Context:
Despite the targets set under the National Health Policy (NHP) 2017, public health expenditure remains below expectations, raising concerns about healthcare access and federal fiscal balance.
Key Highlights:
- NHP 2017 Target
- Increase public health expenditure to 2.5% of GDP by 2025.
- Target not achieved.
- Spending Trends (2017-18 to 2025-26)
- States: Increased from 0.67% to 1.1% of GDP.
- Union Government: Declined from 0.37% to 0.29% of GDP.
- Union health budget (2025-26) is 4.7% lower in real terms than 2020-21.
- Centrally Sponsored Schemes (CSS)
- Share of Union health spending transferred to States:
- Declined from 75.9% (2014-15) to 43% (2024-25).
- Reflects fiscal hyper-centralisation.
- Health and Education Cess (HEC)
- Intended to augment health and education funding.
- Allegedly used to supplement general revenues rather than expand spending.
- Scheme-Level Impact
- National Health Mission (NHM):
- Real-term decline of 5.5% on average in NDA’s second tenure.
- Core to rural and primary healthcare strengthening.
- Pradhan Mantri Swasthya Suraksha Yojana:
- Faces allocation pressures.
- International Comparison
- Countries like Bhutan, Sri Lanka, and BRICS nations spend significantly more per capita.
Relevant Prelims Points:
- National Health Policy 2017: 2.5% of GDP target.
- Centrally Sponsored Schemes (CSS): Shared funding model (Centre + State).
- Health and Education Cess: Levied on income tax to fund health and education.
- Revenue vs Capital Expenditure in health.
- Structure and objectives of NHM (launched 2005).
Relevant Mains Points:
- Federalism & Fiscal Architecture
- Health is a State subject (Entry 6, State List).
- Declining Union transfers strain poorer States.
- Cooperative vs coercive fiscal federalism debate.
- Equity & Access
- Low public spending increases:
- Out-of-pocket expenditure.
- Health inequality.
- Undermines Universal Health Coverage (UHC).
- Post-Pandemic Fiscal Priorities
- COVID-era spike driven by States.
- Reversal indicates shifting Union priorities.
- Structural Issues
- Underutilisation of cess funds.
- Inadequate capital investment in public health infrastructure.
Way Forward:
- Restore momentum towards 2.5% GDP target.
- Increase untied grants to States.
- Ensure transparency in cess utilisation.
- Prioritise primary healthcare and preventive services.
UPSC Relevance:
- GS 2: Health, federalism, social justice.
- GS 3: Public expenditure management.
- Prelims: NHP 2017, NHM, CSS structure.