Up to 14 States will pay dearly for not upgrading their health infrastructure in line with the demands of the National Health Mission being steered by the Ministry of Health. They will lose a substantial 20 per cent chunk of the funding from the Centre, over ₹440 crore, that had been tied to certain conditions.

Bihar and Madhya Pradesh are among the bigger States to have suffered the most penalty. The hillStates of Uttarakhand and Himachal Pradesh, the north eastern states of Nagaland, Meghalaya, Sikkim and Arunachal Pradesh, the Union Territories of J&K, Lakshadweep and Delhi, and Goa and West Bengal will collectively lose over ₹440 crore for not performing well on immunisation, and falling short on parameters such as upgrading district hospitals, running of primary health centres, screening for non-communicable diseases (NCDs) among people over 30 years, availability of mental health services, and digitising human resources (HR).

“For the last few years, the Ministry of Health and Family Welfare (MoHFW) has been experimenting with linking at least a part of the budget to the agreed conditions being met to enhance performance and to focus on health sector reforms. This is a step towards Result Based Financing (RBF) where the States could get more budgetary support if they performed well on the agreed indicators and may lose out part of the funding if they did not meet the set performance benchmarks,” said Manoj Jhalani, additional secretary, Ministry of Health.

“This meant that while 80 per cent of the resource envelope earmarked for the State would be certainly available, 20 per cent would depend on the State’s performance on agreed conditionalities. The States which do not fulfil the criteria could lose up to 20 per cent of funding under the NHM,” he added.

For example, of the 20 per cent incentive pool of ₹246.61 crore that Bihar was supposed to receive, a penalty of ₹155.75 crore will be deducted, and only ₹90.87 crore will be released. In case of Delhi, while 20 per cent of the NHM fund accounts for ₹28.44 crore, up to ₹7.48 crore will be deducted and ₹20.96 crore will be available for release.

Apart from this, for 2018-19, 20 States and Union Territories were able to earn incentive.

For example, the incentive for screening 30-plus population for NCDs was earned by 23 States. This includes 11 which were able to screen more than 15 per cent of the 30-plus population, and therefore, earned full points. Seven have neither earned any incentive nor penalty against the set indicator. Tamil Nadu has reported 100 per cent screening of 30-plus population, followed by Goa at 68 per cent and Daman & Diu at 57 per cent, while the lowest was reported by Bihar and Madhya Pradesh (1 per cent). Nil achievement was reported by Delhi and Lakshadweep Islands.

“Approximately ₹3,265 crore of the NHM funds were put aside for disbursement to the States on the basis of the performance of the States on the conditionalities,” the report released by NHM States.

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