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Public health is in crisis in Bihar. Why isn’t it spending health funds?

Healthcare workforce piece. Public health system concept.
Patients wait to be seen at a medical clinic in Bihar.

The Centre issued Rs 88.5 crore to the Bihar state government in the last fiscal year to strengthen its public health system. Astonishingly, the state government spent less than one-third of it.

The news comes at a time when the public health infrastructure in the state is being heavily scrutinised and castigated in many quarters following the tragedy of more than 150 child deaths due to encephalitis in the Muzaffarpur district. Adding to the scrutiny was a Niti Aayog report released in the aftermath, which paced Bihar near the bottom of the list of Indian states ranked according to their performance on healthcare. 

The funds allocated to Bihar – lower than other states owing to chronic underspending of healthcare funds – were for the purpose of implementing Ayushman Bharat in the state. Spending a mere Rs 27 crore, the state was able to create only 600 health and wellness centres (HWCs). Uttar Pradesh – named the worst state in India on health by Niti Aayog – created more than 2,000 such facilities by comparison. 

The Centre has also flagged low rates of beneficiaries availing insurance cover under Ayushman Bharat. Just Rs 51 crore worth of claims were made under the scheme, covering 50,369 healthcare visits. This is despite there being almost eleven million families eligible for Ayushman Bharat in the state according to government figures.  Indeed, just 36 of the families affected by the encephalitis outbreak eligible for treatment under Ayushman Bharat accessed it. 

While Ayushman Bharat is by no means a pancaea for strengthening public health infrastructure, the funds allocated to Bihar provided some opportunity to fortify the frontline of its public health system through the creation of HWCs and enable beneficiaries to avail treatment and services. Had funds been properly spent, timely diagnoses could have been made in a number of the encephalitis cases, potentially averting a number of the deaths.

This is not the first time a state has been flagged for failing to spend funds allocated for healthcare. Between the 2011-12 and 2015-16 FYs, states failed to spend 29 percent of finances issued under the National Health Mission – totalling Rs 9,509 crore. In some instances, funds were misappropriated to matters unrelated to health. This is despite health being a major priority of citizens. Residents of Bihar are no exception to this. 

At a time when public health in India languishes amidst shortages of doctors and inadequate infrastructure and government spending remains low, it is important to recognise the Bihar child deaths as a preventable tragedy. With this in mind, state governments failing to make the most of what is afforded them for public health must be held to account.

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