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BUDGET BRIEFS

Vol 8/Issue 3

National Health Mission (NHM)


GOI, 2016-17
The National Health
HIGHLIGHTS
Mission (NHM) is the
Government of Indias
(GOI) largest public health 19,437cr 14,827cr
programme. NHM consists GOI allocations for NHM GOI allocations for NRHM
of two sub-missions: in FY 2016-17 in FY 2015-16
National Rural Health
Mission (NRHM)
National Urban Health SUMMARY & ANALYSIS
Mission (NUHM)
In FY 2016-17, GOI allocated `19,437 crore to NHM, an increase of 2 per cent from FY 2015-16.
Using government data, this I n FY 2015-16 allocations for NRHM accounted for 79 per cent of the total NHM budget,
brief reports on the trends which is an 11 per cent decrease from FY 2014-15.
in allocations, release and
expenditure for NRHM T here are state-wide variations in releases. In Uttarakhand releases were only 11 per cent of
allocations in FY 2015-16, compared to 83 per cent in FY 2014-15. The corresponding figures
Cost share and for Bihar are 75 per cent and 69 per cent, respectively.
implementation: From FY E xpenditure was slow in FY 2015-16. Rajasthan had spent only 13 per cent of its approved
2015-16, 60 per cent of the
allocation by the end of the second quarter of FY 2015-16, compared with 34 per cent in the
funds are to come from
second quarter of FY 2014-15.
GOI and the rest from the
states. Prior to this, 75 per  evised GOI cost share reduced GOI allocations from 66 per cent of approvals in FY 2014-15 to
R
cent of the funds came 41 per cent in FY 2015-16.
from GOI. Release of funds
is based on states Project
S pending priorities have changed. 33 per cent of the NHRM budget was allocated to the
Implementation Plans (PIP). NRHM Flexipool in FY 2015-16 compared to 44 per cent in FY 2014-15, while allocations for
the National Disease Control Programme (NDCP) increased.

 n 25 December 2014, the Ministry of Health and Family Welfare (MHFW) launched Mission
O
Indradhanush to achieve full immunisation coverage by 2020. However, funds approved in
2015-16 for immunisation decreased to 2 per cent of total approvals from 4 per cent in FY
2014-15.

Accountability Initiative, Centre for Policy Research, Dharam Marg, Chanakyapuri, New Delhi - 110021
Prepared by: Padmapriya Janakiraman, pjanakiraman@accountabilityindia.org & Avani Kapur, akapur@accountabilityindia.org
Special thanks: Prerananandita Baisnab
TRENDS IN GOI ALLOCATIONS FOR NHM
In May 2013, GOI launched NHM a comprehensive health scheme aimed at guiding states
towards universal access to healthcare through strengthening health systems, institutions and
capabilities. NHM consists of two sub-missions: a) National Rural Health Mission (NRHM)
launched in 2005, and b) National Urban Health Mission (NUHM) launched in 2013.

A
 llocations: In FY 2016-17, GOI allocated `19,437 crore to NHM. This was a 2 per cent increase
over FY 2015-16.

NHM ALLOCATIONS BETWEEN FY 2011-12 AND FY 2016-17

19,122 19,437
20000 18,375 18,609
17,310 17,188
16000

12000

8000

4000

0
2011-12 2012-13 2013-14 2014-15 2015-16 2016-17
GOI allocations for NHM

Source: India Expenditure Budget, Vol 2, Ministry of Health and Family Welfare. Available online at: http://
indiabudget.nic.in.

11%
Note: Figures are in `crore and are revised estimates, except for FY 2016-17 which are budget estimates. FY 2016-15
figure includes expenditure on the National Health Mission: AYUSH as classified in the Demands for Grants.
Last accessed on 29 February, 2016.

decrease in NRHM
allocations between TRENDS IN GOI ALLOCATIONS AND RELEASES
FY 2014-15 and
FY 2015-16
FOR NRHM
G
 OI allocations: NRHM is the largest component of NHM, accounting for 79 per cent of total
NHM allocations in FY 2015-16. Since FY 2014-15, budget documents have stopped reporting
NRHM allocations separately. Data from the quarterly reports of NRHM indicates that in FY
2015-16, `14,827 crore was allocated to NRHM an 11 per cent decrease over FY 2014-15.

Total approvals under NRHM are based on Project Implementation Plans (PIP) submitted
by state governments and the total resource envelope available with GOI. This resource
envelope includes GOIs own funds, proportional share of state releases and uncommitted
unspent balances available with the states.

T here are differences in allocations proposed by states and those approved by GOI. In FY
2015-16, 91 per cent of the total funds proposed by states were approved.

R
 eleases: : Till FY 2013-14 funds for NRHM were released directly by GOI and state
governments to autonomous implementing bodies known as State Implementation
Societies (SIS). In FY 2014-15 a new fund flow mechanism was introduced. Under this system,
GOI allocations are first released to the state treasury. The money is then routed by the state
health department to SIS.

2 ACCOUNTABILITY INITIATIVE, INDIA


The proportion of allocations released to state governments has been dropping consistently. Andhra Pradesh and Bihar
In FY 2009-10, 99 per cent of allocations were released. This dropped to 88 per cent in FY had the lowest approval
2014-15. rate with 52% and
This drop in releases can be largely attributed to decreases in six major states, namely
Jharkhand, Andhra Pradesh, Jammu and Kashmir, Himachal Pradesh, Karnataka and 68%
Haryana. of proposals approved in
FY 2015-16
Overall, the pace of fund release in both FY 2014-15 and FY 2015-16 is similar. More than half
the funds had been released by September, halfway through the financial year, in both years.
However, in FY 2015-16, 57 per cent of GOI allocations had been released in the first quarter
itself, compared to 29 per cent in the previous FY.

57% OF NRHM FUNDS RELEASED IN Q1 OF FY 2015-16

60% 57%

40% 32%
29%
21%
20%
6%
0.2% 0% 0%
0%
Quarter 1 Quarter 2 Quarter 3 Quarter 4
% of GOI funds released in 2014-15 % of GOI funds released in 2015-16

Source: NRHM Website, quarterly NRHM MIS reports, June 2014 to September 2015. Available online at: http://nrhm.gov.
in/component/content/article.html?id=405. Last accessed on 25 February, 2016.

TRENDS IN STATE-WISE ALLOCATIONS AND


EXPENDITURES
T o address regional imbalances in health outcomes, NRHM identified a set of 18 High Focus
(HF) states with the poorest health indicators. These states received 62 per cent of the total
GOI allocations for NRHM in FY 2015-16.

 roposed vs. approved allocations: There are state-wise variations in approvals of funds.
P
Andhra Pradesh and Bihar had the lowest approval rate with 52 and 68 per cent of proposals
being approved in FY 2015-16, respectively. In contrast, over 90 per cent of funds proposed by
West Bengal and Odisha were approved, up from less than 80 per cent in FY 2014-15.

R
 eleases: While the overall pace of release of funds for GOI was faster in FY 2015-16, there
were state variations. In FY 2014-15, GOI had released 90 per cent of its allocations for Tamil
Nadu and 83 per cent for Uttarakhand halfway through the financial year. However, in FY
2015-16, during the same period GOI released only 52 per cent and 11 per cent, respectively.
In contrast, fund release was faster in Rajasthan, Assam, Bihar, Himachal Pradesh and Uttar
Pradesh.

BUDGET BRIEFS, NHM, GOI 2016-17, VOL8/ISSUE3 3


UTTARAKHAND ONLY RELEASED 11% OF ITS ALLOCATION IN FY 2015-16
100%
90%
86% 87%
83%
75%
80% 74% 71% 74%
72% 72%
69% 68% 67% 66%
64% 61%
59% 57%
55%
60% 52% 52% 51%
44%
41%
40% 39%
39% 37% 35%
40%

17%
20% 11%
9%
6%
4%
0%
an ha
r h al m ir a ka h u h sh at ra nd ra sh
th Bi des ng sa hm ish ta des ad gar de ujar asht kha ripu de
aja
s ra tB
e As as Od rna ra il N ttis ra G r a T ra
lP es dK Ka rP m a P
ah
a t r l P
R ha n ta Ta Chh ra Ut ha
ac W ua Ut dh M ac
m m An un
Hi m A r
Ja

% of GOI funds released till Quarter % of GOI funds released till Quarter
2 in 2015-16 2 in 2014-15

Source: NRHM Website, quarterly NRHM MIS reports, June 2014 to September 2015. Available online at: http://
nrhm.gov.in/component/content/article.html?id=405. Last accessed on 24 February, 2016.

 xpenditure performance: There are significant state variations in expenditures as a


E
proportion of total approvals (GOI and state shares). In FY 2014-15, Jharkhand spent only 40 per
cent of its total approved budget, down from 61 per cent in FY 2013-14. In contrast, expenditure
in Uttar Pradesh improved from 82 per cent to 94 per cent during the same period.

EXPENDITURE PERFORMANCE VARIED ACROSS STATES BETWEEN FY 2013-14 AND


FY 2014-15
100% 94%
96% 96% 93%
93% 88% 92% 93%
89% 89%
90% 87% 87%
85% 84% 82% 82% 81%
82% 79% 79%
80% 75% 78% 74% 74% 73%
72% 69%

61%
60%

40%
40%
In FY 2014-15, Jharkhand
spent 40% of its total
approved budget while 20%

Uttar Pradesh spent nearly

94%
0%
ha l r at
de
sh an
d
de
sh an ar
h jab desh tra na ga ak
a
ha jar
nd
kh sth tisg un dis rash arya Ben at Bi ha
Pra ra Pra j a t P Pra O a H t r n Gu a rk
a Ut
t
ta
r Ra ha ra ah es Ka Jh
hy Ut Ch dh M W
ad An
M

% spent out of total approvals % spent out of total approvals


in 2014-15 in 2013-14

Source: NRHM website, State Programme Implementation Plans 201314 and 2014-15 for approved allocations.
Available online at: http://nrhm.gov.in/nrhm-in-state/state-program-implementation-plans-pips.html. Quarterly NRHM
MIS reports, September 2015 for expenditures. Available online at: http://nrhm.gov.in/component/content/article.
html?id=405. Last accessed on 1 February, 2016.

4 ACCOUNTABILITY INITIATIVE, INDIA


EXPENDITURE IN RAJASTHAN DROPPED BY 21% BETWEEN SEPTEMBER 2014 AND
SEPTEMBER 2015
35% 34%

30% 27%
25%
25% 23% 23%
21%
20% 17%

15% 13% 13% 13%

9%
10% 8%
7% 7% 9%
6%
4% 5% 5% 5%
5%

r nd ir a h h d an h rh
ha hm ish es es an es ga
Bi k ha
as Od ad ad kh jasth ra
d
tis
ar Pr Pr ttr
a
aP
t
Jh n dK ar al U Ra y ha
ua Ut
t
ac
h
a dh Ch
m m
am Hi M
J
Expenditure as a % of approvals Expenditure as a % of approvals
in 2015-16 in 2014-15

Source: NRHM Website, state records of proceedings 201516. Available online at: http://nrhm.gov.in/nrhm-in-state/state-
program-implementation-plans-pips.html. For GOI allocations, quarterly NRHM MIS reports September 2015. Available
online at: http://nrhm.gov.in/component/content/article.html?id=405.
Last accessed on 1 February, 2016.
Bihar had spent only
The pace of expenditure has been slower in FY 2015-16 for most states. In FY 2014-15, by
September, Rajasthan had spent 34 per cent of its approved allocation. In FY 2015-16, however,
it had spent only 13 per cent. Up to September 2015, Bihar had spent only 4 per cent of its total
4%
of its total approvals by
approvals. September 2015

In contrast, expenditure in Chhattisgarh and Himachal Pradesh was faster in FY 2015-16
compared with the previous year.

TRENDS IN COMPONENT-WISE ALLOCATIONS


AND EXPENDITURES
T here are five main components for which funds are allocated under NRHM. These are:
Reproductive, Maternal, Newborn and Child Health (RMNCH) services
NRHM Mission Flexipool or funds for strengthening health resource systems, innovations
and Information, Education and Communication (IEC)
Immunisation, including the Pulse Polio Programme
National Disease Control Programme (NDCP)
Funds for Infrastructural Maintenance

 llocations: As mentioned earlier, the GOI budget for NRHM decreased in FY 2015-16.
A
Further, the cost share has been revised, with GOI now providing a lower share of NRHM
funds.

GOI allocations as a percentage of total approvals across 16 major states have reduced from
66 per cent in FY 2014-15 to 41 per cent in FY 2015-16.

BUDGET BRIEFS, NHM, GOI 2016-17, VOL8/ISSUE3 5


35% OF GOI ALLOCATIONS WERE FOR FLEXIPOOL

50%
44%

40% 38%
33% 33%

30%
23%

20%
11%
10% 9%
10%

0%
RMNCH NRHM Flexi Pool NDCP Infrastructure

% share of total approvals in 2015-16 % share of GOI allocations in 2015-16

Source: NRHM Website, state records of proceedings 201516. Available online at: http://nrhm.gov.in/nrhm-in-
state/state-program-implementation-plans-pips.html. For GOI allocations, quarterly NRHM MIS reports September
2015. Available online at: http://nrhm.gov.in/component/content/article.html?id=405.
Note: This data pertains to 16 major states of India.
Last accessed on 1 February, 2016.

 comparison of GOI allocations with total approvals across components gives some
A
indication of changes in GOI priorities.

I n FY 2015-16, GOI allocations for NRHM Flexipool were 33 per cent while approvals were 44
per cent. However, allocations for NDCP by GOI appear to be higher in comparison to states.
GOI allocations for NDCP were 23 per cent while approvals were 10 per cent.

 etween FY 2014-15 and 2015-16, GOI allocations increased by a little more than 100 per cent
B
for infrastructure but reduced by 59 per cent for NDCP. For the same period, approvals for
NDCP jumped by 87 per cent but decreased for infrastructure by 5 per cent.

70% OF NDCP PROPOSALS PREPARED BY STATES WERE APPROVED IN FY 2015-16

140%
123%
120%

100% 96% 93%


85%
80% 70%

60%
40%
40% 32%

20%
2% 9% 9%

0%
RMNCH Immunisation NRHM Flexi Pool NDCP Infrastructure
% of total funds approved in 2015-16 % of proposed funds approved in 2015-16

Source: NRHM Website, state records of proceedings 201516. Available online at: http://nrhm.gov.in/nrhm-in-
state/state-program-implementation-plans-pips.html.
Note: This data pertains to 22 major states of India.
Last accessed on 1 February, 2016.

In FY 2015-16, 32 per cent of total NRHM funds were allocated to RMNCH. This was followed
by 40 per cent for Mission Flexipool and 9 per cent each for diseases and infrastructure
maintenance. Funds for immunisation constituted only 2 per cent of the total allocation.

6 ACCOUNTABILITY INITIATIVE, INDIA


Gaps between amounts proposed and final approvals give a sense of GOI prioritisation
across activities, particularly when states expect budget cuts. In FY 2015-16, while states
proposed more than three times the total resource envelope available for NRHM Flexipool,
only 83 per cent of the proposed funds were approved.

Andhra Pradesh and Haryana had the lowest approvals under RMNCH, at 66 per cent and 86
per cent, respectively.

There are state level differences in the pattern of investments across components. Bihar
allocated half of its total funds to the RMNCH, while allocating 29 per cent to NRHM
Flexipool. In contrast, Uttarakhand and Tamil Nadu allocated 37 per cent and 28 per cent of
their funds, respectively, to NRHM Flexipool.

Most states allocated at least 10 per cent of their funds to infrastructure maintenance.

IN FY 2015-16, BIHAR ALLOCATED 48% TO RMNCH, UTTARAKHAND 26% AND


HARYANA 35%

120%

100%
8% 12% 8% 14%
11% 9% 9%
80% 11%

29% 34%
60% 37% 28%
4%
1% 2% 1%
40%
2%
3% 11% 14% Most states allocated
48%
at least

10%
20% 35% 33%
36%
0%
Bihar Uttarakhand Haryana Tamil Nadu

RMNCH NUHM Flexipool Immunisation


of their funds to
NRHM Flexipool Diseases Infrastructure Maintenance
infrastructure
maintenance
Source: NRHM website, state records of proceedings 2015-16. Available online at: http://nrhm.gov.in/nrhm-in-state/
state-program-implementation-plans-pips.html. Last accessed on 1 February, 2016.

BUDGET BRIEFS, NHM, GOI 2016-17, VOL8/ISSUE3 7


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