2017 Tracking Financial Resources for Primary Health Care in Uttar Pradesh, 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 Uttar Pradesh, India Table of Contents Acknowledgement ....................................................................................................................................... IV Abbreviations .................................................................................................................................................. V List of figures .................................................................................................................................................. VI List of tables .................................................................................................................................................. VII 1. Introduction ....................................................................................................................................................1 Concept and purpose .................................................................................................................................................... 1 Scope ................................................................................................................................................................................... 1 Key research questions ................................................................................................................................................2 Resource tracking and management framework ................................................................................................3 Organization of the report ...........................................................................................................................................3 2. Health sector in Uttar Pradesh .............................................................................................................4 Demographic overview ................................................................................................................................................. 4 Healthcare delivery network ......................................................................................................................................5 Human resources in health .........................................................................................................................................5 Health sector performance in Uttar Pradesh ........................................................................................................ 7 3. Methodology ............................................................................................................................................. 10 Overview of the approach ......................................................................................................................................... 10 Limitations ........................................................................................................................................................................13 4. Budgeting and fund flow processes ..................................................................................................14 5. Results ......................................................................................................................................................... 16 Resource mobilization – trends and analysis ......................................................................................................16 Resource allocation – trends and analysis ..........................................................................................................19 Health expenditure analysis – emerging trends ................................................................................................21 Expenditure analysis by cost inputs ..................................................................................................................... 25 Budget execution/utilization ......................................................................................................................................27 Resource productivity ..................................................................................................................................................37 6. Conclusion ..................................................................................................................................................41 7. Policy implication and recommendation ........................................................................................ 43 Tracking Financial Resources for Primary Health Care in Uttar Pradesh, India Annexes .......................................................................................................................................................... 44 Annex 1: Eight study districts – an overview ........................................................................................................44 Annex 2: Classifying Standard Objects of Expenses in the state budget into cost categories ...............47 Annex 3 Classification of NHM expenditure........................................................................................................48 Annex 4: District level expenditure analysis ...................................................................................................... 49 Annex 5 – Productivity analysis ............................................................................................................................. 52 Bibliography .................................................................................................................................................. 57 Tracking Financial Resources for Primary Health Care in Uttar Pradesh, India Acknowledgement This study would not have been possible without the support of the Department of Health and Family Welfare, Government of Uttar Pradesh, State Health Society (Uttar Pradesh) and the Bill and Melinda Gates Foundation. The study is financed as a part of 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. We are also grateful to the support from experts at the Foundation’s India Country Office in New Delhi, including, Sandhya Rao, Dr. Rajeev Ahuja, and Dr. Jack Langenbrunner; for their India relevant policy advise. The authors are indebted to several state officers who took the time and made available their staff during the data collection effort. Of particular note in the Department of Health and Family Welfare are Principal Secretary, Medical, Health and Family Welfare Arvind Kumar; Secretary Health and Family Welfare, Narayan Mishra; all the Chief Medical Officers, District Program Managers and District Accounts Managers from the 8 study districts; Chief Accounts Officer, Mr A K Vajpayee; Statistician, budget division Mr Rakesh Kumar and the World Bank financed UPHSSP Additional Project Director Dr G. P. Shahi. We are also very grateful to the full support of the State Health Society, UP starting with the NHM Mission Director, Mr Amit Ghosh; Senior Manager Finance, Mr Dharmendra Kumar and his team. We would be remiss if we don’t extend special thanks to the UP Technical Support Unit, Team Leader Mr Vikas Gothalwal and his team. IV Acknowledgement Tracking Financial Resources for Primary Health Care in Uttar Pradesh, India Abbreviations AHS Annual Health Survey ANC Ante Natal Care BCC Behavior Change Communication CHC Community Health Center DHS District Health Society DoMH&FW Department of Medical, Health & Family Welfare DPMU District Program Management Unit FMR Financial Management Report (under NHM) GDP Gross Domestic Product GoI Government of India GoUP Government of Uttar Pradesh GPCE Government Primary Care Expenditure GSDP Gross State Domestic Product HMIS Health Management Information System IEC Information, Education, Communication IUCD Intra Uterine Contraceptive Device JSY Janani Suraksha Yojana NHM National Health Mission NHSRC National Health Systems Resource Center NRHM National Rural Health Mission (now NHM) PHC Primary Health Center PRI Panchayati Raj Institution RKS Rogi Kalyan Samity RMNCH+A Reproductive, Maternal, Newborn, Child, and Adolescent Health RoP Record of Proceedings SHS State Health Society SIFPSA State Innovations in Family Planning Services Project Agency SPIP State Project Implementation Plan (of NHM) SPMU State Program Management Unit TGHE Total Government Health Expenditure UP Uttar Pradesh UPSACS Uttar Pradesh State AIDS Control Society VHSNC Village Health, Sanitation and Nutrition Committee V Abbreviations Tracking Financial Resources for Primary Health Care in Uttar Pradesh, India List of Figures Figure 1: Health resource tracking and management framework .....................................................................................3 Figure 2: Flow of public resources for health in UP ..............................................................................................................15 Figure 3: Growth in state’s own revenue and central support over time. .....................................................................16 Figure 4: Distribution of central grants and share of