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What is the status of ‘Government’ & ‘Private’ expenditure on Healthcare in the states?
Sai Krishna Muthyanolla
May 29, 2021
In the previous story, we looked at government & out-of-pocket (private) expenditure on health in India and compared it with few other nations across the world. What is the status of Indian states as far as health expenditure is concerned?
India’s second wave of COVID-19 infection has put an unprecedented strain on the country’s healthcare system. Since early March 2021, official cases and deaths have skyrocketed, recently breaking world records on an almost daily basis. Many experts suspect that with poor record-keeping for the cause of death – and crematoriums overwhelmed in many places – the real numbers of deaths due to COVID-19 could be significantly higher in the country than what is being officially reported. News reports have indicated that the second wave has caused health infrastructure to collapse in several cities, with the most acute shortages being oxygen and hospital beds. In the middle of an ongoing and exponential rise in cases, state governments are scrambling to build up new infrastructure.
In continuation to our recent stories on the extent of government and private spending on healthcare in the country, we look at health financing indicators across major Indian states in this story.  To understand this, we employ the National Health Accounts (NHA) estimates. These estimates are derived within the framework of National Health Accounts Guidelines for India, 2016 and adhere to System of Health Accounts 2011, a global standard framework for producing health accounts. The NHA round 2016-17 provides the most recent data (for the year 2016-17) on commonly used health financing indicators for comparison of health expenditure such as total health expenditure (THE), government health expenditure (GHE), and out-of-pocket expenditure (OOPE). OOPE refers to private expenditure by people either directly to healthcare institutions or indirectly in the form of health insurance premiums.
Share of Total Health Expenditure in GSDP highest for Bihar, UP; lowest for Gujarat, Haryana
The Total Health Expenditure (THE) comprises capital and current health expenditure in both public and private sectors providing healthcare in India. THE constitutes current and capital expenditures incurred by Government and Private Sources including External/Donor funds. For the year 2016-17, Total Health Expenditure (THE) for India is estimated at Rs. 5.81 lakh crores (3.8% of GDP and Rs. 4381 per capita).
Total Health Expenditure (THE) as a percentage of Gross State Domestic Product (GDSP) indicates overall health (government and private) spending relative to economic development. The NHA 2016-17 estimates indicate that:
Share of Government Health Expenditure in GDSP consistently low among major states
GHE constitutes spending under all schemes funded and managed by Union, State and Local Governments including quasi-governmental organizations and donors in case funds are channeled through Government organizations. GHE has an important bearing on the health system as low Government health expenditures may mean high dependence on household out-of-pocket expenditures, leading to indebtedness in many poor & vulnerable households. For the year 2016-17, Government Health Expenditure (GHE) for India has estimated Rs. 1.88 lakh crores (32% of THE, 1.2% GDP and Rs. 1418 per capita).
Government Health Expenditure (GHE) as a percentage of Gross State Domestic Product (GDSP) indicates the government health spending relative to economic development. The NHA 2016-17 estimates indicate that:
Share of Government Health Expenditure in Total Health Expenditure low in major states
While the total health expenditure comprises capital and current health expenditure in both public and private sectors providing healthcare, GHE constitutes spending under all schemes funded and managed by the government. GHE has an important bearing on the health system as low government health expenditures may mean high dependence on household out-of-pocket expenditures.
The following graph indicates the share of government health expenditure in total health expenditure across major states:
Evidently, a high number of major states have an estimated low share (<30%) of Government Health Expenditure in Total Health Expenditure. This would, in turn, have negative implications for out-of-pocket expenditure in these states, since health expenditure constitutes a major part of household expenditure in poor & vulnerable households.
Out-of-Pocket Expenditure on healthcare significantly higher than Government Expenditure in all major states
Out-of-Pocket Expenditures are expenditures directly made by households at the point of receiving health care. This indicates the extent of household spending towards healthcare payments. For the year 2016-17, the Household Out of Pocket Expenditure on health (OOPE) for India is estimated at Rs. 3.4 lakh crores (58.7% of THE, 2.2% of GDP, Rs. 2570 per capita).
Comparing health expenditures and out-of-pocket expenditure from NHA 2016-17 estimates indicates that:
Featured Image: Government & Private Expenditure on Healthcare


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What is the status of Infrastructure in Primary Health Centers (PHCs)?
Sai Krishna Muthyanolla
June 13, 2020
COVID-19 has once again reminded us of the importance of a strong public health system. India has poor public health infrastructure right from the grass root level. Here is an analysis of the infrastructure at PHCs across the country.
India has now at the fourth position in the list of worst hit countries by COVID-19.  The number of cases has crossed 3 lakh. As the number of cases continues to increase, the public health system in the country is put to test. Questions are being raised in multiple states about the adequacy of facilities in our hospitals. Since public health facilities alone cannot handle the load of patients, private hospitals are also taking in COVID-19 patients in many states.  States like Tamil Nadu and Maharashtra have considered capping the cost of treatment in private hospitals to prevent exploitation.
The flipside of this focus on COVID-19 meant that prevention and treatment of non-communicable diseases have been severely disrupted around the world, according to a WHO survey. People suffering from other non-communicable diseases are at a greater risk because of comorbidity. But such people are reluctant to go hospitals fearing risk of contracting the virus. On the other hand, human and material resources are being diverted for the fight against COVID-19 across countries.
Public healthcare centres have been converted to dedicated COVID-19 facilities
According to WHO, primary healthcare plays an important role in differentiating patients with respiratory symptoms from those with COVID-19, making an early diagnosis, helping vulnerable people cope with their anxiety about the virus, and reducing the demand for hospital services. Earlier in May, the Government of India, converted some public health facilities across the country into dedicated COVID Hospitals, COVID Health Centres, and COVID Care Centres for COVID-19 management.  Based on the severity of the infection in a person, they will be sent to either of these three.
Not only during a pandemic like this one, but Primary Healthcare Centres or PHCs act as linchpin in rural health services in India as they are the first point of contact between the community and a medical officer.  PHCs are envisaged to provide integrated curative and preventive healthcare to rural population, which is a majority in India. There are three tiers of rural health institutions- Sub Health Centre, Primary Health Centre (PHCs), and Community Health Centre (CHCs).
Three tiers of rural public health institutions exist in India
As per the ‘Minimum Needs Program’ introduced during the Fifth Five Year Plan, one Sub Centre was to be established for a population of 5000 people in plains and for 3000 people in hilly and tribal areas. A PHC was to be established for 30,000 population in plains and 20,000 in tribal and hilly areas, and one CHC or Rural Hospital for a population of one Lakh. PHCs act as referral centres for around 6 Sub- Centres and CHCs act as referral centres for around 4 PHCs, for patients requiring specialized healthcare services.
Despite the prescribed standards on the availability of facilities in PHCs, not all of them have adequate facilities. From shortage of doctors to physical infrastructure and drugs, there are many bottlenecks to the effective functioning of PHCs in the country.
58% of PHCs in India are concentrated in six states with 54% Rural Population
Data from the Ministry of Health shows that there is a total of 16,613 PHCs functioning in India as of 31 March 2019. Karnataka, Uttar Pradesh, and Rajasthan have more than 1700 PHCs each while Bihar, Madhya Pradesh, and Maharashtra also have more than 1000 PHCs each. 58% of the PHCs in the country are concentrated in these six states. These 6 states account for 54% of the rural population of the country as per the 2011 Census.  It must be noted that Andhra Pradesh, Telangana, and Goa have Health and Wellness Centres (HWCs) in place of PHCs.
Not even half of the PHCs function round the clock
Only 40.5% of these PHCs (6,733) in the country are functional 24*7. Sikkim is the only state where all the 24 PHCs function round the clock. Among other states, only Tamil Nadu, Tripura, Manipur, Punjab, Jharkhand, Madhya Pradesh, and Mizoram have more than 70% of the PHCs rendering 24*7 service. Despite home to a  large number of PHCs, Uttar Pradesh and Rajasthan have only about 22% and 35% of the PHCs functioning 24*7 respectively. No PHCs function round the clock in Gujarat.
Labour rooms, though essential, are unavailable in 28% of the PHCs
Though labour rooms are considered essential in PHCs, data shows that only 72% of the PHCs in the country have labour rooms. The labour rooms are supposed to be equipped with basic medical equipment that are necessary for mothers & infants such as oxygen supply, suction machines etc. Less than 50% of PHCs in Maharashtra, Delhi, Himachal Pradesh, and Kerala have labour rooms.
Meanwhile, operation theatres are optional in PHCs. However, only select surgical procedures can be carried out, such as vasectomy, tubectomy, and hydrocelectomy even if there is an operation theatre. There should be separate facilities for the storage of sterile and unsterile equipment, regular fumigation of the theatre, and a separate area for changing and sterilization. Across the country, around 36.5% of the PHCs have operation theatres. All the PHCs in the states of Punjab, Sikkim, and Mizoram have operation theatres.
Almost a quarter of PHCs in India do satisfy the minimum requirement of 4 beds
As per the guidelines of the Indian Public Health Standards, every PHC should have at least 4 to 6 beds, with earmarked wards for males and females. It also necessary that these wards have separate toilets for males and females. But less than 77% of the PHCs have the minimum requirement of 4 beds. Mizoram, Sikkim, Karnataka, Madhya Pradesh, Gujarat, Rajasthan, and West Bengal are the states which have fulfilled the requirement in all the PHCs. Less than half the PHCs in Maharashtra, Himachal Pradesh, Assam, Kerala, Odisha, and Delhi have 4 beds.
More than half the PHCs in Jharkhand do not have electricity and two-thirds do not have regular water supply
Electricity supply and regular water supply are two important basic amenities required for functioning of PHCs. Electricity supply is required for storage of vaccines, emergency services including deliveries and surgeries. It is alarming to note that about 4.8% of the PHCs (1590) in the country do not have electricity supply and 8.2% of them (2716) do not have regular water supply. In Jharkhand, even though the state has fared above national average in terms of PHCs functional 24*7 and availability of labour rooms, 55.2% of the PHCs do not have electricity supply and 65.5% of them do not have a regular water supply.
Jammu and Kashmir, Uttarakhand, Arunachal Pradesh, Odisha, Uttar Pradesh, and Nagaland have also reported more than 10% of the PHCs functioning without electricity supply. In Nagaland, Manipur, Jammu and Kashmir, Uttarakhand, and Meghalaya, at least 20% of the PHCs do not have regular water supply. States of Tamil Nadu, Sikkim, Punjab, Bihar, Kerala, and Delhi have electricity and water supply in all PHCs.
More than 15% of the PHCs in each of Arunachal Pradesh, Uttar Pradesh, Uttarakhand, Jammu and Kashmir, and Nagaland, do not have an all-weather motorable approach road. At the national level, there are around 1,355 PHCs without an all-weather motorable approach road. Though the availability of a computer with internet connectivity for data management is mandatory, only about 76.5% of PHCs in the country have a computer and 57% have a telephone.
Government has to strengthen the public healthcare in India
Public health and hospitals are state subjects. Recruitment of doctors, and other administrative matters in PHCs thus fall under the purview of respective state governments. Financial support and technical support are extended to states and UTs by the centre through National Health Mission. As is evident from the data, PHCs in India do not even have the minimum required infrastructure as mandated by the relevant guidelines. The status of public healthcare system in the country will not improve unless governments invest more in these facilities. Lack of such facilities in the public sector forces people to approach private hospitals resulting in increased out of pocket expenditure. Lack of these basic facilities also discourage doctors from working in PHCs which predominantly cater to the needs of the rural poor. In addition to poor infrastructure, skewed distribution of doctors and paramedical staff and their shortage is another important issue that is plaguing the public health system. COVID-19 has once again reminded us of the importance of strengthening our public health systems right from the grass roots.
Featured Image: Infrastructure of Primary Health Centers

source: news-factly

license: Creative Commons - Attribution - https://creativecommons.org/licenses/by/4.0/

author: Sai Krishna Muthyanolla


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Data: What is status of State’s Own Tax Revenue (SOTR) of various states?
Sai Krishna Muthyanolla
March 24, 2020
A major part of state government’s budgetary resources come from State’s Own Tax Revenue (SOTR). Here is a detailed analysis of SOTR & its share in overall tax revenue of states.
Likein the case of central government, each state incurs expenditure in the form ofadministrative costs, funding of various schemes, building of infrastructureetc. This is met by the income generated through various sources.
Theincome generated by states for various activities include revenue receipts liketaxes & grants and capital receipts like loans.
Ofthis, Tax Revenue forms a substantial portion of revenue receipts for most ofthe states. The tax revenue earned by the states further includes ‘States ownTax Revenue’ (SOTR) and their respective share in the Union Taxes. Thedevolution of union tax revenue to the states depends on the recommendations ofthe Finance Commission.
SOTR
varies from State-state
Stateswhich are able to generate more revenue on their own are less dependent on thedevolution & central grants. The generation of SOTR varies from state to state,with few states performing very well on this front and few others stilldepending largely on their share of Union Taxes and Grants-in-aid provided bythe Centre.
Ingeneral, SOTR includes revenues earned through – Sales Tax, State Excise duty,SGST, Land Revenue, Stamps & Registrations etc. Few states have other taxesrelevant to their own state.  In thisstory we analyse the trends of SOTR earned by the states for the five-yearperiod of 2014-19.
Theinformation submitted by each state to Comptroller and Auditor
General (CAG) is considered for this analysis. For the numbersrelating to 2018-19, ‘Monthly Key Indicator’ report for March-2019 isconsidered. For the numbers relating to the earlier years i.e. 2014- 18, theannual ‘Accounts
at a Glance’ report submitted by the states to the CAG isconsidered.  Delhi, Goa & Puducherryare excluded from the analysis as there is no data available on the CAGwebsite.
SOTR
accounts for more than 80% of the total tax revenue in Haryana, Karnataka,
Maharashtra & Telangana
Forthe year 2018-19, SOTR accounted for 83.79% of the tax revenue in Haryana. Evenin the four years prior to this, SOTR accounted for 88.62%, 84.91%, 83.76% and84.92% of the total tax revenue earned by the state. SGST followed by sales taxforms the major share of the SOTR in Haryana.
Telanganahas managed to increase the share of SOTR to 83.64% of the total tax revenue forthe first time in 2018-19. Although it did have a higher share of SOTR inearlier years, the share was in the 70s. This increase is both due to theincrease is SOTR for 2018-19 (by 10 thousand cores) as well as a fall in amountreceived as devolution of union tax revenue. It is also one of the few stateswhich is showing a year on year increase in the share of SOTR.
Apartfrom Haryana, Maharashtra is another state where the SOTR share is more than80% between 2014-19. In 2014-15, SOTR share in Maharashtra was highest at  86.71% of the total tax revenues. Share ofSOTR in the subsequent years fell slightly but is still in the 80s.
InKarnataka, the share of SOTR was 80.23% of its tax revenue  in 2018-19. In the previous years, it hoveredin lower 70s. In the year 2014-15, SOTR accounted for 82.73% of the total taxrevenue. The increase in 2018-19 is result of an increase in State taxrevenues.
Forall these four states, the tax revenue forms the major chunk of total revenuereceipts with Non-tax Revenue and Grants-in-aid contributing a minor share.
Share
of SOTR between 70 -80% of the total tax revenues for five states
In2014-15, the share of Kerala’s SOTR was at 81.63% of the total tax revenue. Inthe subsequent years, however, its share in the total tax has fallen while theamount has increased. In 2018-19, the share of SOTR in Kerala’s tax revenueswas 79.91%.
Andhra Pradesh has managed to increase its SOTR share in 2018-19 to 73.52%, an increase by 10% from the previous year. During the previous three years between 2015-18, the states SOTR share hovered in the 60s. Even in the case of AP, the recent increase is due to both the increase in actual SOTR as well as the decrease in the state’s share in union taxes.
Althoughthe three states of Gujarat, Kerala and Tamil Nadu have their SOTR share in 70sbracket, there is a consistent decline over the five-year period. Each of thesestates had the SOTR share in 80s in 2014-15. The proportionate increase of sharein Union taxes was higher than SOTR which led to this situation.
UP’s
SOTR share in total tax revenue crossed 60% in 2018-19
Uttar Pradesh has been among the low performing states in terms of Tax Revenues earned through SOTR. In 2014-15, the share of SOTR was 52.68% of the total tax revenue which further reduced in the subsequent three years to  47.13%, 44% and 44.61% respectively.  However, in 2018-19, there has been a steep increase in the share of SOTR to 60.95%. This increase is due to around 60% increase is SOTR compared to that of the previous year. The phenomenal increase in state GST collection in 2018-19 is the main contributor which increased to more than ₹ 82 thousand crores in 2018-19.
Chhattisgarh,Himachal Pradesh, Rajasthan, Uttarakhand and West Bengal all have recorded afall in their share of SOTR in total tax revenue year on year during the period2014-19. For these states’ revenue earned through SGST could not cover up thereduction relating to taxes on Sales, Trade etc.
Bihar
& Jharkhand have increased their SOTR share in 2018-19
As in the case with U.P, Bihar also saw a significant jump in SOTR in 2018-19. While the share of SOTR in total tax revenue is still a lowly 47.59%, this is a significant improvement over 28.74% and 35.96% in the previous two years. This increase can be attributed to a significant increase in the SGST collection. It also needs to be noted that since 2016-17, Bihar does not have income through Excise tax due to the prohibition of liquor in the state.
Althoughthere is an increase in Jharkhand’s SOTR in 2018-19, the state has reduced SOTRearnings during the five-year period. Assam, Madhya Pradesh & Odisha arethe other two states which have seen a fall in SOTR, with the reduced SGST collections.The share of SOTR data for 2017-18 and 2018-19 is not available for J&K. Buteven this state has shown a declining trend compared to the previous years. Jharkhanddoes receive a considerable amount in the form of Grants-in-aid from the Centre.
Majority
of the Tax revenue of North East states is their share of Union taxes
Overthe five-year period, the State’s share of Union Taxes received by ArunachalPradesh has increased from ₹ 1,109 crores to around ₹ 10 thousand crores.During the meantime, SOTR has only increased from ₹ 462 crores to ₹ 1,073crores. The share of SOTR has therefore fell drastically from 41.64% in 2014-15to only 9.33% in 2018-19.
Even the other states in North East India are also heavily dependent on their share of central taxes.  Among these states, Meghalaya and Tripura are considerably better with a higher SOTR share. However, even for these states, SOTR does not cross 30% with the major chunk of the tax revenue coming from their share in central taxes.
The data in respect to the division of tax revenue into SOTR and Share in Union taxes, is not available in 2018-19 for Sikkim, Mizoram and Nagaland. However, even these states show a significant fall in the share of SOTR.  Apart from the tax revenues, the North-Eastern states also receive substantial Grants-in-Aid.
Fall
in share of SOTR across multiple States
NorthEastern States, Bihar, Jharkhand, U.P etc. are the states with a lesser shareof SOTR and have been receiving a major portion of their tax revenue throughdevolution of union tax revenue.
Meanwhile,among the larger states, Maharashtra, Karnataka, A.P, Telangana, Kerala, TamilNadu etc. SOTR share is substantially higher in the state’s total tax revenues.
However, a common trend that can be seen in recent years (2014-19) is the general fall in SOTR across multiple states, including the higher-performing ones. One key contributor to this is the lower SGST revenues. In the case of some states like U.P, an increase in SGST revenue has helped in the increase of SOTR.
The states with a higher SOTR are also observed to have been doing well in their SGST collections. However, only two years of data is available post the implementation of GST and it would be too early to predict future trends.
Focus on creating avenues to increase SOTR could help in having stable budgets and economic planning, irrespective of the changes in the devolution of union tax revenue.


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Data: What is the status of Water-borne diseases in India?
Sai Krishna Muthyanolla
April 15, 2022
Water-borne diseases in India cause a huge disease burden while also resulting in significant loss of life. It is a major cause of death in Children under five. Since water-borne diseases can only be reduced by access to safe drinking water, the government launched the National Rural Drinking Water Programme (NRDWP) in 2009, which is now called the Jal Jeevan Mission.
Among the many things that are life-giving, water stands out as the most critical. Our lives are intrinsically related to water because 60% of our body is water only. Every human needs to consume a certain quantity of water to just function normally. And this consumption of water should be of certain acceptable quality standards. Any imbalances in these standards could make water the most lethal life-taking fluid. In other words, “What Gives Life, Can Also Take Life”.
Access to safe drinking water can improve living standards & life expectancy by reducing the disease burden. Globally, around 2 billion people consume water contaminated with faeces. The consumption of such unsafe water can result in water-borne diseases. According to a 2020 report of  WaterAid India, 1 in every 10 people do not have access to a safe drinking water source.  In India, these water-borne diseases are estimated to pose an economic burden of approximately 600 million USD per year, as per a UNICEF update. Areas with poor sanitation, inadequate supply and unhygienic practices have a high probability of water-borne disease transmission. If left untreated, these could translate into larger outbreaks, causing a public health emergency. Acknowledging the importance of water and sanitation, the United Nations adopted ‘Clean Water and Sanitation’ under goal 6 of the Sustainable Development Goals. Reducing the incidence of water-borne diseases is only possible by providing access to safe & affordable drinking water.
In India, the responsibility of providing healthcare facilities lies primarily with the state government as ‘Health’ is a State Subject, and the Union government provides technical and financial assistance to the states. Since water-borne diseases have the potential to become outbreaks, these are captured under the Integrated Disease Surveillance Program (IDSP).
In this story, we look at the data related to the prevalence of water-borne diseases in India over the last few years. The data is primarily sourced from annual National Health Profiles published by the Central Bureau of Health Intelligence, Jal Jeevan Mission dashboard, and parliamentary questions.
What are water-borne diseases?
In simple terms, these are the diseases that have ‘water’ as the common mode of transmission. This transmission could be either due to the direct consumption of such contaminated water or through food. In addition to direct consumption, using contaminated water for personal hygiene or recreation could also potentially cause diseases. There are four major water-borne diseases that are rampant across the world and India:
How is the data regarding these water-borne diseases collected?
As stated earlier, these water-borne diseases have the potential to transform into outbreaks, causing a public health emergency. To prevent such rapid spread, the Government of India initiated a program called IDSP in 2004, with the assistance of the World Bank. The primary objective is to detect such outbreaks and provide early warnings. Under this, ‘Surveillance Units’ are set up at all the three levels of the government – Central, State and District. The data is collected on a weekly basis and is directly uploaded at the district level.
The reporting is done in three formats:
The data is then collected and collated by the designated person, who must be familiar with these reporting formats. After the collation of data, if there is a sudden increase in the cases, it must be informed to the Designated Surveillance Officer (DSO).
These forms have a list of diseases that are to be identified and reported by the designated person. The daily figures are collated under tally sheets and each record is stored for future reference. More on this is available in the IDSP Manual for medical officers.
The trend in water-borne diseases in India:
Diarrhea accounted for more than 85% of the major Water-borne disease cases
Among the four major water-borne diseases in India, diarrhea is the most widely reported one, followed by typhoid and viral hepatitis. The cases of cholera are very minimal in comparison to these three. Over the years, from 2013-19, Diarrhoea accounted for more than 85% of all the cases reported under these heads. Rest is comprised of Typhoid, also called enteric fever, with around 14% of the cases and hepatitis with 1% of all the cases.
Huge inter-state variation in the incidence of water-borne diseases
There is a huge inter-state variation in the cases relating to water-borne diseases. Nine states accounted for more than 65% of all the cases reported on diarrhea and typhoid. This category of states is not homogenous- both relatively developed states like Karnataka, Maharashtra, Andhra Pradesh, and relatively less developed states like Odisha, UP, Madhya Pradesh, and Rajasthan are a part of this group.
Significant increase in Diarrhoea cases in 2019
As noted earlier, Diarrhoea cases make up most of the water-borne disease-related cases. As per a report in IndiaSpend from 2018, diarrhea alone is responsible for more than 60% of the deaths that are caused due to water-borne diseases in India. It is the second leading cause of death in children under the age of five years. Across the states, over the years, there is no clear pattern of the incidence of this disease. Most of the states showed a spike in the year 2019, after which there is a decline in the number of cases of diarrhea reported. However, only in Telangana, there is a clear pattern of reduction over the years.
Efforts to minimize water-borne diseases:
Safe Drinking Water and proper sanitation measures are necessary to prevent the outbreak of water-borne diseases. To achieve these goals, the Government of India launched National Rural Drinking Water Programme (NRDWP) in 2009. The objective of the scheme was to provide every rural person with safe and adequate water for all purposes. In 2019, the scheme was subsumed under Jal Jeevan Mission (JJM) to provide potable water to every rural household by functional tap connection by the year 2024. Despite the presence of such a program for 13 years, there has not been significant progress in the achievement of objectives. Only 10 states and UTs have been able to provide tap water connection to more than 90% of the households and only 48% of total households in India have a tap water connection as per data on of the JJM as of 13 April 2022.
Water Testing is critical to measure standards
Water testing is an important mechanism to ensure that the provided water is safe and meets acceptable quality standards. Currently, this testing is done in two ways: through field testing kits and to collect samples and test them in the laboratories. These laboratories are spread across India to ensure adequate testing across the country. The status of the country-wise availability of laboratories and the samples tested during 2021-22 as of 14 April 2022 is as below.
Climate change increases the likelihood of water-borne diseases:
Climate change leads to a series of cascading events – flooding, heavy rainfall, and increased temperatures across the globe. Because of these events, the transmission pathways are more likely to get affected. As a result, the likelihood of food and water-borne diseases would exacerbate further. Changes in the duration of seasons could also extend the transmission season’s length, further increasing the vulnerability of these diseases.
India is one of those countries that could get severely impacted due to climate change and global warming. Adequate measures should be taken as early as possible to mitigate the effects of climate change on the spread of infectious diseases, which could burden the health sector further.
Featured Image: Water-borne diseases


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Data: What Is the Trend in Gross NPAs, Write-Offs of Banks?
Sai Krishna Muthyanolla
December 1, 2022
Data obtained via RTI & RBI’s DBIE database indicates that while Gross NPAs have reduced from the high of 2017-18, write-offs have also broadly increased. Here is a look at the trend in Gross NPAs, Write-offs, New Accretion to NPAs, and actual recoveries.
The Loans or advances provided by the banks are considered assets, as the banks earn interest from them. However, the banks also carry the risk of default in loan repayment. Such loans which are overdue for a specific period are considered Non-Performing Assets (NPAs). The detailed definition of what is considered an NPA can be seen here.
NPAs are not desirable from a banking perspective. A higher volume of NPA is one of the challenges ailing the Indian Banking system. There are various factors that contribute to loans turning into NPAs. Challenges relating to irrational lending, deficiencies in monitoring, slow-down in the economy, etc. are a few of the various factors influencing the NPA situation in the country. Over the years, the Government of India has taken various steps to reduce the NPA burden including write-offs, incentives for repayment, among others.
So, what is the current NPA situation with the Indian Banking sector, and what are the recent trends? Who are the major contributors towards the NPAs?  In this two-part series on NPAs, we analyse the data to throw some light on these questions. In the first story, we look at the trends in Volume of NPAs, Write-offs and Recoveries across different types of bank groups.
Methodology: The data being analysed is obtained in response to a Right to Information (RTI) application filed with the Reserve Bank of India (RBI). The information includes – New Accretion to NPAs, Actual Recoveries and Write-offs across the different types of banks in the country.  The Bank group types include – Public Sector Banks, Private Sector Banks, Foreign Banks & Small Finance Institutions. In the story, Total Banks would refer to the cumulative sum of these 5 types of Banks. The information obtained is for the period 2014-15 to 2021-22 (as on 31 December 2021).  The Gross NPA data is obtained from RBI’s DBIE statistics.
The total write-offs for the five-year period 2016-17 to 2020-21 is around Rs. 8.8 lakh crores
As per RBI’s DBIE statistics, the Gross NPAs of all banks for the year 2020-21 is around Rs. 8.41 lakh crores. It is the continuation of the declining trend in the value of Gross NPAs for the last few years. After a peak in 2017-18, when the gross NPAs increased to 10.37 lakh crores, there has been a declining trend.
During this period, the trend in new accretion to NPAs s i.e., the newly added NPAs have seen a varying trend. After a high of Rs. 9.66 lakh crores in 2017-18, the accretion to NPAs has seen a decreasing trend. In 2020-21, there was an accretion of Rs. 4.8 lakh crores to NPAs. By the end of the 3 quarter in 2021-22, the new accretion of NPAs amount to Rs. 4.5 lakh crores. As indicated earlier, this information is obtained through an RTI filed by Factly.
In 2020-21, the value of Actual Recoveries was Rs.1.59 lakh crores. It has to be noted that the actual recoveries refer to the recoveries out of those categorized as NPAs and not the recoveries for written-off loans. The actual recoveries show a declining trend from the high of Rs. 2.23 lakh crores in 2019-20, wherein it was Rs. 2.38 lakh crores in 2018-19.  During the first three quarters of 2021-22, the recovery is around Rs. 1.46 lakh crores.
Despite a declining trend in the recovery of the loans, we have seen that that there is a fall in the gross NPAs. The write-offs by the banks can be a reason for this. In 2020-21, NPAs worth Rs.1.91 lakh crores were written off by the banks. In 2019-20, the write-offs were around Rs. 2.2 lakh crores. Overall, during the five-year period 2016-17 to 2020-21, the total value of NPA write-offs amounts to around Rs. 8.8 lakh crores. It forms a significant portion of NPAs.
However, these trends vary across the banks. Here is a look at the Banking groupwise trends in NPAs.
Around 80% of the Write-offs during five-year period 2016-17 to 2020-21 are by Public Sector Banks
The Public sector banks account for a major share of the total Gross NPAs. In 2020-21, the NPAs of Public sector banks constitute around 72% of the total, with the Private Sector Banks, Foreign Banks & Small Financial Institutions accounting for the rest.
Within the Public Sector Banks, the State Bank of India and Punjab National Bank have the highest share of gross NPAs.  The Gross NPAs of Public sector banks have had a declining trend since 2018-19. This could be because of the write-offs and decreased new accretion in these years. Although the Rs.1.35 lakh crores written-off during 2020-21 is less than the previous years, overall, a total of Rs. 7.03 lakh crores were written off by public sector banks in the five years between 2016-17 and 2020-21. This accounts for around 80% of the total write-offs during that period. State Bank of India, and the Punjab National Bank have the highest share of these write-offs.
Steady increase in the gross NPAs of Private Sector Banks
Compared to the Public Sector Banks, the Private sector banks have a lower volume of NPAs.
However, there has been an increasing trend in the NPAs accumulated by private sector banks in recent years.
The Gross NPAs of these banks in 2014-15 was Rs. 33.7 thousand crores. By 2017-18, it nearly quadrupled to Rs. 1.2 lakh crores. By 2019-20, the value of NPAs peaked to Rs. 2.05 lakh crores. There is a slight fall in 2020-21 at 2.02 lakh crores.
ICICI, IDBI, HDFC & Axis Banks are the four major banks, with the highest value of NPAs. These are also the larger private-sector banks. The increasing trend of NPAs is visible through the increased value of new accretion to NPAs. In 2014-15, it was Rs. 49.9 thousand crores, followed by a year-on-year increase until 2019-20, wherein Rs. 2.22 lakh crores NPAs were newly added.  During the three quarters of 2021-22, the new accretion of NPAs is Rs. 2.01 lakh crores, which is already higher than in 2020-21. Comparatively, the actual recoveries are lower, though they show an increasing trend. The write-offs show a year-on-year increase. The write-offs in 2020-21 were Rs. 52.75 thousand crores, the highest annual figure since 2014-15.
Increase in the Gross NPAs of Small Financial Institutions in 2020-21
Compared to the public sector banks & private banks, the volume of NPAs of Small Financial Institutions (SFIs) has been lower, with these institutions also being comparatively smaller. However, there is a developing situation with the NPAs in the SFIs. In 2020-21, the value of NPAs in these financial institutions was Rs. 11.9 thousand crores compared to only Rs.3.42 thousand crores in 2019-20. Further, the new accretion to NPAs in 2020-21 was Rs. 10.9 thousand crores. The Gross NPAs could further increase, as the new accretion to NPAs is Rs.14.9 thousand crores in just the first three quarters of 2021-22. Compared to the other banks, the trends in Foreign Banks do not have much variance over the years.
From the data, it is evident that few of the Public Sector Banks and Private sector banks account for a major share of the Gross NPAs and the amount of NPAs being written off. Since banks provide credit to various sectors of the economy, an analysis of the NPAs sector-wise could provide more insights. In the second part, we would cover the sector-wise analysis.

created: December 1, 2022


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Data: What is the trend in the disease burden of vector borne diseases in India?
Sai Krishna Muthyanolla
August 26, 2022
India traditionally has seen a high burden of vector-borne diseases such as Malaria, Dengue, Chikungunya, Japanese Encephalitis among others. While significant progress has been made in controlling some, the same is not the case with diseases like Dengue.
The outbreak of COVID-19 demonstrated how disease outbreaks impact a nation. Every sector of the nation was affected, be it the economy, tourism, people, livelihoods, and trade. It is therefore important to understand the disease lifecycle. Adequate research and budgeting coupled with infrastructure provisioning must be done to ensure such outbreaks do not become uncontrollable.
India is one of the high disease burdened countries in the world. It ranks second in the early deaths due to PM 2.5, the leading contributor to global tuberculosis cases,  3% of global malaria burden, and contributes significantly to cases of non-communicable diseases across the world. In addition to this, seasonal outbreaks like malaria, dengue, and other viral diseases have become endemic to several parts of the country. In today’s story, we look at the data regarding vector-borne diseases in India and their trend.
Malaria
Malaria is caused by Plasmodium parasites that are transferred from infected female Anopheles mosquitoes to humans through their bites. The two most dangerous parasite species, P. falciparum and P. vivax, are among those that cause malaria in humans. In African continent, P. falciparum is predominant while P. vivax is common in countries other than sub-Saharan Africa.
Globally, around 241 million malaria cases were reported in 2020, an increase from 227 million in 2019, as per the World Malaria Report 2021. Diseases due to P. Vivax decreased from 18.5 million (8%) in 2000 to 4.5 million (2%) in 2020.  India contributes to 83% of the malaria cases and 82% of malarial deaths in the Southeast Asian region. Sri Lanka and China, in this region, are declared malaria-free by the World Health Organization (WHO).
India also aims to become Malaria free by the year 2022. All of the States and Union Territories (UTs) in the country are split into three categories in accordance with the National Framework for Malaria Elimination (NFME) India, 2016–30, which was launched in February 2016 and aims to phase out malaria by the year 2027. By 2020, 15 low burden States (Category 1) are targeted for complete elimination, while the target for 11 States with a moderate disease burden (Category 2) is 2022. For ten States with a heavy load (Category 3), the target year is 2027. Two States, Mizoram with an annual parasite incidence (API) of 4.61 and Tripura (API 2.43), have high malaria incidence rates according to statistics from 2021. API is less than one in all other states. However, several districts in six States (Chhattisgarh, Jharkhand, Maharashtra, Meghalaya, Odisha, and West Bengal) do have more than one API.
Incidence of Malaria in India
India has made significant progress in controlling malaria. The annual malaria cases fell from 2.03 million in 2000 to 0.16 million in 2021. These P. falciparum (Pf) cases fell from 1.14 million in 2000 to 0.10 million in 2021. However, the share of P. falciparum cases (%) rose from 38.8% in 2000 to 63.1% in 2021. It can be said that P. falciparum remains the most dominant parasitic species in India.
The number of annual deaths due to malaria also shows a decline. It fell from 932 in 2000 to 90 in 2021. This decline is not continuous, as the period between 2006-2010 showed an increase in malarial deaths.
Declining Annual Parasite Incidence (API) and Slide Positivity Rate (SPR) of Malaria
The annual parasite incidence (API) defined as the number of new infections per year per 1000 population, has been declining constantly from 2.12 in 2001 to 0.12 in 2021. Similarly, the Slide Positivity Rate (SPR), defined as the number of laboratory-confirmed malaria cases per 100 suspected cases examined also fell from 2.31 in 2001 to 0.14 in 2021. These indicators point out the significant progress made in controlling the malarial incidence in India.
6 States account for more than 50% of all malaria cases reported from 2016 to 2021
As mentioned earlier, some states have a high incidence of malaria, and they are categorized as high and medium burdened states. From 2016 to 2021, only six states accounted for nearly half of the total malaria cases reported in India. States like Chhattisgarh, Jharkhand, Odisha, Madhya Pradesh, Maharashtra, and Gujarat accounted for more than 50% of total reported cases. Excepting Gujarat and Maharashtra, most of the eastern parts of India including the Northeastern states are highly malaria disease burdened. Incidentally, all these eastern states are home to significant tribal populations.
Dengue cases continue to be worrisome
It is a viral disease caused by the bite of the Aedes Aegypti mosquito. Usually, it occurs in two forms – Dengue fever and Dengue Haemorrhagic Fever (DHF), out of which DHF is the more severe and could be fatal. While all genders and age groups are equally affected, children are more vulnerable to death during a DHF outbreak.
Unlike malaria, the progress in controlling dengue cases in India has not been as successful. The cumulative cases in reported in India rose from 99,985 in 2015 to 2,05,243 in 2019, thereafter which it fell to 1,93,245 in 2021. The COVID-19 outbreak year 2020 saw a steep decline in the number of cases and deaths reported.
The performance across states is not uniform. Traditionally, high incidence states like West Bengal saw a decline in cases, while states like Uttar Pradesh, Punjab, Madhya Pradesh, Gujarat, Haryana, and Rajasthan saw a big spike in cases in 2021, compared to their earlier trends.
Chikungunya cases continue to be sporadic
The chikungunya virus, which belongs to the family Togaviridae and genus Alphavirus, is what causes the disease. Aedes mosquitoes, especially Aedes aegypti, are the main source of chikungunya transmission. The virus that causes it is carried by the bite of infected mosquitoes, and it is crippling but not lethal. It resembles the dengue disease but has no specific treatment.
There is no specific trend observed when one looks at the chikungunya cases over the last six years. The total number of cases kept increasing and decreasing over the years. It was 3,342 cases in 2015, which rose to 26,364 in 2016, then decreased to 9,756 in 2018, and rose to 11,888 in 2021. The percentage of confirmed cases out of the suspected cases decreased from 18.5% in 2017 to 6.9% in 2022 (provisional, as of 31 May 2022). Traditionally, seven states – Andhra Pradesh, Karnataka, Maharashtra, Madhya Pradesh, Tamil Nadu, Gujarat, and Kerala, account for more than 75% of the total cases, barring a few years. The sudden spike in 2021 is due to the increase in infection in the states of Gujarat, Karnataka, and Maharashtra in an exponential manner.
Japanese Encephalitis and AES cases fall after a rise from 2015 to 2019
Japanese Encephalitis (JE) is spread through the bites of female mosquitoes, particularly those in the Culex tritaeniorhynchus, Culex vishnui, and Culex pseudovishnui groups. It is an arbovirus that mostly affects the central nervous system. It is predominantly zoonotic, with the man serving as an unintentional host. Only farm pigs and wild birds are carriers of the Japanese encephalitis virus, and it is not humanly transmissible. JE is the most common viral encephalitis in Asia with case fatality rates ranging from 0.3% to 60%. Acute Encephalitis Syndrome (AES) also belongs to a similar kind of disease affecting the nervous system.
For the purpose of analysis, cases and deaths of both AES and JE are cumulatively taken. It is observed that from barring 2018, from 2015 to 2019, the number of cases of AES and JE rose. It was 11,584 in 2015, which increased to 17,540 in 2019.  In 2019, the number of cases fell sharply. The number of deaths due to AES and JE declined gradually from 1,584 in 2016 to 290 in 2021, except in 2019 when a slightly higher number of deaths were reported than in the previous year 2018.
A decline in Kala Azar cases in India from 2014
A parasitic protozoan of the genus Leishmania causes the slow-progressing indigenous sickness kala-azar. Leishmania donovani is the sole parasite responsible for this sickness in India. The parasite is frequently detected in bone marrow, spleen, and liver and particularly affects the reticuloendothelial system. It is endemic in the eastern Indian States of West Bengal, Bihar, Jharkhand, and Uttar Pradesh. In 1990–1991, the Government of India (GoI) began a centrally supported Kala-azar Control Programme in the endemic states out of concern for the growing Kala-azar issue in the nation. State governments covered the costs associated with implementation while the GoI provided medications, pesticides, and technical support. The National Health Policy of 2002 established a deadline of 2010 for Kala-azar eradication in India, but that deadline was later changed to 2015.
Though the target of eradicating Kala Azar by 2015 has not been achieved completely, India is on the path to achieving that target sooner. As mentioned above, it is endemic to only a few states in India. The cumulative Kala Azar cases in ten states were 9,241 in 2014, which gradually reduced to 1,276 in 2021 (provisional data), and 533 in 2022 (provisional till July). The number of deaths also fell from 11 in 2014 to 6 in 2020. However, 2021 and 2022 reported an increase in the number of deaths due to Kala Azar.
Filariasis
Several parasitic spherical, coiled, and thread-like worms from the family Filaridea are the cause of filariasis. Nematode worms such as Wuchereria bancrofti or Brugia malayi are the disease’s causative agents.  The illness, which is responsible for a considerable deal of societal shame, frequently presents as odd swelling of the legs and hydrocele. Wuchereria bancrofti, a species, is to blame for 99.4% of cases in India, while Brugia malayi is only 0.6% of the problem. In 18 states and union territories, Lymphatia filaria is a common problem. Brugian filariasis caused by Brugia malayi is only seen in six states—UP, Bihar, Andhra Pradesh, Orissa, Tamil Nadu, Kerala, and Gujarat. Filariasis is endemic in 328 districts across 20 States and Union Territories in India. Among states, Uttar Pradesh tops with 51 districts, followed by Bihar with 38 districts, Tamil Nadu, and Odisha with 20 districts, Jharkhand with 18 districts, and Maharashtra with 17 districts.  About 40% of all cases of lymphatic filariasis (LF) worldwide are caused by India.
To curb Filariasis, the National Filaria Control Programme was launched in 1955. Though initially confined to urban areas, the programme has been extended to rural areas since 1994.  Another campaign to eradicate lymphatic filariasis (ELF) was launched in June 2004. Accelerated Plan for Elimination of Lymphatic Filariasis was launched during the 10 Global Alliance Elimination of Lymphatic Filariasis on 13 June 2018. According to the WHO’s Road Map for Neglected Tropical Diseases (NTDs), the Government of India has set the goal of eradicating lymphatic filariasis (LF) by 2030.
Featured Image: Vector-borne diseases in India


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Data: What is the worth of Oil Bonds pending for repayment?
Sai Krishna Muthyanolla
April 13, 2020
The Modi led NDA government has increased the excise duty on petrol & diesel  multiple times during the last 6 years. Though there has been a substantial fall in the global crude oil price, the same benefit has not been passed onto the customers. One major reason cited for not reducing the prices is the burden of oil bonds. What is the pending burden of oil bonds? How much has the current government repaid? Here are the details.
On 13 March 2020, the Government of India increased the excise duty onpetrol and diesel by ₹3 per litre. The hike in special excise duty on petrol and diesel was by ₹ 2, taking the total to ₹10 per litre for petrol and ₹ 4 per litre for diesel.  Additionally, the road cess on both petrol and diesel was increased by ₹ 1 each from ₹ 9 per litre, taking the total to ₹ 10 per litre for both petroland diesel. While this move will help the government garner additional revenuein these bleak times, this increase comes at a time when the global crude oilprices are witnessing a sharp decline.
The opposition led by the Congress criticized the government over thishike and alleged that the government was not transferring the benefits of fallin crude oil price to the people. Rahul Gandhi took on to twitter to criticize the finance minister for the hike.
During the recent budget session of parliament, the government passedthe Finance Bill  which givesthe government the power to increase additional excise duty up to ₹18 per litreon petrol and up to ₹ 12 per litre for diesel. Since the NDA came to power, theexcise duty on petrol & diesel has been increased multiple times.
One of the major reasons cited earlier by the Bharatiya Janata Party fornot reducing the taxes is the burden of repayment of oil bonds that were issuedduring the Congress led UPA’s term.
There have been instances during the previous term of the NDA Government where claims have been made by those in the government that they repaid more than ₹1.5 Lakh crore worth oil bonds which were issued during the Manmohan Singh ledUPA government. Even in the Bharatiya Janata Party’s twitter handle, an infographic claiming that the NDA government repaid pending oilbonds worth ₹ 1.3 Lakh crore and an interest of ₹ 40,000 crores was posted inSeptember 2018.
Factly had earlier done a fact check on this claim using data available in the budgetdocuments. It was found that the NDA Government had repaid oil bonds worth ₹3,500 crores only. The Petroleum Planning and Analysis Cell (PPAC), an organization attached to Ministry of Petroleumand Natural Gas was formed replacing Oil Coordination Committee in 2012. PPAC  had also confirmed in September 2018 that the government had indeedrepaid only ₹ 3,500 crore worth oil bonds. Even in Rajya Sabha, the government stated the same as a response to aquestion.
What are oil bonds? What is its purpose?
During the UPA and even during the Vajpayee government, the governments issued oil bonds instead of paying Oil Marketing Companies (OMCs) for subsidies extended on petrol, diesel and other oil products. These oil bonds were issued as compensation to these OMCs which are like government securities which are long-dated. The maturity period can extend for a period of 10 to 20 years. In short, in order to compensate for the losses incurred when the prices of petrol and diesel are regulated, oil bonds were issued by the government.  For example, the following is a notification on oil bonds that were issued by the UPA government in 2008.
Who issued oil bonds?
Oil bonds were issued by all the governments until about 2010. Not only the UPA government but also the Atal Bihari Vajpayee led NDA government had also issued oil bonds. This is evident from the budget speech for 2002-03 of the then finance minister, Yashwant Sinha. Sinha had mentioned that the government would issue oil bonds.
What is the worth of oil bonds pending?
The details regarding pending oil bonds and the amount of interest to bepaid on the oil bonds are listed in the budget documents. In the 2014-15 receipt budget, as per annexure 6E titled ‘Special Securities Issuedto Oil Marketing Companies In Lieu Of Cash Subsidy’, pending liabilitiesrelated to oil bonds were ₹ 1,34,423 crores. That is, an amount of ₹ 1,34,423crores were the total value of pending oil bonds by the end of 2013-14.
How much has the NDA government repaid?
The NDA government came into power in May 2014. Between 2014-19, duringthe NDA regime, only two sets of bonds were due for maturity and these maturedin 2015 whose total value was ₹ 3500 crores. This was clarified by thegovernment in an answer in Rajya Sabha and also by the PPAC. Annexure 2E of receipt budget 2019-20 showed the same liabilities. When the NDA governmenttook over, the pending liabilities stood at ₹ 1,34,423 crores and by 2018-19,the same stood at ₹ 1,30,923 crores. This clearly indicates that the NDAgovernment repaid only ₹ 3,500 crores.
Between 2019-24, in the current & second term of the Modi led NDA,  oil bonds worth a total of ₹ 41,150 croresare due for maturity as per the budget document. Till date, none of the remaining oil bonds havematured. Two sets of oil bonds together worth ₹ 10,000 crores are due formaturity in 2021.
How about the interest on oil bonds?
The Government of India’s payment of interests have been listed in thedocument, ‘Interest Payments’ in the demand of grants of the Ministry of Financeunder the expenditure budget. This document lists all the interest paymentsmade by the government including the interest on special bonds to oilcompanies. Both UPA and NDA governments have been paying interest on oil bonds forthe last twenty years.
Trend in the last twenty years
In the subsequent graph, the interest paid by the different governments in the last 23 years in lieu of oil bonds has been represented. It is observed that, under UPA-I, there is a substantial increase in the interest liability because of the issuance of multiple oil bonds. Under UPA-II between 2009-14, a total of ₹ 53,136 crores have been paid as interest on oil bonds. The previous NDA government paid a total of ₹ 50,216 crores as interest in the 2014-19 period. The revised estimate for 2019-20 is ₹ 9989.96 crores and the same amount has been budgeted for interest payment in 2020-21.
Since 2015-16, there has been no change in the amount paid as interest on oil bonds as no bonds were due for maturity. This also substantiates the fact that there has been no repayment during this period, the last payment was in 2015. Both UPA-II and NDA-I have made an interest payment of more than ₹ 50,000 crores during their five-year tenures. The government also confirmed in the Rajya Sabha that there are around ₹ 1.3 Lakh crores worth oil bonds to be repaid in the coming years starting 2021.
Featured Image: Worth of Oil Bonds pending for repayment


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Data: WhatsApp Banned More Than 6.9 Crore Accounts in The Last Two Years
Sai Krishna Muthyanolla
July 27, 2023
The IT Rules of 2021, mandate big technology companies or the SSMIs to publish a monthly compliance report which includes the details of complaints from users via grievance mechanism and action taken on them, including data on any proactive action. Data from the last 24 months indicates that more than 6.9 crore accounts were banned by WhatsApp out of which 1.53 crore were proactively banned.
In the previous story, we analysed the trends in the grievances received by SSMIs including WhatsApp, Twitter, Koo and Google, as per data provided in their monthly compliance reports.
In this second part, we review the trends in grievances of other SSMIs – Meta, ShareChat & Snapchat. We will also analyse other information published in these grievance reports including – ban appeals, proactive action along with platform specific reports submitted by few these SSMIs.
The data for this story is sourced from datasets available on Dataful compiled from the compliance reports published by SSMIs.
Declining trends of Grievances resolved through tools provided by Facebook
Compliance reports published by Meta includes data for Facebook as well as Instagram.
Facebook: During the period June 2021 to May 2023, Facebook received around 48.9 thousand grievance reports through their Indian Grievances mechanism. In the recent months, there is an exponential increase in the number of grievance reports received. In March 2023, more than 7 thousand grievance reports were received, which was more than four times the previous month. This number more than doubled in May 2023 with 16.9 thousand grievance reports.
While the number of grievance reports has increased, there is fall in the proportion of these reports being resolved. One of the means of resolving the grievances reported are the tools provided to the users by the platform.  These tools include pre-established channels to report content for specific violations, self-remediation flows where they can download their data, avenues to address account hacked issues etc. While the number of such grievances resolved have increased, their proportion comparted to the reports received is on a decline. In May 2023, 14% of the grievances reported were resolved through automated tools. During the initial months it was around 75%-80% on average.
Apart from the grievances resolved via tools provided by Facebook, there are certain grievances which needs specialized review by the platform itself.  As of May 2023, around 63% of the grievances reported needed specialised review. Out of these 30.7 thousand reports, only about 6.7 thousand were actioned. There are various reasons as mentioned in the image below for the reports not actioned even after specialised review.
A major portion of the grievances received on Facebook are about “Inappropriate or Abusive Content” and “Bullying or Harassment”
Instagram: Nearly 1.17 lakh grievance reports were received by Instagram, with a proportionally higher number of reports since December 2022. The highest number of reports received in a month was in January 2023. After a decline in the ensuing months, the number of grievance reports increased to 16.2 thousand in May 2023. Even in the case of Instagram, “Inappropriate or Abusive Content” and “Bullying or Harassment” are the main reasons for raising grievances.
Akin to Facebook, Instagram also provides users with tools to resolve their grievances. While there is an increase in the number of reports resolved through the tools provided, there is a general decline in the proportion of grievances resolved compared to the ones received.  Around 68% of the grievances reported i.e., 79.8 thousand reports required specialised review by Instagram. Of these, 29.1 thousand were actioned and the rest not actioned.
It ought to be noted that both in case of Facebook and Instagram, irrespective of the grievance reports being actioned (via tools & specialised review) or not actioned, nearly 100% of the reports were responded to.
On Snapchat, most reports received were of Harassment while highest actioned was for Sexually explicit content
Snapchat is an Instant messaging app. As per the data provided in their compliance reports, about 28.8 lakh content and accounts were reported between the period June 2021 and May 2023. The monthly report of Snapshot does not provide separate numbers for content reported and accounts reported.  However, in case of action taken, it is reported separately. During this period, a total of 4.62 lakh content pieces is enforced by Snapchat. The report also does not define what Snapchat means as enforced. Further, 3.41 lakh unique accounts were enforced by Snapchat.
Harassment and Bullying is the topmost category under which grievances were reported by the users. This is followed by Impersonation and Sexually Explicit Content. These three categories account for 75% of the content and accounts reported on the platform. In case of action taken, Sexually Explicit Content is the category where most reports were enforced. This category accounts for 59% of the content enforced and 52% of the unique accounts enforced by Snapchat.
ShareChat: ShareChat is an Indian Social networking platform which allows user-generated content creation on its platform. It reported that a total of 11.9 crore user complaints were received between June 2021 and May 2023.  Most of the complaints received were related to abusive language.
6.94 crores accounts banned by WhatsApp
The compliance reports updated by SSMIs also include information on the accounts that were banned. WhatsApp, Snapchat, ShareChat and Twitter are the 4 SSMIs that have updated this information.
As per the data provided by WhatsApp, a total of 6.94 crore accounts were banned during this period. The reasons for banning an account is not specified by WhatsApp. Data indicates around 3-fold increase in the number accounts that were banned in May 2023 compared to that of May-June 2022. In May 2023, around 64 lakh accounts were banned by WhatsApp.
In the case of Snapchat, there is no specific trend. Nearly 27 thousand Snapchat accounts were deleted during July 2021 to May 2023. As per data provided by Twitter, around 1.4 thousand accounts were suspended based on the grievances received. Out of these, suspension of 177 accounts were overturned.
In case of ShareChat, around 39 lakh accounts were banned. Out of these, 13.56 lakh accounts were banned for a period of 360 days. Around 2.42 lakh accounts were banned for a period of 30 days. Banning of editing profile remains the highest type of ban imposed by ShareChat with 11.63 lakh bans of such nature.
Spam, Graphic content, Adult Nudity and Sexual Activity are the categories under which content was proactively actioned on Meta Platforms
Apart from the user complaints, SSMIs have also taken proactive action on the content and activity of the users. Collated information on proactive action of SSMIs can be found on Dataful.
Here is a snapshot of the major trends relating to proactive action.


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Data: Wheat stock with FCI just above the minimum level at the beginning of July 2022 while Rice stock is better placed
Sai Krishna Muthyanolla
September 19, 2022
The FCI is mandated to procure & stock food grains (primarily wheat & rice) to ensure food security & implement the various schemes of the government. As per data on the FCI portal, the wheat stick at the beginning of July 2022 was just above the minimum required level while the rice stock was better placed.
India ranks next only to China in the production of Wheat and Rice in the world. However, the standing differs when the question of the exports of these food grains is concerned. India is the largest exporter of Rice in the world but is only a marginal player as far as the export of wheat is concerned.
Off late, India is making efforts to improve its position as a supplier of wheat in the global market. As both Russia & Ukraine are among the top wheat exporting countries, their ongoing conflict has created an international demand for wheat supply. However, amidst estimates of lower production of wheat, there has been a change in India’s stand on restricting wheat exports. Factly’s detailed story on the trends in export of Rice & Wheat can be read here. Controlling the rising wheat prices and ensuring food security in the country are cited among the reasons to impose an export ban despite the increase in international demand.
All these developments have brought to focus the availability of food grain stocks in the country. The Food Corporation of India (FCI) is mandated to maintain satisfactory levels of food grain stocks to ensure food security. The increasing buffer stocks with FCI have traditionally been a cause of concern because of storage & other concerns. Factly’s story on the increasing buffer stocks can be read here. Amidst reports of reduced estimates of wheat production, we look at the stock position of rice & wheat with FCI and the trend over the years.
Wheat Stocks in Central Pool during 2022 comparatively lower during same period in previous years.
The FCI maintains information on the food grain stocks in the Central Pool at the beginning of the month. The information includes the stocks for Rice, Wheat, Un-milled Paddy, and Coarse grains.  The stocks with FCI include ‘Operational Stocks’ and ‘Buffer (Reserve) Stocks’. Operational Stocks are to meet the monthly demand under the ‘Public Distribution System’ (PDS) to ensure Food security. The buffer stocks are maintained to meet any exigencies or to cover any shortfall in procurement.  Here is a look at the trends in the stock position of Wheat and Rice.
Wheat: At the beginning of the current month i.e., September 2022, the volume of wheat stock with the Central pool was 248.2 Lakh Metric Tonnes (LMT). It is less than 50% of the stock during the same time in 2021, which was 517.9 LMT. It is only in 2016 that the wheat stock was lower at the beginning of September than it is in 2022 which was a year of low stock.
The trend in a shortfall in the volume of wheat stock at the beginning of the month in 2022 compared to previous years, is observed in all of 2022.  Since January, there has been a month-month shortfall in 2022 compared to 2021. Especially, the difference is higher since May 2022. This coincides with the Rabi Marketing Season for the procurement of wheat.
Rice: Compared to the wheat Stocks, the stocks of rice had a lesser shortfall in 2022. During most of the year, the stocks in 2022 were higher than the respective same months in the previous years.  The shortfall is only in the recent months of July & September. However, unlike in the case of Wheat, the rice stocks are higher than that of the years prior to 2021. It ought to be seen if the recent trend continues in the coming months.
Stock of Wheat at the beginning of current quarter just above the minimum stock levels.
As the data indicates, the stocks of wheat in the Central Pool in 2022 are much lower than the stock levels in the previous year. The stock position is dependent on various factors including the volume procured and the extent of the stocks distributed. The trends in the stock fluctuate based on these factors. However, ensuring the minimum stocks is necessary to meet the demand for PDS & other schemes. The government of India notifies the minimum stocks that need to be maintained in the Central Pool at the beginning of each quarter. This factors in the procurement season, the distribution, etc. The current food grain stocking norms are in effect from 01 July 2017.
As per the stocking norms, at the beginning of the current quarter i.e., 01 July 2022, FCI is required to maintain a minimum of 245.8 LMT as Operational Stock of wheat and another 30 Lakh MT as a reserve. Hence, the stock level of wheat as of 01 July is ought to be 275.8 LMT. As per the monthly stock position, the total stock of wheat in the Central pool at the beginning of July 2022 was 285.1 LMT, marginally more than the minimum level. As per the stocking norms, wheat stocks at the beginning of this quarter are supposed to be the highest since it follows the procurement season.
At the beginning of the next quarter i.e., on 01 October, the minimum stock needs to be 205.2 LMT, including both operational and reserve stocks. As highlighted earlier, the stock levels of wheat at the beginning of September 2022 were 248.2 Lakh MT, which would reduce further after the take-off for PDS & other schemes during the month.
In contrast, the rice stocks are better placed. At the beginning of the quarter, the minimum required stocks of rice are 115.4 LMT in operational stock and another 20 LMT as buffer stock. The actual stock level of rice as of 01 July 2022 was 317.1 LMT.  By the beginning of next quarter i.e., as of 01 October 2022, the Rice stock is required to be at 102.4 LMT. Despite the decline compared to the previous year, the stock levels of rice at the beginning of 01 September were at 244.6 LMT.
Reduction in the procurement of Wheat during 2022
Procurement of food grains and their take-off i.e., distribution are the two influencing factors of the stock position. The higher buffer stocks of rice & wheat built up over the years to a large extent are due to the higher procurement of these food grains by FCI.
As the data indicates, while the trends in the stock position of Rice relatively remained the same, there is a fall in the stocks of wheat. This can be attributed to the lower procurement of wheat in 2022. The procurement of Wheat is part of the Rabi Marketing Season (RMS) which Runs from April-March.
For RMS 2022-23, a total of 187.93 LMT of wheat is procured as per the latest data on the FCI portal. This is only about 43% of the procurement of wheat in the previous season. Since 2010-11, this is the least procurement for wheat. The fall in procurement is observed across all the major states.
Punjab from where the highest volume is procured, only 96.5 LMT was procured in the current season compared to 132.2 LMT in the previous season. In Haryana, it more than halved to 41.9 LMT compared to 84.9 LMT in the previous season. In Madhya Pradesh, which traditionally has the high procurement along with Punjab, the procurement of wheat was 46 LMT compared to 128.2 LMT in the previous season. In Uttar Pradesh, only 3.4 LMT was procured in 2022-23, whereas it was 56.4 LMT in the previous season. In an answer provided in the Lok Sabha in August 2022, the government acknowledged the fall in procurement and stated that procurement of wheat has fallen due to higher purchase of wheat by traders as the market price of wheat had shot up due to the prevailing international geopolitical situation.
On the other hand, there has not been much variance in the procurement of Paddy and Rice, which could be a reason for no major change in the stock position of Rice.  It ought also to be noted that the production of wheat in the current year is lower. As per the latest 4th Advance Estimates, the production of Wheat for 2021-22 is estimated at 106.84 million tonnes compared to the 110 million tonnes target. In the previous year i.e., 2020-21, the production of wheat was 109.59 million tonnes.
Apart from NFSA, an additional 346 LMT of Wheat lifted under PMGKAY
There are various Schemes through which the Food Grains are issued from the Central Pool. A major portion of this is for the implementation of NFSA (National Food Security Act). During 2021-22, a total of 217.52 LMT of Wheat and around 273.59 LMT of Rice were distributed under NFSA. In the previous year, it was 221.5 LMT of wheat and 302.4 LMT of rice respectively. Allocation is also made for other welfare schemes.
With the onset of COVID-19, the Government of India announced Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY), which aimed at providing Food Security.  The scheme was initially announced for the period April-June of 2020 and was further extended five times with the latest extension of PMGKAY-6 being for the period April-September of 2022.
During the 6 phases of PMGKAY, around 346 LMT of wheat and 542.3 LMT of Rice were distributed. During this period, 501.7 LMT of wheat was distributed under the regular NFSA scheme and in the case of rice, it was 678.5 LMT. The additional wheat lifted under PMGKAY might have had a bearing on the buffer wheat stocks. However, lower production and lower procurement of wheat have compounded the impact on wheat stocks, the impact of which is not seen in the case of rice.
Featured Image: Food grain stocks

created: September 19, 2022


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Data: Where are we on Maternal & Child Mortality indicators?
Sai Krishna Muthyanolla
March 6, 2021
Over many years, India has made considerable progress on many of the maternal & child mortality indicators. However, we are still far away from achieving the targets under the UN SDGs. Data indicates that while some states are already achieved the targets, few other states continue to bring down India’s progress.
The National Health Mission (NHM) was launched by the central government in 2013 subsuming the National Rural Health Mission and the National Urban Health Mission. The objective of the mission is to strengthen the healthcare systems in the country. Under the scheme, the central government provides technical and financial support to the States/UTs for the same on the basis of proposals submitted by them. Under the National Health Mission, targets have been set in alignment with the targets of the National Health Policy 2017 (NHP) and Sustainable Development Goals (SDG-3).
Investing in the health of women and children is a vital part of the right to health. One of the core areas the NHM focuses on is Reproductive and Child Health. For this, the Government of India is implementing a Reproductive, Maternal, Newborn Child plus Adolescent Health (RMNCH+A) strategy to improve ‘Maternal and Child health’ outcomes such as morbidity and mortality.
In this story, we look at the progress States have made with respect to four key mortality indicators of reproductive and maternal health, viz. Maternal Mortality Ratio (MMR), Infant Mortality Rate (IMR), Under 5 Mortality Rate (U5MR), and Neo-natal Mortality Rate (NMR). Data for this story has been compiled from the Sample Registration System survey.
MMR has dropped from 556 in the 1990s to 113 in 2016-18 period
Maternal Mortality Ratio is defined as the proportion of maternal deaths per one lakh live births. As maternal deaths are considered a rare event, the estimates have been calculated by pooling in the data for three years.
In 1990, India’s MMR was as high as 556 meaning 556 women died during childbirth for every lakh live births. Approximately, 1.38 lakh women died every year due to complications related to pregnancy and childbirth back then.  India has made significant progress in reducing MMR in recent years. MMR has dropped from 130 in 2014-16, to 122 in 2015-17, and 113 in 2016-18. As per targets set under SDG-3, the United Nations aims to bring down the global MMR to less than 70 deaths per lakh live births by 2030. As per NHP 2017, the target for MMR is 100 per lakh live births by 2020. This clearly indicates that India has not achieved the target and still has quite some distance to cover to achieve both the targets under NHP as well as SDG.
MMR in Assam is 215, three times the target set by UN for 2030
MMR across states varies from a high of 215 in Assam to a low of 43 in Kerala. State-wise data indicates that only the southern states of Andhra Pradesh, Telangana, Kerala, and Tamil Nadu, and Maharashtra have already achieved the target under SDG-3 of less than 70 deaths per lakh live births in 2016-18. Tamil Nadu, Kerala, and Maharashtra have had an MMR below 70 since 2014-16.
On the other side, the MMR in Assam was as high as 237 in 2014-16 and has dropped to 215 in 2016-18. However, it is still almost twice the national MMR. Meanwhile, in Uttar Pradesh, the MMR increased from 201 in 2014-16 to 216 in 2015-17 and has dropped below 200 for the first time in 2016-18. Uttarakhand which had an MMR of 201 and Jharkhand 165 in 2014-16, have reported MMR below 100 in 2016-18. While most states have brought down the MMR during this period, Punjab has reported an increase from 122 to 129.
India’s IMR has declined over the years
Infant Mortality Rate is defined as infant deaths (less than one year) per thousand live births. India’s IMR has decreased considerably from 129 per 1000 live births in 1971 to 110 in 1981 and from 80 in 1991 to 32 in 2018.
Kerala’s IMR is 7 while MP has reported 48
Madhya Pradesh has the highest IMR of 48 deaths per thousand live births in 2018. The state’s IMR was 47 in 2016 and 2017. Other states which have witnessed an increase in the IMR during the three years are Chhattisgarh (38 in 2017 to 41 in 2018) and Jharkhand (29 in 2016 to 30 in 2018). Meanwhile, Kerala is the only state which has a single-digit IMR (7), the lowest in the country. Delhi’s IMR has dropped from 18 to 13 in the 3 years between 2016 & 2018.  Maharashtra’s IMR has remained stagnant at 19 in all these three years.
The government’s target under NHM is to reduce IMR from 37 deaths to 26 deaths per 1000 live births. It is observed that only 9 states- Karnataka, Jammu & Kashmir, West Bengal, Punjab, Himachal Pradesh, Maharashtra, Tamil Nadu, Delhi, and Kerala have achieved the target in 2018.
11 states have achieved NHP’s 2020 NMR target
Neonatal Mortality Rate (NMR) refers to the death of a live-born baby within the first 28 days of life. NMR is calculated as the number of infants that have died per thousand live births. The United Nation’s SDG-3 target is to reduce neonatal mortality to at least as low as 12 deaths per 1000 live births by 2030. That is, NMR should be below 12 by 2030. The NHP’s target is to bring NMR down to 20 by 2020.
India’s NMR dropped from 24 in 2016 to 23 in 2018 and ranges from 14 in urban areas to 27 in rural areas. This is almost twice the NMR target the UN SDGs set for 2030. In 2018, 11 states had already achieved the NMR target set by the NHP of 2017. These are Gujarat, Telangana, Jammu & Kashmir, Karnataka, West Bengal, Himachal Pradesh, Maharashtra, Punjab, Delhi, Tamil Nadu, and Kerala. Kerala has reported the lowest NMR of 5 while the NMR of Madhya Pradesh was the highest at 35, in 2018.
NMR has increased in MP, UP, and Chhattisgarh
Unlike the trend in most states, Madhya Pradesh has reported an increase in NMR in the 3 years between 2016 & 2018. Similarly, Uttar Pradesh and Chhattisgarh, which have the second and fourth highest NMR in India have also reported an increase during this period. Punjab and Maharashtra have maintained NMR at 13 between 2016 and 2018. Uttarakhand has shown the most significant improvement in NMR in the three years- from 30 to 22 deaths per 1000 live births.
India’s U5MR has also declined but varies across states
U5MR is the probability per 1,000 births that a new-born baby will die before reaching age five, if subject to current age-specific mortality rates. In simpler terms, U5MR is defined as the number of deaths of children under 5 years of age in a given year per 1,000 live births in that year.
India’s U5MR was 39 in 2016, which dropped to 37 in 2017, and stands at 36 in 2018. Despite the decline, India’s U5MR continues to be significantly higher than the UN’s SDG 3 target to keep it at least as low as 25 deaths per 1000 live births by 2030. The NHP’s 2020 target for U5MR is 32.
Only 7 states have managed to attain the SDG target in 2018 itself. These are Himachal Pradesh, Jammu & Kashmir, Punjab, Maharashtra, Tamil Nadu, Delhi, and Kerala. Like in the case of other mortality indicators, Kerala has also reported the least U5MR of 10. Madhya Pradesh has reported an increase of U5MR to 56 in 2018 and continues to record the highest U5MR in the country. Jharkhand and Maharashtra have also reported a marginal increase in the U5MR in the last three years. A total of 11 states have achieved the NHP’s 2020 U5MR target of 32 per 1000 live births.
India has made progress, but still far from achieving targets under SDG
The four mortality indicators discussed above are indirect indicators about the availability and access to health facilities. They also provide an understanding of other social indicators such as education, nutrition, and immunization. Most of these deaths referred to under these indicators are preventable provided there is necessary intervention at the right time.
On the whole, what is evident from the above data is that India has made considerable progress in all these indicators. However, we are still far from achieving the UN’s SDG targets. Even the NHP’s targets which are more realizable have not been achieved by India and the majority of the states. Across indicators, it is seen that certain states like Kerala, Delhi, and Tamil Nadu are performing much better than the states like UP, MP, and Jharkhand. These trends call for a more targeted approach in states where the indicators are still quite high. The progress made by many states may be short-lived since the pandemic has curtailed the provision of many health facilities and affected routine health services. The government must ensure the availability of these facilities alongside the vaccination drive for COVID-19.


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Where does India stand in ‘Private Health Expenditure’ compared to other countries?
Sai Krishna Muthyanolla
May 28, 2021
The COVID-19 pandemic has highlighted the weaknesses in the public healthcare system in India. The share of ‘private health expenditure’ out of the total health expenditure has been traditionally high in India. But how does it compare with other countries?
The second wave of the COVID-19 pandemic in India is deadlier than the first wave and overwhelmed the country’s healthcare systems. Shortage of oxygen cylinders, drugs, ICU beds, vaccines, and even medical practitioners was visible across the country. The pandemic exposed the deep underlying problems in the Indian healthcare system. In an earlier story, it was observed that India lagged behind many other countries in terms of its expenditure on health as a share of GDP. In 2018, as per figures of the World Bank, India’s current expenditure on healthcare accounted for 3.5% of the GDP.
Nearly three-fourths of India’s health expenditure is through private funding
India’s public spending on healthcare, that is, the money spent by the government, constituted little less than 27% of the current health expenditure in the country in 2018 and domestic private health expenditure constituted more than 72% of India’s current health expenditure as per the figures of the World Bank.  Private expenditure includes expenditure by households (out-of-pocket expenditure), corporations, and non-profit organizations. This may be prepaid to voluntary health insurance or paid directly to healthcare institutions. It is evident that private expenditure dominates the healthcare expenditure in India, which means that the people bear the maximum cost of their healthcare.
Domestic private health expenditure per capita refers to average current health expenditures funded from domestic private sources spent per person in the country. In order to make the comparison across countries uniform (so as to get the global perspective), per capita, private health expenditures are converted to a common currency (US dollar) and adjusted to take account of the different purchasing power of the national currencies. Current private expenditure on health per capita expressed in international dollars at purchasing power parity (PPP) from the World Bank database is used in this story. The latest data available is from the year 2018.
India’s private expenditure has nearly doubled since 2008
India’s domestic private health expenditure per capita in PPP terms has almost doubled from $101.8 in 2008 to $199.1 in 2018.  On average, there has been an annual growth of $9.7 in private health expenditure. While the growth was gradual in other years, there was a sudden increase of nearly $35 in the year 2013.
To understand India’s position vis-à-vis other nations, we compared the per capita expenditure among developed countries like US, UK, Australia, Denmark, and Sweden (which have a high per capita national income), Indonesia and Vietnam from Southeast Asia, BRICS nations, and India’s neighbours – Nepal, Bangladesh, and Pakistan.
India’s per capita private expenditure was higher than its neighbours
India’s private per capita expenditure in 2018 was higher than that in Nepal, Pakistan, Bangladesh, and Indonesia. The private per capita expenditure in the US was 26 times that of India, and in Australia, it was 7.7 times. UK and Denmark had an expenditure of more than $900 per capita while Brazil and Sweden had more than $800 per capita. Russia’s private health expenditure was more than $600 while South Africa’s was close to $500. China’s expenditure was more than double that of India. Among the 15 countries we compared, Bangladesh had the least private health expenditure at $84.
The US which had the highest per capita national income also recorded the highest private health expenditure per capita. Barring the Nordic countries- Sweden and Denmark, and China, Brazil, the general trend is that the private health expenditure increased with the national income.
It has to be noted that the per capita ‘Gross National Income’ (GNI) is different for each of these countries. A comparison of private health expenditure with per capita GNI indicates that in 2018, a person in the US spent 8.26% of per capita GNI on health while it was around 3.03% in India. This was least in the Nordic countries (around 1.5%).
Share of private health expenditure in India & Bangladesh among the top 12 in the world
The trend in the share of current health expenditures funded from domestic private sources has been compared for the 15 countries. It is seen that in 2018, Bangladesh and India were among the top 12 countries in the world with the most share of private expenditure in healthcare. Among the 15 countries considered here, Bangladesh had the highest share with 76% of health expenditure covered through private sources followed by India with 72%. Nepal and Pakistan too reported more than 60% of the total expenditure covered through private sources.  On the other hand, in Denmark, private expenditure was just around 16% of the total health expenditure while in Sweden, it was below 15%.
Trends since 2008 reveals that share of private expenditure in healthcare has remained consistent in Denmark with around 16% while in Sweden, it has dropped from 17% to 15%. In India and Bangladesh, private health expenditure was always more than 70% of the total health expenditure. Meanwhile, in Pakistan, China, Vietnam, and Indonesia, the share of private expenditure on healthcare declined over the years. Even in the US and South Africa, the share of private expenditure on health decreased over the years. However, the decline is marginal in these countries and not as apparent as in the case of the developing Asian countries. In Russia, UK, Brazil, and Australia, the share of private health expenditure increased marginally between 2008 & 2018.
Health system in US is mix of public and private
In the USA where the per capita private health expenditure is the highest, the health system is a mix of public and private insurers and health care providers. The federal government in the US funds the national Medicare program for adults aged 65 and above. For persons with disabilities as well as for veterans and low-income persons, there are programs such as Medicaid and the Children’s Health Insurance Program funded by the government. Private insurance which accounts for the bulk of health insurance in the country is provided by employers or funded by individuals from their own earnings.
In Sweden and Denmark, majority of the cost is borne by government
In Sweden, the bulk of health and medical costs are paid for by regional and municipal governments and contributions from the national government while patient fees cover only a small percentage of costs. Most of it is borne from the taxes paid by residents. Meanwhile, in Denmark, the financing is majorly from general proportional income tax for the central budget and proportional income tax at the local level. Out of pocket expenditure is mainly for paying for medicines, dental services, physiotherapy, and glasses. A significant proportion of the population is covered by some form of private health insurance (approximately 40% by complementary private insurance and 35% by duplicate private insurance). Spending through voluntary health insurance amounts to less than 3% of all health spending. Major government spending in these countries explains why the private expenditure is low in these two countries.
India’s out-of-pocket expenditure is very high, pushing many to poverty
In India, the private sector plays a key role in healthcare since the public healthcare system does not cater to all the needs. Not just in metros and big cities, private healthcare plays a significant role in tier I and tier-II cities. Hence, it is of no surprise that private expenditure accounts for a lion’s share of health expenditure in India, meaning a high share of out-of-pocket expenditure.
The high out-of-pocket expenditure (OOPE) is a major contributor to poverty in the country, according to the Economic Survey. The survey suggests an increase in public spending from 1% to 2.5-3% of GDP, as envisaged in the National Health Policy 2017, so as to decrease the OOPE from 65% to 30% of overall healthcare spend. Increasing public health expenditure is critical for an equitable, affordable, and the accountable healthcare system. According to the NCRB, 17.1% of the suicides in 2019 were due to illnesses, and one of the reasons could be the inability to afford treatment.
A NITI Aayog report from 2017 observed that low-income states with low revenue capacities were spending much lower on health-related services. India also lags behind in the targets with respect to Sustainable Development Goal No.3 which aims to ensure healthy lives and promote well-being for all ages. The COVID-19 pandemic has exposed the weaknesses in the public healthcare system and has highlighted the need for increased public spending on health so as to be better prepared for the future.
Featured Image: Private Health Expenditure


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Data: Which State has a better Fish Production ratio corresponding to the Central Funds transfer?
Sai Krishna Muthyanolla
February 19, 2021
This story is second in the series on centre’s transfer of funds to states under various fisheries related schemes. The data used in the story is from the RTI response we received from the Ministry of Finance. We take a look at the transfer under various schemes, state-wise transfers and the states that have a better fish production ratio corresponding to the central funds transfer.
In the earlier story, we explored the data related to assistance provided by the Centre to states for various fisheries-related schemes and analysed the trends over the years.  In this story, we explore these trends further in detail and analyse any impact they might have had on fish production in these states.
Prior to the Integration, Scheme for Welfare of Fishermen accounted for 30% of the transfer to States
As highlighted in the earlier story, since 2017-18, a new umbrella scheme i.e., Blue Revolution: Integrated Development & Management of Fisheries was introduced, which was restructured as a merger of various ongoing fisheries-related schemes.
According to the data that we received from the Ministry of Finance through RTI, the Centre transferred funds to the states under the below four schemes prior to the implementation of the integrated scheme of ‘Blue Revolution’.
We have also highlighted in the earlier story that all the transfers to the states made in 2016-17 were under ‘Inland Fisheries’. The review of the available data for various schemes since 2014-15, prior to integration is as follows.
Decrease in transfer of funds to Tamil Nadu & Karnataka under Integrated Scheme with an increase in transfers to other States
During the first year of implementation of the new Integrated Scheme (2017-18), Tamil Nadu received the highest amount with Rs. 113.43 crores, in continuation of the trend, observed in earlier years where the state received the most funds through various schemes.  However, there has been a decline in the transfer of funds to Tamil Nadu since then.
Karnataka & Maharashtra have seen a varying trend, but their position among the states receiving the most funds fell in recent years. On the contrary, Kerala has seen an increase in the transfers received under the new integrated scheme, where-in transfers they increased from Rs. 8.12 crores in 2017-18 to Rs. 93.57 crores in 2019-20. Another state, which has a year-on-year increase, albeit with a lesser amount is Madhya Pradesh.
Since the implementation of the new scheme, various states have received higher transfers during various years.
By bringing a greater number of states into the funding fold & increased funding to states, the Integrated scheme looks like taking a more holistic approach at the national level at least in the distribution of the central funds. However, information on the specific projects being undertaken under these schemes would shed light on the utilization and outcome of these transfers.
The reduction in transfers for states like Tamil Nadu, Karnataka, and others does raise questions on the rationale of the funding decisions since these states have traditionally received more funds. This is especially important considering the fact that the ‘National Scheme for Welfare of Fishermen’ was one of the schemes under which these states received a higher share of funds prior to the launch of the Integrated scheme.
Tamil Nadu has lower production in spite of higher fund transfers, while Odisha has shown an increase in production in line with transfers
The goal of the various central schemes related to fisheries is to increase the fish production of the country. One of the stated objectives of the Integrated scheme of ‘Blue Revolution’ is to increase the overall fish production.
Based on the data regarding the transfers made under various schemes, we have analysed the impact of these transfers by taking into consideration the overall fish production of the respective states. For this analysis, we have relied on theHandbook on Fisheries Statistics-2018’, which is the latest available handbook. This limits our analysis to exclude 2018-19 & 2019-20, i.e., 2 out of the 3 years since the integrated scheme has come into effect.
It has to be noted that apart from the Central transfers, there might be many other factors influencing the production – existing infrastructure, state-level schemes & initiatives, availability of water resources, etc. While this method might not be foolproof, it is aimed at ascertaining any impact of the central fund transfers on fish production in states.
We have considered the metric of ‘Tons per Thousand rupees’ for this analysis. This implies – Number of Tons of fish production per every Thousand rupees being transferred under various schemes.
With multiple schemes being integrated into a single integrated scheme in 2017-18, and increased transfers to various states since 2017-18, the trends post 2017-18 would offer better insights on the impact of the central funds’ transfer on fish production. This can however be ascertained only after the fish production data is released up to 2020-21.
Featured Image: Fish Production

created: February 19, 2021