To strengthen the primary healthcare system and to address the gaps that have been unearthed during the Covid pandemic the latest budget has allocated Rs 13,192 cr for Health. Again, in a clear departure from earlier practices this amount will be allocated to panchayati raj and urban local bodies for them to spend in accordance with recommendations of the 15th Finance Commission. Meanwhile the Ministry of Health and Family Welfare is in the process of drawing up the guidelines about where this money will be spent. This is the first tranche of a total grant of Rs 70,051 crore earmarked for the health sector at the rural and urban local body levels over the award period of five years.
A Committee headed by the Health Secretary, comprising principal secretaries of health of all states will draw a timeline of deliverables and outcomes for each of the five years along with a definite mechanism for flow and utilisation of these grants. This mechanism has to be in place by April 2021 for the first instalment of funds to start flowing by July 2021, according to the report.
In states, a committee under the chief secretary and comprising officials of the state departments of health, panchayati raj and urban affairs, and select representatives from all three tiers of rural and urban local bodies will decide on further devolution. Usually, money meant for health schemes is given to states. This is the first time PRIs and ULBs will be directly involved in the spending of central funds.
The total grants-in-aid support to the health sector over the award period works out to Rs 1,06,606 crore which is 10.3 per cent of the total grants in-aid recommended by The Finance Commission. This works out to about 0.1 per cent of the GDP. The Commission also says that grants for the health sector will be unconditional. The panel has recommended that primary healthcare should be the number one commitment of every state. Moreover, primary health expenditure should be increased to two-thirds of the total health expenditure by 2022. The total public expenditure on health by states and the Centre should touch 2.5 per cent of GDP by 2025.
The idea that health funds should be routed through PRIs at the district, village and block levels is based on the Kerala government model from 1996 to transfer 35-40 per cent of the state’s development budget to local governments. Under this model, sub-centres and primary health centres (PHCs) in rural areas were brought under the overall supervision and control of gram panchayats, putting in place mechanisms for greater community involvement.
This is a very sound model but the problem is with states like Meghalaya where there are no elected urban local bodies or panchayats. In such a situation how will the funds devolve to these bodies that have no accountability mechanisms in place? Meghalaya should start exercising its mind over this issue.