Unpaid ASHA workers, ambulances stalled: Is Maharashtra’s public health system running on credit? | Mumbai News

Under the National Health Mission (NHM) — the Centre’s flagship programme that funds a significant part of India’s public healthcare delivery system, including maternal healthcare, rural outreach services, ASHA workers, ambulance networks and contractual medical staff — states submit annual PIPs outlining funding requirements, healthcare targets and implementation plans.

Officials said many healthcare schemes and projects approved under earlier PIPs are now continuing as “carry-forward liabilities” — unpaid dues from previous years that have spilled into the current financial year because committed funds are yet to be fully released.

“Overall, the delay in fund flow has crossed Rs 1,800 crore, creating enormous financial pressure across Maharashtra under the NHM,” a senior official said. A state official told The Indian Express, “We have raised and submitted all our concerns before the Centre during the May 26 meeting. Yes, funds have been pending for the last two years. Many ongoing healthcare projects and schemes sanctioned under previous PIPs are now continuing as carry-forward liabilities. The funds we are demanding this year include projects already sanctioned but not completed because the funds have not been received.”

The Ministry of Health and Family Welfare and the Press Information Bureau did not respond to queries from The Indian Express.

Under the NHM funding structure, 60 per cent of funds are released by the Centre and 40 per cent by the state government. “The state cannot release its share unless the Centre first issues the sanction order for its portion. Without the 60 per cent central share order, the state cannot proceed with releasing its corresponding 40 per cent share,” an official involved in fund allocation said.

“We have given them several reminders over the last few months and they keep saying the funds will come,” the official added. Officials said the delays have now begun affecting multiple components of the public health system, including contractual healthcare workers, medicine procurement, diagnostics, ambulance services and outreach healthcare programmes in rural and tribal regions.

According to documents accessed by The Indian Express, pending NHM-related liabilities in Nandurbar district alone have crossed Rs 4.08 crore. “Every day we are requesting vendors not to stop services because it will directly affect patient care,” a senior health official from Nandurbar said on condition of anonymity.

“There have been times when we had to arrange money from our own pockets to pay for diesel because there were no funds to even bring back the medicine van from Pune and ensure medicines reached rural hospitals and Primary Health Centres,” the official said.

Officials said delayed payments have affected free sonography services, dialysis-linked medicine procurement, diagnostic services, ambulance payments and specialist consultations in several districts.

State health officials said they are increasingly depending on temporary financial adjustments and credit arrangements with vendors to keep services functioning, with the biggest challenge being salaries of contractual NHM staff spread across the state. There are around 45,000 NHM-linked employees in Maharashtra, including ASHA workers, contractual doctors, nurses, ANMs, technicians, counsellors and ambulance staff.

Some ASHA workers and labour unions alleged that payments to frontline workers had been delayed for several months. “It has been over six months since ASHA workers received their salaries,” said Shubha Shamim, State Vice-President of CITU, adding that scheme workers would stage protests at Azad Maidan in Mumbai from June 1.

Senior officials, however, said the department had been attempting to manage salary payments by adjusting funds released later under subsequent instalments. “Recently, around Rs 1,138 crore was received, out of which nearly Rs 850 crore was immediately used to clear pending liabilities,” an official said.

Officials said the department has now begun prioritising only the most essential services.“Ambulance services, medicine supply and emergency healthcare cannot stop. We are delaying vendor and agency payments because patient care has to continue somehow,” another official said.

Officials said they expect the situation to stabilise if the next tranche of NHM funds is released by June or July.