Underutilization in the National Health Mission: A Story of Misaligned Public Financing and Health Financing Objectives in India

The following sections are included:Political commitments for increasing public investments for health without a clear strategy and significant reforms in the public financial management system are unlikely to bridge the gap between policy and action.Health system’s unpreparedness to absorb additional funding is a significant bottleneck to equitable health outcomes.The performance of India’s National Health Mission (NHM) is highly variable across Indian states. Often, the states with the greatest need have been the least able to take full advantage of the funding provided from central sources to strengthen primary health care (PHC) services.Systemic remedies provided introduced new complexities that require higher competencies in government and management, which are not equally distributed across the states.The task for governments, at both central and state levels, is to address the causes of performance weaknesses in these systems, including leadership and governance issues. Increasing government funding for health is unlikely to take off in India until these systems prove their capability.