National Health

Mission (NHM)

Kavita Singh, Director -Finance

 Need of Investment in Public Health
• Healthcare spending in India for 2014 is about 4.7% of its GDP.
• Of this Government Health Expenditure (GHE) is 30%. A
majority, 62% of healthcare expenditure is Household out of
pocket (OOPE).
• Nearly 55 million people getting impoverished on account of
health care expenditure.
• India ranks a low 175/188 in OOPE and 154/185 in terms of
Public Health Expenditure out of Total Current Health
Expenditure in 2015.
• Increase health expenditure by Government as a percentage of
GDP from the existing 1.15% to 2.5 % by 2025 (NHP 2017).
Source: Health financing indicators for India 2014; Global Health Expenditure Data Base (GHED), World Health Organization
 Health Policy -2017
• New Health Policy 2017 emphasizes the proposed
Health Financing -
• Increase health expenditure by Government as a
percentage of GDP from the existing 1.1 5 % to 2.5 %
by 2025.
• Increase State sector health spending to > 8% of their
budget by 2020.
• Decrease in proportion of households facing
catastrophic health expenditure from the current levels
by 25%, by 2025.
Source: New Health Policy 2017
 Year wise Expenditure to achieve 2.5% of GDP  
(Rs. In Lakh Crore)  

GDP assuming GDP with Rate Expenditure 32% of 68% of

% of
Year @7.5% at current of Inflation on Health (% Expend. for Expend. for  
expenditure
prices of 2017-18 @4%only of GDP) Centre State

1 2 3 4 5=4*2 7 8  
2017-18 1.20% 166.28 172.93 2.08 0.66 1.41  
2018-19 1.20% 178.75 185.90 2.23 0.71 1.52  
2019-20 1.27% 192.15 199.84 2.54 0.81 1.73  
2020-21 1.45% 206.56 214.83 3.11 1.00 2.12  
2021-22 1.70% 222.06 230.94 3.93 1.26 2.67  
2022-23 1.95% 238.71 248.26 4.84 1.55 3.29  
2023-24 2.20% 256.61 266.88 5.87 1.88 3.99  
2024-25 2.50% 275.86 286.89 7.17 2.30 4.88  
Source: GDP of 2017-18, as per Economic Survey, Vol.II for the year 2017-18 .
 Allocation –DoHFW
Rs. in Crore

12th Plan
12th Plan Actual BE BE
Particulars Approved
Budgetary Allocation (2018-19) (2019-20)
Outlay
NHM 1,93,405.71 91,022.82 25,155.00 26,945.00
(47.06% of 12th Plan (15.6 % increase over (7% increase over last
(NRHM+
NUHM)
Outlay) last BE) BE)

Total 2,68,551.00 1,29,150 52,800.00 61,398.12

(DoHFW- (Depart of (48.09% of 12th Plan
NHM + H&FW) Outlay) (11.5% over last BE) (16% increase over last
Health) BE)

# New Streams of Health Financing –

Health & Education Cess - Existing 3% education Cess to be replaced by 4% health
and education cess.
Higher Education Funding Agency (HEFA) to be restructured to fund infrastructure
and research in medical Institutions.
India Infrastructure Finance Corporation Limited (IIFCL) will be utilized to raise
funds for Health Projects.
 Department-wise Budget Estimate (Gross) 2018-19
Rs. in Crore
B.E. B.E.
Department
2018-19 2019-20
Health 20671.00 23,097.12
NHM 25154.00 26,945.00
156.00
RSBY 2,000.00

PMJAY 6400.00
HRH & Medical
4,225.00 4250.00
Education
Tertiary Care
750.00 550.00
Programme
National Rural Health Mission (NRHM) launched on 12th
April, 2005

To bring greater focus on high focus States and rural population,

particularly marginalized and vulnerable population.

Architectural correction through integration of vertical programmes,

decentralization and communitization.
National Urban Health Mission (NUHM) launched on
1st May, 2013

1057 cities and towns covered.

Strengthening facilities in urban area in term of infrastructure,

equipment and manpower.
 National Health Mission - Vision

“Attainment of Universal Access to Equitable,

Affordable and Quality health care services,
accountable and responsive to people’s needs,
with effective inter-sectoral convergent action to
address the wider social determinants of health”.
NATIONAL HEALTH MISSION
Flexible Pools under NHM
 ` 2 Sub-Missions
NRHM NUHM

Communica
NRHM –Flexible pool-
ble Disease Comprehe
(I)RCH Pool
Pool nsive
Health System
(II) Health System Primary
Strengthening
Strengthening
Pool
Health
(i) Other Health Care
System Strengthening

(ii) Comprehensive
Primary Health Care Health System Strengthening- includes components -- NPCD, NOHP, Burns &
(iiI) ASHA Benefit
Trauma, NPCF and other New Initiatives under NCD
Package including
social benefits
 NATIONAL HEALTH MISSION - COMPONENTS
 RCH Flexipool-
• RMNCH + A - Reproductive, Maternal, Neonatal, Child &
Adolescent Health.
NRHM- RCH • Immunization- Routine Immunization & Pulse Polio
Pool Immunization.
• NIDDCP- National Iodine Deficiency Disorder Control
Programme

 Health System Strengthening – ASHAs, Human Resources including

AYUSH, Mobile Medical Units, Referral Transport, Free Drugs &
Free Diagnostics, Biomedical Equipment Management, Quality
Assurance & Kayakalp, Infrastructure, etc.

• To strengthen the existing primary health care facilities and provide

National Urban new facilities for the un-served population in urban areas & urban
Health Mission poor. Major components Planning & Mapping, Programme
Management, Training, Human Resources, Community process.
 NATIONAL HEALTH MISSION - COMPONENTS
• RNTCP – Civil Works, Laboratory materials for testing etc.
Communicable • NVBDCP- Malaria, Dengue, AES etc.
Diseases Pool • NLEP- HR, Mobility support
• IDSP- HR, Mobility support
• NVHCP-National Viral Hepatitis Control Programme, Drugs

• National Prog. For Prevention & Control of Cancer, Diabetes,

Non
Cardiovascular Diseases & Stroke (NPCDCS)
Communicable • National Prog. for Control of Blindness (NPCB).
Diseases Pool • National Mental Health Prog.(NMHP)
• National Tobacco Control Prog. (NTCP)
• National Prog. for Health Care of Elderly (NPHCE)

Infrastructure • To meet salary requirement of Auxiliary Nurse Midwives

Maintenance (ANMs) and the Lady Health Visitors (LHVs) etc.  
Progress
 Financial Progress under NHM
Progress under NHM

Central Grants of Rs.222,114 Crore has been

National Health Mission released to strengthen Health System under NHM.
(NHM)
The States have contributed Rs.64,647 crore
Two Sub Missions towards State share under NHM in the 60:40/90:10
(NRHM &NUHM)
ratio.

Total funds of Rs. 286,761 crore was made available

till 2018-19.
 PLAN WISE ALLOCATION & RELEASE UNDER NHM
(Rs. in crore)

Central % Expenditure
Sr. No. Financial Year B.E. R.E.
Expenditure against R.E.

1  10th FYP (2 years) 15,424 13,951 13,771 99%

2 11th FYP 70,030 68,064 66,131 97%

3 12th FYP 1,00,748 91,023 90,184 99%

26,110 25,975
9 2017-18 21,941 99%

26,118 26,053
10 2018-19 25154 100%

  Total (NHM) 233,297 225,266 222,114 99%

Absorption capacity of States (Budget Vs Release)
Rs.in crore
 Proposed Vs. Available Budgetary Outlay for National Health Mission

2018-19 2018-19 2019-20 2019-20

Sl. No.Name of the Scheme
(Proposed) (Approved) (Proposed) (Approved)

1 NRHM-RCH Flexible Pool 16,019.60 15,006.33 22350.00 16,885.73

RCH Flexible Pool including RI, PPI and
a 7,000.00 5253.51 8720.00 5253.51
NIDDP
b Health System Strengthening under NRHM 9,019.60 9752.82 13850.00 11,632.22

2 NUHM -Flexible Pool 1,000.00 875.00 1400.00 950.00

3 Flexible Pool for Communicable Diseases 2,620.40 1928.00 3200.00 1928.00

Flexible Pool for Non-Communicable
4 2,000.00 1004.67 3100.00 717.00
Diseases, Injury & Trauma
5 Infrastructure Maintenance 6,360.00 5693.41 6643.00 6043.52
6 Others including Pilot Projects, NPMU, DR 78.71 373.49 231.00 357.36

10 PMDP For Jammu & Kashmir 273.71 273.71 63.36 63.36

Total 28,352.42 25154.61 36,987.36 26,945.00

 Need for Enhanced Allocation
Strengthening of Sub Health Centers as Health & Wellness
Centers to provide comprehensive primary care.
Comprehensive Primary Health Care including screening of
common NCD such as Hypertension, Diabetes, common Cancer.
Increasing number of PHCs and CHCs as per IPHS norms and up-
scaling of existing initiatives e.g. strengthening facilities to IPHS
Up- scaling Free Drugs & Diagnostics Scheme.
 Need for Enhanced Allocation

Need to eliminate TB and Measles

Strengthening of District Hospitals to provide multispecialty care
& Training and e-Hospital Implementation
Universal Health Coverage (UHC) Pilots
Scaling up of new life saving vaccines
Budgetary provision for Diagnosis, Treatment and e-health
initiatives
Strengthening of Drug regulatory system in the country
 ALLOCATION FOR 2019-20 UNDER DIFFERENT POOLS OF NHM

Allocation
Sl. No. Name of the Flexible Pools % of Allocation
(Rs.in crore)
A NRHM-RCH Flexible Pool 16,885.73 63%
RCH Flexible pool including Routine Immunization, Pulse Polio Immunization,
1
National Iodine Deficiency Disorders Control Programme etc.
5,253.51 19%
2 Health System Strengthening under NRHM 11,632.22 43%
B National Urban Health Mission-Flexible Pool 950.00 4%
C. Flexible Pool for Communicable Diseases 1,928.00 7%
D. Flexible Pool for Non-Communicable Diseases, Injury & Trauma 717.00 3%
E. Infrastructure Maintenance 6,043.41 22%
Misc. Programme
F.
(NPMU, Pilot projects, SDRS, PMDP etc.)
420.86 2%
 
Grand Total
26,945.00
ALLOCATION FOR 2019-20 UNDER NHM
 ACTIVITY-WISE APPROVALS UNDER NRHM-RCH FLEXIBLE POOL 2018-19

Amount(Rs. in
S.No RCH Flexible Pool Activities Lakhs) %
1 Maternal Health (including JSY & JSSK) 329,436.45 40.28
2 Programme / NRHM Management Cost 229,498.43 28.06
3 Family Planning 93,243.92 11.40
4 RBSK 74,261.74 9.08
5 Training 50,390.50 6.16
6 Child Health (including JSSK) 32,419.32 3.96
7 Adolescent Health / RKSK 5,132.68 0.63
8 Tribal RCH 1,518.55 0.19
9 Vulnerable Groups 816.57 0.10
10 PNDT Activities 1,238.45 0.15
TOTAL 817,956.62 100
ACTIVITY-WISE APPROVALS UNDER NRHM-RCH FLEXIBLE
POOL 2018-19
ACTIVITY-WISE APPROVALS UNDER HEALTH
SYSTEM STRENGTHENING POOL 2018-19 (in
descending order)
Amount
S.No. Activity %
(Rs. in Crore)
1 Human Resources 9471.33 0.62
2 PROCUREMENT 527871.46 34.55
3 ASHA 248867.42 16.29
4 Hospital Strengthening 192092.83 12.57
5 National Ambulance Service 111052.46 7.27
6 UF/AMG /RKS 119635.08 7.83
7 Planning, Implementation and Monitoring 112270.49 7.35
8 IEC-BCC NRHM 64629.85 4.23
9 Innovations 40320.57 2.64
10 National Mobile Medical Vans 25324.28 1.66
11 PPP/ NGOs 69686.22 4.56
12 Other Expenditures 3317.14 0.22
13 Drug Ware Housing 3219.97 0.21
14 Mainstreaming of AYUSH 229.22 0.02
Total 1527988.33 100
NHM PLANNING PROCESS
 Communicated to States States submit Draft PIP

Communicated to States/ UTS

When States/UTs do not respond to
request of supporting details
To be circulated to Divisions
 BOTTOM -UP APPROACH FOR PLANNING

Integrate

State Programme
State Integrate
Implementation Plan

District Health District District Integrate

Action Plan

Block Health Block Block Block

Action Plan Integrate

CHC/PHC CHC/PHC CHC/PHC CHC/PHC

Gram Gram Gram Gram Gram

Panchayat Panchayat Panchayat Panchayat Panchayat
Inputs from Gram
Panchayat level and
CHC/PHCs
Financial implications
 RESOURCE ENVELOPE
 Unspent balance (Committed & Un-committed) at the
beginning of the Year
 Central (GOI) Allocation to the States/UTs
--80% (assuming no reduction on account of fulfillment of
conditionalities) and
--20% for Incentives
 State Share 40% or 10% (NE and Hilly States)

Less: Committed Un-spent Balance for validation

Net Resource Envelope Available for Fresh Approvals
From FY 2019-20, Separate proposals are asked on unspent balances
as supplementary proposals
 WEIGHTAGE FOR ALLOCATION OF FUNDS
Population of Each State is given a weightage as
under:
NE and 3 Hilly States (H.P., J&K & Uttrakhand) (11) : 3.2

Small UTs : (4)

(Lakshadweep, Daman & Diu, D& N Haveli & Andaman) : 3.0

EAG States, Except Chhattisgarh, Jharkhand (5) : 1.3

Chhattisgarh & Jharkhand (2) : 1.5

All other States/UTs (14) : 1.0
BASIS OF CENTRAL ALLOCATION TO STATES/UTS
Name of the Pool Basis of Allocation

RCH Flexible Pool 75% Total population & 25% Rural area

Mission Flexible Pool now Health Systems 75% Rural Population & 25% Rural Area
Strengthening
50% weightage on Urban Population & 50% weightage
on slum population
National Urban Health Mission (NUHM)
(Covering Cities in State Capital and Distt. HQ with Population 30,000
Flexible Pool and Other Cities with 50,000 & above population) – 1000 + Cities

Flexible Pool for Communicable Disease Disease burden basis

Flexible Pool for Non-Communicable Disease 75% Total population & 25% Rural area
 COMMITTED & UN-COMMITTED BALANCE

Committed Unspent Balance comprises of ----

(i) All advances given to Subsidiary Units, Implementing Agencies,
(ii) Work orders issued for any work but not paid (such as Procurements,
Civil Works etc.)
(iii) Any other activity committed for implementation but not initiated
during the current financial year e.g. ASHA’s, Training, JSY, JSSK.

 All such activities need to be revalidated for expenditure in the next

financial year.
 No fresh approvals is required for these activities.
 These Committed activities are against the ROP approvals already given.
 COMMITTED & UN-COMMITTED BALANCE
Uncommitted Unspent Balance :
Unspent Balance remained for those activities which could not be
commenced in the current financial year and expected not to be utilized
further.

The unspent balance assigned under the pools for expenditure becomes
free for fresh approval in the next financial year .

Letter on disclosure of Unspent Balances though Supplementary

PIPJS P letter on USB.pdf for 2019-20 have been issued
JS P letter on USB.pdf
 FUNDING PATTERN UNDER NHM

• From F.Y. 2015-16, keeping in view of the recommendation of 14th

Finance Commission the Centre- State funding pattern has been
revised to 60: 40 from 75:25 in all States excluding NE & 3 Hill
States where it is 90:10.

• All UTs are 100% Centrally funded except Delhi & Puducherry.

• Incentive Pool of 20% of Central allocation has been created from

2018-19 to be effected from 2019-20 on the basis of
conditionalities of 2018-19.
 FLEXIBILITIES UNDER NHM

A. In–built flexibility as PIPs are proposed by States.

B. Utilise the amount of matching State share under any of the
programme /schemes under any of the flexible pools of NHM as
per the need of the State.
C. Under Infrastructure Maintenance (IM), 100% releases are
made by way of reimbursement on the basis of ASE and
instalment payment made towards salary, therefore the State
share accrued under IM can be used as per the discretion of the
State.
D. Pay demand based activities, salaries not to be withhold.
Payment can be made from savings available under any pool.
 Release under NHM
 Two types of Grants in aid are released to States
a) Cash Grant b) Kind Grant

Funds are released in 3 parts ---

 General , Scheduled Caste Sub Plan (SCSP), Scheduled Tribe Sub Plan (STSP).

 All releases are made on the basis of Census Population of 2011.

 Further break up releases in Revenue and Creation of Capital Assets.
Creation of capital assets involved in Health System Strengthening, NUHM and NCD. Basically
where civil construction is involved.
 CRITERIA FOR RELEASE OF FUNDS
First release of 75% of 80% of B.E.
a) No shortfall under State’s Matching contribution.
b) Provisional UCs of last F.Y.
c) Regular Financial Reporting and Physical Reporting in FMR & SFP
d) Considering the Unspent balance
e) Transfer of fund from Treasury to SHS.
Final release of balance 25% of 80% of B.E
Same as (a) to (e) above.
Receipt of Statutory Audit Report and Audited UC
Ensure the increase in State Health Budget by 10% over last year.
20% of funds under Flexi Pools have been earmarked towards
Incentivization of States/Uts.
 New Initiatives
• Single Bank Account to avoid parking of funds and
better financial utilisation.
• National Consultation with Banks for finalisation of
RFP has been held and is in the process of
dissemination.
• Dash Board is being developed in support of NIC
for online booking of expenditure in FMR from
peripheries.
40
 Cost Benefits & Cost Control Practices

Cost Control Mechanisms in NHM Context:

• Procurements through Competitive Bidding
• Differential Financing under Untied funds, Referral Transport etc.
• Need based procurements.
• Centralized procurement of medicines through bulk purchases.
• Single bank account system to avoid loss of interest.
 Auditing under NHM
• Performance Audit under NHM by CAG
• Statutory Audit by CAG empanelled major CA Audit firms.
(Mandate – 100% for DHS and 40% for Blocks)
• Concurrent Audit by CA Audit firms on monthly basis.
However, reports to be issued on quarterly basis.
(100% for all Blocks)
• IPAI Audit for selected States.
• Internal Audit.
 Critical Observations

Avoid parking of funds as that would hamper the implementation.

 Not to include the Bank balances of Non-NHM Schemes such as

Finance Commission, NABARD, State Health Schemes as that would
make the overall balance under NHM heavier in the Balance sheet and
leading to CAG’s observation on high unspent balance with State Health
Societies.

Prohibit the diversion of NHM funds to State run health schemes.

 Critical Observations
Civil works: Rule 351 of PWF&AR provides that the availability of land should
be ensured before awarding the construction work.

Bank accounts needs to be operated by Joint signatories, at least one person

must be regular.

Closure of Non-Operative Banks Accounts.

Mapping of All Banks with PFMS application.

Funds received at SHS , DHS and Blocks need to be transferred immediately

to subsidiary units after considering the unspent balances.
 Critical Observations
Ensure Compliance of GFR Rules, 2017 for release of funds, procurement of Services,
Goods etc.

 State Finance Rules for Procurement of Services, Goods may be followed.

Temporary loans can be taken and to be returned to original pool on receiving of funds.
Permanent diversion is prohibited.

Regular monitoring of advances with Age wise analysis

Ensure JSY and ASHA Payments through DBT

Ensure submission of Consolidated FMR with Physical achievements on monthly basis

covering all programmes of NHM (including IM)
 Critical Observations
FMR includes expenditures from each programme and of all levels.

Monitoring and ATR on the findings of the Concurrent Audit and

Statutory Audit.

Plan training programmes on FM within the State and District

Understand and implement the concept of ongoing activities and

issue directions for continuation of such activities after 31 st March
without waiting for ROP.
46
 Critical Observations
Non preparation of Bank Reconciliation Statement (BRS).

Non-maintenance of Fixed Assets Registers.

Splitting of Invoices to avoid competitive bidding – Especially Procurement Processes.

Booking of expenditure without approvals or more than approvals.

Non compliance of procurement procedures.

Books of accounts not closed at year end and interest nor accounted for.
 Important Communications
Advances to Implementing Agencies for Civil works, Procurements may be
treated as deemed Expenditure for the purpose of Release proposals.

 Refer to D.O. Letters issued from time-to-time providing instructions/

guidelines – such as Banking Arrangement, Temporary diversion of funds,
non- holding of committed liabilities etc.

Refer D.O. letters on separate reporting of expenditure given under Tribal

Sub Plan (TSP). etc.
 CHALLENGES
Compliance of DOE conditionalities on just in time basis

Ensure to receive funds from State Treasury to SHS within 15 days of

transfer.

Fulfillment of ROP conditionalities to earn Incentives.

Increase in Health Budget at least by 10% over last year.

Improve the pace of utilization to avail the full Central Grant.

 CHALLENGES
 Timely submission of Audited UCs

 Submission of Certified Audited Expenditure on time to claim

arrears under IM.

 Contribution of Matching State Share simultaneously with Central

Grants including IM

 Statutory Audit Report to be approved by Governing Body.

 Also laying of Audit Report in the house of State Legislative Assembly.

 CHALLENGES
Timely appointment of Auditor (Statutory and Concurrent Audit)

Sharing of Concurrent Audit Summary with the Ministry.

Creation of Internal control team to monitor the progress on Civil works, HR

placement , Procurements etc.

Review of Financial progress on regular basis against the monitorable

indicators.
 CONDITIONALITIES
FRAMEWORK: 2018-19
 Source of
Incentive/
  Conditionality Incentive/penalty verificatio
Penalty
n
1. Incentive or Based on the ranking which will measure NITI +40
penalty based on incremental changes: Aayog to
NITI Aayog 1.States showing overall improvement to be report -40
ranking of States incentivized
on ‘Performance
2.States showing no overall increment get no
on Health penalty and no incentive
Outcomes’
3.States showing decline in overall
performance  to be penalized
(% of incentive/penalty to be in proportion to
overall improvement shown by the best
performing State and the worst performing
State: +40 to -40)
 
Source of Incentive/
Conditionality Incentive/penalty
verification Penalty

2 Ranking of District At least 75% (in Non EAG) and 60% HMIS and NITI +10
Hospitals in terms (in EAG and NE states) of all District Aayog DH ranking to
of input and Hospitals to have at least 8 fully report -10
service delivery functional specialties as per IPHS :
10 points incentive

Less than 40% in Non EAG and 30%

in EAG to be penalized up to 10
Points
 
Source of Incentive/
Conditionality Incentive/penalty
verification Penalty

3 Operationalization At least 5% of the total budget to be State report  +20

of Health and proposed for HWC and CPHC. State to NHSRC report to
Wellness Centers operationalize 15% of SCs and PHCs as RHS -20
(HWC) HWCs.
 
Source of Incentive/
Conditionality Incentive/penalty
verification Penalty

4 % districts covered 75% of the districts covered-10 points Report from +5

under Mental 50% of the districts in Non EAG and Mental Health to
health program 40% of the districts for EAG- incentives Division -5
and providing 6 Points MoHFW
services as per
framework
Less than 40% EAG and less than 50%
Non EAG to be penalized 6 Points
Less than 30% in EAG and 40% in Non
EAG to be penalized 10 Points
 
Source of Incentive/
Conditionality Incentive/penalty
verification Penalty

5 % of 30 plus 15% of 30 plus population screened for Report from +5

population NCDs: 10 Points incentive NCD division to
screened for NCDs MoHFW and -5
7% of 30 plus population screened for State reports
NCDs : 6 Points Incentives Any Survey
data available

Less than 3% of 30 plus population

screened for NCDs : 6 Point penalty

Less than 2% of 30 plus population

screened for NCDs : 10 Points penalty
(Out of total State population)
 
Source of Incentive/
Conditionality Incentive/penalty
verification Penalty

6 HRIS implementation Ensure implementation of HRIS for HRIS (State) +15

all HRH (both regular and and HMIS to
contractual ) in the State. Salary report - 15
invoice and transfer order to be
generated by HRIS. Line listing of all
staff for all facilities to be available.
HRIS data should match with HMIS
reporting. Cases where it does not
state should provide reason and
numbers. +10 to -10 for HRIS
operationalization and +5 to -5 for
synchronization with HMIS State
 
Source of Incentive/
Conditionality Incentive/penalty
verification Penalty

7 Star rating of PHCs 75% (in Non EAG) and (60% in EAG and HMIS +5
(both Urban and NE) of the PHCs having 3 or more star to
rural) based on rating : 5 Points incentives
-5
inputs and
provision of the
50% (in Non EAG) and 40% (in EAG and
service package NE) PHCs having 3 or more star rating: 2
agreed
Points incentive

Less than 40% (in Non EAG) and 30% (in

EAG and NE) of PHCs having 3 or more
star rating to be penalized: 5 Points
PFMS
 PFMS

State wise PFMS Registration Status

 PFMS -CHALLENGES
• PFMS and Treasury integration is completed in 30 States.

• Inadequate Internet connectivity in North Eastern States and

Rural Areas.

• Integration of Government Tax Agencies on PFMS.

• Complete Accounting Package for Audit Purpose.

• Synchronization of various state run applications with PFMS such

as ASHA Soft, OJAS etc.
 Health Care Financing

NHA NHA NHA

S.No. Indicator
(2004-05) (2013-14) (2014-15)

1. Total Health Expenditure (THE) as percent of GDP 4.2 4.0 3.9

Government Health Expenditure as percent of Total

2. 22.5 28.6 29.0
Health Expenditure

Private Health Insurance Expenditure as percent of

3. 1.6 3.4 3.7
Total Health Expenditure

Out of Pocket Expenditure as percent of Total Health

4. 69.4 64.2 62.6
Expenditure