The Central government has two ongoing programmes relating to education and healthcare the Sarva Shiksha Abhiyan (SSA) and the National Rural Health Mission (NRHM) and according to the audit performance of the programmes by the Accountability Initiative of the Centre of Policy Research, it can be seen that though the government has been constantly increasing outlays, the expenditure and outcomes are lagging far behind.
For instance, during the Eleventh Five-Year plan, the Central governments budget for SSA increased nearly three-fold from R21,360 crore in FY 2007-08 to R61,734 crore in FY 2011-12. In fact, during this period, the per-student allocation has more than tripled from an India average of R1,598 in FY 2007-08 to R4,746 in FY 2011-12. However, expenditure has failed to keep pace as only 61% of the allocation was spent in FY 2011-12.
There are other deficiencies in the actual implementation of the programmes by the state governments. There is a large number of vacancies in key posts such as block resource coordinators. For instance, in FY 2011-12, 60% of the BRC posts in Bihar and 58% on Orissa were lying vacant. Even learning levels have remained low. Another disturbing trend is that despite the governments rising spend, the share of enrolments in private schools as a percentage of total enrolments is increasing. In Punjab, for instance, the total share of enrolment in government schools dropped from 83% to 70% between 2007 and 2010.
Another interesting trend noted is that a large percentage of funds is generally spent towards the end of the fiscal year. For instance, in FY 2007-08, 70% of the total funds were spent in the last two quarters of the year. There were some improvements in FY2011-12 when expenditure was incurred more evenly with 44% spent in the first two quarters and 56% in the last two quarters. Though this improvement is due to the introduction of a new reporting format, the quality of reporting is a concern area. For instance, in FY 2010-11, the audited expenditure for Chhattisgarh was 65% less than the format for monthly reporting.
The performance with regard to NRHM follows a similar track. While public expenditure on health accounted for just 1.3% of the GDP in FY 2011-12, which is significantly lower than that for most other developing countries, the Central governments allocation for NRHM have more than doubled since its launch in 2005. In FY 2011-12, NRHM allocations stood at R20,855 crore, accounting for 60% of the total ministry of health and family welfares budget. Expenditure as a percentage of total releases has improved over the last six years. For instance, when NRHM was launched in FY 2005-06, only 72% of the total released funds were spent which went up to 86% in FY 2011-12.
However, most states have been slow in releasing their required share for NRHM. In FY 2010-11, Andhra Pradesh did not release any money to the state health society, while West Bengal and Bihar released 79% and 48% less than the required share.
There are other gaps in allocation versus outcome. While financial allocation for increasing human resources in public health facilities has increased nearly three-fold between FY 2010-11 and FY 2012-13, vacancy rates for doctors in primary healthcare centres across the country remain very high. Specialists are even harder to find and community health centres do not have the required number of specialists.