Improving Healthcare in West Bengal through Medium-Term Expenditure Framework

Video | 16 October 2020

Since 2012, ADB has been in collaboration with the Government of West Bengal for increasing the total efficiency in public expenditure and ensuring that these expenditures are directly linked to the desired outcomes and achieve better service delivery. ADB’s Second West Bengal Development Finance Program supported the introduction of medium-term expenditure framework (MTEF) in the Health and Family Welfare Department of West Bengal. MTEF is a transparent planning and budget formation process which allocates public resources according to their strategic priorities and desired outcomes while ensuring overall fiscal discipline. With adequate medium-term planning, West Bengal was able to establish outpatient department services in 41 hospitals, and provide free medical care, medicines, diagnostic tests and implants. In addition, the government implemented schemes to cover expenses on all surgeries performed on children and provide health insurance to cover hospitalization costs of up to $7,000 per family per annum for 15 million families. ADB plans to further support the adoption of MTEFs by other departments as part of its proposed West Bengal Public Finance Management Reforms Program.

Transcript

Improving healthcare in West Bengal by linking government’s expenditure with targeted health outcomes—
West Bengal is one of the most populous states in India. A growing population and shortage of medical and healthcare facilities has led to increasing challenges in the area of public health. There is a need to ensure that the money spent by the government on healthcare yields the desired health outcomes efficiently.

  • 1.5 crore (15 million) families covered
  • INR5 lakh ($7,000)/family/annum
  • INR10,500 crore ($1.5 billion) health budget

Soundbites:

Dr. Sudip Kumar Sinha, Additional Secretary, Finance Department, Government of West Bengal
Under the Asian Development Bank-assisted Second West Bengal Development Finance Program, we have been implementing medium-term expenditure frameworks for two line departments, namely the Health and Family Welfare Department and the School Education Department on a pilot basis.

Parwez Ahmad Siddiqui, Secretary, Department of Finance, Government of West Bengal
Medium-term expenditure framework is a transparent planning and budget formulation process. Public resources can be allotted to their strategic priorities while ensuring overall fiscal discipline. The efficiency and effectiveness in budget management is significantly enhanced under this process.

Hari Krishna Dwivedi, Additional Chief Secretary, Department of Finance, Government of West Bengal
We took up health, which was great challenging for us because we had a large number of flagship programs of the central and state government but the budget alignment with the delivery outcomes was not there. The basic objective was to increase total efficiency in public expenditure and to see that the public expenditure is directly linked to the outcomes and achieves better service delivery. One of the key instruments, among many, was the development of medium-term expenditure framework, and this was the first of its kind in West Bengal.

Vivek Kumar, Principal Secretary, Department of Health and Family Welfare, Government of West Bengal
In a very bold and unprecedented policy decision, the state government has withdrawn all user-charges which were leviable in the state’s government health system. This means that all medicines, all costs related to diagnostic tests and implants are free of cost in government hospitals and health facilities. Under the Shishu Saathi Scheme, all surgeries performed on children are free of cost. All costs are covered by the state government. Then we have a health insurance scheme, a very ambitious and successfully implemented health insurance scheme in which 15 million families of the state are covered under the Swasthya Saathi Scheme under which each family is covered for indoor hospitalization costs up to $7,000 per family per annum. The state government has actually increased the budgetary support that it provides to the health department. My budget for the year, the current financial year is close to $1.5 billion.

Dr. Sudip Kumar Sinha, Additional Secretary, Finance Department, Government of West Bengal
We are planning to extend this MTEF in other major departments also which are directly implementing social sector infrastructure programs.