The main public health programmes in India aimed at millions of rural poor have been in confusion for months after the government of India changed the distribution pattern of funds. The union health ministry started sending funds for public health programmes to state treasuries, instead of direct transfers to its regional arms to give the states more power.
National Health Mission (NHM) and India's AIDS prevention programmes suffered as the poorly run regional bureaucracies were unable to cope. So, thousands of health workers were not paid for months and the construction of clinics in rural areas was delayed.
"The progress in NHM works has slowed down considerably in most of the states," Health Minister J.P. Nadda wrote in a letter to the finance minister in November. "I urge you to review the decision and allow the ministry to transfer funds directly to state health societies."
Still, India struggles to spend all of its allocated health funds because of an inadequate number of doctors and hospitals, and intrusive incompetence. Data shows the government has only once spent all of its health budget since 2005.
Manoj Jhalani, joint secretary at health ministry, told that several states have voiced concern about the delays and discussions are ongoing to resolve the situation. Several NHM officials were deprived of funds for months. Salaries, training and building new clinics were hit.
"If resources are not provided in time, implementation of the programme does get affected. There has been some impact on the smooth operation of NHM," Jhalani said.
In Jammu and Kashmir, 9,000 health workers have not received salaries for three months and cash incentives for women who give birth in a government hospital have been withheld, said Yash Pal Sharma, the state's director for the NHM.
"Outreach programmes have been severely impacted. The entire system has been paralysed, bureaucracy has become bureau-crazy" said a health ministry official in New Delhi.
The new payment system has also affected India's AIDS prevention drive, a programme separate from the NHM. Workers from high-risk groups, such as sex workers and injectable drug users, employed to run programmes within their communities, are quitting because of irregular pay.
Rama, a project manager in one such community-based programme for sex workers in Mumbai, said 17 of her 23 team members have quit because of delayed salaries. New people hired will take months before they can efficiently run the programme. "It takes a lot of time to build trust within our communities. Our HIV testing numbers have fallen by half because sex workers don't trust new people," said the 26-year-old.
India runs more than 1,800 community-based programmes for AIDS prevention. The World Bank has estimated India's policy of targeting sex workers to control AIDS would avert three million infections during 1995-2015.