Expenditure on health schemes continues to remain stagnant despite several commitments by the government. The UPA, in the National Common Minimum Programme in 2004, mentioned that total public spending in health would be raised to level of two to three percent of the GDP. But no adequate financial resource was allocated. The combined budgetary allocation (i.e., the total outlay from both union and state budgets) for health stood at a meager one percent of GDP for 2009-10. While state figure is yet to be estimated, figure for central budgetary estimate remains at 0.33 percent for 2011-2012.

The report backs the suggestion of high level expert group on universal health coverage, formed by the planning commission to make healthcare an ‘entitlement to every citizen’.

The centre for budget and governance accountability (CBGA) has come up with these figures in its recent report revealing the weaknesses in India’s health financing system. The CBGA report outlays the allocation and expenditure by central and state governments on flagship health schemes, like National Rural Health Mission (NRHM).

According to the report, there has been a substantial increase in the per capita expenditure on NRHM (from 40 in 2006-7 to 113 in 2009-10) and it is more visible in the North Eastern states.  With a decline in infant and maternal mortality rate, there has been improvement in outcomes. However, the huge shortfall in human resources impairs proper functioning of NRHM.

Although the scheme provides for one accredited social health activist (ASHA) per 1000 population, there is not even one ASHA per village in the country (638,588 villages as per Sample Registration System, 2007). The number of auxiliary nurse midwives (ANMs) at public health centres (PHCs) and sub-centers are close to the required number, but the situation with respect to male health workers is different. The shortage is acute in Arunachal Pradesh, Bihar, Tamil Nadu and Rajasthan where it ranges from 80 to 90 percent.

The report says that the inter-state allocation issue needs to be addressed where allocation of funds seems to be driven by state’s share of rural population. For example, Rajasthan received only 5.8 percent of NRHM funds from 2005-06 to 2009-10 although it accounts for about 10 percent of maternal deaths in the country. Whereas Maharashtra received more than seven percent of NRHM funds despite lower mortality figures.

Health management information system data suggests that utilisation of funds at the state and district levels is not uniform with states and districts being able to spend money on some activities while funds for other areas are not used. Funds for family planning, janani suraksha yojana, intensive pulse polio immunisation and activities carried out by agencies like UNICEF were better utilized.

The out-of-pocket expenditure on healthcare is almost 80 percent in the country where 70 percent goes into buying medicines. To reduce health care burden on people it is important for the government to provide essential medicines for free and reconfiguration of the entire health system making it an insurance based system.

The report lauds efforts of the government that the Approach Paper of the 12th Plan recognises the need of comprehensive health care with greater emphasis on communicable diseases, preventive health care, need for upgradation of rural health care services to Indian Public Health Standards with districts as the unit for planning and training.