India’s main public health programmes, aimed at millions of rural poor, have been in disarray for months because the government changed the way that over $1.3 billion in funds were distributed, according to data and letters seen by Reuters.
Last year, in a bid to give the states more power, the Union health ministry started sending funds for public health programmes to state treasuries, instead of direct transfers to its regional arms.
But poorly-run regional bureaucracies were unable to cope and both the flagship National Health Mission (NHM) and India’s AIDS prevention programmes suffered — thousands of health workers were not paid for months and the construction of clinics in rural areas was delayed.
Eleven letters obtained by a Reuters reporter under Right to Information (RTI) Act revealed the health ministry’s desperate, and failed, attempts to push states to release funds to NHM arms.
“The progress in NHM works has slowed down considerably in most of the states,” Union health minister JP Nadda wrote in a letter to the finance minister in November. “I urge you to review the decision and allow the ministry to transfer funds directly to state health societies.”
The decision last year to route many payments through states, launched by the previous Congress party-led government, affected other sectors as well, but the impact on health programmes has been glaring.
Since April, the Centre has sent more than $1.3 billion to the states for the NHM.
No state treasury released the funds to the designated health societies within a stipulated 15-day period, according to government data seen by Reuters. More than $180 million is still to be released.
Manoj Jhalani, joint secretary at the Union health ministry, told Reuters that several states have voiced concern about the delays and discussions are ongoing to resolve the situation.
In Jammu and Kashmir, 9,000 health workers have not received salaries for three months, said Yash Pal Sharma, the state’s director for the NHM.
Treasuries in Meghalaya and Mizoram held NHM funds for 151 days and 79 days, respectively, data as on February 22 showed. In India’s third-largest state, Maharashtra, funds sent in June reached the health society in December.
India’s AIDS prevention drive, a programme separate from the NHM, was also affected by the new payments system. Workers from high-risk groups, such as sex workers and injectable drug users, who are employed to run programmes within their communities are quitting because of irregular pay.
Government data showed that National AIDS Control Organisation (NACO) released $67 million to state governments in recent months as a second installment for the overall programme, but only $39 million reached its state-level health societies.