UNHEALTHY STATE OF HEALTH MISSION
National Health Mission (NHM) funds not spent by states over five years to 2016 increased by 29 per cent, according to a recent audit by the Comptroller and Auditor General (CAG). It also reported delayed transfers and misallocation of these funds.
The NHM, launched in 2005, is India’s largest health programme aimed at providing universal access to health care. Among its primary missions are improving maternal and child health, and controlling communicable and noncommunicable diseases.
The NHM also disburses funds to state health societies to help strengthen local health systems, institutions and capabilities. Rural health centres in India are short of human resources and infrastructure. Sub-centres were 20 per cent short of human resources, 29 per cent of them did not have a regular water supply, 26 per cent lacked electricity supply and 11 per cent were not connected by allweather roads.
The government has denied charges of financial irregularities. Funds were being released as soon as states fulfilled the requirements for allocation, according to Manoj Jhalani, additional secretary and mission director, the NHM.
An analysis of the CAG audit highlighted the following problems in the disbursement and usage of health funds:
The amount not spent by state health societies went up from ~73.75 billion in 2011-12 to ~95.09 billion in 2015-16.
State treasuries delayed the transfer of ~50.37 billion and ~40.16 billion released in 2014-15 and 2015-16 to state health societies. The transfer that is supposed to take 15 days took between 50 and 271 days.
In six states — Andhra Pradesh, Gujarat, Jammu and Kashmir, Rajasthan, Telangana and Tripura — ~360 million was diverted to other schemes, such as the Mukhyamantri Shubh Lakshmi Yojana (chief minister’s scheme for baby girls) and the Sukhibhava Scheme (assistance for institutional deliveries) in Telangana.
As many as 18 states spent only 32 per cent of the allocation, which was already 36 per cent less.
“There are a number of reasons for unspent funds, ranging from the lack of human resources to complicated procedures for procurement in construction-related activities,” said Avani Kapur, fellow at the Centre for Policy Research and director of the Accountability Initiative. “Another key factor is the uncertainty in the timing and funds received under the scheme. There is often a mismatch in between the state/district administration demands and what is approved and received.”