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
