15th Finance Commission to study the spending on health

The Fifteenth Finance Commission and the World Bank will study the spending on health through Centrally sponsored schemes and for the first time will devote an entire chapter on health financing, N.K Singh Chairman of the Commission said on Tuesday.
The High Level Committee on Health sector constituted by the Commission will dove-tail their study and analysis to come up with suitable recommendations for health sector, Singh said.

For a better understanding of the contours of India’s Health Sector and in view of the Union Government’s need and intention for reprioritization of its health spending, the 15th Finance commission held a detailed meeting with representatives of the World Bank, Niti Aayog and member of the Commission’s High level group (HLG) on the health sector on Tuesday.

In wake of covid-19 pandemic, the World Bank urged the government to develop and roll-out real time surveillance and reporting system for human and animal health surveillance as most future outbreaks will be Zoonotic (from animals to humans).

World Bank said that the roll-out targeted investments are important to enhance integrated public health laboratory infrastructure and functions in states where capacities are weak. It called for developing and deploying district surveillance teams with core competencies in integrated disease surveillance across different states and at the central level to enhance analytical capacity for early and appropriate response (Epidemic Intelligence Service).

During the meeting it was discussed that Finance Commission may like to look at health in three different ways: grants to enhance per capita spending, block grant for capacity building and a performance incentives for certain health outcomes.

“A pivotal role may be played by local bodies. Also, more than 60% of health demand in India is supplied by private sector. Leveraging private clinics along with DBT may be used as tools to increase engagement with private sector,” said Dr Junaid Ahmad, Country Director, The World Bank.

“Importance of non-communicable disease can’t be undermined. Another area that needs focus is infectious disease programs like tuberculosis,” he said.

The world bank highlighted that the quality of care has emerged as a key issue in India’s health system. Also, there is huge variability across states and care providers.

To ensure better quality of spending, there is a need for PFM reforms to improve budget execution, resource allocation formulas from states to districts should better reflect population need (mortality/morbidity/equity) rather than historical norms, reduce fragmentation of health protection schemes and a gradual shift to demand-side financing modalities, it said.

There is also a need for renewed focus on equity and need citing example of national health mission (NHM) should be related to per capita spending on health, similarly, spending per beneficiary must increase in poorer States.

“Needs-based transfer formulas for health should be carefully designed. Also, a separate health equalization pot is needed. Explicit accountability frameworks including target results need to be explored. Greater attention to resource allocation is required within States. Service delivery should rely on a robust public/private mix,” the world bank said.

The World Bank recommended that strengthening of surveillance and district level capacity should be done to identify and respond to future epidemics.

The world bank urged that institutions like ICMR, NCDC and NDMA should be strengthened for disease preparedness, diagnostics, investigation, response and population health. Institutional reforms and innovations should be promoted in vertical disease control programs like TB, HIV, VBD. Local bodies like municipalities should also be strengthened in terms of resources and capacity building so that they can play incremental role in health care delivery.

“The public –private partnership in health sector should be encouraged and there should be enhanced focus on investigative infrastructure of health,” said Dr Randeep Guleria, Director, AIIMS said. – Livemint