• India’s prime health programs in disarray due to slow funds distribution
  • March 11, 2015

                      Undoubtedly, it''s a cause of great concern. India''s flagship public health programs to serve millions of urban and rural poor are now hurdled for months due to the changed way of over $1.3 billions’ federal funds distribution, by the government. This is in accordance with the data and the letters seen by the sources.

     In order to strengthening the Indian states last year the federal health ministry started sending funds for public health programs to state treasuries, instead of direct transfers to its regional arms. But poorly-run regional bureaucracies were unable to cope and both the flagship National Health Mission (NHM) and India''s AIDS prevention programs suffered - thousands of health workers were not paid for months and the construction of clinics in rural areas was delayed.

    State governments sometimes did use the funds proposed for health programs, for time being, to meet needs of other sectors, health officials said. The funds involved amounted to about one-third of the total federal spending on health, and led to further deterioration in India''''''''s tattered public health system. An info from the Right to Information Act  reveales the health ministry''s desperate, and failed, attempts to push states to release funds to NHM arms.

    Health Ministry pointed this out  in a letter to the finance minister in November saying,"The progress in NHM works has slowed down considerably in most of the states..I urge you to review the decision and allow the ministry to transfer funds directly to state health societies."

    This decision created problems to other sectors also. The decision last year to route many payments through states, launched by the previous Congress party-led government, affected other sectors as well, but the impact on health programs has been glaring.

    In comparison with other states Indias expenditure on health is too poor. India spends just 1 percent of its GDP on public health, less than Afghanistan and Sierra Leone. On Saturday, the federal government increased the annual budget for its main health department by just 2 percent to $4.8 billion. Still, India struggles to spend all of its allocated health funds because of an inadequate number of doctors and hospitals, and bureaucratic bungling. Data shows the government has only once spent all of its health budget since 2005.

    Let’s go on some data analysis. Since April, the federal government has sent more than $1.3 billion to the states for the NHM, which undertakes treatment of diseases such as tuberculosis and malaria, construction of rural health centers and immunization drives. No state treasury released the funds to the designated health societies within a stipulated 15-day period, with delays running into months in some cases, according to government data seen by Reuters. More than $180 million is still to be released.

    The Joint Secretary, Health Ministry, Manoj Jhalani states that several states have voiced concern about the delays and discussions are ongoing to resolve the situation.

    "If resources are not provided in time, implementation of the program does get affected. There has been some impact on the smooth operation of NHM," the health secy says. Jhalani said. Several NHM officials also voiced that the state health units were deprived of funds for months. Salaries, training and building new clinics were hit.

    Salaries are also not paid for months. In the northern state of Jammu and Kashmir, 9,000 health workers have not received salaries for three months and cash incentives for women who give birth in a government hospital have been withheld, said Yash Pal Sharma, the state''s director for the NHM.Treasuries in the north-eastern states of Meghalaya and Mizoram held NHM funds for 151 days and 79 days, respectively, data as of Feb. 22 showed. In India''s third-largest state Maharashtra, funds sent in June reached the health society in December.

    "Outreach programs have been severely impacted," said a health ministry official in New Delhi. "The entire system has been paralyzed, bureaucracy has become bureau-crazy."

    Acquired Immune deficiency syndrome is still deadly disease challenging the new age high-tech medical science universally. India''s AIDS prevention drive, a program separate from the NHM, was also affected by the new payments system. Workers from high-risk groups, such as sex workers and injectable drug users, who are employed to run programs within their communities are quitting because of irregular pay. Rama, a project manager in one such community-based program for sex workers in Mumbai, said 17 of her 23 team members have quit because of delayed salaries. New people hired will take months before they can efficiently run the program.

    Positive enough are the signs showing decrease in the country’s aids patient in recent years. "It takes a lot of time to build trust within our communities. Our HIV testing numbers have fallen by half because sex workers don''t trust new people," said the 26-year-old, who says she moonlights as a sex worker herself to survive. India runs more than 1,800 community-based programs for AIDS prevention. The World Bank has estimated India''s policy of targeting sex workers to control AIDS would avert three million infections during 1995-2015.

    Knowing this also painful that not all proposed money reaches to its goal. Government data showed that India''s National AIDS Control Organisation released $67 million to state governments in recent months as a second instalment for the overall program, but only $39 million reached its state-level health societies. The first instalment of $78 million was released by state treasuries after months of delays.

    Sounding concern says government officials in  New Delhi. "What can we do if states are not caring about its people?..Now we are at risk of the numbers (of AIDS patients) increasing again."



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