Gujarat government officials have complained that they do not have "enough freedom" to spend funds coming from the Government of India for upgrading the state's health services. Participating in an internal meeting with the Jan Swasthya Abhiyan (JSA), they said, "We were given this freedom in 2005 (a year after UPA came to power). But it was taken away recently."
JSA is an all-India network of NGOs working for promoting the concept of health for all, considering health as one of the essential human rights. Officials bemoaned this amidst Government of India, especially Niti Aayog vice-chairman Arvind Panagariya, repeatedly insisting that state budgets should be increasingly decentralized.
Briefing JSA activists on the way the funds, provided under the National Health Mission (NHM), were being used for health facilities in the state, the officials told the meeting, called in Ahmedabad to "understand" budget making, that things have particularly turned bad because "it is impossible to utilize funds meant for a particular head for needs requiring more attention."
Pointing to other difficulties, one official said, "Earlier, the Government of India would provide 90 per cent of the funds under the NHM. However, this has gone down to 60 per cent now. Earlier, the mission director had the powers to use 20 per cent of its budget. But those powers have been taken away."
"Thus, the freedom that the officials enjoyed previously in utilizing funds is not there anymore", the official said, adding, "As a result of the curtailment of powers, things, village health committees are provided just about Rs 10,000, Primary Health Centres (PHCs) just Rs 1.75 lakh, Community Health Centre (CHCs) and sub-district hospitals Rs 5 lakh and district hospitals Rs 10 lakh."
The official admission of lack of powers to utilize funds came following JSA activists complained of poor health services in Gujarat. They highlighted how, despite having 3,000 PHCs, people in a large number of rural areas have to go as far away as 45 kilometres for get basic treatment. They added, that there is a "dire shortage" of physicians and health experts in PHCs and CHCs, as a result of which patients perforce have to travel to big cities for treatment.
Pointing out that, often, in the process, the patient passes away, on activist reported that in Amreli district in Saurashtra region, even in the district hospital does not have any gynecologist, pediatrician or anesthesiologist, one reason why patients cannot be treated in there.
"There is no blood bank facility in a large number of areas", complained another activist, adding, "As a result, it is impossible to bring down maternal mortality rate, which remains on a higher site."
Well-known budget analyst Mahinder Jethmalani, who heads Pathey Budget Centre in Ahmedabad, said that just about 0.75 per cent of the budget is spent on health services in Gujarat, which is "negligible", adding, "What is worse, even the budget allocation is not fully utilized."
Analyzing the latest 2016-17 budget, Jethmalani pointed towards "gross discrepancy" that exists between the spending for health in villages and cities. "While it is Rs 1,144 per capita in urban areas, it is just about 377 in rural areas", he said, adding, "For medicines just about Rs 45 per capita is being spent, as against Tamil Nadu, which spends Rs 65 per capita."