Eleventh Five Year Plan

106 Eleventh Five Year Planetc., providing for little flexibility to respond to anyhealth emergency. To address these issues, governmenthas initiated several interventions under the NRHMsuch as District Health Action Plan, National HealthAccounting systems, management capacity at alllevels, improved financial management, and closemonitoring.Source: NHA Cell, MoHFW, GoI (2005).FIGURE: 3.1.15: Source of Health Care Financingin India, 2001–02ditures on health (through the Central and StateGovernments), as a percentage of total governmentexpenditure, have declined from 3.12% in 1992–93to 2.99% in 2003–04. Similarly, the combined expenditureon health as a percentage of GDP has alsomarginally declined from 1.01% of GDP in 1992–93to 0.99% in 2003–04. In nominal terms, the per capitapublic health expenditure increased from Rs 89 in1993–94 to Rs 214 in 2003–04, which in real terms isRs 122 (Figure 3.1.16).3.1.196 Health care is financed primarily by StateGovernments, and State allocations on health are usuallyaffected by any fiscal stress they encounter. Besideschronic under funding, the sector has been plaguedwith instances of inefficiencies at several levels resultingin waste, duplication, and sub optimal use of scarceresources. All these factors combined have had an adverseimpact on the public health sector’s ability toprovide health care services to the people.3.1.197 There was also a gradual decline in theproportion of funds released to States by CentralGovernment when the States were themselves underfiscal stress. This resulted in sharp reduction in capitalinvestment in public hospitals, low priority to preventiveand promotive care, and inefficiencies inallocations under national health programmes. Thefinancing system is equally dysfunctional as fundsare released in five-year cycles, divided under differentand complex budget heads—revenue, capital,3.1.198 It is estimated that in order to meet the targetexpenditure level, total Plan expenditure will need togrow at 29.7 % annually during the first three yearsof the Eleventh Five Year Plan, which breaks down to30.2 % for the Centre and 29.2 % for the States. As aresult, total health expenditure of the Centre and States,respectively, will rise to 0.55% of GDP and 0.85% ofGDP in 2009–10. In the last two years of the Plan, totalPlan expenditure will need to rise at about 48%annually. This will result in a total health expenditureof 0.87% of GDP by the Centre and 1.13% by States in2011–12. Therefore, during the Eleventh Five Year Plan,while the Central Government makes every effort toaugment resources for health, State Governments willbe persuaded to assign at least 7–8% of State expenditurestowards health care.3.1.199 During the Plan, the objective of every Statewill be to increase competition among providers, createoptions for consumers, and ensure oversightthrough elected local bodies and Panchayats. State governmentswill also focus on integrating public healthprogrammes with other public health interventionslike drinking water, sanitation, nutrition, primaryeducation, roads, and connectivity. State governmentswill be persuaded to allocate more resources for thesesectors through better fiscal management andreprioritization.MONITORING OUTCOMES VERSUS OUTLAYS3.1.200 The allocation of funds among differentlevels (namely primary, secondary, and tertiary) anddisease control programmes has been changing. Themanner in which resources are allocated shows a widedisparity in spending and outcomes. It is thereforenecessary to focus on health outcomes rather thanhealth outlays, including a disaggregated examinationby gender, class, caste, etc. to assess their impact ondifferent groups. During the Eleventh Five Year Plan,