Higher allocation sought for `second generation problems'

Thiruvananthapuram DEC. 24. Kerala's presentation before the Twelfth Finance Commission has several unique features. This is for the first time that the State has made out a case for higher allocation to tackle `second generation problems' relating to development.

The memorandum and the rather elaborate annexures relating to the requirements of various departments in fact invite the Finance Commission to look at the State's problems in a different perspective, given its highly acclaimed social development. The State has therefore highlighted the need to address the `second generation problems', which mainly relates to sustaining the levels of development it has so far achieved and compensation for the committed liability incurred over the years.

One of the major issues that Kerala has highlighted is the huge financial outlay it would have to make to sustain the achievements in the health sector. According to the projections presented to the 12th Finance Commission, the State would have to incur Rs. 1,500 crores during the 2005-2010 period under 11 major heads to tackle what is now termed as second generation problems.

Even though the State is far ahead in the public health scenario in the country, it is facing major health and medical care issues peculiar to demographic and epidemiological transitions. Besides, expenditure on health care delivery is shrinking year after year resulting in a wide gap between demand and supply.

It has highlighted the need for more allocation for maintenance of infrastructure and equipment, drugs and diet in view of the fact that more than 60 per cent of the population seek health care in public health institutions, streamlining and strengthening the drug storage facilities and introducing computerised inventory management, strengthening of blood bank facilities in view of the prevalence of HIV/AIDS, strengthening of laboratory facilities, better mental health particularly for prevention of suicides, health care for elderly, trauma care, bio-medical waste disposal, and computerisation for effective disease surveillance, inventory management and networking.

"These are second generation problems which need to be addressed by the Finance Commission. The Planning Commission allocates funds for setting up new infrastructure under the plan. In addition, the Centre has of late been announcing a large number of projects funding backward areas directly. For a State like Kerala, which has already achieved certain levels of development, the key issue is how to sustain them,'' according to the Planning Board vice-chairman, V. Ramachandran.

According to the projections, Kerala would have to incur nearly Rs. 1,000 crores on free medicines and diet for the weaker sections of the population who depend on public health institutions during the 2005-2010 period. Expenditure under these heads would go up from Rs. 109 crores and Rs. 22 crores in 2005 to Rs. 214 crores and Rs. 37 crores respectively by 2010. For bio-waste management, the State has projected an investment of Rs. 250 crores during the five-year period from 2005.

Kerala has highlighted the fall in the expenditure on health and family welfare from 17 per cent in 1995-96 to 16 per cent in 1999-2000, which comes to around 6 per cent of the revenue expenditure. The bulk of the resources are being spent on administration, including salary other than being used for providing quality health care.

The expenditure on salary came to two-thirds of the revenue expenditure during 1999-2000. The net result has been deterioration in the quality of buildings and equipment, supply of drugs, etc. In spite of high salary expenditure, there is acute mismatch of staffing pattern and also shortage to some extent. There is not only a need to increase the allocation of resources for the public health system, but more immediately there should be a balanced distribution between sectors and on components having a direct bearing on the delivery of quality services.

The State has also asked for higher allocation for the care of elderly through the establishment of clinics, emergency management units to cater to the ageing population. Trauma care is another area in which the State has given emphasis owing to the high rates of road accidents in the State.

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