3 min read.Updated: 25 Jan 2018, 08:54 AM ISTDipti Jain
The utilization and management of funds allocated for healthcare leave much to be desired
Bengaluru: The growing reports of child deaths from different parts of the country since last summer’s Gorakhpur tragedy have finally put the spotlight on India’s growing healthcare crisis. Poor funding is one big reason behind the crisis but poor management of health funds is equally to blame, a Mint analysis shows.
The growing recognition of India’s healthcare crisis has led to growing calls for increased public funding of healthcare. But Budget 2018 may not see much of an increase, according to a Reuters report.
One reason why the finance ministry may not have been impressed with the health ministry’s demands for more funds is because a good chunk of health funds remain unutilized.
As with everything else, there is wide variation in utilization rates across the country. Among states, some with the poorest health outcomes, such as Bihar and Uttar Pradesh, were among those with the highest share of unspent funds allocated under the National Health Mission (NHM) in 2016-17.
Even where funds are channelled, quality of care remains poor. As a previous Plainfacts column pointed out, 47% of the people who visit a public hospital do so because they have no choice. And while private clinics are more popular, doctors in such clinics are often inadequately qualified.
Yet, public sector doctors are often unavailable or offer poor quality care, data from the latest round of the National Family Health Survey (NFHS) conducted in 2015-16 shows. Fifty-five percent of households reported not using government health facilities when sick, and 48.1% of such households cited poor quality of care as one reason for avoiding public health facilities. There seems to be a broad correlation between quality of care and usage, the data shows.
A key reason for the poor quality of public healthcare services in India is the lack of adequate data and monitoring. The NFHS report itself comes after a gap of a decade. And the health ministry’s real-time health management information system (HMIS) suffers from poor quality and data gaps. A 2017 Comptroller and Auditor General (CAG) report showed that 18% of health facilities did not even report basic infrastructure data in the HMIS portal in 2015-16. The CAG also found wide-ranging discrepancies between what the HMIS system reported and the physical records. For instance, the number of infant deaths recorded by the HMIS in Jharkhand was substantially lower than the number in the physical records.
Little wonder then that India remains highly vulnerable to infectious diseases even as it under-reports several major infectious diseases. The World Malaria Report 2017 shows India has among the weakest malaria surveillance system with only 8% cases detected, lower than countries such as Zimbabwe, Nigeria, Pakistan, Indonesia, etc. India’s reporting of tuberculosis cases is no better.
Clearly, more funds for the health sector need to be complemented with institutional reforms to ensure greater transparency and accountability. It is likely that more accurate and timely data on diseases and health services will spur governments at all levels to take healthcare more seriously than they do today.
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