3rd International Conference on Management, Economics and Social Sciences (ICMESS'2013) January 8-9, 2013 Kuala Lumpur (Malaysia)

Health Expenditure And Health Infrastructure In Class-I Towns Of , India

Ajit Kumar

infrastructural facilities. Provision of infrastructural health Abstract— Success of a State hinges on its knowledge economy facilities is government’s responsibility. But due to inadequate which is a function of a healthy population. Health constitutes a basic expenditure and dominance of private spending in health need of human beings which paves a way to a virtuous cycle of sector, there is unequal availability of health infrastructural multi-dimensional development. A State suffers an irrevocable services across strata, gender and location. This is the national setback in absence of an appropriate equilibrium between health expenditure and health infrastructure. Public expenditure on health is level story. Town level story may be different as municipal less than 1 per cent of GDP in India which is worrisome. Provision of corporations of different class-I town might be spending infrastructural health facilities is government’s responsibility. But different amount of money on different priorities. So due to inadequate expenditure and dominance of private spending in relationship between infrastructural health facilities and public health sector, there is unequal availability of health infrastructural expenditure at the level of class-I towns requires a deeper services across strata, gender and location. Micro units of analysis analysis. such as class-I towns provides deeper insights into the health sector. This paper is a probe into the relationship between infrastructural health facilities and public expenditure in class-I towns of Uttar II. LITERATURE REVIEW Pradesh in India. Das [1] examines the relationship between health Keywords— Expenditure, Health, Infrastructure, expenditure and health infrastructure and concludes that it is Knowledge-economy not mono causal. They maintain a feedback type of relationship. When expenditure is adequate, sound I. INTRODUCTION infrastructure is created and when there is sound MPIRICAL evidences suggest that mere emphasis on infrastructure, investment is poured out to improve the E economic development and neglect of social development existing level of health care facilities. Mehrotra [2] has results in lopsided development and ultimately slowing explored the health care system in Uttar Pradesh. According to down the tempo of economic development. The top priority him there are many loopholes in the provision of health care accorded to economic sector and marginal policy attention to facilities. Government machinery is dependent upon NGOs to social sectors like education and health results in economic provide the facilities to the poor. He finds health infrastructure prosperity accompanied by social poverty. Social poverty inadequate in the state. Duggal [3] did a study on India level particularly in the fields like education and health finally and comes with a conclusion that health budgets are sinking eclipses economic development and ultimately quality of life. continuously. Peter and Ahuja [4] also validate this statement Indian towns have been growing economically at a rapid pace through their study. George Thomas [5], in his study finds that particularly after the advent of New Economic Policy of 1991. cost of health care services is soaring high, mainly in big However, this rapid economic development has not been cities. Ritu [6] sarcastically remarks that now public health accompanied by social development particularly health sector services have become ‘Cinderella’ in the social sector. development. Health sector has been accorded very low Nandraj and Duggal [7] explain that spatially there are priority in terms of allocation of resources. Public expenditure widening gaps in health care expenditure. So it is found that on health is less than 1 per cent of GDP in India. It has further town level research in health care facilities is lacking in the witnessed decline during the post economic liberalization contemporary scenario. This paper is an effort towards this period. The meagre resource allocation to health sector has unexplored direction. adversely affected access, availability, and quality of health services. Sound Physical infrastructure is a cornerstone for III. OBJECTIVES desired health sector development. Without sound physical infrastructural facilities, health sector is like a house built The objectives of this study are as follows: upon the sand, which is not going to last for a long time. • To bring out the spatial inequalities among class-I Quality and quantity both are directly affected by lacuna in towns of Uttar Pradesh in terms of health expenditure. • To present the spatial inequalities among class-I Ajit Kumar is with the University, New Delhi, India towns of Uttar Pradesh in terms of health infrastructure. (phone: +919958310075; e-mail:[email protected]).

114 3rd International Conference on Management, Economics and Social Sciences (ICMESS'2013) January 8-9, 2013 Kuala Lumpur (Malaysia)

• To capture the consistency/inconsistency between Pradesh(UP) have been divided into four regions i.e. class-I levels of health expenditure and health infrastructure. towns of Western UP, class-I towns of Central UP, class-I towns of Eastern UP, and class-I towns of Southern UP i.e. IV. HYPOTHESES Bundelkhand. Spatial inequalities in terms of health Following are the hypotheses of this study: expenditure can be shown by taking into consideration the • As the level of health expenditure increases, level of three benchmarks of expenditure. The first benchmark is: health infrastructure also get enhanced. Towns spending more than 20% of their total receipt on health infrastructure, second benchmark is: towns spending 10-20% • Class-I towns of Western Uttar Pradesh are leading of their total receipt on health infrastructure, third benchmark in health expenditure as well as in health infrastructure. is: towns spending less than 10% of their total receipt on • 'High expenditure and low infrastructure' type of health infrastructure. The towns falling under Western UP. inconsistency in any town indicates either corruption or wrong and first benchmark are: Mathura, Chandausi, Rampur, priorities. Meerut, Aligarh, Moradabad, Farrukhbad-cum-Fatehgarh, and • 'Low expenditure and high level of infrastructure' Hathras. The only town of western UP, falling under second type of inconsistency indicates dominance of private sector in benchmark is, Saharanpur. Rest of the towns in Western UP health services. fall under third benchmark. The towns falling under central UP and first benchmark are: Fatehpur, Sitapur, and V. STUDY AREA Raebareilly. Only falls in the second benchmark, This study covers all the 54 class-I towns in Uttar Pradesh and the rest of towns fall in the third benchmark. Towns of according to 2001 census of India. The following Map I eastern UP, falling under first benchmark are: , shows the location of the study area: Sultanpur, Ghazipur, Ballia, Faizabad. Basti and Mirzapur of MAP I eastern UP come under second benchmark. Jhansi Municipal Board is the only town of Bundelkhand under first LOCATION OF STUDY AREA benchmark. No town of Bundelkhand fall under second benchmark. Banda and Lalitpur come under third benchmark. Uttar Pradesh has 54 class-I towns. Western UP has 26 class-I towns, central UP has 11 class-I towns, eastern UP has 14 class-I towns and Bundelkhand region has 3 class-I towns. To show the compatibility among four regions regarding different number of towns in each of them, ratios between no. of towns under concerned benchmark and total no. of towns in the concerned region have been worked out for both health expenditure and health infrastructure. The summary of inequalities in health expenditure can be presented as follows:

TABLE I INEQUALITIES IN HEALTH EXPENDITURE Number of Number Number Regions towns of towns of towns Source: Census of India, 2001 having having having composite composite composite Index values Index Index VI. DATABASE >20 values 10-20 values <10 Western UP 8 (1848/6006) 1 (231/6006) 16 (3696/6006) The main data source of this study is 'Town Directory', Central UP 3 (1638/6006) 1 (546/6006) 8 (4368/6006) 2001 census of India. Primary Census Abstract of Uttar Eastern UP 5 (2145/6006) 2 (858/6006) 7 (3003/6006) Pradesh (UP), 2001 and Statistical handbook of UP 2001 are Bundelkhand 1 (2002/6006) 0 (0/6006) 2 (4004/6006) also referred in this study. Source: Calculated by author

VII. LIMITATIONS OF DATA Note: Numbers in the brackets show ratios between no. of towns in the concerned category and total no. of towns in the concerned region. For The ‘Town directory’ of UP for the recently concluded comparison purposes all the ratios have been converted into ratios having census of India 2011 is not available till now. So, this study same denominator. has to limit itself only for the year 2001. According to the Table I, it is clear that towns in Eastern UP are leading in spending on health infrastructure, followed VIII. MAIN ANALYSIS by Bundelkhand, western UP and lastly by central UP It is To show the spatial inequalities in terms of health surprising that western UP is not leading in spending on expenditure and health infrastructure, class-I towns of Uttar health infrastructure against the common expectation. It may

115 3rd International Conference on Management, Economics and Social Sciences (ICMESS'2013) January 8-9, 2013 Kuala Lumpur (Malaysia)

have many interpretations. One of them might be the high TABLE III

spending from private sector and many clues indicate towards RELATIONSHIP BETWEEN HEALTH EXPENDITURE AND HEALTH this inference. INFRASTRUCTURE To show the spatial inequality in terms of health Health Health Possible Towns infrastructure, the values of composite index have been Expenditure Infrastructure Explanation Saharanpur divided into three categories. These categories are the same as Medium High Inconsistent/ Private Muzaffarnagar followed in the case of spending on health infrastructure. First Low High Inconsistent/ Private Moradabad category towns of western UP are: Noida, Rampur, High Low Inconsistent/ Other Sambhal Farrukhabad-cum-Fatehgarh, Muzaffarnagar, Mainpuri and Low High Inconsistent/ Private Modinagar. Second category of western UP includes Aligarh, Chandausi High Low Inconsistent/Other Saharanpur, Sambhal, Hapur, Hathras and the rest fall in third Rampur High High Consistent category. First category town of central UP includes Lucknow Amroha and Fatehpur. Second category of central UP includes Low Low Consistent Meerut Raebareilly and Etawah and the restt fall in the third category. High Low Inconsistent/Other Modinagar First category town of eastern UP includes Faizabad and Low High Inconsistent/ Private Ghaziabad Mirzapur. Second category includes Basti and Varanasi and Low Low Consistent Noida the rest fall in the third category. There is no first category Low High Inconsistent/ Private Bulandshahr town in Bundelkhand region. Second category towns are also Low Low Consistent Aligarh missing in Bundelkhand region. So in infrastructure all the High High Consistent three towns of Bundelkhand region fall in the third category. Hathras High High Consistent Thus western UP is leading in health infrastructure. Summary Mathura High Low Inconsistent/Other of the inequalities in the level of health infrastructure can be Firozabad represented through the table below: Low Medium Inconsistent/ Private Etah Low Low Consistent TABLE II Mainpuri Low High Inconsistent/ Private INEQUALITIES IN HEALTH INFRASTRUCTURE Bareilly Low Low Consistent Pilibhit Regions Number of towns Number of towns Number of towns Low Low Consistent Shahjahanpur having composite having composite having composite Low Low Consistent Lakhimpur Index values >20 Index values 10-20 Index values <10 Low High Inconsistent/ Private Sitapur Western UP 6 (1386/6006) 5 (1155/6006) 15 (3465/6006) High Low Inconsistent/Other Hardoi Central UP 2 (1092/6006) 3 (1638/6006) 7 (3822/6006) Low Low Consistent Unnao Eastern UP 2 (858/6006) 3 (1287/6006) 9 (3861/6006) Low Low Consistent Bundelkhand 0 (0/6006) 2 (4004/6006) 1 (2002/6006) Lucknow Medium High Inconsistent/ Private Source: Calculated by author Raebareli Medium Low Inconsistent/Other Etawah Low High Inconsistent/ Private Kanpur CB To examine the relationship between health expenditure Low Low Consistent Orai and health infrastructure, correlations and regressions have Low Low Consistent Jhansi MB been worked out. Pearson’s correlation values show positive High Low Inconsistent/Other Lalitpur and significant results for the correlation between health Low Medium Inconsistent/ Private Banda expenditure and health infrastructure. So, it is evident that Low High Inconsistent/ Private high health expenditure would lead to high level of health Fatehpur High High Consistent infrastructure. Regression results between health expenditure Allahabad High Low Inconsistent/Other and health infrastructure are weak and it is found that only Bahraich 10% of the relationship between health expenditure and health Low Low Consistent Gonda infrastructure is explained by health expenditure, which Low Medium Inconsistent/ Private Basti means, there are some other indicators which are essential to Medium Medium Consistent Gorakhpur capture the complete picture. Low Low Consistent Deoria The consistency/inconsistency between the relationship of Low Medium Inconsistent/ Private Ballia health expenditure and health infrastructure and possible Medium High Inconsistent/ Private Jaunpur explanations are presented in the Table III as follows: Low Low Consistent Ghazipur Medium Low Inconsistent/Other Mirzapur Medium High Inconsistent/ Private Source: Calculated by author Note: Inconsistent/Private= Higher Private Spending Than Public Spending Inconsistent/Other= Spending on Other Priorities or Prevailing Corruption

116 3rd International Conference on Management, Economics and Social Sciences (ICMESS'2013) January 8-9, 2013 Kuala Lumpur (Malaysia)

IX. FINDINGS AND CONCLUSIONS [7] Ravi Duggal & Sunil Nandraj, “Health expenditure across state: Regional disparity in expenditure”, Economic and Political weekly, Main findings and conclusions of this study can be Vol.30, No.16, P901, 1995. summarized in the following way: • Towns in Eastern UP are leading in spending on health infrastructure, followed by Bundelkhand, western UP and lastly by central UP. It is surprising that western UP is not leading in spending on health infrastructure against the common expectation.

• Western UP is leading in health infrastructure followed by central UP, Eastern UP and Bundelkhand.

• Pearson’s correlation values show positive and significant results for the correlation between health expenditure and health infrastructure meaning thereby that high health expenditure would lead to high level of health infrastructure.

• Regression results between health expenditure and health infrastructure are weak and it is found that only 10% of the relationship between health expenditure and health infrastructure is explained by health expenditure, which means, there are some other indicators which are essential to capture the complete picture

• There is high inconsistency between health expenditure and health infrastructure. It indicates that private sector is much more active in providing health care facilities than that of public sector.

All the hypotheses were established except second hypothesis which says that western UP is leading in health expenditure as well as in health infrastructure. It does lead in health infrastructure but it is not leading in health expenditure. So, it can be concluded that public sector spending on health care facilities is meagre and private sector is using this opportunity very well. It is resulted into skewed distribution of health care facilities across the class-I towns of Uttar Pradesh, which ultimately would lead to costly and poor health care facilities for the urban poor. So it is high time for responsible urban authorities to consider all the loopholes and to re-orient their policies.

REFERENCES

[1] L.N. Das, “Financing of health infrastructure in India”, Asian Economic Review, Vol.50, No.2, P377, 2008. [2] Santosh Mehrotra, “Public health system in U.P.:What can be done?” Economic and Political weekly, Vol.43, No.49, P46, 2008. [3] Duggal, Ravi, “Sinking flagships and health No.33, budgets in India”, Economic and Political weekly, Vol.44, P14, 2009. [4] Peter Berman & Rajeev Ahuja, “Government health spending in India”, Economic and Political weekly, Vol.43, No.26-27, P209, 2008. [5] Ashish Thomas George, “Good health at low cost: How good and how low?”, Economic and Political weekly, Vol.40, No.25, P2488, 2005. [6] Ritu Priya, “Public health services: Cinderella in the social sector”, Economic and Political weekly, Vol.39, No.33, P3671, 2004.

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