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District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri
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District fund flow under National Rural Health Mission and service delivery: some insights from Karnataka - K. Gayithri

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  • the service delivery by pharmacist,doctor,nurses-health team in detail has to be highlighted
    raghukiran
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  • 1. District fund flow under NRHM and service delivery: some insights from Karnataka Dr.K.Gayithri Institute for Social and Economic Change, Bangalore
  • 2. Background
    • A part of a broader study that aimed at :
    • Developing a comprehensive picture of funds flows across all levels of healthcare services (state – district – block – individual health facilities), within the framework of “district health system”, which the NRHM aims at strengthening and empowering.
    • To track the district level funds flow and expenditure, 2 districts, which are representative of the variations expected in the healthcare provisioning in the state under study were selected- Gulbarga and Chitradurga.
    • Within each district sample of 1district hospital, 2 block level hospitals/FRUs, and 8 PHCs and sub centers, were selected in consultation with the state and district officials.
  • 3. Structure of presentation
    • State level NRHM funding: Whither need based planning?
    • District level fund distribution under NRHM: Karnataka Case
    • Select districts: fund flows; Fund decentralization major cost drivers
    • Fund predictability
    • Issues of concern and policy intervention
  • 4. NRHM: PIP; Release; Expenditure
    • PIP allocations do not get completely translated into releases and releases in turn are not completely spent.
    • Fund underutilization even while there are complaints of fund shortage is a clear anomaly
  • 5. NRHM: PIP; Release; Expenditure percentages
  • 6. NRHM funds: District wise share and per capita expenditure While the share of expenditure to a large extent reflects the need of the region going by its backwardness, they are clearly getting lesser funds in terms of per capita funding
  • 7. NRHM expenditure in the study districts* (Rupees in Lakhs)
    • Exp pattern in Gulbarga- A cause for concern An abs. decline in allocation Towards RCH,DCP And a sharp increase In NRHM additionalities -Chitradurga has a larger increase
    Head Chitradurga Gulbarga 2008-09 2009-10 Growth rate 2008-09 2009-10 Growth rate RCH 294.67 (38.79) 368.71 (44.07) 25.13 797.93 (52.83) 613.96 (40.53) -23.06 NRHM Additionalities 354.13 (46.61) 359.43 (42.96) 1.50 533.01 (35.29) 787.96 (52.01) 47.83 RI & DCP 110.91 (14.60) 108.56 (12.97) -2.12 179.53 (11.89) 113.02 (7.46) -37.05 Total 759.71 836.72 10.14 1510.47 1514.95 0.30
  • 8. Per Capita Expenditure * Per capita expenditure pertains to the entire district Source: District Financial Abstract Prepare by District Program Management Unit Head Chitradurga Gulbarga 2008-09 RCH 17.27 21.74 NRHM 20.76 14.52 RI & DCP 6.50 4.89 Total 44.53 41.15 2009-10 RCH 21.29 16.39 NRHM 20.75 21.03 DCP 6.27 3.02 Total 48.31 40.44
  • 9. Total funds and Fund Decentralization Health Expenditure (Rupees in Lakhs) Health sector funds are predominantly from the treasury route in both the districts. Share of district hospital is much larger in Gulbarga as Compared to that of Chitradurga- also seems to have better Fund Decentralization Facilities Chitradurga Gulbarga Treasury NRHM Total Treasury NRHM Total DHO 579.08 (12.99) NA 579.08 (12.99) 434.39 (7.74) NA 434.39 (7.74) District Hospital 2050.97 (46.02) 25.29 (0.57) 2076.26 (46.58) 3530.82 (62.93) 23.23 (0.41) 3554.05 (63.34) Taluk Hospital 633.21 (14.21) 17.88 (0.40) 651.09 (14.61) 562.54 (10.03) 19.94 (0.36) 582.48 (10.38) CHCs 470.93 (10.57) 20.85 (0.47) 491.78 (11.03) 393.89 (7.02) 39.03 (0.70) 432.92 (7.72) PHCs 478.98 (10.75) 46.45 (1.04) 525.43 (11.79) 483.15 (8.61) 60.64 (1.08) 543.79 (9.69) SCs 127.47 (2.86) 6.30 (0.14) 133.77 (3.00) 62.40 (1.11) 0.80 (0.01) 63.20 (1.13) Total 4340.64 (97.38) 116.77 (2.62) 4457.41 (100) 5467.19 (97.44) 143.64 (2.56) 5610.83 (100)
  • 10. Major cost drivers Facilities Chitradurga Gulbarga Treasury NRHM Treasury NRHM Salary Non Salary Salary Non Salary Salary Non Salary Salary Non Salary DHO 8.86 4.13 0.00 0.00 5.44 2.30 0.00 0.00 District Hospitals 42.19 3.82 0.05 0.51 56.89 6.04 0.00 0.41 Taluk Hospitals 12.84 1.36 0.07 0.33 9.62 0.41 0.12 0.24 CHCs 9.76 0.80 0.05 0.41 6.88 0.14 0.28 0.41 PHCs 10.47 0.28 0.35 0.69 8.39 0.22 0.47 0.61 SCs 2.82 0.04 0.00 0.14 1.06 0.05 0.00 0.01 Total 86.94 10.44 0.53 2.09 88.28 9.16 0.87 1.69
  • 11. Staff strength
    • Sanctioned and working positions at Group C level is higher in Gulbarga than Chitradurga
    • For every Doctor Chitradurga DH Has 1.74 Group C officers- Gulbarga has 5.62
    Staff Position of District Hospitals Designation Chitradurga Gulbarga Sanctioned Working Vacant Sanctioned Working Vacant Group A 28 23 5 49 39 10 Group B 15 4 11 10 5 5 Group C 103 40 63 289 219 70 Group D 148 75 73 255 118 137 Total 294 142 152 603 381 222
  • 12. Poor alignment of releases and expenditure
    • Complete mismatch between release and expenditure at all the facility levels
  • 13. Receipt and Expenditure of NRHM Funds by District Hospital, Gulbarga
  • 14. Fund Predictability and bunching of expenditure
    • Funds received by each sub center at varied points of time.
    • Funds received at the fag end of the financial year.
    • Instances of fund disbursal after the lapse of the financial year
  • 15. Policy correctives
    • PIPS, releases and expenditure to be better aligned
    • Enhance the planning rigor to better address the area needs. Population of a region and health needs to serve as a basis in resource allocation
    • Strict adherence to financial year releases and expenditure, no spillovers
    • Fund release to be better stream lined and rush of expenditure to be controlled
    • Maternity benefits reaching beneficiaries much after the event

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