Syllabus
GS Paper 2 – Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Context
Fiscal space and good operational frameworks at the State-level could make a difference to the efficacy of the Budget allocations for health schemes.
Source
The Hindu | Editorial dated 5th September 2024
Gap between allocations for health, outcomes in States
The realisation of the full potential of Union Budget allocations for the health sector is heavily dependent on State-level implementation. Many of these allocations are made under Centrally Sponsored Schemes (CSS) , where States share a substantial part of the cost and bear the responsibility for on-ground execution. Success in utilising these funds effectively hinges on fiscal capabilities, operational frameworks, and addressing various systemic challenges at the State level.
Centrally Sponsored Schemes (CSS)
Are government programs implemented by state governments but funded primarily by the central government with a defined shareholding. This means that while the states are responsible for the execution of these schemes, the central government provides the majority of the financial resources.
- Key features of CSS:
- Shared funding: The central and state governments contribute to the scheme’s funding in predetermined ratios, which can vary depending on the specific scheme.
- Central guidelines: The central government sets the guidelines and objectives for the scheme, ensuring consistency across states.
- State-level implementation: The state governments are responsible for implementing the scheme within their respective jurisdictions.
- Monitoring and evaluation: The central government monitors the progress of the scheme and evaluates its effectiveness.
CSS for Health Sector
Two examples for Centrally Sponsored Schemes in Health Sector are:
- Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM)
- Health and Wellness Centres (AB-HWCs): Establishes health and wellness centres at the grassroots level to provide comprehensive primary healthcare services, focusing on preventive and promotive health services.
- Block-level Public Health Units (BPHUs): Aims to create public health units at the block level to strengthen the district health system and address public health emergencies.
- Integrated District Public Health Laboratories (IDPHLs): Develops public health laboratories at the district level to ensure timely testing and diagnosis of diseases, improving surveillance and early detection of outbreaks.
- Critical Care Hospital Blocks (CCHBs): Establishes specialised critical care units in district hospitals to enhance their capacity to deal with emergencies and pandemics.
- Pandemic Preparedness: The scheme focuses on strengthening health infrastructure to prepare for future health crises, with provisions for robust surveillance systems, research, and healthcare delivery mechanisms.
- Human Resources for Health and Medical Education (HRHME)
- Expansion of Medical, Nursing, and Paramedical Colleges: Establishes new medical, nursing, and paramedical colleges, especially in underserved areas, to increase the availability of healthcare professionals across the country.
- Upgradation of District Hospitals: Attaches existing district hospitals to newly established medical colleges to improve medical training and healthcare service delivery in rural and semi-urban areas.
- Increase in Seats: Increases the number of seats in medical, nursing, and paramedical courses to address the shortage of healthcare professionals.
- Focus on Teaching Faculty: Aims to address the acute shortage of faculty in medical institutions by filling vacant teaching positions and improving recruitment.
- Specialised Training Programs: Focuses on providing continuous professional development and skill enhancement programs for healthcare workers.
Issues with these schemes
Low Fund Utilisation
- Poor Fund Absorption: In the PM-ABHIM, only 29% of the allocated budget was spent in 2022-23, and HRHME faced a similar fate with utilisation around a quarter of the budget.
- Reduced Budget Allocations: Due to persistent underutilisation, the central government reduced allocations in subsequent budgets.
- Administrative Delays: Complex administrative structures at the State level often result in slow fund disbursement and project delays.
- Overlap in Funding: Multiple funding sources with similar activities create confusion and hinder effective financial management.
Challenges in PM-ABHIM
- Complex Grant Utilisation: Only 45% of the 15th Finance Commission health grants were utilised between 2021-22 and 2023-24, largely due to complicated execution structures.
- Integration of Vertical Programmes: States need to integrate different public health laboratories, which requires significant planning and coordination across multiple health schemes.
- Construction Delays: Infrastructure projects under PM-ABHIM, like CCHBs and BPHUs, face delays due to bureaucratic red tape and stringent procedural requirements.
Faculty Shortage in Medical Colleges
- AIIMS Faculty Shortage: Over 40% of teaching positions in newly established AIIMS institutions are vacant, impacting the quality of education and health service delivery.
- State Medical Colleges: States like Uttar Pradesh have a 30% faculty vacancy rate in recently established government medical colleges, affecting their functioning.
- Specialists for Critical Care: A shortage of medical specialists, particularly in rural and semi-urban areas, hampers the establishment of Critical Care Hospital Blocks (CCHBs).
- Impact on Medical Education: The shortage of qualified faculty is a significant hurdle in the efforts to set up new medical institutions and expand existing ones.
Fiscal Space in States
- Recurring Costs after 2025-26: States will need to bear the recurring operational costs of health infrastructure built under PM-ABHIM once central support ends.
- Need for Fiscal Space: States must create the fiscal capacity to continue supporting infrastructure, staffing, and other recurrent costs, especially in regions with weak financial positions.
- Heavy Dependency on CSS: States rely heavily on central funding for health schemes, making the lack of fiscal space a critical issue for sustainable health outcomes.
- Competing Health Priorities: States also need to allocate funds for other CSS initiatives and their own health schemes, increasing the fiscal burden.
Way Forward
- Strengthen Fiscal Space at State Level: States need to allocate more resources to health and improve their fiscal management to sustain recurring costs after central support ends.
- Improve Public Financial Management
- Streamline Fund Disbursement: Simplify bureaucratic processes and introduce reforms to ensure faster and more efficient fund disbursement mechanisms.
- Better Monitoring Systems: Strengthen real-time monitoring and reporting systems for better tracking of fund utilisation and project progress.
- Address Faculty Shortages and Human Resource Gaps
- Recruitment Drives: Launch special recruitment campaigns for medical, nursing, and paramedical faculty in underserved regions, especially in rural areas.
- Capacity Building: Invest in training programs and skill development to build a robust pool of healthcare professionals.
- Incentivise Specialists: Provide incentives such as better pay, allowances, and housing to attract specialists and teaching staff to work in government institutions.
- Collaborate with Private Sector: Partner with private medical institutions and NGOs to fill teaching and specialist positions in public hospitals and colleges.
- Ensure Better Coordination in Scheme Implementation
- Simplify Scheme Guidelines: Make operational guidelines of schemes like PM-ABHIM and HRHME more user-friendly to reduce confusion and delays.
- Decentralised Planning: Allow States more autonomy in designing health infrastructure projects tailored to local needs while ensuring alignment with national objectives.
Conclusion
Addressing the challenges in health sector fund utilisation requires a multi-faceted approach that includes improving fiscal space, streamlining administrative processes, and building healthcare capacities. By strengthening both human and infrastructure resources, enhancing public financial management, India can ensure better utilisation of the allocated funds and achieve the desired health outcomes.
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Related PYQ
“Besides being a moral imperative of Welfare State, primary health structure is a necessary pre-condition for sustainable development.” Analyze. [ UPSC Civil Services Exam – Mains 2021]
Practice Question
Discuss the significance of centrally sponsored schemes like Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) and Human Resources for Health and Medical Education (HRHME) in strengthening India’s healthcare system. [250 words]
Guidelines to Answer
- Introduction:
- Briefly introduce PM-ABHIM and HRHME as key Centrally Sponsored Schemes (CSS) aimed at strengthening healthcare infrastructure and human resources in India.
- Body
- Emphasize the role of AB-HWCs, BPHUs, IDPHLs, CCHBs in improving health preparedness and critical care infrastructure.
- Highlight the expansion of medical, nursing colleges and the increase in healthcare workforce through HRHME, aimed at addressing healthcare professional shortages.
- Explain the challenges in fund absorption and execution delays at the state level.
- Recommend steps for strengthening state-level fiscal space and improving planning.
- Propose measures to enhance recruitment, training, and retention of healthcare professionals.
- Conclusion:
- Conclude by emphasizing the need for better state-level implementation and long-term planning to ensure the success of these schemes and improve healthcare outcomes.