Measures taken by the National Health Mission (NHM) have given a positive fillip to the health sector across the country in the past 15 years, a study published in the Public Health For All journal has concluded.
The States received funding only if they complied with the Central Government’s schemes, and States were nudged to enhance investment in primary health care. This had a positive impact, write researchers Shankar Prinja, V.R. Muraleedharan and Girija Vaidhyanathan in Financing Primary Healthcare Fiscal Federal Relations in India in the journal published by India International Centre.
The researchers studied the impact of public health policies and the Centre’s contribution in four States – Tamil Nadu, Kerala, Haryana and Bihar. They found that States had slowly increased allocation to their health budgets. The target of 8% of total State budget has yet to be achieved. The target was envisaged in the National Health Policy of 2017. In 2018-2019 states spent an estimated 5.2% of the total budget on health.
That NHM’s conditional allocation has helped is seen from the steady fall in the country’s infant mortality rate. Also, the disparity in per capita public spending across States has reduced. But health departments continue to struggle with the issue of underspending of allocated funds. The NHM is not likely to withdraw conditions to contributions it makes to the States in “the near future” given that the NHM is invested with implementing centrally-sponsored schemes with a sizable allocation, the researchers conclude.
States must develop concrete plans to build their primary health care delivery system to achieve one of the key objectives of the NHM – universal health coverage. For States to develop a clear road map, the Centre must develop a National Database of Health System Cost, which should be updated with the estimated cost of comprehensive primary health care, researchers recommend.
They posit that the way forward is to make realistic estimates of the cost of delivering (primary, secondary and tertiary) healthcare; to arrive at a threshold level of cost-per year of quality adjusted life year (QALY) gained through primary healthcare interventions.
