Allocations for Health Sector: State-Level Challenges and Opportunities

Syllabus: GS2/ Health

In Context

• The Union Budget’s allocations for health sector initiatives like the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) and Human Resources for Health and Medical Education (HRHME) depend heavily on State-level implementation.
  • These Centrally Sponsored Schemes (CSS) require States to share costs and manage operations.

Key Issues Pertaining to This

• Low Fund Utilisation:
  • In PM-ABHIM, only about 29% of funds were utilised in 2022-23. In HRHME, fund absorption was similarly low.
  • Factors like complex grant structures and overlapping funding streams have slowed implementation. For instance, only 45% of the health grants from the 15th Finance Commission were utilised, highlighting inefficiencies in the system.
• Construction Delays:
  • Many scheme components involve construction, which is often delayed by rigid procedures and administrative hurdles. This affects fund absorption rates.
• Faculty Shortages:
  • A significant shortage of teaching faculty across newly created medical colleges, especially in Empowered Action Group (EAG) States like Uttar Pradesh, where 30% of teaching positions remain vacant. This shortage is particularly severe in rural Community Health Centres (CHCs), where two-thirds of specialist positions are unfilled.

Fiscal Constraints at the State Level

• States must bear the recurring costs of maintaining the health infrastructure built under PM-ABHIM and HRHME. Since the Union government’s support for human resources is limited until 2025-26, States will need to plan for long-term financial commitments.
• Creating fiscal space will be essential for sustaining these health initiatives and meeting additional costs.

Way Ahead

• Address Human Resource Shortages: Filling teaching faculty and specialist vacancies is critical to ensuring that new medical infrastructure is fully utilised.
• Improving fund utilisation through better public financial management processes at both the State and central levels can help accelerate implementation.
• Long-term Financial Planning: States need to plan for the recurring expenditures required to maintain the infrastructure built under these schemes, ensuring sustainable health services beyond 2025-26.
• Infrastructure Expansion: Expanding infrastructure beyond urban centres, particularly in underserved areas, is crucial for addressing regional health disparities.

Conclusion

• The success of Union Budget allocations for the health sector largely depends on overcoming the challenges at the State level, including better fund utilisation, addressing faculty shortages, and ensuring long-term fiscal planning. 
• Collaboration between the Union and State governments, along with improved implementation mechanisms, will be key to transforming these initiatives into meaningful health outcomes.