HEALTH BUDGET IN KARNATAKA
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- Title
- HEALTH BUDGET IN KARNATAKA
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c Q PS
Centre for Budget and Policy Studies
Dr. Vinod Vyasulu
Director
The Chairman,
Task Force on I ffealth and Familv Welfare.
PHI Building,
Seshadri Road,
Bangalore 560001
7 February 2001
Dear Dr Sudarshan,
I am enclosing the rex ised report on Health Finances in Karnataka. I hope it is in time for
you to process further.
I his papei has been ievised in the light of comments we received in the last meeting of
the i ask Foice with tnose undertaking studies. We have tried to incorporate all the points
made when data were available
I would like to thank you and the other members of the Task force, and the many officials
who have helped us when we were working on this paper. Without such help, we could
not have achieved anything. Thank you.
We would like to use tnis paper as a starting point for discussion with others interested in
such issues. I had mentioned this to you some time ago. 1 hope this will be OK with the
Task Force now that the paper has been finalised
We have received the first installment of fee for this paper. After the last meeting 1 had
submitted a request for the second installment. It has yet to be released.
Now that the paper is completed and submitted, perhaps the entire balance can be
released to us now
Yours sincerely.
1C, S.V. Complex, 1st Floor, 55 K.R. Road, Basavanagudi, Bangalore - 560 004. India
Phone . ++ 91 -80-6522327
Fax : ++91-30-661 6401 e-mail : cbps@vsnl.com
The Health
Budget
in
Karnataka
r
The Health Budget
in
Karnataka
A Indira
Vinod Vyasulu
Centre for Budget and Policy Studies,
SV Complex, 1st floor,
55 KR Road,
Basavangudi,
Bangalore 560004
e-mail: cbpsf^vsnl.com
February 2001
Butch, the worst of human ills
[Poor Tattles found] are “little Bills9!
And, with no balance in the Bank,
What wonder that his spirits sank?
Still, as the money flowed away,
He wondered how on earth she spent it.
*You cost me twenty pounds a day.
At least/ Cried Tattles [and he meant it].
She sighed. “Those drawing Rooms, you know!
I really never thought about it:
Mamma declared we ought to go—
We should be nobodies without it.
That diamond-circlet for my brow—
I quite believed that she had sent it.
Until the Bill came in just now—“
"Viper/1’ cried Tattles [and he meant it].
Poor Mrs. T. could bear no more,
But fainted flat upon the floor.
Mamma-in-law, with anguish wild,
Seeks, all in vain, to rouse her child.
“Quick! Take this box of smelling-salts!
Dent scold her, James, or you'll repent it,
She's a dear girl, with all her faults—“
“She is!9 groaned Tattles [and he meant it].
“I was a donkey9, Tattles cried,
“To choose your daughter for my bride!
‘Twas you that bid us cut a dash!
‘Tis you have brought us to this smash!
You don't suggest one single thing
That can in any way prevent it—a
“Then tuhaVs the use of arguing?”
“Shut up!” cried Tattles [and he meant it]. *
Lewis Carroll
Table of Contents
Section 1 Introduction
Section 2 Budget System
Section 3 Results
Section 4 District Plan Allocations
Section 5 Conclusions
Acknowledgements
This is a revised and expanded version of a study
undertaken for the Task Force on Health and Family
Welfare set up by the Government of Karnataka. While
the monograph incorporates changes suggested by the
Task force on the draft submitted earlier, it also includes
the results of more recent research at the district level
which were not part of the terms of reference of the study
for the Task Force. We hope this report will be useful to
all those concerned with health planning in Karnataka.
We are grateful to all who helped us. In particular,
we would like to thank Dr H Sudarshan, Dr CM Francis,
Dr Thelma Narayan, Shri P Padmanabha, Shri Sanjay
Kaul and several other officials in the Health and Finance
Departments for taking time out to discuss issues and
provide help in accessing data. Our colleagues in CBPS
worked very hard amidst frustrations of power failures
and data corruption. But none of them is responsible for
errors of fact and opinion that remain.
The Health Budget
in
Karnataka
1. Introduction
This monograph is organised as follows. In section 2, the budget system,
concepts, and limitations are discussed. In section 3, the results emerging from an
analysis of the available data in Karnataka are presented. Section 4 presents
details of allocations for health at the district level. Section 5 is a brief conclusion.
Health is a state of positive well-being for an individual and for a community.
And this is essential in all aspects of life, be it the health of the people or the health
of the finances which are a crucial input into the governing system. Health of all is
primarily a state’s responsibility. The Directive Principles of State Policy in the
Indian Constitution [Part 4] make this clear.
Much has been done in terms of focussing on preventive and public health,
and encouraging public participation in the provision of health services. The private
sector in different forms has played a major role in service provision, and
individuals have spent considerable amounts on health matters. In spite of this,
the state’s role in the overall administration and implementation to cover the whole
population in health matters cannot be ignored. Rather, the state has a key role to
play in ensuring that health services of adequate standard are available to citizens.
In the process, it may use private parties for certain functions, but that does not
absolve the state of its overall responsibility. It is in this background that we look
at health finances.
Health is a subject in the state list in the Indian constitution: the primary
responsibility for health services provision lies with the state government. The
union does have a role, but it is in providing guidance and resources for matters of
national priority. The state has so far been providing these services through the
Ministry of Health, which is responsible for policy matters, and the Directorate of
Health and Family Welfare, which is responsible for implementing these policies in
the state. For this purpose, it has an elaborate set up at state, district and lower
levels. This set up is well established in the state governmental system.
In 1993, the Constitution was amended to bring in a third tier of local self
government, and health is a subject that is also in the list of subjects that states’
may place in the purview of these bodies. In rural areas, with which this
monograph is concerned1, this refers to the three levels of panchayats—zilla, taluk
and gram panchayats. These panchayats are the local manifestation of the state.
All of the department employees at the district level have been deputed to the zilla
panchayats in Karnataka—and they are to implement the various schemes. There
is today some tension between the departmental employees and the newly
1 The health situation in urban areas deserves an independent study. This is a limitation of
this study to be noted at the outset.
i
established political local panchayats2. This is not surprising at a time of structural
change.
In this transition from a political system that consisted of two levels—union jl
and state—to one of three levels, union, state and panchayat—several problems 1
have arisen. These will undoubtedly be sorted out in time3. However the major
fiscal responsibility of financing the health sector still wrests with the State |(
government. The zilla panchayat so far only acts as a conduit for the transfer of
funds.
Health is today set in a complex context of multiple levels of government
action. In Karnataka, which has been a pioneer in panchayati Raj experiments4,
this is especially true. The department is manned by doctors, administrators, para
medical staff, health inspectors, etc. And the form of implementation, which was
completely departmental, has changed to provide a role for panchayats. Elected
representatives now make demands upon the staff of the health department in the
local areas. This has led to controversy and differences of opinion: by and large, the
department is not convinced that transferring responsibility to the panchayats will
serve a positive long term goal5. They would like to limit the role of panchayats, at
least where health issues are concerned. This is the background for the present
study.
The present study looks at the following issues: (1) the expenditures of
medical and public health and (2) the expenditures of health-related sectors.
Ideally this should include the following:
a. analysis of expenditures of medical and public health - urban health services
(UHS), rural health services (RHS) and public health services (PHS) for the
revenue, capital, and loan accounts and
b. analysis of expenditures of related sectors, viz., (I) water supply and sanitation;
(ii)social security and welfare; (iii) nutrition; (iv) family welfare
To study the above, the data that we have used are as follows:
1. The Research and Statistics Wing of the Finance Department of the Government
of Karnataka (GoK) has collated information on the expenditure patterns (head
of account wise) for the period 1960- 1990. We have taken the major head-wise
expenditures for M&PH; WSS; Nutrition; General education; and Family Welfare
for revenue, capital, loan accounts, wherever possible - 1960-61 to 1989-90
from this document.
2 D.Rajasekhar, Sashikala Sitaram and Vinod Vyasulu, ^Decentralisation in Karnataka”
paper prepared for the World Bank, June 2000.
3 Vinod Vyasulu, “Decentralisation, Democratisation, Finances and the Constitution,” Paper
prepared for the Panel on Decentralisation of the National Commission to Review the
Working of the Constitution, Bangalore, November 2000.
4 For an overview, see D Rajasekhar et al, op cit. Also Vinod Vyasulu, Decentralisation from
Above, CBPS, Bangalore March 2000.
5 This has been a major area of debate in the Task Force.
2
2. The Finance Department, GoK has an Accounts Reckoner for 1990-2001. This
gives the major headwise data for the 1990s. This has been used to get the
figures for revenue expenditures, capital outlay and loan receipts and
disbursements.
However with the data it is still not possible to do (a) breakup between UHS,
RHS and PHS and (b) to say what proportion of loan is towards health per se from
the larger division between central schemes, centrally sponsored and state
sponsored schemes. It is understood that the loans from the Government of India
come in different forms for the central schemes, centrally sponsored and state
sponsored schemes. The breakup is 70:30, meaning, 70% of the funds come as
loans and rest 30% comes as grants-in-aid. Even where funding from donors
abroad is concerned, it reaches the state government in this form. For the state,
70% is a loan to be. repaid to the union. The state is not concerned in repayments
abroad, and the risk from exchange rate fluctuations—rupee depreciation—is borne
by the union of India.
It is to be noted that the two data sources cited above are not comparable,
even though both come from the Finance Department of the GOK. This is because
whereas the first data is from 1960-1993, the second source is only for the 1990s
decade. The base for the calculation of deflators has been changed in 1993-94, the
cut-off point in the first data set. Hence what we have done is to use the first data
set to understand the earlier time periods, mainly in terms of five year plans and
the second data-set used to study the latest decade in as much detail as is
possible. It would not be justified to link them and draw a trend line.
Before proceeding further, it may be helpful to recall a few facts to provide a
context. These are taken from the Government of Karnataka’s 1999 report Human
Development in Karnataka. While the social sector expenditure of the state has
been hovering around 38% of total revenue expenditure, the average annual
expenditure on health-related items of expenditure accounts for 25.7% of the total
expenditure on social services. This is second only to the share of the education
sector of 53%. There is also considerable private expenditure, but that is outside
the scope of this monograph.
2. The Budget System
Each year, in February or March, the finance minister of the state presents a
budget to the state assembly, under Article 202 of the constitution. This lists the
revenues available with the state, and the manner in which they are to be spent.
This is in an essential sense, the major policy statement of the government,
concretely listing its priorities. This budget must be approved before the start of the
next financial year—April 1. The budget shows in detail what the government plans
to do over the coming financial year. It also presents revised estimates of what has
been accomplished in the current year and actual figures for the year past. An
analysis of the budget then represents what the government has actually done, as
opposed to what it claims in other forums. Hence the importance of ongoing budget
analysis.
3
Apart from the well known Revenue and Capital accounts, Government
accounts in India are divided into two categories, “plan” and “non-plan”. Plan
figures represent new initiatives, while non-plan figures are in the nature of
expenditures on past commitments. At the end of a plan period—five years—plan
programmes are to be transferred to the non-plan category.
The budget afiocates money to “schemes”. Schemes are specific proposals for
spending money. An example would be a scheme for the eradication of leprosy—a
worthy cause. The scheme would then define how leprosy is to be identified, how its
magnitude is to be assessed, and how, given certain parameters, the scheme is to
be implemented. A scheme brings with it’s a set of rules and guidelines on how it is
to be implemented, and it provides no scope for modifications^. It would specify
how much of the allocation may be used in salaries for nurses, how much for the
purchase of medicine in some cases, which medicine also. These schemes are
locally implemented by the departmental machinery.
Sometimes it is not possible to transfer a plan scheme of one plan to the
non-plan account of the succeeding plan, for a number of reasons—usually a
shortage of funds. In such cases, these schemes are earned on under the plan
head. This means that salary and other routine payments are paid from plan funds
meant to finance new schemes. This has two implications: funds for new and
innovative ideas get squeezed, and salary and other routine expenditures make
their appearance in the plan account. Thus, for recent years and plans, it cannot
be assumed that plan expenditures represent new schemes or investments. In fact,
as a plan progresses, the salary component of the plan account increases, so that it
often only in the first or second year of a five year plan that investment can take
place. The usefulness of the ‘plan' and non-plan’ categorisation has been
questioned for such reasons.
ELach of the major departments of the state government—of which Health is
°ne prepare a budget estimate, based on the priorities of the government, and
send it to the Finance Department in the second half of the financial year.’ This
forms the basis on which the Finance Minister makes allocation decisions for the
various ministries in the government—there is of course a great deal of discussion
that precedes the decision. Once approved by the Assembly, it becomes the
programme that the ministry will implement in the coming year.
Decisions about plan expenditures at the local level are made in the
Planning Department of the state government. The system works as follows:
Based on the allocations for schemes in f
the current year, and actual
expenditure patterns, and the ‘target' for the district indicated by
j the Planning
Given that it is designed by bureaucrats in the capital—of the union or the state—it is
designed to meet the requirements of the “average district. No district, is however, average
in this sense: each has specific features of its own. Thus it is difficult to implement a
scheme at the ground level. But although this is known funds are not given on a broad
programmatic basis, such as eradication of chronic diseases, but on clear cut schemes.
4
Department, the district officers prepare a draft budget for the next year7. This,
after formal approval in the zilla panchayat, is referred to the Planning Department.
The Planning Department, in consultation with the Finance Department, has a
tentative figure within which the year’s expenditure must be kept.
Once the estimates are received from the districts, discussions take place
between the district officials and the Planning Department officials in the Planning
Department, at the end of which a decision is reached about the level of
expenditure on plan subjects in each district. This, after consultations with the
Finance Department, becomes part of the state budget. Once the budget has been
passed by the Assembly, the moneys are transferred to the districts and can be
spent. This is the theory.
In reality, the releases of funds approved to the districts depends on many
factors—the Ways .and Means position of the state, for example. It is not
uncommon for small sums due from a government department to be held up for
such reasons. Those who are to receive the money are often in the dark about the
reasons for the delay. In recent years, with the deterioration in the state of
government finances, this problem has become more acute. Thus, the budget
figures speak of intentions, but cannot be taken as a firm basis for decisions
involving spending because of this problem of delayed releases. It adds an
unnecessaiy element of uncertainty into the local system. Programme and scheme
implementation then suffers.
Across districts in the State, many of these activities are co-ordinated by the
Rural Development and Panchayati Raj Department, under whose control the Chief
Executive Officer of the zilla panchayat works. At the local level, the CEO must
work in co-ordination with the elected president of the ZP.
It is possible that several departments are undertaking expenditure that
pertains to health. For example, the Department of Disabled Welfare may have an
item on, say special hospitals for handicapped people. There could be others of
this type. Such items, should rightly be included in a study of health expenditures.
But it is a tedious task that cannot be easily undertaken without access to the
detailed budget documents. They are not taken into consideration in this study.
This limitation should be noted at the outset.
The link documents provide information on the amounts allocated to each
district under different major and minor heads8. It must be noted that actual
expenditures may differ from these allocations. Thus, these figures may be seen as
representing the stated goals of the government. There may be a difference with
what actually happens9—this has to be studied separately by looking at the district
level expenditures. Such figures are not available in the state capital in detail—
collecting them from each district is a tedious and time consuming task.
7 In practice, they take the figure for the year past, increase it by 10%, and forward it to
their departmental heads. There is little by way of zero base budgeting and the like.
8 The CBPS is undertaking a separate study of district allocations for health, which should
be ready soon. It will be shared with a range of citizens concerned with health issues.
Q A. Indira:
study of zilla panchayat budgets in two districts, CBPS. Bangalore March
2000.
5
The state government can only spend money on the basis of approvals by the
Assembly, and the procedures that have evolved over the years are rigid and time
consuming. For one reason or another, no government has made any attempt to
modify these procedures. Thus, even after approval in the Assembly, there are a
large number of rules and regulations that make the spending of money by
government departments slow and time consuming. Often this results in the
objective of the exercise being lost in a morass of paper work.
Recognising this rigidity in the financial system, many states resorted to the
method of setting up autonomous” societies under the Registration of Societies
Act, to undertake important projects. These societies were designed to function
under the Minister and Secretary of the concerned Pepartmmt, with a specially
appointed Project Director to run the society which enjoys considerable financial
autonomy10. But it must be noted that they led to greater centralisation at the state
level, for they by-pass local governments—and they also did not come under
detailed legislative scrutiny11. Many of these societies also created a parallel local
structure for their work, thus bloating the bureaucracy12.
The funds available came from different sources. There were the own
revenues of the state what it collected from taxes in its jurisdiction. There were
the transfers of the state s share of union taxes, shared with the states’ on the
basis of the recommendations of the Finance Commissions. And then there were
transfers from the Planning Commission13. These were union finances that it
passed on to the states in programmes of national importance, on soft terms14.
But the releases to local areas15 depended, increasingly so in recent years,
upon the ways and means position of the state government. Thus, even after
budget approval, funds were often not made available because of cash crunches in
the state. It is therefore important, to understand the expenditure process at local
levels, to distinguish between allocations approved, and releases made to local
bodies. Money allocated may be released in February—then it will be difficult to
spend it effectively. To fully appreciate the complexities involved, a study of releases
is also necessary. In this study however we have not taken into consideration
releases but actual expenditures at the state level as these are the audited figures
placed in the House. At the district level, we deal with allocations only. Further
work is needed to confirm or reject these findings on an empirical basis.
3. The Results at the State Level
10 We wonder if the KHSDP is such a body?
h For details, see L.C.Jain and A Indira, 'Budget Analysis: For Whose Sake?”, Keynote
Address at an international conference in Bombay, November 5-9, 2000.
12 Discussed in Vinod Vyasulu Decentralisation from Above, op cit.
13 These transfers include funds from external donors.
11 These have been changing. At present 30% is grant and the rest a loan on varying terms,
to be repaid over a long period like 25 years. The exchange risk in the case of hard currency
loans is borne by the union government.
,o M. Govinda Rao, Director, ISEC, Bangalore in a personal communication, has spoken of
the results of his recent research, which shows that, at an all India level, devolutions to
local bodies come to 0.04% of the GDP. The local governments cannot be very important!
6
We present below the results of a simple analysis of the data available under
the heads of health, and health related finances—loans etc at the state government
level.
3.1 Medical and Public Health:
Here under Medical care is included medical relief, which consists of
conventional curative medical facilities such as PHCs and sub-centres, hospitals
and dispensaries; indigenous systems of medicine; health insurance schemes for
formal sector employees and their families; medical education and research;
direction and administration. Under Public Health comes prevention and control of
communicable diseases, health education, immunisation and other public health
activities.
Trend growth rates for the period 1960-61 to 1989-90 shows that M&PH has
shown under the revenue account a growth of 4.2°/o for total expenditures, 3.33%
growth for non-plan and 0.82°/o growth-in plan expenditures. This would imply that
little by way of investment is taking place—a warning for the future health of the
system.
As a percent of SDP it is seen that the expenditure on health services in the
1960s it was 0.6%, 0.8-1% during 1970s; and from 1 to 1.1% in 1980s and 90s.
The per capita expenditure has risen from around Rs.8/- in 1960-61 to Rs.21/- in
1989-90’6. Whether this is adequate or not needs to be judged with reference to a
standard norm—we are not aware of one.
Table 1: Revenue Expenditure under the major head Medical and Public Health in
the period 1960-1990
(Rs. In crores)
Growth
M&PH
Year
33.09
in FYP 1961-66
-7.65
30.56
Annual plans 1966-69
165.35
81.09
IV FYP 1969-1974
162.47
100.36
V FYP 1974-79______
44.22
-72.78
Annual plan 1979-80
379.87
759.05
VI FYP 1980-85
739.98
94.80
VII FYP 1985-90 __________ _ ______________
Source: compiled from the GoK Finance Report
In the above table 1, we can see that the expenditures in the third and
fourth five year plans are far smaller than in the latter plans. In the last two five
year plans, namely eighth and the ongoing ninth plan, the expenditures have been
Rs.2230.75 crores and Rs.3259.35 crores respectively. This is at current prices—
inflation has not been adjusted for. The real increase then may be much less than
16 Dr.S.Subramanya. IAS. Government Health Expenditure in Karnataka since 1960,
KHSDP Paper made available to us by the Task Force.
7
these figures suggest. The growth rates at current prices show that the growth has
been largest during the sixth five year plan, i.e., 1980-85.
In terms of percentage of total state government expenditure it is interesting
to note that M&PH has always hovered around 6%.
Table 2: Capital Outlays towards Medical and Public Health in the period
1960-1990
(Rs. In crores)
________ Year_______
M&PH
Growth
III FYP 1961-66
-1.30
Annual plans1966-69
2.20 -269.23,
IV FYP 1969-1974
1.49
-32.27
VFYP 1974-79
6.08 308.05
Annual plan 1979-80
1.21
-80.10
VI FYP 1980-85
13.25 995.04
VII FYP 1985-90
13.64
2.94
The capital outlays on M&PH (Table 2) has been growing more slowly than
the revenue expenditures. Capital expenditures are those that are expected to give
returns over a term longer than one year. Is the state discounting the future? The
growth rates at current prices is also given alongside for comparison. The main
inputs in terms of growth seems to have been in the fifth five year plan and the
sixth five year plan.
We next present the plan and non-plan expenditures incurred on M&PH for
the period 1990-91 to 2000-01. We have deflator figures with 1993-94 as the new
base till 1998-99 which is used for deflating the expenditures in current terms.
Table 3 Health and Famfly Welfare Head wise expenditure (plan) (Rs in Cr.)
____ Current
prices prices
[Current
Constant
Year|M&PH~ FW___ TOTAL Deflator M&PH FW
[total"
41.68
1990- 91
35:i7
7685
88.94 46.86 39.54
86.41
1991- 92
39.39
50.38
89.77
90.25 43.65 55.82
99.47
52.92
1992- 93
54.98 107.90
94.33 56.10 58.28 114.39
62.60
1993-94
59.42 122.02 100.00 62.60 59.42 122.02
87.29
1994- 95
76.55 163.84 106.98 81.59 71.56 153.15
1995- 96
119.54
86.81 206.35 114.80 104.13 75.62 179.75
1996- 97
144.26
74.63 218.89 123.43 116.88 60.46 177.34
1997- 98
157.72 106.09 263.81 129.62 121.68 81.85 203.53
147.47
1998- 99
84.85 232.32 138.46 106.51 61.28 167.79
160.04 167.85 327.89
19992000RE
2000- 01BE
177.69 195.21
372.9
Avg -71.15 -77.00 -73.83
growth
Source : Finance Department GOK
8
Table 4 Health and Family Welfare Head wise expenditure (non-plan) (Rs. in Cr.)
Current
constant
FW
TOTAL
Deflator M&PH
FW
TOTAL
Year M&PH
3.10
166.16
88.94
163.06
186.82
183.34
1990- 91
3.49
3.48
205.60
90.25
227.81
202.12
223.96
3.86
1991- 92
3.75
252.31
248.56
94.33
267.48
263.50
1992- 93
3.98
3.62
269.22
100.00
265.60
269.22
1993- 94
265.60
3.62
4,64
289.27
293.91
274.73
106.98
1994- 95
270.40,
4.34
4.67
290.11
285.44
114.80
252.71
248.64
1995- 96
4.07
5.58
300.62
306.20
123.43
248.08
1996- 97
243.56
4.52
6.35
360.55
129.62
278.16
354.20
273.26
1997- 98
4.90
476.08
7.68
468.40
343.84
138.46
338.29
1998- 99
5.55
11.03
575.89
564.86
19992000RE
10.18
639.73
649.91
200001BE
Avg
-83.44
-83.46
-84.38
growth
Source : Finance Department GOK
In the recent decade of 1990s ffable 3 and 4), it is seen that the trend
growth rate for the plan expenditures has been 39.58% as compared to non-plan in
the same period 1990-2000 where it has grown at 175.02%. Hence it can be seen
that the non-plan component is larger than the plan component. To a large extent,
this may reflect the importance of salaries in this category—and the impact of the
fifth pay commission recommendations being accepted by the union government.
Given that human resources are the backbone of health services, this in itself is
not something one can consider as a negative factor. If people are working in a
motivated manner, this may even be positive. What has to be assessed is whether a
less than 40% increase in plan expenditures is adequate to meet the long term
health goals of the state government.
At constant prices similarly it is seen that the growth over the period 199091 to 1998-99 has been smaller under plan heads when compared to the non-plan
expenditures.
Similarly for family welfare the plan component is larger. Through the years
family welfare has largely been under the plan head only. Whether this refers to the
family planning programme or something else has to be looked into. If yes, it may
be important from a long term point of view, but is it a part of health policy in the
immediate future? How is family planning linked to health in the short term? Can it
not be argued that improvements in the health situation will improve the prospects
of success in family planning? If so, are these the right priorities?
3.2 Health related sectors
Under this can be included the following heads17.
17 There is a certain judgement involved in this. Ultimately, every thing is related to
everything else—where do we draw the line? For example, should pensions be part of the
health-related sector?
9
a. Family Welfare - includes maternal and child health and family planning
b. Water Supply and Sanitation - includes outlays on provision of potable water
aXP?eS>
drainag«- and waste disposal facilities in rural and urban
ureas.
c. Nutrition - programs to supplement nutrition for children and pregnant and
nursing mothers and the Integrated Child Development Scheme
d. Social security and Welfare - dealing with the disabled welfare
and old age
pensions
Table 5 Revenue Expenditure of Health-related sectors during 1960-90
(Rs. In crores)
Year
1961-66
1966-69
1969-74
1974-79
1979- 80
1980- 85
1985-90
wss
Nutri
51.16
1.95
16.03
0.51
181.10
0.61
288.61
178.22
41.03 2184.87
SSW
15.06
12.46
40.51
19.90
7.30
80.83
425.99
435.16
Avg
growth I____________
Source : Finance Department GOK
FW
4.04
8.03
68.68
•178.78
1006.31
Under health-related sectors on the revenue side (Table 5) it is seen that in
SsV^I Q89e00aSjieen w7oCreaSe “ exPenditure fram 2% of SDP in 1960-61 to
5.8/0 in 1989-90. From 1972 onwards there is increased expenditure in health
services as well as health-related services is. In the period 1960-1974 there has
been nearly no expenditure under the heads of family welfare, WSS, nutrition
As a percent of total revenue expenditure the health-related sectors
accounted for 21% in 1960-61 and rose to 30% in 1989-90
?U,rin?^the51Ve,year plans (Table 5) it is :
plan aU heahh-relalcd seettra
received more attention,
expenditure has been poor. Family welfare largely
nutrition
a plan expenditure has also
grown in the later years. It is quite clear that WSS
FW and nutrition have received
more impetus in the latter part of 1980s, that is seventh
’
plan onwards.
When we see the growth of expenditures over the various periods it comes
out quite clearly that the major jump in expenses is seen in the seven* five
plan in all the health-related sectors.
seventn five year
'h' “““ has hovered around 6% of the tot^11011817
health expenditure
1H Dr.S.Subramanya, op.cit
10
Table 6: Capital Outlays on Health-related sectors during 1960-90
(Rs. In crores)
WSS
FW
Year
1.11
1961-66~
2.49
1966-69
3.00
1969-74
0.65
1974-79
1.32
0.00
1979- 80
0.05
1980- 85
0.55
40.63
1985-90
-92.92
Growth__________
Source : Finance Department GOK
The capital outlays however show expenditures only under water supply and
sanitation which has received attention under all the plans. There has been an
improvement in the infrastructure - laying of pipes, etc.
We next see how the capital outlays have been in the recent decade of
1990s.
Table 7 Capital Expenditure on health and health-related sectors in the
___________ (Rs in crores)
1990s (Plan)______________
Constant______
Current
SSW
WSS
FW
Defl
M&PH
SSW
WSS
M&PH FW
Year
1.10
0.00
5.51
1.88
4.9' ____ 0
0.98 88.94
1.67
1990- 91
3.40
0.00
2.60
3.25
3.07 90.25
2.93 2.35 ____ 0
1991- 92
2.58
0.00
0.39
7.16
94.33
2.43
0.37
____
0
6.75
1992- 93
0.68
0.26
0.00
9.99
0.26
~
0.68
100.00
____
0
9.99
1993- 94
1.39
0.00
0.20
10.20
106.98
1.49
____
0
10.91 0.21
1994- 95
1.00
2.70
0.00
12.04
114.80
1.15
13.82 3.10 _____0
1995- 96
1.62
1.99
0.00
6.42
2.00 123.43
7.93 2.46 _____0
1996- 97
1.67
11.98
0.00
52.58
2.16 129.62
1997- 98 68.16 15.53 _____ 0
0.92
106.84
63.47 16.26
1.28 138.46
1998- 99 87.88 22.52 147.93
2.39
159.90
39.32
79.78
19992000RE
2.34
55.38 33.45 107.89
200001BE
-90.68
275.58 -67.20
Avg
growth
Source : Finance Department GOK
Capital outlays (table 7) made under the various heads have been small.
There is nearly nothing under non-plan and all the expenditures largely remains a
plan expenditure. Surprisingly under WSS no expenditures were seen in the early
years in the documents for which no plausible explanation can be given.
11
Table 8: Revenue expenditure on health and health related sectors in 1990s
(Rs. n crores)
Health and FW
_____ Year
WSS
Nutrition
1990- 91
_________ 494.5
123.8
142.8
1991- 92
_________ 520.6
142.8
137.3
1992- 93
594.8
158.1
50.2
1993- 94
_________ 599.1
181.5
39.0
1994- 95
_________ 669.6
225.6
51.4
1995- 96
_________ 743.1
296.1
75.5
1996- 97
_________ 619.2
301.0
89.1
1997- 98
________ 709.1
359.7
87.4
1998- 99
_________ 873.6
257.6
82.5
1999- 2000RE
__________________
940.8
268.4
83.7
Source: Expenditure Pattern of the Health Sector in Karnataka, Subramanya and
P.H.Reddy, Southern Economist, 1997
The revenue expenditure on the health-related sectors is given in table 8.
The annual compound growth rates for health and family welfare is 7.4%, 8.9% for
WSS and 5.8% for nutrition. The expenditure on health and family welfare
increased from 15.8% to 16.9%, that of WSS increased from 3 to 4%. The share of
nutrition declined from 5.1% to 1.5%. •
Trend in expenditure on health related items19
Table 9: trend in expenditure on health related items
Per capita Per capita Exp.
On Exp.
On Exp.
On
exp.
On exp.
On health
health and health
health
health and related
FW as % of related
related
Year
FW
items as % state’s
items as %
services at services at of state’s revenue
ofSDP
current
current
revenue
exp.
prices Rs.
prices Rs.
exp.
1990- 91
526.1
110.5
29.1
6.1
5.6
1991- 92
548.8
114.7
28.5
6.0
5.3
562.1
1992- 93
128.9
28.1
6.4
5.4
1993- 94
583.1
127.9
28.7
6.3
5.3
1994- 95
611.9
132.3
29,1
6.3
5.4
1995- 96
666.8
134.5
29.0
5.9
5.7
1996- 97
674.7
126.6
27,4
5.1
5.6
1997- 98
730.4
143.1
29.3
5.7
5.7
1998- 99
808.5
174.1
28.1
6.0
1999863.1
185.1
28.5
6.1
2000RE
Exp.
On
health and
FW as % of
SDP
1.2
1.1
1.2
1.2
1.2
1.1
1.0
1.0
I
The per capita expenditure on health related activity in 1999-00 is Rs.863
and that on health and FW component Rs. 185. The health related activities
account for 28.5% of total revenue expenditure of the state and the health and FW
account for 6.1% of state revenue expenditure. The expenditure on health related
activities formed 5.7% of SNDP in 1997-98 and on health and family welfare was
19
Source: Expenditure Pattern of the Health Sector in Karnataka, Subramanya and
P.H.Reddy, Southern Economist, 1997.
12
1.1%. Experts have to say if this is adequate—the figures do not, cannot, speak for
themselves.
3.3 Loans
The aspect of loans, it seems is a very worrying matter because of the overall
fiscal situation in Karnataka20. From the consolidated finance accounts of the
period 1960-1993, it is seen that total revenue expenditure shows a compounded
growth of 12% in the period 1960-61 to 1970-1971 and a compounded growth of
16% in the period 1980-81 to 1990-91. The growth in the period 1970-1971 to
1990-91 at 14.77% has been higher than in the period 1960-61 to 1990-91 at
13.92%.
Social services shows a higher growth rate at 15% in the period 1960-61 to
1990-91 as compared to both general and economic services which have grown at
13%. The overall scenario of revenue and capital expenditure at the macro level has
a significant impact on what finally flows to health as a whole. During the 1990s, it
is seen that social services is proportionately higher than the economic and general
services. It has grown at 66% as against the general services which has grown at
59%. Economic services shows an increase higher than the social and general
services at 70%.
General services, which was less than social services in 1991-92, has almost
caught up with social services in 1999-2000. We are not sure what this represents.
Is it simply an increasing size of government? Is it better salaries to the same
number of government staff? Is it a less than adequate allocation to social services?
Is it growing inefficiently? This should be looked into.
Table 10: Fiscal summary of Karnataka21
99-00(BE)
95-96 96-97
97-98
98-99(RE)
Fiscal indicators _____ 90-91
16.15
16.17
15.61 ______ 15.81
16.13
15.99
Total rev and grants_____
10.23
10.34
9.79 _______ 9.79
10.01
9.93
State's own tax revenue
1.17
1.34
1.34
1.85 1.197
1.64
State's
own non-tax
_____
3^
revenue_________ ______
11.40
11.03
12.19
11.12
11.65
11.66
State's own revenue_____
4.74
4.68
3.99
4.48
4.47
4.33
Central transfers_______
17.54
17.46
15.81
16.27
15.85
16.77
Rev exp_______________
3.12
3.49
3.33
3.27
3.23
2.06
Cap. Exp and net lending
20.66
20.95
19.18
19.08
20.00
18.33
Total exp
_____
-4.51
-5.14 '
-4.01
-3.47
-3.01
-2.20
Fiscal deficit_______ __
-1.39
-1.65
-0.20
0.32
-0.78
Revenue deficit________ _ -0.14
1.22
1.06
0.53
0.58
0.55
0.60
Financing of debt _____
2.07
1.83
1.34
1.35
1.20
1.46
Internal debt_________
0.84
Q.67
0.53
0.60
0.49
0.52
Loans from the centre
-0.51
0.28
0.39
-0.21
0.64
-0.35
Small savings and PF
0.89
1.29
1.24
0.35
0.88
0.00
Others_________ ______
26.54
24.24
22.01
20.74
19.69
20.68
Off-budget financing
O/ s debt__________ ____
Source: Finance Department, GoK
30 White Paper on Karnataka State Finances. Finance Department, March 2000.
White paper, op.cit
13
I
The increase in revenues has been slower than the increase in GSDP and
therefore revenue-GSDP ratio declined from 16.2% in 1995-96 to 15.8% in 199899.
In analysing indebtedness in Karnataka, it is necessary to account for the
fact that the state has been raising funds from the market through various
corporations to finance some important infrastructure projects. These are not
included in the budget, but debt servicing and repayment of loans of these
corporations is entirely the responsibility of the state government. Important
examples of this include the Krishna Bhagya Jal Nigam Ltd. and the Karnataka
Neeravari Nigam Ltd. These are off-budget liabilities which has to be taken into
consideration.
The indicators of financial performance of the State Government have been
calculated by the CAG and presented to the House in March 1999. This is the latest
data that is available on this subject. This is because there is always a lag of two
years for every final audited statement of the financial year. We present here the
analysis and figures from the CAG report, for an over all understanding about the
severity of the strain on the state finances.
The main indicators of financial performance are:
(i)
(ii)
(iii)
(iv)
sustainability - the degree to which a government can maintain existing
programs and meet existing creditor requirements without increasing the
debt burden.
flexibility - degree to which a government can increase its financial resources
to respond to rising commitments by either expanding its revenues or
increasing its debt burden.
vulnerability - degree to which a government becomes dependent: on and
therefore vulnerable to sources of funding outside its control on influence,
L.
both domestic and international.
Transparency - timely presentation indicating the efficiency of budgetary
process and accuracy of the estimates.
14
Table 11: Financial Indicators of Government of Karnataka
Sustain ability
1994-95 1995-96 1996-97 1997-98 1998-99
Balance from current reserves (BCR)
848
1550
1060
1337
538
(rupees in crores)_________________
641
Primary deficit(PD) (rupees in crores)
409
736
1495
216
Interest ratio_______________________
0.07
0.04
0.06
0.08
0.09
Capital outlay/capital receipts_______ 0.1972
0.78
1.11
0.63
0.68
Total tax receipts/GSDP___________ _
0.12
0.13
0.13
0.13
0.12
State tax receipts/GSDP_______
0.1
0.1
0.1
0.1
0.1
Return on investment ratio__________ 0.0052 0.0028 0.0038 0.0034 0.0025
Flexibility_________________________
BCR_______________________________
848
1550
1060
1337
538
Capital repayments/capital borrowings
0.13
0.21
0.17
0.2
0.17
State tax receipts/GSDP_________ ___
0.1
0.1
0.1
0.1
0.1
Debt/GSDP______________________
0.23
0.23
0.23
0.24
0.26
Vulnerability____________________ _
Revenue deficit (RD)(rupees in crores)
297
62
579
277
1215
Fiscal deficit (FD)(rupees in crores)
1513
1457
1944
1610
3112
Primary deficit(PD) (rupees in crores)
641
409
736
216
1495
PD/FD____________________________
0.42
0.28
0.38
0.13
0.48
RD/FD____________________________
0.2
0.3
0.17
0.39
Outstanding guarantees/revenue
0.55
0.55
0.51
0.1971
0.53
receipts____________________________
Assets/liabilities____________________
1.05
1.05
1
0.99
0.93
Source : CAG Report 3, March 1999
Using the above definitions the financial indicators for GoK have been
calculated by the CAG22. The behaviour of the indices / ratios can be discussed in
brief as follows:
Sustainability:
1- Balance from current reserves (BCR) : BCR is defined as revenue receipts minus
plan assistance grants minus non-plan revenue expenditure. A positive BCR
shows that the state government has surplus from its revenues for meeting plan
expenditure. The table shows that in the last five years 1994-95 to 1998-99, the
BCR came down from Rs. 1337 crores to Rs.358 crores indicating a significant
decline in availability of funds for plan expenditure.
2. Interest ratio
interest payments - interest receipts
Total rev. receipts - interest receipts
The higher the ratio the lesser the ability of the government to service any
fresh debt and meet its revenue expenditure from its revenue receipts.
22 Report of the Comptroller and Auditor General of India for the year ended 31 March
1999, No.3 (Civil), GoK. The definitions for the various financial indicators are also given.
is
I
In case of Karnataka, the ratio has significantly increased showing clearly
that the availability of funds for program spending has decreased indicating a
strain on the sustainability.
3. Capital outlay/capital receipts: this ratio indicates to what extent the capital
receipts are applied for capital formation. A ratio of less than one would not be
sustainable in the long term inasmuch as it indicates that a part of the capital
receipt is being diverted to unproductive revenue expenditure. On the contrary,
a ratio of more than one would indicate that capital investments are being made
from revenue surplus as well. A rising trend in this means an improvement in
the fiscal performance of the state.
Here the table shows that the ratio has been less than 1 except during 199596. In 1996-99 there was steady decline in the ratio indicating that increasingly the
capital receipts were not available for investment.
4. Tax receipts/ GSDP:
Tax receipts consist of state taxes and state’s share of central taxes. Tax
receipts suggest sustainability. But the ratio of tax receipts to GSDP would have
implications for the flexibility as well. While a low ratio would imply that the
government can tax more, a high ratio points to the limits of this source of finance
but also its inflexibility.
In Karnataka, the ratio in the last five years has been constant at 0.13
throughout except during 1994-95. Similarly the ratio of state tax receipts to GSDP
has also been constant at 0.10. Inspite of more than four fold increase in RD
during 1994-95 to 1998-99, the tax GDP ratio did not change which indicated
government’s preference for relying on borrowings to meet its deficits.
5. Return on investment ratio: this is the ratio of the earnings to the capital
employed. These include the returns on govt’s investments in statutory
corporations, govt companies, joint stock companies and co-operative
institutions. A high ROI indicates sustainability. As can be seen here it is
virtually nil throughout the studied period.
Flexibility:
6. Capital repayments vs capital borrowings: now this indicates the extent to
which the capital borrowings are available for investment, after repayment of
c;apital. The lower the ratio, the higher would be the availability of capital for
investment.
Here we see that the ratio has steadily increased during 1994-95 to 1998-99
from 0.13 to 0.17 with even higher levels in between. This shows lesser amount of
funds available for investment.
7. Debt to GSDP : the GSDP is the total internal resource base of the state govt,
which can be used to service debt. An increasing ratio of debt/GSDP would
16
signify a reduction in the government’s ability
to meet its debt obligations and
therefore increasing risk for the lender.
from
deb“obHgations
g "
rati° haS
m°Ved UP *
last
°f 1116 S-emment to meet its
Vulnerability:
RD the more vulnerable is the state XTm
borrowings. The RD as a pe^Tf £
1116
borrowings of the govt are being used to finance non-productive revem^eZ
the sJate
W°rSe
016 state because that would indicate
^creasing without adding to the repayment capacity of
Dunng 199839% of the borrowings were applied to meet the revenue
expenditure
compared
20%” in 1QQ4 o=; Th;.* ■ jmed“
revenue
the financial as
posMoi
of thetosite
’ Ser
“ep
lin' ”
9
case ot Karnataka the ratio has been rather small and below 0.5 though the
ratio increased significantly during 1998-99 and would, prima facie sSXt
^creased ayailabihfy of funds, it should be seen in conjunction wi* S^Sct
grim pictu^sSe0gJXjfy^S“terZt^fSS^tO "
10 Guarantees to revenue receipts: indicates the risk exposure of the state govt
0 1971^0 100« QQPaya Here tlliS rati° has
from 0.55 in 1994-95 to
0.1971 m 1998-99, indicating a huge increase in the risk exposure of the state
revenues to the outstanding guarantees.
^3^
17
Transparency:
There has been no delay in submission of the budget and its approval.
The White Paper also gives the projection of current fiscal trends which we
present below23.
Table 12: Projection of current fiscal trends (status quo scenario) (% of GSDP)
95-96 96-97
97-98 98-99 99-00 00-01 01-02 02-03 03-04
Details
(RE)
(BE)
(proj)
(proj)
(proj)
(proj)
16.17 15.99
15.61
Rev_______________
15.81
16.15 15.88 15.99 16.12 16.24
17.11 17.81
16.19 18.34 17.68 17.86 17.05 16.81
Non-int exp_______
16.59
0.31
-0.89
-0.42
Rev surplus/RD
-1.98
-1.85
-1.78
-1.99
-2.16
-2.32
-0.94
-1.83
Primary
-1.13
-2.53
-1.53
-0.34
-1.99
-0.69
-1.05
surplus/PD_______
2.07
2.18
2.34
Int.payts__________
2.61
2.98
3.79
3.70
3.39
3.56
-3.01
-4.01
Gross fiscal!
-3.47
-5.14
-4.51
-4.14
-5.38
-4.61 | -4.39
surplus/ deficit
_I
19.69 20.68
Debt stock of GOK
22.01 24.24 26.54 29.06 : 30.65 : 31.85 I 32.68
58.5
60.9
77.3
78.2 i 78.2
63.6
Committed
70.1
74.7
79.6
.1
I
exp/Rev (%)_______
42.9
51.0 ' 49.8
44.7
45.6
(salaries+pension) /
50.1
52.6
48.5
52.4
!
rev(%)_____________
15.7
Debt service/rev
16.3
18.0
20.1
22.1
31.0
24.9
27.2 ! 28.4
Ii
(%)________________
__________________
Source: White Paper on Karnataka State Finances, March 2000
It is quite clear that the state government finances are in the red and need
urgent redressal. It has come to our understanding that the specific loan
apportioning towards health is given in the form of schemes. The specific details
about this may be available with the Secretary (Expenditure) who is also in-charge
of the Project Management Unit in the Finance Ministry. However this is a huge
task that has not been attempted here. But it needs to be undertaken.
However it would be more pertinent at this point for us to look at the various
loan components that the state receives. Most of the loans come under three welldefined schemes: central schemes, centrally sponsored and the state-sponsored
schemes.
23 White Paper, opcit. pp. 14-4.14
18
04-05
(proj)
16.37
16.39
-1.54
-0.01
3.85
-3.86
33.15
79.1
47.4
31.7
Table 13: Centrally sponsored schemes (revenue a/c) - current prices
FW
Year
M&PH
WSS
SSW
Nutrition
Total
1990- 91
379.30 3050.45
2068.87
111.19
6263.12
1991392.92 1909.97
2274.19
144.25
0.94
5165.04
1992
621.59 4143.76
1992- 93
2250.82
24.79
19.01
7348.87
1993- 94
609.42 5317.39
3465.23
26.44
3.42
9640.96
1994- 95
879.82 2769.22
4579.24
19,62
8599.43
1995- 96
793.07 2323.21
6408.71
90.99
9925.06
899.34 1052.60
1996- 97
6579,28
23.84
9010,74
983.97 2134.53 10273.67
1997- 98
35.10
14044.98
1998- 99
1017.85 1999.45 11541.58
24.80
15019.15
A/C
19991535.21 8346.08 11397.08
40.00
23064.98
2000 -RE
2000- 01864.26 9577.24 12494.60
45.00
23755.66
BE_______
Source : Finance Department , GOK
Table 14: Centrally sponsored schemes
(revenue a/c(Rs. In Lakhs) - constant prices
M&PH FW
WSS
SSW
Nutrition [Total
1990- 91
88.94 426.47 3429.78 2326.14 125.02
7041.96
199190.25 435.37 2116.31 2519.88 159.83
1.04
5723.04
1992
1992- 93
94.33 658.95 4392.83 2386.11
26.28
20.15
7790.60
1993- 94
100.00 609.42 5317,39 3465.23
26.44|
3.42
9640,96
1994- 95
106.98 822.42 2588.54 4280.46
18.34
8038,35
1995- 96
114.80 690.83 2023.19 5582,50
79.26
8645.52
____ 70
1996- 97
123.43 728.62 852.79 5330,37
19.31
7300.28
1997- 98
129.62 759.12 1646.76 7925.99
27.08
10835,50
1998- 99
138.46 735.12 1444.06 8335.68
17.91
10847.28
Under the centrally sponsored loans - revenue account (table 13 & 14) we
see that the total moneys have increased over the period 1990-91 to 2000-01 under
M&PH and WSS. There is however nothing allocated towards nutrition under the
head social security and welfare. Family welfare also shows a gradual decrease in
the same period. As far as family welfare is concerned it is largely under the plan
head. Health per se is still a small portion.
19
Table 15: Centrally sponsored schemes (capital a/c)
(Rs. in Lakhs)
Current
Constant
FW
M&PH
TOTAL Defl
M&PH
FW
TOTAL
1990- 91
1430.80 456.89
2059.95 88,94 1608.72 513.1971 2316.11
239.39 214.68
1991817.35 90.25 265.25
905.65
237.87
1992
14.89
1992- 93
656.53
1245.1970 94.33 695,99
15.79 1320.58
1993- 94
981.09
0.02
1887,55 100.00 981.09
0.02 1887.55
1994- 95
1021.21 ____ 0
2071,08 106.98 954.58
0.00 1935.95
1995- 96
1295.22 ____ 0
2187.29 114.80 1128.24
0.00 1905.30
1996- 97
741,47
20.51
1641.35 123.43 600.72
16.62 1329.78
1997- 98 6765.78 141,07
7786.66 129.62 5219.70
108.83 6007.30
8739.24 215.41
1998- 99
34523.1972 138.46 6311.74
155.58 24934.07
avg
-56.41
-96.64
19.62
growth
Under the centrally sponsored schemes - capital account (table 15) we see
that the figures are fluctuating in the period 1990-91 to 2000-01. A large increase
is seen in 1997-98 and 1998-99 under M&PH.
Table 16: State sponsored schemes (revenuea/c) - current prices
Medical &
Family
Water
Public
Year
Welfare
Supply
Health
& Sanitation
1990- 91
3663.64
466.17
2983.26
1991- 92
3433.61
3128.23
4145.16
1992- 93
4562.42
1353.96
5751.76
1993- 94
5585.83
624.35
7232.65
1994- 95
7766.58
673.75
11733.19
1995- 96
11072.93
661.21
13924.69
1996- 97
13445.54
379.02
17277.52
1997- 98
14669.23
521.78
19978.18
1998- 99
13689.27
499.55
15118.31
1999-2000 -RE
14348.56
489.11
13904.32
2000-01-BE
16812.30
922.81
14669.66
Source : Finance Department, GOK
20
(Rs. in Lakhs)
Social
Security
Nutrition
& Welfare
1297.04
733.34
1620.30
840.18
1842.24
890.39
884.43'
1796.39
1875.89 1566.30
2699.10 2932.63'
4395.12 3535.42'
3967.98 3431.69'
3337,41 3290.68'
4050.96 3392.51'
5340.65 3634.84'
Total
16587.41
22028.22
27333.37
34160.60
44290.85
63113.59
75518.57
73100.18
69813.76
70183.70
83853.39
Table 17: State sponsored schemes (revenue a/c) - constant prices
_____ (Rs. in Lakhs)
Deflator Medical & Family
Water
Social
Year
Public Welfare
Supply
Security Nutritio
Health
&
& Welfare
n
Sanitation.
1990- 91
88.94 4119.23 524.14
3354.24
1458.33 824.53
1991- 92
90.25 3804.55,3466.18
4592.98
1795.35 930,95
1992- 93
94,33 4836.66 1435.34
6097.49
1952.97 943.91
1993- 94
100.00 5585.83 624.35
7232.65
1796.39 884.43
1994- 95
106.98 7259.84 629.79 10967.65
1753.50 1464.11
1995- 96
114,80 9645.41 575.97 12129.52
2351.13 2554.56
1996- 97
123.43 10893.25 307.07 13997.83
3560.82 2864.31
1997- 98
129.62 11317.10 402.55 15412.88
3061.24 2647,50
1998- 99
138.46 9886.80 360,79 10918,90
2410.38 2376.63
Avg
-73.33 -92.35
-63.83
-81.64 -67.97
growth
Total
18650.11
24408.00
28976.33
34160.60
41401.06
54976.99
61183.32
56395.76
50421.61
-69.96
Under the state sponsored schemes - revenue account (table 16 &17) we
once again see that the moneys expended are rising. However here M&PH shows a
comparable nse with WSS. Family welfare has a smaller share as compared to
under the centrally sponsored schemes. Nutrition has also an increasing share over
the years.
Table 18: State sponsored schemes (capital a/c)
______________ Current
Constant
Year M&PH FW
WSS
Total
Defl M&PH FW
WSS
Total
1990- 91 1430.8
1991- 92 239.39
1992- 93 656.53
1993- 94 981.09
1994- 95 1021.21
1995- 96 1295.22
1996- 97 741.47
1997- 98 6765.78
1998- 99 8739.24
A/C
19997950
2000RE
20005538
01-BE
456.89 _______ 0 2059.95
214.68 _______ 0
817.35
14.89
0.32
1245.7
0.02 _______ 0 1887.55
_____ 0 ________ 0 2071.08
_____ 0 _______ 0 2187.29
20.51 _______ 0 1641.35
141.07 _______ 0 7786.66
215.41 14792.79 34523.72
300
15990 24840.98
245
10789
88.94 1608.72 513.71
0.00 2316.11
90.25 265.25 237.87
0.00
905.65
94.33 695.99 15.79
0.34 1320.58
100.00 981.09
0.02
0.00 1887.55
106.98 954.58
0.00
0.00 1935.95
114.80 1128.24
0.00
0.00 1905.30
123.43 600.72 16.62
0.00 1329.78
129.62 5219.70 108.83
0.00 6007.30
138.46 6311.74 155.58 10683.80 24934.07
16876
avg
growth
-56.41 -96.64
19.62
Capital account figures for state sponsored schemes (table 18) again shows a
large nse in M&PH while smaller or negligible rises in FW and WSS
WSS.
VH
) *
21
HC'ioo
U9579
Table 19: State sponsored schemes (loan a/c)
Current
Constant
Total
WSS
Defl
WSS
Total
1990- 91 1361.05 1361,05 88.94 1530.301 1530.301
6847 90.25' 7586.704 7586.704
1991- 92
6847
1992- 93 3696.02 3696.02 94,33' 3918.181 3918.181
3406 100.00'
1993- 94
3376
3376
3406
3318 106.98' 3073.472 3101.514
1994- 95
3288
1995- 96
4682 114.80' 3878.049 4078.397
4452
1996- 97
5907 123.43 4777,607 4785,708
5897
1997- 98 1682.96 1682.96 129.62' 1298.38 1298.38
1998- 99 7843.86 7843.86 138.46' 5665.073 5665.073
avg
-58.87
-58.87
growth
Source : Finance Department, GOK
The loans under state sponsored schemes (table 19) shows that the loans
were allotted only towards WSS.
Table 20: Central plan schemes (Rs. In’Crores
Current
Constant
WSS|M&PH Deflator WSS M&PH,FW
FW
1990- 91
2 1.49
88.94 2.25
1.68
1.3
1991- 92
3
90.25 3.32
1.44
3 1.26
1992- 93
94.33 3.18
1.34
1993- 94
3 0.82
100.00 3.00
0.82
5 43.61
1994- 95
106.98 4.67
40.76
1995-96
0 58.71
114.80 0.00
51.14
1996^97
0 61.65
123.43 0.00
49.95
1997- 98
0 81.22
129,62 0.00
62.66
0 60.75
1998- 99
138.46 0.00
43.88
avg
191.00
growth
The central plan (table 20) also shows a similar feature with small increase
over the period till 1994-95 under M&PH head, and then shooting up in the last
five years from 1995-96 to 2000-01. WSS has had no moneys expended under this
scheme in the last five years while it is more or less fluctuating and in smaller
measures for SSW.
4. District Allocations for Health
In this section, we look at the allocations made for health at the district level
from the data provided in the link documents. We repeat, these are allocations—
expenditures may be different2', and the data for that has to be collected from each
district.
24 A Indira, A Study of zilla panchayat budgets in two districts—Dharwad and Bangalore
[rural], CBPS, March 2000 for details of the differences.
22
We first present an analysis of allocation as given in the link documents.
These are at current prices unadjusted for inflation. Then we provide the same
data for constant prices, after deflating the numbers using the national income
implicit deflator for 1993-94. This may be challenged—it is the best we could get,
and are open to other methods of deriving constant prices. This then may be
treated as a first cut estimate.
It would be useful to get these estimates on a per capita basis. We have
population figures at the district level for 1991—a census year. We also have
estimates made by a demographer for the year 199525. Por these two years, we
provide per capita allocation estimates.
Table 21: Proportion of district health allocation to total district allocation (%)
Diatricts
1992-93 |1993-94 11994-95 1995-96 1996-97
-------------1997-98
Bangalore(Urban)
3.65
3.96
3.65
3.65
3.41
2.51
5.77
Bangalore(Rural)
6.37
5,01
5.30
4.71
3.64
Chitradurga____
5.20
5.19
3.89
4.51
3.89
2.51
Kolar
3.59
4.06
2.76
2.94
2.77
1.75
Shimoga________
3.15
4,69
4.11
3.50
2.74
2.04
Tumkur
4.80
4.63
2.98
2.73
2.62
3.33
Mysore
4.15
4.98
4,39
3.68
3.31
3.18
Chikamagalur
4.81
6.06
4,89
4.27
3.83
3.90
DK_____________
4.39
4.86
3.82
4.01
3.47
3.56
Hassan_______
5.85
6.98
6.04
5.95
4.28
2.41
Kodagu
6.32
6.51
6.26
5.34
5.15
4.36
Mandya
5.78
6.43
5.40
4.75
4.49
4.11
Belgaum________
6.03
5.40
4.94
3.68
3.65
2.93
Bijapur_________
4.52
5.14
4.28
4.42
4.42
2.22
Dharwad
5.23
6.19
4.29
3.78
3.86
2.53
UK
6.19
6.14
6.05
4.44
4.05
2.63
Gulbarga
4.31
5.92
3.90
4.74
3.87
2.45
Bellary__________
6.91
6.69
5.30
3.83
3.18
2.24
Bidar___________
4.64
5.47
4,34
4.45
4.45
3.51
[Raichur
2.32
4.08
3.12
2.58
2.52
1.65
The proportion of medical and public health allocation to the total district
outlays are calculated at current prices. It is interesting to note that over the period
1992-93 to 1997-98 there is a consistent drop across ah districts in the state,
There seems to have been a slight improvement in 1993-94 but then again there
has been a drop after that.
The worst affected it seems is Raichur which had a share of 2.32 in 1992-93
notja veiprbig sum down to 1.65 in 1997-98. Similarly Kolar also shows a fall from
3.59 in 1992-93 to 1.75 in i1997-98. Interestingly the Hassan, constituency of a
former Prime Minister shows- a very rapid decline from 5.85 to 2.41. The biggest
25 We are indebted to Ramesh Kanbargi of the Centre for Social Development in Bangalore
for providing us with this data.
23
slide seems to be in Belgaum from 6.03 to 2.93. These are also districts with a low
Human Development Index26.
We can next look at the per capita figures for two time points, namely 1991
and 1995 for the districts for the total health allocation. This has been calculated
for health allocations at constant prices which have been deflated against the
national implicit deflators.
Table 22: Per Capita allocations
(in Rs.)
Districts
Per capita 1991 Per capita 1995
Bangalore(Urban) 0
_ .94
1.67
Bangalore( Rural)
_8,62
12.82
Chitradurga____
__________ 7.57
9.97
Kolar________ _
6.15
7.62
Shimoga________ _5.22
7.87
TumkuT
7.24
6.65
Mysore_________
6.05
6.67
Chikamagalur
1
_0.68
13.08
DK
5
_.61
6.60
Hassan_________ 9
_ .06
12.79
Kodagu_________ _10.27
19.14
Mandya________
7
_ .88
9.71
Belgaum________ 7
_ .47
6.62
Bijapur_________ _8.58
9.09
Dharwad
_5.50
6.97
UK
1
_ 1.12
11.35
Gulbarga_______
_7,50
10.49
Bellary_________
_8.35
9,10
Bidar___________ _8.45
10.85
Raichur
3.55
5.35
Except for a few districts like Kodagu, Chitradurga, Gulbarga, and a few
others the per capita allocations have not actually gone up veiy much in all
districts. Also the rise is not proportionate over the districts.
In the next three tables we have the allocations towards rural health
services, public health services and the Indian systems of medicine in the districts.
Rural Health Services
The mean allocation for rural health services to the districts.under the plan
head has increased from 12.95 lakhs in 1987-88 to 73.87 lakhs in 1997-98. Both
are at current prices. There has been a steady increase over the intervening period
also.
26 Government of Karnataka, Planning Department, Human Development in Karnataka,
1999.
24
The highest allocation has been in the district of Chitradurga at 60 13 lakhs
over the penod and the lowest to Bangalore urban district at 22.54 lakhs
d<?triC,S
58
P1M'
» 19S7-8S was
0—at.ons
The growth of allocations towards
forva^g in the study period. Not all districts show ^ZTcr^Torls^
patt:Sea"SXTth^PrXgn<!I“D;
allocation compared to others shows a steadv^W
aver ae period. Mysore on the 0^ hana shows ^tuS,,"
25
’
having lower
Table - 23 district allocation towards Rural Health Services (Cunent Prices )
Districts
Bangalore(Urban)
Bangalore(Rural)
Chitradurga_____
Kolar_________
imoga_________
Tumkur________
Mysore________
Chikamagalur
DK __________
Hassan_______ _
Kodagu________
Ma nd ya________
Belgaum_______
Bijapur________
Dharwad_______
UK___________
Gulbarga______
Bellary________
Bidar_________
Richer
Mean_______
Stdev
Co-Eff ofVar.
(Rs. In Lakhs)
1994-95 1995-96 1996-97 1997-98
1987-88 1988-89 1989-90 1990-91 1991’92 1992-93 1993-94
8.00
12.64
20.18
28.75
17.13
19.67
22.92
10.75
25.48
10.28
11.00
6.20
21.74
15.01
14.52
21.48
19.69
24.15
11.69
13.22
7.16
5.18
46.65
45.07
20.39
25.16
36.95
22.10
30.90
14.74
28.82
11.71
16.26
28.15
9.62
26.55
35.75
29.60
23.49
14.22
11.65
48.10'
47.41
67.40
29.00
22.60
54.31
22.78
44.05
60.51
22.79
31.00
35.88
42.90
35.36
32.82
30.40
40.80
19.80
11.40
19.97
66.55
63.10
64.90
32.00
53.70
54.39
32.77
45.40
69.27
27.50
66.50
65.80
42.30
54.51
40.78
63.50
71.20
35.80
22.75
27.00
75.50'
88.25'
75.25
72.00
69.50
82.50
50.00
56.50
88.50
26.50
73.00
73.50
86.00
78.00
50.50
90.00
102.50
50.50
67.50
30.60
70.75^
82.20
89.75'
92.00'
16.97
25.37
7.43
18.46
7.17
13.32
9.06
12.23
10.95
16.06
9.72
12.18
6.56
7.20
13.79
16.40
19.85
14.03
15.69
15.92
9.15
17.87
9.17
6.70
5.13
13.03
8.73
13.68
17.82
18.94
17.53
14.04
4.32
12.95
5.80
44.76
12.95
4.80
37.10
16.73
6.29
37.59
23.92
11.80
49.31
35.55
15.28
42.98
49.63
16.83
33.91
69.15
20.22
29.24
67.04
20.94
31.23
6.90
8.69
10.33
15.57
11.35
12.84
27.82
26
54.75
79.70
56.00
45.25
83.50
27.50
79.00
80.80
80.99
82.38
46.10
47.00
99.50
56.60
56.50
38.80
73.00'
98.60'
92.75'
90.00'
54.80'
74.98
55.50
60.00
84.70
26.50
78.25
62.00
76.00
83.81
46.85
63.20
79.65
58.28
62 ?0?
67.98
18.56
27 ja
50.17
40.50
50.00' 71.68'
98.80’ 89.50'
89.00' 68.36'
70.50' 75.20
53.70' 89.57
36.62' “80.30
75.13
61.00
94.00
58.00
77.09
88.10
37.30
36.50
89.05 101.00
60.40
67.29
75.28
94.20
105.57 118.57
31.89
35.10
82.50
91.00
62.50
76.80
77.4?
66.91
59.40
69.85
68.92
22.28
32.32
73.87
20.51
27.76
mean
22.54
45.08
60.13'
59.70
47.60
42.91
51.49
37.47
45.71
53.94
24.51
49.82
46.37
50.78
55.30
32.80
50.73
55.81
38.8?
35.25
Stdev
15.77
29.18
33.85
28.22
32.17
25.12
24.96
22.82
21.50
35.50
9.44
37.63
26.47
32.72
40.41
12.75
28.84
32.99
24.04
27.24
co-var
69.98
64.72'
56.29
47.28'
67.59
58.55
48.47
60.91
47.04
65.83
38.52
75.53
57.08
64.44
73.07
38.88
56.86
59.11
61.971
77.28
growth
-33.90
-25.01
-21.24
-60.09
-39.77
-36.58
-73.76
-59.75
-66.32
-5.68
-81.63
28.06
-58.78
-24.46
-11.86
-73.52
-53.30
-41.551
-42.17
-17.68
Public Health Services
88 to
smaller than the previous years where the allocations were larger.
The standard deviation was 15.97 in 1987-88 and 50.12 in 1997-98.
The coefficient of variation also shows a variation among the years from
33.18 in 1987-88 to 43.77 in 1998-98
^mong me years irom
W,>Uld n”d to study
a bit ■»“' *»
if sf how
C“ “ b'
expenditures are being made
under different heads and not necessarily going towards PHS?
27 A.Indira, et.al. op.cit
CBPS has been working on a study - whether a District Planning Committee can
work. This work is located in Kodagu.
27
Table 24 District allocation towards public health services (Current Prices)
(Rs. In lakhs)
Districts
Bangalore(Urban)
Bangalore(Rural)
Chitradurga
Kolar__________
Shimoga_______
Tumkur________
Mysore________
Chikamagalur
DK___________
Hassan________
Kodagu________
Mandya________
Belgaum_______
Bijapur________
Dharwad_______
UK___________
Gulbarga_______
Bellary________
Bidar__________
Raicbur
Mean_______
Stdev______
Co-Eff ofVar.
1987-88 1988-89 1989-90 1990-91 1991-92 1992-93 1993-94 1994-95 1995-96 1996-97 1997-98 mean
51.10
55.48
66.45
65.19
69.08
50.78
36.11
23.44
18.90
76.10
51.81
51.35
76.15
64.30
89.55
42.00
54.24
62.40
21.55
72.13
76.42
74.35
83.01
75.00
119.03
55.31
55.25
37.50
62.49
79.88
71.13
76.60
70.03
99.91
65.39
49.49
30.06
48.15
15.97
33.18
62,82
23.33
37.13
59.77
18.68
31.25
12.50
45.31
36.83
59.57
56.22
49.73
67.55
47.27
46.46
53.99
17.74
52.20
20.00
72.45
65.20
51.20
71.70
61,88
62.38
41.60
54.79
55.35
27.92
100.00
80.05
103.11
91.35
69.47
48.03
40.5C
60.00
107.00 145.00
131.44 148.00
87.75 122.00
67.00 109.00
157.40 157.25
135.60 191.35
76.85 120.00
108.73 150.25
92.25 139.50
22.50 50.00 72.50
87.00 124.25
86.00
205.72 213.73 222.50
183.89 162.70 185.85
138.61 187.85 254.10
89.66 105.89 116.55
144.40 125.10 223.50
101.56 140.56 144.30
77.98 100.70
75.97
63.60 115.40
62.68
59.50
131.00
149.00
92.00
87.00
132.10
204.28
113.00
141.85
130.05
77.50
115.45
22320
200.65
229.22
137.05
228.50
160.66
96.27
104.35
68.70
188.00
175.20
114 00
93.19
133.85
189.40
104.50
156 00
161.22
83.00
117.00
231.00
256.70
218.10
121.00
278.50
140.35
115.14
97.40
39.42
72.00
220.00' 159.20
175.20 113.50
117.50
76.20
66.95
94.50
146.30 189.48
228.38 204.60
102.50 115.47
163.50 160.50
67.20
124.90
68.20
82.50
117.95 108.11
240.71 213.39
260.30 128.10
219.93 129.19
132.90
83.92
224.50 136.20
87.55
123.20
120.09' 77.71
90.15' 65.29
81.43
23.55
28.92
96.13
46.60
48.48
145.10
49.80
34.32
140.63
51.96
36.95
152.11
59.28
38.97
152.85
59.26
38.77
28.75
87.51
82.47
94.99
92.51
96.23
98.57
71.59
76.82
75.08
31.72
78.25
124.06
97.97
28
29.56
82.00
101.47
55.60
61.00
128.00
118.44
75.31
92.47
67.80
110.96
45.90
41.37
114.51
50.12
43.77
Stdev
40.89
119.42
111.83
83.83
79.57
119.68
144.55
82.74
109.60
93.61
21.11
54.16
48.46
26.96
16.67
45.49
60.82
30.11
46.65
38.34
50.47
26.77
92.80
171.06
152.47
154.82
97.93
159.26
105.56"
79.47’
24.98
72.45
72.60
69.09
25.80
67.63
38.68
26.72
co-var
51,62
45.36
43.33
32.16
20.95
38.01
42.07
36.39
42.57
40.96
53.04
26.92
42.35
47.62
44.63
26.34
42.47
36.65
33.62
Indian Systems of Medicine
Of all the allocations, this head seems to receive the lowest share. The
mean allocation over all the districts in 1987-88 was 0.65 lakhs which has
limped upto 13.35 lakhs in 1997-98. The standard deviation in 1987-88 was
0.66 and 5.49 in 1997-98. The coefficient of variation shows a great fall over
the years from 101.20 in 1987-88 to 41.14 in 1997-98.
29
Table 25: District allocation towards Indian System of Medicine
Districts
(Current Prices)
(Rs In Lakhs)
1995-96 1996-97 1997-98
1987-88 1988-89 1989-90 1990-91 1991-92 1992-93 1993-94 1994-95
Bangalore(Urban)
Bangalore(Rural)
Chitradurga
Kolar__________
Shimoga_______
Tumkur________
Mysore_________
Chikamagalur
DK___________
Hassan_______ _
Kodagu________
Mandya________
Belgaum_______
Bijapur________
Dharwad_______
UK___________
Gulbarga______
Bellary________
Bidar__________
Richer
0.40
2.81
1.12
0.86
0.63
0.62
1.80
0.32
0.00
0.03
0.25
0.00
0.57
0.56
0.46
0.20
0.70
0.30
0.65
0.70
0.90
8.64
2.68
1.00
0.83
1.42
3.32
0.35
1.85
0.05
0.85
0.00
1.85
0.61
0.55
1.45
2.48
0.85
1.60
1.72
0.90
8.64
2.68
1.00
0.83
1.42
3.82
0.35
1.35
0.05
0.85
0.00
1.85
0.61
0.55
1.45
2.48
0.85
1.60
1.72
1.41
2.18
3.50
1.67
0.94
4.60
7.24
4.10
2.70
2.00
3.00
1.00
2.13
0.00
0.32
1.50
2.70
1.09
6.20
1.72
1.55
2.18
5.91
3.00
4.50
4.00
7.69
8.40
3.80
3.30
3.08
2.00
6.14
1.00
3.36
1.67
13.75
5.00
8.05
7.40
8.50
10.25
7.60
4.50
5.00
6.70
9.82
9.00
6.00
10.63
5.00
5.50
17.00
14.50
12.00
6 50
26.00
10.50
10.00
8.00
12.00
11.50
18.75
8.25
10.00
&.50
11.00
11.00
7.00
15.00
5.00
7.00
17.00
14.50
19.00
6.50
26.00
16.50
10.00
11.50
11.10
13.75
16.00
8.25
12.00
9.60
10.00
13.50
10.00
17.00
5.00
15.00
17.00
9.75
27.88
8.00
25.00
15.00
11.67
11.50
12.20
21.00
22.30
9.75
14.00
12.50
10.00
13.50
13.00
14.00
6.50
14.50
22.00
19.00
34.19
9.50
30.20
15.00
11.76
12.50
12.50
23.00
22.50
9.50
12.50
15.00
10.00
18.50
13.50
14.00
7.00
17.00
23.00
26.50
35.00
8.00
33.00
17.50
12.00
13.00
8.17
6.68
12.00
6.36
15.75
20.81
16.90
21.11
15.00
11.00
10.10
12.50
19.00
8.58
34.57
9.76
37.60
17.00
15.00
13.60
Mean_______
Stdev
Co-Eff ofVar.
0.65
0.66
101.20
1.65
1.86
112.77
1.65
2.50
~L87
4.79
3.11
64.90
9.65
5.03
52.10
12.35
5.17
41.90
13.35
5.49
41.14
15.87
7.01
44.15
17.15
7.84
45.71
15.57
8.27
53.09
1.89
114.44
74.61
30
mean
6.33
10.06
10.46
4.92
7.00
7.83
8.33
9.10
6.75
7.91
4.24
6.77
11.69
8.69
15.26
4.96
18.17
9.05
8.05
7.58
stdev
5.26
2^04
8.20
3.61
5.95
6.39
4.25
7.28
5.36
6.83
3.01
6.78
9.01
9.07
co-var
83.10
69^96
78.42
73.31
84.96
81.56!
611.07!
80.03^
85.68
-78.39
'-2^60
-32.77
127.27
205.13
-14.65
499.72
79.52
86.24
71.00
100.16
3233.33
267.27
77.70
104.40'
99.83^
15.24
“
74.66
3.70
77.1£
14.03
82.2CT
7.44
4.90
5.21
growth
60.84
68.71
203.03
39.29'
583.20
343.64
388.31
415.15
10979
’ 76.62
5. By Way of A Conclusion
Stin“
GoK set up ’^^^for^^o^Health^arMi^Mnn^WetfM-e^^e^ere^a^ttred1'!^!
the data required would be made available.
m aH,Nn°nC
not be
Yet. few were in a position
documents of the state government are not available on the website [in any
detml] nor m any book shops. Even when they are supposed to be priced
pubhcations-end few> are-lt ls difficult to get them. The largest percentage
of our time in tins study was in chasing the chimera called data.
k?ne -aSOnfWe 'ioIuId not §et data was probably because it was not
fn^^fTh frUnd hard tO beHeVe m 1116 honing- But after a meeting
m the office of the Commissioner for Health and Family Welfare, we had no
nnt pn?
aCCCP &1S
reality- Much °fthe re^red data simply does
TLvJL
allied sectors of health—waster supply etc. This increase in health related
fhX>/
fPlaCe m the C°nteXt °f a re^atively stable level of
expenditure of 6/o of total expenditure on medical and public health. Is such
stabffity adequate given the requirements of the population for health
XTlZel
of finances alone cannot answer this question. To see if
d^ nit hLve CXPen
13 adeqUate* One needs 311 acceptable norm. This We
p^p.
resolutions to incur the expenditure. The priorities are not set by them and
the power to approve does not vest with them. They pass resolutions to
justify what the state government departments have decided to do. It is thus
not possible to make any statements about their relative efficiency or
efficiency
effectiveness in the absence of actual experience of devolution of fiscal
responsibilities. Bu a system that keeps them out of health care is likely to
be a sys em that will fail-and the existing top down one has failed. Why not
try a truly decentralised system?
y
31
U9579
j jq
Table 26: proportion of district outlays to state receipts
(in % terms)
Details
_______
1992-93
1993-94 1994-95 1995-96 1996-97 1997-98
Proportion of district outlays
12.36
12.54
13.92
12.88
12.85
12.65
to total revenue receipts of the
State___________________ ___
Proportion of district outlays
11.98
12.78
13.35
12.97
11.93
12.53
to total revenue expenditure of
the State___________________
Proportion of district outlays
9.08
8.27
9.32
10.38
10.81
9.33
to total receipts (capital and
revenue) of the State
Proportion of district health
35.78
39.71
34.04
26.87
21.50
17.21
allocations to total health
expenditure in the state
Source: compiledfrom Finance Accounts, GoK
We have calculated the proportions at constant prices for the district
outlays as given in the Link documents for the last six years. From the
second data set, giving data for the decade of 1990s, the revenue receipts,
revenue expenditures and total receipts of the state was taken
It is seen from the above table that the proportion
[
of total district
outlays to the total revenue receipts of the state iis hovering around 12.3 to
13%, with no substantial rise over the years.
Similarly, the proportion of total district outlays to the total revenue
expenditures of the state also shows a figure of around 11 to 12%. As a
proportion of district outlays to total receipts of the state shows a lower
figure of around 9% over the years.
The more worrying figure comes with the proportions of district health
allocations to the total health expenditures made at the state level. It is seen
that a share of nearly 35% in 1992-93 has steadily fallen over the years to a
low of 17% in 1997-98. These were the years in which decentralisation was
supposed to be gaining momentum in the country. Where health is
concerned in Karnataka, these figures suggest that decentralisation was
being rolled back, if these numbers are any indication.
Considering that health as a proportion in total social services sector
has only about 1.5% share, as seen earlier, the above figures are to be taken
seriously to understand how much of the money is really flowing down to the
districts for the improvement of the health sector.
Loans have been an increasing part of the financing of all programmes
in the state, not just health. The loan burden is increasing, but it has not
been possible to calculate the health sector’s exact share in this loan
burden.
The finance data also suggest that the state, in financial terms, is
becoming increasingly more susceptible to financial stress. The CAG data we
have cited shows this clearly.
32
ch of this is tentw^ depth studies of the integrity of the
<ocess-for exampfetwhat extent do allocations differ from
inc:
’ at what level «#what processes are decisions made and
on,
.re essential for a HF understanding of health—and other
elop.-ental—finances”
• ust b^ea^Ss\ a atC m*
PartS °f our Population-not
"“Presentari^
d eC0M-L?U
peOple themselves. People’s
ho now
DerSPeClaIly
1116 depressed classes and women,
be an
-4S-
i
nJ.’
" “5jS'eSXe"0"' “S ” ”
^^‘spraHdin this monograph—tentative though it
sud»*^on- 14 is when questions are asked,
? d^3nd answersarfwlutions, that such analysis can begin to
Tfrn™ ° Pollcy- TiH »Jt wifi remain in solitary and splendid
from/eahty. What wc®claim then, is to have made '
a beginning,
G°rdian kl«t'tee such debate is concerned. We look
to wnere this will take ux
9
I
.i
J
■i
B
33
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