Health Empirics

India’s road-crash toll is large and rising. Earmarked road-safety revenue is meant to fund prevention and trauma care, but money collected is not a service delivered. We asked where the chain from earmarked receipt to health service broke, which fund design held best, and whether value for money could be assessed. We analysed the three eligible statewide Comptroller and Auditor General of India audits of road-safety systems or funds: Tamil Nadu (2013–2018), Kerala (2013–2018) and Karnataka (2014–2021). Forty-four page-linked findings were coded along an eight-stage conversion chain, and fund designs and financing funnels were compared without ranking states. Tamil Nadu spent ₹165.37 crore of a ₹946.19 crore receipt base (17.48%); Kerala transferred ₹173.12 crore of ₹608.63 crore statutorily due (28.44%); Karnataka transferred ₹480.50 crore of accumulated cess late and had used 2.27%. Every audit documented breaks in transfer, allocation, execution, monitoring and closure, and Karnataka’s cess remained untransferred for three years after its audit. No record allowed all four value-for-money dimensions to be judged. A statutory, non-lapsing fund with an automatic transfer share is necessary but not sufficient; release must be tied to a costed pipeline, commissioning conditions and one identifier linking spending to outcome.