The most recent ‘Fiscal Health Index’ (FHI) released by NITI Aayog has placed West Bengal,once the country’s leading economy, in the lowest tier. The observation based on key elements like quality of expenditure, revenue mobilization, fiscal prudence, debt index, and debt sustainability reflects the poor macroeconomic stability of the state. With high debt, large interest payment, weak revenue generation and reliance on non-tax revenue, the state is facing critical challenges on fiscal sustainability.

There is little scope to argue that the fiscal strain directly compromises the healthcare ecosystem. Over the years West Bengal has received substantial financial support from the Central Government through the National Health Mission (NHM), Prime Minister-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM), Finance Commission and so on. A careful analysis of the allocation, release and expenditure of NHM for the past fifteen years reveals persistent under-utilization of funds with high unspent balances carried forward from the previous years. Furthermore, the state’s own health sector allocation continues to be around 5-6 per cent which is well below the National Health Policy 2017 recommendation of at least 8 per cent of the budget to health.

The recurring concern has been the gap between approved resources and their translation into measurable improvements in service delivery, infrastructure, workforce strengthening, and public........

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