Startup India” will surely start up the “Millennial India”.
– Raj Nehru

If Abraham Maslow comes back to life for a day to review his theories, he will be shocked to see that millennials of today are proving his theories wrong. Goldman Sach in their millennial report has found some interesting data which says that “must have’s” of previous generation are no more important to the new generation. They are either putting off major purchases or avoiding them entirely. Take the case of buying a house or a car. More than 60 % of millennials do not find a need or a necessity to buy a house or a car. Instead they are exploring new set of services that provide them access without the burden of ownership giving rise to what they call a Sharing Economy. More and more millennials are getting attracted to technology that is being leveraged by them for instant access for information on product, price, and features and also peer reviews. This new attraction is actually shaping the new market and is transitioning the conventional economy to millennial economy.

In fact I recall some months back when my daughter familiarized me with Play store, I found some wonderful apps that helped me to get rid of driving through the erratic traffic that would drain my energies during high traffic hours, almost every day. Precisely, I would not had even bothered to explore technologically enabled solutions to various existing problems but when I decided to explore alternatives, I also found Ola and Uber apps and many other. Since last few months I have travelled 90% of my daily transportation requirements, using these innovative tools. The Ola share has in fact further helped me to save on my petrol bills. I also asked couple of drivers about their experience and believe me in some cases I have found well educated youths driving these cabs who claimed to earn between 60k – 90 k per month, depending how far and how long their wheels keep moving. Millennials have sharp appetite for simplifying things and will suggest very different ways to handle our daily problems. Skilling them in the right manner and harnessing their capabilities will shine our nation.

Millennials of today are very different in their perceptiveness, thought process, judgement and action. Their expectations and challenges are also different than the conventional ones. They are looking for more in life than just a job and are driven by the desire to do something worthwhile. Money is no more a top driver. There is a very unique diffusion of social and economic factors that is driving most of the millennials to experiment, innovate, take risks and embrace challenges. As rightly said, “GenY of today is turning into a Generation “Y not…start this in my parents Basement”. Personal Learning & Development is a big driver and is linked to faster growth and progression. Millennials of today are no more motivated by stability and security and will prefer to change the business and organization faster. They are no more attracted to one role for longer time anymore. They are committed to their experimenting thought process than to any company. Opportunities that provide flexibility and opportunity to grow and progress are their biggest attraction. Millennials prefer to work in a decentralized environment.

They operate with a no blame mentality and have tenacity to take personal responsibility and accountability for their success or failure and hence prefer to work in a more empowered and decentralized environment. I work in a BPM organization where we have more than 80% of millennial staff. In all my interactions with them, I have noticed that majority of these youngsters bring variety of skills and are also passionate to pursue them and therefore do not want to limit themselves to one box of interest or skills. Most of these millennials that I meet are looking for opportunities that enable them to make a difference. They would prefer to work in an environment that is open and values individual differences.

Today’s India predominantly comprises of this young population thus making it world’s youngest economy and allowing itself with a natural potential of transforming that has not been done for decades. The opportunity of being a young millennial economy is an assurance to progress and growth given that millennials thrive on challenging “status quo” and would want to create and recreate, find new and efficient ways to work. Given their high appetite for taking risks, they can help in nation building by letting their inner ideas and thoughts taking shape in the form of new ventures, startups. The opportunity for the nation is to meet their expectations and also transform it into a progressive feature that contributes not only to the nation but to the world as well.

Startup India, Stand up India launched by our Prime minister, is a great thought in this direction. It is a clarion call for the young population of India, that bubbling with energy, ready to work on new and innovative ideas that can help set new businesses and produce the young entrepreneurs of the millennium who will help the nation to outperform all other nations in the years to come with a phenomenal positive impact on our economy. The objective of Startup India is to boost their potential of entrepreneurial capability, harness their ideating capacity, and leverage their energy and sense of urgency. This is being ensured through various steps that this program has ensured in the form of single window system, easing bureaucratic hurdles, providing incubation centers and facilitating through financial assistance through financing options consequently leading to economic progress and employment generation. Start Ups are the perfect tool to address and channelize the ideas, creativity, freshness, aspiration, flexibility and innovative mid set of millennials in India. Startup India will help our youngsters to find answer to most of their challenges that they encounter in traditional work environment and conventional work set ups. Read More


ASHA – An Overstretched link

Author: Dr Ruchi Verma
Surveillance Medical Officer, World Health Organization
Adjunct Faculty, Global Village Foundation

ASHA stands for Accredited Social Health Activist and plays a pivotal role in NRHM for health care delivery in rural areas. The concept was born in China by the name of Barefoot doctors in 1950s, as a main play in primary health movement (Bajpai & Dholakia, 2011). The idea was further adopted by Bangladesh and later Iran in 1972 and 1979, respectively (Bajpai & Dholakia, 2011). The Alma-Ata declaration of 1978 highlighted the concept of community health workers to improve the starving primary heath care (Saprii, Richards, Kokho, & Theobald, 2015). The newly launched recommendation was quickly perceived by many countries and reaped the benefit. Iran launched the CHW framework in the form of Behadasht yar (female) & Behyraz (male) (Bajpai & Dholakia, 2011). Government of India adopted this after a long slumber, in 2005 with the birth of National Rural Health Mission (NRHM). (Government of India. Ministry of health and family welfare, n.d.)

Based on the concept of CHW, ASHAs were recruited through NRHM as incentive based community workers for community mobilization, enhancing awareness and as an important link between the community and the public health care. The main focus of their work has been on maternal and child health, the core pillars of a healthy society. ASHAs in most places have a minimum basic education of Tenth standard. However this criterion is relaxed in many places, in case of manpower shortage.

Inception of ASHA had the simple vision of strengthening the abysmal primary health care (PHC) through strong communication between members rooted in the same community (ASHAs). Although an excellent much needed step, the ever expanding healthcare needs of the inherently complex Indian society are burdening ASHAs and needs a serious thought.

ASHA has multitudes of general responsibilities roughly categorized into the following (PK, 2015):

  1. link worker/facilitator- for antenatal and postnatal care
  2. Community health worker– for immunization of children, treating simple ailments, birth registrations, promoting DOTS-TB referral and use of ORS & Zinc in diarrheal illnesses
  3. Social activist– community mobilization for civil rights, special focus on increasing awareness among marginalized sections of the community.

Since ASHA is working through multiple sectors governed by different bodies, it makes ASHA accountable for all those sectors. There are a few things to be kept in mind- the responsibilities of ASHA change with the focus of the government (state and central), with most lucrative incentives and the amount of work in each scheme. India accounts for 17% of the global maternal mortality and 21% of the global childhood deaths (PK, 2015). The GoI has two vertical programs targeting the above mentioned. First, Reproductive Maternal and Neonatal, Child Health (RMNCH) aims at holistic health of both the mother and the child, however, pivots at the maternal health for the success of the program. Second, the Expanded Programme on Immunization (EPI) targets maximal coverage and complete immunization of less than 3 year old children. Much of the health workforce functions are the same at the ground level. ASHA works for both the programmes along with Auxiliary Nurse Midwife (ANM) under the leadership of Medical officer at the PHC or Community Health Center (CHC). According to the requirements of the government (state, local) and the running programs, the priorities for ASHAs fluctuate constantly. In states like U.P where the immunization is wretched, the pressure from the administration to improve the same ultimately falls on the ground level workers like ASHAs.

Strengthening the primary health care system is a major focus, however the strategy towards that is blurry in terms of action. The need of the hour is to generate and build the capacity of ground zero workforce to comply with the persistently growing demand in primary health sector. There are two options for enhancing the quality of primary health delivery at the ground level- Firstly, a basic pay along with the incentives to reduce attrition and maintain the quality of work. Secondly, focus on refresher trainings by the medical officers and partner agencies UNICEF, WHO, etc. Finally, there is a need to curb irregularities in the financial pay out to the workforce.


  • Bajpai, N., & Dholakia, R. H. (2011). Improving the Performance of Accredited Social Health Activists in India, (1), 1–63.
  • Government of India. Ministry of health and family welfare. (n.d.). About Accredited Social Health Activist (ASHA).
  • PK, F. F. R. M. V. K. K. A. A. S. M. (2015). Assessment of “accredited social health activists”-a national community health volunteer scheme in Karnataka State,India. TT -. Journal of Health, Population, and Nutrition, 33(1),137–145.
  • Saprii, L., Richards, E., Kokho, P., & Theobald, S. (2015). Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles. Human Resources for Health, 13(1), 95.

Decoding the Health Budget of India

Author: Dr. Malini Nagulapalli,
(Coordinator, Public Health)

Health care system acts as a measure of efficiency and success of the governments across the globe. Therefore, it does not come as a surprise that healthcare plan is the predominant topic of discussion in the ongoing presidential campaigns in the USA. In the current fragile situation, where countries are facing potential threat of fatal epidemics, India should focus on providing accessible, affordable and equitable healthcare services. Faced with the twin burden of communicable and non-communicable diseases, the government of India should enhance efforts towards strengthening Primary Healthcare Centers (PHCs) with a robust referral system to the tertiary care. In addition, consistent processes and policies should be churned out to reduce out of pocket (OOP) expenditure that potentially pushes middle-income families into poverty. To this end, the government of India should plan the health budget to meet all planned and unplanned health care requirements. In this article, we attempted to elucidate the allocations and expenditures in the Health sector. We hope that this effort will initiate dialogue to enhance fiscal discipline and formulate coherent policies.

General Outlay of Health Budget for FY 2015-16

  • Health budget in 2015-16 was chalked out for the Department of Health and Family Welfare (DoHFW), Department of Health Research (DoHR) and Department of AIDS Control (DoAC) (Fig. 1a). In contrast, allocations to DoAC are included within the grants to DoHFW in the budget for FY 2016-17 (Fig. 1b)
  • Fig. 1a: Schematic of the Health budget outlay for the FY 2015-16.
  • digram-1


  • In comparison to the previous year, the allocation to DoHR was increased by 11.2% and 13.1% in 2015-16 and 2016-17 respectively (Fig 2). On the other hand, the allocation to DoAC increased from 1400 crores in 2015-16 to 1700 crores in 2016-17.

Fig 2: Allocations to DoHR (in crores)

  • The DoHFW governs a number of schemes within Health and National Health Mission (NHM). In general, Health sector schemes comprise of
    1. Central Sector Schemes (CSS),
    2. Central Sector-Family Welfare-Schemes of NHM and
    3. CSS for HR, Medical Education and Training.
    4. National AIDS and STD Control Programs have been added recently to the umbrella of Health in 2016-17. The operational costs of all central government institutions for health, medical colleges, hospitals, dispensaries, social marketing, IEC/BCC viz., fall in this category. Health sector funds provide for both Revenue and Capital expenditures of all the CSS programs.

  • National Health Mission on the other hand, comprises of health schemes aimed at system strengthening in rural (NRHM) and urban (NUHM) areas. NHM schemes were initiated with a view to achieve the Millennium Development Goals (MDGs) by improving health indicators like MMR, IMR, U5MR and TFR. Some of the vital schemes in NHM are Mission Indradhanush for immunization of children with a goal of 80% coverage, Janani Suraksha Yojana (JSY), Janani-Shishu Suraksha Karyakram (JSSK), Rashtriya bal Swasthya Karyakram (RBSK), Rashtriya Kishor Swasthya Karyakram (RKSK) for Reproductive Mother Child Neonatal Healthcare with recent addition of Adolescent healthcare (RMNCH+A) to the umbrella. In addition, communicable diseases, non-communicable diseases, mental health programs, care for the elderly and various other secondary and tertiary care facilities have been initiated under the overarching umbrella of NHM.

Major Heads and Allocations in Revenue and Capital Sections for DoHFW in 2015-16 and 2016-17

NHM was given the highest priority in 2015-16 with 77.4% (18,295 crores) of the total Revenue-Plan budget or 56.52% of total budget. Of this, 67.13% of NHM was allocated to states to carry out the underlying schemes (Table 1). Medical and Public Health on the other hand was allocated 32.52% (10525.42 crores) of the total budget (32,368.67 crores). The rest was divided between North-Eastern (NE) areas, family welfare, discretionary grants, secretariat viz., (Table 1).

The allocations to Health sector were increased by 14.42% in 2016-17 relative to the previous year. Funds to medical and Public Health sector and Family Welfare sector were increased by about 24% and 42% in FY 2016-17 compared to 2015-16. The capital outlay for family welfare and housing was reduced by 28% and 49%. The capital budget for Medical and Public Health, however, has been increased by 82% (Table 1).

Table 1: Allocations under major heads for FY 2015-16 and FY 2016-17


The Non-Plan part of the Revenue budget constituted about 24.16% of the total budget in 2015-16 and 23.1% in 2016-17. Interestingly, approximately 39% and 30% of non-plan component is allocated to salaries and supplies and materials respectively in 2015-16 (Fig. 2). About 12.6% is allocated to medical treatment and Central Government Health Scheme (CGHS) in 2015-16. In 2016-17, CGHS has been granted 11.6% of the non-plan component.

Fig. 2 : Break-up of the Non-Plan component of Revenue section of Health Budget(2015-16)


Savings or Unspent Funds in Previous Years

In India, the Public expenditure on healthcare as percent of GDP has increased from approximately 1.2% in 2015-16 to 1.3% in 2016-17, which is far below the OECD averge od 6.5%. Even with meager allocations, the healthcare system is not equipped to completely absorb the funds. For instance, huge amounts of funds to the tune of 3192.32 crores, 2715.67 crores and 3596.02 crores have been recovered at the end of 2013-14, 2014-15 and 2015-16 financial years, respectively (Table 3). In general, Medical and Public Health and Family Welfare sections of the Health department have been observed to perform poorly in fiscal terms. In addition, approximately 1000 crores in RCH flexible pool and 50 crores in Mission flexible pool were not spent in the financial year 2014-15.

Table 3: Savings or unspent funds in last two financial years


*BE- Budget Estimates

Concerns and Challenges in Health Care System Due to Poor Fiscal Discipline

A number of issues have to be addressed to improve the financial allocation efficiency and absorption capacity of the health care system in India.

  1. The most prominent concern is the lack of real time knowledge of the flow of funds.
  2. Delay in furnishing utilization certificates by the concerned departments needed to track the expenditures, leads to poor fiscal planning.
  3. A lag in transferring funds from the state treasury to health societies by 5-6 months deprives the societies of the much needed and allocated funds.
  4. Lack of trained work force at PHCs to implement high priority schemes like geriatric care, mental health programs, mass disease screening and diagnostics.
  5. Lack of cGMP compliant PSUs to manufacture sera/vaccines which are otherwise purchased from pr ivate sector.
  6. Unanticipated cost-escalation in flagship schemes.
  7. In view of the fatal epidemics and natural calamities occurring across the world, healthcare disaster management has to be strengthened through appropriate allocations.
  8. Essential activities like free drugs and diagnostics, strengthening district hospitals, and sub-centres, Tribal sub-plans should be insulated from budget cuts.
  9. Disease burden of communicable and non-communicable diseases has to be addressed in a timely fashion through drugs, therapies etc., Otherwise, the entailing costs may disrupt planned interventions.
  10. Surveillance programs and intelligentsia in relevant institutes have to be strengthened to avoid internal leakage and draining of funds.


A bulk of the budget is allocated to states to carry out crucial schemes under NHM. However, approximately 10% of the funds are unspent at the end of each financial year. Also, approximately 20% of funds allocated to Capital section have been surrendered previously (Table 3). It is evident that these funds could be channeled to more vital schemes to provide maximal health coverage and to strengthen trained work force at grass root level. Finally, there is an urgent need to improve the fiscal discipline of states through concurrent monitoring and evidence based policies.