Underfunding of government health programmes both at the national and state levels is a major concern in India, says a new report published by the World Health Organization's Regional Office for South-East Asia. The report titled 'India Health System Review' says the underfunding continued in spite of higher levels of tax devolution from the central to state governments. It also states that the existing systems for regulation of private players in India are lax and variable.

"Three sets of functions underlying the public sector health services must be strengthened: resources, governance and quality. Doubling public health spending, contributed by both the central and state governments, in the next 5 years to reach the target of 8% from the current 4–5% of government expenditure, ought to be prioritized along with mechanisms to strengthen public financial management system so that funds allocated are used efficiently and equitably," the report said. Given the huge shortfalls, the report recommends that a significant share of the increased health sector investment fund must be used to recruit and train health professionals, especially nurses and allied healthcare professionals, to deliver primary care effectively. Pooled procurement of medicines and supplies and improved supply chains in the public health system can increase efficiency and cost-effectiveness, it suggested.

On the private healthcare sector, the report commented that the dominant, for-profit private care is highly commercialised and yet lacks standardisation of quality or costs and requires effective regulation. "Improving the quality of care in the private sector becomes critical as it needs to be made accountable to patients' safety, clinical outcomes, prescriptions that are appropriate to clinical conditions and therapeutically effective. The current model dominated by fee-for-service in private health-care services induces unnecessary and inappropriate care and is resource-inefficient. Efforts to improve the implementation of the Clinical Establishments Act and Rules must be enhanced. Improved implementation of regulations aimed at controlling costs and quality must be accompanied by transparent and socially accountable regulatory processes with less bureaucratic hassles," it said.

The report pointed out that the 15th Finance Commission (2021– 2026) has awarded an unconditional health grant to states (local governments and state governments) accounting for 10.3% of the total grant-in-aid and said that whether these translate into additional resources for health at the state level and whether or not there is adequate absorptive capacity at lower levels to use these funds remains to be seen.

The report has been prepared by Sakthivel Selvaraj, Public Health Foundation of India, Anup K Karan, Indian Institute of Public Health, Swati Srivastava, Medical Faculty and University Hospital, Heidelberg University, Germany, Nandita Bhan, Center on Gender Equity and Health and Indranil Mukhopadhyay, Jindal University.

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