CAG audit highlights neglect of public health sector: ₹1.32 lakh crore unspent over five years

By A Representative

A Comptroller and Auditor General (CAG) audit has highlighted chronic underspending in India’s public health sector, revealing that the Union Ministry of Health and Family Welfare failed to utilise ₹1,32,749 crore over a five-year period from 2019-20 to 2023-24. The findings were cited by the advocacy group Jan Swasthya Abhiyan India (JSA India) in a press statement, raising concerns over gaps between policy commitments and actual fiscal practices.

The statement comes at a time when the latest Union Budget projects an increase in health sector allocations, signalling what the government describes as a renewed commitment to public health. However, JSA India pointed out that public health expenditure as a share of GDP has remained largely stagnant, hovering between 0.29 percent in 2024-25 and 2025-26 and 0.31 percent in 2023-24. According to the organisation, this persistently low level of investment has weakened public health infrastructure, human resources and essential services across the country.

JSA India noted that a recurring pattern of underspending is evident from the “lapsed budget” figures reported in the Union government’s finance accounts. Despite already modest allocations, the Health and Family Welfare Ministry consistently surrendered large portions of its approved budgets. An examination of budget trends over the past five years shows a decline in real health expenditure when adjusted for inflation and growing healthcare needs.

The organisation also drew attention to repeated observations made by the CAG in its audit reports on the Union government’s finance accounts over the last five years. It said that despite these reminders, neither the Public Accounts Committee nor the Ministry of Finance has taken adequate corrective measures to ensure realistic budget planning and timely utilisation of funds.

According to JSA India representatives Amulya Nidhi and Gorang Mohapatra, a review of audit comments on expenditure by both the Department of Health and Family Welfare and the Department of Health Research shows that there was not a single financial year in which either department spent close to its full allocation. They warned that persistent underspending, especially against already low allocations, has serious implications for the survival and effectiveness of the public health system.

The group cited CAG audit data showing significant savings, or unspent funds, under major health grants. In 2023-24, the Department of Health and Family Welfare spent ₹95,561.02 crore against an approved provision of ₹1,04,683.17 crore, leaving ₹9,122.15 crore unutilised. In 2022-23, the same department left ₹14,472.40 crore unspent. Similar trends were observed in the Department of Health Research, which recorded savings of ₹121.85 crore in 2023-24 and ₹768.56 crore in 2022-23.

Referring to the latest CAG audit report (Report No. 4 of 2025), JSA India said the gap between stated intentions and fiscal outcomes becomes even more evident in the case of health and education cess collections. The audit noted that collections from the health and education cess rose significantly from ₹41,310 crore in 2018-19 to ₹61,814 crore in 2022-23, while total cess and surcharge collections reached ₹4.81 lakh crore in 2022-23.

However, the audit clarified that health-related cesses are not ring-fenced for health spending. Instead, these revenues are credited to the Consolidated Fund of India, with no transparent mechanism to ensure that funds collected in the name of health are actually used to strengthen public health systems.

JSA India stressed that public health spending remains far below the long-stated commitment of 5 percent of GDP. It also flagged the absence of transparency and outcome-based reporting on health-related revenues collected by the Union government.

The organisation demanded that the CAG urgently release key audit observations on the Union government’s finance accounts for 2024-25 during the current parliamentary session. It also called for health cess revenues to be specifically earmarked for public health, arguing that budget announcements and rising cess collections cannot substitute for sustained, real investment in public healthcare. Strengthening the financial capacity of states to deliver public health services was also identified as a priority.

JSA India further urged that audits of the Union government’s finance accounts be finalised within a reasonable timeframe, ideally within nine to eleven months of the close of the relevant financial year, to enable timely accountability and corrective action.

Comments

From algorithms to exploitation: New report exposes plight of India's gig workers

By Jag Jivan The recent report, "State of Finance in India Report 2024-25," released by a coalition including the Centre for Financial Accountability, Focus on the Global South, and other organizations, paints a stark picture of India's burgeoning digital economy, particularly highlighting the exploitation faced by gig workers on platform-based services.

India’s road to sustainability: Why alternative fuels matter beyond electric vehicles

By Suyash Gupta* India’s worsening air quality makes the shift towards clean mobility urgent. However, while electric vehicles (EVs) are central to India’s strategy, they alone cannot address the country’s diverse pollution and energy challenges.

Over 40% of gig workers earn below ₹15,000 a month: Economic Survey

By A Representative The Finance Minister, Nirmala Sitharaman, while reviewing the Economic Survey in Parliament on Tuesday, highlighted the rapid growth of gig and platform workers in India. According to the Survey, the number of gig workers has increased from 7.7 million to around 12 million, marking a growth of about 55 percent. Their share in the overall workforce is projected to rise from 2 percent to 6.7 percent, with gig workers expected to contribute approximately ₹2.35 lakh crore to the GDP by 2030. The Survey also noted that over 40 percent of gig workers earn less than ₹15,000 per month.

Swami Vivekananda's views on caste and sexuality were 'painfully' regressive

By Bhaskar Sur* Swami Vivekananda now belongs more to the modern Hindu mythology than reality. It makes a daunting job to discover the real human being who knew unemployment, humiliation of losing a teaching job for 'incompetence', longed in vain for the bliss of a happy conjugal life only to suffer the consequent frustration.

Budget 2026 focuses on pharma and medical tourism, overlooks public health needs: JSAI

By A Representative Jan Swasthya Abhiyan India (JSAI) has criticised the Union Budget 2026, stating that it overlooks core public health needs while prioritising the pharmaceutical industry, private healthcare, medical tourism, public-private partnerships, and exports related to AYUSH systems. In a press note issued from New Delhi, the public health network said that primary healthcare services and public health infrastructure continue to remain underfunded despite repeated policy assurances.

Jayanthi Natarajan "never stood by tribals' rights" in MNC Vedanta's move to mine Niyamigiri Hills in Odisha

By A Representative The Odisha Chapter of the Campaign for Survival and Dignity (CSD), which played a vital role in the struggle for the enactment of historic Forest Rights Act, 2006 has blamed former Union environment minister Jaynaynthi Natarjan for failing to play any vital role to defend the tribals' rights in the forest areas during her tenure under the former UPA government. Countering her recent statement that she rejected environmental clearance to Vendanta, the top UK-based NMC, despite tremendous pressure from her colleagues in Cabinet and huge criticism from industry, and the claim that her decision was “upheld by the Supreme Court”, the CSD said this is simply not true, and actually she "disrespected" FRA.

Death behind locked doors in East Kolkata: A fire that exposed systemic neglect

By Atanu Roy* It was Sunday at midnight. Around 30 migrant workers were in deep sleep after a hard day’s work. A devastating fire engulfed the godown where they were sleeping. There was no escape route for the workers, as the door was locked and no firefighting system was installed. Rules of the land were violated as usual. The fire continued for days, despite the sincere efforts of fire brigade personnel. The bodies were charred in the intense heat and were beyond identification, not fit for immediate forensic examination. As a result, nobody knows the exact death toll; estimates are hovering around 21 as of now.

When compassion turns lethal: Euthanasia and the fear of becoming a burden

By Deepika A 55-year-old acquaintance passed away recently after a long battle with cancer. Why so many people are dying relatively young is a question being raised in several forums, and that debate is best reserved for another day. This individual was kept on a ventilator for nearly five months, after which the doctors and the family finally decided to let go. The cost of keeping a person on life support for such extended periods is enormous. Yet families continue to spend vast sums even when the chances of survival are minimal. Life, we are told, is precious, and nature itself strives to protect and sustain it.

When resistance became administrative: How I learned to stop romanticising the labour movement

By Rohit Chauhan* On my first day at a labour rights NGO, I was given a monthly sales target: sixty memberships. Not sixty workers to organise, not sixty conversations about exploitation, not sixty political discussions. Sixty conversions. I remember staring at the whiteboard, wondering whether I had mistakenly walked into a multi-level marketing office instead of a trade union. The language was corporate, the urgency managerial, and the tone unmistakably transactional. It was my formal introduction to a strange truth I would slowly learn: in contemporary India, even rebellion runs on performance metrics.

Search This Blog