A Comment on Maharashtra’s Public Health Expenditures

Maharashtra is one of the most developed states in India with an income of over 1540000 crores (per capita 130,000) but despite this it is projected to spend only Rs. 7400 crores on public health services (including medical education and capital expenditure) in 2013-14 or a mere 0.48% of the total income of the state. This is in sharp contrast to the peak that Maharashtra had reached of 1% of SDP and 6% of government expenditure for public health expenditure in 1985-86. Since then the trend has been downwards declining rapidly through the nineties and the new millennium, which was contradictorily the period of high economic growth. (see Table below for trends in public health spending).

Maharashtra Public Health Expenditure Trends and  Key Ratios

	1985-86	1995-96	2001-02	2006-07	2008-09	2010-11	2011-12	2013-14 BE
Public Health Expd  Rs.bill	2.77	9.06	15.82	23.24	32.05	46.5	54.1	73.9
Per capita Rs.	63.73	105.95	163.89	220.28	294.31	413.70	474.15	629.47
% to Govt exp	5.97	5.18	4.22	2.96	3.21	3.74	3.83	4.11
% to SDP	1.0	0.70	0.74	0.40	0.42	0.45	0.45	0.48

Source: Maharashtra Civil Budget Estimates, various years; Maharashtra Economic Survey, various years

While we do see a small upturn presumably due to NRHM in the last few years it is certainly not commensurate both with Maharashtra’s high income growth as well as with what is happening in a number of other states who are catching up with Maharashtra in their health outcomes. Infact Maharashtra’s rank in key health outcomes has declined in recent years. For instance Maharashtra’s rank among all states with respect to IMR is 12 but its neighbor Goa with an IMR of 10 in contrast to Maharashtra’s 28 has the lowest IMR in the country.  Goa’s extraordinary performance is due to its much better endowed public health system as well as a high level of public health spending of Rs. 2213 per capita in 2010-11 which was over five times of what Maharashtra spent in the same year. Within Maharashtra if we look at the Mumbai Municipal Corporation we see that it has budgeted to spend as much as Rs. 2509 crores or about Rs.1800 per capita (this excludes what the state government spends in Mumbai) in 2013-14 nearly three times of what the state government spends on average in the state.

So what is very clear when we look at Maharashtra’s health  budget is that too little is being allocated and this then gets reflected in the pathetic situation of public health and public health facilities – huge vacancies in Rural Hospitals and other hospitals as well as PHCs, especially of doctors, specialists and nurses, gross inadequacy of drug supplies in public facilities, poor maintenance of public health facilities and key equipment etc.. The CBM (Community Based Monitoring) process is Maharashtra which is exerting demand side pressure is a good opportunity to pressurize the state government to raise substantially public health budgets. To begin with if Maharashtra is able to reach the national average of 1% of SDP immediately it will be a great step and then it can gradually move towards the UPA goal of 3% of GDP.

Ravi Duggal