Will Health Grants to Local Governments by the Fifteenth Finance Commission Eventually Become a Victim of Mission Creep Syndrome?





While the health grants to local governments recommended by Fifteenth Union Finance Commission in the wake of Covid 19 pandemic lays emphasis on the trust-based approach to local governments and decentralization of health, the danger of Mission Creep can undo the potential and effectiveness of the grants to strengthen the primary health care sector. Lack of sensitization towards local governments; the misconception that local governments and its stakeholders are illiterate, weak and corrupt entities;  absence of an institutional monitoring mechanism to conduct a follow-up of the recommendations made by the respective Finance Commissions; lack of co-ordination between various Ministries of union and state governments; and the erosion of cooperative federalism can all contribute to health grants falling prey to the vicious cycle of Mission Creep Syndrome.


Mission Creep Syndrome, Union Finance Commission, Health Grants, Local Governments, Decentralization, Trust-Based Approach


Download data is not yet available.

Authors Bio

Jos Chathukulam, Centre for Rural Management

Jos Chathukulam is the Director of Centre for Rural Management (CRM), Kottayam, Kerala.

Manasi Joseph, Centre for Rural Management

Manasi Joseph is a Researcher at Centre for Rural Management (CRM), Kottayam, Kerala.


Accountability Initiative, Centre for Policy Research. 2019. A Study for the Fifteenth Finance Commission, Centre for Policy Research, New Delhi.

AnanthPur, Kripa and Research Team. 2021. A Study on Need Based Devolution to Rural Local Bodies in Tamil Nadu, Madras Institute of Development Studies (MIDS).

Belagere, Chetana. 2021. “Indian medical service cadre soon?” The New Indian Express, March 21, 2021. Accessed March 25, 2021: https://www.newindianexpress.com/cities/bengaluru/2021/mar/21/indian-medicalservice-cadre-soon-2279481.html

Comptroller and Auditor General of India. 2016. Report of Comptroller and Auditor General of India on Local Self Government Institutions, Government of Kerala. Report No. 5, New Delhi: Union Government.

Chakraborty, Pinaki. 2021. “Balancing Fiscal Need and Macroeconomic Stability: COVID-19 Context and the Fifteenth Finance Commission”, Economic and Political Weekly, 56(33).

Finance Commission of India. XV Finance Commission Report for 2021-26, Finance Commission in Covid 19 Times, Volume I Main Report, October 2020.

Kodi S M. and Sharma S K.2021. “Realities, Scope, Challenges, and Facilitators for Implementation of Nurse Practitioner's Role in India: A Review,” International Journal of Nursing Sciences, 8(2):237-242.

Lahariya, C. 2020. “Health & Wellness Centres to Strengthen Primary Health Care in India: Concept, Progress and Ways Forward,” Indian Journal of Paediatrics, 87:916–929.

Lowe, Grainne., Tori, Kathleen, Jennings, Natasha., Schiftan Dan and Driscoll, Andrea. 2021. Nurse Practitioner Work Patterns: A Cross‐Sectional study. Nursing Open. 8(2): 966-974.

Maier, C. B, Barnes, H., Aiken, L. H, and Busse, R. 2016. “Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential.” BMJ open, 6(9): e011901.

Nair, N V and Moolakattu, J S. 2018. Fiscal Decentralization and State Finance Commissions, Mittal Publications: New Delhi.

Nankani, Mahek. 2022. “Who’s stopping an Indian Medical Service? The govt — it thinks IAS officers are enough.” The Print, January 4, 2022. Accessed January 15, 2022: https://theprint.in/opinion/whos-stopping-an-indian-medical-service-the-govt-it-thinks-ias-officers-are-enough/794183/

National Health Systems Resource Centre (2021). Operational Guidelines for PM Ayushman Bharat Health Infrastructure Mission.

Press Information Bureau. 2021. “Ayushman Bharat Pradhan Mantri Jan Arogya Yojana” (Press Release from Ministry of Health and Family Welfare), 14. Press Information Bureau, July 23, 2021. Accessed May 17, 2022: https://www.pib.gov.in/PressReleasePage.aspx?PRID=1738169

Rao, Govinda M. 2020. “Continuity and fiscal follow-through.” The Hindu, February 5, 2020. Accessed February 5, 2020: https://www.thehindu.com/opinion/lead/continuity-and-fiscal-follow-through/article30736905.ece

Rao, Govinda M. 2021. “Fiscal Transfers in Pandemic Times,” Economic and Political Weekly, 56 (33).

Rural Health Statistics (2019-2020), Government of India, Ministry of Health and Family Welfare Statistics Division, Government of India.

Shukla, Anuradha. 2020. “Fifteenth Finance Commission told to review stand on special and nutrition grants.” The New Indian Express, February 3, 2020. Accessed: February 4, 2020: https://www.newindianexpress.com/business/2020/feb/03/fifteenth-finance-commission-told-to-review-stand-on-special-and-nutrition-grants-2098249.html

Thimmaiah, G. 2002. “Finance Commission: Decline of a Constitutional Institution,” Economic and Political Weekly, 37, (47):4664-68.

Times News Network. 2021. “The Finance Commission has tried to balance the three criteria of need, equity and efficiency.” Times of India, February 5, 2021. Accessed February 6, 2021: https://timesofindia.indiatimes.com/blogs/the-interviews-blog/the-finance-commission-has-tried-to-balance-the-three-criteria-of-need-equity-and-efficiency/