Data Dive: How Healthy Are the Five Poll-Bound States?
Uttarakhand only poll-bound state to have allocated over 5% of its budget for health in last five years, reveals analysis of key health indicators of the 5 states
Uttarakhand is the only poll-bound state, among five that go to polls next month, that allocated more than 5% of its budget to health even once in the last five years, shows data published by the Reserve Bank of India (RBI). In fact, the state set aside more share of its budget for healthcare than all the other four states all through the last five years.
In 2021-22, Uttarakhand allocated 5.12% of its total budget (Rs 3,438.84 crore) to health, Uttar Pradesh 3.18%, Punjab 1.89%, Manipur at 2.82%, and Goa allocated 3.5% of its finances to health. While Goa stood second in budget allocation on health, it spent the biggest share of its budget on health during the last three years.
While information on budget allocations has been released for the last five years (2017-18 to 2021-22), data on amount spent by states is available only for three years (2017-18 to 2019-20).
Ahead of elections, FactChecker analysed key health indicators of the five poll-bound states — health budget, malnutrition, infant mortality rate, and total fertility rates — using data published by the RBI and National Family Health Survey (NFHS).
Uttar Pradesh
Health Budget: In 2021-22, Uttar Pradesh government set aside the largest amount for health among all poll-bound states — Rs 32,000 crore — but this too just constituted 3.18% of the state's total budget. Although this also shows that the share of total budget allocated for health in the state has increased from 2.34% in 2017-18.
The amount allocated for health increased from Rs 18,294 crore to Rs 32,009 crore in the same period, an increase of almost 75%. The state has allocated an average of Rs 20,527 crore to health every year between 2017-18 and 2019-20 and has spent, on an average, 89.2% of that amount every year. But the amount spent has still been less than 1% of the state's expenditure across the last three years (2017-18: 0.95%, 2018-19: 0.78%, 2019-20: 0.85%).
Malnutrition: Nutritional imbalance is measured through three indicators: Stunting (children under 5 years who have low height for their age), wasting (low weight for height in children under 5), being underweight (low weight for age).
While India's most populous state saw a dip in all three, according to the NFHS, the percentage of stunted children in UP (39.7%) stayed above the national average (35.5%).
Similarly, the share of underweight children reduced from 39.5% in 2015-16 to 32.1% in 2019-21, which was on par with the national average (32.1%). Also, wasting among children reduced from 17.9% to 17.3% in the state.
Mortality & Fertility: The infant mortality rate (IMR) dipped from 63.5 in 2015-16 to 50.4 in 2019-21. But it's still higher than the national average of 35.2 infant deaths per 1000 live births.
Total fertility rate (TFR), which is the average number of children per woman, reduced from 2.7 to 2.4, which is higher than the national average of 2.
Goa
Health Budget: The share of the state's budget set aside for healthcare has seen a jump from 3.02% in 2017-18 to 3.5% in 2021-22. In the same period, the amount allocated for health too jumped by 70.24% (Rs 952 crore in 2017-18 to Rs 1,620 crore in 2021-22).
The state spending on health saw a rise of 19.8% and the share of the budget spent on health too increased from 2.55% in 2016-17 to 4.47% in 2019-20.
Malnutrition: Every one in four children under 5 is stunted in Goa. The state saw a 5.7% rise in stunting in the last five years — 20.1% in 2015-16 to 25.8% in 2019-21.
While the percentage of wasted children decreased from 21.9% in 2015-16 to 19.1% in 2019-21, those who are underweight increased from 23.8% in 2015-16 to 24% in 2019-21. The state fared much below the national average on stunting and wasting.
Mortality & Fertility: The state's IMR dropped to less than half in the five years — from 12.9 in 2015-16 to 5.6 in 2019-21. The TFR of the state also went down to 1.3 in 2019-21 from 1.7 in 2015-16.
Punjab
Health Budget: Although Punjab saw the share of state budget allocated to health drop from 2.56% in 2017-18 to 1.89% in 2021-22, the amount set aside to be spent on healthcare increased in this period by 37.94% — Rs 3,522 crore in 2017-18 to Rs 4,859 crore in 2021-22.
The state has, on an average, allocated Rs 3,598 crore every year for health and has been able to spend 90.42% of that amount. Although the state's health spending has been less than 2% of its total expenditure, the amount it has spent on healthcare has increased from Rs 2,789 crore in 2017-18 to Rs 3,610 crore in 2019-20.
Malnutrition: Punjab witnessed a reduction in all three indicators of malnutrition. Share of stunted children dropped from 25.7% in 2015-16 to 24.5% in 2019-21. Similarly, those wasted decreased from 21.9% in 2015-16 to 19.1% in 2019-21. The state also has a 4.7% smaller share of underweight children — 21.6% in 2015-16 to 16.9% in 2019-21.
Mortality & Fertility: The fertility rate in the state remained unchanged at 1.6 throughout the five years, meanwhile its IMR reduced from 29.2 in 2015-16 to 28 in 2019-21.
Manipur
Health Budget: Health allocation in the state's total budget has seen a small rise in the last five year — from 2.08% in 2017-18 to 2.82% in 2021-22.
In fact, the amount spent on health in the state also increased from Rs 613 crore to Rs 720 crore in 2019-20 and the share of total expenditure on health increased from 2.2% in 2017-18 to 2.69% in 2019-20.
The north-eastern state has spent an average of 77.85% of the amount it set aside for health between 2017-18 and 2019-20.
Malnutrition: The north-eastern state has the lowest numbers among all poll-bound states, and they are well below the national average. Percentage of stunted children went down from 28.9% in 2015-16 to 23.4% in 2019-21. Similarly, the share of wasted children reduced to 9.9% in 2019-21 and the share of underweight children dipped by 0.5% to 13.3% in 2019-21.
Manipur: With an IMR of 25, Manipur is the only state out of the 5 poll-bound states that saw its mortality rate shoot up by 3.3 from 21.7 in 2015-16. This is still below the national average. The TFR of the state, however, was higher than the national average at 2.2 in 2019-21, which was 2.6 in 2015-16.
Uttarakhand
Health Budget: This is only one of the five poll-bound states to have allocated more than 5% of its budget (5.12% to 2021-22) anytime in the last five years. In 2017-18, it was at 3.77%. The state's health budget allocation also shot up in the five years — Rs 1,692 crore in 2017-18 to Rs 3,438 crore in 2021-22, which is a 103% jump.
In the last three years, the state hasn't spent more than 3% of its total expenditure on health — 1.75% in 2017-18, 2.04% in 2018-19, and 1.89% in 2019-20. But, the amount it spent on health rose by 29.7% — from Rs 1,619 crore to Rs 2,100 crore in the same period.
Uttarakhand has, on an average every year, allocated Rs 1,992 crore for health and spent 97.3% of it.
Malnutrition: Like Punjab, Uttarakhand also saw a downward trend in all these indicators. Between 2015-16 and 2019-21, prevalence of stunting dipped to 27% from 33.5%; wasting was down from 19.5% to 13.2%, and percentage of underweight children reduced from 26.6% to 21%. This means even all three statistics are well below the national average.
Mortality & Fertility: IMR, like UP, was higher than the national average too. At 39.1, the state's IMR saw a reduction from 39.7 in 2015-16.
The fertility rate of the state also reduced from 2.1 to 1.9 in 2019-21.