New Delhi: The Union health ministry, which proposes to increase its budget for family planning in the next financial year, failed to use about 40% of its allocation for family planning programmes in the current financial year.

Only 60.7% of the funds allocated to the family planning programme have been used across states during the current financial year which would end in March, according to the ministry’s Financial Management Report 2016-17.

The budget allocation for family planning is currently only 4% of the total Reproductive and Child Health (RCH) flexi-pool budget.

According to the report, the lowest utilization of funds was recorded by Uttar Pradesh (38%), followed by Bihar (48%), and Chhattishgarh (49%) in the high focus category of states for family planning.

In the north-east, the lowest funds were utilized by Meghalaya (26%), Manipur (35%) and Sikkim (46%). Interestingly, national capital Delhi spent only 36% and Chandigarh 26% of the total funds allocated for family planning.

“Under National Health Mission (NHM), family planning is one of the major activities. The funds are approved activity-wise but are allocated and released to states pool-wise under NHM. Approvals are given on the higher side to improve the absorption capacity of the states,” Ashwini Kumar Choubey, minister of state for health told Lok Sabha last week.

“However, expenditure under the particular scheme depends on the overall availability of funds in a particular year. Moreover, public health being a state subject, its implementation primarily lies with the state. The government has proposed to increase the budget allocation under NHM for financial year 2018-19 to ministry of finance,” stated Choubey.

Public health experts say that poor resource allocation and low budget utilization exacerbate the inadequacy of financial resources for health. Effective allocation and utilization is also constrained by public financial management design, operational processes, and governance factors.

“There is persistent under spending of health budgets, which is worse in the poorer states. This is caused by problems in governance, public financial management design, and operational constraints. Because poorer states are more dependent on central subsidies, greater under spending of these subsidies affects them more,” said Peter Berman, health economist with Harvard T.H. Chan School of Public Health, who recently studied government financing of healthcare in India since 2005.

“More spending on health is needed, but it must be accompanied by better measures to improve the use of appropriated funds, especially where there is a dire need of healthcare funds,” he said.

The Union health ministry earlier this year launched Mission Parivar Vikas for over 146 high-fertility districts that have a total fertility rate (TFR) of 3 and above. TFR is the number of children who would be born per woman (or per 1,000 women) if she/they were to pass through the childbearing years bearing children according to a current schedule of age-specific fertility rates. At least 56% of the 261 districts are in the seven high-focus states—Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Jharkhand, Chhattisgarh and Assam.

These districts are currently contributing to 28% of India’s population.

“Attention to family planning is crucial for India in current times. As per the estimation of the government, if the current unmet need for family planning could be fulfilled within the next five years, India can avert 35,000 maternal deaths and 1.2 million infant deaths. If safe abortion services are coupled with an increase in family planning, the savings made to the country could be to the tune of Rs6,500 crore,” said Poonam Muttreja, executive director, Population Foundation of India.

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