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

District fund flow under NRHM and service delivery: some insights from Karnataka Dr.K.Gayithri Institute for Social and Economic Change, Bangalore

Background ,[object Object],[object Object],[object Object],[object Object]

Structure of presentation ,[object Object],[object Object],[object Object],[object Object],[object Object]

NRHM: PIP; Release; Expenditure ,[object Object],[object Object]

NRHM: PIP; Release; Expenditure percentages

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

NRHM expenditure in the study districts* (Rupees in Lakhs) ,[object Object],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

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

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)

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

Staff strength ,[object Object],[object Object],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

Poor alignment of releases and expenditure ,[object Object]

Receipt and Expenditure of NRHM Funds by District Hospital, Gulbarga

Fund Predictability and bunching of expenditure ,[object Object],[object Object],[object Object]

Policy correctives ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

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