|
 In a bid last year to give India's states more power, the federal
health ministry started sending funds for public health programs to
state treasuries, instead of direct transfers to its regional arms.
But poorly-run regional bureaucracies were unable to cope and both
the flagship National Health Mission (NHM) and India's AIDS
prevention programs suffered - thousands of health workers were not
paid for months and the construction of clinics in rural areas was
delayed.
In some cases, state governments temporarily used the funds
earmarked for health programs to meet needs of other sectors, health
officials said.
The funds involved amounted to about one-third of the total federal
spending on health, and led to further deterioration in India's
tattered public health system.
Eleven letters obtained by a Reuters reporter under India's Right to
Information Act revealed the health ministry's desperate, and
failed, attempts to push states to release funds to NHM arms.
"The progress in NHM works has slowed down considerably in most of
the states," federal Health Minister J.P. Nadda wrote in a letter to
the finance minister in November. "I urge you to review the decision
and allow the ministry to transfer funds directly to state health
societies."
The decision last year to route many payments through states,
launched by the previous Congress party-led government, affected
other sectors as well, but the impact on health programs has been
glaring.
India spends just 1 percent of its GDP on public health, less than
Afghanistan and Sierra Leone. On Saturday, the federal government
increased the annual budget for its main health department by just 2
percent to $4.8 billion.
Still, India struggles to spend all of its allocated health funds
because of an inadequate number of doctors and hospitals, and
bureaucratic bungling. Data shows the government has only once spent
all of its health budget since 2005.
Since April, the federal government has sent more than $1.3 billion
to the states for the NHM, which undertakes treatment of diseases
such as tuberculosis and malaria, construction of rural health
centers and immunization drives.
No state treasury released the funds to the designated health
societies within a stipulated 15-day period, with delays running
into months in some cases, according to government data seen by
Reuters. More than $180 million is still to be released.
"BUREAU-CRAZY"
Manoj Jhalani, joint secretary at India's health ministry, told
Reuters that several states have voiced concern about the delays and
discussions are ongoing to resolve the situation.
"If resources are not provided in time, implementation of the
program does get affected. There has been some impact on the smooth
operation of NHM," Jhalani said.
Several NHM officials interviewed by Reuters said the state health
units were deprived of funds for months. Salaries, training and
building new clinics were hit.
[to top of second column] |
In the northern state of Jammu and Kashmir, 9,000 health workers
have not received salaries for three months and cash incentives for
women who give birth in a government hospital have been withheld,
said Yash Pal Sharma, the state's director for the NHM.
Treasuries in the north-eastern states of Meghalaya and Mizoram held
NHM funds for 151 days and 79 days, respectively, data as of Feb. 22
showed. In India's third-largest state Maharashtra, funds sent in
June reached the health society in December.
"Outreach programs have been severely impacted," said a health
ministry official in New Delhi. "The entire system has been
paralyzed, bureaucracy has become bureau-crazy."
AIDS PROGRAM
India's AIDS prevention drive, a program separate from the NHM, was
also affected by the new payments system. Workers from high-risk
groups, such as sex workers and injectable drug users, who are
employed to run programs within their communities are quitting
because of irregular pay.
Rama, a project manager in one such community-based program for sex
workers in Mumbai, said 17 of her 23 team members have quit because
of delayed salaries. New people hired will take months before they
can efficiently run the program.
"It takes a lot of time to build trust within our communities. Our
HIV testing numbers have fallen by half because sex workers don't
trust new people," said the 26-year-old, who says she moonlights as
a sex worker herself to survive.
India runs more than 1,800 community-based programs for AIDS
prevention. The World Bank has estimated India's policy of targeting
sex workers to control AIDS would avert three million infections
during 1995-2015.
Government data showed that India's National AIDS Control
Organisation released $67 million to state governments in recent
months as a second installment for the overall program, but only $39
million reached its state-level health societies. The first
installment of $78 million was released by state treasuries after
months of delays.
"What can we do if states are not caring about its people?" said a
government official in the federal capital, New Delhi. "Now we are
at risk of the numbers (of AIDS patients) increasing again."
(Editing by Raju Gopalakrishnan)
[© 2015 Thomson Reuters. All rights
reserved.] Copyright 2015 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed. |
