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.
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This kind of inefficiency also reminds me of broader issues around accountability and patient safety. For example, concerns like Medical Negligence in Malaysia show how important strong oversight, proper resourcing, and legal protections are in ensuring patients receive the care they deserve. Discussions like this help shed light on why systemic improvements are essential.