A series of new health programmes launched over the last several months has burdened the BJP-led government in Maharashtra, rendering it unable to expand existing programmes to all districts in the state over the last two years.
Data accessed by The Indian Express from the Department of Finance of the Directorate of Health Services (DHS) shows that three programmes — the Integrated Disease Surveillance Programme, National Programme for Prevention and Control of Deafness, and National Oral Health Programme — have received zero funds in 2015-16 from the state government, when their approved Programme Implementation Plan was Rs 160 lakh, Rs 80 lakh and 44 lakh, respectively.
A study by the Indian Institute of Management-Ahmedabad may have ranked Maharashtra on top in the health index, but the state is still battling significant malnutrition cases — 95,743 severe acute malnourished children to be precise. As the state government struggles to reopen the village child development centres and children treatment centres to curb malnutrition, the health department is heavily relying on the tribal and women and children development departments for support.
Since the Devendra Fadnavis-led state government assumed power in 2015-16, the National Health Mission’s policy to increase state funding from 25 per cent to 40 per cent, alongside a drop in the Centre’s share from 75 to 60 per cent, has further added worries for the government, having to dive deeper into its pockets.
Programmes such as palliative care, tobacco control and elderly care have been slow-starters. In 2014-15, the National Programme for Health Care of Elderly received Rs 56 lakh of the Rs 87 lakh sanctioned. In 2015-16, it received Rs 151 lakh of the Rs 194 lakh sanctioned. The deficit has hampered programme expansion, screening and its awareness campaigns. The situation mirrors in other programmes that have been initiated on pilot basis but fail in expansion due to fund crunch.
Currently, the non-communicable diseases programme runs in only 17 districts, mental health programme runs in 16 districts, deafness programme in 16 districts and oral health programme in 26 districts. “For expansion to one more district, if we need Rs 2.5 crore, approval is for Rs 1 crore. How can a programme get expanded in such a case,” said a senior health official at the DHS.
Also, for appointments of medical staff and their training, the health department relies heavily on the Accredited Social Health Worker (ASHA), who monitors a rural population of 1,000 people. An ASHA worker has to monitor over 12 programmes in a village apart from handling women and child nutrition and immunisation.
“We are given incentives if we work well in certain programmes. But after visiting few houses each day, it becomes impossible to begin work for other programmes,” said Lakshmi Duparbole, an ASHA worker in Solapur.
As government initiates newer programmes, no additional posts have been sanctioned, thereby burdening the existing force of medical officers, nurses and technicians. For instance, the deafness control programme has posts for ENT surgeons vacant in 16 districts, has only eight of the audiologists sanctioned, and has posts for data entry operator, consultant and programme assistant vacant at the state level.
In the last two years, the Union government has slowly withdrawn from national health programmes, shifting the responsibility to state governments. Additionally, the state government in its own health budget this year made cuts to certain programmes. “This year’s budget for nutrition was cut down by more than half. After a lot of protests, some funds were rolled back in supplementary budget,” says Ravi Duggal, attached with the International Budget Partnership.
The state government’s flagship programmes such as A P J Abdul Kalam Amrut Yojana to offer free food supplements for pregnant and lactating mothers has also been a slow starter, despite getting rolled out in November 2015. With lack of nutrition centres for children, the government programme may impact the maternal and child health care and its mortality rate.
The programmes that kick-started in the last five years include deafness control, oral health, palliative and non-communicable diseases. While non-communicable disease such as heart ailments, hypertension, stroke and diabetes are responsible for 68 per cent cases in the state, its funding forms only one per cent of total approved budget.
“If the resources are limited, the programme suffers. But we manage by borrowing funds from other programmes,” said Dr Sadhana Tayde, Joint Director at DHS.
The state government’s core focus for coming years will be tribal health upgrade, especially reduction in infant mortality and neonatal mortality. For that, a slew of programmes are being chalked out. Attempts to revive village child development centres and children treatment centres will be a part of it.
“Our aim is to reduce infant mortality rate further down by 2019. Maharashtra comes third after Kerala and Tamil Nadu,” said Dr Satish Pawar, Director at DHS.