2020

## Demand For Grants 2020-21 Analysis Health And Family Welfare

The Ministry of Health and Family Welfare 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) regulating medical education and training.  The Department of Health Research is broadly responsible for conducting medical research. This note analyses the financial allocation trends and key issues concerning the health sector. 

## Overview Of Finances

Overall, India's public health expenditure (sum of central and state spending) has remained between 1.2% to 1.6% of GDP between 2008-09 and 2019- 20.1,2,3  This expenditure is relatively low as compared to other countries such as China (3.2%), USA (8.5%), and Germany (9.4%). In 2020-21, the Ministry received an allocation of Rs 67,112 crore.  This is an increase of 3.9% over the revised estimates of 2019-20 (Rs 64,609 crore).4 
Under the Ministry, the Department of Health and Family Welfare accounts for 97% of the Ministry's allocation, at Rs 65,012 crore.  Whereas, the Department of Health Research is allocated Rs 
2,100 crore (3% of the allocation).   

% 
RE 
BE 
Item 
Actuals 
2018-19 
2019-20 
2020-21 
Change 
(RE to 
BE) 
52,954 
62,659 
65,012 
3.8% 
Health & Family Welfare Health Research 
1,728 
1,950 
2,100 
7.7% 
Total 
54,682 
64,609 
67,112 
3.9% 

Note: BE - Budget Estimate; RE - Revised Estimates. Sources: Demand Nos. 42 & 43, Ministry of Health and Family Welfare, Union Budget 2020-21, PRS. 

The revised estimate in 2019-20 for the Department of Health and Family Welfare matched the budget estimate of Rs 62,659 crore.  Whereas, the Department of Health Research slightly overshot its budget estimate by Rs 50 crore. Table 2 contains the allocation to major expenditure heads under the Ministry for the year 2020-21.   

under the Ministry (in Rs crore) 
% 
RE 
2019-
BE 
2020-
Major Heads 
Actuals 
2018-19 
20 
21 
Change 
(RE to 
BE) 
NHM (total) 
 31,045  33,790   33,400  
-1% 
-NRHM 
25,495 
27,834 
27,039 
-3% 
-NUHM 
868 
950 
950 
0% 
-Others 
4,682 
5,006 
5,411 
8% 
8,718 
10,095 
9,616 
-5% 
Autonomous Bodies (AIIMS, PGIMER, ICMR) 
1,998 
3,200 
6,400 
100% 
Ayushman Bharat: Pradhan Mantri Jan Arogya PMSSY 
3,797 
4,733 
6,020 
27% 
1,803 
2,956 
2,900 
-2% 
National AIDS & STD Control Programme Family Welfare Schemes 
      598  
776        831  
7% 
      227  
114  
       29  
-75% 
Rashtriya Swasthya Bima Yojana Others 
6,497 
8,946 
7,916 
-12% 
Total 
 54,682  64,609   67,112  
4% 

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. 
Autonomous Bodies include the All India Institute of Medical 
Science, Post Graduate Institute of Medical Education and 
Research, Chandigarh, and the Indian Council of Medical 
Research, New Delhi 
Sources: Demand No. 42 & 43, Ministry of Health and Family 
Welfare, Union Budget 2020-21, PRS. 

 
The National Health Mission (NHM) receives 
about 50% of the Ministry's allocation, which 
amounts to Rs 33,400 crore in 2020-21. Under the NHM, the rural component, i.e., the National Rural Health Mission (NRHM) has been allocated Rs 27,039 crore, a 3% decrease over the revised estimates of 2019-20.  The allocation for National Urban Health Mission (NUHM) at Rs 950 crore remained the same over the revised estimates of 2019-20. 
 
Other items under NHM include funds for health and medical education amounting to Rs 4,686 crore in 2020-21.   
 
Allocation to autonomous institutes like the AIIMS and the Indian Council of Medical Research saw a decrease of 5% at Rs 9,616 crore from the revised estimates of 2019-20.   
 
Pradhan Mantri Jan Arogya Yojana has seen the 
highest increase in allocation at 100% (Rs 6,400 crore) over the revised estimates of 2019-20 (Rs 3,200 crore).  The scheme provides a cover of Rs five lakh per family per year to about 10.7 crore families belonging to the poor and vulnerable population.   
 
Higher allocation has been made for Pradhan Mantri Swasthya Suraksha Yojana at Rs 6,020 crore (27% increase).  It focuses on correcting regional imbalances in the availability of affordable tertiary healthcare services.  

## Budget Speech Highlights 2020-21

 
A health cess of 5% will be levied (in addition to customs duty) on certain medical devices, such as X-ray machines, imported into India. This cess may be utilised for the financing of health infrastructure and services. 

 
Viability gap funding window has been proposed for setting up hospitals in the publicprivate partnership mode.  Proceeds from taxes on medical devices would be used to support this health infrastructure. 
 
Jan Aushadhi Kendra Scheme will be expanded to all districts offering 2,000 medicines and 300 surgicals by 2024. 

## Trends In Allocation And Expenditure

In the last 15 years, the allocation to the Department of Health and Family Welfare has increased from Rs 11,366 crore in 2006-07 to Rs 65,012 crore in 2020-
21.  Over the period 2006-20, the Compound Annual Growth Rate (CAGR) has been 13%. CAGR is the annual growth rate over a certain period of time.   
Note: % change in allocation is BE (2020-21) over RE (2019-20) 
for 2020-21. 

Sources: Union Budgets, 2006-07 to 2020-21; PRS. 

Table 3 indicates the actual expenditure of the 
Department of Health and Family Welfare 
compared with the budget estimates of that year 
(2010-20).  The utilisation has been over 100% in 
the last three years, i.e., the Department exceeded its 
budget estimates.  As per the revised estimates of 
2019-20, the Department has already reached 100% 
utilisation.   

| Year    | BE     | Actuals    | Actuals/BE    |
|---------|--------|------------|---------------|
| 2010-11 | 23,530 | 22,765     | 97%           |
| 2011-12 | 26,897 | 24,355     | 91%           |
| 2012-13 | 30,702 | 25,133     | 82%           |
| 2013-14 | 33,278 | 27,145     | 82%           |
| 2014-15 | 35,163 | 30,626     | 87%           |
| 2015-16 | 29,653 | 30,626     | 103%          |
| 2016-17 | 37,066 | 37,671     | 102%          |
| 2017-18 | 48,853 | 51,382     | 105%          |
| 2018-19 | 52,800 | 52,954     | 103%          |
| 2019-20 | 62,659 | 62,659*    | 100%          |

Note: BE - Budget Estimates; *Revised Estimates. Sources: Union Budgets, 2010-20; PRS. 

## Financial Allocations To Outcomes National Health Mission

The National Health Mission (NHM) consists of two 
sub missions, the National Rural Health Mission 
(focused on rural areas) and the National Urban 
Health Mission (focused on urban areas).   NHM 
aims at strengthening public health systems and 
healthcare delivery.   

The various components under NHM 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. 

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

The allocation for NHM in 2020-21 (Rs 33,400 
crore) saw a 1% decrease over the revised estimates 
of 2019-20. NHM's percentage share in the total 
budget has decreased from 73% in 2006-07 to 50% 
in 2020-21.  

In 2020-21, there has been no change in allocation 
towards all the flexible pools.  The funding for the 
flexible pools are: (i) Rs 5,703 crore for the 

immunisation pool, (ii) Rs 2,178 crore towards the flexible pool for communicable diseases, and (iii) Rs 717 crore towards the flexible pool for noncommunicable diseases. 

| Targets (2012-17)             | Status (as on Dec 2019)    |
|-------------------------------|----------------------------|
| Reduce IMR to 25              | IMR has reduced to 35 in   |
| 2017.                         |                            |
| Reduce MMR to                 |                            |
| 100/1,00,000 live births      |                            |
| MMR has reduced to 122 in     |                            |
| 2017.                         |                            |
| Reduce TFR to 2.1             | TFR has reduced to 2.3 in  |
| 2016.                         |                            |
| Annual Malaria Incidence      |                            |
| to be < .001                  |                            |
| Annual Malaria Incidence      |                            |
| is 0.02 in 2019.              |                            |
| Less than 1 % microfilaria    |                            |
| prevalence in all districts   |                            |
| Out of 256 endemic districts, |                            |
| 99 have reported incidence    |                            |
| less than 1% till 2018.       |                            |
| Kala-Azar  elimination by     |                            |
| 2015, <1 case per 10,000      |                            |
| population in all blocks      |                            |
| 92% endemic blocks have       |                            |
| achieved the elimination      |                            |
| target in 2019,               |                            |
| Reduce annual prevalence      |                            |
| and mortality from            |                            |
| Tuberculosis by half          |                            |
| Incidence reduced from 300    |                            |
| per lakh in 1990 to 204 per   |                            |
| lakh in 2017.                 |                            |
| Mortality reduced from 76     |                            |
| per lakh in 1990 to 31 per    |                            |
| lakh in 2017.                 |                            |

Source:  Health and Family Welfare Statistics 2017; Unstarred Question No. 4335, Ministry of Health and Family Welfare, Lok Sabha, December 13, 2019; PRS. Note: IMR-Infant Mortality Rate; MMR-Maternal Mortality Rate; TFR-Total Fertility Rate. 

The objective of NHM is to ensure universal access to equitable, affordable, and quality health care services.  This is done through improving health infrastructure and enhancing service delivery by training human resources in healthcare.  Healthcare infrastructure in India can be categorised into physical infrastructure and the *human resources* 
who provide medical services.    

## Physical Infrastructure

Depending on the level of care required, healthcare in India is broadly classified into three types.  This classification includes primary care (provided at primary health centres), secondary care (provided at district hospitals), and tertiary care institutions (provided at specialised hospitals like AIIMS). Primary health care infrastructure provides the first level of contact between health professionals and the population.5 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).6  A similar set up is maintained in urban areas.7   
The number of SCs, PHCs, and CHCs in 2005 and 2018 respectively across rural and urban areas are given in Figure 2.   
Source:  Comparative Statement, Health Management Information System; PRS. 

A shortfall has been observed at different levels of 
the healthcare delivery system.  As of 2018, there is 
a shortage of 2,188 CHCs, 6,430 PHCs and 32,900 
SCs.8  The Ministry has noted that the existing ones 
are also poorly equipped and have inadequate 
infrastructure with many PHC's functioning in 
erstwhile single room SCs and many SCs in 
thatched accommodation.9   Note that under NRHM, 
states were permitted to establish facilities as per 
need.  However, not many states did so due to lack 
of funds and the inability to close down even 
existing facilities (not in use) due to administrative 
bottlenecks.9   

Under NHM, support is provided to states to 
strengthen existing public health facilities.  As of 
2018, there are 25,778 government hospitals 
(including community health centres) in India.10  
Further, states have constructed 268 new district 
hospitals and upgraded 3,288 hospitals.3  With 
regard to secondary and tertiary care, the HLEG 
(2011) recommended that in order to guarantee 
secondary and tertiary care, equitable access to 
functional beds must also be provided.11   According 
to the World Health Statistics, India ranks among 
the lowest in this regard, with 0.7 beds per 1,000 
people, far below the global average of 3.4 beds.12    
It recommended functional bed capacity should be 
expanded to 2 beds per 1000 population by 2022.    

## Human Resources In Health

Between 2014 and 2018, the number of registered 
doctors increased by 24% from 7,47,109 to 
9,23,749.8  Note that despite the increase, there has 
been a steady increase in the shortfall of doctors, 
specialists and surgeons.  For example, as of 2018, 
there is a shortfall of 46% of doctors, and 82% of 
specialists including surgeons, obstetricians, 
gynaecologists, physicians, and paediatricians in 
Primary Health Centres across India.8 

Certain reasons identified for the shortage of personnel in government facilities include: (i) poor working environment, (ii) poor remuneration making migration to foreign countries and to the private sector more attractive, and (iii) procedural delays in recruitment and poor forward planning for timely filling up of positions.  It has been estimated that filling up human resource gaps in 16 states, would require an outlay equivalent to 0.6% to GDP.11 Table 5 shows the number of health professionals in India.   

| Profession   |           | 2014   |
|--------------|-----------|--------|
| Allopathic   |           |        |
| Doctors      |           |        |
| 7,47,109     | 9,23,749  | 24%    |
| AYUSH        |           |        |
| Doctors**    |           |        |
| 7,36,538     | 7,99,879  |        |
| 9%           |           |        |
| Nurses and   |           |        |
| Pharmacists  |           |        |
| 32,86,157    | 40,91,597 |        |
| 25%          |           |        |

Notes: **includes Ayurveda Unani Siddha Naturopathy Homeopathy. Source: Economic Survey 2019-20; PRS. 

## Pradhan Mantri Jan Arogya Yojana (Pmjay)

Launched in September 2018 under the Ayushman Bharat programme, PMJAY aims to provide a cover of Rs five lakh per family per year to 10.7 crore families (no cap on family size and age) belonging to poor and vulnerable population.13  The scheme subsumed two centrally sponsored schemes, namely, Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme.   
Benefits:  The scheme provides insurance coverage for secondary and tertiary healthcare.   At present, 1,393 procedures across different specialties such as general medicine, oncology, cardiology, and orthopaedics are covered.   In addition, the scheme provides for pre and post hospitalisation expenses. In 2020-21, PMJAY has been allocated Rs 6,400 crore, an increase of 100% over the revised estimates of 2019-20.  In 2019-20, the scheme was allocated Rs 6,400 crore which was revised downward to Rs 3,200 crore. A study report by the 15th Finance Commission estimated the demand and expenditure on the PMJAY for the next five years.  It stated that the total costs (centre and states) of PMJAY for 2019 could range from Rs 28,000 crore to Rs 74,000 crore.14  This estimate takes into account: (i) the assumption that all targeted beneficiaries will be covered (approximately 50 crore people), (ii) hospitalisation rates over time, and (iii) average expenditure on hospitalisation.  Further, it noted that these costs could go up to between Rs 66,000 crore and Rs 1,60,089 crore in 2023 (accounting for inflation).   

Note that, the Standing Committee on Health (2018) 
and a study report of the 15th Finance Commission 
(2019) have noted that PMJAY is just an extension 
of RSBY which provided for coverage of up to Rs 
30,000 per family per annum.14,15  Hence, to ensure 
proper implementation of the scheme, an analysis of 
the failures and inadequacies of RSBY should be 
done.  This would look at whether: (i) RSBY 
covered all potential beneficiaries, (ii) 
hospitalisation rates increased under the scheme, 
and (iii) insurance companies were profitable under 
the scheme. 

While PMJAY provides coverage for secondary and 
tertiary levels of healthcare, most of the out-of-the-
pocket expenditure made by the consumers is 
actually on buying medicines (52%), and towards 
public hospitals (22%) (See Figure 3).16  Out-of-the-
pocket expenditure are the payments made directly 
by individuals at the point of service where the 
entire cost of the health service is not covered under 
any financial protection scheme.    

Several expert bodies including the High Level 
Expert Group (HLEG) set up by the Planning 
Commission (2011) and the High Level Group of 
Health Sector (2019) have observed that focus on 
prevention and early management of health 
problems can reduce the need for complicated 
specialist care provided at the tertiary level.11,17  It 
recommended that the focus of healthcare provision 
in the country should be towards providing primary 
healthcare.     

In this context, as part of the Ayushman Bharat programme, 1,50,000 existing Sub Health Centres (first contact between health system and population) and Primary Health Centres (referral unit for Sub Centres) will be upgraded to Health and Wellness Centres by December 2022.  These centres will provide comprehensive primary health care, free essential drugs and diagnostic services. The table below shows details regarding the implementation of the Ayushman Bharat programme which includes PMJAY and Health and Wellness Centres.   

| Indicators                              | All India    |
|-----------------------------------------|--------------|
| Beneficiary families covered (in lakhs) | 1,363        |
| % claims paid                           | 63%          |
| Number of empanelled hospitals          | 19,752       |
| Health and Wellness Centres             | 29,572       |

Sources:  Lok Sabha Unstarred Question No. 1,066, Ministry of Health and Family Welfare, answered on November 22, 2019; HWC Portal, Ayushman Bharat; PRS. 

## Pradhan Mantri Swasthya Suraksha Yojana

Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) has been implemented since 2003 with objective of: (i) correcting regional imbalances in the availability of affordable and reliable tertiary healthcare services, and (ii) augmenting facilities for quality medical education in the country.  This includes establishing AIIMS like institutions and upgrading certain state government hospitals.  Over the years, the scheme has been expanded to cover 20 new AIIMS and 71 state government hospitals. In 2018, the Comptroller and Auditor General (CAG) noted that all new AIIMs overshot their completion time by almost five years.18  There were similar delays observed in the upgradation of state government hospitals.  Further, it was found that the Ministry had estimated the capital cost for setting up six new AIIMS in Phase 1 to be Rs 332 crore per institute.  After four years, this cost was revised to Rs 820 crore per institute, on account of shortcomings in planning and assessment of requirements.  The Standing Committee on Health and Family Welfare (2017 and 2018) noted that this indicates poor assessment of time and cost which have left the allocated funds unused.15,19  
Notes:  Values for 2019-20 and 2020-21 are revised estimates and budget estimates respectively  
Sources: Union Budget 2008-09 to 2020-21; PRS. 

In 2020-21, the allocation to PMSSY increased by 
27% over the revised estimates of 2019-20 (see 
Figure 6) at Rs 6,020 crore.  Allocation towards 
PMSSY increased from Rs 654 crore in 2010-11 to 
Rs 6,020 crore in 2020-21. 

## The National Medical Commission Act, 2019

A legislation regarding the medical regulatory authority was passed by Parliament to oversee medical education and practice.  The National Medical Commission Act, 2019 replaced the current Medical Council of India (MCI).  The MCI was established under the 1956 Act to establish uniform standards of medical education and regulate its practice. The Act provides for a medical education system which ensures: (i) availability of adequate and high quality medical professionals, (ii) adoption of the latest medical research by medical professionals, (iii) 
periodic assessment of medical institutions, and (iv) 
an effective grievance redressal mechanism. 

## Health Research

The Standing Committee on Health and Family 
Welfare (2018) noted that there is a huge, persistent, 
and recurring mismatch between the projected 
demand for funds and actual allocation to the 
Department of Health Research.20,21  In 2020-21, its 
allocation has seen an increase of 7.7% over the 
revised estimates of 2019-20 at Rs 2,100 crore.  The 
Committee also noted that the Department had 
reported shortfall of funds for implementation of 
projects and on the other hand, there was 
underutilisation of funds released.  

This mismatch between the demanded and allocated 
funds has led to impact in terms of restrictions in the 
sanctioning of new labs, providing recurring grants 
to the ongoing projects, and upgradation of health 
research infrastructure.20  This also led to 
repercussions in the medical research output.  For 

## 

example, in two years i.e. 2015 and 2016, only 1,685 research papers have been published by the Indian Council of Medical Research and 3 patents have been granted against the 45 patents filed.20   

## Drug Regulation

The central and state agencies for drug regulation are governed by the Drugs and Cosmetics Act, 1940 (DCA).  The DCA provides for the regulation of import, manufacture, sale, and distribution of drugs. Although the DCA is a central legislation, it is implemented by the states. Over the years, various Committees have examined the issues relating to the regulation of drugs. The Mashelkar Committee Report (2003) highlighted the following challenges of the drug regulatory system: (i) inadequacy of trained and skilled personnel at the central and state levels, (ii) lack of uniformity in the implementation of regulatory requirements and variations in regulatory enforcement, and (iii) inadequate or weak drug control infrastructure at the state and central level.22 Expert committees have recommended many steps to address these concerns regarding drug regulation in the country.22,23,24   They include: (i) a new independent and professionally run regulatory body, Central Drug Administration reporting directly to MoHFW, (ii) categorising the states in terms of scale of industry (manufacturing and sale) and investment in their regulation accordingly, (iii) the revision and imposition of higher fees for drug applications, clinical trials, and registration of imported drugs and foreign manufacturers, and (iv) establishment of technical expert committees for new drug approvals.  

## Quality Of Drugs

The Standing Committee Report (2013) found that the prevalence of poor quality drugs to be around 7- 8 % where non-standard drugs outnumber spurious drugs.25 
                                                           

The extent of 'non-standard quality' drugs in the 
National Drug Survey between 2014 and 2016 was 
3.2%.26  The extent of 'spurious' drugs during the 
same time period was 0.02%.26  A drug is deemed to 
be 'spurious' if:  (i) it is manufactured under a name 
which belongs to another drug, (ii) if it is an 
imitation of another drug, (iii) if it has been 
substituted wholly or partly by another drug, and 
(iv) if it wrongly claims to be the product of another 
manufacturer.27 

With regard to quality of drugs, the Mashelkar 
Committee recommended that: (i) states should take 
more samples to check the quality of drugs 
manufactured and sold in the market, (ii) states 
should also monitor the source of purchase and 
quality of drugs stocked by registered medical 
practitioners, and (iii) number of drug inspectors 
and their skills must be upgraded according to the 
load of work of inspections and monitoring.22    

Drug pricing 

The National Pharmaceutical Pricing Authority 
(NPPA) monitors the availability and pricing of 
drugs in the country.  NPPA fixes the prices of 
drugs/devices included in Schedule I of Drugs 
(Prices Control) Order (DPCO), 2013 after their 
notification under National List of Essential 
Medicines (NLEM).  NLEM, 2015 consists of 3,754 
medicines in total.  Wherever instances of 
manufacturers/ importers charging prices higher 
than the prices fixed by the NPPA are reported, 
these cases are examined in detail.  Since the 
inception of NPPA in 1995 till 2019, 2,038 demand 
notices have been issued to pharmaceutical 
companies for having overcharged patients on the 
sale of formulations at prices above the ceiling 
prices notified by NPPA.28  An amount of Rs 5,477 
crore is still remaining to be paid and an amount of 
Rs 4,033 is under litigation.28 

%20-
%202014/Rural%20Health%20Care%20System%20in%20India.
pdf.   
7 Framework for Implementation, National Urban Health Mission 
,May, 2013, 
http://nrhm.gov.in/images/pdf/NUHM/Implementation_Framewo
rk_NUHM.pdf. 
8 Rural Health Statistics 2018, Health Management Information 
Systems, Ministry of Health and Family Welfare. 
9 "Survey Report & Recommendations of Clinical 
Establishments", Ministry of Health and Family Welfare, 2013, 
http://clinicalestablishments.nic.in/WriteReadData/788.pdf. 
10 Health and Family Welfare Statistics 2017, Ministry of Health 
and Family Welfare. 
11 "High Level Expert Group Report on Universal Health 
Coverage for India", Planning Commission of India, November 
2011, 

http://planningcommission.gov.in/reports/genrep/rep_uhc0812.pd
f.  

                                                                                                                                                                                     
http://www.mohfw.nic.in/sites/default/files/38300411751489562625.pdf 17 A Report of the High Level Group of Heath Sector, 15th Finance Commission, https://fincomindia.nic.in/ShowContentOne.aspx?id=27&Section=1 18  Report No. 10, Performance Audit on Pradhan Mantri Swasthya Suraksha Yojana, August 7, 2018, https://cag.gov.in/content/reportno10-2018-performance-audit-pradhan-mantri-swasthya-suraksha-yojana-ministry-health. 19 19 "Report no. 99: Demands for Grants 2017-18 (Demand No. 42) of the Department of Health and Family Welfare", Standing Committee on Health and Family Welfare, March 20, 2017, http://164.100.47.5/newcommittee/reports/EnglishCommittees/Committee%20on%20Health%20and%20Family%20Welfare/99.pdf 20 "Report no. 100: Demands for Grants 2017-18 (Demand No.43) of the Department of Health Research", Standing Committee on Health and Family Welfare, March 20, 2017, http://164.100.47.5/newcommittee/reports/EnglishCommittees/Committee%20on%20Health%20and%20Family%20Welfare/100.pdf. 21 Report No. 107, Demand for Grants 2018-19 (Demand No. 43) of the Department of Health Research, Standing Committee on Health and Family Welfare, March 2018, https://rajyasabha.nic.in/rsnew/Committee_site/Committee_File/ReportFile/14/100/107_2018_6_16.pdf, 22 Report of the Expert Committee on "A Comprehensive Examination of Drug Regulatory Issues, including the problem of Spurious Drugs", Ministry of Health and Family Welfare, November, 2003, http://pharmaceuticals.gov.in/sites/default/files/MashelkarCommitteeReport.pdf. Family Welfare, Ministry of Health and Family Welfare, May 8, 2012, http://164.100.47.5/newcommittee/reports/EnglishCommittees/Committee%20on%20Health%20and%20Family%20Welfare/59.pdf. Family Welfare, Ministry of Health and Family Welfare, May 8, 2012, http://www.cdsco.nic.in/writereaddata/D&C_ACT_AMENDMENT_2008_file.pdf 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. 

| 2019-20                                        | 2019-20    | 2020-21    |
|------------------------------------------------|------------|------------|
| Major Heads                                    |            |            |
| 2018-19                                        |            |            |
| Actuals                                        | BE         | RE         |
| % Change                                       |            |            |
| RE (2019-                                      |            |            |
| 20)/Actuals                                    |            |            |
| (2018-19)                                      |            |            |
| Change                                         |            |            |
| between                                        |            |            |
| RE 2019-                                       |            |            |
| 20 and BE                                      |            |            |
| 2020-21                                        |            |            |
| Department of Health Research                  | 1,728      | 1,900      |
| Department of Health and Family Welfare        | 52,954     | 62,659     |
| Pradhan Mantri Swasthya Suraksha Yojana        | 3,797      | 4,000      |
| Family Welfare Schemes                         | 598        | 950        |
| National AIDS and STD Control Programme        | 1,803      | 2,500      |
| National Health Mission                        | 31,045     | 32,995     |
| -National Rural Health Mission                 | 25,495     | 27,039     |
| -National Urban Health Mission                 | 868        | 950        |
| -Tertiary Care Programs                        | 289        | 550        |
| -Strengthening of State Drug Regulatory System | 179        | 206        |
| -Human Resources for Health and Medical        |            |            |
| Education                                      |            |            |
| 4,214                                          | 4,250      | 4,500      |
| Infrastructure Development for Health Research | 103        | 160        |
| Rashtriya Swasthya Bima Yojna                  | 227        | 156        |
| Pradhan Mantri Jan Arogya Yojana               | 1,998      | 6,400      |
| Autonomous Bodies                              | 8,718      | 9,920      |
| Others                                         | 6,394      | 7,478      |
| Total                                          | 54,682     | 64,559     |

Sources:  Demand for Grants, Ministry of Health and Family Welfare, Union Budget, 2020-21; PRS. 


## State-Wise Numbers On The Health Sector

Average health expenditure 
State 
Average health expenditure 
(rural) 
(urban) 
Andhra Pradesh 
         13,227  
         31,242  
Arunachal Pradesh 
           5,678  
           8,926  
Assam 
           6,966  
         47,064  
Bihar 
         11,432  
         25,004  
Chhattisgarh 
         12,149  
         22,647  
Delhi 
         30,613  
         34,730  
Goa 
         29,954  
         23,165  
Gujarat 
         14,298  
         20,155  
Haryana 
         18,341  
         32,370  
Himachal Pradesh 
         18,860  
         28,590  
Jammu & Kashmir 
           8,442  
         13,948  
Jharkhand 
         10,351  
         13,151  
Karnataka 
         14,091  
         22,190  
Kerala 
         17,642  
         15,465  
Madhya Pradesh 
         13,090  
         23,993  
Maharashtra 
         20,475  
         29,493  
Manipur 
           6,061  
         10,215  
Meghalaya 
           2,075  
         18,786  
Mizoram 
           8,744  
         13,461  
Nagaland 
           5,628  
         15,788  
Odisha 
         10,240  
         19,750  
Punjab 
         27,718  
         29,971  
Rajasthan 
         12,855  
         16,731  
Sikkim 
           8,035  
           9,939  
Tamil Nadu 
         11,842  
         23,757  
Telangana 
         19,664  
         20,617  
Tripura 
           5,694  
         11,638  
Uttar Pradesh 
         18,693  
         31,653  
Uttarakhand 
           9,162  
         25,703  
West Bengal 
         11,327  
         24,875  
Andaman & Nicobar Islands 
           3,373  
           8,389  
Chandigarh 
         16,389  
         35,158  
Dadra & Nagar Haveli 
           4,219  
           7,749  
Daman & Diu 
         10,223  
           6,930  
Lakshadweep 
         10,418  
           8,604  
Puducherry 
           7,965  
         14,076  
All India 
         14,935  
         24,436  

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


|                                                                                                             | Population    | Crude      |
|-------------------------------------------------------------------------------------------------------------|---------------|------------|
| State                                                                                                       | (Million)     | Birth Rate |
| Total                                                                                                       |               |            |
| Fertility                                                                                                   |               |            |
| 2011                                                                                                        | 2016          | Rate, 2016 |
| Under 5                                                                                                     |               |            |
| mortality                                                                                                   |               |            |
| rate, 2016                                                                                                  |               |            |
|                                                                                                             |               |            |
| Number of                                                                                                   |               |            |
| live births                                                                                                 |               |            |
| per 1,000                                                                                                   |               |            |
| in a                                                                                                        |               |            |
| population.                                                                                                 |               |            |
| Number of                                                                                                   |               |            |
| children                                                                                                    |               |            |
| born to a                                                                                                   |               |            |
| woman in                                                                                                    |               |            |
| her life time                                                                                               |               |            |
| Death                                                                                                       |               |            |
| between 0-                                                                                                  |               |            |
| 5 years,                                                                                                    |               |            |
| per 1,000                                                                                                   |               |            |
| live births                                                                                                 |               |            |
| Andhra Pradesh                                                                                              | 49            | 16         |
| Assam                                                                                                       | 31            | 22         |
| Bihar                                                                                                       | 104           | 27         |
| Chhattisgarh                                                                                                | 26            | 23         |
| Gujarat                                                                                                     | 60            | 20         |
| Haryana                                                                                                     | 25            | 21         |
| Jharkhand                                                                                                   | 33            | 23         |
| Karnataka                                                                                                   | 61            | 18         |
| Kerala                                                                                                      | 33            | 14         |
| Madhya Pradesh                                                                                              | 73            | 25         |
| Maharashtra                                                                                                 | 112           | 16         |
| Odisha                                                                                                      | 42            | 19         |
| Punjab                                                                                                      | 28            | 15         |
| Rajasthan                                                                                                   | 69            | 24         |
| Tamil Nadu                                                                                                  | 72            | 15         |
| Telangana                                                                                                   | 35            | 18         |
| Uttar Pradesh                                                                                               | 200           | 26         |
| West Bengal                                                                                                 | 91            | 15         |
| Arunachal                                                                                                   |               |            |
| Pradesh                                                                                                     |               |            |
| 1                                                                                                           | 19            | 2.7        |
| Delhi                                                                                                       | 17            | 16         |
| Goa                                                                                                         | 1             | 13         |
| Himachal Pradesh                                                                                            | 7             | 16         |
| Jammu & Kashmir                                                                                             | 13            | 16         |
| Manipur                                                                                                     | 3             | 13         |
| Meghalaya                                                                                                   | 3             | 24         |
| Mizoram                                                                                                     | 1             | 16         |
| Nagaland                                                                                                    | 2             | 14         |
| Sikkim                                                                                                      | 1             | 17         |
| Tripura                                                                                                     | 4             | 14         |
| Uttarakhand                                                                                                 | 10            | 17         |
| Andaman &                                                                                                   |               |            |
| Nicobar Islands                                                                                             |               |            |
| 0                                                                                                           | 12            | 1.5        |
| Chandigarh                                                                                                  | 1             | 14         |
| Dadra & Nagar                                                                                               |               |            |
| Haveli                                                                                                      |               |            |
| 0                                                                                                           | 25            | 3.3        |
| Daman & Diu                                                                                                 | 0             | 24         |
| Lakshadweep                                                                                                 | 0             | 19         |
| Puducherry                                                                                                  | 1             | 14         |
| All India                                                                                                   | 1,211         | 19         |
| Sources: Census Data 2011; Sample Registration System 2019; Health and Family Welfare Statistics 2017; PRS. |               |            |

 

Life 
Expectancy 
Maternal 
Mortality 
Underweight 
children (%)  
Infant Mortality 
Rate (per 1000 
live Births) 2016 
2015 
Ratio        
2015-17 
at Birth 
(Years)     
2012-16 
Composite index of stunting and wasting 
Number of infants who die before reaching one, per 1,000 live births 
Number of maternal deaths, per 1,00,000 live births 
How long a new born can expect to live, on existing death rate 

2020