Our previous study of health expenditure across the states analysed the government financial data (of Ministry of Health and Family Welfare) under all major heads of accounts, but it did not have break up of data within those heads. The need for such data for research and advocacy purposes is obvious. Thus, in 1994-95 a project to collect disaggregated data on the major disease control programmes (Malaria, Tuberculosis, Leprosy, Blindness and AIDS) for the period 1989-90 to 1994-95 was undertaken. This study revealed many disturbing trends in the financial support provided by the government for these diseases afflicting millions in our country.
Only in the period between 1951-61, when the country declared war against malaria, was about one fourth of the total government health expenditure spent on Disease Control Programmes (DCPs), but thereafter it has remained on an average around 12% to 13%. This is despite the fact that overall morbidity due to communicable diseases has not declined.
Further, the expenditure on DCPs has also shown a declining trend as a percentage of government expenditures. A major reason for this has been a decline in central government grants to the states. The states most adversely affected are Assam, Karnataka, Madhya Pradesh, Punjab, Rajasthan and Tamil Nadu. Only a minuscule per capita amount is allocated to the DCPs. For instance, Bihar, West Bengal, Assam, Karnataka, Rajasthan and Tamil Nadu spend, on an average, a meager Rs. 7 per capita per annum on the DCPs.
Within DCPs, on an average, more than 50% of the expenditure is incurred on malaria, 15% to 20% on leprosy, 3% to 4% on tuberculosis and less than 1% on blindness control. AIDS being a new entrant, the expenditure on it is reflected only in some of the state budgets.
Further, the major item of expenditure under the DCPs is on the payment of salaries of personnel while the supply of essential drugs for treatment, supplies for preventive measures, transportation etc. are provided inadequate funding.
The study concludes that the principal reason for this state of affairs is the dissipated and program based approach. What the country needs is a universally accessible comprehensive health care within which the priority areas like disease control are adequately taken care of. In the absence of the former, the latter is unlikely to realise its objectives.
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