Page 144 - GHES-3-3

Global Health Economics and
Sustainability
A comparative analysis

policies are critical for mitigating pandemics or other & Shrestha, 2020). Most research on this subject has
health crises. Governments can effectively mitigate the been conducted at the national (Allan, 1965; Auld, 1970;
impact of such crises by investing in healthcare goods Chakraborty & Sinha, 2018; Zakaria & Ali, 2010) or state
and services and striving for universal coverage (Tekle (Dholakia, 2015; Khan et al., 2018; Chakraborty et al., 2019;
et al., 2023; Foo et al., 2022; Kutzin, 2020). On the one Chakraborty & Shrestha, 2020; Jacob & Chakraborty, 2020)
hand, governments’ public health expenditures must levels, analyzing overall budget estimates and comparing
ensure the efficient implementation of public health policy them to actual figures. Few studies have examined central
(Jakovljevic et al., 2016). Suppose governments develop a or state governments’ sector-specific fiscal marksmanship.
series of systematic and scientific policy implementation Barring studies on budgetary discipline concerning
plans (Vega-Royero & Sibona, 2023) but cannot fund the educational expenditure (Chakraborty & Choudhury,
corresponding public health expenditure due to insufficient 2005) and health expenditure (Jani, 2022) across Indian
resources; this situation might result in a poor effect states, there is little evidence in the literature (Jakovljevic
of policy implementation in controlling the pandemic et al., 2016).
(Ghaffari Darab et al., 2021; GBD 2016 Occupational Risk The extant research indicates a strong correlation
Factors Collaborators, 2020). When fiscal resources are between COVID-19 fatalities and the financing of
scarce, public health spending should be directed toward
scientific and effective policies (Tyrovolas et al., 2018). healthcare systems (Moolla & Hiilamo, 2023; Ma et al.,
Historically, challenges in coping with sudden health and 2022), coupled with the unexpected healthcare expenditures
natural emergencies have devastating consequences across incurred by both state and federal governments to combat
the pandemic. Therefore, this study offers comparative
the countries of the Global South (Jakovljevic et al., 2021; insights into fiscal discipline regarding health expenditure
Walker et al., 2020). Essential medicines and sanitary between the pre-COVID-19 and COVID-19 periods.
consumables were mostly delivered promptly; however,
difficulties arose due to insufficient fiscal reserves, that By examining the fiscal management of health spending
is, budgetary savings (Maqbool et al., 2023; Shaikh & before and during the pandemic, the research aims to
Ali, 2020; Hou & Hou, 2013) for extraordinary situations shed light on the effectiveness of resource allocation
such as floods, earthquakes, volcanic eruptions, military and financial preparedness in addressing public health
conflicts, and infectious disease epidemics (Josephson crises. This approach helps comprehend deviations from
et al., 2021; Local Burden of Disease Vaccine Coverage budgeted expenditure estimates at the onset of the health
Collaborators, 2021). Given the scarcity of financial crisis, which directly affects crisis management planning,
resources, particularly in a low-resource setting like India, particularly in the context of health system interventions
resource waste can have serious consequences, which during health emergencies (Vysochyna et al., 2023; Micah
increases the significance of predicting government budget et al., 2021). It is critical to discuss fiscal discipline at this
allocation. Various challenges can arise if government level, especially in light of the pandemic’s onset and the
estimates are inaccurate, resulting in unintended/adverse resulting public health disaster.
macroeconomic consequences (Sahoo et al., 2023). The present study looks at state-level health
Moreover, an unexpected need to finance the deficit expenditure, fiscal marksmanship, and COVID-19 cases in
occurs in cases where actual expenditure exceeds budgeted India. This research compared health expenditure between
expenditure (Sennoga & Balma, 2022). In contrast, if the the pre-COVID-19 and the COVID-19 period for India
actual expenditure is less than budgeted, there will be idle and selected states, investigated fiscal marksmanship in
resources that could otherwise be put to productive use. the context of health expenditure at the national and state
As a result, accurate forecasts are critical for proper budget level, and assessed the impact of fiscal marksmanship on
implementation. Regarding the global health spending COVID-19 deaths.
landscape, reliable projections are particularly relevant
for the emerging BRICS (Brazil, Russia, India, China, and 2. Data and methods
South Africa) markets that have led the world’s real gross The study examined the period from 2017 to 2021. Since
domestic product (GDP) growth for a long time (Sahoo the occurrence and peak of COVID-19 occurred primarily
et al., 2023b). in 2019 – 2021, it divided the analysis into two periods,
Fiscal marksmanship is an empirical test to detect that is, pre-COVID-19 (2017-late – 2019) and COVID-19
forecasting errors in macroeconomic variables such period (late-2019 – 2021). The study used data from
as deficits, expenditures, and revenues (Jani, 2022). Its India and selected Indian states. Data on fiscal indicators
primary objectives include estimating errors in forecasting on health were from different union and state budget
and identifying different parts of the error (Chakraborty documents, data on population density were from Census

Volume 3 Issue 3 (2025) 136 https://doi.org/10.36922/ghes.2920