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Before union budget’s cutback, State health budgets rose to 21 percent

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New Delhi: An analysis of government data released in October 2015 revealed that state health budgets, taken together– rose 21 percent in the previous year, before the 15 percent ‘cut’ in central funding of national health programs in the union health budget of 2015-16.

However, this increase is not uniform across states, indicating that states, especially smaller ones, unable to raise enough money, are spending less on health and education. Exactly how many states spent to compensate for central spending cutbacks over the past year is unclear because that data will only be available by the end of 2016.

As many as 58 per cent of Indians in rural areas opt for private healthcare (68 percent in urban areas), as we reported, because public health care is inadequate, and healthcare expenses push an additional 39 million people back into poverty every year, a Lancet paper said.

In anticipation of the transfer of money to states – a process called devolution, proposed in December 2014 by the 14th Finance Commission, Delhi had increased payments to state plans during the 2014-15 budget: Transfers rose by 108 percent to Rs 2,59,855 crore ($43 billion) for the state plans, according to reporters.

Many increases to states were substantial, particularly in key areas such as village development, education, health and agriculture. The idea, to quote from a government document, was to “provide greater ownership to state governments in implementation of plans schemes and avoid thin spreading of resources, model of restructured centrally sponsored schemes (CSSs) continues. Higher allocation under State/UT (union territory) plan is reflective of this”.

Between 2014-15 and 2015-16, unconditional transfers of tax revenues – or “untied” funds, to use official jargon– rose 55 percent, from Rs.3.38 lakh crore to Rs. 5.24 lakh crore, according to the budget’s revised estimates released in October 2015 (The budget is prepared using income estimates, typically revised after six months to account for actual tax received).

The union health budget rose six percent, from Rs.29,492.5 crore in 2013-14 to Rs. 31,274 crore in 2014-15, the year the National Democratic Alliance (NDA) presented its first budget. The cuts came in the second year of the NDA, 2015-16.

Smaller states can’t find money, therefore, cut health funding.

Although 18 states with poor health indicators, called “high-focus states”,– increased health spending in anticipation of central cutbacks, our analysis reveals how smaller states have cut health spending because they did not have the money.

Jharkhand and Odisha increased their health spending by 80 percent and 73 percent respectively between 2013-14 and 2014-15. Some states saw marginal increases; Tripura and Manipur cut health spending.

Money to create infrastructure has risen in state budgets, from 37.2 percent in 2011-12 to 50 percent in 2014-15, while funds for staff salaries and other administrative expenses fell from 62.2 percent to 49.9 percent.

“The country is close to completing its first budget cycle since the implementation of the FFC (14th Finance Commission) recommendations; any rigorous assessment of the real impact of these recommendations is difficult owing to large gaps in available data,” said a report from the Accountability Initiative, a Delhi-based think-tank. (Prachi Salve, IANS/indiaspends.org)

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A New Virus Typhus Rises In Los Angeles

Officials in Los Angeles say they are working toward housing for the county’s 53,000 homeless residents to relieve conditions that help give rise to typhus and other diseases.

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coal miner,Typhus
Retired coal miner James Marcum, who has black lung disease, takes a pulmonary function test at the Stone Mountain Health Center in St. Charles, Virginia, U.S., May 18, 2018. (VOA)

Typhus, a bacterial infection that is sometimes life threatening, is on the rise in Los Angeles and several other U.S. cities. Public health officials say homelessness is making the problem worse and that the disease, which is associated with poverty and poor sanitation, is making a comeback in the United States.

Los Angeles County has seen 64 cases of typhus this year, compared with 53 at the same point last year and double the typical number, with a six-case cluster among the homeless in L.A. this year. Two cities in the county that have separate counts are also seeing higher numbers: Long Beach with 13 cases, up from five last year, and Pasadena with 20, a more than three-fold increase from 2017.

At a clinic in the L.A. neighborhood called Skid Row, Dr. Lisa Abdishoo of Los Angeles Christian Health Centers is on the lookout for symptoms.

“It’s a nonspecific fever,” she said, “body aches, sometimes a headache, sometimes a rash.”

This kind of typhus is spread by fleas on rats, opossums, or even pets and is known as murine typhus, from the Latin word for “mouse.”

The risk is higher when people live on the streets in proximity to garbage, but the disease seems to be spreading through the Southern United States.

Not the typhus of WWI

“It’s never been considered a very common disease,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, “but we seem to see it more frequently. And it seems to be extending across from Southern California all along the Mexican border into southeastern Texas and then into the Gulf Coast in Florida.”

 

Typhus
A homeless man sits at his street-side tent along Interstate 110 along downtown Los Angeles’ skyline, May 10, 2018. Thousands of homeless people sleep on the streets of Los Angeles County.. VOA

 

Texas had 519 cases last year, said spokeswoman Lara Anton of the Texas Department of State Health Services. That’s more than three times the number in 2010, with clusters in Houston and Galveston. No figures for this year have been released.

This is a separate disease from typhoid fever and is not the epidemic form of typhus that caused hundreds of thousands of deaths in war time. That type, called epidemic typhus, is carried by body lice and often spreads in conflict zones. It led to millions of deaths in World War I alone.

Flea-borne typhus, the kind seen in California and Texas, is serious but often clears up on its own and responds to an antibiotic, Abdishoo said.

Typhus
Dr. Peter Hotez, dean of the Baylor College of Tropical Medicine, shows Associated Press journalists areas of Houston’s 5th Ward that may be at high risk for mosquitoes capable of transmitting the Zika virus in Houston.. VOA

“It seems to get better a little faster if you have the treatment,” she said. “But there are cases where people have had more severe complications — it’s rare, but getting meningitis, and even death,” she cautioned.

Migration, urbanization, climate change

The reason for increased typhus numbers is uncertain, but it may be linked to migration, urbanization and climate change, said Hotez, the disease specialist. In some parts of the world, typhus is still linked to war and instability, “in the conflict zones in the Middle East, in North Africa, Central Asia, East Africa, Venezuela, for instance with the political instability there,” he said.

Murine typhus is one of several diseases on the rise in the southern United States, Hotez said.

Typhus
People line up on Skid Row in Los Angeles to receive food, water, clothing and other basic necessities from Humanitarian Day Muslim volunteers.. VOA

“Others include dengue, now emerging in southern Texas and Florida, the Zika virus infection, Chikungunya. We have a huge problem with West Nile virus,” he added, and Chagas disease, a condition usually seen in Latin America.

A report in May from the U.S. Centers for Disease Control and Prevention found that such “vector-borne” diseases, transmitted by ticks, fleas or mosquitoes, more than doubled in the United States between 2004 and 2016.

Hotez says they are on the rise in many industrial nations with crowded cities and pockets of poverty.

Also Read: A Full Guide To Public Health Disease Hepatitis

Skid Row physician Abdishoo says flea-borne typhus is still uncommon on the streets of Los Angeles, but “it has us all on high alert for this illness that we don’t necessarily think too much about. We want to be vigilant,” she added, “when you see a communicable disease on the rise.”

Officials in Los Angeles say they are working toward housing for the county’s 53,000 homeless residents to relieve conditions that help give rise to typhus and other diseases. Voters approved funding in 2016 and 2017 to finance the efforts. (VOA)