Que. Examine the factors that contribute to the gap between budgetary allocations for the health sector and the actual outcomes at the State level in India. Discuss how fiscal space and operational frameworks at the State level impact the efficacy of health schemes.
प्रश्न: स्वास्थ्य क्षेत्र के लिए बजटीय आवंटनों और राज्य स्तर पर वास्तविक परिणामों के बीच अंतर के कारकों का परीक्षण कीजिए। साथ ही, यह भी चर्चा कीजिए कि राज्य स्तर पर वित्तीय गुंजाइश और परिचालन स्वास्थ्य योजनाओं की प्रभावशीलता को कैसे प्रभावित करते हैं।
Structure(i) Introduction: Briefly state the gap between health sector budget allocations and outcomes. Also, highlight the importance of state-level execution for effectiveness. (ii) Main Body: Highlight the factors that contribute to the gap and how fiscal space and operational frameworks impact the efficacy of health schemes. (iii) Conclusion: Summarize the need to strengthen fiscal space, streamline operations, and enhance state-level accountability for better health outcomes. |
Introduction
The realization of budgetary allocations in India’s health sector largely depends on state-level factors, especially since many health schemes are implemented through Centrally Sponsored Schemes (CSS), which require cost-sharing and effective execution by the states. However, there is often a significant gap between allocations and actual outcomes due to a combination of fiscal and operational challenges at the state level.
Factors Contributing to the Gap
(i) Low Fund Utilization: Complex grant structures and bureaucratic delays hinder the efficient use of allocated funds. For instance, under the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), actual expenditure often falls short of budgeted allocations, affecting scheme outcomes.
(ii) Inefficient Financial Management: States often struggle with financial management, leading to significant underutilization of allocated funds. In the Human Resources for Health and Medical Education (HRHME) initiative, inefficiencies in deploying capital expenditures have resulted in lower-than-expected fund utilization.
(iii) Shortage of Human Resources: A severe shortage of healthcare professionals, particularly in newly established medical colleges and rural health centers, undermines the effectiveness of health schemes. States like Uttar Pradesh face challenges in filling vacant teaching and specialist doctor positions, limiting their ability to maximize health investments.
(iv) Weak Infrastructure: States often struggle to integrate new health schemes with existing programs. This lack of cohesion, coupled with inadequate health infrastructure in many regions, contributes to low service delivery, especially in rural and underserved areas.
(v) Administrative Complexities: Health schemes are frequently plagued by bureaucratic inefficiencies and the involvement of multiple agencies. For example, the implementation of Integrated District Public Health Laboratories (IDPHLs) requires complex restructuring of public health systems, leading to delays in execution and underperformance in health outcomes.
Impact of Fiscal Space and Operational Frameworks
(i) Limited Fiscal Space: While the central government funds initial capital expenditures, states must bear recurring costs such as salaries and maintenance. Limited fiscal capacity, as seen in several Empowered Action Group (EAG) states, restricts their ability to sustain health initiatives post-funding, as with PM-ABHIM beyond 2025-26.
(ii) Competing Budgetary Priorities: Health often competes with other sectors such as infrastructure and education for budgetary allocations. This imbalance affects states’ ability to prioritize healthcare spending, leading to a mismatch between allocation and outcomes.
(iii) Operational Complexities: Overlapping funding sources and complex bureaucratic processes slow the implementation of health schemes. For example, restructuring public health systems for Integrated District Public Health Laboratories has proven difficult, leading to delays and reduced efficiency.
(iv) Inadequate Monitoring and Accountability: Weak monitoring mechanisms at the state level limit accountability, resulting in poor implementation and leakage of resources. This lack of oversight further widens the gap between planned and actual health outcomes.
(v) Regional Disparities in Outcomes: States with stronger governance, such as Kerala and Tamil Nadu, show better outcomes in health schemes compared to those with weaker administrative structures like Bihar and Uttar Pradesh, further emphasizing the importance of robust state-level frameworks.
Conclusion
The gap between budgetary allocations and actual health outcomes at the state level in India is driven by fiscal limitations, inefficient operational frameworks, and weak governance structures. Addressing these issues requires improving fiscal space, enhancing coordination in the execution of health schemes, and focusing on capacity building, particularly in states with weaker health systems. Strengthening these areas is crucial to achieving the desired health outcomes and ensuring equitable access to healthcare across the country.
