GS II: Issues related to health.
Context: Amid declining global health aid and strained public finances, there is increasing emphasis on improving the efficiency, quality and governance of public health expenditure to strengthen health systems and advance Universal Health Coverage (UHC).
Key Highlights
- Declining Global Health Financing: Development Assistance for Health (DAH) has declined sharply after the COVID-19 pandemic, with major donors such as the United States, United Kingdom, France and Germany reducing foreign health assistance.
- Fiscal Constraints: Rising public debt and increasing interest payments have reduced the fiscal space available for health spending in many developing countries.
- Persistent Health Financing Gap: Although the share of health expenditure in Gross Domestic Product (GDP) has improved in many Low- and Middle-Income Countries (LMICs), per capita public health spending remains significantly below the level required for Universal Health Coverage.
UPSC Course Fees Online
Major Challenges in Public Health Spending
- Low Budget Utilisation: A significant proportion of allocated health funds remains unspent, reducing the effectiveness of public health programmes. In India, utilisation under several components of the National Health Mission (NHM) has remained suboptimal.
- Priority to Curative Care: Public expenditure continues to focus more on secondary and tertiary healthcare, while preventive and primary healthcare receive relatively lower investment.
- Weak Governance: Corruption, administrative inefficiencies, delayed fund releases and weak public financial management reduce the impact of health expenditure on health outcomes.
- Inadequate Decentralised Capacity: Weak governance and institutional capacity at the State and local levels affect efficient service delivery.
Measures to Improve Public Health Spending
- Improve Budget Execution: Ensure timely utilisation of allocated funds through better planning, monitoring and financial management.
- Prioritise Preventive Healthcare: Increase investment in primary healthcare, disease prevention, immunisation, sanitation and health promotion to reduce long-term disease burden.
- Strengthen Governance: Improve transparency, accountability, procurement systems and public financial management to enhance efficiency and reduce leakages.
- Enhance Decentralised Planning: Empower States and local health institutions with greater financial autonomy and institutional capacity.
- Ensure Flexible Budgeting: Develop adaptive financing mechanisms that can respond quickly to public health emergencies and emerging health challenges.
Related Government Initiatives
- Ayushman Bharat Programme: Strengthens Primary Health Care through Ayushman Arogya Mandirs and provides financial protection through the Pradhan Mantri Jan Arogya Yojana (PM-JAY).
- National Health Mission (NHM): Supports strengthening of public health infrastructure, human resources and healthcare delivery systems.
Way Forward
- Increase Public Health Investment: Gradually raise public health expenditure while ensuring greater efficiency in resource utilisation.
- Adopt Outcome-Based Budgeting: Link health expenditure with measurable health outcomes and performance indicators.
- Strengthen Primary Healthcare: Shift policy focus towards preventive, promotive and community-based healthcare.
- Improve Governance Reforms: Enhance budget credibility, digital financial management, transparent procurement and institutional accountability across all levels of government.
Click to Know UPSC Offline Courses
Conclusion
Building resilient health systems requires not only higher public investment but also better governance, efficient utilisation of resources and greater emphasis on preventive healthcare. Improving the quality of public spending will be critical for achieving Universal Health Coverage, reducing health inequalities and strengthening India’s long-term health security.
3 Aug 2026
