Recently, the Standing Committee on Health and Family Welfare submitted its report to the Parliament on the National Commission for Human Resource for Health Bill, 2011. The objective of the Bill is to “ensure adequate availability of human resources in the health sector in all states”. It seeks to set up the National Commission for Human Resources for Health (NCHRH), National Board for Health Education (NBHE), and the National Evaluation and Assessment Council (NEAC) in order to determine and regulate standards of health education in the country. It separates regulation of the education sector from that of professions such as law, medicine and nursing, and establishes professional councils at the national and state levels to regulate the professions. See here for PRS Bill Summary. The Standing Committee recommended that this Bill be withdrawn and a revised Bill be introduced in Parliament after consulting stakeholders. It felt that concerns of the professional councils such as the Medical Council of India and the Dental Council of India were not adequately addressed. Also, it noted that the powers and functions of the NCHRH and the National Commission on Higher Education and Research (to be established under the Higher Education and Research Bill, 2011 to regulate the higher education sector in the country) were overlapping in many areas. Finally, it also expressed concern over the acute shortage of qualified health workers in the country as well as variations among states and rural and urban areas. As per the 2001 Census, the estimated density of all health workers (qualified and unqualified) is about 20% less than the World Health Organisation’s norm of 2.5 health workers per 1000 population. See here for PRS Standing Committee Summary. Shortfall of health workers in rural areas Public health care in rural areas is provided through a multi-tier network. At the lowest level, there are sub health-centres for every population of 5,000 in the plains and 3,000 in hilly areas. The next level consists of Primary Health Centres (PHCs) for every population of 30,000 in the plains and 20,000 in the hills. Generally, each PHC caters to a cluster of Gram Panchayats. PHCs are required to have one medical officer and 14 other staff, including one Auxiliary Nurse Midwife (ANM). There are Community Health Centres (CHCs) for every population of 1,20,000 in the plains and 80,000 in hilly areas. These sub health centres, PHCs and CHCs are linked to district hospitals. As on March 2011, there are 14,8124 sub health centres, 23,887 PHCs and 4809 CHCs in the country.[i] Sub-Health Centres and Primary Health Centres
Table 1: State-wise comparison of vacancy in PHCs
Doctors at PHCs |
ANM at PHCs and Sub-Centres |
|||||
State | Sanctioned post | Vacancy | % of vacancy | Sanctioned post | Vacancy | % of vacancy |
Chhattisgarh | 1482 | 1058 | 71 | 6394 | 964 | 15 |
West Bengal | 1807 | 801 | 44 | 10,356 | NA | 0 |
Maharashtra | 3618 | 1326 | 37 | 21,122 | 0 | 0 |
Uttar Pradesh | 4509 | 1648 | 36 | 25,190 | 2726 | 11 |
Mizoram | 57 | 20 | 35 | 388 | 0 | 0 |
Madhya Pradesh | 1238 | 424 | 34 | 11,904 | 0 | 0 |
Gujarat | 1123 | 345 | 31 | 7248 | 817 | 11 |
Andaman & Nicobar Isld | 40 | 12 | 30 | 214 | 0 | 0 |
Odisha | 725 | 200 | 28 | 7442 | 0 | 0 |
Tamil Nadu | 2326 | 622 | 27 | 9910 | 136 | 1 |
Himachal Pradesh | 582 | 131 | 22 | 2213 | 528 | 24 |
Uttarakhand | 299 | 65 | 22 | 2077 | 0 | 0 |
Manipur | 240 | 48 | 20 | 984 | 323 | 33 |
Haryana | 651 | 121 | 19 | 5420 | 386 | 7 |
Sikkim | 48 | 9 | 19 | 219 | 0 | 0 |
Meghalaya | 127 | 23 | 18 | 667 | 0 | 0 |
Delhi | 22 | 3 | 14 | 43 | 0 | 0 |
Goa | 46 | 5 | 11 | 260 | 20 | 8 |
Karnataka | 2310 | 221 | 10 | 11,180 | 0 | 0 |
Kerala | 1204 | 82 | 7 | 4232 | 59 | 1 |
Andhra Pradesh | 2424 | 76 | 3 | 24,523 | 2876 | 12 |
Rajasthan | 1478 | 6 | 0.4 | 14,348 | 0 | 0 |
Arunachal Pradesh | NA | NA | NA | NA | NA | 0 |
Assam | NA | NA | NA | NA | NA | 0 |
Bihar | 2078 | 0 | NA | NA | NA | 0 |
Chandigarh | 0 | 0 | NA | 17 | 0 | 0 |
Dadra & Nagar Haveli | 6 | 0 | NA | 40 | 0 | 0 |
Daman & Diu | 3 | 0 | NA | 26 | 0 | 0 |
Jammu & Kashmir | 750 | 0 | NA | 2282 | 0 | 0 |
Jharkhand | 330 | 0 | NA | 4288 | 0 | 0 |
Lakshadweep | 4 | 0 | NA | NA | NA | 0 |
Nagaland | NA | NA | NA | NA | NA | 0 |
Puducherry | 37 | 0 | NA | 72 | 0 | 0 |
Punjab | 487 | 0 | NA | 4044 | 0 | 0 |
Tripura | NA | NA | NA | NA | NA | 0 |
India | 30,051 | 7,246 | 24 | 1,77,103 | 8,835 | 5 |
Sources: National Rural Health Mission (available here), PRS.Note: The data for all states is as of March 2011 except for some states where data is as of 2010. For doctors, these states are Bihar, UP, Mizoram and Delhi. For ANMs, these states are Odisha and Uttar Pradesh. |
Community Health Centres
Table 2: Vacancies in CHCs of medical specialists
Surgeons | Gynaecologists | Physicians | Paediatricians | |
State |
% of vacancy |
|||
Andaman & NicobarIsland | 100 | 100 | 100 | 100 |
Andhra Pradesh | 74 | 0 | 45 | 3 |
Arunachal Pradesh | NA | NA | NA | NA |
Assam | NA | NA | NA | NA |
Bihar | 41 | 44 | 60 | 38 |
Chandigarh | 50 | 40 | 50 | 100 |
Chhattisgarh | 85 | 85 | 90 | 84 |
Dadra & Nagar Haveli | 0 | 0 | 0 | 0 |
Daman & Diu | 0 | 100 | 0 | 100 |
Delhi | 0 | 0 | 0 | 0 |
Goa | 20 | 20 | 67 | 66 |
Gujarat | 77 | 73 | 0 | 91 |
Haryana | 71 | 80 | 94 | 85 |
Himachal Pradesh | NA | NA | NA | NA |
Jammu & Kashmir | 34 | 34 | 53 | 63 |
Jharkhand | 45 | 0 | 81 | 61 |
Karnataka | 33 | NA | NA | NA |
Kerala | NA | NA | NA | NA |
Lakshadweep | 0 | 0 | 100 | 0 |
Madhya Pradesh | 78 | 69 | 76 | 58 |
Maharashtra | 21 | 0 | 34 | 0 |
Manipur | 100 | 94 | 94 | 87 |
Meghalaya | 50 | NA | 100 | 50 |
Mizoram | NA | NA | NA | NA |
Nagaland | NA | NA | NA | NA |
Odisha | 44 | 45 | 62 | 41 |
Puducherry | 0 | 0 | 100 | NA |
Punjab | 16 | 36 | 40 | 48 |
Rajasthan | 57% | 46 | 49 | 24 |
Sikkim | NA | NA | NA | NA |
Tamil Nadu | 0 | 0 | 0 | 0 |
Tripura | NA | NA | NA | NA |
Uttar Pradesh | NA | NA | NA | NA |
Uttarakhand | 69 | 63 | 74 | 40 |
West Bengal | 0 | 57 | 0 | 78 |
India | 56 | 47 | 59 | 49 |
Sources: National Rural Health Mission (available here), PRS. |
[i]. “Rural Healthcare System in India”, National Rural Health Mission (available here).
The Finance Minister, Ms. Nirmala Sitharaman, presented the Union Budget for the financial year 2019-20 in Parliament on July 5, 2019. In the 2019-20 budget, the government presented the estimates of its expenditure and receipts for the year 2019-20. The budget also gave an account of how much money the government raised or spent in 2017-18. In addition, the budget also presented the revised estimates made by the government for the year 2018-19 in comparison to the estimates it had given to Parliament in the previous year’s budget.
What are revised estimates?
Some of the estimates made by the government might change during the course of the year. For instance, once the year gets underway, some ministries may need more funds than what was actually allocated to them in the budget, or the receipts expected from certain sources might change. Such deviations from the budget estimates get reflected in the figures released by the government at later stages as part of the subsequent budgets. Once the year ends, the actual numbers are audited by the Comptroller and Auditor General of India (CAG), post which they are presented to Parliament with the upcoming budget, i.e. two years after the estimates are made.
For instance, estimates for the year 2018-19 were presented as part of the 2018-19 budget in February 2018. In the 2019-20 interim budget presented in February 2019 (10 months after the financial year 2018-19 got underway), the government revised these estimates based on the actual receipts and expenditure accounted so far during the year and incorporated estimates for the remaining two months.
The actual receipts and expenditure accounts of the central government are maintained by the Controller General of Accounts (CGA), Ministry of Finance on a monthly basis. In addition to the monthly accounts, the CGA also publishes the provisional unaudited figures for the financial year by the end of the month of May. Once these provisional figures are audited by the CAG, they are presented as actuals in next year’s budget. The CGA reported the figures for 2018-19 on May 31, 2019.[1] The Economic Survey 2018-19 presented on July 4, 2019 uses these figures.[2]
The budget presented on July 5 replicates the revised estimates reported as part of the interim budget (February 1, 2019). Thus, it did not take into account the updated figures for the year 2018-19 from the CGA.
Table 1 gives a comparison of the 2018-19 revised estimates presented by the central government in the budget with the provisional unaudited figures maintained by the CGA for the year 2018-19.[3]
Table 1: Budget at a Glance: Comparison of 2018-19 revised estimates with CGA figures (unaudited) (Rs crore)
Actuals |
Budgeted |
Revised |
Provisional |
Difference |
|
Revenue Expenditure |
18,78,833 |
21,41,772 |
21,40,612 |
20,08,463 |
-1,32,149 |
Capital Expenditure |
2,63,140 |
3,00,441 |
3,16,623 |
3,02,959 |
-13,664 |
Total Expenditure |
21,41,973 |
24,42,213 |
24,57,235 |
23,11,422 |
-1,45,813 |
Revenue Receipts |
14,35,233 |
17,25,738 |
17,29,682 |
15,63,170 |
-1,66,512 |
Capital Receipts |
1,15,678 |
92,199 |
93,155 |
1,02,885 |
9,730 |
of which: |
|
|
|
|
|
Recoveries of Loans |
15,633 |
12,199 |
13,155 |
17,840 |
4,685 |
Other receipts (including disinvestments) |
1,00,045 |
80,000 |
80,000 |
85,045 |
5,045 |
Total Receipts (without borrowings) |
15,50,911 |
18,17,937 |
18,22,837 |
16,66,055 |
-1,56,782 |
Revenue Deficit |
4,43,600 |
4,16,034 |
4,10,930 |
4,45,293 |
34,363 |
% of GDP |
2.6 |
2.2 |
2.2 |
2.4 |
|
Fiscal Deficit |
5,91,062 |
6,24,276 |
6,34,398 |
6,45,367 |
10,969 |
% of GDP |
3.5 |
3.3 |
3.4 |
3.4 |
|
Primary Deficit |
62,110 |
48,481 |
46,828 |
62,692 |
15,864 |
% of GDP |
0.4 |
0.3 |
0.2 |
0.3 |
|
Sources: Budget at a Glance, Union Budget 2019-20; Controller General of Accounts, Ministry of Finance; PRS.
The 2018-19 provisional figures for revenue receipts is Rs 15,63,170 crore, which is Rs 1,66,512 crore less than the revised estimates. This is largely due to Rs 1,67,455 crore shortfall in centre’s net tax revenue between the revised estimates and the provisional estimates (Table 2).
Major taxes which see a shortfall between the gross tax revenue presented in the revised estimates vis-à-vis the provisional figures are income tax (Rs 67,346 crore) and GST (Rs 59,930 crore). Non-tax revenue and disinvestment receipts as per the provisional figures are higher than the revised estimates.
Table 2: Break up of central government receipts: Comparison of 2018-19 RE with CGA figures (unaudited) (Rs crore)
|
Actuals |
Budgeted |
Revised |
Provisional |
Difference |
Gross Tax Revenue |
19,19,009 |
22,71,242 |
22,48,175 |
20,80,203 |
-1,67,972 |
of which: |
|
|
|
|
|
Corporation Tax |
5,71,202 |
6,21,000 |
6,71,000 |
6,63,572 |
-7,428 |
Taxes on Income |
4,30,772 |
5,29,000 |
5,29,000 |
4,61,654 |
-67,346 |
Goods and Services Tax |
4,42,562 |
7,43,900 |
6,43,900 |
5,83,970 |
-59,930 |
Customs |
1,29,030 |
1,12,500 |
1,30,038 |
1,17,930 |
-12,108 |
Union Excise Duties |
2,59,431 |
2,59,600 |
2,59,612 |
2,30,998 |
-28,614 |
A. Centre's Net Tax Revenue |
12,42,488 |
14,80,649 |
14,84,406 |
13,16,951 |
-1,67,455 |
B. Non Tax Revenue |
1,92,745 |
2,45,089 |
2,45,276 |
2,46,219 |
943 |
of which: |
|
|
|
|
|
Interest Receipts |
13,574 |
15,162 |
12,047 |
12,815 |
768 |
Dividend and Profits |
91,361 |
1,07,312 |
1,19,264 |
1,13,424 |
-5,840 |
Other Non-Tax Revenue |
87,810 |
1,22,615 |
1,13,965 |
1,19,980 |
6,015 |
C. Capital Receipts (without borrowings) |
1,15,678 |
92,199 |
93,155 |
1,02,885 |
9,730 |
of which: |
|
|
|
|
|
Disinvestment |
1,00,045 |
80,000 |
80,000 |
85,045 |
5,045 |
Receipts (without borrowings) (A+B+C) |
15,50,911 |
18,17,937 |
18,22,837 |
16,66,055 |
-1,56,782 |
Borrowings |
5,91,062 |
6,24,276 |
6,34,398 |
6,45,367 |
10,969 |
Total Receipts (including borrowings) |
21,41,973 |
24,42,213 |
24,57,235 |
23,11,422 |
-1,45,813 |
Note: Centre’s net tax revenue is gross tax revenue less share of states in central taxes. Figures for GST include receipts from the GST compensation cess. Note that GST was levied for a nine-month period during the year 2017-18, starting July 2017.
Sources: Receipts Budget, Union Budget 2019-20; Controller General of Accounts, Ministry of Finance; PRS.
While the provisional figures show a considerable decrease in receipts (Rs 1,56,782 crore) as compared to the revised estimates, fiscal deficit has not shown a comparable increase. Fiscal deficit is estimated to be Rs 10,969 crore higher than the revised estimates as per the provisional accounts.
On the expenditure side, the total expenditure as per the provisional figures show a decrease of Rs 1,45,813 crore as compared to the revised estimates. Certain Ministries and expenditure items have seen a decrease in expenditure as compared to the revised estimates made by the government. As per the provisional accounts, the expenditure of the Ministry of Agriculture and Farmers’ Welfare and the Ministry of Consumer Affairs, Food and Public Distribution are Rs 22,133 crore and Rs 70,712 crore lower than the revised estimates, respectively. The decrease in the Ministries’ expenditure as a percentage of the revised estimates are 29% and 39%, respectively. The food subsidy according to CGA was Rs 1,01,904 crore, which was Rs 69,394 crore lower than the revised estimates for the year 2018-19 given in the budget documents.
[1] “Accounts of the Union Government of India (Provisional/Unaudited) for the Financial Year 2018-19”, Press Information Bureau, Ministry of Finance, May 31, 2019.
[2] Fiscal Developments, Economic Survey 2018-19, https://www.indiabudget.gov.in/economicsurvey/doc/vol2chapter/echap02_vol2.pdf.
[3] Controller General of Accounts, Ministry of Finance, March 2018-19, http://www.cga.nic.in/MonthlyReport/Published/3/2018-2019.aspx.