Inter-State Disparities in Public Health Expenditure and Infant Mortality Rates: A Bivariate and Cluster Analysis

Abstract

India’s states spend very different amounts on public health, and their infants face very different chances of surviving the first year of life. This study asks how closely the two gaps travel together. Using official National Health Accounts estimates of per capita government health expenditure for 2019–20 and Sample Registration System infant mortality rates for 2020, we examine 18 major states through correlation, log-linear regression, and k-means cluster analysis. Spending varied more than five-fold, from ₹701 per person in Bihar to ₹3,829 in Himachal Pradesh, while infant mortality ranged from 6 per 1,000 live births in Kerala to 43 in Madhya Pradesh. The association was negative and moderate (Spearman’s ρ = −.48, p = .043), but per capita spending alone accounted for only about a fifth of the variation in infant mortality. Cluster analysis produced four state groupings (silhouette = .44). The most revealing was a group of six states, including Uttar Pradesh, Madhya Pradesh, and Odisha, whose spending sat close to the median but whose infant mortality remained the highest in the country. Bihar and Jharkhand, the lowest spenders, reported lower infant mortality than this group. The results suggest that additional money is necessary but not sufficient; how funds are converted into functioning maternal and newborn services appears to matter at least as much as the amount allocated