With development assistance for health collapsing globally and national budgets strained by record public debt, the article argues that the critical challenge for low- and middle-income countries is not merely raising health expenditure, but radically improving how existing allocations are executed, targeted, and governed.

• DAH peaked in 2021 during COVID-19 and has been declining since. In early 2025, the United States — historically contributing over one-third of all global DAH annually — announced cuts of approximately 67% to its foreign assistance programme, including health.
• The United Kingdom, France, and Germany followed with cuts of 39%, 35%, and 12% respectively. OECD estimates suggest total health funding could drop by up to 60% from its 2022 peak.
• The US cut directly threatens PEPFAR (which disbursed $7+ billion annually for HIV/AIDS treatment across Africa), Global Fund contributions, USAID's maternal and child health programmes, and pandemic preparedness financing.
• For sub-Saharan Africa — where DAH constitutes 20–30% of total health expenditure in many countries — these cuts represent a structural shock, not a marginal adjustment.

• Global public debt reached a record $102 trillion in 2024, with developing countries accounting for $31 trillion. Since 2010, developing-country public debt has grown twice as fast as that of advanced economies.
• In 2024, developing countries paid $921 billion in net interest payments on public debt (UNCTAD data) — a figure that directly crowds out health, education and infrastructure spending.
• The debt service-to-revenue ratio in many LMICs now exceeds 20–30%, leaving minimal fiscal space for social sector investment. The IMF has identified over 50 developing countries as being in debt distress or at high risk.
• This dual compression — falling aid and rising debt burden — means LMICs cannot simply wait for more money; they must extract greater value from existing allocations.

• World Bank data show health budgets in LMICs are executed at only 85–90% of allocation — lower than both general budget execution and education sector execution. This implies a structural de-prioritisation of health at the implementation stage.
• In India, a Parliamentary Standing Committee found that only about two-thirds of the allocation for the flagship health infrastructure mission (PM-ABHIM — Pradhan Mantri Ayushman Bharat Health Infrastructure Mission) was spent in 2024–25.
• Within the National Health Mission (NHM), the op-ed claims only 26% of funds earmarked for communicable and non-communicable disease control programmes was utilised in 2024–25. Note for students: independent programme-level data (NHM financial management reports) indicate utilisation rates for NDCP/NCD pools are typically closer to 47–50%; the 26% figure is the op-ed author's claim and should be treated as an assertion pending primary source verification, not a settled statistic.
• Low execution is typically driven by weak procurement systems, staff vacancies, bureaucratic delay in fund release, and poor demand-side awareness — not simply budget inadequacy.

• A fundamental allocation distortion in public health budgets: the bulk of spending goes to curative care at secondary and tertiary levels (hospitals, specialist services), while primary and preventive care — far more cost-effective and equity-enhancing — is underfunded.
• London School of Hygiene & Tropical Medicine estimates suggest India spends less than one-quarter of its public health money on preventive care — despite the outsized cost-effectiveness of prevention (immunisation, sanitation, early detection, vector control).
• The public goods argument: The strongest case for public health spending is in areas of genuine market failure — infectious disease control, sanitation, vector control, vaccination — where the private sector will under-supply because benefits are non-excludable. Curative services for common illnesses are largely deliverable by the private sector at competitive prices; public money spent there displaces, rather than complements, the market.
• As India's population ages (the share of population above 60 is projected to double from ~10% in 2024 to ~20% by 2050), the disease burden will shift toward non-communicable diseases (NCDs) — cardiovascular disease, diabetes, cancer, chronic respiratory conditions. Public spending will need to recalibrate toward risk factor reduction, screening, and long-term disease management.
• The goods-and-services execution gap is particularly damaging: wage bills are paid in full, but drugs, supplies and diagnostic equipment are under-procured, leaving paid health workers without tools to deliver quality care.

• Empirical evidence confirms a governance-spending interaction: countries with lower corruption and higher bureaucratic quality see significantly stronger positive effects of public health spending on child mortality, maternal health, and infectious disease outcomes. Simply increasing spending in weak governance environments fails to improve health outcomes.
• Decentralisation of health delivery to state and local government — India's NHM is a notable example — makes sub-national governance quality the decisive variable. A dysfunctional district health system absorbs central funds without producing health outcomes.
• Public Finance Management (PFM): Encompasses budget formulation, fund release mechanisms, procurement systems, accounting, audit and evaluation. PFM weakness is the single most common explanation for health budget under-execution. Key reforms: improving cash disbursement predictability, involving front-line health workers in budget planning, and introducing flexible contingency allocations for pandemic-scale events.
• Procurement reform offers large efficiency gains: the government is the dominant buyer of pharmaceuticals, vaccines and medical equipment. Better procurement (generic medicines, aggregated demand, e-procurement transparency) can stretch health rupees significantly without additional allocation.

• National Health Mission (NHM): Launched 2013, merging National Rural Health Mission (NRHM, 2005) and National Urban Health Mission (NUHM); the primary fiscal and programmatic vehicle for public health in India. Centrally sponsored scheme with 60:40 Centre-State funding ratio (for general states).
• PM-ABHIM (Pradhan Mantri Ayushman Bharat Health Infrastructure Mission): Launched October 2021; ₹64,180 crore outlay over 5 years; focuses on health infrastructure — critical care blocks, urban health and wellness centres, national disease surveillance network, virology labs.
• Ayushman Bharat — PM-JAY: Health insurance scheme covering secondary and tertiary hospitalisation for the bottom 40% of the population (₹5 lakh/family/year). Primarily curative in focus — illustrates the tertiary-care spending bias the article critiques.
• National Health Policy 2017: Targets public health expenditure of 2.5% of GDP by 2025 and primary care allocation of at least two-thirds of total public health expenditure. Neither target has been achieved.
• ASHA workers and Anganwadi: India's community health worker network — critical for last-mile primary and preventive care delivery under NHM. Their effectiveness is precisely the type of spending that warrants prioritisation under the article's framework.

• Structural under-funding still matters: The efficiency argument, while sound, risks being used to defer necessary spending increases. At 1.4% of GDP, India's public health spending is among the lowest in comparable economies; efficiency gains from better governance cannot substitute for the resource gap entirely.
• Execution gaps have political economy causes: Budget under-utilisation in health is not simply an administrative failure — it reflects political economy factors including the political salience of hospital-building over less visible preventive programmes, state capacity constraints in tribal and remote areas, and central-state fiscal tensions in a CSS framework.
• Governance reform is slow: The article correctly identifies governance as the multiplier, but PFM reform and bureaucratic capacity-building operate on decade-scale timelines — whereas the DAH collapse is immediate. The mismatch in timeframes is a real tension.
• Equity dimension: Better-governed states (Kerala, Tamil Nadu, Himachal Pradesh) are already performing well on health outcomes; the governance-efficiency prescription benefits them disproportionately. States with weakest governance (Bihar, UP, MP) — where health outcomes are worst — face the steepest reform barriers. A purely efficiency-focused framework may worsen inter-state health inequity.

India has built one of the developing world's most extensive protected-area networks, but the ecological realities of the 21st century — climate change, infrastructure expansion, and habitat fragmentation — demand a conservation paradigm shift: from isolated sanctuaries to connected, inclusive landscape-scale conservation through OECMs and ecological corridors.

• India's PA network covers only about 5% of the country's land area — well below the CBD's 30×30 target. But even where PAs exist, they are often too small and too isolated to sustain minimum viable populations of large mammals (tigers, elephants, leopards) that require contiguous range of hundreds of square kilometres.
• Habitat fragmentation: India's infrastructure expansion — National Highway network (approximately 1.46 lakh km), rail network (68,000+ km route km), power transmission lines, irrigation canals — has fragmented wildlife habitats into increasingly disconnected patches. Road kills are now a leading cause of wildlife mortality for species including elephants, leopards and sloth bears.
• Climate change: Habitat suitability is shifting altitudinally and latitudinally. Species must migrate to track their climate envelope; isolated PAs cannot accommodate such range shifts. The Himalayan ecosystem — glaciers, alpine meadows, montane forests — is particularly vulnerable, with documented upward shifts in species distribution ranges.
• Genetic exchange: Small, isolated populations suffer inbreeding depression. Genetic connectivity — the ability of individuals to move between populations and exchange genetic material — requires physical corridors of habitable land linking PAs.
• The "island biogeography" problem: MacArthur and Wilson's theory (1967) predicted that island-like habitat patches lose species over time at rates determined by area and isolation. India's fragmented PAs effectively behave as ecological islands — making biodiversity loss structurally inevitable without landscape connectivity.

• OECMs (Other Effective Area-based Conservation Measures) are defined under the CBD as "geographically defined areas other than Protected Areas, which are governed and managed in ways that achieve positive and sustained long-term outcomes for the in-situ conservation of biodiversity with associated ecosystem functions and services, and where applicable, cultural, spiritual, socio-economic and other locally relevant values."
• Operationalised under CBD Decision 14/8 (2018) at COP-14 in Sharm el-Sheikh; formally integrated into the Kunming-Montreal GBF (2022) as a key tool for achieving the 30×30 target.
• OECMs can include: community-managed forests and sacred groves, private wildlife conservancies, defence land with incidental biodiversity value, sustainably managed production forests, coastal and marine areas under community stewardship, and urban green spaces.
• The key distinction from PAs: OECMs do not require formal legal designation as "protected area" — they are recognised for their conservation outcomes regardless of primary management objective. A forest managed primarily for timber can be an OECM if it demonstrably delivers positive biodiversity outcomes.
• India's OECM potential: India has vast areas outside the formal PA network with significant biodiversity value — Van Panchayats in Uttarakhand, Community Forest Resource rights under the Forest Rights Act, 2006, sacred groves (Dev Vans/Devarakadus) across Western Ghats, Northeast, and tribal belts, privately conserved areas (PCAs), and military/defence forest areas. Formal OECM recognition would count these toward India's CBD commitments without requiring legal PA designation.

• The article proposes a National Conservation Estate — an ecological network comprising PAs, OECMs and other biodiversity-rich landscapes, irrespective of ownership, legal designation or primary management objective.
• This mirrors models in New Zealand, Canada, and parts of the EU, where "conservation estate" encompasses not just formal reserves but private land covenants, indigenous-managed territories, and production landscapes with conservation stewardship obligations.
• Ecological corridors are the physical connecting tissue — strips or networks of habitat linking PAs and OECMs, enabling wildlife movement. Examples in India include the Terai Arc Landscape (connecting Corbett-Dudhwa corridor), the Central Indian Corridor (Pench-Kanha), the Western Ghats corridor, and the Elephant corridors mapped by the Wildlife Trust of India (101 corridors identified nationally).
• The Delhi-Dehradun Economic Corridor (NH-334) has incorporated wildlife overpasses, underpasses and vegetated crossing structures as part of road design — cited in the article as proof that development and connectivity need not conflict.

• India has no dedicated OECM recognition mechanism in law. The Wildlife Protection Act and Forest (Conservation) Act do not use the OECM category. Formal OECM recognition would require either a new regulatory framework or an amendment to the Biological Diversity Act, 2002.
• The Forest Rights Act, 2006 recognises community forest resource (CFR) rights — a natural OECM candidate — but its implementation has been uneven; in many states, CFR rights remain patchy and disputed.
• The National Board for Wildlife (NBWL) under the Wildlife Protection Act approves diversion of PA land for development projects. Its decisions have been criticised for insufficient weight given to corridor impacts and landscape-level connectivity.
• Van Panchayats (community forest management bodies in Uttarakhand under the UP Panchayat Forest Rules, 1931 as adapted) manage over 500,000 hectares — a natural OECM base but currently unrecognised as such.

• OECM: Other Effective Area-based Conservation Measure — defined under CBD Decision 14/8 (2018); conservation outcome-based, not dependent on formal PA status.
• 30×30 Target: Kunming-Montreal GBF (CBD COP-15, December 2022) — 30% of land and 30% of oceans under effective conservation by 2030.
• National Biodiversity Authority (NBA): Statutory body under the Biological Diversity Act, 2002; headquartered in Chennai; regulates access to biological resources and benefit-sharing.
• Wildlife (Protection) Amendment Act, 2022: Brought in new schedules (Schedule I–IV replacing I–VI), increased penalties, and introduced provisions for recognising conservation reserves and community reserves — the legal category closest to OECMs in Indian law.
• Project Tiger / NTCA: National Tiger Conservation Authority — statutory body under Section 38 of the WPA (post-2006 amendment); manages Tiger Reserves as Critical Tiger Habitats + Buffer Zones; India has 58 Tiger Reserves as of 2025.
• Island Biogeography Theory: MacArthur and Wilson (1967) — species richness on habitat islands is a function of area and isolation; foundational ecological basis for corridor conservation.
• Delhi-Dehradun Economic Corridor: A greenfield 210 km expressway; includes 12 wildlife underpasses, overpasses and eco-friendly structures to maintain connectivity in the Shivalik foothills — cited in article as a positive example.
• Sacred Groves (Dev Van/Devarakadu): Community-protected forest patches with religious or customary significance; found across India (estimates range from 1–1.5 lakh groves); significant biodiversity reservoirs and natural OECM candidates.

• Governance of OECMs is contested: The OECM framework risks being gamed — governments may designate areas as OECMs to count toward 30×30 targets without genuine conservation management. Without robust additionality criteria and outcome monitoring, OECMs become a paper exercise.
• Community rights vs. conservation state: A "National Conservation Estate" must navigate the unresolved tension between tribal and forest-dwelling communities' rights (Forest Rights Act, 2006) and the state's conservation objectives. Past PA-establishment has involved forced displacement of communities (the "fortress conservation" model), and OECM frameworks that impose conservation obligations on community-managed land without community consent risk repeating this pattern.
• Corridor land acquisition: Establishing ecological corridors through private agricultural or settlement land requires either acquisition or payment for ecosystem services (PES) — both politically and financially challenging at scale.
• Infrastructure vs. ecology — structural conflict: The article cites the Delhi-Dehradun corridor as a positive example, but the Forest Conservation Act, 2023 amendments have been criticised by ecologists for exempting strategic road, rail and defence projects near PA boundaries from prior clearance requirements — a systemic regression even as project-level mitigation improves.