Top

PharmacoEconomics - Open

Published in:

Open Access 01-12-2017 | Original Research Article

Utilization of Intergovernmental Funds to Implement Maternal and Child Health Plans of a Multi-Strategy Community Intervention in Haryana, North India: A Retrospective Assessment

Authors: Madhu Gupta, Federica Angeli, Hans Bosma, Shankar Prinja, Manmeet Kaur, Onno C. P. van Schayck

Published in: PharmacoEconomics - Open | Issue 4/2017

Abstract

Introduction

A multi-strategy community intervention known as the National Rural Health Mission (NRHM) was implemented in India from 2005 to 2012 in an attempt to reduce maternal and child mortality.

Objective

This study examined the extent to which the NRHM’s maternal and child health (MCH) sector plans were implemented. We observed trends in how intergovernmental (use of central government funds by state governments) budgets were allocated and used to implement MCH plans in Haryana, India.

Methods

We conducted a retrospective assessment of programme implementation plans, MCH budget allocation and expenditure and financial monitoring reports during the NRHM implementation period. The yearly budget utilization rate was calculated for each MCH strategy implemented. On the basis of this budget utilization rate, we classed the extent of MCH strategy implementation as fully, partially or not implemented. The status of MCH indicators before, during and after the NRHM period was obtained from national demographic surveys. The budget utilization rate was correlated with MCH outcomes.

Results

The overall budget allocated for MCH plans increased from $US6.6 million during the 2005–2006 period to $US66.7 million in the 2012–2013 period. The rate of budget utilization increased from 20.6% in 2007–2008 to 89% in 2012–2013. Expenditure exceeded the initially allocated budget for patient referral services (111.5%), human resources (110.1%), drugs and logistics (170%), accredited social health activists (133.3%) and immunization (106.4%). Additional budget was obtained from the state health budget. Plans for referral services, human resources, drug provision, accredited social health activists and immunization were fully implemented, few schemes (<1%) were not implemented, and all other schemes were only partially implemented. MCH indicators improved significantly (p < 0.05). The rate of institutional childbirth was highly and positively correlated with rates of budget utilization for implementing accredited social health activists (r = 0.96) and financial incentives for hospital delivery schemes (r = 0.5).

Conclusions

The trend for increasing use of the allocated budget for MCH strategies, improvement in MCH indicators and their positive correlation indicate better and more effective implementation of NRHM MCH strategies than in the past in Haryana, India. However, overall, the NRHM was only partially implemented.

Available only for authorised users

The World Bank. Maternal mortality ratio (modeled estimate per 100,000 live births). http://data.worldbank.org/indicator/SH.STA.MMRT. Accessed 5 Oct 2016.

The World Bank. Mortality rate, infant (per 1,000 live births). http://data.worldbank.org/indicator/SP.DYN.IMRT.IN. Accessed 5 Oct 2016.

Millennium Development Goals. Millennium project. http://www.unmillenniumproject.org/goals/gti.htm. Accessed 13 Oct 2016.

Nolan T, Angos P, Cunha AJ, Muhe L, Qazi S, Simoes EA, et al. Quality of hospital care for seriously ill children in less-developed countries. Lancet. 2001;357(9250):106–10.CrossRefPubMed

International Institute of Population Sciences. National Family Health Survey-3. Ministry of Health and Family Welfare. New Delhi. India. 2005–2006. http://rchiips.org/nfhs/pdf/India.pdf. Accessed 27 Apr 2017.

Government of India. Data.govin. Rural health statistics in India—2005. Report 2004-05. https://data.gov.in/catalog/rural-health-statistics-india-2005#web_catalog_tabs_block_10. Accessed 27 Apr 2015.

Ministry of Health and Family Welfare. National Health Mission. 2005–2012. http://www.pbnrhm.org/docs/mission_doc.pdf. Accessed on 27 Apr 2017.

Campbell OM, Graham WJ. Lancet maternal survival series, steering group. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–99.CrossRefPubMed

Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet. 2003;362:65–71.CrossRefPubMed

10.

Mosley WH, Chen LC, editors. Child survival: strategies for research. Population and development review: a supplement to volume 10. Cambridge: Cambridge University Press; 1984.

11.

Rustein OS. In: Setty-Venugopal V, Upadhyay UD, editors. Birth spacing: three to five saves lives. Population Reports, 2002 Series L (13). Baltimore: Johns Hopkins Bloomberg School of Public Health, Population Information Program; 2002.

12.

Rustein OS. Factors associated with trends in infant mortality in developing countries during 1990s. Bull World Health Organ. 2000;78:1256–68.

13.

Planning Commission. Evaluation study of National Rural Health Mission (NRHM) in 7 states. Programme Evaluation Organisation. Planning Commission. New Delhi: Government of India; 2011. http://planningcommission.nic.in/reports/peoreport/peoevalu/peo_2807.pdf. Accessed 29 June 2014.

14.

Mukherjee S. A study on effectiveness of NRHM in terms of reach and social marketing initiatives in rural India. Eur J Sci Res. 2010;42(4):573.

15.

Jain N, Srivastava NK, Khan AM, Dhar N, Adish V, Menon S, et al. Assessment of functioning of ASHA under NRHM in Uttar Pradesh. Health Popul Perspect Issues. 2008;31(2):132–40.

16.

Chaturvedi S, De Costa A, Raven J. Does the Janani Suraksha Yojna cash transfer program to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh. Glob Health Action. 2015;8:27427. doi:10.3402/gha.v8.27427.CrossRef

17.

Sah PK, Raut AV, Maliya CH, Gupta SS. Performance of village health, nutrition and sanitation committee: a qualitative study from rural Wardha, Maharashtra. Health Agenda. 2013;1(4):112–7.

18.

International Institute for Population Sciences. District Level Household and Facility Survey (Reproductive and Child Health Project). Ministry of Health and Family Welfare. New Delhi. India. http://www.rchiips.org/ARCH-1.html. Accessed 10 July 2013.

19.

Gupta M, Angeli F, Bosma H, Rana M, Prinja S, Kumar R, et al. Effectiveness of multiple-strategy community intervention in reducing geographical, socioeconomic and gender inequalities in maternal and child health outcomes in Haryana, India. PLoS One. 2016;11(3):e0150537.CrossRefPubMedPubMedCentral

20.

Kenney MK, Kogan MD, Toomer S, van Dyck PC. Federal expenditures on maternal and child health in the United States. Matern Child Health J. 2012;16(2):271–87. doi:10.1007/s10995-011-0745-5.CrossRefPubMed

21.

Lyatuu MB, Mkumbwa T, Stevenson R, Isidro M, Modaha F, Katcher H, Dhillon CN. Planning and budgeting for nutrition programs in Tanzania: lessons learned from the national vitamin A supplementation program. Int J Health Policy Manag. 2016;5(10):583–8. doi:10.15171/ijhpm.2016.46.CrossRefPubMedPubMedCentral

22.

Gupta M, Angeli F, van Schayck OCP, Bosma H. Effectiveness of a multiple-strategy community intervention to reduce maternal and child health inequalities in Haryana, North India: a mixed methods study protocol. Glob Health Action. 2015;2015(8):25987. doi:10.3402/gha.v8.25987.CrossRef

23.

Shenghelia B, Murray CJL, Adams OB, et al. Beyond access and utilization: defining and measuring health system coverage. In: Murray CJL, Evans DB, editors. Health systems performance assessment: debates, methods and empiricism. Geneva: World Health Organization; 2003. p. 221–35.

24.

National Health Mission. Financial Management Group. Available at http://mohfw.nic.in/index1.php?lang=1&level=1&sublinkid=95&lid=10. Accessed 27 Apr 2017.

25.

Ministry of Health and Family Welfare. Government of India. National Rural Health Mission. Operational guidelines for financial management. January 2012. http://www.upnrhm.gov.in/site-files/gogl/Operational_Guidelines.pdf. Accessed 4 Sept 2016.

26.

Ministry of Health and Family Welfare. Government of India. National Health Mission. State Program Implementation Plan. Available at http://nhm.gov.in/nrhm-in-state/state-program-implementation-plans-pips.html. Accessed 27 Apr 2017.

27.

Ministry of Health and Family Welfare. Government of India. National Health Mission. State Program Implementation Plans. Haryana. Available at http://nhm.gov.in/nrhm-in-state/state-program-implementation-plans-pips/haryana.html. Accessed 27 Apr 2017.

28.

Ministry of Health and Family Welfare. National Rural Health Mission. Framework for implementation. Government of India. New Delhi. 2005–2012. Available at http://www.nipccd-earchive.wcd.nic.in/sites/default/files/PDF/NRHM%20-%20Framework%20for%20Implementation%20-%20%202005-MOHFW.pdf. Accessed 27 Apr 2017.

29.

National Rural Health Mission, Govt. of India. Draft Record of Proceedings of the National Programme Coordination Committee (NPCC), to approve PIP of Haryana, held under the Chairmanship of Shri G. C. Chaturvedi, Additional Secretary and mission Director, NRHM for approval of NRHM Programme Implementation Plans of States and UTs for the year 2009–2010. http://www.nrhmharyana.gov.in/files/ROP%202009-10.pdf. Accessed 6 Apr 2015.

30.

NRHM Management Information System Reports. Available at http://www.nrhmharyana.gov.in/. Accessed 27 Apr 2017.

31.

International Institute of Population Sciences. District Level Household Survey-2. Reproductive and Child Health Project. Ministry of Health and Family Welfare. New Delhi. Haryana. 2002-04. Available at http://rchiips.org/pdf/state/Haryana.pdf. Accessed 27 Apr 2017

32.

International Institute of Population Sciences. District Level Household survey-3. State Fact Sheet Haryana. Ministry of Health and Family Welfare. New Delhi. India. 2007–08. http://rchiips.org/pdf/rch3/state/Haryana.pdf. Accessed 27 Apr 2017.

33.

International Institute of Population Sciences. District Level Household survey-4. State Fact Sheet Haryana. Ministry of Health and Family Welfare. New Delhi. India. 2012–13. Available at http://rchiips.org/pdf/dlhs4/report/HR.pdf. Accessed 27 Apr 2017.

34.

W.K. Kellogg Foundation. Using logic models to bring together planning, evaluation and action. Logic Model Development Guide. Michigan: W.K. Kellog Foundation; 2004. pp. 1–14. https://ag.purdue.edu/extension/pdehs/Documents/Pub3669.pdf. Accessed 27 March 2017.

35.

Berman P. Health sector reform: making health development sustainable. Health Policy. 1995;32(1–3):13–28.CrossRefPubMed

36.

Brinkerhoff DW, Bossert TJ. Health governance: principal-agent linkages and health system strengthening. Health Policy Plan. 2014;29(6):685–93.CrossRefPubMed

37.

Kaur M, Prinja S, Kumar P, Kumar R. Decentralization of health services in India: barriers and facilitating factors. WHO South East Asia J Public Health. 2012;1(1):94–104.CrossRefPubMed

38.

Brixi H, Mu Y, Targa B, Hipgrave D. Engaging sub-national governments in addressing health equities: challenges and opportunities in China’s health system reform. Health Policy Plan. 2013;28:809–24. doi:10.1093/heapol/czs120.CrossRefPubMed

39.

Prinja S, Jeet S, Kaur M, Aggarwal AK, Manchanda N, Kumar R. Impact of referral transport system on institutional deliveries in Haryana, India. Indian J Med Res. 2014;139(6):883–91.PubMedPubMedCentral

40.

Singh SR. Public health spending and population health: a systematic review. Am J Prev Med. 2014;47(5):634–40. doi:10.1016/j.amepre.2014.05.017.CrossRefPubMed

41.

Prinja S, Kumar M, Pinto AD, Jan S, Kumar R. Equity in hospital services utilization in India. Econ Political Wkly. 2013;XLVIII(2):52–8.

42.

Gupta M, Mukherjee A, Sen TK, Sirinivasan R. Improving effectiveness and utilization of funds for selected schemes through suitable changes in timing and pattern of releases by the centre: a report of research project sponsored by the Planning Commission of India. New Delhi: National Institute of Public Finance and Policy; 2011. http://planningcommission.nic.in/reports/sereport/ser/ser_effect0304.pdf. Accessed 24 March 2017.

43.

Concurrent Audit of NHM Haryana at District Level. 2014–2015. http://www.nrhmharyana.gov.in/Writereaddata/userfiles/file/pdfs/concurrent_audit_2014_15_districts.pdf. Accessed 25 March 2015.

44.

Witter S, Jones A, Ensor T. How to (or not to) … measure performance against the Abuja target for public health expenditure. Health Policy Plan. 2014;29(4):450–5. doi:10.1093/heapol/czt031.CrossRefPubMed

45.

Fan VY, Iyer S, Kapur A, Mahbub R, Mukherjee A. Review of intergovernmental fiscal transfers for health: lessons learned and looking ahead. https://www.cgdev.org/sites/default/files/CGD-AI%20Consultative%20Review%20of%20IGFT%20for%20Health.pdf. Accessed 24 March 2017.

46.

Rao KS, Selvaraju S, Nagpal S, Sakthivel S. Financing of health in India. 2005. http://aksocculthelp.yolasite.com/resources/Health_Financing_of_Health_in_India.pdf. Accessed 6 May 2015.

47.

The World Bank. China 2030: building a modern, harmonious, and creative high-income society. Washington: The World Bank; 2012.

48.

Adam T, Hsu J, de Savigny D, Lavis JN, Rottingen JA, Bennett S. Evaluating health systems strengthening interventions in low-income and middle-income countries: are we asking the right questions? Health Policy Plan. 2012;27(Suppl 4):iv9–19.PubMed

Title: Utilization of Intergovernmental Funds to Implement Maternal and Child Health Plans of a Multi-Strategy Community Intervention in Haryana, North India: A Retrospective Assessment
Authors: Madhu Gupta
Federica Angeli
Hans Bosma
Shankar Prinja
Manmeet Kaur
Onno C. P. van Schayck
Publication date: 01-12-2017
Publisher: Springer International Publishing
Published in: PharmacoEconomics - Open / Issue 4/2017
Print ISSN: 2509-4262
Electronic ISSN: 2509-4254
DOI: https://doi.org/10.1007/s41669-017-0026-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Utilization of Intergovernmental Funds to Implement Maternal and Child Health Plans of a Multi-Strategy Community Intervention in Haryana, North India: A Retrospective Assessment

Abstract

Introduction

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2017

Choosing Between Unicompartmental and Total Knee Replacement: What Can Economic Evaluations Tell Us? A Systematic Review

Economic Evaluation of Fulvestrant 500 mg Compared to Generic Aromatase Inhibitors in Patients with Advanced Breast Cancer in Sweden

Development of a Procedure for the Government Provision of Bone-Anchored Prosthesis Using Osseointegration in Australia

Acknowledgement to Referees

Methodological Issues in Economic Evaluations Submitted to the Pan-Canadian Oncology Drug Review (pCODR)

Eliciting the Monetary Value of a Quality-Adjusted Life Year in a Greek Outpatient Department in Times of Economic Austerity