Prashant Raymus CEHAT, MUMBAI Seminar on Seminar on "Maharashtra's Budget 2011: A Scrutiny of Development Discourse A Scrutiny of Development Discourse" 25 March 2011 Maharashtra’s Health Budget : A Macro Perspective

Fiscal Health of the Maharashtra State  GSDP Growth Rate % for last 10 years  Surplus/deficit indicators For year , & surplus of revenue over expenditure i.e Rs. 810, 14,803 & 5,577 crore respectively. for year surplus of Rs. 8,006. Maharashtra enacted the Maharashtra FRBM Act in April 2005 moved towards reducing deficit

 States Revenue receipts (Tax 1 and Non Tax revenue 2 ) as % of GSDP for year is and later years decline to 9.05 %  The State ’ s Own tax revenue remain stagnant around 7.6% of GSDP for 3 years and last year declined to 7.17 %. The expected State ’ s Own tax revenue has not grown in response to increasing GSDP.  The States focus on Non-tax sources (Non-tax revenues largely comprise Interest receipts, and receipts from General, Social, and Economic services) to mobilise greater revenues this has performed well in , increased from 2.26 ( in ) to 3.15 ( ) percent of GSDP by introducing suitable reforms of improved cost recovery. Revenue receipts

Expenditure Economic Services Agriculture and allied services, Rural development, Special programmes for hill Areas, Irrigation and Flood control, Energy, Industry and Minerals, Transport, Science Technology and Environment and Secretariat of department of Economic Services.  Share of development oriented program is 80 % and other expenditure only around 14 %.  Economic services expenditure increased at a Growth rate of % and its share as percentage of Total expenditure increased from to 30.81% for year to , in shown a drastic increase to 35 %  With NSDP shows the growth rate of for last eight year, the economic services as per centage of NSDP has shown an increasing trend from 3.61 to 5.5 % in to

Social Services  Social services expenditure showed a growth rate of 8.40 % and as per centage of NSDP remain stagnant around 5.5% for to years and later decline  State with higher rate of economic growth, intra–state distribution of income inequality stay very high  Standard Deviation of per capita NDDP for the all district [ of Maharashtra (excluding the Mumbai), the dispersion increase from 0.28 in to 0.33 in [  Close look at these values indicates that aggregate inequality did not rise much till 1997, but there has been rise during the last few years ie from till  While inter district income differences are high, state investment in social sectors would help to offset the imbalance of income disparity. But as we have seen earlier this has not happened

Public Sector Health Care Financing and Expenditure  Health is a ‘state’ subject. States account for nearly 80 per cent of all public expenditure on health and the rest being borne by central government expenditure and tied grants to the state  Total government health care expenditure increased from Rs 1,775 crore in to Rs. 4,961 crore in (Actual). For ( RE) is Rs. 4,961 crores and ( BE) is Rs. crore  In real terms Rs 1,090 crore in to Rs. 3,036 crore in (using as the base year). This shows a 9 % per year real increase but the overall government spending also increased at the that rate % in real terms

 Health expenditure as percent to total Social Services expenditure, ( RE) (BE) Public Health Exp1,7751,6971,9251,9242,0712,3882,7833,4453,9114,9615,344 Public Health Exp (real term) 1,0901,1181,9241,6241,9022,4582,8773,036 as % of Tot Exp ** as % of Social Service** Public Health Expenditure, Maharashtra (Rs. in crore) For two years ( & ) it moved up a little but a closer look indicates the share of centrally sponsored schemes/Central plan schemes contribution in the total health expenditure increased from 10.8 per cent in to 13 percent in , indicating state abducting its role of welfare state.

Table Distribution of the health resources in district  exclusively “supply-side considerations” (i.e., the existing supply of infrastructure and personnel).  As of 2009, CAG report observes, against the additional requirement of 2,627 Sub Centres, 394 PHCs and 95 CHCs to be set up during the Mission period, construction of only 161 Sub-Centres was completed and no new PHCs and CHCs were set up during

Conclude: Maharashtra needs to increase the health budget substantially at least upto 3% of NSDP on the average as mandated by the NRHM to be able to provide quality public health care when we are talking about effective delivery of currently mandated health services as per government policy. State government planning authority need to take serious action for removing regional imbalance and for maintaining inter-district equity while making provisions for health services.