written for CBGA's Budget Track - special issue on the 14th Finance Commission
Resource distribution between Centre and States is determined by
provisions in the Constitution. The subjects are divided between the Centre and
States and post 73rd/74th Amendment also further devolved
to districts, municipalities and panchayats. There is a constant tussle between
the Centre and States for a fair share of the resources and the mandate to
determine this is given to the Finance Commission under Article 280. Each five
years the Finance Commission defines the envelope of the share between the
Centre and States as well as determines the broad parameters for sectoral
allocations which states receive from the Centre’s share (Article 275) through
the Planning Commission and/or centrally sponsored schemes. The Centre under
Article 282 can also give discretionary grants as per its own prerogative.
On the state’s part they want a larger share in the overall
envelope so that they can autonomously design their own policies and programs.
At present states feel constrained in terms of resources earmarked as their
direct share from the national kitty. They get only about 32 percent directly as
their own share and the remaining from the central pool. From the latter the
states get about half the share through policies and programs that is
determined by the Centre mostly via the Planning Commission.
Politics
of Fiscal Federalism
Being a federal country the states are perhaps right in their
assertion that the share they get directly as their own resources is quite
meagre and inadequate for them to plan boldly, especially for key social sector
allocations like health, education, social welfare, rural development etc..,
which are all primarily state subjects. In reality the states get only about
one-third share of the revenues but share the burden of over two-thirds of the
expenditure. This imbalance of spending with limited resource generation
sources, since the Centre appropriates the main sources of revenues under its
control, reduces state’s capacity to develop on its own free will. Given this
asymmetrical fiscal federalism, the politics within the states has been
changing over time with regional parties becoming dominant and national parties
increasingly becoming dependent on the regional parties in coalition
governments. This political scenario is now exerting pressure on liberalizing
the fiscal federalism towards a much larger share for states but such a demand
for increased regional hegemony is often construed by the Centre as being
“anti-national” and weakening the unified integrity of the Indian nation state.
The Centre’s logic is that if states get a larger share directly or
they are given more lucrative revenue raising options under their control there
would be unhealthy rivalry amongst states leading to unnecessary conflicts
which would be a burden for the Centre to manage. Further the huge regional
imbalances of resources and capacities across different states, backwardness in
development etc. may get exacerbated if the Centre has less control over
distribution of resources. Also the states’ fiscal management capacities are
questioned given that their ability to manage existing resources is weak and an
increased volume of resources may be beyond their “capacity to absorb”.
The Quest
for Fiscal Devolution
Politically the trend over the last two decades has been greater
decentralization wherein more powers and subject devolution has moved from
Centre to States and from States to local governments. Representative
governance has been devolved, administrative devolution has happened but there
is strong reluctance by the Centre for fiscal devolution. As mentioned earlier
politics and administration has regionalized and good governance is not possible
without adequate control over fiscal resources. So the new battle-ground in
Centre –State relations is going to be greater fiscal devolution and so the
task of the 14th and subsequent Finance Commissions is going to be
achieving a more acceptable balance in resource distribution both between
Centre and States as well as across sectors, especially the share for social
sectors like health, education, social security, employment guarantee, food
security, social welfare, dalit and adivasi development etc., given that many
of these entitlements are being legislated into rights.
During the UPA decade under the flagship programs such
entitlements have increased and have raised demand expectations. Resource
commitments by the Centre to these flagships have also seen an increase but
most of these programs being state subjects one has not seen in most states any
substantial increases in state budget commitments. While allocations may have
increased gross underspending happens and for this the Centre blames the states
for lack of absorptive capacity. Is this allegation by the Centre correct? The
story is not as simple as it is made out to be. The political economy of
absorptive capacity is quite devious. I will illustrate this through the
example of the health sector.
Absorptive
Capacity Issue – the case of the Health Sector
To begin with I want to give the example of how underfunding
destroyed one of the best healthcare systems in India, the health services run
by the Municipal Corporation of Greater Mumbai (MCGM). Right through the
sixties, seventies and eighties between one-fourth and one-third of the MCGM
core budget was committed to public health and healthcare services. Almost
everyone in Mumbai, especially for hospital care, utilized these services even
though there was overcrowding and waiting in long queues. At the turn of the
nineties, under structural adjustment reform policies the MCGM too came under
its impact and social sector expenditures were compressed and a declining trend
emerged. From 25 percent of its budget for healthcare in 1991 to 15 percent by
1996 and down to an abysmal 9 percent in 2014[1]
the public health services of MCGM were starved of resources resulting in
crippling them. The first impact was on consumables like medicines and
diagnostic inputs for which prescriptions were provided to procure privately,
next was maintenance of facilities and equipment which created frustration
amongst staff and patients. The consequence was that the middle class patients
deserted the system and opted for the emergent health insurance option, often
with employer support, for treatment in private hospitals. This was a
tremendous loss to the public health system as the voice of the system that
kept it on its heels was snuffed out. As though this was not enough the MCGM
introduced user fees from 1999 and this was the proverbial last straw that
broke the camel’s back. Next a lot of the dedicated health professionals left,
new recruitments stopped and the public health system, from a universal access system,
became a system for the poor and consequently it became a poor and
underfinanced system. This is reflected in declining budget commitments over
the last two decades and which is at its lowest today.
Why I have narrated the Mumbai story is because there is an
important message in it for the Finance Commission to reflect upon - running
any service delivery system requires a reasonable amount of resources which
need to be costed properly. The failure to do so in India has wasted huge
resources in the social sectors, especially health and education. Health
centres and hospitals, schools and colleges are set up without proper
determination of unit cost of these services for the population it is supposed
to serve. Budget allocations are made in an ad
hoc manner and consequently they do not result in effective services and
benefits that reach people. For instance according to WHO to run a robust
comprehensive primary health care system with adequate support of secondary and
tertiary services a country on average would need to invest about 5% of its
GDP. In India’s case we are still hovering around 1% of GDP despite the UPA
promise of upto 3% GDP commitment before the end of its term. Without such a
volume of rationally allocated resources the healthcare system will continue to
remain a targeted and selective health system which would prevent any
significant progress towards better health outcomes. The Finance Commission
needs to consider this very seriously and push for budgetary allocations which
have a rational cost basis. The absence of the latter is what brings to the
fore the question about absorptive capacity.
To illustrate the problem of absorptive capacity let us look at
how resources are allocated. A Primary
Health Centre is set up, staff sanctions are made and most staff recruited,
medicines, diagnostics etc. are provided. But if we look at allocations they
are not adequate to meet the needs of the PHC which has to cater to 20000 to
30000 population. Studies for instance show that medicine requirement for
outpatient care is Rs. 50 to 60 per capita per year whereas the average PHC
gets only Rs. 8 to 10 per capita annually for medicines. Naturally this reduces
credibility of the PHC and only the very poor come to it. So there is clearly
underfunding in the PHC budget. Further because of the poor conditions of the
PHCs it is difficult to find doctors and nurses, the key professionals, to work
at the PHC. So because sanctioned posts are not filled there is underspending.
The story for rural, district and teaching hospitals is the same – underfunded
budgets, leading to loss of credibility, poor quality, frustration, sanctioned
posts not filled up leading to underspending. This underfunding and underspending
viciousness is the root cause of poor service delivery and this can certainly
not be termed as lack of absorptive capacity at the service delivery level.
The problem therefore is not the
absorption capacity but the bureaucracy itself which does not have the capacity
to plan and budget in a way that service delivery is appropriately structured
and financed so it can meet the demands of the people. Further, the central and
state bureaucracies are unwilling to let loose their control over the
healthcare delivery system, despite a lot of talk about decentralization. They
may allow decentralized planning through the panchayats and even provide some
untied funds for the direct use by the latter, but they will never transfer fiscal,
governance and management autonomy and control to units who directly provide services
and have to face the direct flak of people day in and day out for inadequate
and poor quality services. This is where the problem lies in resource
allocation and use. Those who deliver care, who understand and know the
situation and hence can plan and budget the resources, have no role in decision
making and those who govern from the state and national capitals take all
decisions without having a clue to what the ground realities are[2].
To conclude the question of absorptive
capacity is a convenient tool which the bureaucracy uses to circumvent real
issues that are a cause of the underfinancing and underspending of social
sector budgets. The lack of bottom up planning and budgeting that is based on expressed
needs and demands of the community for which services are being provided, and
the lack of decision-making power and autonomy to govern and manage the
provider institutions are the main causes for poor service delivery. This needs
to be remedied immediately if resources invested in public services have to
realize the policy goals. The 14th Finance Commission must engage
with these concerns and suggest mechanisms which will strengthen local
capacities to take charge of fiscal management and determine their own
budgetary requirements to fulfil demands of its communities.
[1]
Budget documents of various years of the MCGM; also see DNA Mumbai edition
25-09-2013 Minimum Healthcare for Maximum City (pg 4) and Ravi Duggal: An
increase in healthcare budget to 1991 levels is urgent need DNA 25-09-2013 (pg
4)
[2]
Ravi Duggal: Sinking Flagships and Health Budgets in India, Economic and
Political Weekly, Vol XLIV No 33, Aug 15 2009
