BUDGETARY IMBALANCES IN THE HEALTH CARE SYSTEM OF NWFP: 1990-2004

ABSTRACT

Aims: Keeping priorities like population size, poverty and health status of the population for rational budget allocation, this study was done to analyze the budgetary imbalances among various districts of the province (NWFP) since 1990 to 2004.

Methodology: The retrospective evaluation was done in 24 districts of NWFP and is based on secondary data ranging from 1990 to 2004 which has been taken from Economic Survey of Pakistan, Annual Development Plan, Budget Documents, Finance Department, Govt. of the NWFP, Development Budget (Annual Development Plans) Health Sector (NWFP) and Social Action Program (SAP) Progress Report- SAP section, P & D Department, Govt. of NWFP.

Results: The findings reveal that while making budgetary allocations the important component like areas of the districts, population size, poverty status and health status were not considered. The allocation of Rs. 13.777 million made for district Tank in 2006-07 was minimum as compared to other districts of the province although the district has more area as compared to some other districts.  In contrast Rs. 23.549 were allocated to district Bannu which has a population of 8,63,000, despite the fact that Bannu has low area as compared to other districts like Lakki, Kohat, Karak and Chitral. District Charsadda got Rs. 59.317 million in 2000-01 and Rs. 114.65 million in 2005-06, although the district has a huge population and the increase in the total budget amount was not proportional to the population. District Lakki was allocated Rs. 35.34 million 2001-02 which was increased to Rs. 81.46 in 2005-06 though the district has low standard of living in terms of per capita income as compared to other districts. The daily per capita income of district Shangla was low ( Rs. 12) as compared to other districts while its budgetary allocation was Rs. 20.454 million only which is low as compared to many of the districts of the province. Malakand agency and district Shangla are backward in terms of basic health facilities, but still the budget allocated was not according to the requirement. The total budget allocated to district Swat was Rs. 150.18 million in 2000-01 which was drastically reduced to Rs. 87.84 million in 2005-06. Bunair and Chitral have high poverty and morbidity and are economically backward but they had been allocated lesser funds than the required. High share of salary in the budget has left less space for funding in the service sector.

Conclusions: Spending at provincial level has no match with the requirements of the provinces and often the muscle power and the nuisance value play a more active part in acquiring the funds/ allocation rather than need. The allocation for Health sector is grossly underestimated. Budget allocation should not be made on the basis of population only but it should also include area, health status and poverty in a particular district. It is suggested that 60% of the total budget should be allocated on the basis of population, 20% on the basis of area, 10% on the basis of health status and 10% on the basis of poverty