POLITICS-With Such Friends..

against the rise of only 10 per cent between 1995-96 and 1996-97 makes little sense.
Moreover, recent analyses of the response of state budgets to reduced devolutions from the centre show that, with some variations, states tend to protect public health expenditure at the cost of medical services. Between 1990 and 1993 while there was a fall of 2 to 5 per cent in the states* total health expenditure, there was not an equivalent fall in public health spending, although the pattern of depressed expenditures was not the same under all the heads. Therefore, only a substantial increase in the Plan allocations for vertical centrally-funded public health programmes will offset the attenuation of the entire medical and health care fabric as a result of the state governments' financial constraints. This has not happened over the last five years. Overall the allocations for public health programmes have shown increases ranging between a high of 23 per cent in 1995-96, partly accounted for by the plague control programme, to a low of 10 per cent in the 1997-98 budget. This also substantiates the arguments against vertical disease programmes and in favour of lump sum allocations for health to the states to be spent on programmes most in keeping with different regions' requirements.