The National Health Mission is the Government of India’s largest public health programme. It consists of two sub-missions: (1) National Rural Health Mission (NRHM) (2) National Urban Health Mission (NUHM).
Using government data, this brief reports on:
Trends in allocations, releases and expenditures for NHM
Trends in infrastructure and human resources in the rural health care system
Trends in maternal and child health
The Pradhan Mantri Gram Sadak Yojana (PMGSY) was launched by the Government of India (GOI) on 25 December, 2000 to provide all-weather road connectivity in rural areas. PMGSY is administered by the Ministry of Rural Development (MORD).
Using government data, this brief reports on PMGSY progress along the following parameters:
Overall trends in allocations and expenditures
Trends in sanction of projects
State-wise progress on road works completed
Overall progress in ensuring rural connectivity
India’s move to electrify every village and household in the country has been lauded as a success. Building on decades of targeted programmes and public investments by multiple governments, the country completed 100% village electrification in April 2018; a year after, it has electrified nearly all ‘willing’ households. Despite the time it took to get here, these achievements are important milestones in India’s development trajectory. But does connecting households to the electric grid resolve the electricity access challenge? The answer depends on whether electrons flow through the wires and whether all consumers are served equally and adequately.
Using government reported data, this brief looks closely at the effects of the Fourteenth Finance Commission (FFC) recommendations on state finances in Bihar, with a particular focus on effects on social sector investments.
The brief asks two key questions:
Did increased tax devolution result in enhancing fiscal space for states?
Has the changed fiscal structure resulted in any visible shifts in social sector investments at the state level?
Between FY 2006-07 and FY 2010- 11, allocations for the Ministry of Panchayati Raj (MoPR) more than doubled from 2,000 crore to 5,171 crore. In FY 2015-16, GOI discontinued key schemes run by the Ministry. Consequently, allocations have fallen to 95 crore.
BRGF has been discontinued in FY 2015-16. This brief reviews the performance of the scheme from its launch in FY 2006-07 to FY 2014-15.
BRGF is made up of two components: a) district component covering 272 backward districts across 28 states administered by the MoPR, and b) state component which includes a special plan for Bihar, Odisha and West Bengal, administered by the erstwhile Planning Commission.
Allocations for the state component have more than doubled from 2,130 crore in FY
2010-11 to 5,000 crore in FY 2013- 14. In contrast, allocations for the district component decreased by 45% during the same period.
There are two types of grants released under the district component — a Development Fund (DF) grant and a Capacity Building (CB) grant.
Release of funds has slowed down in the last three years. In FY 2014- 15, only 49% of total entitlements under DF and 21% under CB had been released. In fact, 32% districts got no DF releases in FY 2014-15.
Utilisation of funds under BRGF is high. Between FY 2009-10 and FY 2013-14, on average, 85% of total funds released under the scheme were spent.
Eligible districts received more than 5 times the money through MGNREGS than through BRGF district component.
In FY 2015-16, 34,699 crore was allocated to MGNREGS, accounting for 47% of the total MoRD budget. An additional 5,000 crore has been committed in 2015-16, based on resource availability.
The timing of fund releases has slowed down considerably in FY 2014-15. In FY 2013-14, 60% of the funds were released by the first quarter of the financial year. However, in FY 2014-15, only 43% had been released in the first quarter.
There has been a steady decline in persondays of employment generated in the last 3 years from 230 persondays in FY 2012-13 to 132 persondays in FY 2014-15 (till February).
In FY 2013-14, several states had spent more than the total funds available with them. Consequently, MGNREGS had an outstanding liability of 5,512 crore at the start of FY 2014-15.
Delays in payment is a serious problem. In FY 2014-15, 72% of all payments were delayed beyond 15 days. 13% of these were delayed by more than 90 days.
The Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) mandates a compensation to be paid to beneficiaries for delayed payments. However, only 6 states have paid any compensation, Maharashtra paid the highest amount at 6.6 crore.
The highest proportion of employment has been generated in the most backward districts of the country through the programme. Summary & analySiS
Total public health expenditure (GOI and states) more than doubled between FY 2008-09 and FY 2014- 15. However, as a percentage of GDP, expenditures in FY 2014-15 remained at 1.2% of GDP.
GOI allocations for NHM stand at 18,875 crore in FY 2015-16, an increase of 1% over FY 2014-15. However, the NHM website reports that allocations to the NRHM have fallen 8% from 18,229 crore to 16,809 crore from FY 2013-14 to FY 2014-15. In 2013, GOI launched the National Urban Health Mission(NUHM). However, allocations for NUHM are low at 5% of total NHM approvals in FY 2014-15. There are state-wise differences in expenditure of funds across various components of NRHM. In FY 2013- 14, while Tamil Nadu was able to spend 96% of approved funds under the Mission Flexi Pool, Uttar Pradesh spent only 38%.
There have been marginal improvements in health infrastructure. Between March
2013 and March 2014, shortfall in Primary Health Centres (PHCs) and Community Health Centres (CHCs) dropped by 1 percentage point each.
The number of medical professionals fell between FY 2013- 14 and FY 2014-15. The number of doctors at PHCs reduced by 7%, while the number of specialists at CHCs reduced sharply by 30%.
India has made some progress in health outcomes. Infant mortality rates fell to 40 deaths per 1,000 births in 2013, as compared to 57 in 2006.
With the launch of the Right to Free and Compulsory Education (RTE), the total SSA budget (including GOI and state shares) increased over 2-fold from `27,552 crore in FY 2009-10 to 69,982 crore in FY 2012-13. Since FY 2013-14, however, the total approved budget has been reducing. In FY 2014-15, 54,925 crore were approved under SSA, a drop of 22% from FY 2012-13.
There are differences between allocations proposed by states and those approved by GOI. In FY 2013- 14, only 51% of the proposed budget was approved. This improved marginally to 58% in FY 2014-15.
Padhe Bharat Badhe Bharat (PBBB) is a new initiative introduced by GOI in 2014 to improve comprehension and learning ability of children in Classes 1 and 2. With the launch of PBBB, investments in learning increased in Gujarat from 12% in FY 2012-13 to 21% in FY 2014-15.
Despite 5 years of RTE, compliance with infrastructure norms has been slow, particularly for provisions such as girls’ toilets, playground and construction of boundary walls. However, the number of classrooms in relation to students enrolled has increased from 32 in FY 2009-10 to 28 in FY 2013–14.
Compliance with RTE related norms doesn’t always lead to better learning outcomes. For instance, Kerala, which is ranked 1 in learning as per the National Achievement Survey for Class 8, is ranked 14 on the Educational Development Index (EDI).
Centre for Policy Research organized the ‘Dialogues on Private Sector Participation in Sanitation’ on March 14th, 2019, bringing in private-sector practitioners and infrastructure experts, sanitation sector professionals and policymakers to share their insights and experience. The objective of the Dialogue was to build knowledge-sharing networks, to learn from several state-specific implementation experiences and initiate a broader discussion on the potential for private sector participation in the sanitation value chain. The points of discussion include emerging structures of public private partnerships across the country in FSSM (Faecal Sludge and Septage Management) with possible service models for collection, conveyance and treatment alongside risks associated with them. The measures that can be taken from experiences in other urban infrastructure sectors have also been discussed.
Ayushman Bharat, under the aegis of the Ministry of Health and Family Welfare (MoHFW), was launched by Government of India (GoI) on 23 September 2018. The programme consists of two initiatives: (1) The Pradhan Mantri Jan Arogya Yojana (PMJAY); and (2) The establishment of 1.5 lakh Health and Wellness Centres (HWCs). Against the backdrop of the COVID-19 pandemic, this brief uses government data to analyse:
Past trends in GoI allocations, releases, and expenditures;
Eligibility and claims under PMJAY till September 2020; and
Number of operational HWCs, staff in-position, and footfall.