Nine states including UP, MP and Rajasthan suffer worst healthcare in India

Nine of India’s poorest states–home to 581 million or 48% of India’s population–account for 70% of the country’s infant deaths, 75% of under-five deaths and 62% of maternal deaths

Nine of India’s poorest states–home to 581 million or 48% of India’s population–account for 70% of the country’s infant deaths, 75% of under-five deaths and 62% of maternal deaths, but do not spend even the money they have set aside for healthcare, according to an IndiaSpend analysis of 2017 Reserve Bank of India , lower than the budgeted 4.1% for Bihar and 6.6% for Rajasthan.

Seven of the nine “high-focus” states report such underspending.

“High focus states allocate large amounts to social sector to improve their indicators but in reality they spend only a small amount, compared to what is allotted,” Kapur said. “Hence, it is necessary to consider actual accounts in order to know the proper outcomes.”

So, while some “high-focus” states spent less money than set aside by their budgets, other states outspent–by proportion as ratio to aggregate expenditure–other larger states on healthcare and family welfare, but that had no relation to their healthcare indicators.

Since 2008, Rajasthan increased its spending by 0.8% and its MMR decreased 23% while Andhra Pradesh’s spending increased by 0.5% and MMR decreased 31%.

Assam, which spends 4.2% of its total expenditure on health and has 31.2 million people, has an MMR of 300 deaths per 100,000 births–comparable to Zambia and Thailand–while Kerala, which spends 5.3% on 33.4 million, reported an MMR of 61, comparable to Sri Lanka and Poland.

Madhya Pradesh, which reported an infant mortality rate (IMR)–deaths per 1,000 live births–of 51 in 2015-16, spends 4.3% of total expenditure on healthcare–against 5% that was budgeted–and, as IndiaSpend reported on January 21, 2016, is worse off than some of the world’s poorest countries, such as the Gambia and Ethiopia.

Spending more on healthcare did not improve institutional births

In the nine “high-focus” states we studied, 72.6% of all births were in healthcare institutions, a steady improvement but below the national average of 78.9%, according to the 2015-16 National Family Health Survey (NFHS-4) the latest available.

Tamil Nadu with 72.1 million people spends 4.7% of its total budgeted expenditure on public healthcare and family welfare and reports 99% institutional births, while Jharkhand, with 33 million, spends 4% and reports 61.9% institutional births.

There is a 13% shortfall of CHCs in the “high-focus” states, according to

Bihar was 93% short of specialists in CHCs, while the comparable figures were 90%, 84% and 84% in Chhattisgarh, Uttar Pradesh and Jharkhand, respectively, in March 2016, according to Accountability Initiative budget brief on National Health Mission.

The infrastructure shortage is made worse by the fact that in all the nine states, healthcare programmes are accessed by richer households while many poor households are excluded due to high direct and indirect costs, according to this 2012 study in PLOS-ONE, an online open-access scientific journal.

Such infrastructure shortages exacerbate inadequate spending and deliver low heath achievements. Increased primary healthcare spending reduces child and infant mortality rates, according to this 1999 research paper by the International Monetary Fund.

Promoting community-based education on improved maternal and newborn care, and home-based treatment for newborn infections could enhance child survival in the “high- focus” states “significantly”, said the 2012 PLOS-ONE study.

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