –709.613 –10.07 -- --
Table 2.4 shows the programmes and schemes where there was under-spending, which the appro-
priation accounts describe as ‘saving’. It must be of course pointed out that the saving of resources
also means that this amount was not invested in the implementation of planned programmes and
interventions, denying children the benefit from them.
TABLE 2.4. || Appropriation Account of Government of India ( 2008–2009 to 2010-2011) (` Lakh)
Year Scheme Total Grant Actual Expenditure Excess (+)
Saving (-)
2008–2009
Manufacture of Sera/Vaccine – B.C.G.
1200 431.03 –768.97
IEC on PNDT Act 900 350.87 –549.13
Kalawati Saran Children’s Hospital, New Delhi 355.97 785.94 +429.97
RCH –Expenditure at Headquarters 425 325.36 –99.64
IEC– RCH Project 9067 4513.88 –4553.12
Training in RCH 600 381 –219.00
RCH Flexible Pool for State PIPs 83742.02 167767.19 +84025.17
Pulse Polio Immunisation Programme 7344.32 14620.69 + 7276.37
Procurement of Drugs & Equipments (other than
Vaccines etc.)
30000 17715.66 –12284.34
2009–2010
1750 473.57 –1276.43
IEC on PNDT Act 900 196.89 –703.11
Kalawati Saran Children’s Hospital, New Delhi 3700 4135.15 +435.15
RCH–Expenditure at Headquarters 350 518.90 +168.90
Training in RCH 600 457.84 –142.16
Procurement of Drugs and Equipments (other than
Vaccines etc.)
3335 6601.23 +3266.23
RCH Flexible Pool for State PIPs 304849 348030.77 +43181.77
Pulse Polio Immunisation Programme 1898.73 3797.38 +1898.65
Routine Immunisation Programme 41421 26893 –14528.00

27
Year Scheme Total Grant
Actual
Expenditure
Excess (+)
Saving (–)
2010–2011
1725 1000.39 –724.61
IEC on PNDT Act 990 646.14 –343.86
Kalawati Saran Children’s Hospital, New Delhi 870.50 1575.24 +704.74
Procurement of Drugs and Equipments (other than
Vaccines etc.)
22500 17769.64 –4730.36
RCH–Expenditure at Headquarters 622 –237.82
RCH Flexible Pool for State PIPs 22906.47 45470.13 +22563.66
2011–2012
Manufacture of Sera/Vaccine–B.C.G. Vaccine
Laboratory, Guindy, Chennai
1940 904.45 –1035.55
IEC on PNDT Act 990 616.17 –373.83
IEC–RCH Project 6569 8146.73 +1577.73
Training in RCH 1000 897 –103.00
Procurement of Drugs & Equipments (other than
Vaccines etc.)
25000 2153.41 –22846.59
RCH–Expenditure at Headquarters 522 667 +145
RCH Flexible Pool for State PIPs 218800 258883.97 +40083.97
Assistance from UNICEF 3500 3805.33 +305.33
Sunday
Times of
India, New
Delhi July 17,
2011

28
A Closer Look at the Schematic Allocations under the Child
Health Sector
National Rural Health Mission
National Rural Health Mission (NRHM) was launched in 2005 to provide effective health care to the
rural population throughout the country with special focus on 18 states having weak public health
indicators and/or weak health infrastructure. It was launched with the objective of improving the
access to quality healthcare especially for the rural women and children and in strengthening of
health infrastructure, capacity building, and decentralised planning.19
The mission targets are set to provide universal access to rural people to effective, equitable, afford-
able and accountable primary healthcare. Some of the strategies employed by the mission to achieve
its goals were:
a. promoting access to improved healthcare at household level through ASHAs,
b. strengthening sub-centres, PHCs and CHCs,
c. preparing and implementing of inter-sectoral district health plans and integrating vertical
health programmes at all levels, and
d. envisaging health plan for each village through the Village Health Committee, etc20
.
As part of the infrastructure strengthening under the NRHM, 10,473 sub-centres, 714 primary
health centres (PHCs), and 245 community health centres (CHCs) have been newly constructed. A
total of 8,199 PHCs have been made functional as 24X7 services across the country. Further, nearly
2,024 vehicles are operational as mobile medical units (MMUs) in 459 districts in the country under
the NRHM.21
The community based functionaries, named as Accredited Social Health Activist (ASHA) have been
envisaged under the NRHM as a first port of call for any health related demands of deprived sec-
tions of the population, especially women and children, who were finding it difficult to access health
services.
In India, public health nursing in the villages today is still limited to services rendered by Mul-
tipurpose Health Worker (Female) [MPHW(F)] or Auxiliary Nurse Midwife (ANM). ANMs are
regarded as the first contact person between people and organisation, between needs and services
and between consumer and provider. Their services are considered essential to provide safe and
effective care and as a vital resource to achieve the health-related targets. NRHM provides that the
ANMs will have the support of 4-5 ASHA and the AWWs in discharging her duties and the role
envisaged in the mission.22
19 http://mohfw.nic.in/WriteReadData/l892s/8%20Chap%20IV%20PAGE%2026-137%20Review%20Performance-73398458.pdf (accessed on
30.04.2014).
20 http://mohfw.nic.in/WriteReadData/l892s/8%20Chap%20IV%20PAGE%2026-137%20Review%20Performance-73398458.pdf (accessed
on 30.04.2014).
21 Economic Survey of India – 2012-2013 (accessed on 6.05.2014).
22 Malik Geeta, ‘Role of Auxiliary Nurse Midwives in National Rural Health Mission’, March 2009 VOL C No. 3, The Nursing Journal of India;
http://www.tnaionline.org/april-09/8.htm (accessed on 23.05.2014).

29
For such significant position of the ANMs a sum total of ` 402.88 crore were floated under Train-
ing of ANM programme over the period of six years of study. This programme observed an average
under spending of about 3 per cent till the year 2011–2012.
Reproductive and Child Health Programme
The Reproductive and Child Health programme (RCH) II under the National Rural Health Mis-
sion (NRHM) addresses the factors contributing the Infant and under-five mortality including. The
major components of child health programme are:
I. Establishment of New Born Care facilities and Facility Based Integrated Management of Neo-
natal and Childhood Illnesses (F-IMNCI),
II. Navjaat Shishu Suraksha Karyakram,
III. Integrated Management of Neonatal and Childhood Illnesses (IMNCI) and Pre- Service IMN-
CI Home Based Care of Newborns,
IV. Universal Immunisation,
V. Early detection and appropriate management of Acute Respiratory Infections, Diarrhoea and
other infections,
VI. Infant and young child feeding including promotion of breast feeding,
VII. Management of children with malnutrition,
VIII.Vitamin A supplementation and Iron and Folic Acid supplementation.
Facilities for care of Sick Newborn such as Special New Born Care Units (SNCUs), New Born Sta-
bilization Units (NBSUs) and New Born Baby Corners (NBCCs) are being set up at different lev-
els in the country. So far, 388 SNCUs are now functioning in the country. There are at present 1,542
NBSUs established at Community Health centres/FRUs and there are 11,458 functional NBCCs in
the country.23
For under 5 mortality rate Home Based New Born Care (HBNC) scheme has been launched to
incentivize ASHA for providing Home Based Newborn Care. ASHA will make visits to all new-
borns according to specified schedule up to 42 days of life and an incentive of `50 will be provided
per home visit of around one hour duration. Another scheme to treat severe acute malnutrition
amongst children is Nutritional Rehabilitation Centres (NRC), 577 Nutrition Rehabilitation Cen-
ters have been operationalized in the country till September 2012.24
A New initiative Janani Shishu Suraksha Karyakram (JSSK) was launched on 1st June 2011 and
has provision for both pregnant women and sick new born till 30 days after birth. The initiative
would promote institutional delivery, eliminate out of pocket expenses which act as a barrier to
seeking institutional care for mothers and sick new borns and facilitate prompt referral through free
23 http://mohfw.nic.in/WriteReadData/l892s/CHAPTER%205.pdf (accessed on 02.05.2014).

30
transport. More than `1,437 crore have been allocated to the States for the year 2011–2012 for pro-
viding free entitlements under JSSK. While `2,059.78 crore have been approved for 2012–2013.25
Pulse Polio Immunisation Programme
With the global initiative of eradication of polio in 1988 following World Health Assembly resolu-
tion in 1988, Pulse Polio Immunisation programme was launched in India in 199526
by the Gov-
ernment of India, in co-operation with international agencies, state governments and non-govern-
ment/voluntary organizations. PPI was initiated with the objective of achieving hundred per cent
coverage under Oral Polio Vaccine (OPV) and aims to reach the unreached children.27
Children in the age group of 0-5
years administered polio drops dur-
ing National and Sub-national Im-
munisation rounds (in high risk ar-
eas) every year. About 172 million
children are immunised during each
National Immunisation Day (NID).
The last polio case in the country
was reported from Howrah district
of West Bengal with date of onset 13
January 2011. Thereafter no polio
case has been reported in the country
(25th May 2012). World Health Or-
ganisation (WHO) on 24th February
2012 removed India from the list of countries with active endemic wild polio virus transmission.28
The Pulse Polio Immunisation Programme is funded both from Indian budget and externally Aided
projects. External funding is received from World Bank and Kreditanstalt Fur Wiederaufbau (KfW)
(German Development Bank).29
The allocation for this programme has decreased from `1,055.03 crore in 2008–2009 to `663.02
crore in 2012–2013. Throughout the study period the amount was highest in 2009–2010 which was
`1,123.27 crore. Under the NRHM-RCH Flexible pool head an amount of `252.64 crore was allo-
cated in 2013–2014 for this programme as Grant in Aid General and a separate allocation of `394.31
crore was made for Supplies and Material under the same head.
The actual expenditure under this scheme had remained very inconsistent, in the first two years
i.e. 2008–2009 and 2009–2010 the expenditure had seen over spending of the budget but the follow-
26 http://nrhm.gov.in/images/pdf/programmes/Immunisation/pulse-polio-programme/brief_note.pdf (accessed on 29.04.2014).
27 http://indiagovernance.gov.in/bestpractices.php?id=143 (accessed on 29.04.2014).
28 http://nrhm.gov.in/images/pdf/programmes/Immunisation/pulse-polio-programme/brief_note.pdf (accessed on 29.04.2014).
29 http://blmungekar.com/parliament/questions-put-by-me/1627-funding-pattern-of-the-pulse-polio-immunisation-project-.html (accessed
on 28.04.2014).
Achievements/ Status
(2011–12)
As per the reported data of Health Management Information System
(HMIS) antigen wise all India coverage is as follows:
BCG 90.93%
DPT3
86.33%
OPV3
82.37%
Measles 85.57%
Full Immunisation 84.02%
JE Vaccine 21.75%
(As on 02nd November, 2012)
Source: Review Performance, Chapter 4, Ministry of Health and Family
Welfare

31
ing years i.e. 2010–2011 and 2011–2012 observed an under spending of the resources. An average
amount of `979.84 crore was allocated from 2008–2009 to 2011–2012 and the average expenditure
for the same period was `979.43 crore so the difference is very low in terms of average allocation
and expenditure.
As per the Appropriation account of 2010–2011 and 2011-2012, the saving occurred under this
scheme was due to requirement of fewer funds towards operating cost of Pulse Polio Programme
owing to less number of National Immunisation Days/Sub-National Immunisation Days.30
Routine Immunisation Programme
Immunisation Programme is one of the key interventions for protection of children from life threat-
ening conditions, which are preventable. It is one of the largest Immunisation programme in the
world and a major public health intervention in the country. Immunisation Programme in India
was introduced in 1978 as Expanded Programme of Immunisation (EPI).
As per our study the budgetary provision received under this scheme both from Govt. of India and
international collaboration (known as Externally Aided projects) have substantially gone down by
32.65 per cent in 2009–2010 (from `615 crore in 2008–2009 to `414.21 crore in 2009–2010 and
`450 crore in 2010–2011). In 2011–2012 the allocation rose little higher than the previous financial
years to `505.99 crore then again it dropped to `467.64 crore in 2012–2013 and surprisingly there
no allocation for the 2013–2014 for this Scheme.
In 2013–2014, Routine Immunisation programme received an amount of `6.15 crore under NRHM-
RCH Flexible Pool as Grant in Aid general. And under Supplies & Material head a sum of `464.49
crore was allocated.
Despite, such drastic fall in the budgetary allocation, the actual expenditure continued to be lower
in all the four years from 2008–2009 to 2011–2012. In 2008–2009, out of `615 crore only `282.38
crore was spent. As per Appropriation account the saving occurred in 2008–2009 due to non-ap-
proval of the Hepatitis B scheme by the Cabinet. In 2009–2010 and 2010–2011, the saving occurred
due to non-approval of the pentavalent vaccine scheme by the government and less procurement of
Cold Chain Equipments and Routine Vaccine on account of retendering.
Only in 2012–2013 the resource utilisation was little better out of `467.64 crore, the total expendi-
ture was `402.42 crore. So an average of `496.30 crore was allocated from 2008–2009 to 2011–2012
and out of which an average of `222.72 crore was spent which 44.87 per cent and rest of the funds
remained as saving.
Share of Externally Aided Component (EAC)
The budget for children’s health is heavily dependent on external aid, with more than one of its budget
coming from it. Of all sectors in BfC, health sector receives the maximum share of external aid (EAC).
30 Appropriation Account 2010–2011 and 2011–2012-MHFW (accessed on 17.04.2014)

32
During our period of study from 2008–2009 to
2013–2014, the average share of EAC in health
sector for children was almost 25 per cent. In
other words, more than one fourth of the allo-
cations made for the health sector for children
came from external aid.
Scheme like RCH flexible pool for state PIPs,
Pulse Polio Programme, Routine Immunisation
Programme, and Supply of Vaccine under these
two schemes receive major foreign assistance.
The share of EAC in BE in 2008–2009 was 33 per cent (`2,164.13
crore), which further kept on rising in the following financial years
to 38 per cent in 2011–2012. However, the share had went down
drastically to 11 per cent 2012-2013 (to `1,072.86 crore) and even
decreased further in 2013–2014 about 6 per cent (to `558.31 crore).
The average share of actual spending on child health EAC was 36.05 per cent. In 2011–12, the share
of AE that came from external aid was more than the share of BE that came from EAC (BE was
`2,935.49 and AE was `3,139.99).
TABLE 2.5 || Externally-Aided Components in Child Health
EAC in Health (` Crore) Share of EAC in Health (Per cent)
Year BE RE AE BE RE AE
2008–2009 2164.13 1857.05 1810.26 33.09 29.81 31.37
2009–2010 2269.79 2377.68 2295.19 34.15 35.24 35.33
2010–2011 2736.78 2227.98 1922.11 37.47 31.08 29.24
2011–2012 2935.49 2857.88 3139.99 38.17 38.03 48.29
2012–2013 1072.86 903.70 NA 11.44 12.01 NA
2013–2014 558.31 NA NA 5.82 NA NA
Average 1956.227 -- 1527.93 24.89 -- --
Conclusion
Despite such consistent assistance and allocations, the major schemes remain marred by poor im-
plementation strategies and under spending. Now, when the whole globe is putting much focus on
Post MDG Agenda, India is still lagging behind and is yet to achieve the MDG goals and 100 per
cent Immunisation.
24.89
EAC in Child
Health
75.11
Other than Child
Health
FIGURE 2.6 || Average Share of EAC in Health
( 2008–2009 to 2013–2014) (per cent)
More than one fourth of the
allocations made for the health
sector for children came from
external aid.

33
ANNEXURE
Child Health
Kalawati Saran Childrens Hospital, New Delhi (` thousands)
Year BE RE AE
2008–2009 250000 382700 340647
2009–2010 370000 398700 413515
2010–2011 392600 463100 462974
2011–2012 500800 500800 480080
2012–2013 554000 554000 NA
2013–2014 645000 NA NA
Upgradation/Strengthening of Nursing Services (ANM/GNM) (New) (` thousands)
Year BE RE AE
2008–2009 0 0 0
2009–2010 0 0 0
2010–2011 0 0 0
2011–2012 0 0 0
2012–2013 0 0 NA
2013–2014 1332760 NA NA
IEC-Adolescent Health (RCH) (` thousands)
Year BE RE AE
2008–2009 50500 50500 39093
2009–2010 15000 15000 11079
2010–2011 16500 16500 3052
2011–2012 16500 16500 12670
2012–2013 22300 22300 NA
2013–2014 23300 NA NA
RCH Flexible Pool for State PIPs (` thousands)
Year BE RE AE
2008–2009 22357500 27382900 30731702
2009–2010 30484900 29580000 34803077
2010–2011 33965000 33410000 36221366
2011–2012 38050000 37850000 42053917
2012–2013 43455100 33500000 NA
2013–2014 0 NA NA

34
Routine Immunisation Programme (` thousands)
Year BE RE AE
2008–2009 10693000 4693500 4486063
2009–2010 7964200 7964200 6172109
2010–2011 8620000 8890800 7741534
2011–2012 10119900 8031000 7435852
2012–2013 12384900 11215400 NA
2013–2014 0 NA NA
RCH-Expenditure at Headquarters (` thousands)
Year BE RE AE
2008–2009 30000 42500 32536
2009–2010 35000 67400 51890
2010–2011 62200 62200 38418
2011–2012 52200 79000 66780
2012–2013 105000 55300 NA
2013–2014 0 NA NA
Pulse Polio Immunisation Programme (` thousands)
Year BE RE AE
2008–2009 15447500 16816500 16808627
2009–2010 16518900 17400400 17461934
2010–2011 15975900 14501100 14580255
2011–2012 11545800 12706200 11971412
2012–2013 11699000 14929000 NA
2013–2014 0 NA NA
RCH Flexible Pool (NRHM) (` thousands)
Year BE RE AE
2008–2009 0 0 0
2009–2010 0 0 0
2010–2011 0 0 0
2011–2012 0 0 0
2012–2013 0 0 NA
2013–2014 47111200 NA NA

35
Pulse Polio Immunisation Prog. GIA (NRHM) (` thousands)
Year BE RE AE
2008–2009 0 0 0
2009–2010 0 0 0
2010–2011 0 0 0
2011–2012 0 0 0
2012–2013 0 0 NA
2013–2014 7637900 NA NA
Material Assistance for Strengthening of National Immunisation Programme and Polio Eradication (` thousands)
Year BE RE AE
2008–2009 190000 200000 190000
2009–2010 0 0 0
2010–2011 0 0 0
2011–2012 350000 350000 380533
2012–2013 3323600 1641900 NA
2013–2014 3323600 NA NA
Pulse Polio Immunisation Prog (Supplies & Material) NRHM-RCH Flexible Pool (` thousands)
Year BE RE AE
2008–2009 0 0 0
2009–2010 0 0 0
2010–2011 0 0 0
2011–2012 0 0 0
2012–2013 0 0 NA
2013–2014 3943100 NA NA
Lady Reading Health School & Ram Chand Lohia Infant Welfare Centre (` thousands)
Year BE RE AE
2008–2009 18700 19800 15913
2009–2010 21500 22800 18026
2010–2011 25600 21000 19307
2011–2012 29000 26000 19741
2012–2013 30000 28800 NA
2013–2014 35500 NA NA

36
Upgradation/Strengthening of Nursing Services (ANM/GNM) (New) (NE Area) (` thousands)
Year BE RE AE
2008–2009 0 0 0
2009–2010 0 0 0
2010–2011 0 0 0
2011–2012 0 0 0
2012–2013 0 0 NA
2013–2014 167200 NA NA
IEC-Adolescent Health (RCH) (NE Area) (` thousands)
Year BE RE AE
2008–2009 5100 5100 0
2009–2010 1100 1100 0
2010–2011 1210 1200 0
2011–2012 1200 1210 0
2012–2013 1200 0 NA
2013–2014 0 NA NA
RCH Flexible Pool for State PIPs (NE Area) (` thousands)
Year BE RE AE
2008–2009 2992500 3377200 0
2009–2010 4965100 4733700 0
2010–2011 4535000 4685000 0
2011–2012 4950000 4950000 0
2012–2013 5930000 5070000 NA
2013–2014 0 NA NA
Training in RCH (` thousands)
Year BE RE AE
2008–2009 60000 50000 38100
2009–2010 60000 47000 45784
2010–2011 70000 70000 61024
2011–2012 100000 100000 179400
2012–2013 230000 190000 NA
2013–2014 230000 NA NA
Procurement of Drugs & Equipment (other than Vaccines etc) (` thousands)
Year BE RE AE
2008–2009 3000000 3000000 1771566
2009–2010 1000000 1500000 1326723
2010–2011 2000000 2250000 1776964
2011–2012 2500000 2501000 215341
2012–2013 2876500 990500 NA
2013–2014 2875000 NA NA

37
Pulse Polio Immunisation Programme (operating cost) (NE Area) (` thousands)
Year BE RE AE
2008–2009 134000 276700 0
2009–2010 276700 175000 0
2010–2011 300000 165700 0
2011–2012 160000 160000 0
2012–2013 165000 165000 NA
2013–2014 0 NA NA
Pulse Polio Immunisation Prog. GIA (NRHM) (NE Area) (` thousands)
Year BE RE AE
2008–2009 0 0 0
2009–2010 0 0 0
2010–2011 0 0 0
2011–2012 0 0 0
2012–2013 0 0 NA
2013–2014 412100 NA NA
Supply of Vaccine under Routine Immunisation (NE Area) (` thousands)
Year BE RE AE
2008–2009 1487000 258500 0
2009–2010 260000 260000 0
2010–2011 330000 290000 0
2011–2012 300000 210000 0
2012–2013 230000 220000 NA
2013–2014 0 NA NA
NRHM-Training of ANM/LHVs (GIA) (` thousands)
Year BE RE AE
2008–2009 0 0 0
2009–2010 0 0 0
2010–2011 0 0 0
2011–2012 0 0 0
2012–2013 0 0 NA
2013–2014 12200 NA NA
Child Care Training Centre Singur Total (` thousands)
Year BE RE AE
2008–2009 77500 105500 95775
2009–2010 125000 172300 133300
2010–2011 143100 156400 138134
2011–2012 165000 165000 141896
2012–2013 170000 151700 NA
2013–2014 160000 NA NA

38
IEC (RCH) Project (` thousands)
Year BE RE AE
2008–2009 906700 906700 318465
2009–2010 841500 841500 840417
2010–2011 925650 925650 960623
2011–2012 916900 925450 1076743
2012–2013 1360800 1860890 NA
2013–2014 1772900 NA NA
IEC on PNDT Act (` thousands)
Year BE RE AE
2008–2009 90000 90000 35087
2009–2010 90000 90000 19689
2010–2011 99000 99000 64614
2011–2012 99000 99000 61617
2012–2013 91260 90070 NA
2013–2014 101360 NA NA
Training of ANM/LHV (` thousands)
Year BE RE AE
2008–2009 711800 626600 655892
2009–2010 652800 562300 590077
2010–2011 753600 711900 819711
2011–2012 887800 895400 0
2012–2013 1022800 0 NA
2013–2014 0 NA NA
RCH Research & Study Activities (` thousands)
Year BE RE AE
2008–2009 54000 34000 29317
2009–2010 24000 6500 5766
2010–2011 22000 10100 8893
2011–2012 16500 13000 477
2012–2013 18000 2000 NA
2013–2014 18000 NA NA
Strengthening of Maternal Health & Child Health wing/Hospitals and other wings (` thousands)
Year BE RE AE
2008–2009 30000 30000 0
2009–2010 0 0 0
2010–2011 0 0 0
2011–2012 0 0 0
2012–2013 0 0 NA
2013–2014 0 NA NA

39
RCH Purchase & Supply of materials (` thousands)
Year BE RE AE
2008–2009 3000000 3000000 1771566
2009–2010 1000000 1500000 1326723
2010–2011 2000000 2250000 1776964
2011–2012 2500000 2501000 215341
2012–2013 2876500 990500 NA
2013–2014 2875000 NA NA
Routine Immunisation Prog (NRHM) (` thousands)
Year BE RE AE
2008–2009 0 0 0
2009–2010 0 0 0
2010–2011 0 0 0
2011–2012 0 0 0
2012–2013 0 0 NA
2013–2014 7608400 NA NA
Supply of RCH Drugs & Equipments (` thousands)
Year BE RE AE
2008–2009 2580000 0 0
2009–2010 895000 1391500 1593505
2010–2011 1790000 1790000 728551
2011–2012 2235000 1785000 34417
2012–2013 2570000 894400 NA
2013–2014 568100 NA NA
Supply of Vaccine under PPI Programme (NE Area) (` thousands)
Year BE RE AE
2008–2009 129000 205000 0
2009–2010 203800 110000 0
2010–2011 200000 120000 0
2011–2012 110400 110400 0
2012–2013 120400 122400 NA
2013–2014 0 NA NA
RCH Flexible Pool (NRHM) (NE Area) (` thousands)
Year BE RE AE
2008–2009 0 0 0
2009–2010 0 0 0
2010–2011 0 0 0
2011–2012 0 0 0
2012–2013 0 0 NA
2013–2014 6358900 NA NA

40

41
With special focus on early childhood care and development, HAQ’s analysis of the budget for the
child development sector also includes those schemes which do not fit in other sectors but are
meant for overall development of children such as Sabala for adolescent girls and Saksham for ado-
lescent girls.
Status of child development in India
As per NFHS -3 43 per cent of children under the age of five years are underweight for their age.31
More than half (54 per cent) of all deaths before the age five years in India are related to malnutrition.32
Seven out of every 10 children age 6-59 months in India are anaemic. Three per cent of children age 6-59 months is (the
age of 5 years) severely anaemic, 40 per cent are moderately anaemic, and 26 per cent are mildly anaemic.33
Only 25 per cent of newborns were put to the breast within one hour of birth. Less than half of children (46 per cent)
under six months of age are exclusively breastfed. India has the highest number of low birth weight babies per year at an
estimated 7.4 million.
As per the Lok Sabha unstarred question # 1228 dated 13 August 2013, India’s birth registration is 81.3 per cent.
Share of Development Sector
As our study shows, development sector was allocated an average of 1 per cent in the Union Budget
during 2008–2009 to 2013–2014. Within the budget for children (BfC), the share has been almost
22 per cent in the same period (Figure 3.1 & 3.2).
31 http://www.rchiips.org/nfhs/nutrition_report_for_website_18sep09.pdf (accessed on 12.05.2014).
32 Ibid.
33 Ibid.
CHAPTER THREE
CHILD DEVELOPMENT

42
Even while there has been an increase in allocation in real terms,
as a share within the Union Budget and the BfC, and as a share
between 2008–2009 to 2013–2014, there are years which have seen
fall in the share of allocations in comparison to the preceding year
(2009–2010 and 2013–2014) (Figure 3.3 and Table 3.1).
TABLE 3.1 || Share of Development BE within Union Budget and BfC
Year Development
BE(`crore)
Union Budget BE
(`crore)
BfC BE (`crore) Share of Development (BE)
in Union Budget (Per Cent)
Share of Development
(BE) within BfC
(Per cent)
2008–2009 6485.10 750884 42888.17 0.86 15.12
2009–2010 6988.04 1020838 43736.29 0.68 15.98
2010–2011 10354.70 1108749 53941.49 0.93 19.20
2011–2012 11801.62 1257729 52431.59 0.94 22.51
FIGURE 3.1 || Average Share of Development BE in Union
Budget ( 2008–2009 to 2013–2014) (Per cent)
Of every 100 Rupees allocated
in the Union Budget, 1 rupee
is for children’s development
programmes….
0
5
10
15
20
25
30
0.86
15.12
0.68
15.98
0.93
19.20
0.94
22.51
1.18
26.49
1.17
26.02
2008–09 2009–10 2010–11 2011–12 2012–13 2013–14
Development (BE) within BfCDevelopment (BE) in Union Budget
FIGURE 3.3 || Share of Development (BE) in Union Budget and BfC ( 2008–2009 to 2013–2014) (in Per cent)
FIGURE 3.2 || Average Share of Development BE within BfC
( 2008–2009 to 2013–2014) (Per cent)
1.00
Child Development
1.00
Other than Child
Development
21.75
Child Development
78.25
Other than Child
Development

43
Year Development
BE(`crore)
Union Budget BE
(`crore)
BfC BE (`crore) Share of Development (BE)
in Union Budget (Per cent)
Share of Development
(BE) within BfC
(Per cent)
2012–2013 17652.47 1490925 66633.75 1.18 26.49
2013–2014 19527.91 1665297 74939.76 1.17 26.02
Average 12134.97 1215737 55761.84 1.00 21.75
Rate of Change in Child Development
The average rate of change from 2008–2009 to 2013–2014 at BE stage was 26.02 per cent rang-
ing from 7.76 between 2008–2009 and 2009–2010 to almost 50 per cent between 2009–2010 and
2011–2012 for BE.
The rate of change is impacted by the increase in allocations or spending such as the increase in
2010–2011 and 2012–2013 was due to increase in allocation for the State government, Union Ter-
ritories and for the North Eastern & Sikkim Area as also the Special Component for schedule Caste
and Tribal Area Sub Plan.
The rate of change in the RE and the AE stage does not follow the same patterns. The rate of change
in RE in 2011–2012 (by 55.09 per cent) over the preceding year was due to higher allocation for the
Integrated Child Development Scheme (ICDS) in the State Government, Union Territories and
Northeastern Areas from `2992.90 crore (including State Govt, UTs & Northeastern) to `7047.21
crore (Table 3.2).
TABLE 3.2 || Rate of Change in Union Budget, BfC and Child Development Budget (Per cent)
Union BfC Child Development
Year BE RE AE BE RE AE BE RE AE
2009–2010 35.95 13.39 15.9 1.98 117.87 14.6 7.76 28.72 27.48
2010–2011 8.61 19.09 16.87 23.33 –44.06 11.81 48.18 19.87 24.37
2011–2012 13.44 8.4 8.94 –2.8 13.3 13.83 13.97 55.09 47.79
2012–2013 18.54 8.5 NA 27.09 9.73 NA 49.58 7.86 NA
2013–2014 11.7 NA NA 12.64 NA NA 10.62 NA NA
Average (BE) 17.65 -- -- 12.45 -- -- 26.02 -- --
Allocation & Expenditure under Child Development
The allocation for development (BE and RE as well as actual expenditure (AE) has seen a consistent
rise over the years Figure 4.4.
Some years have seen a substantial increase such as in 2010–2011 there was a sudden hike of 48.17
per cent with increased allocations for ICDS, Under ICDS—Supplementary Nutrition and World
Bank Assisted ICDS project IV, SABLA and Conditional Maternity Benefits Scheme (IGMSY), under

44
Grant in Aid to State government, Union Territories and North eastern & Sikkim Area. The following
financial year i.e., 2011–2012, it increased by 20.70 per cent (`1,1801.62 crore) (Figure 3.4).
Revised Estimates (RE) in
2009–2010 and 2011–2012
was higher than the BE. How-
ever, rest of the years RE head
had remained lower than BE.
During our study we have
found that there has been
over spending with respect to
both at the BE as well as RE.
There has been an average of
13.53 per cent over spending
till 2011–2012 which means
that the actual expenditure (AE) has been more than allocation (BE) in most years for the child
development sector (in 2008–2009 the BE was `6,485.10 crore whereas the AE was `6520.63, which
is 0.5 per cent over spending and in 2009–2010 the AE was 19 per cent more than BE) (Table 3.3).
This over spending might be because of excess expenditure in Rajiv Gandhi National Crèche
Scheme for the Children of Working Mothers. The only year that observed an under spending/
saving of the allocated funds was 2010–2011 (0.2 per cent under spending).
TABLE 3.3 || Allocation and Expenditure in Development Sector (`crore)
2008–2009 6485.10 6471.35 6520.63 35.5 0.5 –13.8 –0.2 49.3 0.8
2009–2010 6988.04 8329.82 8312.48 1324.4 19.0 1341.8 19.2 –17.3 –0.2
2010–2011 10354.70 9985.04 10338.16 –16.5 –0.2 –369.7 –3.6 353.1 3.5
2011–2012 11801.62 15485.56 15279.14 3477.5 29.5 3683.9 31.2 –206.4 –1.3
BE RE AE
0
5000
10000
15000
20000
6485.10
6988.04
10354.70
17.652.47
11801.62
19527.91
6471.35
8329.82
9985.04
16702.00
15485.56
0.00
6520.63
8312.48
10338.16
0.00
15279.14
0.00
2008-09 2009-10 2010-11 2011-12 2012-13 2013-14
FIGURE 3.4 || BE,RE & AE in Child Development (` Crore)
-5
0
5
10
15
20
25
30
35
0.5
19.0
-0.2
29.5
2008–09 2009–10 2010–11 2011–12
FIGURE 3.5 || Expenditure (AE) in Child Development ( 2008–2009 to 2011–2012)
(Per cent)

45
2012–2013 17652.47 16702.00 NA NA NA –950.5 –5.4 NA NA
Average
(till 2011-12)
8907.37 10067.94 10112.60 1205.24 13.53 1160.58 13.03 44.66 0.44
Table 3.4 shows the programmes and schemes where there was under-spending, which the appro-
priation accounts describe as ‘saving’. It must be of course pointed out that the saving of resources
also means that this amount was not invested in the implementation of planned programmes and
interventions, denying children the benefit from them.
TABLE 3.4 || Appropriation Account of Government of India ( 2008–2009 to 2010–2011) (` lakhs)
Year Scheme Total Grant Actual
Expenditure
Excess +
Saving –
2008–2009 National Institute of Public Co-operation and Child
2778.50 797.76 –1980.74
Rajiv Gandhi National Crèche Scheme for the Children of
Working Mothers
9610.00 8751.38 –858.62
Integrated Education in Nutrition 907 458.25 –448.75
2009–2010 National Institute of Public Co-operation and Child
2416.00 2150.00 –266.00
Working Mothers
9152.00 9994.27 +842.27
2010–2011 Integrated Child Development Services (ICDS) 2520.00 1913.04 –606.96
Rajiv Gandhi Scheme for Empowerment of Adolescent
Girls (RGSEAG)
300 22.07 –277.93
Indira Gandhi Matritva Sahyog Yojana (CMB Scheme) 200 32.25 –167.75
Integrated Education in Nutrition 1080 857.94 –222.06
Working Mothers
6335.00 6936.13 +601.13
2011–2012 Integrated Child Development Services (ICDS) 3052.00 2004.88 –1047.12
World Bank ICDS IV Project 7500.00 0 7500.00
Working Mothers
7651.00 7383.5 –267.50
Rajiv Gandhi Scheme for Empowerment of Adolescent
Girls (RGSEAG)
720 60.25 –659.75
Indira Gandhi Matritva Sahyog Yojana (CMB Scheme) 580 108.24 –471.76

46

47
A Closer Look at the Schematic Allocations under the Child
Development Sector
Integrated Child Development Scheme
The Ministry of Women and Child Development has the responsibility to ensure the rights of the
child to life and survival, enhancing physical, psychological cognitive development and emotional
and social wellbeing, access to nutrition education and health care.
Integrated Child Development Scheme is the largest
flagship programme for Early Childhood Develop-
ment aiming at improving the nutritional and health
status of children from 0-6 years of age group. ICDS
was launched in 1975 in 33 blocks (projects) with
4,891 AWCs34
. It also has a component addressed
to the adolescent girls and lactating mothers. There
were 7,076 ICDS Projects with 13.72 lakh Angan-
wadi Centres/mini-Anganwadi Centres sanctioned
as on 31 December 2012.
As on 31 January 2013, 7,025 projects and 13,31,076 AWCs are operational across 35 States/UTs,
covering 927.66 lakh beneficiaries under supplementary nutrition and 346.66 lakh 3-6 years chil-
dren under pre-school component.35
Although ICDS has the potential to impact reduction of mortality, morbidity and under nutrition
amongst children and pregnant women, its impact on child survival and development has not been
convincing, provoking debate and questions over its service delivery and quality. Although the ser-
vices are much in demand, they have been generally poorly delivered and uncoordinated.36
As per the Appropriation account 2008–2009, there was a saving of `2731.67 lakhs (against the
sanctioned provision of `4220.00 lakhs), which was due to non-receipt of complete proposals from
the States and concerned organisations. In 2009–2010, saving of `1920.20 lakhs (against the sanc-
tioned provision of `3459.00 lakhs) occurred due to receipt of less viable proposals from States and
Union Territories (without legislature), non-holding of award function for Anganwadi workers and
availability of unspent balances with Life Insurance Corporation. In 2010–2011 saving of `606.96
lakhs (against the sanctioned provision of `2520.00 lakhs) was due to delay in receipt of inward
claims from Union Territories of Chandigarh and Dadra & Nagar Haveli and in 2011–2012 saving
`1047.12 lakhs (against the sanctioned provision of `3052.00 lakhs) was due to delay in receipt of
claims from Union territory of Delhi and Dadra & Nagar Haveli.37
34 Annual Report 2012–2013 – Ministry of Women and Child Development (accessed on 12.05.2014).
35 Annual Report 2012–2013 – Ministry of Women and Child Development (accessed on 12.05.2014).
36 Report of the Sub-Groups on Child Rights for 12th Five Year Plan http://wcd.nic.in/reportsgdtd01032012.pdf (accessed on 09.05.2014).
37 Appropriation Account ( 2008–2009 to 2011–2012)- Ministry of Women and Child Development (accessed on 15.05.2014).
Some reasons attributed for under-spending/saving in ICDS:
Non-receipt of complete proposals from the States and
concerned organizations
Receipt of less viable proposals.
Non-holding of award function for Anganwadi workers
and availability of unspent balances with Life Insurance
Corporation.
Delay in receipt of inward claims.

48
As per economic survey of India 2012–2013, ICDS has been now universalised with cumulative
approval of 7076 projects and 14 lakh AWCs including 20,000 anganwadis ‘on demand’. A proposal
for strengthening and restricting of the ICDS scheme with an overall budget allocation of `1, 23580
crore during Twelfth plan has been approved and will be rolled out in all the districts in three years.
Greater emphasis is being laid on awareness generation, convergence with the MGNREGA, and
MIS-based monitoring.38
The World Bank Assisted ICDS-IV Project
Since 1980, when the World Bank began supporting ICDS, it has completed six projects in support
in an effort to contribute to improving malnutrition and early childhood development in India.
The Government of India has now expressed strong interest in continuing the World Bank support
for the next five-year cycle, which is referred as the ICDS IV project for the period 2008–2009 to
2013–2014.39
The Cabinet Committee on Economic Affairs (CCEA) has approved implementation of the Interna-
tional Development Association (World Bank) assisted ICDS Systems Strengthening and Nutrition
Improvement Project (ISSNIP) in its meeting held on 4 October 2012, with a total outlay of `2,893
crore over 7 years. The cost sharing ratio for the project between the World Bank and Government
of India is 70:30 and that between GoI and States is 90:10.
The project is proposed to be implemented in 162 districts having higher proportion of malnour-
ished children in eight States, viz. Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Maharashtra,
Rajasthan, Uttar Pradesh and Andhra Pradesh along with urban pilots in and around NCR of Delhi
and convergent nutrition actions pilots in some selected districts in two other States viz., Odisha
and Uttarakhand.
For this, in the Annual Plan 2012–13, an amount of `102.80 crore (with `71.96 crore as EAP Com-
ponent) was allocated at BE stage. However, the amount was reduced to `8.00 crore at RE stage,
against which expenditure for an amount of `7.79 crore (97 per cent of RE) has been incurred till 8
March 2013.40
As per Appropriation Account of MWCD, in 2011–2012, under World Bank ICDS IV Project a sum
of `7500.00 lakhs remained wholly unutilized due to non-receipt of approval from the Planning
Commission. The anganwadi centre, set up under the ICDS, is the nodal body for a number of other
initiatives.
Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG) –
SABLA
‘Rajiv Gandhi Scheme for Empowerment of Adolescent Girls-Sabla’ was introduced in 2010. It is a
comprehensive scheme for the holistic development of adolescent girls. Sabla is being implemented
38 Economic Survey of India - 2012-2013 (accessed on 20.05.2014).
39 http://wcd.nic.in/icds_iv_handbook_(for_website).pdf (accessed on 20.05.2014).
40 http://wcd.nic.in/publication/AR201213_english.pdf (accessed on 20.05.2014).

Budget for Children in India 2008–2009 to 2013–2014

Budget for Children in India 2008–2009 to 2013–2014

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