SPECIAL 301-Well-Timed Bullying

review of the health sector, the World Bank is at pains to point out that health and family welfare have received a declining share of total spending after 1970 with a "precipitous decline' after 1980. Taking the central budget of 1992-93 as a first test' of the government's interest and ability to respond positively to adjustment, the review professes to have been shocked to find that the allocation for health had remained more or less unchanged from the previous year's. In fact taking into consideration the special assistance of Rs 80 crore for the AIDS programme; the central allocation had ac- tually dropped and budget cuts of up to 40 per cent had been made in vital programmes like malaria eradication, whereas the allocation to programmes with few 'ex ternalities' had risen at the expense of those which benefit the poor. On a self- congratulatory note it goes on to point out that the finance minister was prevailed upon to 'adjust' the health allocation upwards. The review's prescriptions for a healthier future include: strengthening the health budget and doubling allocations to endemic disease programmes; improving equity and targeting externalities, that is restoring cuts to disease programmes which affect large numbers; defining an effective package/standard of input to primary level institutions; protecting capital investment by ensuring maintenance budgets; improving cost recovery from the affluent for hospitals (currently less than I per cent of the cost is collected from patients and this should be increased to 20 per cent); and enhancing private sector effectiveness by adequate quality control What has been the impact of this advice on the central budget for the health sector in 1993-94? The total plan and non- plan allocation for 1993-94 is Rs 2,060.47 crore, an increase of 15.4 per cent over the revised estimate for 1992-93 and 31 per cent over the budget estimate for that year. This represents a minuscule 1.58 per cent of the total estimated plan and non-plan expenditure of the centre Although central allocations for health comprises only about 6 per cent of the total public expenditure on health, they set a trend motivating state spending. Moreover, the central allocations go to epidemic disease pro grammes which have large externalities. The current budget thus shows no signs of a change in perspective. Slightly more than 62 per cent of the tout (Rs 1,280.72 crore) goes to the family welfare programme It has often been pointed out that this causes a distortion in priorities which goes beyond the expenditure figures. Family welfare (earlier family planning) has continued to take an increasingly large share of the total central budget allocations for health