In News

In early November 2021, a potentially game-changing and transformative development went by, almost unnoticed — the release of ₹8,453.92 crore to 19 States, as a health grant to rural and urban local bodies (ULBs), by the Department of Expenditure, the Ministry of Finance.

Significance of allocation

• It would be 2.3% of the total health expenditure (both public and private spending together) in India and 5.7% of the annual government health expenditure (Union and State combined - 2017-18 figures).
• It is equal to 18.5% of the budget allocation of the Union Department of Health and Family Welfare for FY 2021-22 and around 55% of the second COVID-19 emergency response package announced in July 2021.
• The single most significant health allocation in this financial year with the potential to have a far greater impact on health services in India in the years ahead.

What went wrong?

• The government funding for urban primary health services was not channelled through the State Health Department and the ULBs did not make a commensurate increase in allocation for health.
• In 2017-18, 25 years after the Constitutional Amendments, the ULBs and RLBs in India were contributing 1.3% and 1% of the annual total health expenditure in India.
• There was a Resource crunch or a lack of clarity on responsibilities related to health services or completely different spending priorities.
• Lack of coordination between a multitude of agencies which are responsible for different types of health services (by areas of their jurisdiction)
• In urban settings, most local bodies were spending from less than 1% to around 3% of their annual budget on health, almost always lower than what ULBs spend on the installation and repair of streetlights.
• Urban India, with just half of the rural population, has just a sixth of primary health centres in comparison to rural areas.

Effective measures

• The grant should be used as an opportunity to sensitise key stakeholders in local bodies, including the elected representatives (councillors and Panchayati raj institution representatives) and the administrators, on the role and responsibilities in the delivery of primary care and public health services.
• Awareness of citizens about the responsibilities of local bodies in health-care services should be raised. Such an approach can work as an empowering tool to enable accountability in the system.
• Civil society organisations need to play a greater role in raising awareness about the role of LBs in health, and possibly in developing local dashboards (as an mechanism of accountability) to track the progress made in health initiatives.
• Mechanisms for better coordination among multiple agencies working in rural and urban areas should be institutionalised.
• Time-bound and coordinated action plans with measurable indicators and road maps need to be developed.
• The young administrators in charge of such RLBs and ULBs and the motivated councillors and Panchayati raj institution members need to grab this opportunity to develop innovative health models.

Way Forward

• India’s health system needs more government funding for health. However, when it comes to local bodies, this has to be a blend of incremental financial allocations supplemented by elected representatives showing health leadership, multiple agencies coordinating with each other, increased citizen engagement in health, the setting up of accountability mechanisms and guiding the process under a multidisciplinary group of technical and health experts.