Tracking Financial Resources For Primary Health Care In .
2017Tracking financialresources for primaryhealth care in BIHAR,IndiaPeter Berman, Manjiri Bhawalkar,Rajesh JhaA report of the Resource Tracking andManagement ProjectHarvard T.H. Chan School of Public HealthBoston, MA, USAJune 2017
Tracking financial resources for primary health care in BIHAR, IndiaTable of ContentsAcknowledgement. IIIAbbreviations.IVList of figures.VIList of tables.VII1. Introduction. 1Concept and purpose. 1Scope. 1Resource tracking and management framework. 1Key research questions.2Organization of the report. 32. Health Sector in Bihar. 4Demographic overview. 4Healthcare delivery network. 4Human resources in health. 4Health sector outputs and performance in Bihar.53. Methodology. 7Overview of the approach. 7Limitations.84. Budgeting and fund flow processes.115.Results.14Resource mobilization – trends and analysis.14Resource allocation – trends and analysis.17Health expenditure analysis.18Overall trends.18Expenditure by levels of care with focus on primary care. 21Expenditure by types of inputs. 23Budget execution and budget utilization analysis. 256. Conclusion.337. Policy implication and recommendations.34Annex 1: Data sources. 36Annex 2: District expenditure analysis.37Bibliography. 40
Tracking financial resources for primary health care in BIHAR, IndiaAcknowledgementThis study would not have been possible without the support of the state of Bihar, Bihar State Health Society,and the Bill and Melinda Gates Foundation. This study is financed by the Gates Foundation learning grant –Resource Tracking and Management/India. The authors acknowledge the Senior Program Officer, Dr. Hong Wang,for his unrelenting support and technical input. The authors are also grateful for the support from experts at theFoundation’s India Country Office, including, Sandhya Rao, Dr. Rajeev Ahuja, and Dr. Jack Langenbrunner; Ms UshaKiran,and Mr. Debarshi Bhattacharya for their India relevant policy advise. This study would not have been possiblefor incredible effort by Finance Consultant Mr KC Saha. His expertise and vast network of professional connectionsmade much of the data collection possible. The authors are indebted to several state treasury officers who took thetime and made available their staff during the data collection effort. Of particular note in the Department of Financeare Secretary - Resource and Expenditure Mr Venkatesh Prasad; Joint Secretary -Treasury Mr Kameshwar Ojha;Under Secretary – Budget, Mr Ajay Kumar Thakur, and their teams. The authors are grateful to the support fromChief Treasury Officers Rakesh Kumar Choudhari, Mohammad Sahik, and Mr Vijay Kumar Azad. Much gratitudeis owed to the State Health Society Bihar and its officers and accountants, particularly the Additional Director –Finance, Mr. Khalid Arshad. The team would also like to acknowledge the support from Population Foundation ofIndia for state level data.IIIAcknowledgement
Tracking financial resources for primary health care in BIHAR, IndiaAbbreviationsAHSAnnual Health SurveyANMAuxiliary Nurse MidwifeAPHCAdditional Primary Health CenterASHAAccredited Social Health ActivistBEBudget EstimateCAGComptroller and Auditor GeneralCHCCommunity Health CenterDDODrawing and Disbursing OfficerDHSDistrict Health SocietyDoMH&FWDepartment of Medical, Health & Family WelfareDPMUDistrict Program Management UnitEDLEssential Drug ListFCFinance CommissionFGDFocus Group DiscussionFMRFinancial Management Report (of NHM)FWFamily WelfareGDPGross Domestic ProductGoIGovernment of IndiaGPCEGovernment Primary Care ExpenditureGSDPGross State Domestic ProductHMISHealth Management Information SystemHRHuman ResourcesHSPHHarvard T.H. Chan School of Public HealthIDIIn-depth InterviewIMRInfant Mortality RateJSYJanani Suraksha Yojana (Mother/Maternal Safety Program)MFPMission Flexi Pool (of NHM)NDCPNational Disease Control ProgramNGONon-Government OrganizationNHMNational Health MissionNHSRCNational Health Systems Resource CenterNRHMNational Rural Health MissionIVAbbreviations
Tracking financial resources for primary health care in BIHAR, IndiaPHCPrimary Health CenterRBIReserve Bank of IndiaRCHReproductive and Child HealthRERevised EstimateRKSRogi Kalyan Samiti (Patient Welfare Committee)RoPRecord of ProceedingsRs.RupeesSHBState Health BudgetSHCSub Health CenterSHEState Health ExpenditureSHSBState Health Society BiharSPMUState Program Management UnitTGHBTotal Government Health BudgetTGHETotal Government Health ExpenditureTORTerms of ReferenceTRBTreasury Route BudgetUCUtilization CertificateUSDUnited States DollarsVHNDVillage Health and Nutrition DayVHSNCVillage Health, Sanitation and Nutrition CommitteeVAbbreviations
Tracking financial resources for primary health care in BIHAR, IndiaList of figuresFigure 1: Resource tracking and management framework.2Figure 2: Channels of Treasury and Society budgets for health. 12Figure 3: State’s own revenues and central support.14Figure 4: Composition of central funds to Bihar. 15Figure 5: Allocation of funds between sectors over time. 15Figure 6: Bihar health budgets over time. 16Figure 7: Budget allocations by levels of care.17Figure 8: Resource allocation ratios.18Figure 9: TGHE with NHM share. 20Figure 10: Relative growth rate of health expenditure in Bihar. 20Figure 11: Per capita expenditure on health. 21Figure 12: Per capita expenditure on primary care. 22Figure 13: Health expenditure (treasury route) trend by functions. 22Figure 14: Expenditure by types of inputs: 2012-13 & 2013-14. 23Figure 15: Utilization of health budgets in Bihar: 2007-08 to 2013-14. 26Figure 16: Utilization rates by cost inputs & levels of care.27Figure 17: NHM utilization by components. 29Figure 18: Utilization of Mission Flexi Pool budget lines under NHM. 29Figure 19: NHM MFP line item budget shares and utilization rates. 30Figure 2A: Real growth in TGHE in Bihar study districts between 2009-10 & 2014-15. 38Figure 2B: Impact of NHM on primary care expenditure levels in Bihar study districts. 39VIList of Figures
Tracking financial resources for primary health care in BIHAR, IndiaList of tablesTable 1: Performance against select health indicators in EAG States: a comparative overview.5Table 2: Bihar health sector performance against key impact indicators.6Table 3: Coding of budget heads using the NHSRC Budget Tracking Toolkit. 7Table 4: Sample units & tools for the qualitative component.8Table 5: Type of health facilities as per population norms under the Indian PublicHealth Standards.9Table 6: Sources and managers of funds in Bihar health system. 12Table 7: Total health budget by source. 16Table 8: Total government health budget and expenditure in Bihar. 19Table 9: Health expenditure trends in Bihar. 19Table 10: Primary care expenditure through different routes. 21Table 11: Expenditure on drugs & pharmaceuticals. 24Table 12: Utilization rates under NHM in Bihar. 26Table 2A: TGHE in study districts in Bihar.37Table 2B: NHM as a share of TGHE in study districts in Bihar.37Table 2C: Year-on-year growth rate in TGHE (adjusted at 2004-05 prices).37Table 2D: Primary care as a share of TGHE in study districts in Bihar. 38VIIList of Tables
Tracking financial resources for primary health care in BIHAR, India1. IntroductionThe performance of a country’s health system is determined by a number of factors, including those related tosystem financing. Improvement in health of the population, financial risk protection and citizen satisfaction arethree main goals often used to assess health system performance (Roberts et al., 2003). Developing strategies tomeet those goals, enabling mid-course correction, and measuring health system performance rely on availability ofsound data. To play an effective stewardship role in providing healthcare to its citizens, government needs evidenceof how well health resources are managed (Powell-Jackson et al., 2007). Health resource tracking can be an integralpart of governments’ efforts to strengthen the health system.The post-2015 development (Sustainable Development Goals) agenda includes a renewed focus on Universal HealthCoverage (UHC) and more emphasis clearly on system-strengthening approach. Primary care, including preventiveservices and maternal and child health, forms the backbone of a cost-effective health system. Health resourcetracking can be applied to government financing of primary health care as one contribution to strengthening healthsystems.Concept and purposeThe Resource Tracking and Management (RTM) Project at Harvard T.H. Chan School of Public Health (HSPH)helps improve understanding of the financing of primary health care in Ethiopia and India and its effects on healthsystem performance. This project was funded by a grant from the Bill and Melinda Gates Foundation. The grantincludes the opportunity for learning from India, with a specific focus on Uttar Pradesh and Bihar. Following aninitial rapid assessment (Berman et al, 2013) and consultation with India’s Ministry of Health and Family Welfareand the Gates Foundation’s India Office it was decided that grant activities would focus on the following questions:what is the total resource envelope for primary care (including state and central contributions); whether allocationof public resources for primary care activities is well aligned with resources needed; whether there is adequateutilization of the allocated funds; whether primary care spending is purchasing the right mix of inputs to assuredelivery of maximum outputs; and eventually better targeting of primary care resources to benefit the poor.ScopeThe scope of this report is limited to public sector financing in the state of Bihar only, and does not include privatesector or household expenditures on health. Two other reports, one on Uttar Pradesh and the other at the nationallevel, have also been prepared under the RTM project.Financial scopeWe analyzed budget allocation and expenditure data for seven years (from financial year 2007-08 to 2013-14). Thescope includes government financing through the budget / treasury route (funds pooled by the state from generaltaxation) and through other sources of central government support for health routed through the Department ofHealth and Family Welfare and the State Health Society, Bihar.Geographical scopeAnalysis at the state level is based on the consolidated financial and output data for the entire state of Bihar. Inaddition, six districts Bhagalpur, Darbhanga, East Champaran, Kishanganj, Patna and Sheohar were identified for adeeper dive to better understand expenditure trends and use of government funds.Resource tracking and management frameworkThe study used the Resource Tracking and Management (RTM) project framework presented in Figure 1 below.1Introduction
Tracking financial resources for primary health care in BIHAR, IndiaFigure 1: Resource tracking and management frameworkResourceMobilizationWhat are thedeterminants of totalresource envelope forhealth at national andsub-national levels?ResourceAllocationHow are fundsallocated to differentprograms andfunctions at nationaland sub-nationallevels? What factorsdetermine theallocation to primarycare?ResourceUtilizationAre the allocatedfunds beingutilized? Whatfactors drivesuccessful budgetexecution? Whatare the existingbottlenecks?ResourceProductivityHow effectivelyare resourcesbeing translatedinto services?What are theeffects on volumeand quality?ResourceTargetingAre inputs benefitingthe intendedindividuals andpopulation? Is publicspending reaching thepoor?Key research questionsBased on the above framework, the study looked at compositional changes in allocation and expenditure patternsacross different levels of care with special focus on primary care and across cost inputs (human resource, operationalcosts, drugs and pharmaceuticals and capital projects).The study addressed the following questions:a. What are the total government health budgets and expenditures in Bihar and how are they distributedacross cost categories, and across time?b. What is the priority accorded to the health sector vis-à-vis other social sectors as per budget allocations bythe state government?c. What are the sources of financing for government spending and what are their shares?d. What is the trend of actual expenditure versus budget/allocation across time?e. What is the total government health expenditure as a percentage of the total government expenditure?What is the trend across time? How does it vary for Society and Treasury routes?f.What is the total government expenditure on primary care as a share of the total government expenditureon health?g. What is the per capita state government health expenditure over time?h. How much is being spent on drugs and pharmaceuticals over time?i.To what extent do budget allocations result in actual expenditures? Are there any differences in budgetutilization between Treasury and Society routes? What are the factors that facilitate or inhibit utilizationof funds?2Introduction
Tracking financial resources for primary health care in BIHAR, IndiaOrganization of the ReportThe next section summarizes the performance of the health sector in Bihar, followed by the methodological approachwe employed to understand the resource flows in Bihar. The
Tracking financial resources for primary health care in BIHAR, India Acknowledgement This study would not have been possible without the support of the state of Bihar, Bihar State Health Society, and the Bill and Melinda Gates Foundation. This study is financed by the Gates Foundation learning grant – Resource Tracking and Management/India.
Bruksanvisning för bilstereo . Bruksanvisning for bilstereo . Instrukcja obsługi samochodowego odtwarzacza stereo . Operating Instructions for Car Stereo . 610-104 . SV . Bruksanvisning i original
10 tips och tricks för att lyckas med ert sap-projekt 20 SAPSANYTT 2/2015 De flesta projektledare känner säkert till Cobb’s paradox. Martin Cobb verkade som CIO för sekretariatet för Treasury Board of Canada 1995 då han ställde frågan
service i Norge och Finland drivs inom ramen för ett enskilt företag (NRK. 1 och Yleisradio), fin ns det i Sverige tre: Ett för tv (Sveriges Television , SVT ), ett för radio (Sveriges Radio , SR ) och ett för utbildnings program (Sveriges Utbildningsradio, UR, vilket till följd av sin begränsade storlek inte återfinns bland de 25 största
Hotell För hotell anges de tre klasserna A/B, C och D. Det betyder att den "normala" standarden C är acceptabel men att motiven för en högre standard är starka. Ljudklass C motsvarar de tidigare normkraven för hotell, ljudklass A/B motsvarar kraven för moderna hotell med hög standard och ljudklass D kan användas vid
LÄS NOGGRANT FÖLJANDE VILLKOR FÖR APPLE DEVELOPER PROGRAM LICENCE . Apple Developer Program License Agreement Syfte Du vill använda Apple-mjukvara (enligt definitionen nedan) för att utveckla en eller flera Applikationer (enligt definitionen nedan) för Apple-märkta produkter. . Applikationer som utvecklas för iOS-produkter, Apple .
Object tracking is the process of nding any object of interest in the video to get the useful information by keeping tracking track of its orientation, motion and occlusion etc. Detail description of object tracking methods which are discussed below. Commonly used object tracking methods are point tracking, kernel tracking and silhouette .
och krav. Maskinerna skriver ut upp till fyra tum breda etiketter med direkt termoteknik och termotransferteknik och är lämpliga för en lång rad användningsområden på vertikala marknader. TD-seriens professionella etikettskrivare för . skrivbordet. Brothers nya avancerade 4-tums etikettskrivare för skrivbordet är effektiva och enkla att
Den kanadensiska språkvetaren Jim Cummins har visat i sin forskning från år 1979 att det kan ta 1 till 3 år för att lära sig ett vardagsspråk och mellan 5 till 7 år för att behärska ett akademiskt språk.4 Han införde två begrepp för att beskriva elevernas språkliga kompetens: BI
