Health planning in India 1951–84: the role of the Planning Commission

Abstract

An attempt is made to answer 2 sets of questions: how much is spent by Indian central and state governments on sectors and how does this relate to plan and nonplan expenditures; and how far does the Indian case support the argument that health sector expenditure in developing countries is skewed too far in favor of curative health services in urban areas. The term health refers to the Indian budgetary categories of medical and public health; health-related includes the plan categories of health family planning (or family welfare) water supply and sanitation and where possible nutrition. In India the most obvious feature of public sector health expenditures is that little in absolute terms is spent directly on providing health services to the population. How little continues to be unclear partly because of the complications caused by the different agencies concerned with health-related issues. The main areas which tend to be omitted from discussions of health expenditures in India are social insurance and nutrition. All government expenditures in India are divided into plan and nonplan categories. The plan covers most new developmental expenditure; the nonplan category covers routine activities. In general for health topics plan expenditures have included all those on preventive campaigns family planning and some water supply and sanitation. In other parts of the health budget only new developments have been paid for from the plan budget with recurrent costs becoming part of the nonplan budget at the end of the relevant plan. In general there have been 3 financial categories of plan expenditures: those paid for totally by central government and disbursed by its own agencies; those paid for in whole or in part by the center but disbursed by state governments; and those funded and disbursed by the state governments. Family planning always has been a completely centrally funded area. The Planning Commission both in its own right and as a channel for foreign pressures has ensured that the Indian plans have been fairly consistent in their emphasis on rural preventive services but the Planning Commission can only restrain expenditures by state governments (rather than being able to insist on spending) and is only concerned with plan expenditures. The actual patterns of total health expenditures may be very different. The differences between outlays and actual plan expenditures are considered along with total health expenditures in some states. In sum the balance between major categories of health expenditure has shifted dramatically towards family planning and the shift is most marked in plan expenditures.