Health Financing in India A Case Study of Gujarat and Maharashtra
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- Title
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Health Financing in India
A Case Study of Gujarat and Maharashtra - extracted text
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Health Financing in India
A Case Study of Gujarat and Maharashtra
Study Sponsored by USAID
— wtuiary
ORC
OPERATIONS RESEARCH GROUP
BARODA
Health Financing in India
A Case Study of Gujarat and Maharashtra
'I
M. E. KHAN
C, V. S. PRASAD
I
I S
I
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OPERATIONS RESEARCH GROUP
Dr- VIKRAM SARABHAI MARG,
BARODA-390 007.
1985
PREFACE
The outlay in the Health Sector has increased many fold
over the last three decades - from 65,3 crores in the First
Five Year Plan to 2831.1 crores during the Sixth Five Year
Plan period. Apart from the public financing, the private
and voluntary organisations do contribute to the Health
Sector.
Individual families spend a portion of their
income topreserve the health of their members. However,
it is not precisely knownwhat is total outlay (from all
the sources) which is being spent towards Health and Family
Welfare Services and their respective shares in the total
expenditure. Further it is also clearly not known as to
which services are given more support by the government,
private and voluntary organisations.
For an effective planning and monitoring of health schemes
and programmes and in order to understand the various
sources from which money goes into the health and its .
subsectors viz. Medical, Public Health and Family Welfare
and how the total sectoral money is distributed a) to
different schemes and b) under various detailed heads like
sal.aryz drugs, materials and supplies, transport etc. perhaps
it is necessary to look into the health financing jnechanism
in India.
Further, it is also important to know as to what
proportion of the available resources are being spent
towards various MCH programmes. Such an exercise could
help in allocating the funds more meaningfully and may
facilitate in achieving the national genl of health For
All by 2000 A.D.
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Study of health financing in totality is an expensive and
time consuming effort as it demands probing of all sources
which concribute to the upkeep
of health of the people.
Some of the important sources are Publac Sources (Govt.)
Private Sources such as industries/ Voluntary and Charitable
Organisationsand Individual families.
Particularly the
first and the last ones are most important as these two
sources contribute the major share of the total expenditure
on health.
The present study is an attempt primarily to study the
expenditure pattern from public sources.
In the present
exercise a detailed analysis has been made of) the Sixth
Plan health outlays at the national level as well as for
the States of Gujarat and Maharashtra.
In case of the above
two states/ detailed analysis of total health care expendi
The study reveals that even though
ture has also been made.
the plan documents put lot of emphasis on MCH and training
of paramedical staff/ the same is not reflected either in
allocation or at actual execution level.
The study was undertaken on behalf of USAID/ New Delhi.
During the study, we have been immensely benefited by a
series of discussions with Dr. W.B. Rogers Beasley, Chief/
Office of Health/ Population and Nutrition, USAID# and his
other colleagues, particularly. Dr. John A. Rogosch and
Dr. Spencer M. Silberstein.
Their comments on the earlier
^e are equally thankful to the
draft vzere quite useful.
State and District Officials of Gujarat and Maharashtra,
who provided full support and cooperation in providing
necessary information. But for their support the study
could have not been completed.
for OPERATIONS RESEARCH GROUP
M*E. Khan
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CONTENTS
I.
Introduction
1. 1
Objectives of the Study
Data Collection
2
1. 2
1.3
Problems and Limitations of the Study
3
4
1.4
Structure of the Report
5
II
Review of Literature
2.1
Demand for Health Services
11
2. 2
Reasons for Not Seeking Government Medical Services
2.3
Coverage of Children Under Immunisation
12
14
2.4
Level of Infant Mortality and Major Causes of
Infant Deaths
Conclusions
2.5
III
17
21
3a 1
Health Financing Mechanism in India
Formulation of Five Year Plans
25
3. 2
Annual Plan
29
3.3
Release of Funds
32
IV
Sixth Five Year Plan Priorities and Financial
Outlays on Health
Priorities
Sixth Plan outlays under Health Sector
Summary and Conclusions
33
V
Sixth Plan Outlays and Expenditure on Health
Sector in Gujarat
*
5.1
Analysis of the Sixth Plan Outlays and Actual
Expenditure on Health Sector
5. 2
59
Detailed Headwise Analysis of Actual Expenditure
Detailed Headwise Analysis of Expenditure on
62
Key FP and MCH Services
Scheme wise and Detailed Headwise Analysis of Health
Care Expenditure at District Panchavat Level During
64
1982-83
Detailed Headwise Analysis of Health Care Expenditure
at Taluka Panchayat Level During 1982-83
67
Summary and Conclusions
69
4.1
4. 2
4.3
5.3
5.4
5. 5
5.6
41
46
50
Page
!
VI.
Sixth Plan Outlays and Expenditure on Health
Sector in Maharashtra
6. 1
Analysis of Sixth Plan Outlays and Actual
Expenditure on Health Sector
jjQrailed Headwise Analysis of Actual Expenditure
6. 2
6.3
6.4
6.5
6.6
80
85
85
Detailed Headwise Analysis of Expenditure on Key
FP and MCH services
88
Schemewise and Detailed Headwise Analysis of
Health Care Expenditure at District Panchayat
Level During 1982-83
Detailed Headwise Analysis of Health Care Cependiture
90
» at Slock Level During 1982-83
92
Summary and Conclusions
VII
Participation of Private Voluntary and Public
Sector Agencies in Health and Family Planning
Programmes
7. 1
7.3
An overview of E.S.I. Scheme
Expenses Incurred by Selected Private and
Voluntary Organisation
Other Industries and Departments
7.3
Summary and Conclusions
109
113
VIII
Summary and Conclusions
114
7. 2
APPENDIX - I
APPENDIX - II
APPENDIX - III
APPENDIX - IV
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10 2
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127 - • 130
131
132
136
135
137
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^^^^ATIONS USED IN THE REPORT
MNP
Minimum Needs Programme
IUD
Intra Uteri(Contraceptive) Device
ORS
Oral Rhydration Solution
Diptheria, Pertuses and Tetanus
Tetanus Toxoid
DPT
TT
DT
Diptheria and Tetanus Toxoid
Net Reproduction Rate
NRR
MCH
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Maternity and Child Health
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USAID-
United States Agency for International
Development
IRHP
Integrated Rural Health Project
India’s population Project
Operations Research Group
Uttar Pradesh
IPP
ORG
U.P.
RGI
PHC
Registra
General of India
- Primary Health Centre
PRC
-
Population Research Centre
NIHFW-
National Institute of Health and Family
Welfare
DIH
Department of International Health
A.P
Andhra Pradesh
H.P.
Himachal Pradesh
S.C.
Sub-Centre
UPS
DHO
International Institute for Population Sciences
Infant Mortality Rate
District Health Officer
T.B.
Tuberculosis Bacilli!
NMEP
National Malaria Eradication Programme
National Filaria Control Programme
National Leprosy Control Programme
Auxilary Nurse Midwife
IMR
NFCF
NLCP
ANM
MPW
CHV
Multipurpose Worker
Community Health Volunteer
\a
/
VHG
Village Health Guide Scheme
LHV
RFWTC
Lady Health Visitor
Regional Family Welfare Training Centres
CC
Conventional Contraceptives
FP
Family Planning
FW
Family Welfare
Expanded Programme of Immunisation
EPI
T.E.
Travel Expenditure
0.E*TELCO -
Office Expenditure
Tata Electrical Locomotive Company
TISCO -
Tata Iron & Steel Company
TMH
Tata Main Hospital
IMR
NDC
SRS
Infant Mortality Rate
National Development Council
ESIC
ESIS
BHEL
SAIL
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Sample Registration System
Employees' State Insurance Corporation
Employees State Insurance Scheme
Bharat Heavy Electricals Ltd.
Steel Authority of India Ltd.
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CHAPTER-I
INTRODUCTION
1.0
Background
Promotion of Health and Family Welfare Programme is a
major concern of our planners and policy makers.
Its
importance can be gauged from the fact that it has found
place in the Prime Minister's 20 point programme. The
outlay in the Health Sector has increased manifold over
the last three decades from Rs.65.3 crores in the First
Five Year Plan to Rs.2831 crores in the Sixth Five Year
Plan period.
Apart from the public financing, the Private
and Voluntary organisations contribute to Health Sector.
Individual families also spend a part of their income"
to preserve the health of their members.
However, it is
not precisely known as to what is the total outlay (from
all the sources) which is being channelized to Health and
Family Planning Sector and their respective share in the
total expenditure.
Further, it is also not clear as to
which services receive more support from government,
private and voluntary organisations.
Government of India, in collaboration with various inter
national agencies, is trying its best to give a new impetus
to the Health Programme by strengthening infrastructure
facilities, manpower and other resources, to improve the
accessibility and utilisation of the Government's Health
Services among the rural masses.
Therefore, it is nece
ssary to look into the relative demands for the various
health services, the sources from which moneys flow into
this sector and the mechanism by which the total allocated
amount is distributed among curative, preventive and MCH
services under various heads such as salary, drugs,
transport etc. Further MCH being the priority area in
2
the Sixth as well as Seventh Plans, it is also important
to know what proportion of the vailable resources is
being spent towards the various components of MCH
programme.
The USAID is one of the donor agencies, that at present
are trying to assist Government of India under Integrated
Rural Health Project (IRHP), in strengthening the health
delivery services in rural areas.
It covers two or three
districts in each of the five States viz. Gujarat,
Maharashtra, Punjab, Haryana and Himachal Pradesh under*
this projects
1.1
Objectives of the Study
The UoAID is keen to understand the above mentioned issues
so as to allocate its funds more meaningfully, Hence the
present study has been undertaken on behalf of USAID with
the following objectives.
1.
To review the available literature on a )health
care expenditure by the Central and State
Governments, private sector and by the individual
families, b) health financing mechanism utilized
by the government to allocate funds for health
sector.
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and Maharashtra at State, District and PHC
levels with special reference to MCH services.
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It was also planned that after the completion of the
present study, a study would be undertaken to^assess the
demand for various health services among the various
categories of families and the expenses incurred by them
in maintaining the health of their family members'^!
As
part of the current work, ORG would assist the USAID
consultant to develop the design of the study and the
research instruments required to collect the relevant
data.
The design and required research instruments for
the second phase of the study, developed by the USAID
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consultant, has already been submitted to USAID office.
New Delhi, and hence will not be discussed here.
The present report addresses itself to the above specified
three objectives.
1.2
Data Collection
The data for the present study was collected primarily
from the publications of rhe State and Central Government,
agencies such as the performance budget. Budget Estimates,
I
Annual Plan, Sixth Five Year Plan, Hand Book of Health
Statistics and Year Book published by the Ministry of
Health and Family Welfare.
Intensive discussions with
the State and Central ministries and other government
officials, particularly officials in the office of the
Comptroller and Accountant General of India etc., were
also held to obtain requisite data.
For collecting data from private and voluntary agencies
the following industrial houses and institutions were
visited as per the proposed plan:
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a)
Tates in Jamshedpur
b)
c)
Birlas in Calcutta
Ramakrishna Mission Ashramas located at
Howrah, Calcutta and Lucknow
Apart from this, a questionnaire was mailed to about one
hundred industries which have assets of value Rs.50 crores
or more, requesting them to provide information on the
medical and MCH facilities provided to their employees
and the expenditure incurred by management in providing
those facilities.
Correspondence was also made with some
of the hospitals run by charitable trusts in Gujarat.
However, this exercise could not help much as we did not
get replies from more than two companies and one charitable
trust.
Inter Mission Business Officer was also contacted in
Bombay to seek information on the expenditure incurred by
all the mission run hospitals.
However, they were also
not in a position to give relevant information.
Problems and Limitations of the Study
1. 3
One of the main handicaps for the investigators was the
Even
non-availability of the data in the required form,
the data which were available were inconsistent; many
times, under the same heads, different publications gave
different figures.
The required information was not
available at one place.
Health being a State subject
under the Indian Constitution detailed break up of the
exoenditure at national level was not presented in the
publications of the Central Ministry or' those of Planning
Commission. Thus extensive efforts had to be made to
do the present analysis. The porblem of data collection
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was further aggravated by the decentralisation of the
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fund disbursing agencies.
For example, in Gujarat, major
portion of the funds in the rural health sector is in the
form of grants-in-aid to district panchayats (Zilla
Parishads) and the actual expenditure details are kept
only at taluka level.
Thus,if one wants to collect
detailed data on health expenditure for the State of
Gujarat, one has to visit 183 talukas.'
What is available
at the State level is only broad break-up, indicating
the grants released to the district panchayats.
Yet another problem was non-availability of the break-up
of the expenditure related with MCHZ which is the main
focus of the present study.
MCH being an integral part
of Health and Family Welfare Programme, no separate
break-up is maintained in regard to the salary, trans
portation etc.
1.4
Structure of the Report
The present report is divided into eight chapters.
first/ presents the Introduction to the study.
The
The
second presents a review of available literature on health
)
financing ^nd utilization of health services.
I-
The third
chapter briefly discribes the mechanisms of health
financing at the Centraland State level.
The fourth
chapter presents the priorities in health sector as
laid out in the Sixth and Seventh Plan documents.
It
also analyses the Sixth Five Year Plan allocations on
health sector at national level.
The fifth and sixth
chapters analyse the expenditure on health sector for
the States of Maharashtra and Gujarat, respectively.
The seventh chapter gives a brief note on the expenditure
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on health and family welfare activities
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undertaken by
The last chapter
gives a summary of the findings and
recommends further
studies which could be undertaken for
generating more
voluntary and private organisations,
meaningful information on the subject
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CHAPTER-11
RK^iew of literature
2.0
Study of health financing in India is still in its
infancy and hardly any literature is available which
could throw light on the area pertaining to the present
enquiry.
While writing this chapter an extensive search
was made to look into the existing literature covering
during the last
most of the studies undertaken in India
fifteen years, including the bench-mark studies conducted
for IPP Projects in Uttar Pradesh and Karnataka, and
those for the Integrated Rural Health Projects (IRHP) in
the States of Bihar and Rajasthan.
Reports of the bench
mark surveys for IRHP in the States of Madhya Pradesh and
Gujarat are yet to be released.
However,
a discussion
with the principal investigator of Gujarat study revealed
that it did not touch any aspect of health financing,
A
list of the major studies reviewed for the present work is
given in Appendix-1.
Issues of various journals like Journal of Family Welfare,
Demography-India, Studies in Family Planning etc., •were
also screened but rarely a paper published in these
journals has dealt with these issues.
A few that were
found were (i) a study based on Harangwal Data (DIH, 1976,
Taylor, et al, H.D.)
z
(ii) a study, conducted by the
Operations Research Group, Baroda, in three villages of
Uttar Pradesh which provided some information on the
financial aspects of health care, andl) (iii) a few other
micro level studies conducted by Banerjee (1980), Ram and
Dutt a (1979). The U'arangwal study showed that of the
total funds available with government health centres.
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upto 75 per cent vzere consumed in salaries; and that in
the villages taken as control group in the Narangwal
Project, not more than 7.2 per cent of the total funds
of the health centre was used for supplies and 2.5 per
cent for drugs.
The rest of the money was spent for
running and maintenance of vehicles and of PHCs et«,.
For the drugs and supplies, no further break-up was
given, and hence
it was difficult to assess the expen
diture on MCH services.
Perhaps most of the money was
spent on curative services only.
In the case of the ORG study, the data was primarily
collected for a study on Changing Role of Women and its
Impact on Their Demographic Behaviour.
I
For this study
three villages, two from western UP and one from eastern
UP were selected and. in each of these three villages,
one female anthropologist was posted for one full year.
Relevant information was collected from 25 families
belonging to various class and caste groups in each of the
three villages by visiting them fortnightly and asking
their time disposition on the previous day and expenditure
on various items including health during the previous
f ortn ight. The study shows that in the two villages
from western UP the per capita expenditure was around
Rs.il/- per month and in the eastern UP village-- Rs. 6.90p.m.
All the expenditure was incurred only for curative purposes.
While calculating the averages, medical expenses of two
families for one month each was discarded as these were
found to be unusually high (Rs. 2500/- in one case and
around Rs.800/- in order) and were incurred because of
major surgical treatment. A comparison of these figures
with the governments ‘ per capita expenditure on health
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shows that individual families per capita expenditure on
health is about ten times
that government was spending
on each individual (Rs. 11.7 per annum) .
Table -2.1
presents the comparative picture of expenditure on health
by individual and government services.
Some other studies conducted by Banerjee, Ram and Dutta,
Rao and Fernandes and Juyal however gave a much lower
estimate of per capita expenditure on medical consultation
and treatment.
According to these studies it turned out to
be Rs.3.25, Rs. 12.51, Rs.13 and Rs.38.7 per person per
year respectively.
None of these studies was however,
prospective in nature and hence could suffer from problem
of recall lapse in giving all possible health care
expenditure.
TABLE
2. 1 : A1WUAL PER CAPITA EXPENDITURE ON HEALTH
State
m
3.
(in Rupees)
Per Capita Expenditure
Individual
families
Government______
Health Family
Health
Welfare
Uttar Pradesh
11.73
1.43
108
Gu j ar at
21.57
2.9 3
NA
Maharashtra
25. 20
2. 23
NA
All India
19.91
1. 84
NA
NA - Not Available
A comparison among the various states indicate considerable
variation in the per capita health expenditure/ the lowest
was for Bihar (Rs. 9. 61) and the higher for Nagaland (Rs. 151.5).
A further analysis of the Government’s expenditure on health
however, shows that the per capita expenditure on health
services both at State and National level has slowly increased
over time (Table 2.2).
For example, in Maharashtra per capita
expenditure on medical and public health was reported to be
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table
- 2.2 :
-
States/Uts
A.P.
Assam
Bihar
PER CAPITA (PUBLIC
(MEDICAL AND PUBLI-
1956
1961
JR) EXPEN DITURE
ON HEALTH
x-EALTH)
66-67
1971
73-74
77-78
78-79
79-80
0.88
2.03
3.61
5.61
6. 19
1.43
2.58
13.49
3.66
16.07
5. 11
17. 26
7.58
1. 64
12. 24
1. 85
14. 28
3. 64
3. 61
14.08
6.94
2.00
4.66
8. 86
6. 75
9.61
8.70
17.06
1. 27
20.00
6. 98
21.57
8. 88
18.91
25. 29
23. 17
30.41
51.40
61.93
0.48
Gujarat
Haryana
H.P.
J & K
3. 29
7.50 10.61
15.02
2. 17
38.57
3. 14
53. 20
5.43
66. 82
6. 26
3.35
12. 64
5.03 10.84
14.50
15.43
0.51
8. 74
2.91
19. 26
3.03
21. 20
8.05
25. 20
6. 41
0.80
2.48
10.76
4. 26
11. 62
7.12
17.05
10.52
16. 88
21.41
25. 34
Meghalaya
22.98
35.73
73. 86
Nagaland
39.98
51.49
81. 22
Karnataka
0.79
Kerala
M.P.
Maharashtra
Manipur
Orissa
Pun j ab
Na Jas th an
0.79
1.53
151.54
6. 34
11.31
13. 65
16.52
2.57
5.00
3.4 0
0.87
12.51
2.84
20.94
4.39
23.80
7.91
25. 69
9.26
19. 69
23. 21
19.74
68. 50
82. io
71.42
14.73
16.72
16. 33
21. 21
25. 86
30.32
0.86
2.56
Tripura
U.P.
171.35
5. 24
0.57
Sikkim
Tamil Nadu
119.90
3. 20
0.73
4.56
5.97
8. 69
1. 18
2. 16
3. 68
4. 2?
2.90
8. 11
4. 10
9.62
6. 63
11.73
7.62
16.54
17. 73
20.12
Goa, Daman, Diu
55. 15
79.53
91. 49
Pondicherry
65. 19
72.07
81.09
Mizoram
65.77
70.75
129.70
W.B.
2.06
Arunachal Pradesh -
AH India
ic
Includes the
1*50* 2. 35*
3.79* 6. 75'
7. 72*
19. 9
expenditure by Central
& State Governments
Source : Health Statistics
of India, CBHI,
Ministry of Health
Family Welfare, New Delhi
1
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Rs. 10.52 in 1973-74 as
against Rs. 25. 24 in 1979-.80.
The
corresponding figures f
or the country as a whole were
Rs.7.72 and Rs.19.91
respectively. However, these figures
should be taken with caution as these are not adjusted for
inflation.
» act a recent analysis by Cassen who had made
such an adjustment
revealed that, taking 1970-71 as base,
the per capita
expenditure on health in real terms registered
a decline during the 1970s (Cassen, 1978)
)
. 26
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2.1
Demand_for Health servirAQ
Sz
4
Although our literature
2u
interest of Demographers
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health service research,
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information on financial
search did not yield required
aspects, it indicated an increasing
and Social Scientists engaged in
in the study of demand for various
sources of medical help
in rural India, as this information
is relevant for the
second phase of the study, it may not
be out of place
to discuss this aspect also in this chapter.
Table 2.3 presents the
findings of some recent studies on
the demand of various health services.
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2
3
2
The table shows that utilisation of health
services
provided by ffiCs/SCs/govenMeht hospitals was
fairly low
in most of the States. Among all the States
for which
_ ta wa. availaole, utilization of FHCs/SCs
seems to be
etter in Gujarat where around 70
per cent of the people
were reported to be seeking medical help
from PHC/subcentres. The percentage of
people depending
entirely- °n
------------Private doccors
varaed from 16 in Gujarat to 77 in Uttar
^adesh.
xthm the States also
also there
there seemed to be
considerabl e variation in the level of utilization of
heal th
rural
Parts of Baroda and Dangs districts
shows that
only about
17 per cent of the people were
depending
entirely
on private practitioners (ORG 1983).
However,
ParZ^r; ?Or eX9n’Ple' 3
StUd* COVering
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!
some other studies the corresponding figures were
reported to be 27.1 in Bharuch, Bhavnagar and Banaskantha
(Ganaotra 1984) and 31 per cent in a study covering nine
districts or Gujarat (Gandotra 1981).
The latter study
further shows that dependence on private services was
highest (72%) in the urban areas.
No such information
was readily available for Maharashtra. The recent bench
mark studies conducted in Bihar and Rajasthan have not
covered these aspects adequately, though these studies
indicated that net, most of th. people prefer Allopathic
system of medicine (TIPS, pRC and RGI 1982, N.I.H F w
1932) .
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Reasons for Not Seeking
.^Government Medical Services
Further analysis shovzs that the main reasons behind not
seeking medical assistance from ffiCs/SCs/Govt. hospitals
and dispensaries were as f ol1ows:
a)
Inaccessibility and remoteness (reported from Bihar,
Gujarat, Kerala, Andhra
Andhra Pradesh,
Pradesh, Himachal Pradesh,
and Rajasthan).
b)
General belief that doctors
: are not available at PHC
and hence visiting PHC/SCs
would merely result in loss
in time and transportation
cost without serving any
purpose (reported from Bihar, Kerala,
Uttar Pradesh
and Rajasthan).
c)
won-availability of required medicines
and belief that
the medicines provided at PHCs/SCs
are of sub-standard
quality (reported from Himachal Pradesh,
Andhra Pradesh,
Gujarat, Bihar, Kerala and Rajasthan).
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TABLE
2. 3
:
State/Study Area
Year of Study
DEMAND FOR VARIOUS SOURCES OF HEALTH SERVICES
PHC/SubCentre
_____ Source of Medical Treatment______
Government
Only Pvt.
’ Sometime
Hospitals
PHC/Sometime Doctors
Pvt. Doctors
2.8
Others
Sample
Size HH
Source
66. 3
3.4
400
ORG-1980
Bihar
(1977)
27.5
Bihar
( 1982)
24.4
6. 1
15.5
51.9
2.0
638
. ORC-1983 I
Guj arat
( 1982)
67. 1
5. 1
9.1
16.7
1.9
645
ORG-1983 I
(1982)
28. 8
42.0
27. 1
2. 1
1799
Gandotra
et.al 1984
31.0
6104
-do-
7 2.0
2783
1982
14. 1
31. 3
37 2
ORG-1983 II
14.9
33. 8
8.8
637
ORG-1983 I
(1981) Rural
69.0
Urban
28.0
H. P.
(1982)
Kerala
( 1982)
22.4
Raj asthan
(1982)
54.5
11.1
29.9
4.5
1750
Suman Mehta
(1984)
A. P.
(1978)
38.0
1.0
58.4
2. 6
400
ORG-1980
UP
(1981)
2.0
37. 1
61. 3*
16934
Kumar et. al
(1983)
UP
(1982)
8.4
77. 6
2.8
1799
ORG-1984
* Out
54. 3
26. 1
11. 2
of 61. 3, 51.7 reported home medicine and remaining 9.6 Quacks etc.
I
OJ
l
14-
d)
Economic considerations lite transportation cost,
cost of medicine etc. (reported from alhar, Kerala,
Uttar Pradesh and Rajasthan) .
e)
Unpleasant behaviour of the doctor
-l. uie aoctors and staff
(reported from Andhra Pradesh, Bihar Guiarat
Kerala).
f)
2.3
'
a
and
"tex1::;rom Bih~-
Coverage of Ch i 1 dr e n Un d e r
Immunisation
The review of the literature shows that
most of the
bench-mark studies conducted under
IRHP and Social Inputs
Projects
contained some information
on the extent of immunication of children
against various infectious diseases.
The findings of these
studies have been summarised in
Table 2.4.
it Can be
seen from the table that performance
of immunisation
■ programme is relatively better in Gujarat
than in the other states.
For example, proportion of
children who were given BCG
‘ ranged from 50 to 83
per cent
among various districts.
In case of Polio the
percentage
of coverage in Gujarat
ranged from 23 to 57 per cent and
in case of triple
ante gen the ccoverage
----ranged between 37
and 51 per cent,
The table also
■
-o indicates that according
to 1978 Survey on Infant and Child .
------ 1 Mortality, conducted
by RGI, the
coverage in Maharashtra for BCG
was around
30 per cent.
In case of Triple antigen,
it ranged between
10 and 18’ Per cent and for
polio the coverage was less
than ten per cent,
However, due to the
recent emphasis
given by .government
on immunisation/ the coverage has
generally increased
it is reflected in a recent
survey
conducted by ORG in Buldana District,
a backward area in
I
I
15
TABLE
2.4 :
PROPORTION OF CHILDREN UNDER FIVE YEARS WHO WERE
IMMUNISED AGAINST VARIOUS DISEASES
I
_______ Proportion Immunised_____
B.C.G.
Polio
Triple
An teg er.
State/
Year of Study
S am p 1 e
Size
Source
Gujarat
( 1982)
82. 6
56O 8
51. 1
519
OP.G-1983 I
Gu j arat
( 1982)
61. 6
38.7***
37.0** *
1796
Gandotra &
Su 1 ochn a -19 84
Gu j arat
(1981)
Ru ral
50.0
27.5*
45.5*
64 37
U rb a r * *
89.0*
79.6
86. 5*
2350
Gandotra et. al
1982
11.9
4.9
9.9
Femal e 22. 3
4.4
9.7
33. 1
8.5
17.5
Female 31.4
7.0
15. 1
31.7
8.0
17. 2
Female 30.1
7.0
16. 3
Ma1 e
3 2.9
7.6
17.5
Fen.ale 3 3.0
8. 4
18.0
Maharashtra
( 1978)
Ru ral
Below 1 year Male
1 Year Male
2 yrs
3 yrs
Male
Maharashtra
( 1981)
28.e****
31.6****
27.0***
Rajasthan
( 1981)
12
10. 2
9
Raj asthan
( 1982)
11.6
11.8
2.0 * * *
Kerala
( 1982)
33.3
48. 1
B ihar
( 1982)
2.8
Bihar
Ru ral
(1981-82)
(Male Child)
(approx)
75 1
RGI
1981
ORG
1962
19 8 2
(appiox)6000 HH NIHF/IIPS
1984
17 50 iiH
Men ta
45. 1
67 6
ORG-1983
9. 2
13. 1
69 3
ORG-1983 I
4.9
3.7
8. 5
3000
(Female Child)
5.0
2. 7
10.C
3000
(Ma le Ch i 1 d)
10.8
9.5
18.6
3000
(Fema 1e Child)
6.8
6. 2
17.2
3000
H. P.
( 1982)
16.8
3 2.0
27.05
400
ORG-1983 II
U. P.
( 198 2)
3.5
16.9
7.5
600
ORG-1983
U. P.
( 1982)
21.8*
20.5***
20.0
1800
ORG-1984
Urban
I
IIPS/RGI- 198 :•
* Percentage refeisto the last two live birth
* Only Baroda city was included in Sample
Percentage of households where at least one child und-?r five years
was giver, the specific vaccination
* *★* Percentage refers to the youngest living children
III
16
Maharashtra,
According to this study the percentages
of coverage for BCG, Polio , Triple antigen were around
29, 36 and 27 respectively,
It is expected that in
of Maharashtra, the coverage
would be still better, The performance
; of Kerala in
the immunisation programme, also seems •
to be relatively
better as the ccn/erage of children
under Polio and
Triple antigen was around 50 per cent,
In case of BCGZ
however, the coverage was only 33 per cent.
other developed districts
Studies from other
states of India present fairly
discouraging picture a- in most of tie cases the coverage
of children under immunisation
programme was less than
20 per cent,
In case of Bihar and Rajasthan
proportion
of children who were given BCG and Polio
were less than
10 per cent, The coverage of children
under immunisation
programme in UP was
was also
also quite low and even within the
State, there seemed to
be vast variation among the
districts.
it ranged from 4
per cent to 22 per cent in
case of BCG; 17 to 21 per cent in
case of polio and
8 to 20 per cent in case of DPT.
The target and
percentage achievement of MCH activities
in Maharashtra, Gujarat and India
as a vzhole is given
in Appendix-11,
It indicates a high degree of target
achievement and in
case of Maharashtrai in most cases
the achievement exceeded the target. ]
However, these
figures
seem to be rather tall claims when we look at
the actual
coverage against infectious diseases revealed
by various
sample surveys and field studies.
*1
17
2.4
Level of Infant Mor^a 1 -ii-xz
Deaths
'
— ~ritiL_andJ^qr_c3USes Qf Infgnt
Table- 2.5 gives the infant
mortality rat-s for
Gujarat,
The table shows
that in 1978/
infant mortality rate in r '
Maharashtra
was
a s compared to Gujarat (122)
fairly low (8i)
J
and
India
Sane recent IMR estimates
a whole (137).
indicate
that
IMR
is
in certain states
°n decline
like Maharashtra,
Kerala
etc.
case
of Maharashtra,
it was quoted to be
torate of Health Services, 1984). 1 , as low as SI (DirecGimilarl Y the infant mortali-ty-rate for Gujarat was reported to
be
114 (SRS).
117 and for India
he statistics for Maharashtra,
be taken with
however. should
caution as it Seemed tQ
Maharashtra and All India,
estimate.
Analysis of the causes of in-F=r,4.
mortality reveal
the largest Per cent o-F s —infant
c
y eveals that
were due to
<srta:rths/t
—
in the respirator system (25 ;
.and "orders
13% durin9 neonatal
period and 12% durinc vo^-fring post-neonatal period). Malnutr^ •
and diorrhoea
-counted tor a^ e
respectively (Tabl e 2. 6).
'
Even though Table -
2.6 does not
categorise tetanus as
one
of infant deaths
separately,
it
accounted for almost 15
Per cent of
the infant deaths in
ttjal India and was the first
among the top
m ant deaths (Table 2.7).
ten causes of
of the major causes
similar analysis for
the states of
Maharashtra and Gujarat
^veals that tetanus
■ was not the
major killer in either
or the two States,
However,
Maharashtra the major
causes of infant
death Were reported to be
(22%)' malaria (7.2%),
prematurity
dysentery (6.1JS), infl„ensa (5_s%)
1
I
H
I
I!
TABLE
2.5
TRENDS IN INFANT MORTALITY RATES FOR GUJARAT
MAHARASHTRA AND ALL INDIA (1972-78)
Urban______
1978
Rural_____
1978
Confined
1972
1978
State
1972
Gu j rat
94
89
139
131
128
122
Maharashtra
70
63
114
88
101
81
All India
85
74
150
137
139
127
1972
I
M
00
I
Source
Registrar General of India, Ministry of Home A"fairs.
Sample Registration System
M
.... II
I
I’
19
TABLE - 2.6 : PERCENTAGE DISTRIBUTION OF ALL INFANT DEATHS
BY CAUSES - ALL INDIA (RURAL) 1979, 1980
I
Major Cause Groups
1979
1980
1. Digestive disorder
3.3
2. 2
2. Coughs (disorders of
respiratory system)
11.9
11.7
3J Fevers
4.8
2.8
4. Dr’sc-as es oecu 1 iar
to infancy
69.1
73. 1
Pre-maturity
21.7
24.5
Respiratory
infection of
new bom
11.3
12.8
Malnutrition
9.0
8. 2
Diarrohea of
new born
7.5
6.9
Convulsions
5.7
4.4
Others
13.9
16. 3
5. Others
Total No.of Infant
Deaths covered in
the Survey
10. 2
10.9
3 296
100.0
3 296
100.0
Source : Registrar General, India - Model Registration
Schemes, Survey of Causes of Death (rural) 1979-A,
Report Series 3, No. 12 - Survey 1986, Series 3
No. 13
Fl
min i
■f'.
in
St
I■
i
TABLE
2.7 :
PERCENTAGE OF INFANT DEATHS AMONG TOP TEN CAUSES
ALL INDIA, MAHARASHTRA AND GUJARAT
Ml
!
Ia
All India
Rural
Urban
Cause of death
_____ Maharashtra
Rural
Urban
_____ Gujarat___
Rural
Urban
Tetanus
15. 2
6. 6
1.7
0.0
0.0
2. 2
Prematurity
7.9
11. 1
22.0
9.9
11.8
9.8
Pneumon ia
6.8
0.0
0.0
0.0
0.9
0.0
0.0
2.9
Jaundice
Dysentry
6. 1
5.4
6. 1
2.6
2.0
6. 3
Accidents & Injury
4.9
5.5
3.8
6. 3
1.8
Influence
4.9
4. 1
4.1
5.8
3.8
6. 3
1.8
Malaria
4.7
2.4
7. 2
2.5
4.7
3.7
1.1
1.8
Measles
Other disorders of
respiratory systems
2. 6
0.0
4.9
2. 1
15.3
0.0
Diarrhoea
1.6
3.8
0.0
4.1
8.5
0.0
Gastro-enteritis
1. 3
3.4
4.5
2. 6
0.0
4.5
0.0
2.0
1. 1
2.6
Diptheria.
Infantile liver
0.0
4.5
4.6
2. 1
Congerital malformation
0.0
3.7
5.1
0.0
0.0
18.4
Total Percentage
54.9
48. 3
63.6
35. 3 .
57. 8
54.0
Source : Survey on Infant & Child Mortality,
i
*
I
to
o
l
1979/ RGI, Nev; Delhi
l
to
21
and accidents and injury (5.5%).
In rural Gujarat,
disorders of respiratory system,(15.3%), prematurity
(11.8%) diarrhoea (8.5%), incidence of accidents and
injuries (6.3%) and influenza (6.3%) were major causes
of infant deaths (Table - 2.7)
Anaylsis of the pattern of child mortality reveals that
after one year of age, pneumonia, typhoid, dysentery,
influenza and diarrhoea turned out to be major causes of
deaths (Table 2.8).
In case of Maharashtra and Gujarat,
though the first ten major causes by and large were the
same as for all India, their order in terms of the
percent of deaths varied.
FOr example,
in case of rural
Gujarat 25 per cent of the children of one year of age
died because of pneumonia and other disorders of respiratory
system, whereas in Maharashtra only 12 per cent deaths were
due to these diseases.
Similarly, the proportion of
deaths due to diarrhoea was 11 per cent in case of Gujarat
while it was less than 8 per cent in Maharashtra.
The
frequency of child deaths due to measles was reported to
be 7 per cent in Gujarat as against 3 per cent in Maharashtra.
In contrast, prematurity, bronchitis and dysentery were
more prevelant in Maharashtra than in Gujarat.
Influenza
however, was reported to be a major cause of death among
one year old rural children both in Gujarat and Maharashtra.
2.5
Conclus ions
The review of the literature presented above reveals that
the study on health financing is yet to take off and
there is hardly any study available on these aspects.
From a case study of three villages in UP, it appears
that per capita expenditure of individual fa
ies cn
health care of their family members is far more than the
per capita expenditure borne by the government. The
difference was observed to be as high as ten times.
TABLE
2.8 :
PERCENTAGE OF CHILD* DEATHS BY TOP TEI CAUSES
Causes of death
Gujarat______
Rural
Urban
All India
Rural
Urban
Maharashtra
Rural
Urban
Other disorders of
Respiratory System
2.9
4.6
20. 3
In fluenza
7.3
7. 1
12.8
Diarrhoea
5.5
5.9
11.0
Dysentry
8. 8
5.3
8.0
Malaria
4.9
4.5
7.4
11.7
Typhoid
9.9
8.7
5.5
4.4
Pnumon ia
10.9
15. 1
4. 6
2.5
6.4
8.7
3. 2
5. 1
6. 1
4. 2
I
4.8
2. 3
to
to
Prematurity
Jaundice/Infantile Lever
3. 1
5. 2
3.0
Congenital Malformation
12.5
Bron chit is
4.4
Diptheria
3. 1
Gas tr center.it is
3. 1
0.0
7.0
Measles
13. 2
10.0
0.7
7.2
14.5
4.6
5.8
4. 3
l
5. 2
2. 8
5.6
14.0
3. 3
5’.. 8
Food Poisoining
11. 3
Accidents & Injuries
3. 6
Tetanus
1.9
2. 1
* Child of one yes-ir old
J
Source : Survey on Infant & Caild Mortality,
1979
I ■Wl—
5
23- -
The review of literature also shows that private practi
tioners were the main sources of health care for majority
of the people in rural India. However, on this account
Gujarat seems to be better as major proportion of the
villagers in tnis State were depending on public health
centres (PHCs/Sub-centres).
Such information for Maharashtra
was not readily available.
The major causes of under-
utilization of public health services were their inaccessi
bility, belief that the medicines provided at HJCs/SCs
were of substandard, economic considerations (towards
transportation and medicine cost), and their apprehension
that the doctor would not be available at PHC for consul
tation.
The study also revealed a very low coverage of children
under immunisation programme, though Gujarat again was
doing better than.any otl?er state.
4
j
4
4
rd
■P
4
D
^4
-1
Maharashtra’s per
formance on this aspects was not encouraging as not more
than 30-35 per cent children were currently given vacci
nation of DPT, Polio and BCG.
The two main reasons for
not giving vaccination to their children were that they
were not approached by anybody and they themselves did
not take initiative oecause they did not consider it was
important.
Yet another major reason was their unawareness
about the protections against these diseases.
J
£
Available information on infant mortality indicates that
H
the current level of II4R for all India was around 114 and
C
that of Gujarat and Maharashtra were reported to be 117
M-l
o
o
-5
5
<
i
0
o
□
O
CO
and 61.
In case of Maharashtra the IMR seems to be an
under estimate as SRS estimate of IMR for Maharashtra
for the year 1977 was reported to be 108. Analysis of
causes of infant mortality shows that in rural India,
■
24
!■
tetanus, prematurity, disorders of respiratory systems
and dysentery were the first four main causes contri
buting to about 39 per cent of the infant deaths.
In
Maharashtra, prematurity was the single most important
factor contributing to 22 per cent of the infant deaths.
Other major killers in Maharashtra were reported to be
malaria, dysentry, influenza and congenital malformation.
In Gujarat the major causes of infant deaths were reported
to be pneumonia and other disorders of the respiratory
system, prematurity, influenza and incidence of accidents
and injuries; they contributed to about 43 per cent of the
infant deaths.
i
1
CHAPTER-III
HEALTH FKANCEG MECHANISM IN INDIA
Since independence, India has been continuously trying
to achieve self reliance in all spheres of activities
through successive Five Year Plans.
The documents of the
Five Year Plans give the general directions and priorities
to be acnieved during the plan periods by optimising the
utilization of scarce resources.
They also set definite
norms and physical targets to be achieved by various
implementing agencies within the framework of allocated
financial outlays.
These norms and priorities are fixed
at the highest level and are guided by both political and
financial considerations. The present chapter briefly
discusses some of these issues.
Forrr.u 1 ation of Flye Jf' ar Plan
The planning process is fairly complicated and decentra
lised and yet at the same time the plan’s overall resource
allocation is done by a centralised decision making body.
Thus,decision making regarding the plan structure ranges
from a grass root block level, to deliberations of a
centralised planning body, the National Development
Council. The following paragraphs describe the sequence
of decision making process in plan formulation.
has been shown in Chart-1.
The same
Understanding of this process
will be useful in analysing the process of financial
allocation on ’Health*.
The National Development Council (NDC)
decision making body in planning.
is the highest
It consists of
Prime Minister, as e the Chairman of Planning Commission,
___
r
i
26
Dy. Chairman of the Planning Commission, Chief Ministers
of various State Governments, -Cabinet^ Ministers in the
Central Ministry at Delhi (Federal Government) and the
Members of the Planning Commission.
As mentioned earlier, on the basis of national needs and
priorities, the NDC decides the brbad objectives and goals
of the plan.
The prioritisation of these objectives is
I
done with the help of a plan outline prepared by the
Planning Commission.
Objectives and goals of the plan
1
are then fed as inputs into the detailed planning model
developed within Planning Commission.
The Planning
Commission then requests the Central Ministries,
(shown
in box M^ in the Chart-1)
Chart-1) , to send their plans and outlays,
sector and projectwise. to the Planning Commission in the
light of broad development directions given by the Planning
Commission.
Arrows in the chart show the directions along
which the information on the plan outlays and projections
flow.
"M^" shov/s that there are two different types of
flows (1) those plan outlays which are to be adjusted by
iterative process and (2) a few outlays which are unchange
I
able and branded as “autonomous investiments", flowing from
Ministries to the Planning Commission.
The former category
of plan outlays hc^ arrows in both directions.
This means
these outlays are finalised by mutual agreement between
the Ministries and the P.lanning Commission.
The second type
of outlays refer to flows which are one-sided only, i.e.
they are regarded in the plan formulation process as
exogen ous.
I
From a few Ministries, instructions regarding the targets
of the plan come as one-way inputs to the Planning CommisOne simple example
sion (say Ministry shown in box M?) .
in the present Sixth Plan exercise is the export targets
■
which are fed by the Ministry of Commerce.
c
r
1
I
26 A
PLAN FORMULATION PROCESS IN INDIA
PRIME
MINISTER
( CHAIRMAN )
I
DEPUTY CHAIRMAN
CHIEF MINISTERS
N. D. C.
<-
CABINET MINISTERS
AND MEMBERS t P. C.
OBJECTIVES AND GOALS
STATE
plans/
SUBJECTS A
SECTOR
(p.c.
economic \
AND PERSPECTIVE
ANALYSIS
>
population
Exports l re.
OUTLAYS
SC
WG
OUTLAYS
SPM
c tHCXAi.
t c ohome
ANALYSIS
STATE'RESOURCLS
-^T-T'
^UTO HO A4 O US
M;
( FA4 C A/T
foreign
TOTAL
RESOURCES
resources
PUBLIC
enterprise
GENERAL equiliBRtUM PLANNING
MODELS
AND PROJECT
SAVINGS
]
I
J
PUBLIC
B ORRo WINGS
CENTRAL
budgetary
I
I
resources
STATE
o
RESOURCES
PCM
Z
INDICATIVE
PUBLIC sector
Inycstmint
^OltCIEt
OUTPUT , CONSUMPTION,
EXPORT, IA1P0RT EEC...
MXCRO ANO M/CKO
____ PL AH
POUt'f
loot!. t
J
PRIVATE
SECTOR
activities
PRIVATE SEC TOR
a»QI IdES
INVESTMENT
I
I
S .
PROJECT
SECTOR
"'"'SERIES / PUauc
VICTOR UNDERTAKINGS
WC
SC
FORKING
group
STATE GO\I( R.NMT NT/ STATE
PUBLIC HCTOt VXPIR1AXINC5
SPM -
STATE PLANS NETTING
PCM
PLANNING COMMISSION
meeting
PC
PLANNING CONMimo^
I
27
27
At the request of Planning Commission,
is done at State level.
The plaming
similar exercise
and Administrative
Department askes each minitry to submit
its plans. Each
department, in turn.
turn, establishes
one or more working groups
to develop detailed plan
in the light of the broad indications regarding the size
and priority of the plan rendered
by the Planning and -ransmitted through the Department of
Planning and Administration.
di^cu'tcinn.r 4- V
Within each ministry extensive
place
to^t^on Zh
31,10119 VariOUS ^irectora'tes attached
lays thus d
' needS an' demandS £tC-
The Plans
-t_
nised a d
0PS°
Vari°UE State Ministries are scruti3.nd consolidated bv the <^+m
tive deoartmpnta
Y
Planning and Administrad
Sent to the Planning Commission. The-e
xx™1: dried infomation ab°ut - -~,
studied them in deta^Zd^3*
,,-c
, .
1
° iTlany a time it constitutes sector
wiw-e wording groups, v^nich go thrcuoh thP a
y uucugn the documents anH
recommend modifications, if required
Th
,
consist of experts d-a^ F
he WOrki^
pg
.
exPert- dxavm fran other ministries, the
Planning Commission it = elf snH =+- +-•
sector.
tMeS from the private
to
P‘,°P0SalS sub"ittea by the Central Ministries
:z:mon in
r'SOUr°e
-e
the ligyt of b"1'^ °f I'ln“'Ce a"° the Reterve Bank in
growth of Z
meC" infO"’ati°" -9-hlng the future
;Theconomy7' a9al"SUpPlie<5
Mission
tha banning
This
in cl os
na
. Oration
”n th® Planning Commission by
f orYni:
a series of rolevan^ ~ i •
y
~
working-groups and committees,
This is shown ' tn
shown m box H of the Chart
AoAin
•
J
c wiaru. Again, this exercise
. “=1!^ r1'136 * reSOUr°eS Mttoata3 i3
41—j.....
28
after finalization, feeds into the
Planning Commission ss
a starting point deterraining the ^'■asounces base of ■the
elan.
In addition uo these inputs Jn pian resources and
on plan resources
outlays received from the different Ministries and States,
the Pfenning commission independently undertakes an analysis
of the economy, irs past and present, in order to develop
relevant behaviour, technology and policy parameters for
the plan.
AH these inputs finally enter into a formalised
model system as shown in the Chart-1 as sectoral and general
eqilibrium model.
This modelling exercise tries to check
the feasibility and consistency of all the programmes and
projects and resources estimates
fed as inputs by the
Ministries and Stares and assesses their
contributions in
attaining the goals and objectives set by the NDC.
If the
goals cannot be achieved or if configuration of the pro
grammes and projects provided by the Ministries and States
are seen to be inconsistent or infeasibile in the light
of the behaviour and technical relations given in the model,
then all the proposals on plan outlays will go back to
respective Ministries and States with a reouest for revision
shown by the dotted lines.
On seme occasions, after they
have been considered by the Planning Commission Meeting
(PCM), which consists of the Prime Minister, Finance
Min^s-cer, Deputy Cnairman and Members of the Planning
Commission and Senior officials, these may even be referred
back to the NDC for the reformulation of the plan objectives.
These to and fro mcve..ients continue until a consensus
among the States, Central Ministries, Planning Coranission
and the NDC regarding the feasibility of the different
plan programmes and their
relevance to attaining desired
objectives is reached.
I
ji
~ vmv
i
29
This is^the stage when the Planning Cormissicn brings out
HL
the draft plan, which after being approved by the NEC
3
becomes the final plan document.
2S
ultimately is placed before the Parliament and the people
for discussion.
-1 is
This plan ^toourr^nta
>P
3. 2
Annual Plan
.sed
In the case of annual plans.
ie al
The following steps are involved in
■k
the exercise is simpler.
arriving at .anrural
budgetary estimates, grants and
appropriations at State
level.
d
n
Acoordang to-the rules madu' by-then Government of. India,, under
he
Art.de =6(3) of the constitute of z„dla and
issued thereunder, the Finance Department has been charged
e
the responsibility to prepare a statement of estimated
revenue and expenditure, which is known as Annual Financial
tatement, to be laid before the legislature in each year,
owexzer, the Finance Department does not conduct this
3.
nz
/
exercise independently.
It asks Department of Plannino and
. ^1 Administration to act as a coordinating body, which
turn requests various ministries to furnish detailed
estimates for the ensumg year.
In turn each department
entrusts this job to all the Directorates and Boards which
'ed
-V s.
are functional heads of various programmes falling under
its purview.
This exercise of
arriving at budgetary provision for the
ensuing year. would start as early as in rhe month of
August of the
current financial year.
The Directorates
review the
progress made in each programme falling under
their jurisdiction in terms of targets achieved and
J
30
expenditure incurred ak
as arf^->nQ+against 4the
Furth-r
v
£ budgeta^ allocations.
Urther they take into
account
the
into account the national
national as wll as
a e policies ana
and priorities
priorities and
and arrive
arrive at
at certain norms
rn terms of physical targets
cargets to
to he
be achieved
achieved In the plan
y
ano work -ut the
th^ financial requirements. The district
authorities are a'--o invoi^ k • i
eictrict
also involved while
outiavs
t are /
6 e£timatin9 these financial
In
case of
n case
o_ incurring expenditure, taking in^o
account the inflation and raise in DA etc. 5 to 10
per cent
increase is incorporated in the new budget estimates
In
case of Family Welfare Programmes, estimates will be’
arrived at taking into account the targets assigned
to
the state in respect of sterilisations, PPP,
oral pill, and
IUD programmes.
in ca£e. of Hc;alth Sec.Lor
the department
or Health and Family Welfare scrutinises the
budgetary
estimates received from various Directorates
to see whether
they are in conformity with the policies and
programmes
evolved at Sfate/Cenural level and modifications
and
adjustments are made, if required.
The documents, with
necessary remarks justifying the need for
raising budgetary
allocations against a particular scheme,
are submitted to
the Department of Planning and Central Administration
AD)-. G‘^ W°Uld ^nsolidate all the glans and budgetary
-revisions requisitioned by individual Departments and
submit it to the Department of Finance.
<
1
j
I
c
f
I-
I
Q
S
The Finance Dr-pa-tment scrutinises
the estimates item hy
item with due consideration to (a)
the expl an at i on
furnished by the estimating officers and (b) the recom_
the
mendations, if any, of the administrative department,
it is necessary, the Finance Department Modifies the
estimates on the basis of actuals of previous year and
availability of the funds.
r
if
£
31
The budget estimates of each sector
are presented under:
>ns.
i)
The various major heads r minor heads, sub-heads
and standard objects of appropriation
ms
ii)
Votable and charged
iii)
revenue and Capital
iv)
Plan and non-plan items
(te?m=SfSitiOnS and
of the above
tenru are given m Appendix-Ill)
rict
3-
icial
t
In
c“d
h r
a.
o
The annual budget thus prepared is submitted to the
Planning Commission,
The Planning Commission scrutinises
the proposed plans and budgetary allocations mostly under
the plan item ano checks whether the budgetary allocations
are in confrrmity with the Centre's policies and programmes,
Before approving tne ouaget,
budget, a
a number
number of
of meetings between
Central and State officials take
place to discuss it.
in
case of health sector .the Centres
and State Health Secretaries, the Planning Commission
Adviser (Health), the
Director
General
.
Of K-arth Services (at Centre), Secretary
tuning. Director of Health Services (£tate) etc> part._
cipate m these meetings.
The total Outlays Qf State
inally aPpr»ed 1„ a meeting held between the Penning
jester et Centre. Cnlef Minister, Denuty Chelraen of
Wnnrng C™isslc„, Chle£ Secretary of the States and
officials from che Central Ministry. The budget
so approved is to be submitted to the Council of State
-inisters by the Finance Department for their approval.
er getting their approval the budget is finally
fZenJed
FiUanCe KiniEter to
legislature in the
■uOrm of Demands.
IT’
■........................................................ -
-—-
—
-
,-...J|
.................................................................................................................. --
32
3.3
Release of Fund
In respect of actual release of funds against Centrally
sponsored schemes (zor example in health sector, family
planning, Minimum Need Programmes, Communicable Diseases,
CHVs etc.). Centre releases the funds on instalment basis.
4. *
At the end of each quarter of the plan year, the State,
should send progress renort giving the targets achieved
and the utilization certificate mentioning the proportion
of appropriated money "spent.
If the expenditure is not
to the tune of 25 per cent or so at the end of the Quarter
the Centre makes a cut accordingly in the grant. However,
if the State makes it up in the next quarter it clears the
blocked amount along with the instalment.
Another
criterion for releasing grants is the extent of achievement
of the targets under I1NP of all sectors put together.
In the case of flow of money from State to district,
the departments release approved budget expenditure
to the Directorates, v/hich monitor the programmes and
release the grants according to the expenditure incurred
by districts.
The mcharge of health programmes at
district level (generally Chief Medical Officer or Civil
burgeon) control the .funds.'and releases- -tcf• PHCs, on the
bills raised by individual PHCs.
However, under decentralised planning in case of Gujarat
and Maharashtra bulk of the money meant for rural
programmes including health goes to District Panchayats
in the form of grant-in-aid.
all the developmental
The overall incharge of
programme at District Panchayat
level, who control all these funds, is district Develop
ment Officer in case of Gujarat and Senior Executive
Officer, in case of Maharashtra. He from time to time,
depending on needs, releases funds for Taluka Panchayats
which in turn sanction funds to PHCs falling in their
jurisdiction for pursuing health and family welfare
activities.
4.
■•■_••
™
CHAPTER-IV
Sixth five ye.^r plan priorities
and financial outlays on health
4.r
The present chapter briefly highlights the priorities
in the health sector as laid down in the Sixth and
Seventh Five Year Plans.
it also attempts to present
the programme-vise outlays to see how far these priorities
are reflected in fmancrel commitments. As health is a
State subject, detailed he-adwise information like salary.
transportation, supplies etc. are not available at
national level.
Hence the present discussion is confined
to the allocation of finances to various programmes.
4. 1
Priorities
The Sixth Five Year Plan clearly underlined that "th
e
investment on health is investment on man and on improving
the quality of his life",
And thus it recognises that
health has to be viewed in its totality as a part of the
strategy of human resource development,
It emphasizes
that to achieve this, horizantal and vertical linkages
have to be established among all the interrelated programmes
like protected Vv citer supply, environmental sanitation and
hygiene. nutrition,
education, family planning and maternal
and child welfare,
Only with such linkages the benefits of
various
programmes can be optimised. An attack on the
problem of diseases■ cannot be entirely successful unless
it is accompanied by an attack on poverty itself which
is the main cause of it.
The Sixth Five Year Plan expresses its total commitment
-o and endorses the policy of Health for All by 2000 AD
enunciated m Alma Ata Declaration in 1977.
It further
34
long rerm
term goal of achieving NRR to
Sets a xony
1 by 19§5.
achieve these goals the strategies suggested
in the plan
to be followed over the next twenty years
are as follows:
1.
Onphasis would be shifted from development of city
based curative services and super-specialities to
tackling rural health problems.
A rural health care
system based on a combination of preventive, promotive
and curative health care services would be built
starting from the village as the base.
2.
up
The infrastructure for rural health
care would
consist of primary.- health centres, each serving
a
population of 30,000 and sub-centres each
serving a
population of 5000. These
norms would be relaxed in
hilly and tribal areas, The village or
a population
of 1000 would form the base unit where
there will be
a trained health volunt eer, chosen by the community.
3,
Facilities for treatment in basic specialities would
be provided at community health centres at the block
level for
a population of 1 lakh (100,000) with a
30 beddec nospital attached and a system of referral
or cases fr m the community health centre to the
district hospital/medical college hospitals will be
introduced.
Various programmes under education, water supply and
sanitation, control cf ccommunicable
---diseases, family
planning, m,-temal and child health
--- 1 care, nutrition
and school health implemented by different
departments/
agancies would be properly coordinated for
optimal
results.
35
5.
Adequate medical and para-medical
manpower would
be trained for meeting the requirements
of a prO’
gramme of this order and all education and
train in g
programmes will be given
suitable orientation towards
rural health care.
6.
The people wculd be involved in tackling their
health problems and community participation in the
Health Programmes wouldbe encouraged.
They would
be entitled to supervise and manage their own health
programmes eventually.
he plan also emphasises the need for strengthening the
Expended Immunisation Programme end the programme of
prophylaxis against iron and VUamin-A deficiency.
a so
It
stressed t.-.e need for controlling the eomtunicable
loesses and giving naw impetus to schemes like malaria
control
leprosy control, T.B. control etc.
The
Programme in the State Sector was marked as the main
rument for the development of rural health care
delivery system.
Empnasis was
planed, on
on
strengthening of the
train ing
programme of AJM and other paramedical staff,
Underlining
the importance of Community Health Voiunt£erc
(CHV) Scheme,
rt was suggeEted that other States like Jainmu
& Kashmir,
oral a, Tamil Nadu and Union Territories
should also be
covered under this programme.
To improve the family planning
programme and to give a
new impetus. various strategies
were recommended.
These include :
36
1.
Adopting ar integrated approach in which MCH
and FP should be given as a package rather than
in isolation.
2.
Imparting he.alrh ard population education through
both formal and non~formal channels of education.
3.
Increasing people's participation and involvement
of voluntary/ agencies.
4.
Increasing the accessibility of MCH and FP
services through making new sub—centres. Primary
Health Centres etc. under MNP.
£
5.
a
Ic
Launching expensive educational and promotional
ir
programmes for increasing the coverage under
6.
c
immunisation and prophylaxis, supplementary
Q
04
nutrition and health care programmes.
fit
Increasing the knowledge about OPS therapy to
Cd
a
minimise casualties due to diarrhoeal diseases.
>
J
H
§
The goals for Health and family Welfare Programme as
given in' the Sixth Plan, and the revised goals as racer tly
published by government are given in Table - 4.1.
Q
X
Eh
hP
The approach paper of the Seventh Five Year Plan endorsed
all the long term goals set in the Sixth Plan, viz. to
x
achieve “health for all by 2000 AD" and to bring down NRR
o
to 1 by 1995.
For this, while primary health care has
been accepted as the main instrument of action, additional
emphasis has been laid down on preventive and cromotive
CO
<C
O
0
aspects and on organising effective and efficient health
services wi.-ich are "comprehensive -in nature, easily and
widely available and accessible to and affordable by the
people
r
i
4
..
(U
F
TABLE
Sr, No.
4.1
Cb
goals for health
Indicator
I
3
Infant mortality rate
Current Level
Rural
136
(1978)
122
Urban
70
(1978)
60-
Total
125
(1978)
10 6
67
(1976)
Perinatal mortalitv
2.
3.
Crude death rate
Pre-school child
(1-5 yrs) mortality
4.
Ma tern al mortality rate
5.
L i f q o; - -
xpectancy at birth
(years)
6.
I
IQ
]
1I
AND FAMILY WELFARE PROGRAMME
1985
1.
3
Around
Goals
1990
87
2000
below 60
30-35
14
12
10.4
(1976-77)
9.0
20-24
15-20
10
(1976)
3-4
2-3
55. 1
54.3
57. 6
57. 1
25
18
10
31
27.0
21.0
37,0
42.0
60.0
1-48 (1981)
1.34
1. 17
2. 24
(1971-81)
1.0
1.90
1. 66
4.4
(1975)
1. 20
3.8
24
4-5
Hale
5 2.6
Pemale 51.6
Babies with birth weight
weight
(%)
(1976-81)
(1976-81)
below 2
64
64
i
uj
below 2500) gms.
7.
8.
30
Crude birth rate
Around 35
Effective couple protection
23. 6
(%)
9.
i-et Reproduction Rate (NA<R)
10.
Growth rate (annual)
11.
12.
13.
Pamily size
Piegnant mothers receiving
ante-n at al care (%)
Deliveries by trained birth
ascendants (%)
40-50
30-35
(March
'82)
l
2. 3
50-60
60-7 5
50
80
100
. 100
1
Table
Sr.
bio.
4. 1
(Contd.)
Current
Level
Indicator
Target set
for Sixth
1985
Goals
1990
2000
Pl an
14.
Immunisaticn status (% coverage)
TT (for pregnant women
48
60
100
100
10 years
*
16 years
*
40
60
68.5
70
100
100
85
10
100
85
15.5
50
70
85
I
OJ
Oj
20
TT (for school children)
DPI (Children below 3 years)
Polio (iifants)
15.
16.
17.
20
25
5
BCG (infants)
65
75.0
70
80
DT
(n ew s ch oo 1 en tran ts
5-6 years)
20
63.0
80
85
85
85
Typhoid (new school entrants
5-6 years)
2
56
70
85
85
Leprosy ~ percentage of diseasearrested cases out of those
detected
20
40
40
60
80
TB - percentage of diseasearrested cases out of those
detec ted
50
75
60
75
90
Blindness - incidence of
1.4
1
1
0.7
0. 3
(%)
* No target v;as set against this at the time of plan formulation
Source : Annual Report,
1
1983-84, Ministry of Health and Family Welfare, Govt. of India
I
39
The approach pacer to the Seventh Plan adds, that
“Qualitative improvements are required in Health and
(0
o
services as well as in education and in training and
man agemen t. Adequate provision of essential drugs
vaccines and se^a neeos special attention in terms of
-P
production z
HD
C
>
o
o
(D
P
O
0)
£
c
o
•H
Sp
+
n
E
ru
c
T5
C
OJ
§
JZ
-P
c
fO
(D
o
X
Oj
I
co
CO
Ch
o
a
(D
X
r-H
fO
p
c
c
7i
4
J
>
The paper recommends,
H
the health problems of the people.
•H
C
-p
p
j
involvement in health and health related programmes
should also be part of the strategy. In particular,
active community participation and involvement of nongovernmental organisations in a massive health education
effort is urgently needed”.
■p
'.0
j
dental health services also need special efforts to
ensure comprehensive coveraae”.
It further adds that
"achieving active community participation and their
o
U-i
■5
P
£'^-O-Li,g ano distribution to ensure universal
accessibility, availa?oility and affordability, Under
heatlh services, school health services and mental and
training and education of doctors
and para-medical personnel needs thorough overhaul.
Teaching and training must be related and relevant to
OJ
o
Family Planning Services, the supplies needed for surh
(D
u
ZJ
o
Training must be need
based, problem-centred and community based. Health
manpower development has been a neglected field which
needs urgent attention ar.d action”
In the field of family welfare and MCH, the Seventh
Plan stresses the need for a) increasing availability
of laprascopes and trained personnel to meet the
growing demand for laparascopic sterilisations,
b) special efforts to promote spacing methods like
IUD, oral pill and other conventional contraceptives.
To achieve this, the taper suggests that imaginative
40
and innovative measure should be oaken for making
conventional contraceptives and oral pills freely and
widely available through an effective social marketing
mechan ism.
The approach pac-er puts special emphasis on intersectoral
4. 3
coordination ano cooperation and the involvement of
voluntary agencies in achieving the national goal of
cringing down
uRR
to one.
the paper further addsz
Advocating the above viewz
"Community participation is
essential for voluntary acceptance of the family planning
Ider.0.ification and active involvement of non
programme.
governmental organisacions and of informal leaders in the
community/ and imparting to them the necessary training
to motivate them uo participate in the orogramme will need
attention and effort".
The Seventh Plan gives high priority to x4CH programme
and recognises its importance in increasing the accep
tance of family planni.'g.
Recognising the urgent need
of bringing down uhe intact and child mortality and its
relationship wits family nlanning, the approach caper
argues that
or the achievement of two child norm, it is
essential that me cnild survival rate is enhanced and
assured".
It points out that "IMP of the country is still
as high as 114 per thousand and more than half of them die
during neonatal period.
Hence, Mother and Child Programmes
will have to be considerably strengthened".
"It further
adds that the MCH component of training of medical and
paramedical personnel needs to be carefully planned and
implemented.
The paper in case of immunisation programme,
underlines the continuing problem with the cold chain and
stresses on its immediate solution,
Similarly the paper
points cut that diarrhoea is still one among the major
causes and "therefore ORS Therapy needs to be • universalised in a more effective manner".
!
K/cfe- -y,
41
The paper further adds that in the Seventh Plan period
vigorous steps will be taken to reduce maternal mortality.
Also, as still more than two-thirds of the deliveries in
rural areas are being attended to by untrained dai, the
dais training programmes will be strengthened.
4.3
Sixth Plan Outlays UnderHealth Sector
4.2 presents in detail the allocation of outlays
Table
for Health Sector in various plans at national level.
As can be seen in the table, the total provision has
been divided into three sub-sectors, viz. health, family
welfare and water supply. An analysis of the data shows
that the total outlays under Health Sector has progressively
increased over plans from Rs.763 million in the First Five
Year Plan to Rs.67531 million in the Sixth Five Year Plan.
The table further shows that within the health sector the
i
proportional allocation of funds among its three sub
sectors have substantially changed over time. In the
case of ’health'*, the proportion has declined from 85.5
per cent in the First Plan to 27 per cent in the Sixth
Plan; in the case of Family Welfare, the proportion
increased from 0.1 per cent in the First Plan to around
24 per cent in the Fourth Plan and then declined to 20.8
per cent in the Fifth Plan and further dropped to about
15 per cent in the Sixth Plan. However, in the ca^e of
water supply, increase
in allocation is substantial, from
14.4 per cent in the First Five Year Plan to 58.8 per cent
in the Sixth Plan.
In absolute terms, the allocation in
case of water supply and sanitation has increased from
Rs. 110 million in the First Plan to Rs. 39 220 million in
the Sixth Plan.
*,health’ sub-sector includes ’medical and public health’
.. —
TABLE -4.2 : TOTAL PLAu PROVISION FOR HEALTH UNDER VARIOUS PLAN PERIODS
AT NATIONAL LEVEL (FIRST TO SIXTH FIVE YEAR PLAN)
Health
Family Welfare
Sub-total
Water Supply
Total Plan Provision
1st
Pl an
(Rs.in Croresz One Crore = 10 million)
2nd
3rd
4 th
Sth
6 th
Pl an
Pl an
Pl an
Pl
Pl an
Plan
an
65. 2
(85.5)
140.8
(64.9)
225.9
0. 1
(0. 1)
2. 2
(1.0)
65. 3
335.5
(28.9)
260.8
(32. 3)
1821.1
(27.0)
24.9
(6.9)
278.0
(23.9)
491.8
(20.8)
1010.0
(14.9)
143.0
250.8
613.5
125 2.6
2831.1
11.0
(14.4)
74.0
(34. 1)
110. 2
548.0
(47. 2)
1107.5
(30.5)
(46.9)
3922.0
(56.1)
76. 3
217.0
361.0
1161.5
2360. 1
6753. 1
(62.6)
I
to
Percentageof the total plan
outlay to Health Sector
I
a)
bj
excluding water supply
■ 6: sanitation
3. 3
3. 1
2.9
3.9
3.. 2
2.9
b)
including water supply
& sanitation
3.9
4.7
4. 2
7.4
6.0
6.9
Source :
t
Health Statistics of Gujarat, 1984, Directorate of Health,
Medical Services and Medical Education, Ahmedabad
si
43
However, analysis of the proportion of the total outlays
of the plans to health and family planning (excluding
water supply and sanitation)fluctuated only around 3 per
cent throughout th? various plan periods.
In fact, as
compared to the First, Second, Fourth and Fifth Plans,
the proportional allocation to health and family welfare
activities in the Sixth Plan was less (2.9%).
Inclusion
of water supply and sanitation, however, shows that the
proportional allocationto health sector has increased
from 3.9 per cent in the 1irst Plan to around 7.0 per cent
in the Sixth Plan.
Table - 4,3 presents rogramme wise allocation of health
outlay during Sixth Plan period. As health is the primary
concern of the State, of the total outlay of Rs.67530
million, Rs. 514 20 million (76.2%) were contributed by States
and the remaining Rs.16110 million (23.9%) by the Centre.
Further analysis shows that out of the total health budget,
Rs. 157694 million (8.5%) was allocated to Minimum Needs
Programme, Rs. 5 2400 million (7.8%) to the control of
Communicable Diseases and Rs.7200 million (10o7%) for
strengthening medical education and health facilities.
The table also shows that the bulk (Rs.6877 -million) of
the outlays under ’family welfare programme1 was earmarked
for the services and supplies.
was Rs.2500 million (3.7%).
The fund allocated to MCH
Allocation for the training
of paramedical staff (ANM/CHV/Dai) however, was a meagre
amount of *<3.88 million (0. 1%) . The corresponding figure
for mass education was Rs. 3 20 million (0.5%). As mentioned
earlier, ’water supply and sanitation got the major share
of the total allocation for the health sector, which was
44
of the order Rs.39220 million (58.1%).
Thus the table
clearly indicates that although the Sixth Plan puts high
emphasis on MCH and paramedical training programmes,
the
same was not reflected in the plan outlays.
A perusal of percentage distribution of the outlays for
‘health’ and ‘family welfare’ programmes, worked out
after suppressing the wat’.r supply and sanitation, shows
that out of Rs, 28309 million, Rs, 1820 million (64.4%)
was allocated to medical and public health (including
iiNP)
and only 35.6 per cent was allocated to ’family
planning’ and ’MCH’ taken together.
It can be further
noted from the table that the proportion of the total
outlays earmarked for MCH programme was only 8.8 per cent.
Table 4.4 presents the programme wise outlays for
’family welfare’ in the current annual plan period, viz.
1984-85.
The table shows that the bulk of the alloca
tion goes for family planning services,
For example,
out of the total Rs 4t>97.7 million provided for Family
Welfare Programme*.
Rs. 920 million (19.6%)
was allocated
for providing incentives only.
Allocation for MCH v/as
only about Rsc 220 million
and for training of
A1\M/LHV/Dais etc.,
(4.8%)
it was around Rs 115 million (2.4%).
Thus even during the current budget, the programmes
continued to be in favour of family planning and enough
outlays were not provided for MCH programme.
In case of
* At the time of finalisation of this report, the budget
for 1985-86 was being presented in the parliament.
According to the available information Rs 5000 million
has been proposed to be spent towards MCH. and family
planning.
No further details were released.
44
TABLE
4. 3
:
-
PROGRAMMEWISE ALLOCATION OF HEALTH OUTLAY DURING
SIXTH FIVE YEAR PLAN
States
Major Proorammes
Percentage to
total outlay_______
including
excluding
water
water
supply
supply
Centre
Total
168O5
27 lo 12
9.6
4.0
305o84
10.8
4O5
Health
Minimum Needs Programme
10 2.6 2
a) Centrally sponsored scheme
b)
Other schemes
305.84
Sub-total
408. 46
168. 5
576.94
20.4
8.5
235.0
289.0
5 24.0
18. 5
7.8
7 20.0
25.5
10.7
(a+b)
Control of communicable
diseas es
PHC,
4 5.0
Hospitals and Dispensaries
Medical Education, Training
576. 50
and Research
Traditional System of medicines
and Homeopathy
Sub-total
II.
29.0
7.5
Others
Total
62.0
I
811.5
432.5
1244.0
44.0
18.5
1219.96
601.0
1820.94
64.4
27.0
687.7
687.7
24.3
10. 1
8. 8
8. 8
0.3
0. 1
Family Welfare
Service and Supplies
Training
(ANM/LHV/Dai)
- FWTCs
32.0
32.0
1. 1
1. 1
MCH
250.3
250. 3
8.8
3.7
Others
31. 2
31. 2
1.1
0.5
1010.0
1010.0
35.6
14.9
Mass Education
Sub-Total II
III. Water Supply & Sanitation
Grand Total
Source :
Planning Commission,
5142
58. 1
3922
3922
1611
6753
Sixth Five Year Plan,
1980-85
100.0
(Draft)
100.0
X
45
TABLE - 4.4 :
PROGRAMMEWTSE OUTLAY ON FAMILY WELFARE
- ALL Ii.'DIA - 19 84-85
(Rs.in Lakh^ 1 Lakh = 0.1 m)
Proposed
Budget
Percentage
of Total
Family Welfare
Direction el
Admin istration
1637.00
3.5
11070.00
23.6
Urban Family Welfare
Serv ices
1151.50
2.4
MCH
2245.00
5. 2
Transport
1260.00
2.7
Compensation
9 200.00
19.6
Other Services and
Suppl ies
6828.01
14.5
Mass Education
1200.00
2.5
ALM & Dais Training
1150.00
2.7
Other Training
6933.28
14.8
Health Guide Scheme
4 30 2. 27
9.2
46977.06
100.0
Rural Family Welfare
Service
Train inq
Total
Sou rce : Performance Budget 1984-85, Ministry of Health
and Family Welfare, Govt, of India, New Delhi
'i • '
46
training, if vze compare tine proportional allocation
during current plan year (2.4) with that of Sixth Plan
(0.9%), 'it appears that of late the attention on paramedical training has comparatively increased.
4.4
Summary and Conclusions^
A review of the priorities listed in the Sixth and
Seventh Five Year Plans for the health sector reveals
that India endorses the Alma Ata declaration of ‘'Health
for All,r by 2000 AD and has also set a national goal
for achieving NRR equal to one by 1995.
To achieve
these objectives the Sixth Five Year Plan and subsequently
the Seventh Plan puts substantial emphasis for streng
thening the health delivery services in rural India.
The Sixth and particularly the Seventh Five Year Plan,
in unambiguous terms, stress, the need for involving
community and non-governmental organisations in promo
ting welfare programmes.
Strengthening of MCH has been
identified as the priority area and suggestions have
been extended to strengthen immunisation programmes
including the imp rove:?, ent in the cold chain system.
Urgent need for increasing the training facilities for
ANMs and other paramedical staff has been underlined.
However, analysis of the financial outlays to health
sector as a whole and in particular to 'MCH' and the
training programme for AK-M during the Sixth Plan period
does not reflect the same concern as projected in the
plan documents. Even though, in absolute value, the
funds allocated to the family welfare programme have
increased substantially, the proportion of the total
plan outlay to health and family planning programme by
and large has remained centred around 3 per cent and
*
47
in fact has declined to 2.9 per cent in the Sixth Plan.
Within health sector a major portion of the funds has
gone to the medical and curative aspects. The proportion^
allocations
to -iQ-i and paramedical training were
reported to be only 8.8 per cent and 0.3 per cent
respectively, indicating that the priority given to MCH
in plan document was not reflected in the outlays.
I
g-^A£TER-V
SJDCTH PLAN_OUTLAYS AKD EXPENDITURE
IN GUJARAT
5.0
Gujarat is a major Indian State, located in the western part
of the country and is ranked as one of the top states in terms
of socio-economic development. According to 1981 Census its
total copulation was
.bout 34 million.
for family planning
programme, it is one of the good performing states with about
37 per cent of the eligible couples being effectively protected
as against the national average of 26 per cent in 1934. However,
crude birth rate, being 34.5 in 1981, is supprisingly still
high. The Infant Mortality Rates (IMR) was also reported to
be quite high and according to SRS estimates for 1970-77, it
was 142 per thousand live births against national average of
132 for the same period. Recently, however,a decline in IMR
has been reported, and now it is quoted to be around 105. '^he
maternal mortality rate was reported to be 3.1 per thousand
live births. Among the various states of India, Maharashtra
and Gujarat are the only two states which contribute to family
plannirjg programme from their own resources.
In the present chapter an attempt has been made to analyse
the plan outlays as well as actual expenditure (plan + non
plan) on health sector in the State of Gujarat,
fically this chapter presents the followin'
analyses.
i fe-i'"
More sped-
four types of
i) an analysis of the StateAs Sixth Five Year Plan
budget for Health Sector in terms of what was planned
and what was actually spent on various schemes.
L-
1I
i
- 49
ii)
an analysis of the expenditure pattern under
various schemes of the total expenditure (both
plan and non-plan taken together)
iii)
a detailed headwise analysis of the total
I
expenditure (both plan and non-plan taken together^
on medical, public health and family welfare i.e.
under these schemes, how money was spent against
various detailed heads such as salaries, drugs
and supplies, transportation etc.
r
■
iv) to conduct a similar exercise for the year
1982-83 at district and taluka panchayat levels
in a selected district.
In all these exercises, MCH has been given special attention.
To obtain actual expenditure during the Sixth Plan period
individual annual expenditure figures for the years 1980-81
to 1984—85 has been pooled. However, in case of 1983-84 and
1984-85 actual expenditure figures were not yet available and
hence the revised budget estimate for 1983-84 and budget
I
.A,
estimates for 1984-85 which are generally close to actual
expenditure were taken.
Considering this limitation, ‘‘actual
expenditure" has been referred as nlikely expenditure” in the |
present analysis.
Also, in case of detailed head wise analysis, the individual <
year expenditures-incurred against the detailed heads for
four years from 1981-82 to 1984-85 were pooled, The detailed
headwise break up of the expenditure for 1980-81 was not
available and hence the same could not included in this
analysis
s
>•
I
■
! fc
i
L
■
fc
F:
50
it■
fUithu-r, as mentioned earlier, in case of Gujarat a fairly
large amount of money is given in the form of grant-in-aid
t..; the District Panchayats,. which are primarily responsible
lor runUng the rural health programmes.
The break-up of the
actual expenditure on all health and family welfare activities
at taluka level including those of PHC, is maintained at the
Taluka Panchayat and is forwarded to District Panchayat at a
1
very later stage aid often only at aggregated level.
...
Thus
to understand the pattern of expenditure on health from public
sources at ■ distru.zi't— and taluka panchayat levels, the Baroda
District Panchayat and one of its Taluka Panchayats were
selected for the study.
The required data at these levels
was collected from District Health Office at Baroda and one
selected talukas. Many of these data were not readily
available and were compiled on special request.
It may be
worth imen't-ionfng that the compilation was a difficult job
because of the spread of data in various records maintained
at different offices and could not have been possible but for
the cooperative attitude of the officials at these offices.
5.1
Analysis of the Sjxth Plan Outlays and Actual Expenditure
on Health Sector
"
Analysis by Sub-secto
Table 5.1 presents the Sixth Plan outlays for Health Sector
along with an estimate of the actual expenditure, incurred
under plan and non-plan components taken together, during
the plan period. As can be seen from the table, out of
about Rs.3020 million allocated for Health Sector, sewerage
and water supply got the largest share (49.9%) followed by
family welfare (22.4%) medical, public health and sanitation
(22.2%) and the nutritional programmes (5.5%).
CISlS3^
*■
n J a)
LO
TABLE
5. 1 :
PROPOSED OUTLAYS FOR HEALTH SECTOxR &
LIKELY EXPENDITURE DURING
SIXTH FIVE YEAR PLAN PERIOD
Sub-sector
Pl an
in Million)
(Rs.
Proposed
ou tl ay
1
Likely
Expenditure
Likely
proposed
(3)/(2)x
100
Non-Pl an
Total
Likely
Likely
ExpendiExpendi
tu re (Rs
ture (Rs
in million)In million)
(3) + (5)
Pl an
Expenditure
as percentage
of total
(3)/ (6) xlOO
2
3
4
5
6
669. 3
510.7
76
3139.2
Family Welfare
3649.9
676. 2
13.9
930.7
138
Nutrition
930.7
166.5
100.0
67.5
41
257.4
3 24.9
20.7
7
I. Health & Family
Wei. fare
Health
Sub-total
I
l
cn
1512.0
1508
99.7
3396.6
4905.5
30.7
II. Sewerage
Water Supply
1507.6
9 64.9
64
469. 4
1434.3
67.3
Total I & II
3019.6
2473.8
82
3866.0
6339.8
38. 9
I
Flve Ygar Plan (Draft), Government of Gujarac
--q°t ,1EstimaUd?etr w98?^3' Ds?t- of Health and Family Welfare
Govt, of Gujarlt,OlanfSJagard Pamily
f°r 1983’84 and 1984-8^
I
Source
o
3)
I
■
|
52
A comparison of these figures with the actual expenditure
under plan component, given in col. 3 of the table-, shows
chat a total of Rs.2474 million was actually spent against
Rs. 30 20 million planned.
This indicates that for every
Rs. 100 planned only Rs.82 was spent during the Sixth Plan
period (col.4). A sub-sector wise comparisons shows that
for every Rs.100 pLanned Rs.76 was spent in case of Health,
Rs.138 in case of family planning, Rs,64 in case of sewerage
and water supply and only Rs.41 in case of nutrition, Thus
the expenditure in all the subsectors except family planning
was lower than what was planned.
j
In other words during
the plan period more attention was paid to family planning,
some what neglecting the rest, particularly the nutritional
programmes.
i
As the Sixth Five Y.ar Plan budget did not include the
expenditure under 'non-plan’ activities - those activities
wnieh were initiated in the earlier plan periods and conti
nuing during Sixth Plan Period, the total expenditure on
health can be obtained only by adding both ’plan* and 'non
plan' expenditure.
in col.6.
J
^he same has been done and presented
The table shows that altogether Rs.6340 million
was spent on health sector, of which largest proportion was
accounted for by health programmes,(57.6%) followed by those
of sewerage and water supply (2 2.6%), family welfare (14.7%)
and nutrition (5.1%). These percentages are quite different
from the corresponding percentages under 'plan' component.
For example the sewerage and water supply, which accounted
for about 50 per cent of the total plan outlay, constituted
only 22.6 per cent of the total health expenditure of the
State during the Sixth Plan period (Table 5. 2) .
On the
contrary, health which accounted for 22 per cent by the
plan outlay, constituted as high as about 58 per cent of
i
53
the total expenditure.
This indicates that relatively
more emphasis vzas given to sewerage and water supply in
This is corroborated also by the figures in
Sixth Plan.
col. 7 of Table 5.2 which gives for each individual sub
sector percentage
share of plan component in the corres
As can be seen,
ponding total expenditure.
in case of
health, only about 14 per cent of the total expenditure
was coming from ‘plan 1 component, whereas in case of
*
i
sewerage and water supply it was as high as 67 per cent.
It indicates thatthe health infrastructure was developed
substantially in the earlier plan periods and hence in the
Sixth Plan, bulk of the money was incurred against 'non
plan1 component.
On the other hand, potable water is
still a serious problem in the villages and hence major
contribution
component.
(67%)
for this sub-sector came under
’plan’
Family Planning being centrally sponsored
-.1
1
programme 100 per cent of the required money was received
under 'plan' component.
Table
5. 2 :
PERCENT DISTRIBUTION OF PROPOSED HEALTH
OUTLAYS AND ACTUAL EXPENDITURE BY SUB- SECTORS
OF HEALTH DURING SIXTH PLAN PERIOD
1
/
Plan
Proposed Likely
expenditure
(Plan +
I. Health and Family Welfare
Health
22. 2
22.4
57.6
Family Welfare
22.4
37.7
14.7
Nutrition
5.5
2.7
5.1
Sub-total I
50. 1
60.8
77.4
49. 9
39. 2
22. 6
3019. 6
2473. 8
6339.8
II. Sewerage and
Water Supply
Total
(Rs in million)
i
54
>■
1
Analysis by Schemes
Scheme wise analysis of the expenditure on various subsectors of health except sewerage and water supply is
presented in Table 5.3.
It snows that during the Sixth
K.
Five Yea r Plan period a total of Rs. 15120 million was
W’-'
proposed in the plan.
Out of this amount, highest propor
tion was allocated to family welfare programme (44.7%),
B"’ ’
followed by control of communicable diseases (21.6%).
minimum needs programme (13.3%), nutrition (11.1%) and
medical education (4,3%), Medical relief accounted for only
2.6 per cent. Total allocation for ‘training’ of paramedical
staff, shown both under the heads of ’training’ and ’family
planning' taken together, constituted only 2 per cent of the
total plan outlay.
A perusal of the percentage allocation against various
schemes reveals that virtually all the money (95.9%) budgeted
against control of communicable diseases was earmarked for
National Malaria Eradication Programme.
In case of Minimum
Needs Programme, of the Rs.2009 million allocated to it,
<s
/1,
55.1 per cent was planned to be spent towards upgrading or
establishing new PHCs and to strengthen the rural health
care delivery services. Another about 37.3 per cent of the
outlay under MilP v/as earmarked to Village Health Guide Scheme
and small portion (7.5% of the oney allocated to MNP and
-
J
I
only 1.0 per cent of the total health budget) was allocated
to MPW scheme. Similafi y under family welfare programme,
out of Rs. 67 6. 27 million major portion of it was allocated
to rural family welfare services (30.6%) followed by direction
and administration (23.8%) and compensation/incentives
(21.5%).
The allocation for MCH component was relatively
much lower as only Rs. 12.5 million constituting about 1.8
per cent of the total allocation to family planning and
bs
’ ’•] AND NON-PLAN EXPENDITURE
SCHEMEWISE PLAN OUTLAYS AND PLAN
(1980-85)
IN GUJARAT DURING SIXTH PLAN PERIOD
I —Pl an
Proposed
outlay
Ac tu a 1
(in
1akhs)
Likely*
Expenditure
%
Actu al
(in
1akhs)
%
Likely
vs
Propo
sed
(4)/(2)
X100
Non plan
Likely
Expendi
ture ( in
1akhs)
10
87.79
0. 18
20
521.86
613.65
1.25
15
591.86
701.44
1.43
16
5.11
209 11239. 21
12016.4 6
24.56
• 6
0.34
166
100.01
152.58
0.3 1
34
5 2. 57
823.82
5.45
206 11339. 22
12163.04
24.77
7
2.65
105.68
0.70
258
101. 2.9
0.42
51
0. 27
20 6. 37
40.75
0.08
35
1 29.31
137.51
10
0. 25
13. 20
0. 28
Pub.Heal th 37.82
Sub-Total
0.
2
118.28
0.78
151
125.60
343.
8
0.70
78.57
6 .
lie al
t pcdtion
2.02
47
2318.74
12
305.4 1
5.34
4. 26
2624.15
644.0
■.
tori of
'••■-•nun icable
7 . . -.s es
16.09
2223.97
52
24 28.4 4
9.48
20.60
4 652.41
3115.0
78
.HE?***
.TCP***
ssc?***
0. 25
207
193.01
16
37.26
0.47
0.12
230. 27
18.0
0.15
55
553.55
4
22. 15
1.17
0. 26
575.70
40.0
it 1 Indness
Control (b)
0. 12
17
23 2.7 2
7
18. 26
0.51
0.69
250.98
105.0
90.53
0.60
259
996.82
1.81"'
10
0.23
887.35
T3 Control/ 35.0
a-J Voluntary
1. 62
0.01
862.00
1.76
0.0
863. 62
0.0
4 862.07
7460.33
15. 19
35
6
7
8
17.7 1 0.12
37 8
70.08
0.07
9 1. 79 0.61
890
0.10
109.50 0.73
7 30
3 68. 27
2.44
771. 25
i'jD.Health 31.73
0. 21
-Total 400.00
5
4
2
3
4.69
0.03
?uo.Health 10.31
. r »• st ion &
in is tration
H • ileal
15.0
.. -u-To tai
ca- Relief
. a.1 Lona thy)
-dieal
..
ming (a)
Helical
r?ub. Health)
r
4?
Plan as
percentage
of total
(4)X8) X100
9
i
ft"
Total
Likely
Expenditure
Actual
%
(in
1akhs)
•.SEP/Others
2598. 25 17. 22
80
Sub-Total 3260.00.
21.56
Const, (e)
/.~gradation
Strengthening
rural health
Services no8.OO
CHV*** (c) 750.0
XPX*** (c) 151.0
7.3
5.0
1.0
403.93
91.08
86.84
2.67
0.60
0.58
36 2567.6
12 1228.04
58
201.83
2971.53
1319.12
288.67
6.05
2. 69
0 . 5 -9
14
7
30
581.85
3.85
29 3997.47
4 579. 32
13
13.3
9.32
2009.0
...□-Total
*.6
• X i.
V III.
IX.
X.
XI.
XI'1.,
I
4
5
6
indigenous
System of
medic 1 ne
120<>0
0.8
149.b9
0.99
124
1553O46 1703.15 3.47
E. S. I. S ch ern e
15.0
0. 1
37.50
0. 24
250
5548.43 5585.93 11.38
Other Expenditure/Sen ices/
Loans
111.43
0.74
364.96
2.4 2
277
1622.55
1387.36
2.83
24
Nutritional
Programme
1665.0
11.01
674.53
4.47
41
2574.11 3248.64
6. 62
20
40.0
0. 1
17.70
0.11
44
2. 82
20.52
0.04
87
Dir. Adm.
1 <.09.4
10.64
10.88
83
134 1.47
1341.47
2.73
Rural FF
S e rv i c e
20 67.6
13.67
15.82
115
2387.87
2387.87
4.86
Orb ar; FP
Serv ice
449.0
2.96
2.96
99
446.57
446.57
0.9 1
MCH
I 25.0
0.82
0.31
38
46.71
4 6.71
0.09
2.58
343
389.85
389.85
0.79
23.08
24 0
3482.0
3482. 6
7.09
School
H»'al th
7
9
10
9
Fcimi.ly Pl rtnni 11 g (d)
Vehicles
113. 5
0.75
•-■onipen.s at Lori
J 450.4
9.59
OSS
366.0
2.4 2
3.06
126
461.63
461.63
0.94
Mass Edu.
67 . 2
0.44
0.82
185
124.4 9
124.4 9
0. 25
Trg. CANH/
RFWTC/PRO)
2 29.6
1.52
3.96
260
597.92
597.92
1. 22
Add.incen
tive
285.0
1.88
Sub-total
Grand Total
*
8
2
1
6762.7
15 1 20.7
47.7
29. 95
1.
29. 25
57. 29
137
9278. 11 9278. 11 18.89
5810.54
15088.65
100
3396.6 49075.82
30.7
by adding
adding the
the actual
actual expe
expenditure of f
The likely expenditure figures are arrived at by
1980-81. 81-82 and 1982-83, revised budget estimate of 83-84 and budget estimate ot
1984-85
** 100 or cent centrally sponsored
***■ 50 per cent c-entrally sponsored
publications showed the FP expenditure under ‘Non-Plan' for
(d) Although the budget
‘- a distribution of the expenditure was shown under
comparison purposes the percentage
table and the ratios of likely vs proposed have been worked out
'plan' In the above t~Ll_
sometimes, for items like ‘Training1; MNP are
For tin? purpose oi standardisation,
i. ji ouped as des*-’r ibed below.
■; and control of blindness
Tn the sixth plan document, the programme’visual impair emen t
(b)
undf/r medical relief, medical education'and public health programmes.
.ipp-rured
under medical relief, medical
------- .
The outlays were all pooled and shown at one place as above
schemes under paramedical ‘training1 which appeared as a part of •medical
(a) One ot the is taken out from the latter and added to the training subhead
education *
CHV and MPW schemes were shown as part of MNP in the sixth plan
.^pto”
(c)
individual annual budget publications they were shown under
Riblic
81-82 and under FP from 82-83 onwards.
However, they, are shown under MK? in d.e
_
above Ccabl e.
1-)
Cons <..* Construe tion of new PHCs/SCs/SHCs.
■
57
only 0.3 per cent of the total health budget was earmarked
under this scheme, Further, allocation against training
component was only Rs. 22.9 million, which constituted
about 3.3 per cent of 'ch budget allocated against family
planning programme and barely 1.5 per cent of the total
health budget.
To see how much was actually spent, against the proposed
budget under 1 plan1, component, a ratio of the actual plan
expenditure to proposed one was calculated for each scheme
s
and presented in col. 6.
The analysis shows that for a
number of schemes/heads much more fund than allocated was
-
spent.
The highest incr.ase was noted in case of direction
and administration in which case for every Rs.100 allocated
to Rs. 7 30 was actually spent.
A similar pattern, however,
with an increase of less order, was observed in case of
'medical relief
(Rs. 206 for every Rs. 100) , ESI (Rs. 250
for every Rs.100) and family planning(Rs.137 for every
It is also important to note that there were
Rs.100) .
many schemes, where actual expenditure was much lower than
planned.
For example, under communicable diseases only
Rs. 80 was spent against every Rs.100 planned. A break up
of the individual programmes within this broad head indi
cates that the expenditure against ’prevention of visual
impairment and control of blindness was fairless (Rs.17 for
every Rs.100) than the proposed one.
Similarly against
NLCP (Rs. 55 for every Rs. 100) and NMEP (Rs.78 for every
!
?
I
Rs.100) lesser money was spent than planned.Under Minimum Needs
Programme construction work lagged far behind their planned
target and under this h-'-ad only Rs. 36 was spent for every
Rs. 100 allocated to it.
Sarne pattern was observed in case
nutrition programmes (Rs.41 for every Rs.100), school health
(Rs.44 for every Rs.100) etc.
Again it is important to
58
note that under family ^j.anning, actual expenditure incurred
against most of its components was higher or equal to the
planned ones, however, the expenditure .against supply of
MCH materials w^s much lower than planned one - only Rs. 38
was spent against for every Rs.100 planned.
i
■
5.1.3 Schemewise Analysis of Total Expenditure (Plan + Non-plan
on Health Sector During Sixth Plan period
As discussed earlier, the true picture about health expendi
ture emerges only from the,pooled expenditure incurred against
both 'plan' and 'non-plan1 components.
The change in the
pattern of total expenditure (plan + non plan) against the
proposed one has already been touched upon in section 5.1.1.
Hence in the following paragraphs only a brief discussion
will be made at scheme level.
As can be
seen from (col.9)
one fourth of the total health care expenditure w^s accounted
for by medical relief followed by family planning (18.9%),
!
control of communicable disease (15.2%), ESI (11.4%) and
Minimum Needs Programme (9.3%). Another 6.6 per cent of the
total expenditure was accounted for by nutritional, programmer
and 5.3 per cent by medical education.
Within these broad
heads, the pattern of expenditure incurred against individual
programmes/scher s remained some wha_ similar to what we
Observed m the
uj. mo plan outlays.
'Training' of
paramedical staff arid expenditure on family welfare training
centres remained a neglected one, and only 2 per cent of the
total health expenditure was spent on it. Similarly,
expenditure against MCH supplies was observed to be 1
meagre 0.1 per cent of the total health budget amounting to
about 4.7 million.
3
1I
J;
fc ■'
'4'
59
Expenditure on Health
buctpr_in Gujarat...Durin1981^85'----------------------------^hc- present section attempts to analyse the health expendi-
ture<- incurred against various
’deatailed heads’ like salary,
office expenditure, transport, materials and supplies etc.
To undertake this analysis, the individual annual expenditure
incurred against major dccailc'd heads during 1981-82 to
1984-85 was pooled to arrive at a consolidated figure for
_as the detailed hcadwise expenditure
the period 1981-85.
-
for 1980-81 was not available, the entire Sixth Plan period
I
could not
>e covered.
However, as we do not expect marked
difference in, the expenditure pattern against detailed heads
the percentages given in Table 5.4 could be safely taken as
I
the average pattern for the whole Sixth Plan period.
The
individual yearwise analysis which were used to arrive at
these figures arc appended at the end of thes chapter.
For a
better understanding, detailed headdwise analysis for the
three subsectors of h<;?alth viz. medical, family welfare and
public health were separately analysed and presented in
the tables.
Table 5.4 shows ti^t about 30 per cent of the total expendi
ture went to salaries,-^/
Grants given to the district
panchayats, local and other bodies contributed to 39.3 per
cent of the total'expenditure.
Aoout 11 per cent was spent
towards drugs materials and supplies.
Thus these three
items taken together constituted about 80 per cent of the
total cxpendituie.
Office and other expenses out together
accounted for another about 13 per cent
1
-
As vq will see in the subsequent analysis, a major
portion of the granb—in-aid (60. 5%) given to district
panchayat under 'Health1 went to ’salary'.
On the basis
of this, a calculation of the total amount spent against
salary worked out to be around 51 per cent of the total
health budget and not 30 per cent as indicated in Table*
5.4.
60
WLE
5^ :
DETAILED HEADWISE EXPENDITURE ON MEDICAL,
FAMILY WELFARE Ai\D PUBLIC HEALTH IN GUJARAT
DURING 1981-85
Medical
Family
Welfare
Public
Health
Any
Salaries
44.4
8.7
20.8
30. 2
To E.
0.5
0. 2
1. 3
0.6
O.E.
7.3
9* 1
1.9
• 6- 8
0. 2
15.3
Ren ts
0. 1
1.0
17. 2
1.5
6. 6
10.9
Panchayat
11.9
65.7
38.7
31.4
Local bodies
0.8
3. 2
5. 1
2.4
Other bodies
5.5
5. 2
5.9
5.5
Scholarship
3.3
0.7
0.3
2.0
Machinery fit Equipment
1.4
0.5
0.3
0.9
Motor Vehicles
0. 5
1.7
0.6
0. 8
Maintenance
0.1
0. 1
i. 1
0. 1
Diet charges
2.4
0.4
1.4
Others
2. 8
5. 3
4. 1
3.7
Total
2093344
902349
994 211
3989904
%
5 2. 5
24. 9
22. 6
Detailed Head
Materials <9 Supplies
Grants
* Pooled over four years
1981-82 Actual,
1984-85 Budget
1981-85
1982-83 Actual/
1983-84 Revised and
Source : Budget Estimates of Health and Family Welfare
Department, 1983-84 and 1984-85, Govt, of Gujarat
Gandhinagar
1
61
i
I
<M« analysis for cacjl subsector shows
against salary (44.4%)..,as lncurrad
fcllowoa by 'BabUo K.,.lth, (2O_8X)
that the maximum
in case of 'medical '
and the least was in
Ta-se differences could
be because of the fact that the schemes
falling under
-dical- by and large are urban based
such as civil
hospitals and medical < ''
colleges against which the State
Government directly spends
and hence could keep records of
expenditure in a detailed
manner. As a result they could
provide complete informatic
n as to how much has been spent
on
salary- and on other
be ailed heads. cn the contrary
a major portion of outlays under
'public health' and 'family
welfare- are given to
^anchayats and local bodies in the
form of grant-in-aid for
waich no detailed headwise inf ormation is available at Sate
level.
in fact as we will see
in subsequent sections,
a major portion of these grants were
spent on 'salary1,
However, it could not be
reflected in
the aoove table for want of the data in
required form.
the case of Family Welfare (8.7%).
Among the three sub-sectors,
the proportional allocation
to materials and supplies was the highe£t under medical
(17.3%) followed
by /Uo/1G health (6.6%) and the least under
family welfare ’(1.5%) #-2/
Compensation/incentives for
family planning
acceptors and motivators constituted 39.9
per cent of the
total expenditure under family welfare
programme.
« appended tables,
materials supplies under ' oubli^h Aa^^enditUre gainst
more but it could not ■q shown cCheal^h should have been
against this durinq 1981-82 and 1982S83°f
rn°ney Sp°n
office expenditure'(OF) and its br!f>83 W3S mer9ed with
and its break up was not available.
il
62
5.3
jQsta il od Headwise Anal vs is n-F
.
MCH SelVir^ in
—-^^P-^ture on Key FP and
-------- ——in ^Jiarat During 1981-85
-------------To get further details
on some of the Key services under
programme, expenditure on each of these WolS
distributed according to the detailed heads ana are presented
in Table 5.5. To arrive
at these consolidated figures, a
similar exercise, as cescribed in previous section,was done.
As per the decentralised
planning the State of Gujarat the
rural family welfare services
are also under the control
of district panchayat and hence
major portion of the expen di
ture under this head (73%) was
shown against grants-in-aid
to district panchayat for which
no further breakup was
avail able.
family welfare
mJ
»
In case of MCHZ the total
expenditure was shown only on
materials sncj supplies
•against which Rs. 2. 17 million, constituting 0.2 per cent of the total
expenditure on family
welfare programme was S',2ent
over period of four yeer*s
(Table 5.5).
Of the total
family welfare expenditure , or)
training of Auxiliary
urse Midwife (ANM)/Lady Health
Visitors (LHV)/Dai etc. an amount
of Rs.36.9 million was
spent constituting about 3.7
per cent of the total sxpenditure.
Under 'other supplies
and services' (OSS), which
include maintenance of beds,
supply of conventional contra
ceptives (CC) and postpartum
centres etc. Rs.41.5 million
was spent during 1981-85 which
constituted 4.2 per cent of
the total family welfare
expenditure during the same period.
Out of this about 19 per cent was incurred against supplies,
l^-tgely of contraceptives.
3
The
i
M ;
S *
F
t
b
fx
c
v
H-
T>
J
X
1
J
figures given against
However,/ an idea
■
about the pattern-of the expenditure
of money given
‘ ss grant-in-aid to district panchayats
is presented in subsequent sections.
)
i
U4
<C
F-
I
TABLE
5.5
EXPNEDITURE ON
: DETAILED HEADWISE ANALYSIS OF/KEY FAMILY PLANNING
IN GUJARAT DURING 1981-8
Kural FP
Services
Urban FP
Services
Salaries
7<4
29.6
T. £.
0.3
0.8
O.E
1.7
3.7
Detailed Head
Materials & Supplies 0.6
Rents
MCH
100.0
Trans
port
Mass
Edn.
0. 2
1.4
4.3
0. 4
ANM MCH SERVICES
Train ing
OSS*
34.4
Compen
Sation
Dire
ction
L Admn.
Total
35. 9
4. 2
8.7
0. 6
0.9
0. 2
0. 2
10. 2
23. 1
5.9
6. 5
6. 8
5. 2
0.7
18. 8
1.0
1.5
5.6
0.5
0. 2
Grants
Pan ch ay at
77.9
2. 3
29. 2
62. 8
22. 1
14.4
80. 2
80.9
65.0
Local bodies
0.0
17. 2
23.8
7.6
0.0
5.6
3. 3
0.3
3.2
Other bodies
0.0
46. 8
1.4
11.0
13.4
5. 6
Scholarship
0.2
M a ch in ery C Equ i p
Equ i pm ent
1.5
6.4
0. 1
Motor Vehicles
38. 1
Maintenancc
Others
Total
(OOOs)
%
*
1981-82 Actual,
9.9
0. 2
317 691
3785 2
3 2. 3
3. 8
1982-83 Actual,
0.7
0.3
0.7
6. 1
2.0
Include maintenance of beds.
Source :
5.2
0.5
2.8
1.7
0. 1
0. 6
0. 1
1. 9
5. 3
0. 3
1.6
5. 3
3. 2
5. 3
2171
3 6897
11564
92146
41468
319358
126699
985 246
G. 2
3.7
1. 2
9. 3
4. 2
3 2.4
12.9
1983-84 Revised ,
supply cc.
1984-85 Budgets
Post partum centres
Pooled over these four years,
etc.
Budget Estimates of Health and Family Welfare Department,
and 1984-85, Govt, of Gujarat, Gandhinagar
1983-84
l
Ch
CO
I
64
proqrZm
V'“rious exponents of family plannino
programmes are mislead-mn
i
on salaries as
"
°nly
merged with Ora.nt-P'ld
t °"
are
to P^chayat,
■
n .h
,
- rant—in—caid
'ld tQ
local bodies
and
other voluntarv
voluntary organisations.
/ the orcak up of which was
not available. However, as
mentioned earlier an idea
about the exact share of salary in the rotal
may be had from subsc-quent sections whore in expenditure
exepnditure
pattern at district
ana taluka. panchayat levels have
been
attempted.
5.4
I
^cnemewise
E2<£enditure
-£Il^Yat__l_ev el Du r in q 1982-83
I
‘->s
mentioned earlier administratively the district
panchayat
is responsible for
running all the health
care and family
welfare programmes in rural
areas and it receive the
necessary funds from the State
Government in the form of
grant-in-aid.
Thc district
panchayat in turn releases funds
to taluka panchayats towards the
disbursement of salaries
and contigencies to all the health
centres falling in ti.eir
respective areas,
areas.
Hence to
study as to which programmes
under health and
and family welfare
received importance at
the actual implementation
implementation stage and how the
total grants
received were
were disr
distributed against salary,
drugs and
materials, transportation
etc., district panchayat of
Baroda and one of its talukas
were selected for the■ study.
The analysis of the health
expenditure for 1982-83 •at the
district and taluka
pan ca ay at: levels are presented in •
Table 5.6 and 5.7
respe ctively.
Table 5.6 shows •'that
’
during 1982-83 the district
panchayat
spent about Rs. 24.96 million
-J on various health and family
welfare services in rural
areas.
However, it may be c
t
h
P
i
N
d
Ii
3r
al
it
rc
a
-<n
65
cautioned here that this figure is
slightly under estimate
ss it did not include the amount rspent on public health
materials like Premaquine, Daraprim
- i and Paracetamol which
the Panchayat (mo) received in kind
and for which prices
were not available.
Although the DHO .officials did
not have the information
on the expenditure on Stats, run
health centres, a rough
estimate provided by an official
indicates tnat the likely expenditure against these
: centres
could be of the <order of about Rs.50 lakhs (half
}
million).
Hence at district
- panchayat level, the total health care
expenditure must be around Rs. 29.96 million during :
1982-83.
Further analysis of the avaiiab^ sxpenaiture data accoraing
to different subsectors
Of health indicates that public
health accounted for
major share (43.2%) followed by family
planning (28.4%) and medical (28.3%).
it can be further seen
in the table that
among various public health programmes,
NMEP topped
against which 23.4 per cent of the total expenditure was incurred.
It was followed by VHG scheme (6.6%).
Interestingly, 4.4
per cent was shown against National
Small Pox Eradication
Programme (NSEP) .which infact was
abandoned around 1976.
Informal discussions with concerned
^utnorities indicated that the staff under this programme
was shifted to other health and family planning programmes,
bur the programme remained
on paper for budgeting purposes,
Tovzards construction
activity the panchayat spent only 6.08
lakhs as against 80 lakhs
approved for the same purpose,
-^mong various
components of family welfare programme rural
4/
llke’ehloroluS^HC0^™)1",?11?6 °f 1), other HMEP materials
3> immunlsa?"" agSts
ok
'M
hd
e^tirmfinn
+. il •
/II? Folio etc.
However,
and the prevailing inlt cosS^f^h98 °£ supPlies received
These figures-™;,
7i!T-
66
Table
5'6 Sche.i •• wis»' Break-u, o: the Health and Family We_i are expenditure
inc.;
'-v District p-!.--,ch;'.yat of Bar-oca dur.ir..~ IPSP-irp®_________■
Scheme/Programme
1.
Actual
Expenditure
(Hs.‘OUUs)
Percentage
708^
28-5
Medical
(CHC/PHO/Upgrade'; SCs/drugs to FPSCs)
II.
to*
total •
Family Welfare*
Direction and administration
FW centres/FP subcentres
363
1.5
5228
12.9
Compensation
2569
10.5
HCH and FP materials
Z4I L
1.7
Vehicles
623.
1 .7
Mass Education
4a
0.2
Dai training
5^
6.2
7099
28.^
&
^0$
1 .b
- NMEP/NFCP
5852
23.6
- NSEP
1086
6.6
NLCP
692
2.0
7A5O
29.8
Sub-total
Public Heal tn
III.
(a) Direction and administration
(DHO establishment/srrengthening DHU scheme)
(b) Control, of communicable diseases-**
Sub-toral(b)
1
(c) Minimum Needs Programme
•j
- Construction of bldgs for PHCs/Subcencres euc.
b08
2.6
- MPW
350
1 .6
HV
1659
6 .b
2817
10.5
51^
1.3
14*
0.1
■
Sub-total
(a) indigeneous syste:. of medicine
Ayurvedic drugs)
)
CMO CHV salary,
(e; Others (Birth and ueatn registration)
Sub-total III
1 '.)780
Grand Total
26963
•' ’
2
Source • District Panr.hayat Rec-ords
include the following
one communit
1th centre
:urred by state run hospitals
Expenditure
of the
A rough estimate of the expen .lit
and three referral nospitals.
centres according to an official at Panchayat was about Rs.c'
Expenditure against MMEP materials like Daraprirn, PremaqUins . - aracetamol
tablets for wr. .ch the prices were not available at the time 01 analysis.
However, fci <•■ the-?
terials like Chloroquine tabs and- BHS (50%), the costs
'.ho-'
ou arid D-.cluded tn the analysis
were worked out
The total s.-.owr
S:.GWr
1.
*
2.
3.
11
II:
the table does not
expenci'ure on NcLicnaJ TB C-.-ntrol Programme wa s not available at PHC office.
_^rl, figures
f_o„._c provided by DHO Office were
Fr materials, the supply
s
converted inte •'■xt.enditure figures .r. rupees bv multiplying the same with
co rres pond i nr U;.jt costs. The so obtained figures were includ-c m the analysis.
Including the costs of NMEP materials like chloroquine ,and BHC (50%)
As regarcs r.UH .it-
67 -
family welfare
contributed
of the total
(Table 5. 6).
oompensation/incentives
eentr.s
12‘9 P£r C<SDt “d “-3 Per cent
-alth aafl family welfare e!tpenditure
Table 5.7 shows that s^l.-pr-.,
Share
Allowed by
compensation/
(about 61 per cent of
tot
dz.gs, materials anQ.
incentives (10 3=/) Vo-r-';
z
Ver2_c2.es (3 2%)
tnat
expenditure under media-,
°f hMith sh°"*
“ ’
Cent O£ the
Public health,
family welfare,
r heT' “hile “ ““
— 40 par ca,t
welfare, compensation/,
- ■ iDa „ h. „ /lac-rt"'e was another major item,
Per cent o£
of the ■
v eh ±c 1 gs
-iatrvely’ more share in family
welfare (6%)
ompar^d to that of in medical (4 5/)
h•,
vehicles were not ^t all
•
^.5/0), while
1 maintained
maint—under public health.
--
Taluka. Panchaytt^ii^iig-^g^lX^^-^ -enditure at
(1982-83).
Sh°WS tHe
This^^79'"
^e pattern of the
dUrln9 thG Same *ear
table snows that the taluka spent Rs 12 65
lakhs for
lZnZ d^rrictTev^ ^i^1^H'09'3™"3However,
Gi estimate, this figure is
also slightly under
estimate, because of the non-availability
of
expenditure data on Pronaquine, Daraprlm and Paracetamol
tatlets.
i-’foot
57 Ss?
note 1-3, the
“’terlals consumed by PHO
thousand ^s^fealT
' p's. 10 thousand and
turned out «
«-'-14
S
TABLE
■‘i
5.7
•J
I
!
Salary
75.9
78.4
43. 6
34.6
60.9
67.7
60.5
58.8
T. E.
6. 3
5. 1
2.8
2. 2
4.1
6.0
4.4
4.3
Drugs/Materials
9.6
11.7
5. 8
5.4
19.0
5.0
12. 8
7.0
Vehicles
4.5
1. 6
6. 2
7. 1
0.0
0.0
3. 1
3. 1
35. 1
46.7
10. 3
17. 2
Compensation/incentives
-
Others
3.7
3. 2
6.5
4.0
16.0
21.3
8.9
9.6
7084
360.3
7099
467. 9
107 80
4 37. 0
24963
1265•2
(Rs in ’000 )
28. 5
Source :
■
rJ
All
Taluka
Dist.
Medical
Dist.
Taluka
%
■
Public Health
Family Welfare*
Dist.
Taluka
Dist.
Taluka
Detailed head
Total
<
DETAILED HEADWISE EXPENDITURE ON MEDICAL FAMILY WELFARE AND PUBLIC HEALTH
It-;CURBED BY DISTRICT PANCHAYAT AND A SELECTED TALUKA PANCHAYAT OF BARODA
DURLI.G 19 8 2-83®
37.0
District and Taluka Panchayat Records
Expenditure against NMEP materials like Daraprim, Premaquine, Paracetamon tablets
for which the prices were not available at the time of analysis.
However for other
materials like chloroquine tabs, and BHr (50%)? the costs worked out and included
in the analysis
In addition to this the District figures do-
M
not include:
expenditure incurred by state run hospitals - one community health centre and
of these
these centres
centres <t
three referal hospitals.
A rough estimate of the expenditure of
according to an official at Panchayat was about Rs.50 lakhs.
Expenditure on National TB Control programme was not available at PHC office.
* As regards MCH and FP materials/ the supply figures provided by DHO/PHC were converted
into expenditure figures in rupees by multiplying the same with corresponding unit
These obtained figures were include——lb—
/
Ch
CO
I
34.5
The totals shown in the table at district and taluka panchyat level do not include
the following
14
il
I
tn
'•
cn
H-
69
A break-up of the avai,artle d3ta in
•
T)
a
4->
n
(•/ o
o
-ubsectora of health viz. meaical r
■,
public hesH-b K
1/ farnily welfare and
nc . health shared 28.5, 34 5 and
n
respectively
A
37-° per Cent
. ,.
y
oet-ilcd headwise analysis
indicates that th a
+-4aiysr. Of expenditure
tnat t^e pattern was morp nr i
at district panchayat level with salary bein^
single largest ltern of aXpanditure (5^ £“’
the
> O
r
c j
c H
o 5
$4
3 ?
O ‘O
£
compensation (17
4.
' followed by
travel all°
"’ttenals a„a supplies (7.M),
alliance (4.0%) ana vehicles (3 0%)
4 f '
analysis shows that whll- „„a
,
'
f“rther
pattern at t , v
'meaical■ expenditure
Of district it “^t
lar?,G
o
> )
£ )
T5 x:
Q) -p
TD I
•H :
-d 'public'health’.
>
o u
were changed because of aifX„T “
ThX^rnT"
between taluka and district
w
o
sectors.
JS cn
O -P -H
Oi
H
M
U]
)
°f public health were
-r-1
>1 >1 c
• ro
H
i’
in the patterns of
‘ Q)
“
perfon“"«
,a
fsnohayats In these t» subAccordingly compensation/lncentives in the case
of family Planning-^
rH
t
and materials and supplies In the case
largely responsible for the changes
expenditure in the respective subsectors.
-C
a rH p
5.6
c
D
•H
4-1
Analysis of the Sixth Plan
outlays of Gujarat
on the health
sector shows that ^ev7<raoe and water
supply was given
special attention in th e S ixth
nt
of the total health budget was Plan and almost 5o pei
allocated to this sub-sector.
It was followed by family welfare
(22.4%)
and medical,
iolic
health and sanitation ( 22. 2?o) .
About 5.5 per cent of tne
total budget
C)
■* _ u
•H
J
0)
M
O
f’
I
W
U- >4
-H 3
_____ ■ was allocated for
44 cn
4
4
4
r_ 1
(L -J
X o
QJ
)
O
nutritional programme.
According to an
'
estimation, the
currently protect^t^is^rlct
°f Co^^s
levels were 42.5 '--J at district
t a a taluka panchayat
U-Ou.j per cent respectively.
(1
k
2J 'O
-P GJ
T
Summary and Conclusions
)
-P Q)
c x:
h n
4
/
/
/
!
70
Scheme wise analysis after suppressing allocation for
sewerage and water supply shows that in the Sixth Plan,
highest proportion of allocation was made for family welfare
programme (44.7%), followed by control of communicable
diseases (21.6%), mnp (13.3%) nutrition (11.1%) and medical
education (4.3%). Only 2 per cent was allocated for training
of paramedical staff.
Under control of communicable diseases,
almost entire fund
(96%) was allocated to NMep#
Similarly under familY welfare
programme, bulk of the
money was allocated to rural family
welfare services
(30.6%) z direction and aministration (23.8%)
and incentives (21.5%).
Supply of iiCH materials constituted
only 1.8 per cent of
the outlays for family welfare programme
and only 0.8
per cent of the total health budget (excluding
sewerage and water supply).
Thus the analysis of the plan
Supply).
al 1 oc at ion in die ates
that
plan documents
documents put
- . even though the
cue p±an
of emphasis on training
training of
of paramedical
paramedical staff and MCH
services, it did not reflect
much in the plan outlays.
An analysis of the actual expenditure (plan 4non-plan) during
ixth Plan Period also sunports the above observation
break up of the actual expenditure shows that during this
A
period altogether about Rs. 4910 million was Spent on h<=a^ th
and family welfare activities.
Out of this ’medical roiief.
nZnted f°r 3 larger £hare (25%) followed by family planning
U /=), control of communicaple diseases (15.2%). 2SI (11.4%),
MNPJ9.3%), nutritional programmes (6.6%) and medical education
in case of p±an outlay, at actual execution stage
also, training of par^edical staff contributed to only 2 per
cent o
the total expenditure (pl an+n on-pl an) and MCH, a
negligible proportion of o.l per cent.
71
comparison of money proposed and spent under plan component
fo. various schemes show’s that in case of direction and
administration, for every Rs.iqo allocated, Rs.730 was
spent.
Similar increase, but of lower order was observed in
case of
medical relief, and family planning.
On the other hand, in
case of
many important schemes, money w..s spent much lesser
than planned, For example, in case of prevention of visual
impairment and control of blindness for every Rs.100 allocated,
only Rs.17 was
actually spent. Similarly other schemes on
which less than 50
per cent of the planned money was spent
were construction work under MNP (Rs.36/ Rs.ioo alloted)
nutrition programmes (Rs.41 / Rs.100 alloted), s.hool health
Rs.44/ Rs.100 alloted)and supply of MCH materials (Rs 38/
Rs.100/ alloted).
ailed head wise analysis of actual expenditure during
1981-85 on health sectorshows that about 51 per cent of the
total health budget was spent against salary and about 11 per
cent towards drugs and materials and supplies. An analysis
by subsectors of health also showed that proportional alloca-
,ion to drugs and materials and supplies was highest under
medical
(17.2%) followed by ‘public health1 (6.6%) and the
least under family welfare, which include MCH materials (1.5%)
According to our analysis during 1981-85, only Rs.2.17 million
constituting 0.2 per cent of family welfare budget was spent
m providing supplies for MCH services.
n analysis at District and Taluka Panchayat levels shows
at during 1982-83 tne total expenditure was of the tune of
-s. 29.96 million and Rs. 1. 265 million respectively. At
tsWka level 59 per cent
the total ex,,Mditure
acoounted
by salary followea/materials and supplies (7.0%), travel
owance (4.0%) and vehicles (3.0%).
-1'
-win-1
72
Thus the analysis of the Sixth Five Year Plan and the
actual expenditure during tfe plan period, brought out
very clearly the fact that the curative services received
more support than the preventive ones.
Importance of KCH
and training of paramedical staff which was repeatedly
mentioned in the plan documents was neither reflected in
the plan outlays nor in the actual expenditure,
In fact,
in case of MCH, less money was spent than actually allocated
in the plan.
^he analysis thus points to a contradiction
between the intention and actual performance and thus
suggesting need for an immediate corrective measures to
remove this anomaly.
- 73
TABLE
5. 8
:
SCitEMEWlSE ANALYSIS OF HEALTH AND FAMILY WELFARE EXPENDITURE IN
GUJARAT FOR INDIVIDUAL YEARS OF SIXTH PLAN PERIOD
(Percentage)
I.
80-81
81-82
82-83
83-84
84-85
80-85
Medical
Public Health
0. 2
0. 2
0. 2
1.4
0. 1
1.4
0. 2
1.4
0. 2
1.5
0. 2
1.3
Sub-toral
0.4
1.6
1.5
1.6*
1.7
1.5
Medical
Public Health
25.0
1. 2
26.0
0. 1
26.6
O’. 1
23.0
0. 2
23. 1
0. 2
24.7
0.3
Sub-total
26. 2
26. 1
26.7
23. 2
23.3
25.0
Medical
Public Health
0.6
0.3
0.4
0.4
0.4
0.2
0.4
0.3
0.4
0.3
0.4
0.3
0.9
0.8
0.6
0.7
0.7
0.7
5. 6
5.8
5. 6
5. 1
5.0
5.3
8.5
0.4
8.6
0.7
1.3
0.5
2. 2
2.0
10.5
0.4
1.4
0.6
1.9
1.5
6.5
0.4
1.5
0.9
2.0
1.6
9.5
’ 0.5
lo 2
0.5
1.8
1.8
Direction & Administration
II. Medical Relief (Al1op a thy)
III. Training
Sub-total
IV. Medical Education
V.
Control
of C-ommunicable Diseases
(Public Health)
NMEP**
NLCP**
NLCP**
Blindness Control (a)
TB Control/3CG Vacination
I'SEP/Others
0. 1
0. 2
1.0
14.5
0.4
1. 3
0. 2
2.4
2.0
Sub-total
11. 2
20.8
15. 3
16.3
12.9
15. 2
7. 2
1.6
0. 2
5.9
3. 1
0.7
6. 3
2.3
0.6
5.5
3. 1
0.6
5.9
3.0
0.7
6. 1
2.7
0.6
9.0
9.7
9. 2
9. 2
9. 6
9. 3
2.9
3.4
4.0
3.5
3.5
3.5
ESI Scheme
10. 2
10. 2
11.1
12. 2
12.5
11.4
IX.
Other Expenditure/Services/Loans
3/ 1
2. 5
2.6
2.9
2.2
2.8
X.
Nutritional Programme
16.8
3.0
5.5
4.8
5.8
6.6
0. 1
(3
1.0
4.5
1.0
2.3
4.5
1.0
4.1
3.9
0.9
2.8
4.6
0.9
0.3
5.7
0.7
0. 1
0.3
1.0
7.3
0.7
0.5
0.7
0. 3
7.9
0.0
0. 2
0.6
17.9
VI.
Minimum Needs Programme
Construetion/upgradation Strength
of rural health services
CHV Scheme*
MPW Scheme **
Sub-total
VII.
VIII.
XI.
XII.
Indigenous Sy st err, of Medicine
School Health
Fan:ily Planning
Direction & Administration
Rural FP Services
Uroan FP' Services
MCH
Veh icl es
Compensation
o.s‘.s
Mass Education
Training (ANM/RFHTC/DRC
Addl. Incentives
Sub-total
GRAND TOTAL
13.6
(Rs. in lakhs)
16.0
7111. 1 8225. 5 9777.7
(3
1.4
6.5
1.1
0.2
3.0
2.9
6.3
0.9
0.1
0.8
9. 3
1. 3
0. 2
1.0
2.7
4.9
0.9
0. 1
0.8
7. 2
0.9
0. 2
1. 2
20.5
22. 8
18. 9
@
11570. 2 12111.3 49095.8
* Steps taken in the preparation of this, are listed in the foot-note given under Table 5.
@ less than 0.05 per cent
I
Source :
Budget Estimates of Health and Family Welfare Department 1983-84 and 1984-85
Government of Gujarat, Gandhinagar
74-
taele
5.9
^-lAIrED Kj.^Da’ISe
EAMIL¥ v-W-IF,:-sRE and DM^EI\tDITuRE* OX' ■medical,
PUBLIC health’^
in
DURING 1981-82
—• gujarai
Detailed Heads
Medical
Family
Weifare@
Public
Health**
Any
14. 9
27.9
2.1
1. 2
36. 1
16.9
Sal arias
T. E.
44.3
7.7
O.E.
1.1
0. 2
Rests
8.6
Grants
0.3
10.7
0.1
Panchayat
Local Bodies
Others
Scholarship
Machinery
Motor Vehich
Maintenance
Material Supply
Diet Charges
Others
12.1
68. 6
2.3
3.0
4.4
4.5
3. 1
0.4
1.5
"0.0
0.7
0. 1
2. 6
0. 1
18. 7
0.2
1. 1
0
1.6
Total
%
(Rs in OOOs)
431343
50.7
2.1
181641
21.3
30.7
29. 8
2.8
2.6
8.0
5.5
0.9
1.9
0. 3
0.1
0.8
0.9
0.0
0.6
0. 1
0.5
0.1
0.6
3.4
2. 2
237 7S-?
85 0771
■■
3
i
1
75
a Ae
. TABLE
5. 10
'I
r
(Percentage; )
Detailed Heads
Salaries
Medical
Family
welfare**
5
Public
Health***
Any
41. 3
5.5
20.9
29.5
0.4
0.5
1.4
0.6
11. 1
12.7
24. 2
14.1
18.5
0.6
0.7
10.9
Pan ch ay at
10.3
7 2.3
40. 3
Local Bodies
Other Bedies
Scholarship
Machinery
Motor Vehicles/
30.0
1.3
1.2
4.7
2. 1
4.4
5.8
1.6
4. 1
T. E.
O.E.
Materials Cc Supplies
Grants
Maintenance
0. 2
2.5
3.2
*
0.1
0.8
1.6
6.6
3.2
977676
5 3 20 24
20 2401
243251
54.5
20.7
24.8
***Excluding Water supply and sanitation
Budget Estimates of Health and Family Welfare
Govt, of Gujarat, Gandhinagar 1984-85
■.... -t-—
l.E
C E
F—t
C“ai
Schc
M
Mote
M. '.n
Tota
*
e-*
Sc’-rt
** Including VHG and MPW scheme
I
1
0.3
Actual Expenditure
Source :
1
1
i
Others
%
c
0.5
0.5
Diet charges
Total (OOOs)
■i
3. 1
0.8
•t
a-r-k'r •
**
1
76
■
TABLE -5.11
Detailed Heads
Medical
Family®
Public
Health**
Any
Salaries
45.8
9.7
T.E.
22.8
30.8
0. 3
0. 2
1.0
0.4
5.1
16.7
T.4
1.8
1.7
10.6
5:i
11. 2
Panchayat
Local Bodies
13. 3
60. 6
4 2.9
3 2.9
5.3
Other Bodies
Scholarship
5.8
2.7
5.8
3.6
9.7
6. 1
2.5
0.9
0. 1
1.5
1. 3
0.5
0.4
0.9
0.6
2. 2
1.0
1.1
0.7
1.6
O.E.
Materials & Supplies
Grants
Machinery
Motor Vehicles/
Maintenance
Diet charges
Others
Total
(Rs in OOOs)
%
2.8
3.0
1.8
3. 2
5.8
5865 34
279129
24. 1
288949
1154612
50.7
25.1
Revised Budget Estimates
Source ;
Budget Estimates of Health iand" Family
”
Welfare for 84-85
Government of Gujarat, Gandhinagar
Excluding Water supply and sanitation
eluding VHG scheme and MPH training
Table
5. 12
DETAILED HEAD .lSE EXPENDITURE* GN MEDICAL FAMILY
raLFASE AND KBLIC HEALTH IB GUJA.U? dSNg
(Percentage)
Detailed Heads
Medical
Family
Welfare£
Public
Health®
Any
Salaries
45.7
10.4
T.E.
24.7
31.8
0.3
0.1
0. E.
0.9
0.4
^9
0.4
2.0
Materials & Supplies
Grants
3.1
15.4
2.4
13.4
11.5
12. 1
64.6
41. 6
32.4
2.3
7. 1
2. 1
6.9
6.7
3.7
6. 2
Scholarship
2.4
0.9
0.1
Mach inery
1.5
1.8
1. 2
0.4
Motor Vehicles/
Main ten ance
1. 3
0.5
2.0
1.3
1. 1
Diet, charges
2.9
0.8
Others
1.7
4.4
8.6
3.8
6.99
624312
321152
263145
1208609
51.6
26.5
21.8
• Panchayat
Local Bod;ies
Other Bodies
Total
(OOOs)
%
★
6
Budget Estimates
Source : Budget -Estimates of Health < "
and Family Welfare for
1984-85, Government of Gujarat, Gandhinagar
Excluding water supply and sanitation
£
■
Including VHG scheme and MP/J training
.A 4b
gjAPTER-VI
SIXTH PLAN OUTLAYS AND EXPEl;DI’TORE
ON HEALTH SECTOR .IN MAHARASHi'RA
6.0
Maharashtra, yet another progressive state of the country,
is situated in the western zone.
According to 1981 census
its total population was
vzas 62.8 million. The performance of
family welfare programme in this state is also good.
It
is one of the two states (the other being Gujarat) which
provide funds from the state resources towards additional
incentives to promote family planning.V Some cf the indices
which indicate an overall improvement in the general health
condition of this state are given in Table - 6.1.
to t e -ealth
29 in 1980.
The birth
declined in Maharashtra and according
ervices, it dropped from 39.8 in 1966 and
Efforts are on to bring it down to 21 by the
year 1991. Reducation in maternal mortality rate has also
been reported and it came down from 3.4 in 1966 to 2 0 in
1980.
These statistics although
aatnougn are encouraging, they should be
taken with a note of caution as some of the independent
studies have indicated that most of the deliveries in the
rural areas were still attended by untrained dais and that
the coverage of children under immunisation orogra™e was
fairly low.
In the present chapter,
as in the previous one, an attempt
has been made to analyse the distribution
of financial outlays
and the actual expenditure incurred
against various health
and family welfare programmes in Maharashtra
during the
Sixth Plan period. The mode of analysis and th-e
aspects
covered are same as detailed in Chapter-V.
1
Family Planning
Programme.
is 100 per cent Centrally Sponsored
TABLE
6.1
:
Sr.
No.
1.
CERTAIN INDICES OF MORTALITY IN MAHARASHTRA
Index
Life expectancy at birth
2.
Death rate per WOO population
3.
Infant mortality rate per 1000
live births
4.
Mortality rate due t
to communicable
diseases (per 1,00,000 population)) *
a)
Cholera
b)
c) ’
d)
g)
f)
g)
Rll diarrhoeal diseases
including Dysentry
Tetanus
Respiratory infections
Small Pox
Malaria
Leprosy
1951
1961
45
(195160)
49
(196170)
22.8
157
18. 1
117
Years
1971
1981
1991
(Target)
5 2. 8
(197175)
57.6
(198185)
64
13.0
85
9. 2
61
9.0
Delow 60
I
30
10
0.3
0. 1
52
100
30
10
6 20
370
240
17
190
180
140
50
90
11
50
0.0
0.0
3
0.0
0.0
0.0
0.0
0.0
0. o
l
10
Estimated rates
Source : Annual Plan 1984-84-85 (Maharashtra)
Directorat ?
of Health Services
vo
80
6. 1
i
Analysis of Sixth Plan C
i^l1 ays an d Actu al
Ou1
Expenditure
on_ Health Sector in Maharashtra
For the Sixth Five Year Plan, a total
outlay of Rs.67440
of Maharashtra. Out
of this Rs. 61750 million (91.5%) was State
's contribution
and the remaining Rs. 5690 million (8.5%) was
envisaged to
be contributed by the Centre against various
centrally
sponsored schemes for different sectors,
Out of the total
plan budget, Rs.8582 million ’
was allocated to the health
sector (medical, public health,/ family welfare,
sanitation
d nutrition) which constituted about 12.7
per cent of the
total outlays.
This proportion is about 80 per cent higher
than the proportion (6.9%) observed
et national level.
Thus, in the State of Maharashtra, 'health'
(including
water supply andsanitation) is given relatively
more
importance than in most other states in the
coun try.
million was allocated to the State
s
6.1.1
Analysis by Subsector
Table 6.2 shows that in the Sixth Plan, the total plan
outlays for the health sector was of the order of Rs.8582
million.
Out of this, the largest share (76.7%) was
allocated to sewerage and water supply, and the health
and ramily welfare programmes, each constituted 10.3
cent of the total outlays.
per
A comparison of these
proposed
outlays witn the actual plan expenditure shows that on the
whole for every Rs.100 planned actually Rs.95 was Spent.
Further comparisons at subsector level shows that the
actual expenditure under 'plan' component was higher than
the proposed one in case of Health (Rs. 207 per Rs.100
planned) and family welfare programme (Rs. 161 per Rs.100
planned) while it was lower in case of
•J
I
sewerage and water
supply (Rs.71 per Rs. 100 planned.
In
programmes,the expenditure incurred
was almost as planned.
case of nutrition
TABLE - 6. 2
:
proposed outlays :FOR HEALTH SECTOR
DURING. SIXTH FIVEI YEAR PLAN PERIOD AND LIKELY EXPENDITURE
Sub-Sector
1
Plan
(Rs. in_milj.^
Proposed Likely
ou tlay
Expenditure
2
I. Health <9 Family
Welfare
Health
Family Welfare
Nutrition
Sub-total i
894.
887.4
Source :
3
4.
5.
5
6
7
260.0
5062
6.7
N. A.
6911. 7
1435.4
N.A.
26. 8
99. 5
N.A.
204 2.0
3523.4
17 3
N. A.
N. A.
M. A.
8582.0
4664.3
8187t7
1. Annual Plan f-9n4b85
Government of- Maharashtra
2■ •
4
Plan Expen
diture as
a percentage
of total
(3)/(6) xlOO'
207
161
95
6540.0
Water Suooly
(I + li)
3
Total likely
expenditure"
(Rs. in
million)
1849.7
1428.7
245.9
II. Sewerage and
Total
Likely
Non-Pl an
vs
Likely
Proposed Expenditure
(3)/(2)
(Rs.in
x 100
mill ion)
71
N. A.
N.A.
95
N. A.
N. A.
stat: Part two.
I
CO
N. A.
Planning Department
Civil Budget Estimate 1984-85
Part tt n +- -i
n
1984-85,
expenditure - Public Health
Deoart^e^J D®talle(3 Budget Estimates of
c
.
Department, Government of Maharashtra
Government^f Maharashtra82""83? Urb9n DeveloPment and Public Health
Civil Budget Estimates,
Medical, Education and Drugs Department,
Govt, of Maharashtra
1983-84 and 1984-85,
6 . Performance Budget 1982-83 (Public
n
r>
' one
7. Performance BU(jqet iggoc^
TTr_,
Govt. Of Maharashtra
'
ban
H-aith
c q
.
H.alth <x
Govt of Mahar^^h-i-T-o
& Sanitation)
„
lanarashtra
Devel°Pment & Public Health Dept. Medical
nx
I
•I
- 82 -
Further analysis of total expenditure (plan + non-plan)
could not be done because of the non availability of
expenditure under ‘non-plan’ component on 'nutrition',
'sewerage and water supply'. However, this has been '
attempted at scheme level, after suppressing nutrition
and sewerage and water supply in the following sections.
6t 1* 2
Analysis by Scheme
Scheme wise analysis of the expenditure on various sub
sectors of the health is presented in Table - 6.3. The
table shows that in the Sixth Plan, a total of Rs.-^2 7
million was proposed.
-■
Out of this, the highest proportion
was allocated to 'family planning' (43.5%) followed by
'minimum needs programme' (K.5%) , 'control of conmunicable
diseases' (lOUffiQ and 'medical education'
(5-9%).,
'medical
relief accounted for 3.6 per cent of the total outlay.
For training of paramedical staff, an amount of Rs.11.5
million was proposed which constituted only 0.6 per cent
of the total health care expenditure.
The table further shows that the pattern of allocation of
health outlays to various schemes was similar to what we
t
observed in Gujarat.
For example, a major part (76.4%) of
the money allocated to communicable diseases was planned
for NMEP, followed by MLCP (8.3%).
The allocation for
the programmes of prevention of visual impairment and
1
=!
control of blindness and T.B. control was around 4 per cent
eath. Out of Rs. 337 million, allocated to MNP, three fourth
(75. QX) waE earmarked for construction and upgradation of
PriCs, followed by CHV schene (2. 2%)an d MPW scheme (3.0%).
No Such analysis could be attempted for the family welfare
programme as its break up under various components was not
avail able.
83
6.3
TABLE
S CH EM EWISE PLAN OUTLAYS AND PLAN AND NON-PLAN EXPENDITURE
IN MAHARASHTRA DURING SIXTH PLAN PERIOD (1980-8 5)
Pl an
Proposed
ou tl av
Ac tu al
( in
million)
1
%
Likely
expenditure
Ac tual
%
(in
mill ioh)
Likely
vs
propo
sed
(4)/(2)
x 100
Total likely
expenditure
Actual
%
(in
mill ion)
Plan as
percentage'
of total
(4)/(7)
x 100
2
3
4
5
6
7
8
9
1.0
0.05
78.9
2.2 -
(b)
870.0
10.4
9.-1
(Allopathy) 74.0
3.6
134.0
5.8
181
177 2.8
21. 2
7.5
11.5
0.6
(7F
9.1
0. 1
0.0
Education
20 3.0
•9.9
213.0
6.0
105
661.1
7.9
3 2. 2
Control of Communicable
lliseases ("Public Health)
RMeP '
NFCP
NLCP
Blindness control
TB Control/
BCG Vaccination
NSEP/Others
165.0
3.4
18.0
8.7
8.8
8. 1
0.2
0.9
0.4
0.4
698.7
12.5
50.4
3. 1
39. 2
19.6
0.4
1.4
0. 1
1.1 r
423
3 68
280
36
445
87 3. 1
35.4
238.5
3. 1
57.4
10.5
0.4
2.9
80.0
35.3
21.1
100.0
68. 3
12. 1
0.7
0.8
Sub-total
216.0
10.6
804.7
22.8
12. 2
3.8
0.5
334.7
209. 1
17.4
. 9.5
5.9
0.5
Direction & Administration
"(b)
Medical Relief
Train ing
Medical
(a.)
Minimum Need3 ProqrammeX^
Rural Health Services(c)
Construetion/Upgradation
& strengthening of Rural
health services
230.1
CHV scheme (d)
75.0
MPW scheme(e)
11.0
Sub
total
336.8
Q.7
95.4
1. 1
0.8
130 2.9
TsT?
61.8
134
279
158
363.7
221.7
17.4
4.4
2.7
0. 2
9 2.0
94.3
100.0
16.5
561. 2
IS. 9
167
60 2.8
Indigenous systems of
medicines
7. 2
12.5
0.
8.4
0. 2
67
24 1.6
2.9
E. S. I. scheme
15.0
0.7
34.3
1.0
228
120 3 . 2
14.4
2.8
Other Expenditure /Servies 25.5
1. 2'
15. 2
0.4
60
248. 1
3.0
6.1
260.0
12.7
24 5.0
7.0
95
N. A.
N.A.
N.A.
N.A.
N.A.
179. 6
310.9
. 51.6
114.5
26.9
60 2.9
91.9
16.5
33.9
5. 1
8.8
1. 5
3. 2
0.8
17.0
2. 6
0.5
1.0
179.6
315.4
51.6
114.5
26.9
60 2. 9
91. 9
16.5
33. 9
2.4
2.2
3. 8
0.6
1.4
0. 3
7. 2
1. 1
0. 2
0.4
100.0
98. 5
100.0
100.0
99.5
100.0
100.0
100.0
100.0
0.0
887.4
14 28.7
40.5
161 1435.4
17.2
99.5
2012.0
3523.4
Nutrition Programme
Fftn-i]y Planninq(ip)
Direction & Admn.
Rural FP services
Urban FP serylces
MCH **
V eh icl es
Compensation
O.S.S
Mass Education
Training(ANM/RFWTC/DRC)
Addl. incentives
Sub-total
Grand Total
M
•I
H
M
3.5
173 8347.0
* Less than 0..05 per cent
N.A.
Not available
Including Expanded Programme
of Immunisation
the yearly Civil Budget Estimates
Performance
budget Publications the
expenditure against 'Training'
'•as always
shown under 'Non-Plan'.
however in the
Jr!nuai pian 1984-85 a
sum of Rs.17.05 million was shown
5 the likely expenditure against
11.0 millions planned
be spent on this 'head'.
However, this amount
is
ot included in
the total plan expenditure for further
inalysis.
|*Penditure on
|ePartment was
(c)
Under this
'head',
the outlays/expenditure meant for
strengthening rural health services are
pooled
regardless they were categorised as MNP or not.
(d)
CHV scheme was shown as a part of
'Direction & Admin
tion! of either Public Health and
'family welfare',
is shown in the above table separately under
(e)
'Secretariat' of the Public Health
also included under both plan and nonas available in the annual budget publica•wever, similar information was not available
(EPI)
'MPW scheme'
planning.
'MNP'.
was shown as tiaining component of fami
This is shown separately under MNP.
Plan heads,
1
jions. Ho.
■nder
proposed outlay and hence could not be included.
K
(f)
Component wise break-up is not available for outlays
of FP.
- 84 •
A scheme wise
comparison of the
^,endlture against
those proposed under 'plan' on
Plan romponent shows that for
almost all the schemes, the actual expenditure was
than planned, for example, in medical relief for more
^s.ioo planned, Ba.161 was spent.
for every Rs,i00 pimned M hlgh
every
against NMEP
was spent.
Slmiiarjv
imilar increase was observers
schemes too, ; excepti- a <
'
°f °ther Pro9rammes/
,
excepting 'prevention of visual im
■
control of blindness' m which ca.
impairment and
.
J v‘n:LCh case for everv
mn t
only Rs. 36 was Spent.
ery Ki-100 planned
6.1.3
Scheme wise
of Tot ,
^Egnjijipre (Plan + non.—Plan Period
Analysis of the total
total expenditure
on health- ■Sector-^io
both plan and non-plan taken
together, shows that a total
of Rs. 8347 million w-s e -.e.,t
■
-ueat on various
health schemes and
ne ^amily welfare programme
during the plan period.
Out
of this, about 21 per cent was spent on
’medical relief1
was followed by family planning (17 2%)
control of
communicable diseases (15.6%),
'
ESI Scheme (14.4%) and
direction and acininistration (10.4%)
. . Medical education
accounted for 7.9 per cent and the
minimum needs programme.
7.2 per cent of the total expenditure,
Training of parameoical staff remained a neglected area
cs the total
expenditure for this (taking both s.
‘public
h aith
.f3mily welfarel) ccnst.tuted
only 0.5 per cent
e m,al health care expenditure,
in addition to this
in the Annual plan 1984-85,
a sume of Rs.17.05 million was
shovTn as ‘plan* expenditure
on 'training'.
Even after
inclusion of this
money, the total expenditure on
remained around Rs-60 million which was only 0 7 i training
was
per cent
of the total
expenditu.e,
Expenditure on epi and
Expenditure
Supply
MCH materials
114. 5 million, •
1.4 per cent of^e31 Ti
CitUtin9
health
individual year wise total
anLys^s
The
analysis is
whi^h
is
.
1S presented in Table 6.8.
appended at the end
Oi- this chapter.
2
supply and nutritional
Detailed Headwise Analysis of Actual Expenditure on Health
Sector in Maharashtra Daring 1982-85
6. 2
As in case of Gujarat, a similar exercise, has been carried
out for Maharashtra to analyse the health care expenditure
incurred against various derailed heads and is presented
in Table - 6.4.
Table shows that 47 per cent of the total
expenditure is accounted for by salaries of the staff and
another about 23 per cent by drugs, materials and supplies.
Grant-in-aid to local bodies constitute about 6 per cent of
the total health care expenditure.
A detailed headwise
comparison of expenditure aiming the three subsectors shows
that the percentage share of salary was more in case of
public health (61%) than medical (50.1%).
In case of
family welfare, it worked out to as 25.5 per cent.
This
low proportion was because of the adhoc expenditure likely
to be incurred for incentives, amounting to Rs.328.5 million
during 1982-85.
Percentage share of drugs, materials and
supplies was the highest in case of medical (21.6%) followed
by public health (17.3%) and family welfare (16.7%).
Similar anal sis for the individual years is presented in
Table 6.9, 6.10
6. 10 and 6.11
6. 11
and appended at the end of the
chapter.
Detailed Head wise Expenditure on Key FP and MCH services
in Maharashtra 1982-83
6.3
Table -6.5 gives further details of some of the key services
under family welfare programme. Table shows that under mral
family planning services including CHV scheme salary accounted
for 53 per cent of the total expenditure followed by materials
and supplies (18.4%).
In case of training programme, salary
accounted for 47 per cent, followed by stipend/scholarships
.
.for the trainees (32.3%) and training materials (10.6%).
Under OSS, which includes, post partum centres, supply of
c
L
86
TABLE - 6,4 ;
5
EX?E^ITURE* ® MEDICAL,
PUBLIC K2ALTH SM^-.ARASHIy.a DURING 1982-35
(Percentage -)
Detailed Heads
Salaries
T. E.
O.E.
Materials & Supplies
^en ts
Medical
Family
Welfare
Publ ic
Health
Any
50. 1
25.3
61.3
47.0 '
0.4
2.3
2.9
2.9
3. 2
1.4
2.7
27. 6
16.7
17.3
2.9
22.8
0.9
0.1
0. 3
0.6
0.0
3. 1
0.1
2. 2
0.6
8.7
8.3
5.7
3.2
0.8
Grants
Panchayat
Local Body
I
Other Bodies
Scholarship
0.1
1.3
1.9
Machinery
2. 6
0. 2
Motor Vihicles/
Maintenance
Diet charges
Others
0. 2
1. 1
1.4
0.9
0. 2
1.0
0.7
0. 1
1.8
13. 2
917. 2
3581. 6
Total (Rs. in million)
%
3.4
6.6
1S70.9
41--. 4 **
793.5
s
1
★
Pooled over three successive years (1982-85)
S ou rc e :
Performance Budgets 1984-85, Directorate of
i cdical Education and Drugs, Public Health
Department, Government of Maharashtra.
e
.1-
** Includes Comnensation/incentives for
acceptors of
sterilizations.
■
■■
- |
iur
1
i
TABLE -
6.5
: DETAILED HEAD WISE EXPENDITURE OL’ KEY FP AND MCH SERVICES IN
MAHARASHTRA DURB^G 1982-85*
Detailed Heads
Rural
FP
Service
Urban
FP
Sendee
MCH
(a)
Trans
port
O.S.S
(b)
Trg.
(c)
Mass
Sdn.
Compens ation
Direc
tion Lc
Adrnn.
Total
Salaries
53.0
18. 2
T.E.
33.8
47. 1
4.6
3 2. 2
25.3
0. 6
0.7
O.E.
1. 5
3. 6
5. 2
2.3
0.8
Rents
1.0
2.7
4. 2
0.1
2.9
0.4
0.1
23. 2
16.7
0. 2
0. 1
4.8
29. 8
8. 9
3 2. 3
0. 2
1.9
1. 2
0. 2
0.6
0.
2. 8
41. 5
190517
15.4
1236350
Materials & Supplies 18.4
Grants
2. 6
1.0
0.8
100.0
51. 6
10.6
98.5
Panchyats
Local Bodies
2.0
79.6
11. 6
Other Bodies
scholarship
Machinery
l
3.0
Equipment
Motor Vehicles
Others
Total
★
100.0
1. 3
1.5
15.3
(1OOOs)
1982-83 Actual,
384066
97.4
44558
3. 6
1983—84 Revised z
32695
19581
31.1
2.6
1.6
68341
5.5
36744
'3.0
11016
0.9
448747
36.3
1984-85 Budget
(a) Including 'CHV Scheme'
(b) OSS includes maintenance
of bedsz supply of conventional contraceptives, post-partum
centres etc.
(c)
Including MPW training
Source •. Performance Budget,
I
0D 1
-J’
19 84—85 Family Welfare,
Public Health Department,
L
)
88
conventional contraceptives and maintenance of beds and
salary accounted for 34 per cent of the total.expenditure.
Another 52 per cent was accounted for by materials and
supplies, which were largely in the form of conventional
contraceptives.
-p
The total expenditure under MCH Scheme
amounting to Rs. 32 million was marked against materials and
!
supplies as the salary part of the MCH services were integ
rated wiuh other puolic health and ’medical 1 services and
Q<
s
the expenditure on other items like’cold chain’. transport
etc.
Information is not maintained separately for those
x:
-p
heads.
fl
(D
X
s
6.4
Scheme wise and Detailed Head wise Analysis of Health Care
Expenditure at District Panchayat Level During 1982-83
I
To see the expenditure pattern in Maharashtra both at
<D
district and block levels the district of Pune and one of
s ■
its blocks were selected and required information were
?
collected.
The results are presented in Tables 6.6 and 6.7.
Table 6.6 shows that in the year 1982—83, a total expenditure
of Rs.41. 2 million was spent by the district panchayat of
§
Pune on rural health care and family welfare activities.
<n
Out of this, 2.5 per cent was spent on ’medical’ services,
scn
29 per cent on family planning, and 28 per cent on control
?
of communicable diseases.
rl
Among various components of FP
compensation and incentives accounted for about 50 per cent
of the total expenditure on family planning where as MCH
I
i
i
s3:i
and family planning materials accounted only five ner cent,
of the family planning expenditure and 1.5 per cent of the
total health expenditure in the year 1982-83.
In the district
panchayat of Pune, NMEP was given considerable emphasis and
it accounted for almost 20 per cent of the total health
g1
a
ph
• J
care expenditure.
- ■
0J1 t
si aM r.
89
■
TABLE -6.6
1
ANALYSIS OS sXPESDITORE
:
raKC™r op
scheme/Sub-head
Actu al
(in ’OOOs)
%
1P42_^4
25. 2
39 2.5
3003.4
627. 3
1.0
-7.3
1. 5
6033.9
34.0
1335.1
55.5
14.6
0. 1
4.5
0. 1
11981.7
29. 1
_5.is_._o_
1. 3
Medical
(PHC/CHC/Rural I’___
Hospitals and
supply of drugs to RFWCS
------- > an d
SCs)
Family Welfare
Direction & Administration
Hural FW/Sub-centres
MCH & fp materials and
supplies
Compensation
Mass Education
Transport
'
Health
a)
DHO Office
b)
Control of Comraunicabl
c diseases
NMEf®
NSEP
, NLCP
TB control
Oth ers
8180.2
1204.9
648.9
4 4 3. 8
906. 2
19. 8
2.9
1.6
1. 1
2. 2
11388.6
27. 6
387.4
2235.4
19.9
0.9
5.4
★
264 2.7
6. 3
•4787. 1
11. 5
41228. 5
100.0
c)
Construction of bldgs for
PHCs/SCs/CHCs
CHV
MPW
d)
Other sc- 2'' __
’ '- b—— 0Tn i ts etc.
V acc in at ion/Mob il e
GRAND TOTAL
Source :
(a)
District PaiTcnayat Records
Less than 0.05 per cent
Excluding the cost of ‘ Premaqu ine 1
tablets.
0>3 HEALTH
I
90
Detailed headvzisc analysis shows that at district panchayat
level salary• accounted for 54 per cent of the expenditure
followed by (compensation and other contingencies (20.1%)
and drugs materials and supplies (16.9%).
These three
items taken together constituted 91 per cent of the expen
diture at district panchayat level.
A similar analysis
was done for the subsectors of health and is presented in
Table 6.7. They follow similar pattern as discussed at
State level.
6.5
Detailed Herd v?ise analysis of Health Care
at Block Level During _1982-83 ~~— Expen
re
To assess the expenditure pattern at block level,
a PHC
located in Otur block of Pune district was selected and
its expenditure was studied in detail.
¥
able 6.7.
The table, shows that during 1982—83,
about Rs. 0.7 million
I
It is presented in
in all
zao spent on various health
and family
welfare programmes.
In addition to this an amount of
Rs.10,000 was spent on T.B. A break up of the total
expenditure according to subsectors shows that 0.28 million
(38.4%) was spent on family planning, Rs.0.23 million
%
(32.2%) on public health and about Rs.0.2 million (28.3%)
on -medical' services.
A detailed headwise analysis shows
tnat at block level, 65 per cent of the total health care
expenditure accounted for by salary, 17 per cent by compen
sate and about 12 per cent by drugs, materiaals and
supplies.
A further analysis by subsectors shows that
-alary accounted for most of the expenditure under public
health (83.3%) and medical (7 2.4%).
Under these two sub
sectors, the next major item was drugs, materials and
supplies, constituting about 12 per cent in case of public
health and 17 per cent an case of medical under family
■welfare.
Salary accounted for 45 per cent, compensation
39 per cent and supply of MCE materials and contraceptives
74 per cent.
A comparison of the exepnditure patterns at
oistrict and PHC l.vels shows that they matched well with
each other.
», j
TABLE
6. 7
Detailed Head
DETAILED H ELD HIS E E. PEIDITUPE C17
ON II
MEDICAL
FAMILY WELFARE AND
PUBLIC HEALTH INCURRED BY DISTRICT PANCHAYAT AND A SELECTED
tHC OF PUNE DISTRICT DURING 1982-83
____ Mcdical_
District PHC
Family Weifare
District
‘PHC
Public Health
District
phe
_____ Any
district
PHC
Sal ary
68. 2
7 2.4
26. 1
T. E.
45.0
64.5
83.3
54. 3
65. 1
2. 3
5. 3
1. 5
3.4
Drugs Mu ter inis
and Supplies
6.0
1.5
3.7
25.4
3.3
17.0(a)
5. 2 (b)
7.4(b)
19.6(b)
11.7(b)
16. 9
11.5
Vehicles (POL
-Hnaintenance .
0.8
3. 5
15. 2
5. 2
0.8
0.0
5.0
3. 1
Others/fp Compensation 3. 3
Contingene ics
1.9
5 2.0
39.0(d)
9. 1
3. 5
20. 1
17.0
18764.6
227. 3
rsr41228.5
Total (in OOOs)
Source
(a)
104 28.4
199.4
District Panchayat
12035. 5
277.9
I
i
704.6 (d)
and PHC record^
Based on MOIs verbal estimate
(b)
(c)
(d)
fhis includes mostly expenditure on incentives
performance statistics supplied by PHC.
wnich was worked on the basis of
This figure does not include expenditure on T.B. performance
VO
I
- 92
6.6
Summary and Conclusions
The study shows that as in case of Gujarat in Maharashtra
also sewerage and water supply received the largest share
(76.7%) of the total Sixth Plan health outlays (Rs. 204 2
million).
Health and family welfare services accounted
for 10.3 per cent each, while the remaining 2.7 per cent
was allocated to nutrition.
Scheme wise analysis, after supressing sewerage and water
supply shows that among the core health and family welfare
prograrrmes, the latter received the largest share (43.5%)
i
of the total health outlays , followed by minimum needs
programme (16.5%)z nutrition programmes (12.7%)zcontrol
of communicable diseases (10.6%), medical education (9.9%)
etc.
. I
Study shows that in all Rs. 35 23 million was spent on
health care activities under ^lan ’ component. • That is
in Maharashtra for every Rs. 100 planned,Rs. 171 was actually
spent on health.
A scheme wise comparisons of the actual
expenditure incurred under ‘plan* component with the
amounts proposed to be spent, indicates that in case of
I
I
almost all the schemes, the expenditure exceeded the plan
outlays, the highest being in all but one Communicable
disease (Rs.372 per Rs.100 planned).
The only exception
i
was the programme of prevention of visual impariment and
)
control of blindness, in which case, for every Rs.100
5
5
I
planned/ only Rs. 36 was spent.
1
indigeneous system of
Another scheme viz.
medicine seemed to have lost some
grounds, as for every Rs.100 planned only Rs.67 was
)
actually spent.
I
)
)
5
)
I
$
D
I
■I
1
H
I
■
Analysis of the total expenditure (Rs. 8347 million, both
plan and non plan expenditure taken . together) shows that
medical relief accounted-
for major share (21%), followed
by FP (17%) MNP (7%) etc.
On medical education a sum of
Rs.661 million, constituting about 8 per cent of the
total health care exoenditure, was spent. On the contrary
on
the expenditure/training of paramedical staff amounted
to only.. Rs. 60 million/
constituting 0.7 per cent of the
total expenditure/,
The preventive and promotion cares,
through EPI and MCH
services accounted for only 1.4 per
cent of the total health expenditure.
Tn fact, the expen
t^R^r aCtUal Supplies of *CH and EPI
° s.43.6 million,constituting only 0.5 materials amounted
per cent of the
total expenditure.
The study further shows that salary,
cent of the total exnen--/
accounted for 47 per
and supplies (22 8%)' •
f°11OW2d by dru9s' materials
(13 2% P tTv
' lnCentiVeS
other adhoc
expenses
J. 2%) , travel and vehicles ( 2%) .
Grant-in-aid to local
bodies was 6 per cent of ths total
expenditure.
detailed headwise analyses Within
showed that under rural FP services. key FP and MCH services
accounted for
52 Per cent and materials and suppliessalary
(18.4%).
training, 47 per cent o' the expenditure went lo Under
the trainers, 32.3 per cent towards stipend of thes alary of
and 11
trainees
per cent towards training materials
The district panchayat and
PHC lesrel analysis indicated
the district panchayat of Punec
anti
one of its PHCs* spent
^s.41 million and 0.7 million
respectively on health
care activities,
Of these 54 and
65 per cent was
accounted for by
salaries at districtPanchayat level
and
EHC level ^espectively.
respectively. The travel
and vehicle
expenses worked out
to be
out to
be R8.77
per cent
that during 1982-83,
^e_ely. other
Other
accounted for 17 -
ra 6-4
Per cent at district level and 12 per
eent at J-HC level.
★
Situated in Otur block
94
TAELE
6.8
SCHEME WISE ANALYSIS OF HEALTH AND FAMILY WELFARE
EXPENDITURE IN MAHARASHTRA FOR INDIVIDUAL YEARS OF
SIXTH PLAN PERIOD
80-81
81-82
82-83
83-84
84-85
80-85
i* Direction & Administration
11.8
11.4
10o7
9.5
9.6
10. 5
ii© Medical Relief (Allopathy)
III. Training
27.9
27. 9
26. 8
13O7
13.5
21o 2
0. 1
0. 1
0. 1
0.2
IV
Medical
8.3
7.8
7. 2
8. 2
8. 1
0.
7.9
V
Control of Communicable
Diseases (Public Health)
Education
NMEP
9.6
8.7
12.0
11. 1
10. 2
10.5
NFCP
0.4
0.4
0.4
0.4
0.5
0.4
NLCP
2.6
2.8
2.5
2.9
Blindness Control
T.B. Control/BCG Vacci
nation
0.4
0.4
0.4
1.6
0.7
2.7
1.7
0.5
0.7
0.7'
1. 1
15.7
14.0
15.8
15.8
16.3
15.6
Construetion/Upgradation
& Strengthening of rural
health services
0.3
0.8
1.3 •
8.7
8.5
4.4
CHV scheme
1.7
2.5
2.4
4.1
2. 2
2.7
MPW Scheme
0. 1
0. 2
0. 1
0.5
0. 2
Sub-total
2. 1
3.5
3.8
12.8
11. 2
7. 3
Sub-tonal
VII.
VIII.
X.
3. 2
0. 1
l0.4
NSEP/Others
VI
3.1
0.1
Minimum Needs Programme/
Rural Health Services .
Indigenous systems of medicine
E.S. I. Scheme
Other Expenditures/Services
Family Planning
Direction & Admn.
2.9
2.8
2.4
3. 1
3. 2
2. 9
16.8
15.8
14. 1
13.4
1, 8
2. 3
13o 2
2.4
14 o4
4.3
0.6
3.2
3. 5
2. 2
3. 5
4.8
3.8
0.6
3^0
Rural FP services
3.7
3.5
2. 1
3.3
Urban FP services
0. 2
0.3
0. 2
0.6
1.5
0. 6
MCH
0.3
0.4
1.9
2.0
1.7
1.4
Veh icles
0. 2
0. 3
0.3
0.4
0.3
0.3
Compensation
3.3
5.8
/7.8
9. 2
8.5
7.2
O.S.S.
0.8
0.9
1. 2
1. 3
1. 3
1. 1
Mass education
0. 1
0. 3
0. 1
0. 3
0. 2
0. 2
Training (AIJM/RFHTC/DRC)
0.4
0. 3
0. 3
0.5
0.5
0.4
Sub-total
9.6
12.4
17. 2
0. 1
21. 1
22.3
17.2
Grant Total(Rs.in million)
1267
1527
1778
1830
194 5
8347
Addl. incentives
Sources and Steos taken in tne preparation of this are same as triose of
Table 6. 3
including EPI
95
Table
6.9
DETAILED KEaDWISE expenditure on
MEDICAL,
family welfare
ai<d public health IN MAHARASHTRA
during 19 8 2-8 3
*
(Percentage.)
Detailed Heads
Medic al
5alaries
T. E.
Materials & Supplies
Grants
Panchayats
Local Body
Other Bodies
Scholarships
Machinery & Equipment
Motor Vehicles/
Maintenance
Diet charges
Others
Total
(OOOs)
%
)
)
)
)
Family
Welfare
Public
Health**
Any
48. 2
30. 1
36.4
41.4
0.4
3.1
2.6
1. 6
3.1
2.4
6.0
3.8
27.4
18.9
21. 2
24.0
5.3
2. 2
20.4
6. 1
5.9
1.8
0. 1
1. 6
)
)
)
)
}
3.0
1.9
1.7
1. 2
0.5
1.0
0.3
0.3
0.9
3.8
2.1
0. 6
2.8
12. 6
38. 2
0.3
13.5
869 235
310303
505732
51.6
1685 270
18.4
30.0
100.0
1.2
Dess than .05 %
*
**
Actu al expen d itu re
Excluding expenditure on water
supply and sanitation
Source :
Performance Budget 1984-86/
pDirectorate of
Medical Education c
and Drugs and Public
-------c Health,
Govt, of Maharashtra
-
I
i
ii
§
96
table 6. 10
PLr-TT^^H^ADv;lSS 2XP®DITURE* ON MEDICAL
DURING lotf az
HJBLIC HE^IH Ux7 MAHARASHTRA
(Percentage.' )
DeaDetailed Heads
Medical
Public
Health**
Any
4 8. 7
21.5
61.7
44.6
0.4
1.6
4.0
1.5
2.8
1.4
1.9
2. 2
1.0
28. 3
0. 1
0. 6
14.9
27.8
0.7
28. 2
Panchayat
0.0
0.0
Local Bodies
'4.4
0.0
10. 2
Other Bodies
o.o
o.o
0. 2
0.0
2.7
2.5
0.6
1. 2
0. 1
3. 1
1. 3
0. 2
0.0
1.7
0.7
0. 1
1.0
0.6
0.3
0.0
0.0
0* 2
3.6
0.0
0. 1
5.3
47.3
0. 3
1.9
14. 9
9017 25
434002
371554
1707 281
25.4
21. 8
100.00
Salaries
T.E.
O’. E.
Rents
Materials & Supplies
Grants
Scholarship
Machinery Ec Equipments
Motor Vehicles
Maintenance
Diet charges
Others
Total
(Rs. in
’OOOs)
%
^r
/
Family
Welfare
5 2. 8
2.6
Revised Budget
** excluding Water supply and sanitation
Source :
Rarformance Budge-*-
“—'
—
Directorate of
Health
DtU3<a"d
- 97
TABLE
6. 11
DETAILED H^ADWISE EXPENDITURE* ON MEDICAL
SS
HEALIH IN naharAshtra
AKD
(Percentage- )
Medical
Family
Welfare
Public
Health **
Any
5 2.5
25.9
55.4
T. E.
53.9
0.3
2.5
1.4
O.E.
1.3
2.3
2. 2
Ren ts
0.5
2.0
0.7
0. 2
0. 2
0.5
27.0
17.0
1.4
19.2
Local Bodies
4.5
12. 2
0.3
Other Bodies
5.7
0.0
0.0
0.9
Detailed Heads
Salaries
Materials & Supplies
Grants
Panehayat
5
Scholarship
1.1
1. 3
0. 1
*
Machinery <9 Equipments
2.9
0. 3
*
Motor Vehicles
1.6
1.0
0. 1
0. 2
0.0
0.7
*
0.8
Maintenance
Diet charges
Others
0. 1
2.9
0.1
1.6
Total (Rs.in Lakh)
%
★
38.5
0.1
12.4
10003
4919
3996
18918
5 2. 9
26.0
21. 1
100.0
Budget Estimate
★
Excluding expenditure on water
supply and sanitation
Source :
*
4.6
Performance Budget 84-85, ?
’
Directorate
of Medical
education and Drugs, Public Health t Govt, of
Maharashtra
'
. z
A
- 99
first introduced in Delhi, and Kanpur in the year 195 2.
It
is mandatory on the part of the
factory/industry to become
member of the ESI scheme,
if the scheme covers the area in
which the industry is located and if
it falls under any of
the following two categories:
a) running with power and has
more than 10 workers
b) running without pov/er but has
more than 20 workers
As on 31.3.1983 it has covered 21 States/Union Territories
an
has opened 472 centres covering 7.18 million employees
and family units with a total coverage of 27.9 million
beneficiaries.
The scheme h-as set up about 85 hospitals.
-s per the existing rules of the scheme, all those drawing
upto Rs.1000/- are covered under the scheme.
Once the
worker is covered under the scheme, he/she pays regularly
to the ESIS certain amount depending on his wages/salary.
- For example a person drawing Rs. 1000/- has to contribute
Ro.15/- a month and the employer is required to contribute
to ESIS double the individual's contribution.
Recently
the government has taken the decision to amend the system
of computing the employer's as well as the employee's
contribution to ESI Scheme and to extend its coverage to
a higher income bracket, viz. to those earning up to Rs.1600/-.
according to the new system, which is expected to come into
force shortly, a flat rate of 2.25 per cent is fixed for
the employee and 5 per cent as the employee's contribution
towarcs ESIS. The insured person and his family will get
free medical help at the ESI Hospital, disoensary, or a
panel doctor recommended by the Corporation. The various
benefits the insured person gets through the scheme
are
as under.
1
At the time of typing of this report, the new rule--
has just been implemented.
i
<
100
1
1. Medical benefits.
(in kind £< services)
(cash)
3. Maternity benefit (cash)
4. Disablement benefit (cash)
2. Sickness benefit
5. Dependent benefit (cash) , and
6. Funeral benefit (cash)
Recently (1982-83) ESI has also resolved to introduce
the
following two important programmes:
1.
Implementation of family welfare and immunisation
programmes as a part of medical care under
’•1
I
ESI scheme
2.
Promotion of treatment to beneficiaries of ESI
scheme in systems of medicine other than allopathy.
At present, the 3SIC has 85 hospitals and 41
annexes with a
total bed strength of about 18000.
This is however 3000 beds
short of the requirement and to make up for this, the ESIC
has reserved 4750 beds in various hospitals.
Over a period Ol time the per capita expenditure of ESI has
increased (Table 7.1).
For example, in the first five years,
expenditure incurred per insured person was Rs.13.35 waich
slowly increased to Rs.157.72 in the Fifth Five Year Plan
and further to Rs.257.41 during 1979-82.
However, these
figures should be taken with a caution as they were not
adjusted against the inflation during the same period.
C
e
S
c
f
T
*
101
Table - 7.1 : EXPENDITURE OF ESIC SCHEMES DURING VARIOUS
PLAN PERIODS
________ Expenditure
Total
Per insured
(Rs. 1000s)
person (Rs)
Period
First Plan
34,056
Second Plan
252,850
13.35
31. 26
Third Plan
683,915
49.37
Inter Plan (1966-69)
833,313
75.71
Fourth Plan
2, 234,421
101.57
Fifth Plan
4,603,701
157.72
257.41
1979-80 to 1981-32
547,911
An analysis of the scheme’s revenue and expenditure details
for the year 1982-83 is presented in Table - 7.2.
In
1982-83 altogether Rs.2831.0 million was spent under this
scheme.
Out of this amount about 63 per cent was spent
against cash benefits and another 31 per cent as medical
benefits to them/their family members,
About 6.5 per cent
accounted for by administration,
No other derailed break
up is available for further analysis.
TABLE - 7.2 : REVENUE AImD EXPENDITURE OF ESIC SCHEME DURING 1982-83
Income
(Rs.jn million)
Expenditure
(Rs. in million)O/
/o
°/o
Contribution both from
employee 6c employer
State’s share
1814.6
80.3
Medical benefit
864.5 30.5
4.0*
0. 2
Cash benefits
Other (rent of quarter
fees, fine etc.)
440.0
19.5
Adm. expenses
1779. 1 62.9
184.4 6.5
Total
2258.6
2831.0
?
-
It is the State’s con trib ■•'.t ion as on the date this budget was
prepared otherwise, State Governments
——. > are supposed to share 1/8
of the medical expenses
He -i io
| /
k*\
LIBRARY
AND
nnrflMfNTATipr
V
< C
■
a
10 2
As can be seen from the above table, from the year 1982-83
the corporation is on loss.
According to a latest release,
for the year 1984-85 the loss is of the order of 116.8
million.
7. 2
w,
£
4
I
Expenses Incurred by Sei P.ci-Prl Private and Voluntary
Organ is ations
j
■
As mentioned in the introduction, to get an idea about the
expenditure incurred by industries in meeting health care
I
1
requirement of their workers, staff and their families, a
case study of two big Industrial houses - Tatas and Birlas
was conducted. For this visits-were made to Bombay, Calcutta
and Jamshedpur to meet their officials and to get the
required information, while in case of Tatas, we were able
to get information some what in detailed form from TISCO
and TELCO, their two gaint
qaint industries, in case of Birlas,
we could not get any relevant data,
Our discussion with
the officials of the various Birla industres, the registered
offices of which are located in Calcutta, indicate that by
and large their employees are mainly covered under ESI Scheme,^
as per rules, each of their companies has been at least
running a dispensary at factory site.
However, from any
Birla industries, vze could not get the required infor
i
mation as all the expenditure are kept in pooled form
under welfare fund v/hich many times include expenditure on
uniform and canteen etc.Birlas have also established an
institute called Birla Medical Research Institute (BMRI)
in Calcutta*
A full-fledged hospital is attached to it.
A visit to the hospital indicated that it has both MCH
■
and family planning services.
At BMRI from where expendi
ture on MCH and FP could have been obtained in required
form, the concerned officials declined to divulge any
1
I
Financial Express, March 24, 1985
103
information. During our Calcutta visit,
some, relevant
information on -health care activities
undertaken by
Ramakrishna Mission
and expenditure incurred.
collected.
was also
In the following paragraphs information
collected during
ese visits of Calcutta, Jamshedpur and
Rombay have been
discussed briefly.
7.2.1
^ertaken^y^W^-^—ily Wel±^.e Activities
Table 7.3 presents the
running their hospital
planning activities
expenditure incurred by TISCO in
and carrying out MCH and family
during 1983-84.
It can be seen in the table that
health, MCE and family
'
planning
TISCO has been promoting
activities through a
number of departments
----- J such as Tata Main
Hospital, Tata
Town Services, Tata Steel Rural
Development Society and
Family Welfare Department,
all located in Jamshedpur
During 1983-84 -in all TISCO
spent Rs.88.5 million on
health care services
through the above
centres. However,
this figure should
incurred by TISCO,
not be taken as total
expenditure
as apart from these services located
in Jamshedpur, TISCO
established three more fullfledged
—■ and mines, the expenditures of
hospitals in collieries
which, are not included because
of the non-availability of
An official from TIoCO however,
estimated that the total health
i care expenditure of TISCO
would be of the order of about J
Rs.130 to 140 millions.
It can be seen in the table that
all the above■ services,
exaeptlng the fainily plannitlg depa.rtII,ent/
data at Jamshedpur,
with a package of se„lces lnclua.Dg
However, programme wise break up
not available.
ere dealing
of the and Family Welfare,
expenditure is
j
104
TABLE - 7.3 :
EXPENDITURE OF HEALTH & FAMILY WELFARE
ACTIVITIES UNDERTAKEN BY TISCO DURING 1983-84
(Rs, in Lakh, 1 Lakh =0.1 million)
Department and Activities
Expenditure
Tata Main Hospital
(Medical/ MCH and Family Welf are))
Salary
Drugs & Materials & Supplies
Maintenance
Others
600.0
%
65.0
26.0
7.0
2.0
Tata Town Services
(Public Health St Immunisation)
214.7*
Community Development and Social Welfare
(Medical, Public Health and Child Welfare)
7.0^
Tata Steel ural Development Society
(Rural and Family Welfare)
10. 3
Health
Salaries
Drugs
Transport
Others
38.8
26. 2
29. 1
5.9
Family Welfare Department
Salary
Incentives
Contingences
53. 3
36.6
49.7
13.7
9
Total
* No break-up
885.3^
is available
1
This department has a number of other community
development and social welfare activities. The total
expenditure towards salary, wages and honorarium and
allowances for the staff involved was about 22 lakhs
during 1983-84.
2,
During our visit to Jamshedpur it was learnt that Tatas
are running three more full-fledged hospitals in the
mines and collieries. Expenditure details of these
hospitals, are not available. However, roughly it is
estimated that taken all costs together, TISCO is
spending about Rs.130-140 million on running hospitals
and other health and family welfare centres.
Source :
Personal visit to TISCO, Jamshedpur
105
7. 2. 2
4
i
Expenditure on Hejlt-h & Family Welfare
Undertaken by TEFCO
:----------- —eirare ^-tivities
Table 7.4 presents the total health < ~ and family welfare
expenditure incurred by TELCO during 1982-83
The TELCO
main factory and its head quarter is
located at Jamshedpur
but it has second! factory at Pune in
Maharashtra. As can
be seen from the •table TELCO maintains
three types of health
care schemes for its workers.
They include i) ESI (fOr
staff having salary Rsa1600 or less ■
per month), 2) Medical
Reimbursement (for staff with salary
' more than Rs.1600) ,
and 3) running of hospitals,
clinics and dispensaries,
The
first two schemes have been in
operation in Tata industries
located in Pune,
In case of those in Jamshedpur the prime
responsibility of p.Toviding medical and MCH cares is in
the hands of hospitals and clinicsrun by the industry.
During 1982-83, altogether TELCO
spent about Rs.42.24
million on health and family welfare care of their workers/
staff and their family members at the rate of Rs.li06 per
employee Out of this, Rs. 13.8 million (3 2.6%) was spent on
drugs, medicine and material
---- supply, followed by Rs.11.1
million (26.3%) on rsalary
'
Rs. 6.0 million (14.2%) on office
expenses and 4.5 million (10.6%)
J on medical reimbursement,
Company’s contribution towards ESI was a small amount of
Rs. 13 million (3.1%) and FP incentives was Rs. 0.7 million
(1.7%).
it is important to note that
in contrast to the
general pattern the largest
Porti°n of the total expenditure
was spent on drugs and
material supply and not on salary.
If we assume that about 60
per cent of the amount spent
under medical reimbursement schene
was also against
purchase of. drugs and the total
expenditure on drugs and
supply will be of the
order of Rs.16.3 million constituting
39.0 per cent of the t otal health care expenditure incurred
by the Company.
!
106
TABLE
■
7.4 : SCHEME WISE AND DETAILED HEAD WISE
EXPENDITURE
KCURRSD BY TELCO DURING 1982-83
r
Scheme and Detailed Head
h
Location of the Factory_____
Jamshedpur
Pune
Total
Scheme I
ESI (Company’s contribution
13
(18.0)
13
(3. 1)
45
(62.0)
45
(10.6)
10 2
(29. 1)
9
(12.4)
111
(26.3)
Drug s/Medic in es/oth er
materials
T. E.
136
(39.0
2
(2.3)
138
(3 2. 6)
16
(4. 6)
0.4
(0.6)
16.4
(3.9)
O.E.
60
(17.0)
60
(14. 2)
Vehicles
2
(6.0)
2
(0. 5)
Incentives
5
(1.4)
2
(2.9)
7
(1.7)
Others (a)
29
(8. 3)
1
(1.4)
30
(7. 1)
Total (Rs.in Lakhs)
350
7 2.4
422.4
25,600
12,600
38, 200
1367
5746
1106
Scheme II
Medical Reimbursement (M.B.S.)
Scheme III
Hospital/Clin ic/Dis pen s ary
Salaries
!
Total No. of employees
Per employee (Rs.)
i
I
Figures in brackets ere percentages
(a) under repairs to buildings « eguipment (13
lakhs in
Jamshedpur and 1 lakh in Pune)
PF & Gratuity contribution (7 lakhs in Jamshedpur) , Contribution to hospitals
(6 lakhs at Jamishedour)
*
★★
L
The company cculd not provide break up separately
under health, MCH and FP.
Although there areno schemes other than the above
ones (listed m the table), the company helps its
employee financially in case of heavy medical expenses
for prolonged illness on a case to case basis. Further
at Pune, the E'BF (Employees' Mutual Benefit Fund) is
totally managed by the monthly contribution of employees,
finployees who do not get total medical reimbursement
from the scheme II (M.B.S.) are financially helped by this
•J
&
f
107
-t
-7
The _reak up of the total health expenditure by various
health and welfare schemes such as MCH,
fp
and curative
services are not maintained and hence could -not be
obtained.
7. 2.3
Schemewise Health Care_Expenditure Incurred by_National
Bayon, Bombay and Ashok Leyland, MadrasT'During 1983 ~
As mentioned in the first chapter, out of 100 industries,
which were mailed a questionnaire (given in Appendix-IV)
only two industries namely National Rayon, Bombay and'
Ashok Leyland, Madras, responded by giving necessary
i
f
information.
Their responses were analysed and presented
m the Table 7.5.
As the table shows both the companies
were spending towards health care of workers and their
ramilies under three different schemes.
The total expen
I
diture incurred against these three schemes by the two
companies during 1983 were 6.46 million and 7.82 million
other words during 1982-83, the two
companies spent on health care activities at the rate of
Rs.860 and Rs.717 per employee respectively,
respectively.
It can be
Bombay has
given more emphasis on running a hospital on its
own to
further seen in the table that National Rayon,
meet health care needs of its employees and workers,
while the second company viz. Ashok Leyland, Madras,
laid
more emphasis on reimbursement scheme and to
some extent
on ESI.
Accordingly, the two industries spent major
portion
of the total expenditure in Scheme I and
Scheme III respectively.
Excepting the health schemes
these two companies did not have
any scheme relating to
MCH and Family Planning.
I
■
i11 !
108
TABLE - 7.5 :
scheme;;ise health care expenditure incurred
BY NATIONAL RAYON .(BOMBAY) AND ASHOK LEYLAi'mD
CCfiPAi^Y (MADRAS) DURING 1983
I
(Rs* i.n Thousands)
National
Rayon
Ashok
Ley lan d
91JL0
3656.6
Scheme - I
(Hospitals/Dispenseries)
Salaries
1053.0
495. 6
Wages
446.0
57.7
Materials & Supplies
98.7
3 20.6
2058.9
4 2. 1
Oth ers
Scheme - il
i
55.5
ESI Contribution
Companies
ii
Scheme
Employees
40.0
212.0
15.5
106.0
III
Medical Reimburseij ent
318^0.
6588.0
2743.0
2743.0
6588.0
Total expenditure
6455.1
7822.0
Company’s expenditure
6439.6
7716.0
Total staff
(7487)
(10768)
Expenditure per employee per annum
(after dropping employees’ contri
bution towards 3SI)
860.0
717.0
Source : Personal Correspondence with the Companies
b
1
109
7.2.4 Itemwise Expenditure con Health Care Activities by
Ramakrishna Mission During 1982-83
Table 7r6 presents itemwise health care expenditure incurred
by hospitals run by Ramakrishna Mission and Maths located in
different parts of the country.
In all there are 11 major
hospitals and a number of dispensaries run by the mission.
Here, again, although these hospitals have been participating
in MCE and Family
Familv Planninn
active
Planning activities
t they do not maintain
separate records and hence desired break -up could not be
obtained.
The table shows that the mission all together spent about
Rs. 30 million during 1982-83 on health services. Salary
constituted about 47 per cent of the total expenditure,
Another about 30 per cent was spent towards drugs.
The total health care expenditure incurred by the hospitals
located in Calcutta, Lucknow and Bombay were 11.1 million,
4.1 million and 1.5 million respectively.
These three
centres takentogether spent about Rs.16.85 million constituting about 56.9 per cent of the total health expenditure of
the Mission,
Similar data for other centres was not
available at Calcutta.
7» 2.5 Other Industries and Departments
Our attempt to collect information on health care expenditure
in other industries
any result.
from secondary source, did not yield
Studies which have addressed themselves to the
social services in organised sectors have also not touched
the financial aspects, primarily because of the lack of
data in the desired form. However, some information on
health care expenditure incurred by undertakings like Air
India, Bharat Heavy Electrials Ltd.(BHEL), Steel Authority
of India Ltd.
in Table 7.7.
(SAIl) , was available and same was presented
TABLE - 7.6
1
6 ITEMWISE EXEP:\DITURE ON HEALTH CARE ACTIVITIES BY RAMAKRISHNA MISSION
AND MATH DURING 19 82-83
Bombay
Tin" 000s)
%
%
Tin odds)
%
1390 2.0
46.9
5623.8
50.0
274 1.8
66.4
530. 2
33. 5
Travelling and
Conveyance
684.4
2.3
155. 2
1.4
285. 5
6.9
27. 2
1.7
Drugs
8735.5
29. 5
*
2 20 2.0
19.8
9 29. 1
22. 5
316.4
20.0
101. 4
0.9
9.5
938. 3
8.4
17 2.5
4. 2
106.7
6.7
511.4
4. 6
—
. ■■
TiFT ooos)
Salaries and other
expenses
«■
Compensation to
FP Cases
Diet charges
2819. 3
. r..^—. — —— ■
Grants to other
institution for health
related activities
I
3486
11.8
1606. 1
14.4
(in 000s)
29627.6
100.0
11138.2
100.0
4128.9
100.0
604.0
38. 1
1584.5
100.0
* Even though annual reports of various Ramakrishna Math and Ramakrishna Miss ions indicate
i no financial
thet they are providing family planning as well as pre and post-natal^ Gate~
at
their
respective
centres.
break-up was maintained either at their headquarters (Howrah) or
Source :
l
o
Others/Miscellaneous
Total
I
%
Lucknow
(in OOOs)~“
Calcutta
All India
Item
1. The General Report of Ramakrishna Math Ramakrishna Mission from Ajril 1982 to
March 1983 Belur Math, Dist. Howrah, w. Bengal.
r 1982-83, Ramakrishna Mission
2. Fiftieth or Fifty-first Annual Report 1981-82,
Seva Pratishtan, Sarat Bose Road, Calcutta ~ 26
•.
3. Ramakrishna Mission, Khar, Bombay 12.
tl
-I
I
-Ill- .
Table - 7,7 : PER CAPITA MEDICAL EXPENDITURE OF SELECTED
AGENCIES DURING 1980-81
Agencies/Organisation
.^Per e.Tpl6yee/family_
Air India
~ '■
725.00
2^.
830.47
BHEL
I
SAIL
^ 677.93
Railways
’310.45
Source :
Lok Sabha, Estimate Committee (1981*82), 22nd
Report of Lok Sabha, Ministry of Health and
Family Welfare.
It is important to note that all the above industries come
under public sector. ’ For private sector, getting information
even in this form, from secondary sources was difficult.
A search of family planning literature however shows that
a number of studies on family planning in organised sectors
have been undertaken but again all of them have left the
finanrial aspects of the programme except mentioning about
the incentives and paid leaves which the industries sanction
to the acceptors or sterilization.
^or example/ in one of the
recent studies (Khan 1982) conducted across 134 industries
indicated that about 7 5 per cent of the industries, who
responded to the mailed questionnaire were giving varied
amount of cash incentive and paid leaves (Table 7*8 and 7.9).
Generally, these incentives were paid over and above to ■
</hat government pays and it ranged between Rs. 50 to 1*00*
Out of these 134 industries, 97 (71%) had provision for
giving paid leave to its workers who undergo vasectomy while
the remaining 39 (29%) did not have such scheme.
In case of
females undergoing tubectomy/ 69 industries (51.4%) had
provision to grant paid leave to their husbands while the
Hi
remaining companies did not have any such schemes.
■■
--'I
112
TABLE — 7« 8 : AMOUNT OF CASH URGENT IVES CT
OFFERED BY
INDUSTRIES FOR STERILISATION
-J ACCEPTORS
Rupees
Vasectomy
50
51-100
101-150—
151-200
201-300
r
301-500
500 +
Total
N
Source
'Tub ectomy
25.4
6.7
20.8
1.5
24. 6
5. 2
6. 2
7.4
34.3
5. 2
16.4
3.0
17. 2
4.5
11.9
7.5
134
134
1 Incentive Scheme for
I
I
Status Paper .
Paper presented at the inter
country seminar on "Incentives for Family-"
1 lanning/Family Welfare in
industrial sector
in industrial
held at Puncak,j Indonesia,/ October 5-7, 1982.
®
TABLE - 7<9 :
"T”
— — _ —.
mm
PERCENTAGE distribution
ACCORDING to NUMBER OF PAIDrLEAVERGrVEN
for ACCEPTORS OF STERILISATION
IXira^ion of leave
Vasectomy
i
l
r
No Leave
2 days
3-5 cays
6 days*
7-10 days
11 days
Total
29. 1
3.0
16.4
3 2. 1
19.4
Tubectomy
48.5
1.5
10.4
16.5
14. 2
8.9
N
134
134
Source : Same cis above
I
113
7.3
Summary & Conclusion
In industries,t Qenerally
generally maintenance
maintenanc of detailed •
on health care e^dlfire of workers are poor L it""^10”
expenditure of
h~
~ -
and other
cares. Even among Tata's
group of industries
particularly TISCO and T31C0 which have
established a very
well organised health infrastructure
for their workers, such
detailed information is not maintained,
On the basis of
the limited information available to us, it
large number of industries including Birlas appears that
depend upon ESI
Schemes for ]
providing health/medical
care to their workers,
Sven if they have their
own hospitals
or dispensaries,
barring a few like those
of Tata’s (a. g. TISCO, TELCO,
Advance Mills etc.;
of them
etc.)
concentrate on curative
part than the preventive and
promotional aspects. Now Family
Planning is, however, enco
'•^raged in most of the big industries
and additional incentives
and paid leave are given to workers
who under go sterilization.
1
I
CHAPTER-VIII
SUMMARY AND CONCLUSIONS The present exercise is undertaken to look into the
health financing in India and in the States of Maharashtra
and Gujarat with special reference to MCH and family
planning (FP). The focus cf the study is to see what
I
proportion of the total outlay on health sector is spent
on family planning and MCH services and under these
’heads' how funds are distributed under detailed heads
like salary, transportation, supply, etc. It is also
planned to highlight the priorities in the Sixth Plan
and the extent to which these priorities are reflected in
the allocation of the budget and execution of the schemes.
Further, the study addresses to some of the other important
issues such as compatibility between proposed and spent
money, percentage share of plan component in the total
expenditure on various schemes etc. It is expected that
such an analysis will be useful for the planners and
programme managers in future planning and monitoring of
the schemes.
An extensive literature search reveals that in India,
study of health financing is still in infancy and hardly
any material is available on these aspects. The main
reason is perhaps embeded in the fact that most of the
published data are of limited value because either they are
aggregated across the entire health sector or the very
basis of budget estimates keep changing from one year to
another posing serious problems in making intertemporal
comparisons. Also, the available fiscal data in many
cases are inconsistent.
{
■J
„■
115
i
On the basis of few available studies , it appears that
per capita expenditure of families on health is far more
than what the government is spending on individual’s health.
A village level case study in Uttar Pradesh shows that
individual expenditure
(Rs. 108 per individual per year) on
health is nine times more than the per capita expenditure
borne by the U-P.
in 1979-80.
Government which is quoted to be Rs. 11.73
I
The corresponding figures were reported to be Rs.20 for
all India, 24 for the State of Maharashtra and Rs. 21 for
Over the period the per capita health care expenditure has slightly increased. However, one study shows that,
Gujarat.
taking 1970-71 as the base, the per capita expenditure on
health in real terms registered a decline.
The study also shows a wide variation with respect to
medical benefits and health care services among ordinary
citizens, government employees/ employees of public and
private sectors undertakings etc.
Table 8.1 provides an
illustrative picture of the extent of variation.
The review of the literature also reveals that majority of
the people depends more on private services than on govern
ment health services.
I
The major causes for the non-utilisa-
tion of public health services 'are reported to be ■inaccessi
bility; economic considerations in terms of loss of time,
cost of transportation and medicines; belief that the medicines
provided by PHC and sub-centres
are
’ sub-standard; the
!
apprehension that the doctors would not be available at PHCZ
and the unpleasant behaviour of the doctors and staff.
!■
J
116
Table - 8. 1 :
PER CAPITA MEDICAL EXPNEITURE OF SELECTED
AGENCIES
Agency/Organ is ation
Service meant for
Per capita
expenditure
on medical
treatment
(Rs.)
Ministry of health
an d F am il y Wei f a re
of Centre, Stat?
and UT
Ordinary citizen
19. 91
CGHS
Employees of Central
Gov emme nt Dep ar tm en ts
27X90
2S0C
Industrial workers and
these covered under Shop
and Establishment Act.
80,99
Railways
Workers employed in
Ministry of Railways
31H.45
Air India
Air India Staff (Govt,
of India Undertaking)
7 25.0
B HEL
Workers of BHEL (Govt,
of India Undertaking: )
Workers of SAIL (Govt,
of India Undertakings)
Workers and Staff of
TISCO (Private Sector)
830.0
SAIL
TISCO
—■■■
677.93
1100
TELCO
Workers and Staff of
TELCO (Private Sector)
1160.0
Ashok Leyland
Workers and Staff of
zishok Leyland)
(Private Sector)
717.0
National Rayon
Workers and Staff of
National Rayon
(Private Sector)
860.0
(Approx)
I
I
117
The review of the literature further shows that, in
rural areas, even today majority of the children under
five1 years of age are not covered under immunisation pro
gramme and thus not many of them had received vaccination
against TT, BCG, polio and or DPT. Coverage was the lowest
in Bihar and UP, where nfot more than 20 per cent children
below five years had received any of the vaccines.
Relatively t this coverage in Gujarat, Maharashtra and
Kerala was some what better. Within the State, inter-
also observed in the coverage of
The major causes as indicated
immunisation of children,
by one <bf• tha studies were 1) the people were not apprOoChed
district variation -is
health worker for providing immunisation and 2) lack
by any
of awareness about the preventive cares.
An analysis of
or outlays
outlay, on health sector (excluding sewerage
and water supply) cl .ally reveals that at national level,
although the allocation in absolute terms increased in
subsequent plans (from 1st to 6th), its proportion to
I
total has remained constant around 3 per cent. The corres
ponding proportions for Gujarat and Maharashtra were 3.6
and 3.0 respectively.
An analysis
of the plan documents reveals that both the
Sixth Five Year Plan and the Approach Paper to the Seventh
Plan put a lot of emphasis on MCH care, immunisation and
training of paramedical staff. However, the same is not
reflected either in the Sixth Year Plan outlays or in the
actual expenditure (Plan + Non-plan) during the plan period.
For example, in Gujarat during plan period (1980-85), the
total expenditure on materials and supplies for MCH services
was Rs.4.7 million constituting only 0.1 per cent of the
I
118
total expenditure on health sector (excluding sewerage
and water supply),.
It was also observed that not only
less money was allocated for MCH services,but also, even
the fund which was proposed under plan component was not
fully utilised. Thus for every wo Rupees proposed for
spending^CH services in Gujarat only Rs. 38 was actually
1
spent. Similar observations were made for Maharashtra
where during 1980-85, a total of Rs.43.6 million,
const!tuting only 0.5 per cent of the total health care and
family planning expenditure was accounted for by supplies
of MCH and EPI materials. A comparison between the
States however shows that
relatively, Maharashtra spent
more money (43.6 million) on supplies for MCH and EPI
services than Gujarat (4.7 mill ion). Al so zunlike Gujarat,
for most of the scheme, Maharashtra spent
money
!
than what, was proposed in the plan.
Study also showed that the training of paramedical and
extension staff received low priority both at national
level as well as in Gujarat and Maharashtra. For example,
in Gujarat, the total expenditure on training of paramedical
staff, shown both under the heads of health and family
planning taken together, amounted to Rs.94.1 million,
constituting about 2 per cent of the total health
care
expenditure. In case of Maharashtra, it turned out to be
only Rs.60 million, constituting a meagre 0.7 per cent of
1
the total health expenditure.
I
In contrast, expenditure on medical education was
i
relatively much more and amounted to Rs.262.4 million
in Gujarat and Rs. 661.0 million in Maharashtra.
In
terms of the proportionate expenditure, medical education
constituted 5.3 per cent in Gujarat and 7.9 per cent in
I
t
■
L
i
jj/i . .mm
-.wuiji. i ,j,. w
wKJiuwaWmij
0
119
Maharashtra of the total health expenditure of the
respective states. At national level also, in the Sixth
Plan, a relatively larger proportion of the health outlays
were earmarked for medical education than the training of
pa rainp'i i cal staff. Keeping in view of the national goal
of 'Health For All By 2000 AD' as well as from the cost
benefit point of view, perhaps it is important that
efforts should be made to increase the number as well as
the quality of paramedical staff by enhancing the training
facilities on the one hand and making the job more
attractive.
According to an estimate, in Maharashtra the expenses for
training a doctor turned out to be Rs. 16042 per annum which
is three times more than the training of a nurse midwife
(Rs.4740 per annum) or ANM (Rs.4546 per annum) (See Table
8.2).
Detailed headwise analysis showed that both in Gujarat
and Maharashtra, the salary accounted for about 47 to 51
per cent of the total health care expenditure. The per
centage share of drugs, materials and supplies was more
in Maharashtra (23%) than in Gujarat (11.0%); vehicle and
travel expenses in th-se two states accounted for about
1.4 and 2.1 per cent respectively. In case of Gujarat,
a sizeable proportion (about 39%) of the total expendituie
was incurred towards grants-in-aid to district Panchayats,
for which no detailed break up was available at the state
level.
I
I
---
120
Table - 8.
:
AVERAGE EXPENDITURE PER CANDIDATE INCURRED
BY TYPE OF TRAINING IN MAHARASHTRA DURING
1982-83
No. of
Students
on Role
Expendi
ture
Rs. in
crores
Expendi
ture per
Student
Professional
(MBBS, M.D.
Dental etc.)
6532
10.46
16042
General Nursing
and Midwifery
257 3
1. 22
4740
ZJNM
865
0.39
4546
7
0.79
109 24
Type
B.Sc. Degree
(Nurses Post
Certificate)
Source :
1. Performance Budget, 1984-85, Directorate of
Medical Education and Drugs
2.
Performance Budget 1984-85, Medical (Non
teaching Govt. Hospital)z Directorate of
Health Services
To see how at actual iiaplementation level, the money was
spent, two district panchayats, one from Gujarat and the
other from Piaharashera were selected and studied,
The
analysis showed that at PHC level more than half of the
money (59% in Gujarat and 65% in Maharashtra)
on salaries.
.as spent
It was followed by compen sat ion/ incentives
to FP acceptors (around 17% each in Maharashtra and
Gu j ar at).
Drugs and supplies of MCH, contraceptive and
NMEP materials. accounted for 7.0 per cent in case of the
PHC from Gujarat and 11.5 per cent in case of PHC from
Maharashtra.
3
■
hr ■_
j A-
/-i’
■
■
A detailed head wise analysis of the
I
121
'family planning* expenditure of the two PHCs showed
that only 5.4 per cent of the total FP expenditure was
incurred against supply of MCH and FP materials in case
of PHC from Gujarat.
The corresponding percentage for
that of Maharashtra was 7.4 per cent.
The present study thus highlights the following:
I
1)
The severe paucity of data prohibits any
derailed
analysis of health financing at the state level.
A
major portion of the health outlays as in case of
Gujarat goes in the form of grant-in-aid to district.
Panchayats and local bodies.
However a break up of
this is not available at state level.
Immediate steps
should be taken to ensure flow of detailed information
on expenditure from talukas districts state so that
it could become an integral part for planning and
monitoring of the programmes.
2)
Training of paramedical staff, whjch is crucial for
the success of health and family welfare programmes
in rural areas, is still not given adequate attention
as the allocation of funds has remained very low.
On
the contrary-', medical education continued to receive
a preferential share in the allocation of funds.
3)
Even though in pion documents and policy papers MCH
is given very high priority, it is not reflected either
in the allocation or the expenditure of funds.
In the light.of above observations it is recommended that
immediate steps should be taken to ensure apprepriate
allocation of funds to MCH services and training of para
medical staff.
It may be also important that similar
exercise should be undertaken to see how other states are
faring on the above aspects.
122
It will be
of particular interest to
study the case.-oE
Kerala, which has
brought down infant and
3 maternal
mortality rates much beiow the national
average.and.
compare it with those
st^tes like Bihar, Up, which
are
still confronted with high infant
mortality.
One of the serious constraints in
conducting such studies
with health and family
welfare programme no
separate accounting is generally
done for each head and thus
: it becomes difficult to
arrave/any precise estimate
'■ of the total expenditure on
MCH services. Many of the
staff on 'health' and 'family
planning' arc a] so
work and hence a portion
of their salary c wild be
aportioned against MCH. However,
this demands an accurate
estimate o the time disposal
of the doctors aad other
functionaries and their time
allocation to various sub
-sectors of health,
No pr.cise
estimate so far is available at
national level or even
at state level in this regard,
decent study undertaken
by ORG, in three states vio.
/ Bihar, Gujarat and Kerala
provides some idea on the
proportion of time spent by
the functionaries on lie al th,
MCH an d family planning
activities. According to the
study, in Gujarat, functionaries were: spending on
an average about 24 per cent
of their time ion health, 25
per cent on MCH and 44 per
cent on family planning.
In case of Kerala, the corresponding percentages were 31,
21 and 31, and in case of
Bihar the^e were 33,17, and 31
respectively (Table 8.3).
These figures clearly indicate
that the vzorkers spent
maximum time on FP, and MCH
w— given least importance
in terms of devoting their •
time on MCH activities,
However, this data is
also incomplete as it does not
provide information about the time allocation of
the
is that MCH being integrated
OF ZZKZ DEVOTED BY FUNCTION/»RIES ON HEaLTH, MCH mND FAMILY
8. 3 : PERCENTAGE OF TIME
ARE.>S OF BIHAR, GUJHR..T /il-iD KERALA
WELFARETHfi/lWRaL
Iix L..- ------
T7JBLE
Proportion of
time devoted
_ Bihar
Health MCH
FP
________Gu j arat_____
Health MCH
FP
Kerala
Health
MCH
FP
15.0
43. 2
4. 2
1. 1
8.9
1.1
1.4
5.0
2. 2
10
10.0
4. 1
9.7
11.5
4.6
0.0
14.7
23.7
8. 6
11- 20
12.5
11.0
9.7
24.1
24.1
4.6
25.9
29.1
18.0
21-30
12.5
21.9
34.7
3 2. 2
26.4
5.7
17.5
19.4
30.9
31-40
10.0
5.5
16.7
21.9
25.3
29.9
6. 3
9.4
10. 1
41-50
17.6
6.8
11. 1
8. 1
10. 3
29.9
13. 9
7.9
12.9
51-7 5
11. 2
5.5
11. 1
1.1
1. 1
27.6
16. 1
6.5
5.8
76-100
11. 2
1.4
2. 8
0.0
0.0
1. 1
4. 2
0.0
1.4
30
73
72
87
87
87
143
139
139
Mean
33.0
16.9
30.8
24. 2
24.7
44. 3
31. 2
21.il
31. 3
S.D.
27.5
19.8
19. 2
12. 2
13.3
14.9
22. 6
16. 6
19. 2
Nil
Total
N
Source :
M.E. Khr., Prasad CVS - A study on Utilization of Health Services in
Rural Ar-as of Bihar, Gujarat and Kerala, Monographed, ORG, 1984
I
hj
UJ
t
....J-
; mi.
1
124 -
doctors and other supporting and
THC.
Further, the inf urination
supervisory staff at
was obtained by interand hence are subjected
to
considerable error due to recall
lepse •
It is suggested
that to reduce the gap of knowledge,
a f ew11 ime motion 1
studies should be
undertaken.
viewing at one point of time
Further, in states like
Gujarat and Maharashtra, where
substantial amount of
money wes given to district panchayat
m the form Of Grant-in_aid aRd who
generally do not feed
back detailed head-wise
-wise expenditure
to the states for
accounting purposes, it is inportant
that on sample basis
some talukas in the- rural
areas and
local bodies in the urban
sreas should be selected and
studies in detail for
assessing their
under various health .Programmes like . expenditure pattern
curative, preventive
and promotive
aspects.
while designing such
studies, care
should be taken to give adequate
types of talukas and PHCs as the representation to all
expenditure can vary
among the- IHCs
considerably because
of the differences in
the performance of individual
programmes as well as social,
cultural and economic background
of tihc- blocks in which
the PHCs are located.
and local bodies
As
discussed in trie begirjuing there
arc number of sources
providing
funds
towards health
caxe of the peoole. They
include Centra and State
Governments, public sector under
ta kin gs, priv ate sector,
local bodies, various health
insurance agencies,
including ESI
/ charitable
—^arie and voluntary
organisation and individual
families themselves
themselves.. However,
it is important to realise
.that m real terms, the iargest
contribution comes from
individual families
families themselv
es,
followed by Government.
The contribution from the
remain ing
I
i.
I
I
I
r
125
seems to be relatively very small.
Roughly, it is
that about 82 per cent of the health expen
estimated
diture is borne by individual families themselves and
about 16 per cent by public sources.
In other words,
at national level, contribution from all other sources
amongst
to only a bare two per cent.
Thus, any study
on health financing should start at family level.
It
is suggested that a number of studies should be launched
in different parts of the country to get a precise idea
of the size and pattern of health care expenditure.
While designing such studies, the following- points should
be kept in mind.
1)
It should be a multi-round study(at least four
bounds in the year) .
a)/capture the effect of seasonality on morbidity
and expenditure pattern.
b) to ovoid the recall lapse.
2)
It should cover fairly a wide arc-a to give a repre-
sentation of
a)
different ecologies
b) socio econoiY-.ic groups of people
c) rural urban background
|
1
In these studies, for all the cases of sickness, occuring
within 15 days proceeding the date of survey,
survey. detailed
information should be collected on the following aspects.
126
1. Consultation fees
2. Costs of medic in e/vitamins/special foods
3. Travel costs
4. Nursing and hospitalisation,
in-patients)
5. Number of working days
costs (in case of
lost
6. Opportunity costs of the persons attending
the patients at horne/hospital, etc.
Information should also be gathered about expenditure
incurred by the families in connection with perinatal, natal/
well baby, infant immunisation cares etc. which :will take
place during- the period of. study.
In -case studies attempt should also be made to understand
reasons for preferring one or the other sources of
medical help.
For example, it will be interesting to
find out as to why people continue to rely on private
than public health care sources.
Sir h studies are quite useful as it will help a) in
estimating the health care expenditure both in size and
pattern,b) to establish the proportion of expenditure met
by individual families vis-a-vis what government spends
for the people to meet their health care needs.
It could
be also taken to demonstrate that the people are spending
and are ready to scend money for their health care if thc-
services are-easily accessible to them and the existing
state services may not be availed by a large section simply
because they are free.
...
tn
127
. I
APPENDIX-I
Ashish Bose, Devendra B. Gupta, Mahendra K.
Premi (Eds)
(1982) ; Social Statistic^ Hg.alth & Education, Vikas
Publishing House Pvt. Ltd. 5, Z^sari Road, New Delhi.
Ashish Bose and P.B. Desai (1983); Studies in Social Dynamics
Hindustan Publishing Corporation'
(India), Delhi.
Ashok Mitra (1978); India.'-S__Fopulation, Aspects of Quality
and Control Vol.lj, Abninav Publications, ijew Delhi.
Banerjee,. Shipra (1984); Study of Public Expenditure on
Health and its Beneficiaries in a Primary Health Centre,
Thesis for M.D. C. C.H.A, Delhi University.
Cassen R.H.
(1979) ;India?s Population, Economy Society, Tha
Macmillan Press Ltd. Delhi
Department of International Health (DIH)
(1976); The Pune-
tional Analysis of Health Deeds and Services, Monograph.
Gandotra M.M., Narayan Das and Devamony Dey (1982); Infant
Mortality and its Causes in Gujarat, Population Resea rch
Centre, Baroda, Monograph.
Government of India (1980); Sixth Five Year Plan 1980-85
(Draft) Planning Commission, New Delhi
Government of India (1982); Performance Budgets, 1982-83 and
1984--85, Ministry of Health and Family Welfare, New Delhi.
Government of India (1984a); _Family Welfare Programme in India
Year Book, 1982-83, Ministry of Health and Family Welfare,
New Delhi.
G
128
government of India (1984b); Health Statistics of India (1983),
Central Bureau of nealth Intelligence, Directorate General
of Health Services, Ministry of Health & Family Welfare,
Nev; Delhi.
Government of Gujarat (1979) ; Sixth Five Year Plan 1980-85
(Draft)
Planning and General Administration, Gandhinagar.
Government of Gujarat (1983)
Budget Estimates for 1983-84
Health and Family Welfare Department, Gandhinagar.
Government of Gujarat (1984); Performance Budge, 1984-85,
Department of Health and Family Welfare, Gandhinagar.
Government of Maharashtra (1984c); Performance Budget 1984-rD3
Perfonriance Budget 1984-85, Family Welfare Public Health
Department, Bombay
Government of Maharashtra (1984d); Performance Budget 1984-85
!
Medical Non-teaching Govt. Hospitals), Public Health
Department, Bombay.
Gupta, J.P.
(1984), "Current Position, Trends and Policy Issues
in Health Care Financing in India”. A Paper presented in
the Fifth Annual Conference of Indian
i
Society of Health
Administrators on Financing of Health Services in India,
held at New Delni, 13 — 15 December 1984.
Indian Institute of Management (1982); Seminar on Government
Expenditure Policy on social Services, Monograph, ZZM,
Ahmedabad.
ZIPS, PRC, Patna, RGI (1982); Report on the Base Line Survey
on Fertility, Mortality and Related Factors in Bihar,
Monograph, ZIPS, Deonar, Bombay.
1
4
jr
129
i
Khan M.E.
C.V.S. Prasad, Ashok Majmudar (1980)
Perception About Family Planning in India
; People’s
- A Study of Bihar
and Andhra Pradesh, Concept Publishing Company,
New Delhi.
han M.E., c.V.S. Prasad (igsik); utilization of Health Services
in Rural India - A Comparative Study of Bihar, Gujarat and
Kerala, Monograph, Operations Research Croup,(ORG) , Ba roda.
Khan M.E., C.V.S. Prasad,
(1983b);
Health Seeking Behaviour and
Adoption of Famjjy Planning in Himachal Pradesh *
A Base
Line Study for an Action Project, Monograph,
(ORG) , Baroda.
Khan M.E., R.
R.B.
B. Gupta (1983c); Integration Qf MCH
planning - An
Baroda.
Action oriented Research, Monooraoh, (ORG)
Khan M.E., Afzal Ahmad and K.K. Verma (1984); Social Impa.-s
I
m.Area Development - A
A Bench-Mark
Study in
in Three
Three Blocks
Bench-Mark Study
of saharampur District of
Pradesh, Monograph,
Ox Uttar
Uttar Pradesh,
Monograph, ORG
Baroda .
Li, ar As hok sand. Lal aan SHi arma (£@83)
and Family Welfare Status
; Demographic; ^.Health - - •
of the Population - A Report
of Base Line Survey’ of the Second India
Popula.tion ^Project,
Population Centre, :Lucknow
Mari Bhat R.N. et al (1984); Vital_Rates in India 1961-81,
National Academy Press, Washington, D.C.
Mishra B.D. , All Ashraf, Ruth Sammons and George Simmons
(1982); Oraanisatio^for Change - Systems Analysis of
EainllY Planning in Rura^Jaata, Radiant Publishers.
Mehta Saman st al (19e4)! Eole of Health
Se„ice£ on
Acceptance of Family Planning, Monograph, 1CMR, Ansari
Nagar, New Delhi
F
130
NIHFW, UPS, DirecLorate of Health Services, Rajasthan and
1
Registrar General of India (1982); Base Line Survey on
Fertility, Mortality, Family Welfare D Utilization of
Health and Family Welfare Services in Rajasthan, Monograph,
NIHFW, New Delhi
Operations Research Group, Area Development through Social
Inputs for Buldana District - Status Plan Bench-Mark,
Monograph, ORG, Baroda
Pai Panandikar, V.A. , R.i\. Bishnoi, OP Sharma (1983); Organ is at ion al Policy for Fanti1 y Planning, U pp al Publishing House,
3 Ansari Road, New Delhi
Planning Commission (1984); The Approach to the Seventh Plan
Government of India, Planning Commission, New Delhi
1
Ram, Eric, R. , and Dutta, B.K.
(1984), Medical Care for the
Rural Pooplu and its Relationship with Income and Educational
Levels, KIHAE, Bulletin IX (3) New Delhi.
RGI (1983), Survey on Infant and Child Mortality, 1979 Office
of the Registrar General of India, Nov; Delhi.
i
I
Srinivasan K., P,C. Saxena, Tarakanitkar (Eds)
(1979); Demographic
and Socio-Economic Aspects of the Child in India, Himalaya
Publishing House, Bombay.
I
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i
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I
F
■
appekdix-ii
CF MCH activities
^S^JVW Pg^
in
MAHARASHTRA & GUJARAT
iiP'5
___
te
pi
i- -' -
I
Target
(000s)
TT for Expectant
Mothers
7956
DPT immunisation
for children
15965
D.T. immunisation
for children
1257 2
Pol io
2399
Ach.
%
89. 5
57.9
86. 1
1881-82
Maharashtra
Target Ach.
(OOOs)
%
Ou]arat
Target Ach.
(000s)
%
All India
Target Ach.
(OOOOs)
%
—19_8_2j-83
Mahar a s h t r a
Target Ach.
(OOOs)
%
Ou j arat
Target Ach.
(000s)
%
1200
138. 8
800
82.0
9000
83. 3
1200
127.0
800
86^7
1950
95.0
1250
65.0
13970
7 2. 6
1700
143.0
1000
78.9
1600
140.7
1200
95.0
12500
81.9
1500
166. 3
1200
80.4
274
149.7
120 182.8
5 236
I
123.8
Prophylaxis Against
Nutritional Anaemia
' for women
85. 2
600
145. 6
300 103.4
to
I
11880 101.9
(53.0))
for childrenll88o 103. 3
1500
116. 6
(51.3)
600 130.0
(55.7)
12000 122.7
(45. 2)
1500
(
173.7
(28.0)
600 140.6
(67.6)
1500
128. 1
600 109.9
12000 116.6
1500
178. 2
600 115.5
Vitamin-A
deficiency
24660
75.7
2 200
51.8
1800
79.9
25000
64. 3
Typhoid
2200
9996
26. 6
61.5
1800
60.0
950
26.7
500
7 2. 1
10000
49. 7
900
151.8
600
71.5
Source : Family Welfare Year Bdok,
1992-82, Ministry of Health and Family Welfare
Government of India, i\ew Delhi
I
132
APPEL7DIX-III
Concepts and Definitions of the Terms used
in the Government's Buduet Publications
'Annual Financial Statement1 or 'Budget1 means a statment
of estimated receipts and expenditure of the state in respect
of a financial year laid before the legislature under Article
of the constitution.
Appropriation :
The amount authorised for expenditure under
a major, minor or sub-head or other unit of appropriation or
a part of that amount placed at the disposal of a disbursing
officer.
The word is also used in connection with provision
made in respect of 'charged' expenditure.
Budget Estimates:
These are the detailed estimates of the
receipts and expenditure included in the budget for a finan
cial year.
Charged Expenditure : Such expenditure/ which is not subject
to the rule of the legislature and is declared to be charged
on the consolidated fund of the state under Article 202(3)
of
the constitution of India.
Consolidated Fund of a State,.:
It is a Fund found under
Article 206 of the constitution comprising all revenues
received by the State Government/ all loans and ways and means
advances raised or received by it and all money received by it
in repayment of loans,
The disbursement made out of these
receipts are shown on the disbursement side.
Contingency Fund of a State :
It is the fund established
by the legislature of the State under the provisiorE of
Article 267( 2) of the constituion and is intended to enable
advances being made there from for the purpose of meeting
unforeseen expenditure pending authorisation of such
expenditure by the Legislature under Article 205 or 206
of the constitution.
133
Departmental Estimates : The estimates
or receipts and
expenditure of a dept, submitted by a head of the dept, or
a controlling officer to the Finance Department through the
administrative department as the material on which to base
its estimates.
Detailed Head :
The smallest accounting unit subordinate to
the sub-head indicating object of expenditure such as
salaries^ travel expenses, etc.
Disbursing Officer :
Dae who draws money for disbursement
on bills from treasury*
A Gazetted Officer who is not a head
of office and who draws his pay and allowances from a treasury
is not included in this term.
I
Estimating Officer : Officer who is primarily responsible
for preparing the estimates of receipts of expenditure.
Financial Year : The period commencing on 1st April of a
Calender year and ending with 31st March of the next calender
year.
Grant : The amount voted by Legislature in respect of a
demand for grant on specific service or for soecific purpose^
Major Head : It is the main unit of account for—the purpose
of recording and classifying the receipts and expenditure of
the State according to various functions of Government e.g.
education, agriculture, health, etc.
Head : It is a head subordinate to a major head or
sub-major head.
It identifies a ’programme.1 undertaken to
achieve the Objectives of the function under plan/non-plan
programmes.
2
Sub-major Head : An intermediate head of accounts introduced
between a major head and the minor head, It can be thought
it is a group of programmes.
‘1
1
134
Demand of Grant : It is a proposal made to the Legislature
on the recommendations of the Governor, for appropriation
of sums out of the consolidated fund of a state for expendi
ture on a particular service or for specific purpose not
charged on the revenue of the state.
The demand will be for
the gross expenditure without taking into the account of
recoveries shows as reduction of expenditure.
Reappropriation : Transfer of funds from one unit of appro
priation under vzhich savings are anticipated to another unit
of appropriation within the same grant to meet the excess
expenditure anticipated thereunder.
II
Revised Estimates : It is an estimate of the probable receipts
or expenditure for a financial year, framed in course of the
year, with reference to the transaction already recorded for
a part of the year and anticipation for the remaining period
of the year, in the light of the order issued or contemplated
to be issued or any other relevant facts.
Sub-Head
: It is the unit of account, next subordinate to
a minor head, which indicates a scheme of activity undertaken
as a part of the programme represented b; the minor head.
I
In regard to non-developmentai or administrative expenditure,
it denotes an organisation or a particular wing of admini
stration.
Revenue Account :
i
It comprises the account of income and
expenditure of the government. The income is derived mainly
from taxes and duties, cesses lev
, etc. imposed by lavzs,
fees for services rendered, fines and penalties , etc.
The
revenue expenditure is such type of expenditure as manage
ment and collection of all taxes, rendering services to
the community, miscellaneous adjustments and other inci
dental expenses, etc.
i .
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136
I
APPZ1TDIX-IV
A STUDY OF HEALTH FIN AN CT/G IN INDIA
(Questionnaire)
1.
Name of the Company :
2.
Address
<■
I
3.
Total No. of workers/
employees
4.
Does your company have any one
or more of the following health
schemes ?(Mark your answers in
the following table)
5.
What is the total contribution
of your company and your employees
towards the scheme in the last
two years ?(Mark the answer in the
table below)
Schemes
Whether
the scheme
operating
in company
ESI
Yes/Ho
Panel Doctor
Yes/No
Company 1s
Contribution
towards the
scheme
1981- ’ 198282
83
Employees *
contribution
towards the
scheme
1981198283
82
Medical Reimbursement
Others (Specify
6.
I
Does your Company run its own hospital/clinic/dispeasary?
Hospital
Cl in ic
Yes/No
Dispensary:
Yes/No
Yes/No
•i
I
135
■ i
Capital -cix enditure :
Che expenditure incurred with the
object of either acq-uirinq or increasin ■ concrete material
and of preman ent nature such as land, buildings, equipments,
etc.
In practice the
expenditure in case of all new original
works where the estimated cost individually exceed Rs.l'lakh
is debited t. the capital head, while the expenditure in case
ox all original works individually costing Rs.l lakh and below
irrespective of whether they form parts of a scheme exceeding
s. lakhs, is debited to revenue account.
Plan_and Non-pl an Sxpendltn re-
The amount spent towards
schemes initiated newly in the current plan period towards
development
such as recruitment of new staff, construction
of ncW centres, etc., is classif iedund .-.r 'plan' expenditure,
while the expenditure incurred for continuing or maintaining
t e infrastructure will be treated under ’non-plan' expenditure.
)
a
A
F
I
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■
—................
137
7.
I
I
Kindly give the oreak
by theJ Company for the
last one y--ar.
bome
y ^uxpo^es during the
I
Health j
I
Salaries
i
Wages
MCH j Family j
I Planning •:
f------- t
Total
—1—
-—4----
Travel Expenses
Office Expenses
+
&ents. Rates and
Taxes
Motor Vehicles an d
Ma in ten enc e
i
Materials and
Supplies
I
~ *-ri
I
Machinery
Equipment
f
Scholarship and
Stipend
I-
Diet Charges
Incentives
1
I
~
!
Others (Specif!)
8.
1
StYm4haVf any Other scheme
through which your employees
9v.t meoical benefit?
If yes what are those?
J '
bv'7:; •
.. ,
I
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