Health Budgets: Beyond the Piecemeal Approach

The report published in the Indian Express today is an interesting read. The Ministry of Finance (MoF) has asked the MoHFW to have a relook at the National Health Mission (NHM) budget of 2017-18 which has planned a renewal of the Mission. The NHM had asked for a little over Rs 33,500 crore for next year and a little over Rs 1,37,000 crore for the next five years. The news report suggests that Expenditure Finance Committee (EFC) of the MoF has raised the questions about the way programme has been implemented and asked the MoHFW to revised the proposal. The intervention of MoF is a welcome step.

The year 2016-17 was the last year of most of the national programmes which also happened to be the last year of the twelfth five-year plan. The programmes include the NHM, the NACP, RNTCP, etc. The annual plans for most of the national programmes are generally part of the strategic plans of the programme for next phase starting in April 2017.

There are three developments worth noting that changed since the preparation of last phase strategic plans of various programmes.

First, the NITI Ayog had proposed to come with 15-year vision plan and through this vision document work towards the social objective mission of UNDP's 2030 sustainable goals which has16 goals with 169 sub-goals. These goals provide a much larger focus on the development. So various strategic plans of programmes need to articulate a vision or plan to guide how these goals will be achieved and how much resources will be required to achieve this.

Second, 14th Finance Commission envisaged giving more untied funds to States with greater fiscal responsibility in implementing centrally-sponsored schemes, and as part of the financial devolution strategy, FC increased the states’ share in central taxes from 32 percent to 42 percent. The new strategic plans for next phases were expected to integrate the developments of larger finance devolution as recommended by the Finance Commission to states. Several programmes had also planned to implement the integration and convergence strategy.

Third, the budget speech of Finance Minister in 2015-16 had mentioned that the government would abandon the plan and non-plan distinction from 2017-18. The budgets of 2017-18 were expected to have new and better rationale for justifying the budgets.

The strategic planning exercise of various programmes is generally expected to start one year in advance. For example, NACO started the exercise of developing a strategic plan by publishing a Mid-term Appraisal of NACP IV by NACO in August 2016. The findings and conclusions of this review were supposed to be integrated into the next phase strategic plan. However, we have not seen this strategic planning exercise moving any further. In the same manner, RNTCP strategic planning exercise started in September 2016, and final draft of the RNTCP programme have been shared with key stakeholders for comments during last week of February.

The new strategic plan of various programmes in the changed focused effort needed to ensure:

• consider all the three developments pointed out above
• cost-effectiveness of interventions
• a clear statement on state-level contribution to funding
• integration and convergence strategies leading to economies
• focus on prevention to ensure it reduces the future health burden
• district-level and state-level plans to ensure there is flexibility at district levels and whether the overall is well integrated and need-based

I am not sure whether various strategic plans meet these expectations, certainly not whether the interventions proposed are cost-effective or not.

* NHM’s health in doubt as Ministry told to revise cost, Indian Express, 9 March 2017