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Tracking Financial Resources for Primary Health Care in BIHAR, India

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Tracking Financial Resources for Primary Health Care in BIHAR, India 2017 Tracking financial resources for primary health care in BIHAR, India Peter Berman, Manjiri Bhawalkar, Rajesh Jha A report of the Resource Tracking and Management Project Harvard T.H. Chan School of Public Health Boston, MA, USA June 2017 Tracking financial resources for primary health care in BIHAR, India Table of Contents Acknowledgement ................................................................................................................................................ III Abbreviations ..........................................................................................................................................................IV List of figures ...........................................................................................................................................................VI List of tables ...........................................................................................................................................................VII 1. Introduction ............................................................................................................................................................ 1 Concept and purpose ............................................................................................................................................. 1 Scope ............................................................................................................................................................................ 1 Resource tracking and management framework .......................................................................................... 1 Key research questions .........................................................................................................................................2 Organization of the report ....................................................................................................................................3 2. Health Sector in Bihar .....................................................................................................................................4 Demographic overview ..........................................................................................................................................4 Healthcare delivery network ...............................................................................................................................4 Human resources in health ..................................................................................................................................4 Health sector outputs and performance in Bihar .........................................................................................5 3. Methodology ....................................................................................................................................................... 7 Overview of the approach .................................................................................................................................... 7 Limitations ..................................................................................................................................................................8 4. Budgeting and fund flow processes ..........................................................................................................11 5.Results ....................................................................................................................................................................14 Resource mobilization – trends and analysis ...............................................................................................14 Resource allocation – trends and analysis ...................................................................................................17 Health expenditure analysis ...............................................................................................................................18 Overall trends ..........................................................................................................................................................18 Expenditure by levels of care with focus on primary care ...................................................................... 21 Expenditure by types of inputs ........................................................................................................................ 23 Budget execution and budget utilization analysis .................................................................................... 25 6. Conclusion ..........................................................................................................................................................33 7. Policy implication and recommendations ..............................................................................................34 Annex 1: Data sources ........................................................................................................................................ 36 Annex 2: District expenditure analysis ..........................................................................................................37 Bibliography .......................................................................................................................................................... 40 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. 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 the Foundation’s India Country Office, including, Sandhya Rao, Dr. Rajeev Ahuja, and Dr. Jack Langenbrunner; Ms Usha Kiran,and Mr. Debarshi Bhattacharya for their India relevant policy advise. This study would not have been possible for incredible effort by Finance Consultant Mr KC Saha. His expertise and vast network of professional connections made much of the data collection possible. The authors are indebted to several state treasury officers who took the time and made available their staff during the data collection effort. Of particular note in the Department of Finance are 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 from Chief Treasury Officers Rakesh Kumar Choudhari, Mohammad Sahik, and Mr Vijay Kumar Azad. Much gratitude is 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 of India for state level data. III Acknowledgement Tracking financial resources for primary health care in BIHAR, India Abbreviations AHS Annual Health Survey ANM Auxiliary Nurse Midwife APHC Additional Primary Health Center ASHA Accredited Social Health Activist BE Budget Estimate CAG Comptroller and Auditor General CHC Community Health Center DDO Drawing and Disbursing Officer DHS District Health Society DoMH&FW Department of Medical, Health & Family Welfare DPMU District Program Management Unit EDL Essential Drug List FC Finance Commission FGD Focus Group Discussion FMR Financial Management Report (of NHM) FW Family Welfare GDP Gross Domestic Product GoI Government of India GPCE Government Primary Care Expenditure GSDP Gross State Domestic Product HMIS Health Management Information System HR Human Resources HSPH Harvard T.H. Chan School of Public Health IDI In-depth Interview IMR Infant Mortality Rate JSY Janani Suraksha Yojana (Mother/Maternal Safety Program) MFP Mission Flexi Pool (of NHM) NDCP National Disease Control Program NGO Non-Government Organization NHM National Health Mission NHSRC National Health Systems Resource Center NRHM National Rural Health Mission IV Abbreviations Tracking financial resources for primary health care in BIHAR, India PHC Primary Health Center RBI Reserve Bank of India RCH Reproductive and Child Health RE Revised Estimate RKS Rogi Kalyan Samiti (Patient Welfare Committee) RoP Record of Proceedings Rs. Rupees SHB State Health Budget SHC Sub Health Center SHE State Health Expenditure SHSB State Health Society Bihar SPMU State Program Management Unit TGHB Total Government Health Budget TGHE Total Government Health Expenditure TOR Terms of Reference TRB Treasury Route Budget UC Utilization Certificate USD United States Dollars VHND Village Health and Nutrition Day VHSNC Village Health, Sanitation and Nutrition Committee V Abbreviations Tracking financial resources for primary health care in BIHAR, India List of figures Figure 1: Resource tracking and management framework ........................................................................2 Figure 2: Channels of Treasury and Society budgets for health .......................................................... 12 Figure 3: State’s own revenues and central support ..................................................................................14 Figure 4: Composition of central funds to Bihar .......................................................................................... 15 Figure 5: Allocation
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