5 September 2024 : The Hindu Editorial Analysis

1. Gap between allocations for health, outcomes in States

(Source – The Hindu, International Edition – Page No. – 8)

Topic: GS2 – Social Justice – Health

Context

The article highlights the challenges faced by States in fully utilising Union Budget allocations for health sector initiatives, such as Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) and Human Resources for Health and Medical Education (HRHME). It emphasises the need for efficient fund absorption, addressing human resource shortages, and ensuring States’ fiscal readiness to maintain infrastructure and manage long-term operational costs.

Realisation of Budget Potential in the Health Sector

• The full potential of Union Budget allocations for the health sector depends heavily on State-level factors.
• Many allocations are for Centrally Sponsored Schemes (CSS), where States share a significant part of the cost and are responsible for implementation.
• The fiscal capacity and operational framework at the State level strongly influence the efficacy of these allocations.

Key CSS Initiatives in the Health Sector

• Two major CSS initiatives are being implemented to enhance physical health infrastructure in States:
  • Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM):
    • Aims to build health and wellness centres (AB-HWCs), block-level public health units (BPHUs), integrated district public health laboratories (IDPHLs), and critical care hospital blocks (CCHBs).
    • Designed to improve India’s preparedness for health emergencies, including pandemics.
  • Human Resources for Health and Medical Education (HRHME):
    • Seeks to increase the number of medical personnel by establishing new medical, nursing, and paramedical colleges, while increasing seats in existing institutions.
    • Focuses on upgrading district hospitals and attaching them to newly established medical colleges.

Low Fund Utilisation

• Central expenditure on these initiatives over the last three Budgets shows poor fund absorption:
  • In PM-ABHIM, the ‘Actual’ expenditure was only around 29% of the Budget estimate in 2022-23.
  • In 2023-24, the ‘Revised Estimate’ was 50% of the Budget Estimate, but the ‘Actuals’ are expected to be lower.
  • In HRHME, fund utilisation was about 25% of the Budget estimates for both 2022-23 and 2023-24.
• Due to low fund absorption, the Budget allocations for both PM-ABHIM and HRHME were reduced in the full Budget compared to the interim Budget.

Factors Behind Low Utilisation in PM-ABHIM

1. Resource Allocation Challenges:
   • Around 60% of the funding component was to be funded through health grants recommended by the 15th Finance Commission.
   • A National Institute of Public Finance and Policy study found only 45% of these grants were utilised between 2021-22 and 2023-24, due to complex execution structures.
2. Integration of Health Laboratories:
   • States had to integrate public health laboratories under different vertical programs, which required extensive reorganisation and planning.
3. Delayed Fund Absorption in Construction Projects:
   • Fund absorption is often delayed due to rigid procedures involved in construction.
4. Overlap of Funding Sources:
   • Some scheme components had funding overlaps from multiple sources, adding complexity to fund absorption.

Faculty Shortage in HRHME

• Even with better fund utilisation for physical infrastructure, faculty shortages pose challenges.
• A study by the Centre for Social and Economic Progress (CSEP) found:
  • Over 40% of teaching faculty positions were vacant in 11 of the 18 newly created All India Institutes of Medical Sciences.
  • In Uttar Pradesh, 30% of teaching positions were vacant in 17 government medical colleges established between 2019-2021.

Fiscal Challenges for States

• States will have to bear the recurring costs of maintaining the physical infrastructure built under PM-ABHIM and HRHME, necessitating additional financial commitments.
• The Union government’s support for human resources will only last until 2025-26 under PM-ABHIM, requiring States to plan for long-term sustainability.

Conclusion

• The effectiveness of capital expenditure allocations in the health sector depends on:
  • The fiscal capacity of States to manage additional recurring expenditures.
  • Addressing structural issues such as human resource shortages.
  • Improving public financial management for executing schemes and grants.
• These factors are critical to ensuring the productivity of budgetary allocations and achieving better health outcomes.

PYQ: Public health system has limitations in providing universal health coverage. Do you think that the private sector could help in bridging the gap? What other viable alternatives would you suggest? (200 words/12.5m) (UPSC CSE (M) GS-2 2015)

Practice Question:  Discuss the challenges faced by States in utilising budgetary allocations for health sector initiatives. Suggest measures to improve fund absorption and long-term sustainability. (250 Words /15 marks)

2. From crisis to cascade of hope

(Source – The Hindu, International Edition – Page No. – 9)

Topic: GS2 – Indian Polity – Federal Structure

Context

The article highlights the resolution of a potential water crisis between Karnataka and Tamil Nadu due to timely rains, leading to surplus water inflows in the Cauvery River. It also emphasises the importance of the Cauvery Water Management Authority (CWMA) and the need for improved transparency and collaboration in future water management.

Relief in Cauvery River Water Dispute

• The Cauvery River, which was on the brink of causing a water crisis in early July 2024 for Karnataka and Tamil Nadu, has seen significant improvement due to rains since mid-July.
• This rainfall resulted in substantial inflows to the river, relieving both states from potential shortages.

Water Realisation for Tamil Nadu

• In 2024, Tamil Nadu received 181 tmc ft of Cauvery water by September 2, surpassing the annual requirement of 177.25 tmc ft, thanks to a strong southwest monsoon.
• This contrasts sharply with 2023, when only 33.2 tmc ft was received by the same date.
• Over the past 30 years, Tamil Nadu faced water distress, receiving less than 100 tmc ft during the June-September period in 11 years.

Importance of the Implementation Mechanism

• The role of the Cauvery Water Management Authority (CWMA) and its supporting body, the Cauvery Water Regulation Committee (CWRC), is crucial for implementing the Tribunal’s final award.
• These institutions were tested during the 2023-24 water year, particularly in handling water disputes between the states.
• Unlike its predecessor, the Cauvery River Authority, which had the Prime Minister as its chairperson, the CWMA is led by a full-time official and includes officers from relevant states and Union government departments.

Recommendations for Improvement

• There is a need for greater transparency in the functioning of the CWMA and CWRC. Decisions should be made public swiftly, and more authentic information should be disseminated, especially in times of crisis.
• If manpower shortages hinder the CWMA’s efficiency, the Union Ministry of Jal Shakti should intervene and resolve the issue.
• The CWMA’s composition should be expanded to include a mix of officials and non-officials, such as farmers, environmentalists, and independent water experts.
  • This multidisciplinary approach would improve decision-making and address issues like environmental degradation and climate change.

Addressing Bengaluru’s Water Shortage

• The current favourable water situation provides an opportunity to tackle Bengaluru’s drinking water shortage, which became critical earlier this year.
• The Supreme Court’s 2018 judgement allocated 4.75 tmc ft of Cauvery water for Bengaluru.
• However, Karnataka is pushing for the Mekedatu Balancing Reservoir-cum-Drinking Water Project, which is currently under review by the Central Water Commission.
• Due to trust issues between Karnataka and Tamil Nadu, particularly over Mekedatu, the Union government could play a third-party role in facilitating the project.
• Exploring such a role could help overcome the longstanding impasse and ensure the optimal utilisation of Cauvery’s water resources, which would otherwise go to waste.

Conclusion

• Despite a challenging start to the 2024-25 water year, timely rains have alleviated the water concerns of both Karnataka and Tamil Nadu.
• Going forward, improving the functioning and transparency of institutions like the CWMA and addressing water shortages in Bengaluru through projects like Mekedatu are essential to optimally managing the Cauvery River’s resources.

PYQ: The interlinking of rivers can provide viable solutions to the multi-dimensional inter-related problems of droughts, floods and interrupted navigation. Critically examine. (250 words/15m) (UPSC CSE (M) GS-1 2020)

Practice Question:  Examine the role of the Cauvery Water Management Authority (CWMA) in resolving inter-state water disputes between Karnataka and Tamil Nadu. How can its functioning be improved to ensure better water management? (150 Words /10 marks)