The Role of State and Central Government in Health Planning

Health planning in India is a collaborative effort that relies on effective coordination between the Central and State governments. Given India’s vast population and diverse healthcare needs, a well-structured approach ensures that policies, programs, and resources reach every corner of the country. Understanding how these two levels of government work together is essential for nursing professionals who operate within this system daily.

The constitutional framework of health in India 🔗

In India’s federal structure, health is primarily a State subject, meaning that State governments bear the main responsibility for organizing and delivering healthcare services to their populations. However, certain aspects of health fall under the Union List or Concurrent List, allowing the Central government to play a significant role in policy-making, funding, and implementing national health programs. This dual arrangement necessitates continuous coordination between the Centre and States to ensure uniformity in health standards while accommodating regional differences.

The Central Council of Health and Family Welfare (CCHFW), established under Article 263 of the Constitution, serves as the apex advisory body that facilitates this coordination. It was set up to provide support and advice to the Department of Health on policy formulation and to recommend broad lines of policy regarding health matters. The council comprises the Union Minister for Health and Family Welfare as Chairman, along with State Health Ministers and other members, ensuring that both central and state perspectives are represented in major health decisions.

Role of the central government in health planning 🔗

At the national level, three key institutions drive health planning and implementation:

Ministry of Health and Family Welfare 🔗

The Ministry of Health and Family Welfare (MoHFW) is the principal ministry responsible for health policy in India. It handles all government programs relating to family planning, public health, and medical education. The Ministry consists of two main departments: the Department of Health and Family Welfare, and the Department of Health Research. These departments work together to formulate policies, allocate resources, and oversee the implementation of health initiatives across the country.

The Ministry coordinates with international health organizations, administers major health programs, and sets standards for medical practice and pharmaceutical products. Through its various divisions, it addresses preventive care, immunization campaigns, environmental hygiene, nutrition, and health education.

Directorate General of Health Services 🔗

The Directorate General of Health Services (DGHS), established on 15 August 1947, functions as an attached organization of the MoHFW. It serves as the apex technical advisory and regulatory body for healthcare in India. The DGHS provides expert guidance on medical and public health matters and acts as a repository of technical knowledge regarding public health, medical education, and healthcare delivery.

The DGHS coordinates with State Health Directorates for implementing National Health Programs through its Regional Offices of Health and Family Welfare. Currently, 19 such regional offices function across India, ensuring proper liaison between the Centre and States for various centrally sponsored health initiatives. The Directorate also oversees Central Government hospitals, medical colleges, and specialized institutions like the National Centre for Disease Control.

Central Council of Health and Family Welfare 🔗

As mentioned earlier, the CCHFW plays a crucial advisory role in health planning. Its functions include recommending distribution of grants-in-aid for health purposes to States, reviewing work accomplished through these grants, and establishing organizations that promote cooperation between Central and State health administrations. The council meets at least once a year to discuss national health priorities and build consensus on policy approaches.

Role of state governments in health planning 🔗

State governments are the primary implementers of health services, operating through a well-defined administrative structure:

State Health Ministry and Secretariat 🔗

Each state has its own Health and Family Welfare Department, headed by a Cabinet-rank Minister who serves as the political head. The administrative head is the Secretary to the Government in the Health Department, usually a senior IAS officer. This Secretary is assisted by Additional Secretaries, Joint Secretaries, and Deputy Secretaries who handle various aspects of health administration.

The State Health Secretariat focuses on policy formulation, budgeting, and administrative coordination. It approves policies, manages finances, and ensures that central guidelines are adapted appropriately for local implementation. The secretariat works closely with advisory councils and technical committees to make informed decisions about healthcare delivery.

State Directorate of Health Services 🔗

While the Secretariat handles policy, the Directorate of Health Services at the state level is responsible for executing these policies on the ground. The Director of Health Services, typically a senior medical officer, oversees the implementation of both state and centrally sponsored health programs. The directorate manages the state’s network of hospitals, primary health centres, community health centres, and sub-centres.

Various program officers under the Director handle specific initiatives such as tuberculosis control, immunization, maternal and child health, and disease surveillance. At the district level, Chief Medical Officers or District Health Officers coordinate healthcare delivery within their jurisdictions.

Central interventions in state health systems 🔗

The Central government actively supports State health systems through several mechanisms:

National Health Mission 🔗

The National Health Mission (NHM), launched in 2005, represents the most significant central intervention in state healthcare. It subsumes both the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). The mission aims to establish a decentralized, community-owned health delivery system with focus on vulnerable populations and underserved areas.

Under NHM, the funding follows a defined ratio between Central and State governments. For most states, the sharing pattern is 60:40 (Centre:State), while for Northeastern states, Himalayan states, and other special category states, it is 90:10. This ensures that poorer states receive greater central support while maintaining state ownership of health programs.

Disease control and immunization 🔗

The Centre plays a direct role in controlling communicable diseases and running immunization programs. Through the National Vector Borne Disease Control Programme, National AIDS Control Programme, and Revised National TB Control Programme, the Central government provides technical guidance, funds, and monitoring support to States. The Universal Immunization Programme ensures that children across India receive protection against preventable diseases, with the Centre providing vaccines and operational support.

Rural health infrastructure 🔗

Central funds support the establishment and strengthening of rural health facilities, particularly in economically weaker states. Sub-centres, Primary Health Centres, and Community Health Centres form the backbone of rural healthcare, and the Centre helps states upgrade these facilities to meet Indian Public Health Standards. Programs like Janani Suraksha Yojana promote institutional deliveries among poor pregnant women, contributing to reduced maternal and infant mortality.

Health financing at the state level 🔗

A state’s ability to finance healthcare depends on several factors:

Own revenue-raising capacity: States with stronger economies can allocate more funds to health through state budgets. This includes revenue from state taxes, fees, and other sources.

Share in central taxes: Under India’s fiscal federalism, states receive a portion of central tax revenues through the Finance Commission’s recommendations. The Fifteenth Finance Commission has allocated specific health grants to states for strengthening primary healthcare and managing public health emergencies.

Central grants and transfers: States receive grants-in-aid from the Centre for implementing centrally sponsored schemes. The National Health Mission funds are managed by State Health Societies, which pool central and state contributions and manage transfers to districts.

According to the National Health Policy 2017, there should be a collective increase in healthcare spending by Centre and States to achieve 2.5% of GDP by 2025. Currently, states bear a significant portion of public health expenditure, making their financial health crucial for healthcare delivery.

Challenges in Centre-State coordination 🔗

Despite well-established mechanisms, several challenges persist in health planning coordination. Fund utilization rates vary significantly across states, with some spending less than two-thirds of allocated amounts. Delays in fund disbursement, human resource shortages, and varying administrative capacities at state levels affect program implementation. Additionally, some states have not adhered to central guidelines for flagship programs, leading to inconsistencies in service delivery.

Effective health planning requires continuous dialogue, capacity building, and flexibility to accommodate regional needs while maintaining national standards. The COVID-19 pandemic highlighted both the strengths and weaknesses of this system, demonstrating the importance of coordinated action during health emergencies.

What do you think? As a nursing professional working within this health system, how do you see the coordination between Central and State governments affecting healthcare delivery in your area? What improvements would you suggest to make health planning more effective at the grassroots level?

References

1. https://www.drishtiias.com/daily-news-analysis/central-council-of-health-and-family-welfare-conference
2. https://en.wikipedia.org/wiki/Ministry_of_Health_and_Family_Welfare
3. https://en.wikipedia.org/wiki/Directorate_General_of_Health_Services_(India)
4. https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=1255&lid=274
5. https://www.iipa.org.in/GyanKOSH/posts/state-government-and-administration-in-india-theory-policy-and-practice
6. https://en.wikipedia.org/wiki/National_Health_Mission
7. https://testbook.com/ias-preparation/national-health-mission
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC11088227/