Rema Nagarajan,TNN | Mar 25, 2014,

  • State spending on health ranges from 4-6 % of the total expenditure for all larger states. Delhi, which allocates 12% of its expenditure on health is an exception, but is not strictly comparable. 
For one, Delhi has several large secondary and tertiary care hospitals which seem to eat up a lot of the funds while primary healthcare suffers, as is evident from the fact that Delhi has the highest IMR among all metro cities and its immunization coverage is barely 72%. Also, as Delhi does not have policing as part of its functions, it is spared a large chunk of spending that can be distributed across other heads.

In terms of outcomes, however, differences across states are significant. Southern states, Maharashtra, Punjab, Haryana and Himachal figure among the best on most indicators, the Hindi heartland among the worst, Gujarat, Bengal, Odisha in the middling range. In coverage of immunization, apart from UP and Bihar with 49% and 40% coverage, several others too don’t achieve the national average of 61%, viz. Assam, Chhattisgarh, Gujarat, Jharkhand, Odisha and Rajasthan . Again, in terms of percentage of institutional deliveries, only three states achieve over 90% – Kerala, TN and Andhra. When it comes to total fertility rate (TFR), a measure of how many children on average a woman has, other than the usual suspects like Bihar and UP where TFR is over 3, even states considered highly developed have a poor record . For instance, Gujarat and Haryana with 2.3, are over the replacement level TFR of 2.1. The replacement rate is the level at which the population would neither rise nor fall. Just nine of the 21 large states have a TFR of 2.1 or less.

While the National Rural Health Mission (NRHM) launched in 2005 has ensured a boost in spending in rural health, especially in terms of physical infrastructure, the shortfall in the numbers of sub-centres , primary health and community health centres in some of the worst performing states such as MP, UP and Bihar remains huge. There remains massive shortfall in personnel including nurses, lab technicians, pharmacists and doctors. Shortage of health personnel is most shocking for specialists, which include gynaecologists, paediatricians, surgeons and physicians. Shortage of specialists is well over 90% in states like Haryana, Gujarat, Himachal and Rajasthan.

Child and maternal deaths may be basic indicators that reveal the state of a healthcare system, some of the most significant causes of death and disease in India among adults are vascular diseases, chronic respiratory diseases, diabetes, tuberculosis, road traffic injuries and cancer. All these account for high expenses on medicines, which comprise almost 75% of out-of-pocket health expenditure. However, barring a few states like TN, Rajasthan and Kerala, the free drug distribution programmes of most states are riddled with inefficiencies.

In 2010, TN and Kerala spent the highest, over 12% of their health budget, on medicines. MP spent 9.3%, Karnataka 6.3%, Haryana 5.5% and Maharashtra just 5.2%. Bihar more than doubled the amount it spent on purchasing drugs – from 3.1% in 2001 to 7.6% in 2010; Gujarat increased it from 3.7% to 7.6% for the same period , while Bengal raised it from 4.3% to 6.8%. UP increased it marginally, from 5.2% to 5.3%.

With basic health indicators in such a dismal state and the demographic transition leading to an increasingly aging population, states have their tasks cut out. As diseases that push up in-patient care – like renal and heart diseases and cancers – grow, a business-as-usual approach clearly won’t suffice.

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