The flagship programmes are plagued by poor delivery systems
The chasm between the promise and performance of the Centre’s high profile flagship programmes, and the still ridiculously low government allocation on healthcare in the country will top the list of business at Friday’s meeting of the Sonia Gandhi-led National Advisory Council (NAC).
As the countdown to the next general elections, less than 11 months away, begins, the NAC remains focussed on the UPA’s unfinished aam aadmi agenda.
Nine years after the UPA came to power, the flagship programmes are plagued by poor delivery systems even as the UPA One’s commitment in the National Common Minimum Programme in 2005 to increase public spending on health from 1.04 per cent of GDP to 2.5-3 per cent remains unfulfilled.
The NAC’s Mihir Shah — who is also a Planning Commission member — will present the draft recommendations on “Reforms in Governance, Strengthening Institutional Capacity and Effective Implementation of Flagship Programmes,” while council members A.K. Shiva Kumar and Mirai Chatterjee will jointly make a presentation on “Universal Health Coverage.”
Devolution of powers
The recommendations on governance reforms, NAC sources told The Hindu, is to realise Rajiv Gandhi’s dream of devolution of powers that lie at the core of panchayati raj. The objective of the presentation’s four key elements — how to improve fund flows, introduce transparency into the working of the flagship programmes, maximise human resource capacity and build a new architecture of knowledge management right down to the sub-district level — is to bridge the gap between what Prime Minister Manmohan Singh describes as the gap between outlays and outcomes.
Similarly, the ultimate objective of the suggestions proffered in the paper on universal health coverage (UHC) is that every citizen should be guaranteed a “national health package (covering both in-patient and out-patient care) that is provided cashless at the point of delivery, either by the government, and where there are critical gaps, or by contracted-in private providers.” The entire public health system will have to be re-structured, the paper says, with reforms in both the public and private sectors. The paper also recognises that it might take the next 10 to 15 years to establish UHC in India.
If the period since 2004 has seen an unprecedented increase in spending in programmes of social inclusion, and a slew of legislation to secure the rights of the most disadvantaged, an analysis by the NAC Working Group on the flagship programmes shows that “inefficient fund flows through the system resulting in delayed releases, are a major bottleneck hampering performance.” The suggestions made include reforming the existing fund flow mechanism at various levels of government by enabling real-time transfer of government funds,” replacing “the file-based system of programme management by an Internet-based system that captures and propels the entire work-flow at all levels — Central, State and local” and providing “all citizens.. real-time visibility of the movement of all government funds meant for them”. It will thus lead to “greater accountability and transparency of fund flows leading to empowerment of citizens, resulting in a powerful check on corruption.”
The paper points out that Andhra Pradesh’s electronic fund management system “has achieved efficient and optimised fund flows for various Rural Development programmes by operationalising the electronic movement of funds from a State-level fund to the destination accounts as and when expenditure is incurred. This system allowed movement of funds from a State fund right through to the beneficiary, cutting down multiple levels of releases.” The Union Rural Development Ministry’s approval is currently being sought for programme management by Internet-based platforms. The paper also argues that while the Union and the State governments must nurture local talent as community resource persons, it should augment its human resource pool by seeking out professionals from the open market. It suggests substantive financial incentives to attract professional talent to backward districts.
Addressing another component — knowledge management — the presentation will recommend actions required to mobilise and manage knowledge resources. “The challenge is to build an adaptive system .. that learns from communities, from academics, and from its own experiences in implementation, and constantly uses this learning to improve programme outcomes on a continuous basis, “ says the paper, adding, “It is vital to recognise all three sources of knowledge as important and complementary: people’s knowledge; academic or professional domain knowledge; and implementers’ knowledge. Most often, it is people’s knowledge that is ignored in programmes.”
The NAC Working Group’s paper on UHC, meanwhile, draws both on the High Level Expert Group (HLEG)’s suggestions as well as the extensive discussions it had with government and NGO experts. It suggests putting in place “an overarching national health regulatory and development framework for ensuring provision of quality health care by both public and private providers.”
The paper also suggests that State governments be given greater flexibility in spending even as they are encouraged to develop more effective mechanisms to monitor performance and ensure compliance with essential requirements of the UHC.