Qual­ity care will boost fam­ily plan­ning ef­forts

De­spite pop­u­la­tion sta­bil­i­sa­tion be­ing a crit­i­cal area, bud­getary al­lo­ca­tions have been skewed and in­suf­fi­cient

Hindustan Times (Gurgaon) - - Comment - POOnaM MUt­trEJa Poonam Mut­treja is ex­ec­u­tive di­rec­tor of Pop­u­la­tion Foun­da­tion of India. The views ex­pressed are per­sonal.

Apos­i­tive for the health sec­tor in last year’s Union Bud­get was the stated goal to in­crease India’s health sec­tor spend­ing from the cur­rent 1.15% of GDP — one of the low­est world­wide — to 2.5% by 2025. One needs to look at bud­getary pro­vi­sions from the per­spec­tive of fam­ily plan­ning.

Ac­cord­ing to the 2015-16 findings of the Na­tional Fam­ily Health Sur­vey 4, the to­tal de­mand for fam­ily plan­ning (FP) among cur­rently mar­ried women be­tween the ages of 15 and 49 is 66%. The un­met need for FP ser­vices is 13%, de­clin­ing by just 1% over the last decade. Less than half (48%) of cur­rently mar­ried women aged 15–49 years use mod­ern con­tra­cep­tives. De­spite ev­i­dence that fam­ily plan­ning is a crit­i­cal area from the per­spec­tive of re­duc­ing ma­ter­nal and infant mor­tal­ity, al­lo­ca­tions have been skewed and in­suf­fi­cient.

Ex­am­in­ing the bud­getary al­lo­ca­tions and ex­pen­di­ture of­fers some in­sight into the rea­sons for the tardy pace in India’s progress on fam­ily plan­ning. The FP com­po­nent gets about 4% of the to­tal bud­get avail­able un­der the Na­tional Health Mis­sion’s re­pro­duc­tive and child health flexi-pool. Anal­y­sis of data shows that in the fi­nan­cial year 2016-17 only 60.7% of the funds avail­able for fam­ily plan­ning were spent. The na­ture of al­lo­ca­tions and spend­ing, whichcur­rent­ly­fo­cus­es­dis­pro­por­tion­ate­lyon ter­mi­nal meth­ods rather than sup­port­ing the pol­icy ob­jec­tives to pro­mote spac­ing be­tween chil­dren and im­prov­ing the qual­ity of care, is a mat­ter of con­cern. For proper spac­ing of chil­dren, women need re­versible con­tra­cep­tive meth­ods. In 2016-17, 64% of the FP bud­get was al­lo­cated to ter­mi­nal and lim­it­ing meth­ods, while just 3.7% went to­wards spac­ing meth­ods. There are also se­ri­ous lim­i­ta­tions in the ca­pac­ity to utilise the funds avail­able for fam­ily plan­ningattheim­ple­men­ta­tion­stage.Forin­stance, 40%ofthe­moneyal­lo­cat­ed­for­re­versiblemeth­od­sre­maine­dunutilised. Ade­cen­tralised,par­tic­i­pa­tory plan­ning process that fac­tors in ac­tual needs and re­source re­quire­ments of dis­tricts, and sys­tem­atic track­ing and mon­i­tor­ing of the spend­ing will im­prove util­i­sa­tion.

In 2016-17, al­most 81% of the FP bud­get was spent on com­pen­sa­tion to ben­e­fi­cia­ries, and in­cen­tives to front­line workers and health care providers of ter­mi­nal meth­ods of fam­ily plan­ning. The skewed em­pha­sis on tar­gets de­feats India’s de­clared pol­icy of pop­u­la­tion sta­bil­i­sa­tion through a rights-based ap­proach to fam­ily plan­ning and re­pro­duc­tive health.

There is ev­i­dence on the ground to show that when there are im­prove­ments in the qual­ity of care, they’ve re­sulted in a dra­matic rise in up­take of fam­ily plan­ning ser­vices. The govern­ment needs to in­crease al­lo­ca­tions and strengthen the sys­tems that would en­able bet­ter util­i­sa­tion of fam­ily plan­ning bud­gets.

In Delhi’s po­lit­i­cal imag­i­na­tion, the real po­lit­i­cal bat­tle of 2018 be­gins in Kar­nataka. It then ends with the three states of Ra­jasthan, Mad­hya Pradesh and Ch­hat­tis­garh, set­ting the stage for the Lok Sabha polls of 2019. But be­fore that, in Fe­bru­ary, three key North­east­ern states — Na­ga­land, Megha­laya and Tripura — go to polls. And to un­der­es­ti­mate the im­por­tance of th­ese elec­tions for ei­ther the peo­ple of th­ese states or the na­tional polity would be a mis­take.

It is im­por­tant be­cause the thread of elec­toral democ­racy within the con­sti­tu­tional frame­work binds Na­ga­land, home to Asia’s old­est in­sur­gency and with a strong con­cep­tion of its own unique­ness and claims of sovereignty with India. Elec­tions have cre­ated and sus­tained a Naga po­lit­i­cal elite which stands at the forefront of de­fend­ing the In­dian sys­tem and is ready to un­furl the In­dian flag. It may not ad­dress the alien­ation of its peo­ple en­tirely — which is why the peace process with rebel groups is so im­por­tant — but a demo­cratic govern­ment pro­vides a chan­nel to ar­tic­u­late some of their con­cerns. This time around, elec­tions have be­come con­tentious. A sig­nif­i­cant sec­tion of Naga civil so­ci­ety and po­lit­i­cal opin­ion, tired of the long drawn peace talks and seek­ing clo­sure, wants a ‘so­lu­tion be­fore elec­tion’. But the Cen­tre is clear that this can­not be a rea­son to post­pone polls. BJP’s gen­eral sec­re­tary, Ram Mad­hav, has said the state needs ‘elec­tions for so­lu­tion’. As the peace talks en­ter the fi­nal lap, Delhi feels hav­ing an elected le­git­i­mate govern­ment in Ko­hima strength­ens its hands.

It is im­por­tant be­cause it has pro­vided a demo­cratic plat­form to trib­als in a Ben­galidom­i­nated polity like Tripura to ar­tic­u­late their as­pi­ra­tions. This, among other fac­tors, has weak­ened the mil­i­tancy that used to en­gulf the state till a decade and a half ago.

It is im­por­tant be­cause demo­cratic


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