District-Level NRHM Funds Flow and Expenditure

Abstract

The issue of small and declining health sector financing by the central and state governments in India is addressed by the launching of National Rural Health Mission in 2005-06. Bottom up planning starting with village as unit used as the main strategy of NRHM to meet the region specific health needs would serve well to promote health sector development. The provision of effective and quality health services with a special focus on the backward districts with weak human development is also slated to be an important objective of NRHM. Analyzing the district level NRHM funds flow and expenditure in Karnataka the present paper argues that the district wise allocations are wrought with poor expenditure planning. Program implementation plans and allocations significantly vary from one another. Such deviations in the earmarking of planned funds defy the very purpose of stringent bottom up planning involving colossal manpower and financial resources to track the grass root felt needs. In addition such aberrations do not help the government in the achievement of professed outcomes. This is a serious lapse in NRHM implementation and can seriously distort the effectiveness of public spending and to be taken care of in future. Utilisation of the allocated resources is poor and there is absolute mismatch between the planned estimates for important components of NRHM like RCH, NRHM additionalities, Disease control program and Immunisation and actual expenditure. Enhancing the government health sector financing in a big way to reach 2-3 percent mark of GDP by 2012 has been an important objective of National Rural Health Mission (NRHM) launched by the Government of India in 2005-06. Both the Central and state governments share the responsibility of enhancing the government spending. As we get closer to 2012, it is necessary to review the success of the NRHM in enhancing the health sector funding by the government, more importantly to know how effectively these funds have got transmitted to the grass root level to be translated to healthcare services. Regarding the aggregate funding of the health sector at the national level to reach 2-3 percent level, it has been observed that while the health sector outlay as a percent of GDP has been increasing ever since the launch of NRHM, it is unlikely that the goal of 2-3 percent of GDP would be reached by 2012. (Berman et al, 2010) At the grassroots level important issues in translating outlays into outcomes relate to whether funding reflects the local needs as identified in the Program Implementation Plan (PIP); whether adequate and timely funding is provided to the health facilities in the districts; whether the backwardness focus that NRHM professes to achieve is attained or not. This gains special importance in the context of NRHM policy pronouncements to provide accessible, affordable, accountable, effective and quality healthcare services, especially to the rural population and vulnerable groups throughout the state with special focus on the backward districts with weak human development and health indicators especially among the poor and marginalized groups like women and the vulnerable sections of the society. (NRHM, Mission document, 2005) The main strategy of the NRHM adopted for the purpose is the decentralized planning in the form of health plans prepared starting with village as a 1 Faculty of Economics, Institute for Social and Economic Change, Nagarabhavi, Bangalore 560072 can be reached at gayithri@isec.ac.in