Abstract

Maharashtra, India’s second most populous state, faces significant health challenges despite its economic prominence. This Public Expenditure Review (PER) analyses trends in the state’s health expenditure from 2012-13 to 2017-18 and evaluates its alignment with the population’s health needs. The study focuses on critical issues, including maternal and child health (MCH), tribal and urban health disparities, growing non-communicable diseases (NCDs), high out-of-pocket expenditure (OOPE), and inadequate public healthcare infrastructure.

Key findings highlight a 15% compounded annual growth in health expenditure, though the share of health spending remains below the national target at 5% of the total state budget. Maharashtra’s health expenditure as a percentage of GSDP is among the lowest nationally, and per capita health spending remains inadequate. The National Health Mission (NHM) contributes 20% to state health expenditure, with underutilisation of funds persisting.

The analysis identifies a decline in communicable diseases but a rising NCD burden, particularly cardiovascular diseases and mental health. MCH remains critical, with high neonatal mortality and poor health indicators in tribal and urban poor populations. The report underscores the need for systemic reforms, including enhanced district-level planning, addressing fund flow delays, prioritizing tribal and urban health needs, and achieving Universal Health Coverage (UHC) through increased fiscal commitment. Bridging these gaps requires both political will and a restructured health financing strategy to ensure equitable healthcare delivery​.

Raghuraman, G., Abraham, S. M., Rao, B.V. M., Minni, P. and Jha, J. (2019). Public Expenditure on Health in Maharashtra. Centre for Budget and Policy Studies and United Nations Children's Fund, New Delhi.