The Hindu Newspaper Analysis

Editorial Topic : Health Budget Allocation and Outcome Gap in Indian States

 GS-3 Mains Exam : Economy

Revision Notes

 

Context:

• State-Level Parameters: The success of Union Budget health allocations depends heavily on State-level fiscal space and operational frameworks.
• Centrally Sponsored Schemes (CSS): States share the costs and responsibilities for implementing major health initiatives funded by the Union government.

 

Major CSS Initiatives for Health Infrastructure:

1. Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM):

1. • Focus: Build health and wellness centres (AB-HWCs), block-level public health units (BPHUs), district public health laboratories (IDPHLs), and critical care hospital blocks (CCHBs) in every district.
   • Objective: Strengthen India’s preparedness for emergencies, such as pandemics.

2. Human Resources for Health and Medical Education (HRHME):

1. • Goal: Scale up medical personnel by establishing new medical, nursing, and paramedical colleges.
   • District-level Focus: Upgrade district hospitals and attach them to newly established medical colleges for local-level healthcare improvement.

 

Concerns: Low Fund Utilisation

• Analysis of Central Expenditure (2022-24):
  • PM-ABHIM: Only 29% of the budget allocation was utilised in 2022-23, with a slight improvement to 50% in 2023-24 (Revised Estimate).
  • HRHME: Less than 25% of the allocated funds were utilised in both 2022-23 and 2023-24.

 

Factors Behind Low Utilisation Under PM-ABHIM:

1. AB-HWC Component:

1. • Finance Commission Grants: Only 45% of the 15th Finance Commission health grants were utilised from 2021-22 to 2023-24.
   • Execution Complexity: Complex execution structures at the State level hindered the absorption of funds.

2. IDPHL Component:

1. • Avoiding Duplication: States needed to integrate public health labs across different programs, requiring extensive reorganisation and coordination.

3. BPHUs and CCHBs:

1. • Procedural Delays: Construction-related components faced delays due to rigid procedures and overlapping funding from multiple sources.

 

Faculty Shortages in Medical Education:

1. Challenges in Filling Vacancies:

1. • Even with better utilisation of infrastructure funds, filling teaching positions remains difficult under HRHME.

2. AIIMS Teaching Shortages:

1. • CSEP Study (2022): 40% of teaching faculty positions are vacant in 11 out of 18 newly established All India Institutes of Medical Sciences (AIIMS).

3. State Medical Colleges:

1. • Uttar Pradesh (2022): 30% of teaching faculty positions were vacant in 17 newly created government medical colleges between 2019-21.

4. Shortage of Specialists:

1. • This shortage of specialists impacts the efforts to establish and upgrade district hospitals and CCHBs under PM-ABHIM.

5. Rural Gaps:

1. • Rural Health Statistics (2021-22): Over one-third of specialist positions in urban Community Health Centres (CHCs) and two-thirds in rural CHCs were vacant as of March 2022.

 

Concerns Related to Fiscal Space in States:

1. Recurring Costs for States:

1. • States are responsible for maintaining the physical infrastructure developed under PM-ABHIM and HRHME, adding financial pressure.

2. Union Government’s Limited Support:

1. • Union government’s support for human resources under PM-ABHIM only extends until 2025-26. Beyond that, States must cover recurring expenses.

3. Long-Term Planning Needs:

1. • States’ Responsibility: States must plan for long-term sustainability, including covering costs beyond the central scheme’s duration to ensure continued benefits from capital expenditure.

4. Creating Fiscal Space:

1. • States must generate the necessary fiscal room to continue supporting CSS health initiatives alongside their own State-level health programs.

 

Key Examples of Low Fund Utilisation and Challenges:

1. State-Level Variations:

1. • Certain States face more significant challenges in utilising allocated funds due to complex execution structures and staffing shortages.

2. Recurring Expenditures:

1. • The burden of managing physical infrastructure falls heavily on States once initial capital expenditures are exhausted, highlighting the need for sustainable funding models.

 

Conclusion:

• Transforming Capital Allocations: Effective health outcomes depend on States’ fiscal capacity, human resource management, and streamlined financial processes.
  • Fiscal Responsibility: States must plan for additional recurring expenditures to maintain the health infrastructure developed under central schemes.
  • Human Resource Gaps: Addressing the shortage of faculty and specialists, especially in rural areas, is critical for the success of initiatives like PM-ABHIM and HRHME.
  • Public Financial Management: Improving financial management at both central and State levels is essential to avoid underutilisation of budget allocations.

 

Facts and Figures:

• PM-ABHIM Utilisation (2022-23): 29% of allocated funds used.
• HRHME Utilisation (2022-24): Less than 25% of budget used.
• AIIMS Faculty Shortages (2022): 40% vacancy rate in 11 out of 18 new AIIMS institutes.
• Uttar Pradesh (2022): 30% of teaching faculty positions vacant in 17 new government medical colleges.
• Rural CHCs (2021-22): Two-thirds of specialist positions vacant as of March 2022.

 

 

 

The Hindu Newspaper Analysis

Editorial Topic : From Crisis to Cascade of Hope: Cauvery River Dispute

 GS-1 Mains Exam : Geography

Revision Notes

 

Context:

• Water conflicts like the Cauvery dispute often generate biased perspectives during crises.
• Currently, the river remains calm, benefiting both Karnataka and Tamil Nadu.

 

Recent Developments in Tamil Nadu’s Water Share:

• Early July Crisis: Both Karnataka and Tamil Nadu were facing a water crisis.
• July-August Turnaround: Heavy rains in the second half of July dramatically improved the situation, turning Tamil Nadu’s deficit into a surplus.
• Full Share of Water Received:

• • Tamil Nadu received its entire water share for July and August as per the Cauvery Water Disputes Tribunal (CWDT) 2007 ruling, modified by the Supreme Court in 2018.
  • The amount received was slightly higher than the allocated share.

• Water Realization:

• • As of September 2, 2024, Tamil Nadu received around 181 tmc ft of water, surpassing the stipulated amount for the entire water year (177.25 tmc ft).

• Monsoon Allocations (CWDT and Supreme Court):

• • July: 31.24 tmc ft
  • August: 45.95 tmc ft
  • September: 36.76 tmc ft

• Impact of Southwest Monsoon:

• • Crucial for Karnataka’s wettest period and the delivery of 123.14 tmc ft to Tamil Nadu.
  • Except for the first few weeks, the water year 2024-25 has been smooth for both States.

 

Water Allocation and Implementation Mechanism:

• Comparisons with Last Year:

• • In contrast to this year, June-September 2023 saw Tamil Nadu receiving just 33.2 tmc ft of water.

• 30-Year Analysis (1994-2024):

• • On 11 occasions, water realization between June and September was below 100 tmc ft, compared to the stipulated 123.14 tmc ft.
  • Distress occurs once every three years.

• Key Implementing Bodies:

• • Cauvery Water Management Authority (CWMA) and Cauvery Water Regulation Committee (CWRC) are responsible for implementing the Tribunal’s final award.
  • Unlike the former Cauvery River Authority, chaired by the Prime Minister and state Chief Ministers, CWMA is led by a full-time official and includes state and Union government officers.

 

Performance of CWMA and CWRC:

• Transparency Issues:

• • Greater transparency is required in the functioning of CWMA and CWRC. All decisions must be made public promptly.

• Information Sharing:

• • Authentic information sharing between Karnataka and Tamil Nadu is crucial for resolving water disputes.

• Manpower Shortage:

• • CWMA faces a shortage of manpower, affecting its efficiency. Union Ministry of Jal Shakti should address this issue.

• Expanding CWMA Membership:

• • The CWMA should include non-official members such as farmers, environmentalists, and independent water experts.
  • This model can take inspiration from the Chennai Metropolitan Water Supply and Sewerage Board Act, which includes non-official directors from various sectors.

• Environmentalist Role in CWMA:

• • The CWMA’s suggested composition by the Tribunal is advisory. Including an environmentalist would help address concerns about the river’s environmental degradation, especially with challenges posed by climate change.

 

Leveraging Positive Sentiment:

• The current favorable water situation can be used to address Bengaluru’s water shortage:
  • Supreme Court 2018: Allocated 4.75 tmc ft of Cauvery water to Bengaluru.
• Mekedatu Balancing Reservoir Project:
  • The Karnataka government is advocating for the ₹9,000-crore Mekedatu project to meet water needs. The project is under review by the Central Water Commission.

 

Challenges and Way Forward:

1. Trust Deficit:

1. • The trust deficit between Tamil Nadu and Karnataka hinders cooperation on projects like Mekedatu.

2. Third-Party Mediation:

1. • The involvement of a third party, such as the Union government, could be explored for the Mekedatu project or other hydro-electric projects across the Cauvery, upstream of the Mettur reservoir.

3. Previous Attempts:

1. • Despite attempts since the late 1990s to resolve disputes, no breakthrough has been achieved.
   • A fresh, serious attempt is needed to optimize the use of precious water resources.

4. Preventing Water Wastage:

1. • Ensuring that unused water does not go to waste is vital, as is currently happening due to the lack of effective projects.

 

Conclusion:

• Optimal Use of Water Resources: Effective third-party participation and sustained dialogue between Karnataka and Tamil Nadu are key to resolving water-sharing conflicts.
• Improving CWMA: Enhancing CWMA’s transparency, manpower, and inclusivity, along with ensuring a balanced approach, can help ensure fair water distribution between the States and address future crises.