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Rs 10,290 Cr Boost For Health Hides Funding Cuts For Key Programmes



health budget

Despite a Rs 10,290-crore increase in health funding for 2017-18, an investigation of the central government’s health budget reveals that most of this money is not being spent on India’s health priorities, which, instead, now face funding cuts.

Elimination of tropical diseases (kala azar, filariasis and leprosy) over the next two years; elimination of a vaccine-preventable disease (measles) by 2020. Elimination of tuberculosis (TB) by 2025; and “significant reduction” of infant and maternal mortality by 2020: These were some key proclamations related to health made by Union Finance Minister Arun Jaitley during his February 1, 2017, budget speech for 2017-18.

Given that India has an infant mortality rate (IMR) of 37 per 1,000 live births–or higherthan the average for 154 middle- and low-income countries–the world’s highest TB burden, with 27% of the world’s new cases, and accounts for 58% of new leprosy cases detected globally, Jaitley appeared to address some of India’s most significant public-health concerns. Adequate funding could lead to significant improvement in India’s health systems and health status.

But Jaitley’s budget indicates inadequate allocations or funding cuts to his declared priorities. Most of the Rs 10,290-crore increase will be spent on issues regarded as low priority: New medical colleges, new premier medical institutions and converting health sub-centres into “health and wellness centres”–but with no more than Rs 60,000 per centre annually.

The question then is, where has this additional money gone? To open new medical colleges, new premier medical institutions–while older ones languish–and converting 150,000 health sub-centres into “health and wellness” centres but without adequate funding.

Measles: Ambitious targets and a Rs 1,000-crore funding cut

To eliminate measles, India will need to invest in stronger immunisation systems and social mobilisation. Most countries that have eliminated measles have used some form of a campaign approach, as India has by starting the first phase of a measles-rubella vaccine campaign to immunise 35 million children in 2017 and 410 million children over the next two years, as this World Health Organization statement pointed out.

Has money been set aside to achieve these targets? It appears not.

The union health budget includes a separate head, the National Rural Health Mission (NRHM), to fund state rural healthcare. Within the NRHM budget is a sub head called the “Reproductive and Child Health (RCH) flexi-pool”, which sets aside funds for immunisation, including funding of the polio-eradication campaign. To improve healthcare in urban areas (where measles remains a significant problem due to high population densities), the central budget sets aside money under the head National Urban Health Mission (NUHM).

To fund the measles campaign and eliminate measles, funding under RCH flexipool (for rural areas) and under NUHM (for urban areas) should have been higher than previous years.

Instead, funding for the RCH flexi-pool has been cut 23%, by more than Rs 1,000 crore, from Rs 5,932 in 2016-17 to Rs 4,566 in 2017-18.

Similarly, funding for the National Health Mission, which aims to provide universal access to affordable and quality healthcare and funds both NRHM and NUHM, has been reduced by Rs 197 crore over a year.

TB: As deaths double, a Rs 13-crore cut in funding

India had double the number of estimated TB deaths in 2015–480,000, up from 220,000 deaths in 2014–because previous estimates were too low, as IndiaSpend reported in October 2016..

India has 27% of the world’s new TB cases–one of the biggest infectious disease killers in India. The country had 2.8 million new TB cases in 2015, up from 2.2 million cases in 2014, according to the World Health Organization’s Global Tuberculosis Report 2016.

In such times, moving the goal post from control to elimination makes sense. In January 2017, the Supreme Court also directed the government of India to move from alternate-day medication to a more effective daily regime. But this would be require a larger budget.

As we said, the union budget’s NHRM head provides for healthcare in rural India. Within this budget head is a sub-head called “Flexible Pool for Communicable diseases”, which includes funding for the Revised National Tuberculosis Program.

Now, funding appears to have increased by Rs 87 crore over a year to 2017-18, but the revised budget estimates–drawn up after the budget is presented–reveals a drop of Rs 13 crore over 2016-17.

Adjusting for purchasing power parity, the funds available for TB control would be even lower, which means there are no new investments at a time when the TB programme needs to be expanded.

Maternity benefit only for first borns; funding short by Rs 11,812 crore

In the 2017-18 budget, funding for Indira Gandhi Matritva Sahyog Yojna (Maternal Benefit Scheme) has risen 226%, from Rs 634 crore ($94.6 million) in 2016-17 to Rs 2,700 crore ($298 million) in 2017-18, but this allocation, as IndiaSpend reported on February 22, 2017, isn’t enough to cover all expectant mothers.

The government had estimated that the the annual requirement for this maternity benefit scheme–which provides iron and folic-acid supplements to pregnant women to prevent maternal anaemia, sepsis, low birth weight, and preterm birth–would be Rs 14,512 crore ($2.1 billion), according the report of the Standing Committee on Food, Consumer Affairs and Public Distribution (2012-13).

“At the rate of Rs 1,000 per month for six months, the scheme expenditure towards maternity benefits to 2.25 crore pregnant and lactating women works out to Rs 14,512 crore per annum,” said the report, quoted in the Indian Express on February 18, 2017.

So, the ministry plans to provide maternity benefits only to first-borns, leaving other children vulnerable.

Of Indian infants who died within 29 days of being born between 2010 and 2013, 48% were underweight or were premature. India has more than 3.5 million preterm births every year, more than any other country, IndiaSpend reported in November 2016.

So where has the additional Rs 10,290 crore gone?

India’s health budget, as we said, rose Rs 10,290 crore in 2017-18 compared to the previous year. While this appears higher than ever, it is inadequate to bring India–which currently spends less than 1.5% of gross domestic product (GDP) on health–close to a minimum desirable health spend: 2% of GDP. As we have seen, this additional money does not seem to have gone to the government’s priorities: Reducing infant mortality or control of TB and other communicable diseases.

Source: Union Budget, 2017-18; * Setting up of two more AIIMS; ** Revised estimates for 2016-17; *** Universal health insurance scheme

Rs 2,855-crore increase for new medical colleges in districts

A major increase in budgetary allocation has been towards more medical colleges at district hospitals, an increase of Rs 2,855 crores, accounting for about 27% of the Rs 10,290-crore rise in health funding.

India does need more medical graduates, but increasing medical colleges will not be easy, considering that even premier institutes, such as branches of the All India Institute of Medical Sciences (AIIMS), set up by ministry of health and family welfare, in state capitals are struggling. For instance, five years after the first batch was admitted, AIIMS Bhopal does not yet have a blood bank and does not conduct surgeries, and important faculty positions are vacant, The Hindu reported in January 2017.

Rs 1,525-crore increase for new AIIMS, while older ones struggle

That bring us to the other significant funding increase: Rs 1,525 crore more over 2016-17 forPradhan Mantri Swasthya Suraksha Yojna (the Prime Minister’s Health Protection Scheme), which is not the same as the more well-known Rashtriya Swasthya Suraksha Yojna(National Health Protection Scheme), which–confusingly–has been renamed the National Health Protection Scheme (more on this later).

The Pradhan Mantri Swasthya Suraksha Yojna is supposed to set up new branches of AIIMS in the states. In addition to the 11 that exist, Jaitley announced setting up of two more AIIMS, in Jharkhand and Gujarat.

Instead of opening new institutes, and investing about 8% of the health budget (Rs 3,975 crore of Rs 47,352 crore) to do so, the government should ideally focus on making sure that the ones already opened are functioning.

Rs 3,000-crore increase to convert health sub-centres to health and wellness centres

Another significant increase of about Rs 3,000 crore is under the “Health System Strengthening” sub-head of NRHM. This is likely to be allocated to another pronouncement: Converting 150,000 health sub-centers nationwide into “health and wellness centres”.

Again, this is not a bad idea, since functional sub-centers can take primary healthcare closer to where people live. But with no plan for this transformation made available–not even how many will be converted this year–Rs 3,000 crore appears inadequate.

For example, even if 25% of the increased allocation under this sub-head is to upgrade sub-centres, no more than Rs 60,000 would be spent per sub-centre.

So, while the current budget’s health proclamations are apt, the funding increases for issues of low health priority are unlikely to make a significant impact on the overall well-being of India’s people.

Correction: We had earlier said that India accounts for 27% of new leprosy cases detected globally. The correct datum is that India accounts for 27% of the world’s new tuberculosis cases and 58% of new leprosy cases detected globally. We regret the error.

(Mohan formerly coordinated health and nutrition programmes for UNICEF’s country office in India and is the co-founder of Basic Healthcare Services, a nonprofit that offers low cost, high quality primary healthcare in rural under-served communities. He is also Director, Health Services, of Aajeevika Bureau, a nonprofit that provides services to labour-migrants.)

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Global sell-off drags Indian equities to 5-month lows




Mumbai, March 24 : A global sell-off triggered by trade protectionist measures imposed by major world economies unleashed the bears in the Indian equity markets during the week, pushing the key indices — NSE Nifty50 and BSE Sensex — to their 5-month lows.

Apart from the prospects of escalating trade wars, the risk-taking appetite of investors was marred by rising crude oil prices, the ongoing turmoil in the domestic banking system as well as the uncertainty on the political situation in the country.

On a weekly basis, the barometer 30-scrip Sensitive Index (Sensex) of the BSE shed 579.46 points or 1.75 per cent to close at 32,596.54 points — its lowest closing level since October 23, 2017.

On the National Stock Exchange (NSE), the wider Nifty50 ended below the psychologically important 10,000-mark and closed trade at 9,998.05 points — down 197.1 points or 1.93 per cent from its previous week’s close — its lowest closing level since October 11, 2017.

“Benchmark indices Sensex and Nifty fell 1.75 per cent and 1.93 per cent respectively during the week, posting their longest stretch of weekly losses in 16 months as the domestic market joined a global sell-off triggered by prospects of a trade war,” Arpit Jain, Assistant Vice President at Arihant Capital Markets, told IANS.

According to D.K. Aggarwal, Chairman and Managing Director of SMC Investments and Advisors, the global stock market traded lower after US President Donald Trump announced sweeping tariffs on Chinese goods, a move that has heightened concerns that the global trade war will escalate.

“Back at home, dragged by escalating trade tensions among global economies, the Indian stock market too witnessed selling pressure amid other domestic factors. Since the beginning of the year domestic market witnessed some hiccups on the back of imposition of LTCG (long term capital gains) tax, liquidity issues, rising bond yields and volatile global markets,” Aggarwal told IANS.

“Also, a surge in crude oil prices impacted the market sentiment. The Indian rupee, too, witnessed a volatile move ahead of Fed rate-hike and global trade war concerns,” he added.

On the currency front, the rupee weakened by eight paise to close at 65.01 against the US dollar from its previous week’s close at 64.93.

“Sentiments were affected by rising crude oil prices, bond yields and a troubled domestic banking system. Uncertainty around the political situation in the country added to the woes, and collectively dragged the sentiment across the street,” Gaurav Jain, Director at Hem Securities, told IANS.

Provisional figures from the stock exchanges showed that foreign institutional investors purchased scrips worth Rs 2,524.13 crore and the domestic institutional investors (DIIs) scrips worth Rs 211.91 crore during the week.

Figures from the National Securities Depository (NSDL) revealed that foreign portfolio investors invested in equities worth Rs 2,060.04 crore, or $316.99 million, during March 19-23.

“The market breadth was negative in three out of the five trading sessions of the week. The top sectoral losers were realty, metal, Bank Nifty and pharma indices. There were no gainers,” said Deepak Jasani, Head – Retail Research, HDFC Securities.

The top weekly Sensex gainers were: NTPC (up 2.90 per cent at Rs 170.15); IndusInd Bank (up 1.36 per cent at Rs 1,750.20); Power Grid (up 1.04 per cent at Rs 194.25); Hindustan Unilever (up 0.05 per cent at Rs 1,299.75); and Larsen and Toubro (up 0.01 per cent at Rs 1,267.75).

The losers were: Yes Bank (down 8.37 per cent at Rs 286.70); ICICI Bank (down 7.48 per cent at Rs 275.80); State Bank India (down 7.13 per cent at Rs 234.60); Tata Steel (down 5.65 per cent at Rs 566.60); and Axis Bank (down 4.29 per cent at Rs 501).

(Porisma P. Gogoi can be contacted at [email protected])

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24% scheme performance indicators of Delhi government ‘off track’



Manish Sisodia

An average 23.7 per cent of output and outcome indicators for various programmes and schemes of the Delhi government departments were “off track” till December last year, analysis of a report tabled in the Delhi Assembly on Wednesday suggested.

The 23.7 per cent of indicators were off track for schemes and programmes of 14 major departments, including Health, Social Welfare and Education, for which funds were allocated in the Delhi Budget 2017-18, according to an IANS analysis of Status Report of the Outcome Budget 2017-18.

The Status Report was presented by Deputy Chief Minister Manish Sisodia.

In the report, the indicators — output and outcome of schemes and programmes — of a department were used to denote whether their schemes were on or off track. Here off track implies the performance or progress of indicators of major schemes of a particular department (till December 2017) was less than 70 per cent of the expected progress.

With 45 per cent indicators off track, the Public Works Department’s schemes performed worst, followed by the Transport Department and the Environment Department, each having 40 per cent of indicators for schemes off track.

The departments whose schemes performed well include the Directorate of Education with 89 per cent indicators of schemes on-track, followed by the Delhi Urban Shelter Improvement Board (DUSIB) with 87 per cent schemes on track and the Delhi Jal Board with 82 per cent programmes on track.

Sisodia said that idea behind the Outcome Budget was to bring a high degree of accountability and transparency in public spending.

The Outcome Budget, which coveres 34 departments of the government, was termed as the “first of its kind” in the country.

Citing an example of Mohalla Clinics, Sisodia said a regular budget tells only about the money allocated for the construction of clinics, while Outcome Budget is about the number of clinics built and the number of people expected to benefit from it.

The Outcome Budget measures each scheme using two indices: output and outcome.

The infrastructure created or services offered due to spending on a particular scheme is termed as output, whereas the number of people benefited and how is termed as outcome.

(Nikhil M. Babu can be contacted at [email protected])

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Will Drabu’s ouster impact PDP-BJP alliance in J&K?

While even Mehbooba’s political adversaries, including the National Conference President, Dr. Farooq Abdullah, have welcomed her decision, her allies in the BJP are not happy at all about her decision.



Jammu, March 15 : The decision by Jammu and Kashmir Chief Minister Mehbooba Mufti to drop Haseeb Drabu from her council of ministers for his remarks at a business meet in Delhi is being hotly debated in political circles – especially what its consequences could be on the state’s PDP-BJP ruling coalition.

By doing what she has done, the Chief Minister has proved that she is prepared take political risks — and taking her for granted is something her colleagues and allies should learn not to do.

Peoples Democratic Party (PDP) leaders were aghast after Drabu, who was the Finance Minister, was quoted as telling a meeting organised by the PHD Chamber of Commerce and Industry in New Delhi that Kashmir was not a political problem and a conflict state but a “social problem”. He said this while seeking investments in the state from businessmen and saying the conditions in the state were conducive to business “where you will find some very interesting opportunities” not just to make money but also to have “a lot of fun and enjoy yourselves”.

PDP Vice President Sartaj Madni had said this was something which negated the very existence of the PDP because it is the firm belief of the party that Kashmir is political problem that needed political remedies to resolve.

Interestingly, instead of voices being raised in Drabu’s favour by his own party men, leaders of the PDP’s coalition unlikely partner Bharatiya Janata Party (BJP) seem to be more worried about the decision to drop him.

Some senior BJP leaders have rushed to Delhi to discuss the development and its fallout on the ruling coalition with the central leadership of the party.

How important Drabu had been for the PDP was proved not once, but many times in the past. The late Mufti Muhammad Sayeed trusted him to work out the terms of the agenda of alliance with BJP National Secretary Ram Madhav that finally paved the way for the present PDP-BJP coalition.

“Mufti Sahib always loved him and would overlook what some of his party men would say about Drabu Sahib,” said a PDP insider, not wishing to be identified.

In a letter released to the media after he was dropped from the cabinet, Drabu expressed sorrow for not being told by the Chief Minister or her office about the decision to drop him.

“I read it on the website of daily ‘Greater Kashmir’. I tried to call the Chief Minister, but was told she was busy and would call back. I waited, but my call was never returned,” he rued.

He also said in his letter that he had been quoted out of context by the media and that he what he had said was that Kashmir is not only a political problem, but that “we must also look beyond this”, Drabu clarified.

Sayeed made Drabu his economic advisor during his 2002 chief ministerial tenure and later made him the chairman of the local Jammu and Kashmir Bank. In fact, Drabu became the point man between the PDP and the BJP after the 2014 assembly elections.

The problem is that many PDP leaders had of late started saying that Drabu was more of “Delhi’s man in Kashmir rather than Kashmir’s man in Delhi”. Drabu is reportedly very close to Ram Madhav, the powerful BJP leader who is in-charge of Kashmir affairs, which many say “cost him his job”. It is this image that has been floating around in the PDP that finally cost him his berth in the state cabinet.

While even Mehbooba’s political adversaries, including the National Conference President, Dr. Farooq Abdullah, have welcomed her decision, her allies in the BJP are not happy at all about her decision.

“What did he say? He said it is a social problem and Kashmir is a society in search of itself. Is this wrong? We don’t think this is something for which such a harsh decision should have been taken,” a senior BJP leader told IANS, not wanting to be named.

His successor, Syed Altaf Bukhari, who has been assigned the finance portfolio, took a major decision immediately after taking over. Bukhari announced that the decision to replace the old treasury system by the Pay and Accounts Office (PAO) has been put on hold. The ambitious PAO system was Drabu’s brainchild.

Bukhari’s decision has been welcomed by hundreds of contractors in the state who had been on strike during the last 13 days demanding their pending payments and suspension of the PAO system at least till March 31.

Would Drabu’s ouster be a storm in a teacup or would it have repercussions on the PDP-BJP ruling alliance in the immediate future? Ironically, Drabu’s PDP colleagues say it won’t be, while the BJP leaders in the state say it would.

By : Sheikh Qayoom

(Sheikh Qayoom can be contacted at [email protected])

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