Small grant but a big opportunity for local bodies

News: 15th Finance commission recommended a health grant of 70,000 crore which is to be released over the next 5 years. Out of this nearly 8000 crore was released to urban and rural local bodies. This would be 2.3% of the total health expenditure. This has the potential of having a huge impact on health services in India.

What were the reasons for failure in the past?

In 1992, with 73rd and 74th Amendment Act, primary health care was transferred to PRI’s and ULB’s (Urban Local Bodies). But this negatively impacted the ULB’s. The government funding for ULB’s was not channelled through State health departments. ULB’s failed to raise their own resources. This was due to lack of finances, lack of clarity of responsibility and having different spending priorities. All this resulted in a financial crunch.

National Rural Health Mission (NRHM, 2005) although partly reduced the issue of RLBs (Rural Local Bodies) not spending on health. But National Urban Health Mission (NUHM) had a meagre annual financial allocation that never crossed ₹1,000 crores.

Hence, in 2017-18, 25 years after the Constitutional Amendments, the ULBs and RLBs are only contributing 1.3% and 1% of the annual total health expenditure in India.

What are the obstacles faced by Urban India in improving the health system?

Urban India, which holds half the population of rural India, has just one-sixth of primary health centre’s as compared to rural India. It faces regular outbreaks of diseases like chikungunya and dengue. Covid-19 pandemic exposed the weak testing and hospital infrastructure of Urban India. There is a lack of coordination and jurisdiction issues between various agencies.

Given these circumstances, 15th FC’s increased grant for NUHM is a welcome step.

What steps are needed to revive the health infrastructure?

– Sensitize the key stakeholders in local bodies, e.g. PRI representatives.
– Raise awareness amongst citizens about the responsibility of local bodies in health care.
– Civil society organizations should raise awareness, develop local dashboards etc.
– Local bodies should augment the FC grants by raising their own resources.
– Institutionalize coordination mechanism amongst various agencies.
– State governments should open up various types of community clinics in rural and urban areas.

What should be the way forward?

While India health system needs funding, it needs to be complemented by various agencies, elected representatives and civil society to ensure that the coveted goal of health for all can be met.

Source: This post is based on the article “Small grant but a big opportunity for local bodies” published in The Hindu on 1st December 2021.