Dataset Information

Public expenditure on Non-Communicable Diseases & Injuries in India: A budget-based analysis.

ABSTRACT:

Background

Resource allocation decisions for disease categories can be informed by proper estimates of the magnitude and distribution of total spending. In the backdrop of a high burden of Non-Communicable Diseases and Injuries (NCDI) in India, and a paucity of estimates on government spending on NCDI, this paper attempts to analyse public sector expenditure on NCDI spending in India.

Methods

Various recent budget documents of the Centre and States/Union Territories have been used to extract expenditure on NCDI. The aggregates thus arrived at have been analysed to estimate aggregate and state level per capita spending. State level spending have been compared against disease burden using DALYs. Patterns of spending on NCDI across states were also analysed together with state level poverty to observe possible patterns.

Findings

The total spending on NCDI by the government is low at less than 0.5% of GDP. NCDI spending is little more than one-fourth of total health spending of the country and most spending takes place at the state level (80%). The Ministry of Health and Family Welfare's share in Central spending on NCDI is around 65%, and currently it spends 20% of its total health spending on NCDI. The gap between spending and DALYs is the most for the economically vulnerable states. Also, the states with high poverty levels also have low per capita expenditure on NCDI.

Interpretation

India does not depend on donor funding for health. It will have to step up domestic funding to address the increasing disease burden of NCDIs and to reduce the high out-of-pocket expenditure on NCDI. Policies on NCDI need to focus on UHC, service integration and personnel gaps.

SUBMITTER: Gupta I

PROVIDER: S-EPMC6742225 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Public expenditure on Non-Communicable Diseases & Injuries in India: A budget-based analysis.

Gupta Indrani I Ranjan Avantika A

PloS one 20190912 9

<h4>Background</h4>Resource allocation decisions for disease categories can be informed by proper estimates of the magnitude and distribution of total spending. In the backdrop of a high burden of Non-Communicable Diseases and Injuries (NCDI) in India, and a paucity of estimates on government spending on NCDI, this paper attempts to analyse public sector expenditure on NCDI spending in India.<h4>Methods</h4>Various recent budget documents of the Centre and States/Union Territories have been used ...[more]

PMID: 31513623

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Project description:Chronic non-communicable diseases (NCDs), such as diabetes and cardiovascular diseases, have reached epidemic proportions worldwide. Health systems, especially those in low- and middle-income countries, such as India, struggle to deliver quality chronic care. A reorganization of healthcare service delivery is needed to strengthen care for chronic conditions. In this study, we evaluated the implementation of a package of tailored interventions to reorganize care, which were identified following a detailed analysis of gaps in delivering quality NCD care at the primary care level in India. Interventions included a redesign of the workflow at primary care clinics, a redistribution of tasks, the introduction of patient information records and the involvement of community health workers in the follow-up of patients with NCDs. An experimental case study design was chosen to study the implementation of the quality improvement measures. Three public primary care facilities in rural South India were selected. Qualitative methods were used to gain an in-depth understanding of the implementation process and outcomes of implementation. Observations, field notes and semi-structured interviews with staff at these facilities (n = 15) were thematically analysed to identify contextual factors that influenced implementation. Only one of the primary health centres implemented all components of the intervention by the end of 9 months. The main barriers to implementation were hierarchical arrangements that inhibited team-based care, the amount of time required for counselling and staff transfers. Team cohesion, additional staff and staff motivation seem to have facilitated implementation. This quality improvement research highlights the importance of building relational leadership to enable team-based care at primary care clinics in India. Redesigned organization of care and task redistribution is important solutions to deliver quality chronic care. However, implementing these will require capacity building of local primary care teams.

Project description:BackgroundExamining the distribution of the burden of different communicable and non-communicable diseases and injuries worldwide can present proper evidence to global policymakers to deal with health inequality. The present study aimed to determine socioeconomic inequality in the burden of 25 groups of diseases between countries around the world in 2019.MethodsIn the current study data according to 204 countries in the world was gathered from the Human Development Report and the Global Burden of Diseases study. Variables referring to incidence, prevalence, years of life lost (YLL), years lived with disability (YLD) and disability adjusted life years (DALY) resulting by 25 groups of diseases and injuries also human development index was applied for the analysis. For measurement of socioeconomic inequality, concentration index (CI) and curve was applied. CI is considered as one of the popular measures for inequality measurement. It ranges from - 1 to + 1. A positive value implies that a variable is concentrated among the higher socioeconomic status population and vice versa.ResultsThe findings showed that CI of the incidence, prevalence, YLL, YLD and DALY for all causes were - 0.0255, - 0.0035, - 0.1773, 0.0718 and - 0.0973, respectively. CI for total Communicable, Maternal, Neonatal, and Nutritional Diseases (CMNNDs) incidence, prevalence, YLL, YLD and DALY were estimated as - 0.0495, - 0.1355, - 0.5585, - 0.2801 and - 0.5203, respectively. Moreover, estimates indicated that CIs of incidence, prevalence, YLL, YLD and DALY for Non-Communicable Diseases (NCDs) were 0.1488, 0.1218, 0.1552, 0.1847 and 0.1669, respectively. Regarding injuries, the CIs of incidence, prevalence, YLL, YLD and DALY were determined as 0.0212, 0.1364, - 0.1605, 0.1146 and 0.3316, respectively. In the CMNNDs group, highest and lowest CI of DALY were related to the respiratory infections and tuberculosis (- 0.4291) and neglected tropical diseases and malaria (- 0.6872). Regarding NCDs, the highest and lowest CI for DALY is determined for neoplasms (0.3192) and other NCDs (- 0.0784). Moreover, the maximum and minimum of CI of DALY for injuries group were related to the transport injuries (0.0421) and unintentional injuries (- 0.0297).ConclusionsThe distribution of all-causes and CMNNDs burden were more concentrated in low-HDI countries and there are pro-poor inequality. However, there is a pro-rich inequality for NCDs' burden i.e. it was concentrated in high-HDI countries. On the other hand, the concentration of DALY, YLD, prevalence, and incidence in injuries was observed in the countries with higher HDI, while YLL was concentrated in low-HDI countries.

Project description:BackgroundEthiopia has experienced great improvements in life expectancy (LE) at birth over the last three decades. Despite consistent increases in LE for both males and females in Ethiopia, the country has simultaneously witnessed an increasing discrepancy in LE between males and females.MethodsThis study used Pollard's actuarial method of decomposing LE to compare age- and cause- specific contributions to changes in sex differences in LE between 1995 and 2015 in Ethiopia.ResultsLife expectancy at birth in Ethiopia increased for both males and females from 48.28 years and 50.12 years in 1995 to 65.59 years and 69.11 years in 2015, respectively. However, the sex differences in LE at birth also increased from 1.85 years in 1995 to 3.51 years in 2015. Decomposition analysis shows that the higher male mortality was consistently due to injuries and respiratory infections, which contributed to 1.57 out of 1.85 years in 1995 and 1.62 out of 3.51 years in 2015 of the sex differences in LE. Increased male mortality from non-communicable diseases (NCDs) also contributed to the increased difference in LE between males and females over the period, accounting for 0.21 out of 1.85 years and 1.05 out of 3.51 years in 1995 and 2015, respectively.ConclusionsWhile injuries and respiratory infections causing male mortality were the most consistent causes of the sex differences in LE in Ethiopia, morality from NCDs is the main cause of the recent increasing differences in LE between males and females. However, unlike the higher exposure of males to death from injuries due to road traffic injuries or interpersonal violence, to what extent sex differences are caused by the higher male mortality compared to female mortality from respiratory infection diseases is unclear. Similarly, despite Ethiopia's weak social security system, an explanation for the increased sex differences after the age of 40 years due to either longer female LE or reduced male LE should be further investigated.

Dataset Information

Public expenditure on Non-Communicable Diseases & Injuries in India: A budget-based analysis.

Background

Methods

Findings

Interpretation

Publications

Public expenditure on Non-Communicable Diseases & Injuries in India: A budget-based analysis.

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