
## Demand For Grants 2017-18 Analysis Health And Family Welfare

The Ministry of Health and Family Welfare (MoHFW) has two departments: (i) the Department of Health and Family Welfare, and (ii) the Department of Health Research. The Department of Health and Family Welfare is responsible for functions including (i) implementing health schemes, and (ii) imparting medical education and training.  The Department of Health Research is broadly responsible for conducting medical research. The Ministry of Health and Family Welfare ranked eighth in terms of the total budgetary allocation in 2017-18.  This note analyses the financial allocation trends and key issues concerning the health sector. 

## Overview Of Finances1

In 2017-18, the MoHFW received an allocation of Rs 48,853 crore. This allocation is an increase of 23% over the revised estimates of 2016-17.  Note that the budget estimates for 2017-18 exceed the budget estimates of 2016-17 by Rs 10,646 crore. Under the Ministry, the Department of Health and Family Welfare received the highest allocation (97%) at Rs 47,353 crore.  This was followed by the Department of Health Research (3%) at Rs 1,500 crore. Table 1 provides details on the two departments under the MoHFW. 

% 
RE 
2016-
BE 
2017-
Major 
Heads 
Actuals 
2015-16 
17 
18 
Change 
(RE to 
BE) 
33,121 
38,343 
47,353 
23% 
Health & Family Welfare Health Research 
993 
1,345 
1,500 
12% 
Total 
34,114 
39,688 
48,853 
23% 

Note: BE - Budget Estimate; RE - Revised Estimates. Sources: Demand No. 42 & 43, Ministry of Health and Family Welfare, Union Budget 2017-18, PRS. 

The revised estimates in 2016-17 for the Department of Health and Family Welfare overshot the budget estimate of that year by Rs 1,282 crore. Similarly, the Department of Health Research also, overshot the budget estimates by Rs 200 crore. Figure 1 contains the split in the allocation under the MoHFW for the year 2017-18.   
 
Key allocation trends are as follows: 

 
The National Health Mission (NHM) received the highest allocation at Rs 26,690 crore and 
constitutes 55% of the total ministry allocation.  
 
This was followed by allocation to autonomous institutes (12%) like AIIMS which saw an increase of 10% at Rs 6,088 crore.   
 
Other top expenditure heads under the MoHFW are Human Resources for Health & Medical Education (8%) at Rs 4,025 crore, Pradhan Mantri Swasthya Suraksha Yojana (4%) at Rs 3,975 crore and National AIDS and STD Control Programme (4%) at 2,000 crore. 
Table 2 notes the allocations and the changes to the key schemes and programmes under the Ministry. 

Table 2: Allocation to major expenditure heads under the MoHFW (in Rs crore) 
% 
Major Heads 
Actuals 
2015-
RE 
2016-
BE 
2017-
16 
17 
18 
Change 
(RE to 
BE) 
19,882 
22,198 
26,690 
20% 
NHM (total) -NRHM 
18,254 
19,462 
21,189 
9% 
     -NUHM 
1,628 
2,736 
5,501 
101% 
4,358 
5,552 
6,088 
10% 
Autonomous Bodies 
581 
1,500 
4,025 
168% 
Human Resources for Health & Medical Education PMSSY 
1,578 
1,953 
3,975 
104% 
1,590 
1,753 
2,000 
14% 
National AIDS & STD Control Programme 
77 
72 
104 
45% 
Infrastructure Development for Health Research NMHP 
35 
35 
35 
0% 
Others 
6,013 
6,625 
5,936 
-10% 
Total 
34,114 
39,688 
48,853 
35% 

Note: BE - Budget Estimate; RE - Revised Estimates; NHM- National Health Mission; NRHM- National Rural Health Mission; NUHM- National Urban Health Mission; PMSSY- Pradhan Mantri Swasthya Suraksha Yojana; NMHP- National Mental Health Programme. Sources: Demand No. 42 & 43, Ministry of Health and Family Welfare, Union Budget 2017-18, PRS. 

 
Human Resources for Health and Medical Education has seen the biggest increase at 168% (Rs 4,025 crore) over the revised estimates of 2016-17.   
 
Higher allocation has been made for Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) at Rs 3,975 crore (104% increase), which focusses on construction of government colleges.   Further, Infrastructure Development for Health Research has been allocated Rs 104 crore (45% increase) which enables infrastructure for advancing medical sciences.  
 
NHM has been allocated Rs 26,690 crore, a 20% increase over the revised estimates of 2016-17.  Under the NHM, National Rural Health Mission (NRHM) has been allocated Rs 21,189 crore, a 9% increase over the revised estimates of 2016-17.  The allocation for 
National Urban Health Mission (NUHM) has increased by 101% at Rs 5,501 crore. 

 
In terms of allocation to specific diseases, National Mental Health Programme has seen a 
0% increase in allocations over the revised 
estimates and stands at Rs 35 crore.  Note that the Mental Health Care Bill, 2016 was passed by the Rajya Sabha and is scheduled for passing in the Lok Sabha during Budget session 2017.2   The Bill requires central and state governments to provide access to good quality and affordable mental health services.  
 
National Centre for Disease Control has seen an increase particularly for the setting up of 27 new branches at Rs 41 crore.  
 
Food Safety and Standards Authority of India (FSSAI) has seen an increase of 86% from the revised estimates of 2016-17 at Rs 134 crore. Note that the Food Fortification Resource Centre was set up in 2016 under the FSSAI. 

## Proposals For The Health Sector In The Union Budget

2017-18 
 
 
 
An action plan to eliminate Kala-Azar and Filariasis by 2017, Leprosy by 2018, Tuberculosis and Measles by 2020. 
 
An action plan has been proposed to reduce Infant Mortality Rate from 39 in 2014 to 28 by 2019 and Maternal Mortality Rate from 167 in 2011-13 to 100 by 2018-2020.   
 
 
1.5 lakh Health Sub Centres will be transformed into Health and Wellness Centres.  

 
 
Additional 5,000 post graduate seats per annum will be created. 
 
Steps will be taken to (i) roll out Diplomate of National Board (DNB) courses in big district hospitals; (ii) strengthen post graduate teaching in select Employee State Insurance and municipal corporation hospitals; and (iii) encourage reputed private hospitals to start DNB courses. 
 
 
Two new All India Institutes of Medical Sciences will 
be set up in the states of Jharkhand and Gujarat. 
 

## Trends In Allocation And Expenditure

As indicated in Figure 2 below, the allocation to the 
Department of Health and Family Welfare has 
increased from Rs 11,366 crore in 2006-07 to Rs 
47,353 crore in 2017-18.  Over the period 2006-18, 
the Compound Annual Growth Rate (CAGR) has 
been 13%.  CAGR is the annual growth rate over a 
certain period of time.   

17) for 2017-18. Sources: Union Budget 2006-07 to 20017-18; PRS. 

Table 3 indicates the actual expenditure of the Department of Health and Family Welfare compared with the budget estimates of that year. The utilisation has been over 80% of the budget estimates as seen in the table, even crossing 100% in the year 2015-16. 

| Year    | BE     | Actuals    | Actuals/BE    |
|---------|--------|------------|---------------|
| 2015-16 | 29,653 | 30,626     | 103%          |
| 2014-15 | 35,163 | 30,626     | 87%           |
| 2013-14 | 33,278 | 27,145     | 82%           |

Note: BE - Budget Estimate. Sources: Union Budgets, 2015-17; PRS. 

The Standing Committee on Health and Family Welfare has observed the following reasons for the underutilisation of funds by the Ministry: (i) slow pace of expenditure on procurement of equipment and capital works; (ii) non-finalisation of machinery and proposals for procurement of machinery; (iii) slow progress in execution of works by the executing agency; and (iv) delays due to pending utilisation certificates which affects expenditure to be incurred by states.3,5   

## Low Public Spending

The public expenditure on health (centre and state) was 2% of the GDP as per the 2016-17 budget estimates.   According to the Economic Survey of India 2015-16, the public health expenditure has remained constant at 1.3% of the GDP, between 2008-09 and 2015-16.4  Note that for 2017-18, it is estimated at 2.2%.5   The draft National Health Policy, 2015 had proposed to increase the public health expenditure to 2.5% of the GDP.6 

India's public health expenditure as a percentage of 
GDP is relatively low as compared to other 
countries.  Table 4 shows the public expenditure on 
health as a percentage of GDP by various countries 
in 2013. 

| Country                   |     |
|---------------------------|-----|
| Public health expenditure |     |
| (as a % of GDP)           |     |
| India                     | 1.1 |
| China                     | 3.1 |
| South Africa              | 4.3 |
| Brazil                    | 4.7 |
| Australia                 | 6.3 |

Sources:  Health Status Indicators, National Health Profile, 2015, Ministry of Health and Family Welfare; PRS. 

In 2011, the High Level Expert Group (HLEG) on 
Universal Health Coverage constituted under the 
Planning Commission made certain 
recommendations with respect to the provision of 
universal health coverage.7   Universal health 
coverage includes ensuring equitable access to 
affordable and appropriate health services of 
assured quality.  The HLEG recommended that the 
central and state governments must increase public 
expenditure on health to, (i) at least 2.5% of the 
GDP by the end of 2017, and (ii) at least to 3% of 
GDP by 2022. 

 

Note:  The countries have been represented according to 
different income levels as classified by the World Bank. 
Sources:  National Health Profile, 2016, Ministry of Health and 
Family Welfare; PRS. 

The World Bank measures the progress made in the 
health sector in select countries of the World 
according to the Universal Health Coverage (UHC) 
Index.  On this Index, India ranks 143 among 190 
countries in terms of per capita expenditure on 
health.  In 2011, while the world average was $146 
PPP, India spent $44 PPP.8,9  Figure 3 notes the 
public expenditure on health by countries classified 
into income levels by the World Bank.  Despite 
being classified as 'low middle income' country, 
India spends less than the 'low income' countries. 

## Financial Allocations To Outcomes  National Health Mission

The National Health Mission (NHM) consists of two sub missions, the National Rural Health Mission (NRHM) (includes health interventions in rural areas) launched in 2005 and the National Urban Health Mission (includes health interventions in urban areas) launched in 2013.   

## Components Of Nhm

NHM includes various components, these include: (i) reproductive, maternal, new born and child health services (RCH Flexi Pool), (ii) NRHM Mission Flexi Pool for strengthening health resource systems, innovations and information, (iii) immunisation including the Pulse Polio Programme, (iv) infrastructure maintenance, and 
(v) National Disease Control Programme. 

## Funding Of Nhm

In 2017-18, the allocation for NHM increased from Rs 22,198 crore in 2016-17 (revised estimate) crore to Rs 26,690 crore in 2017-18.  This is a 20% increase over the revised estimates of 2016-17. Figure 4 indicates the change in the total allocations to NHM as well as change as a percentage of the total Ministry's budget.  It can be observed that while the total allocation to NHM has increased over the years, its percentage share in the total budget has decreased from 73% in 2006-07 to 56% in 2017-18.  This may be on account of increased devolution of resources to states following the recommendations of the Fourteenth Finance Commission. 

The funding for the mission is done through 
flexible pools, such as NRHM-RCH flexible pool, 
and flexible pool for communicable diseases.  The 
rational for creating of the flexible pool is to allow 
more financial flexibility and efficient distribution 
of funds in order to obtain desired health outcomes.  

Note that in 2017-18, among all the flexible pools, 
the non-communicable flexible pool has received 
the highest increase in allocation from Rs 555 in 
2016-17 to 955 crore in 2017-18.  The RCH 
Flexible Pool including Routine Immunization 
Programme, Pulse Polio Immunization Programme, 
National Iodine Deficiency Disorders Control 
Programme etc. has seen a decline of 24% (Rs 
5,966 crore).  Further, Health System 
Strengthening under NRHM has seen a 52% 
increase (Rs 8,383 crore). 

## Release And Utilisation Of Funds

Delays have been noted in the release of funds 
under NHM.  For example, out of the total funds of 
Rs 8,242 crore released in 2016 under RCH and 
Health systems strengthening, Rs 7,460 crore were 
transferred with a delay from 0 to 142 days and Rs 
783 crore is still lying with State Treasury.5  
Further, as of 2016, there are 220 pending 
utilisation certificates amounting to 3,224 under the 
RCH pool.5 

Despite delay in release of funds, effective 
utilisation of funds has been noted in the case of 
NHM where fund releases have been around 98 
percent.  The Standing Committee observes that 
timeliness of transfer of funds is extremely 
important as delayed transfers hamper fund 
utilisation.  In this regard, it has been recommended 
that the existing fund release mechanism for NHM 
needs to be reviewed for better transfer of funds.5  

##  Health Infrastructure And Pradhan Mantri Swasthya Suraksha Yojana

As of 2016, there are 19,653 government hospitals 
(including community health centres) in India, of 
which 80% are rural hospitals and 20% are urban 
hospitals.10  Depending on the level of care 
required, health institutions in India are broadly 
classified into three types.  This includes primary 
care (primary health centres), secondary care 
(district hospitals) and tertiary care institutions 
(specialised hospitals like AIIMS). 

Primary health care infrastructure provides the first 
level of contact between health professionals and 
the population. 11  The HLEG in 2011 had observed 
that focus on prevention and early management of 
health problems can reduce the need for 
complicated specialist care.7   

 

Type of 
% shortfall 
Infrastructure 
Required 
number 
Status 
(As on 
2015) 
Sub-Centre 
1,79,240 
1,55,069 
20% 
Primary Health Centre 
29,337 
25,354 
22% 
Community Health Centre 
7,322 
5,510 
30% 

Sources: Rural Health Statistics 2016, Ministry of Health and Family Welfare, and Rural Health Infrastructure, Ministry of Statistics and Programme Implementation; PRS.  
Broadly, based on the population served and the type of services provided, primary health infrastructure in rural areas consists of a three tier system.  This includes Sub-Centres (SCs), Primary Health Centres (PHCs) and Community Health Centres (CHCs).12  A similar set up is maintained in urban areas.13  Table 5 above contains the required number, current status and the shortfall of rural SCs, PHCs and CHCs.  A shortfall has been observed at different levels of the healthcare delivery system.   
Pradhan Mantri Swasthya Suraksha Yojana Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) has been implemented since 2003 with objectives of (i) correcting regional imbalances in the availability of affordable and reliable tertiary healthcare services, and (ii) to augment facilities for quality medical education in the country.  This includes establishing AIIMS like institutions and upgrading certain state government hospitals.   
Notes:  Values for 2016-17 and 2017-18 are revised estimates and budget estimates respectively  
Sources: Union Budget 2008-09 to 2017-18; PRS. The allocation to PMSSY increased by 104% over the revised estimates of 2016-17.  The allocation to the scheme in 2017-18 is Rs 3,975 crore. With respect to AIIMS, the allocation increased by 4.6% over the revised estimates of 2016-17.  Over the years the allocation increased from Rs 489 crore in 2006-07 to Rs 2,400 crore in 2017-18.   

The Standing Committee while examining the 
functioning of AIIMS observed that out of all the  
projects (completed and on-going), most of the 
projects were unable to meet the cost and time 
deadlines.14  In order to ensure monitoring and time 
bound compliance of the projects, it recommended 
the setting up of an Oversight Committee which 
would report directly to the Director of the 
Institute.  Note that the 2017-18 budget seeks to set 
up two new AIIMS in Jharkhand and Gujarat. 

##  Regulation Of Private Health Services

As per the National Sample Survey 2015, most 
hospitalisation cases were seen in private hospitals 
(68% in urban and 58% in rural areas).15  Further, 
in case of hospitalised, the cost of treatment 
(excluding childbirth) was four times higher in 
private hospitals (Rs 25,850) as compared to that in 
public hospitals (Rs 6,120).15 

The HLEG observed that regulatory standards for 
public and private hospitals are not adequately 
defined and are poorly enforced.  Further, the 
quality of healthcare services varies considerably in 
the public and private sector.16  It has also been 
observed that many practitioners in the private 
sector are not qualified doctors.16   

The 14th Finance Commission study group 
observed that the unregulated nature of the private 
sector is one of the issues leading to the high 
financial burden on households (which is not 
commensurate with the quality of care).17  It 
recommended that a policy measure must be taken 
to regulate the private healthcare sector. 

##  Human Resources In Health

Between 2008 and 2015, the number of registered 
doctors increased from 7,61,429 to 9,60,233 (26 % 
increase).18  Note that despite the increase, there 
has been a steady increase in the shortfall of 
doctors, specialists and surgeons.  For example, 
there is a shortfall of 83.4% of surgeons, 76.3% of 
obstetricians and gynaecologists, 83.0% of 
physicians and 82.1% of paediatricians.19  Table 6 
shows the number of health professionals as of 
2015 and the population served by them.    

According to the Health and Family Welfare 
Statistics 2015, conducted by the Ministry of 
Health and Family Welfare, the shortfall of doctors 
at PHCs increased from 1,004 in 2005 to 3,002 in 
2015.10  On similar lines, the shortfall of the 
number of specialists (such as surgeons etc.) at 
CHCs increased from 6,110 in 2005 to 17,525.10 

| Profession         |          |
|--------------------|----------|
| Number of          |          |
| professionals      |          |
| Population         |          |
| served per         |          |
| professional       |          |
|                    |          |
| Allopathic Doctors | 9,60,233 |
| Nurses*            | 6,73,401 |
| AYUSH Doctors**    | 7,44,563 |
| Pharmacists        | 6,73,401 |

Notes: *includes Auxiliary Nurse Midwives, Registered Nurses, Midwives, Lady Health Visitors, **includes Ayurveda Unani Siddha Naturopathy Homeopathy. Sources: Human Resources in Health Sector, National Health Profile, 2016, Ministry of Health and Family Welfare, PRS.  
With regard to health professionals, the HLEG recommended that adequate number of trained healthcare providers and technical healthcare workers must be ensured at different levels of the health system.7  In order to provide adequate number of trained staff at certain levels of health care, it recommended measures such as introduction of bachelors program in rural health care and a bridge course for health providers to develop appropriate competencies etc.  Further, it also recommended that the density of human resource in health must be increased to achieve the World Health Organisation norms (at least 23 health workers (doctors, nurses, and midwives) per 10,000 population). In this regard, in the 2017-18 Budget, upgradation/strengthening of Nursing Services has seen an increase of 140% from the revised estimates of 2016-17 (Rs 60 crore).  Further, in terms of training of medical professionals, upgradation of State Government Medical Colleges (PG Seats) has seen an increase of 725% (Rs 165 crore) from the revised estimates of 2016-17.  Note that the Budget Speech of 2017-18 highlighted that 
5,000 PG seats would be added per annum. 

##  Health Insurance Coverage

In 2015, 68% patients in rural areas and 75% patients in urban areas stated that the primary source of financing health treatment (i.e. hospitalisation) was through household income.20 In terms of insurance coverage, a significant proportion of the population, 82% of urban and 86% of rural population was not covered under any state sponsored scheme for obtaining support for health expenditure.20  

## Access To Medicines

A large proportion of the out of pocket expenditure of the population on health arises from out-patient care and purchase of medicines.16  These services are mostly not covered by existing insurance schemes.16  In 2011-12, over 60% of the out of pocket health expenditure was on medicines (both in rural and urban areas).9  

The HLEG had observed that an increase in the 
public purchase of medicines will provide for 
adequate supply of drugs to the population.  This is 
expected to reduce the out of pocket expenditure in 
health.  It had recommended that the public 
spending on drug procurement must be increased to 
0.5% of GDP of the country.  

## Rashtriya Swasthya Bima Yojana

The Rashtriya Swasthya Bima Yojana (RSBY), 
launched in 2008, aims to (i) provide financial 
protection against high health cost, and (ii) improve 
healthcare access for below poverty line 
households etc.21  Only 12% of the urban and 13% 
of the rural population from the targeted population 
was covered by schemes such as the RSBY or other 
similar state sponsored schemes.21  

Notes: Values for 2016-17 and 2017-18 are revised estimates and budget estimates respectively.  All other values are actuals. Sources: Union Budget 2011-12 to 2017-18; PRS. 

Figure 6 shows the RSBY allocation since 2009.  
The total allocation to the scheme is Rs 2,250 crore 
in 2017-18, a 10% increase over the revised 
estimates of 2016-17.  Note that in 2016-17, the 
allocation to the RSBY increased by 149% over the 
revised estimates of 2015-16.  The CAGR between 
2009-18 has been 31% for RSBY allocation.   

## Central Government Health Scheme

With regard to the Central Government Health 
Scheme (CGHS), the allocation for 2017-18 is Rs 
1,247 crore (20% increase over the revised 
estimates of 2016-17).  The scheme aims to provide 
healthcare services to central government 
employees, Members of Parliament, etc. With regard to health insurance, the HLEG 
recommended that all government funded 
insurance should be integrated with the Universal 
Health Coverage system.7  In addition, all health 
insurance cards must be replaced by a national 
health entitlement card.

# 

2016/index.html 10  Health and Family Welfare Statistics in India 2015, Ministry of Health and Family Welfare, October 2015, https://nrhm-mis.nic.in/Pub_FW_Statistics2015/Complete%20Book.pdf 11  Chapter VIII: Public Health Care System, Planning Commission of India, http://planningcommission.nic.in/aboutus/committee/strgrp/stgp_fmlywel/sgfw_ch8.pdf 12  Part I, Rural Health Care System in India, Rural Health Statistics, https://nrhm-mis.nic.in/RURAL%20HEALTH%20STATISTICS/(A)%20RHS%20- %202014/Rural%20Health%20Care%20System%20in%20India.pdf 13  Framework for Implementation, National Urban Health Mission ,May, 2013, http://nrhm.gov.in/images/pdf/NUHM/Implementation_Framework_NUHM.pdf. . http://164.100.47.5/newcommittee/reports/EnglishCommittees/Committee%20on%20Health%20and%20Family%20Welfare/87.pdf. http://mospi.nic.in/Mospi_New/upload/nss_71st_ki_health_30june15.pdf. 16 "Chapter: 20, Health, Twelfth Five Year Plan (2012-17)", Planning Commission of India, http://planningcommission.gov.in/plans/planrel/12thplan/pdf/12fyp_vol3.pdf. 17 "Essential Health Package for India Approach and Costing", Report submitted to the 14th Finance Commission, Ministry of Finance, September 2014, http://fincomindia.nic.in/writereaddata%5Chtml_en_files%5Cfincom14/others/40.pdf. 18  "National Health Profile, 2015", Ministry of Health and Family Welfare, 2015, http://cbhidghs.nic.in/E-Book%20HTML- 2015/index.html. 19  Human Resources in Health Sector, National Health Profile, 2016, Ministry of Health and Family Welfare, http://www.cbhidghs.nic.in/E- Book%20HTML-2016/index.html 20  "Chapter three, Summary of Findings, Key Indicators of Social Consumption in India in Health", 71st Round, National Sample Survey 
(NSS), Ministry of Statistics and Programme DISCLAIMER: This document is being furnished to you for your information.  You may choose to reproduce or redistribute this report for non-commercial purposes in part or in full to any other person with due acknowledgement of PRS Legislative Research ("PRS").  The opinions expressed herein are entirely those of the author(s).  PRS makes every effort to use reliable and comprehensive information, but PRS does not represent that the contents of the report are accurate or complete.  PRS is an independent, not-for-profit group.  This document has been prepared without regard to the objectives or opinions of those who may receive it. 

 
State-wise and global numbers on the health sector 

and rural, in Rs) 
Public : Private cases 
State 
Public : Private cases 
(Rural) 
(Urban) 
Andhra Pradesh 
0.29 
3.59 
         13,227  
         31,242  
Arunachal Pradesh 
7.77 
0.14 
           5,678  
           8,926  
Assam 
8.26 
0.94 
           6,966  
         47,064  
Bihar 
0.74 
1.58 
         11,432  
         25,004  
Chhattisgarh 
0.98 
2.40 
         12,149  
         22,647  
Delhi 
1.71 
1.22 
         30,613  
         34,730  
Goa 
1.04 
0.50 
         29,954  
         23,165  
Gujarat 
0.31 
3.29 
         14,298  
         20,155  
Haryana 
0.50 
4.46 
         18,341  
         32,370  
Himachal Pradesh 
3.13 
0.39 
         18,860  
         28,590  
Jammu & Kashmir 
15.39 
0.17 
           8,442  
         13,948  
Jharkhand 
0.66 
2.79 
         10,351  
         13,151  
Karnataka 
0.37 
4.46 
         14,091  
         22,190  
Kerala 
0.53 
2.00 
         17,642  
         15,465  
Madhya Pradesh 
1.15 
1.40 
         13,090  
         23,993  
Maharashtra 
0.24 
4.00 
         20,475  
         29,493  
Manipur 
7.93 
0.27 
           6,061  
         10,215  
Meghalaya 
8.17 
1.11 
           2,075  
         18,786  
Mizoram 
6.14 
0.66 
           8,744  
         13,461  
Nagaland 
2.72 
1.51 
           5,628  
         15,788  
Odisha 
4.35 
0.72 
         10,240  
         19,750  
Punjab 
0.41 
2.31 
         27,718  
         29,971  
Rajasthan 
1.18 
0.84 
         12,855  
         16,731  
Sikkim 
2.66 
0.81 
           8,035  
           9,939  
Tamil Nadu 
0.68 
2.41 
         11,842  
         23,757  
Telangana 
0.40 
3.72 
         19,664  
         20,617  
Tripura 
13.93 
0.12 
           5,694  
         11,638  
Uttar Pradesh 
0.43 
2.53 
         18,693  
         31,653  
Uttarakhand 
1.03 
1.52 
           9,162  
         25,703  
West Bengal 
3.39 
0.90 
         11,327  
         24,875  
15.95 
0.22 
           3,373  
           8,389  
Andaman & Nicobar Islands Chandigarh 
3.39 
0.18 
         16,389  
         35,158  
Dadra & Nagar Haveli 
2.33 
4.03 
           4,219  
           7,749  
Daman & Diu 
0.34 
4.71 
         10,223  
           6,930  
Lakshadweep 
1.69 
0.46 
         10,418  
           8,604  
Puducherry 
0.47 
0.61 
           7,965  
         14,076  
All India 
0.72 
2.13 
         14,935  
         24,436  

Sources: District Level Household and Facility Survey -4 (2012-13); PRS. 

| Average health      | Average health      |
|---------------------|---------------------|
| expenditure (rural) | expenditure (urban) |
| % of                                       | Reasons for not generally using government health facilities among households which do not    |
|--------------------------------------------|-----------------------------------------------------------------------------------------------|
| generally use government health facilities | households                                                                                    |
| that do not                                |                                                                                               |
| State                                      |                                                                                               |
| Facility                                   | Health                                                                                        |
| Waiting time                               | Poor quality                                                                                  |
| generally use                              |                                                                                               |
| government                                 |                                                                                               |
| No nearby facility                         |                                                                                               |
| too long                                   | of care                                                                                       |
| Other                                      |                                                                                               |
| reason                                     |                                                                                               |
| timing not                                 |                                                                                               |
| convenient                                 |                                                                                               |
| personnel                                  |                                                                                               |
| often absent                               |                                                                                               |
| health                                     |                                                                                               |
| facilities                                 |                                                                                               |
| 74.3                                       | 49.2                                                                                          |
| Pradesh                                    |                                                                                               |
| Assam                                      | 34.8                                                                                          |
| Bihar                                      | 93.3                                                                                          |
| Chhattisgarh                               | 63.7                                                                                          |
| Gujarat                                    | 72.5                                                                                          |
| Haryana                                    | 72.3                                                                                          |
| Jharkhand                                  | 77.7                                                                                          |
| Karnataka                                  | 64.0                                                                                          |
| Kerala                                     | 50.0                                                                                          |
| 62.6                                       | 50.8                                                                                          |
| Pradesh                                    |                                                                                               |
| Maharashtra                                | 70.3                                                                                          |
| Odisha                                     | 24.0                                                                                          |
| Punjab                                     | 80.8                                                                                          |
| Rajasthan                                  | 29.8                                                                                          |
| Tamil Nadu                                 | 47.0                                                                                          |
| 84.7                                       | 53.5                                                                                          |
| Pradesh                                    |                                                                                               |
| West Bengal                                | 71.2                                                                                          |
| 17.5                                       | 50.1                                                                                          |
| Pradesh                                    |                                                                                               |
| Delhi                                      | 70.7                                                                                          |
| Goa                                        | 70.4                                                                                          |
| 17.3                                       | 34.1                                                                                          |
| Pradesh                                    |                                                                                               |
| 37.1                                       | 33.2                                                                                          |
| Kashmir                                    |                                                                                               |
| Manipur                                    | 21.0                                                                                          |
| Meghalaya                                  | 35.2                                                                                          |
| Mizoram                                    | 9.4                                                                                           |
| Nagaland                                   | 47.9                                                                                          |
| Sikkim                                     | 8.2                                                                                           |
| Tripura                                    | 20.1                                                                                          |
| Uttarakhand                                | 55.6                                                                                          |
| All India                                  | 65.6                                                                                          |

Sources: District Level Household and Facility Survey -4 (2012-13); PRS. 

## 

| Country      | Population    | Infant    |   Life  |
|--------------|---------------|-----------|---------|
| (Million)    |               |           |         |
| Crude Birth  |               |           |         |
| Rate 2013    |               |           |         |
| Total        |               |           |         |
| Fertility    |               |           |         |
| Underweight  |               |           |         |
| children (%) | Expectancy    |           |         |
| Maternal     |               |           |         |
| Mortality    |               |           |         |
| 2013         | Rate, 2013    |           |         |
| Under 5      |               |           |         |
| mortality    |               |           |         |
| rate, 2013   | (2009-13)     | Ratio     |         |
| (MMR) 2015   |               |           |         |
| at Birth     |               |           |         |
| (Years)      |               |           |         |
| 2013         | $             |           |         |
| Mortality    |               |           |         |
| Rate (per    |               |           |         |
| 1000 live    |               |           |         |
| Births)      |               |           |         |
| 2013         |               |           |         |
| Afghanistan  | 30.6          | 34        |     4.9 |
| Bangladesh   | 156.6         | 20        |     2.2 |
| China        | 1385.6        | 13        |     1.7 |
| 24.9         | 14            | 2.0       |    27   |
| People's     |               |           |         |
| Republic of  |               |           |         |
| Korea        |               |           |         |
| India        | 1252.1        | 20.0      |     2.5 |
| Indonesia    | 249.9         | 19        |     2.3 |
| Iran         | 77.4          | 19        |     1.9 |
| Japan        | 127.1         | 8         |     1.4 |
| Malaysia     | 29.7          | 18        |     2   |
| Myanmar      | 53.3          | 17        |     1.9 |
| Nepal        | 27.8          | 21        |     2.3 |
| Pakistan     | 182.1         | 25        |     3.2 |
| Philippines  | 98.4          | 24        |     3   |
| 49.3         | 10            | 1.3       |     4   |
| Korea        |               |           |         |
| Singapore    | 5.4           | 10        |     1.3 |
| Sri Lanka    | 21.3          | 18        |     2.3 |
| Thailand     | 67.0          | 10        |     1.4 |
| Vietnam      | 91.7          | 16        |     1.7 |
| Botswana     | 2.0           | 24        |     2.6 |
| Cambodia     | 15.1          | 26        |     2.9 |
| Congo        | 4.4           | 38        |     5   |
| Guatemala    | 15.5          | 31        |     3.8 |
| South Africa | 52.8          | 21        |     2.4 |
| Zimbabwe     | 14.2          | 31        |     3.5 |
| Australia    | 23.3          | 13        |     1.9 |
| France       | 64.3          | 12        |     2   |
| Germany      | 82.7          | 8         |     1.4 |
| 63.1         | 12            | 1.9       |     5   |
| Kingdom      |               |           |         |
| 320.1        | 13            | 2.0       |     7   |
| States of    |               |           |         |
| America      |               |           |         |

Sources: National Health Profile, 2016; PRS. 

 