District-Level NRHM Funds Flow and Expenditure

Karnam, Gayithri

doi:10.1177/0019466220120207

Cited by 4 publications

(2 citation statements)

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“…A study on fund flow and service delivery in two districts of Karnataka, by Gayithri highlighted the mismatch between funds released and needs of the district. The expenditure was not in synchrony with the rise in fund allocation, indicating lack of skill to utilise resources in the sub‐district levels 11 …”

Section: Nrhm Rch Flexipoolmentioning

confidence: 98%

“…The expenditure was not in synchrony with the rise in fund allocation, indicating lack of skill to utilise resources in the sub-district levels. 11 There are many challenges faced during utilisation of funds. Studies have shown that there is a delay of around two to 3 months in allocation of the funds to the State and also from the State to the Districts.…”

Section: Nrhm Rch Flexipoolmentioning

confidence: 99%

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Planning and financing of RMNCH+A under National Health Mission: A case study of the Gurugram District of Haryana State

Gaylong

Tiwari

2023

Health Planning & Management

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Background The Health Planning Process under National Health Mission (NHM) is participatory in nature and the State Programme Implementation Plan (PIP) is an aggregation of District PIPs which is examined and approved by the National Programme Coordination Committee (NPCC), Ministry of Health and Family Welfare, Government of India. Many times there are delays in releasing of Record of Proceedings (ROPs)/approvals. This affects utilisation of NHM funds at district level and below and desired outcomes are not achieved. The present study aims to analyse the process of fund flow, disbursement and utilisation of funds on various components under Reproductive Maternal New born Child and Adolescent Health (RMNCH+A) in the district Gurugram. Methodology The study was conducted in the District Gurugram of Haryana State, India. One Community Health Centres (CHCs), two Primary Health Centres (PHCs) and four Sub Health Centres were randomly selected. Primary and secondary data were collected in the study. Medical Officer (I/C), Accounts Staff and Health Workers were interviewed using separate schedules regarding process of disbursement, delays in release and utilisation of funds. Separate checklists were prepared to collect data on availability and utilisation of funds at District, CHC and PHC levels under different components of programme. Findings Study found that PIP is prepared with inputs from Block level but community participation at (PHC) and below was not present. There was a delay in reaching funds to district due to delayed release of ROPs. Almost 30%–40% of the budget could not be utilised due to delay in receiving of budget. Utilisation of funds was less in some programme activities due to vacant positions project staff. Only 38% and 31% of the funds were utilised under the child health and family planning budget head for the district of Gurugram in the year 2016–17. Accounts staffs were overburdened which affected monitoring of funds utilisation. Budget release from State to District and below was through e‐Banking. Auxiliary Nurse Midwives (ANMs) at Sub centre used to get Untied Funds at the end of third quarter. The Government introduced new 18 broad budget heads in NHM Budget for improving utilisation of budget. Conclusion Delayed release of ROPs and erroneous estimation of budget under the programme, very rigid and large number of budget heads poses challenges of understanding and analysing expenditure and affects utilisation of funds under the NHM. Moreover, vacant positions in the programme, unrealistic planning, weak community participation in planning of expenditure and unexplained budget cut in ROPs were main challenges faced by the District.

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Section: Nrhm Rch Flexipoolmentioning

confidence: 98%

Section: Nrhm Rch Flexipoolmentioning

confidence: 99%

Planning and financing of RMNCH+A under National Health Mission: A case study of the Gurugram District of Haryana State

Gaylong

Tiwari

2023

Health Planning & Management

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Resource flow and fund management at district level in Odisha: Evidence for improving district health systems in developing countries

Rout¹,

Chandrashekar

Kadam³

2022

Health Planning & Management

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Planning, budgeting and utilisation of resources at the district level are critical issues for strengthening district health systems. The objectives of this study are to examine budget making, budget execution and budget monitoring processes at the district level; analyse the trend and pattern of public health expenditure at district level. Two districts based on district development index were selected.A mixed-method study design, both quantitative and qualitative, was used. Quantitative data on resource allocations and utilisation by the government for health were collected and analysed. Qualitative interviews were conducted with government officials to examine budget making, execution and monitoring processes. Resources are transferred through treasury and state health society (SHS) to public health institutions at the district level. Bottom-up planning process is mainly followed for money routed through SHS constituting 36%-40% of total district spending. It takes around 21 days to transfer funds from the treasury to the SHS and the district gets a major proportion of total funds within 10-15 days. Overall, utilisation of resources is around 80%-85% under treasury and 71%-85% under National Health Mission. However, utilisation for specific programmes, non-communicable diseases, is extremely low.Multiple bank accounts, number of rules and regulations at each layer of administration make the system complex.There is a lack of integration of different programmes at the district and below. This study suggests to get rid of input-

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Decentralization and decision space in the health sector: a case study from Karnataka, India

Seshadri

Parab

Kotte

et al. 2015

Health Policy Plan.

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Various attempts have been made in India with respect to decentralization, most significantly the 73rd Amendment to the Constitution of India (1993) which provided the necessary legal framework for decentralization to take place. However, the outcome has been mixed: an evaluation of the impact of decentralization in the health sector found virtually no change in health system performance and access to health services in terms of availability of health personnel or improvement in various health indicators, such as Infant Mortality Rates or Maternal Mortality Ratio. Subsequently, there has been a conscious effort under the National Rural Health Mission (NRHM)-launched in 2005-to promote decentralization of funds, functions and functionaries to lower levels of government; and Karnataka had a head-start since devolution of all 29 functions prescribed by the 73rd Amendment had already taken place in the state by the late 1990s. This study presents the findings of an on-going research effort to build empirical evidence on decentralization in the health sector and its impact on system performance. The focus here is on analyzing the responses of health personnel at the district level and below on their perceived 'Decision Space'-the range of choice or autonomy they see themselves as having along a series of functional dimensions. Overall, the data indicate that there is a substantial gap between the spirit of the NRHM guidelines on decentralization and the actual implementation on the ground. There is a need for substantial capacity building at all levels of the health system to genuinely empower functionaries, particularly at the district level, in order to translate the benefits of decentralization into reality.

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District-Level NRHM Funds Flow and Expenditure

Cited by 4 publications

References 2 publications

Planning and financing of RMNCH+A under National Health Mission: A case study of the Gurugram District of Haryana State

Planning and financing of RMNCH+A under National Health Mission: A case study of the Gurugram District of Haryana State

Resource flow and fund management at district level in Odisha: Evidence for improving district health systems in developing countries

Decentralization and decision space in the health sector: a case study from Karnataka, India

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