Understanding India’s Health Budgets

The budget is a vital tool to support the government in executing various programs and schemes in a methodical and strategic manner. Most importantly, it is the document that informs citizens of how taxes are collected and resources are prioritised and spent — how much and on what? But the process by which the budget is prepared and the details of the budget document itself, are not easily comprehensible.

Health budgets (or budget documents in general) have traditionally been viewed as an accounting or administrative document, instead of a strategic policy document. Now, there is growing recognition that many aspects of the budgeting process are deeply embedded in India’s health system performance. Yet India’s 29 health budgets (Government of India plus 28 states) are complex, varied, and poorly understood. Thus, there is value in enhancing our collective understanding of how health budgets are formulated, executed, and evaluated; and in describing the implications of budget processes and structures for undertaking policy-relevant analysis

The main objective of this primer is to offer the reader a way to understand and interpret India’s Union and state health budgets.

National Social Assistance Programme, GOI 2014-15

The National Social Assistance Programme (NSAP) was launched in 1995 with the objective of supporting minimum needs of specified social groups such as the elderly, widows and disabled persons living in below poverty line (BPL) households.

Using government data, this brief reports on trends in budgetary allocation and expenditure along the following parameters:

  • Overall trends in allocations and expenditures
  • Trends in expenditure at the state level
  • Scheme-wise trends in expenditure and coverage of beneficiaries with an emphasis on the Indira Gandhi National Old Age Pension Scheme.

State of Social Sector Expenditure in 2015-16

The 14th Finance Commission’s (FFC) recommendations, accepted by the Union Government in February 2015, set the stage for a radical overhaul of India’s fiscal architecture. The recommendations were designed to enhance fiscal autonomy of states by increasing the vertical tax devolution of the divisible pool of taxes from 32 per cent to 42 per cent. Consequently, the Ministry of Finance (MoF) allocated Rs. 5.24 lakh crore as tax devolution. This was significantly higher than the 2014-15 allocation of Rs.3.38 lakh crore (RE). This increase in devolution was accompanied by several changes in the mode of state transfers, including cuts in centrally sponsored schemes (CSS), the Union Government’s primary vehicle for financing social sector investments in the country.

What are the implications of these changes? Did increased tax devolution result in enhancing the fiscal space available to states? Or was this offset by cuts in CSS and other grants? How have states responded to these changes? Have we seen any changes in the investment patterns of the states? Crucially, has the changed fiscal structure resulted in any visible shifts in social sector investments at the state level?

Based on an analysis of 19 state budgets, this brief presents a preliminary evaluation of the impact of the FFC recommendations on state finances and social sector expenditure.

Direct Benefit Transfer, Jan Dhan, Aadhaar and Mobile, GOI, 2017-18

Direct Benefit Transfer (DBT) is a Government of India (GOI) initiative to transfer cash benefits such as wage payments, subsidies and incentives for a number of government programmes directly into bank accounts of beneficiaries through electronic systems. DBT was designed with the objective of minimising delays in fund flows, ensuring accurate targeting of beneficiaries, and curbing leakage and duplication. A key role in large-scale, real-time implementation of DBT has been envisaged for the JAM trinity: Jan Dhan accounts, Aadhaar numbers and Mobile numbers. Jan Dhan bank accounts aim to ensure universal financial inclusion, Aadhaar numbers provide a means for identification and authentication, and mobile banking offers an alternative mechanism of payment and withdrawal.

Using government data, this brief reports on the following parameters:

  • Trends in coverage of DBT and JAM
  • Extent to which these are being used by government and citizens.

Pradhan Mantri Gram Sadak Yojana, GOI, 2017-18

The Pradhan Mantri Gram Sadak Yojana (PMGSY) was launched by the Government of India (GOI) on 25 December, 2000 to provide all-weather road connectivity in rural areas. PMGSY is administered by the Ministry of Rural Development (MORD).

Using government data, this brief reports on PMGSY progress along the following parameters:

  • Overall trends in allocations and expenditures
  • Trends in sanction of projects
  • State-wise progress on road works completed
  • Overall progress in ensuring rural connectivity