Uttaranchal: Review of Public Expenditure on Health

Until a few years ago, most governments across the world concerned themselves predominantly, with income growth strategies. Most, assumed rising incomes to transform into increased consumption and by analogy to improvement in quality of life. It has been realised that the linkage in this transformation may quite often be tenuous and, that all of what generally passes for as growth (in accounting terms) may not be contributing to development. This report is a review of public expenditure on health services in Uttaranchal.Public Expenditure on Health;

Resource Devolution from the Centre to States: Enhancing the Revenue Capacity of States for Implementation of Essential Health Interventions

Access to adequate health care services is an important component of empowering people with human capital. This, however, can be achieved only when the spending on health care is adequate and delivery systems efficient. Improving health indicators is an important component of the Millennium Development Goals (MDGs) set by the United Nations. There are also important targets on health status achievements set for the Tenth Plan. The Common Minimum Programme of the ruling UPA government also seeks to increase the public expenditure by the Centre and States on health and family welfare schemes from the present level of less than 1% to 2%-3% of the gross domestic product (GDP). The provision of health and family welfare services falls in the realm of concurrent responsibility of the Centre and the States, but the latter have a predominant role in the delivery of these services. However, fiscal pressures at the State level lead to compression of expenditures by the State Governments resulting in an increase in Central financing of these services, particularly for some prioritized programmes implemented through the Centre and Centrally sponsored schemes. Thus, over 85% of the public expenditure on medical and public health is incurred by the State Governments, though the proportion of financing the expenditure by the State Governments is lower. This paper identifies the resource gap between the desired and the actual health expenditure in 15 major States in India (14 large, non-special category States and Assam), and highlights the extent to which the gap can be reduced by augmenting resources at the State level. Further, it estimates the resource gap that cannot be met through States’ own resources and therefore, requires Central transfers. The design of Central transfers needed for meeting the required health expenditure of various States is also discussed.Federal Transfers to Provinces; Public Expenditure on Health

Budgetary subsidies and the fiscal deficit case of Maharashtra

Introduction: Srivastava and Sen (1997) have advanced a framework for the study of government subsidies in India. Their approach estimates subsidy as the un-recovered costs in the provision of goods and services by the government (see the next section for various definitions of subsidy). Specifically, for the state of Maharashtra, the subsidy was estimated at Rupees 9607.41 Crores (Annexure 15, pg 151, NIPFP report) for the year 1993-94, while the Gross Fiscal Deficit (GFD) for the same year stood at Rupees 2265.3 Crores. As a proportion of Gross State Domestic Product (GSDP), these magnitudes were 8.5 and 2 per cent, respectively. The estimated subsidy constituted about 65 (73) per cent of the total (revenue) expenditure.5 Contrast this with the budgetary subsidies estimated between 2 and 2.35 per cent of GSDP by the Finance Department of the Government of Maharashtra (GoM) as shown in Table 1. Excluding the grants-in-aid, the estimate of subsidy varies between 0.8 to 1.05 percent of GSDP. Thus, estimates of subsidies vary widely between the official report (of GoM) and the NIPFP report. The present paper is not an attempt at comparing or reconciling these two estimates. Instead it focuses on the fundamental question of whether the governments budgetary subsidies, estimated as un-recovered costs, can exceed the GFD. The query came up specifically in the context of deciphering the sources of financing of the subsidies (both explicit and implicit) and thus ascertaining who bears the costs of the subsidies. Certain costs are borne by the society at large in terms of loss of productivity and efficiency. These maybe estimated as the social dead weight losses but they may or may not impinge upon the government budget. Subsidies that impact upon the budget must be a part of the expenditures (on goods and services provision) of the government. So long as public expenditure (on goods and services) is financed by tax and non-tax revenues, subsidies represent inter-personal transfers and redistribution, with the government acting as facilitator. The inter-personal transfers are generally achieved through price discrimination across different sections of consumers. So long as such price variations are revenue neutral they have an impact on the resource allocation mechanism but do not influence the sustainability of the government expenditure program. Often government expenditure exceeds the sum of tax and non-tax revenue. The revenues then constitute the recovered costs of government expenditures, while the un-recovered costs have to be financed by borrowings. The total borrowing requirements of the government from all sources are known as the GFD. The GFD is, therefore, a measure of the extent to which the economy is living beyond its present means (income). In reality a substantial component of the GFD may actually represent investment with only a part of it subsidizing the present consumption plan. Even if all the borrowings were assumed to be financing the present consumption plan, this measure of subsidy should not exceed the GFD. A relevant objective here would be to minimize this component of GFD. In this paper we explore the reasons for the wide gaps in the measure of fiscal deficit and the estimate of aggregate subsidy and suggest an improvement in the methodology to estimate the latter. The plan of this paper is as follows. Section II discusses the meaning, scope and definition of subsidy to dispel some of the myths associated with the term. In section III a simple algebraic structure is presented to provide a theoretical ceiling on aggregate subsidy. Section IV elucidates the economic rationale for subsidies and the need to study their impact / incidence as a significant policy tool. Section V critically analyses the methodology followed by NIPFP and outlines the reasons for the errors in the estimates. An alternative formulation to estimate the un-recovered costs (net aggregate subsidy) is then advanced. Finally, section VI concludes by emphasizing the need for reconciliation between the fiscal deficit and aggregate subsidy estimation and the consequent need for broader macroeconomic consistency

Social media measurement and monitoring

This chapter highlights the role that social media measurement and monitoring (SMM) processes can play in influencing business outcomes based on consumer behaviour analysis. It classifies the performance metrics into three groups, namely: Reach helps focus on the probable size of the user base, based on the number of unique impressions, followers, shares, comments and likes. The social media measurement and monitoring process is carried out to measure and monitor social media activities so an organization can achieve its goals. The process begins with a social media audit to assess how efficiently and effectively the brand's existing social media efforts are performing, as well as evaluating where the consumers are engaging and communicating. Mapping of objectives is carried out to understand the direction of the brand with regard to its efforts on social media and what it aims to achieve

A case series of oleander poisoning: challenges faced by emergency physicians in developing countries

Objective: Through the reporting of this case series, we aim to establish whether a conservative approach, through managing arrhythmias and vital signs, can be reliably used as a treatment modality for oleander poisoning in developing countries. Methods: This study is a case series of 11 patients who presented with oleander poisoning and were conservatively managed in the absence of standard antidote. Results: All 11 patients treated with conservative approach survived. Conservative approach included use of atropine for management of symptomatic bradycardia followed by Dopamine infusion, correction of serum potassium and magnesium levels, standby defibrillation, and transvenous pacing. Conclusion: The absence of reliable dosage of poison ingested, the lack of facilities for serum digoxin estimation, and the unavailability of digoxin fab antibodies pose challenges for the management of patients with oleander poisoning. Patients can, however, be managed conservatively following the Advanced Cardiac Life Support (ACLS) algorithm in a setting that lacks the standard treatment of this poison

Uttaranchal: Review of Public Expenditure on Health

Until a few years ago, most governments across the world concerned themselves predominantly, with income growth strategies. Most, assumed rising incomes to transform into increased consumption and by analogy to improvement in quality of life. It has been realised that the linkage in this transformation may quite often be tenuous and, that all of what generally passes for as growth (in accounting terms) may not be contributing to development. This report is a review of public expenditure on health services in Uttaranchal

Uttaranchal: Review of Public Expenditure on Health

Until a few years ago, most governments across the world concerned themselves predominantly, with income growth strategies. Most, assumed rising incomes to transform into increased consumption and by analogy to improvement in quality of life. It has been realised that the linkage in this transformation may quite often be tenuous and, that all of what generally passes for as growth (in accounting terms) may not be contributing to development. This report is a review of public expenditure on health services in Uttaranchal

Anxiety among people living with HIV/AIDS on antiretroviral treatment attending tertiary care hospitals in Lucknow, Uttar Pradesh, India

Background: One of the major health challenges faced by India is the rapid growth of HIV/AIDS and its impact upon human life. Co-morbidities like anxiety are often overlooked while providing ART services to HIV/AIDS patients. Therefore the present study was conducted to assess the anxiety and associated factors among PLHA (People Living with HIV/AIDS) on antiretroviral treatment attending tertiary care hospitals in Lucknow.Methods: Hospital‑based cross-sectional study was conducted from November 2013 to March 2014 among 170 patients on treatment attending antiretroviral therapy (ART) centre of two tertiary care hospitals of Lucknow. Systematic random sampling was used to recruit patients. The anxiety level of all included patients was scored as per Hamilton anxiety rating scale. Results: The mean HAM-A score of 179 patients was 10.74±6.04. Majority (92.1%) of the patients had HAM-A score less than 17 indicating mild severity, 5.0% of the patient had mild to moderate severity while only 2.7% had moderate to severe level of anxiety symptoms. None of the patient had very severe level of anxiety. Significant association was found between level of anxiety symptoms with educational status (0.03), perception of side-effects during last one month (0.03) and duration of treatment (0.04).Conclusions: People living with HIV/AIDS need to be periodically educated and informed about various issues associated with the disease severity and antiretroviral treatment along with its side-effects so that they could better cope with disease and its treatment outcomes over time and be able to seek early treatment accordingly.

Resource Devolution from the Centre to States: Enhancing the Revenue Capacity of States for Implementation of Essential Health Interventions

Access to adequate health care services is an important component of empowering people with human capital. This, however, can be achieved only when the spending on health care is adequate and delivery systems efficient. Improving health indicators is an important component of the Millennium Development Goals (MDGs) set by the United Nations. There are also important targets on health status achievements set for the Tenth Plan. The Common Minimum Programme of the ruling UPA government also seeks to increase the public expenditure by the Centre and States on health and family welfare schemes from the present level of less than 1% to 2%-3% of the gross domestic product (GDP). The provision of health and family welfare services falls in the realm of concurrent responsibility of the Centre and the States, but the latter have a predominant role in the delivery of these services. However, fiscal pressures at the State level lead to compression of expenditures by the State Governments resulting in an increase in Central financing of these services, particularly for some prioritized programmes implemented through the Centre and Centrally sponsored schemes. Thus, over 85% of the public expenditure on medical and public health is incurred by the State Governments, though the proportion of financing the expenditure by the State Governments is lower. This paper identifies the resource gap between the desired and the actual health expenditure in 15 major States in India (14 large, non-special category States and Assam), and highlights the extent to which the gap can be reduced by augmenting resources at the State level. Further, it estimates the resource gap that cannot be met through States’ own resources and therefore, requires Central transfers. The design of Central transfers needed for meeting the required health expenditure of various States is also discussed

Isolated congenital factor VII deficiency

Congenital factor VII (FVII) (proconvertin) is a rare autosomal recessive bleeding disorder. Bleeding manifestations and clinical findings vary widely, ranging from being asymptomatic to life-threatening bleeding. Intracranial bleeding is relatively less common with inherited FVII deficiency than with other coagulation disorders. We report a rare case of congenital FVII deficiency in an 11-year-old male child. The patient had recurrent subdural hemorrhages. The prothrombin time was markedly prolonged with a normal bleeding time, normal partial thromboplastin time and normal platelet count. Treatment consists of replacement therapy with fresh frozen plasma, prothrombin complex concentrates or plasma-derived FVII concentrates, and/or recombinant factor VIIa. Clinical heterogeneity is the hallmark of this disorder