Figure 1 shows higher fund availability in 2019-20 compared to the subsequent two years, probably to address challenges posed by the Covid-19 pandemic in a timely manner in the district. The government reduced allocation in both 2020-21 and 2021-22. According to data compiled from RTIs, in 2018-19, the total fund allocated was Rs. 83.17 crore and Rs. 61.63 crore was released.

Figure 1: Availability of Funds Under NHM in Barabanki

Figure 2 shows the utilisation of funds under NHM in 2018-19 in Barabanki district was similar to that for the state. Of the Rs. 83.17 crore allocated for the district in 2018-19, only Rs. 59.18 crore was utilised. For Uttar Pradesh state, against its allocation of Rs. 5,431.9 crore, it utilised Rs. 3,792.24 crore.

Figure 2: Utilisation of Funds under NHM in 2018-19

NHM has 18 sub-components under which allocations are made to cater to the needs of different sections of the population in a holistic manner and ensure last-mile service delivery by strengthening the overall health infrastructure in the country. These are: (1) Service Delivery (Facility Based), (2) Service Delivery (Community Based), (3) Community Interventions, (4) Untied Funds, (5) Infrastructure, (6) Procurement, (7) Referral Transport, (8) Human Resources, (9) Training and Capacity Building, (10) Review, Research, Surveillance and Surveys, (11) Information Education Communication (IEC)/Behaviour Communication Change (BCC), (12) Printing, (13) Quality Assurance, (14) Drug Warehousing and Logistics, (15) Public-Private Partnership (PPP), (16) Programme Management, (17) IT Initiatives for strengthening Service Delivery and (18) Innovations (if any).

• Figure 3 shows that of the 18 sub-components of NHM, the allocation to human resources was the highest in both 2019-20 and 2020-21. This indicates that the provision of adequate staff has been prioritised to ensure effective healthcare delivery in the district.
• Human resources is followed by allocations to community interventions and facility-based service delivery. However, allocations declined in 2020-21 compared to 2019-20. Among other major sub-components, procurement saw an increase in 2020-21.             

Figure 3: Trends in Budgetary Allocation for Major Sub-Components of NHM in Barabanki

Figure 4 shows the per capita allocation of funds in Barabanki district in 2018-19 was Rs 182, which was only Rs 8 lower than the state figure.

Figure 4: Per Capita Health Expenditure Under NHM in 2018-19 (Rs)

Figure 5 shows that in the five-year period to 2019-20, Barabanki has mostly trailed Uttar Pradesh in share of inpatient departments (IPDs) to outpatient departments (OPDs). This implies that adequate allocation of funds for the provision of tertiary and critical care still needs to be prioritised in the district.

Figure 5: Share of IPDs to OPDs (%)

As per the Indian Public Health Standards (IPHS) guidelines, a population of 3,000-5,000 should be covered by Sub Centres (SCs), 20,000-30,000 by Primary Health Centres (PHCs), 80,000 by Community Health Centres (CHCs) in tribal/hilly and 1,20,000 in plain areas. Figure 6 represents per capita availability of various types of health centres in Barabanki as on 31st March, 2021.

Figure 6: Per Capita Availability of Various Types of Health Centres

The availability of health centres in Barabanki is far from the standards prescribed by the IPHS guidelines. In Barabanki, the average population is 1,71,000 per CHC, 57,200 per PHC and 9,300 per SC. These numbers are higher for Uttar Pradesh: 2,65,000 per CHC, 68,300 per PHC and 9,600 per SC.

According to the PIP, budgetary allocation for the annual maintenance of district hospitals, CHCs, PHCs, Sub Centres, VHSCs (Village Health Sanitation and Nutrition Committee) and additional untied funds was Rs 2.31 crore in 2019-20 and Rs 3.04 crore in 2020-21.

There is also allocation of funds under infrastructure components amounting to Rs 60 lakh and Rs 523.3 lakh in 2019-20 and 2020-21, respectively. Significant funds allocated in 2020-21 under infrastructure was under the sub-head infrastructure strengthening of sub-centres to health and wellness centres (H&WC).

Institutional deliveries: Figure 7 shows that maternal healthcare in Barabanki is highly dependent on the availability and accessibility of public health facilities in the district. Institutional deliveries have exceeded the state average in the last few years. Even as the share of institutional deliveries declined in the state, it remained constant for Barabanki, aided by financial assistance granted to mothers under the Janani Suraksha Yojana (JSY) of NHM.

Figure 7: Institutional Deliveries in Barabanki (%)

Ante-natal check-ups (ANCs): Figure 8 shows that of the pregnant women registered in these five years, only 59% received four antenatal check-ups, with the share being the lowest in 2017-18. This gradually increased owing to greater resource availability.

Figure 8: Pregnant Women Who Received Ante-Natal Check-Up (ANC) in Barabanki (%)

Treatment of anemia: Figure 9 shows that prevalence of anaemia between 2015-16 and 2020-21 has increased for both groups of women—pregnant as well as others, with the increase being more for the former. This indicates that more attention needs to be paid to treat anaemia in the district, especially among pregnant women.

Figure 9: Incidence of Anaemia Among Women in Barabanki (Age Group 15-49 Years, %)

Safety of Home Deliveries: Figure 10 shows that in spite of facilities for institutional deliveries in Barabanki, a considerable segment of pregnant women prefer home deliveries over institutional deliveries in the district. However, it’s a matter of serious concern that a very low share of home deliveries were attended by skilled birth attendants (SBA), increasing the risk of unsafe home deliveries causing mortality and other complications. Thus, adequate provisioning of resources is required to facilitate safe home deliveries.

Figure 10: Share of Home Deliveries Attended by Skilled Birth Attendants in Barabanki (%)

Figure 11 shows that adoption of permanent methods of sterilization has remained constant in Barabanki in the five-year period to 2019-20, but has declined for the state. This has been due to the adequate provisioning of resources under the RCH pool of NHM to facilitate sterilisation services in public health facilities in the district.

Figure 11: Share of Public Institutions in Sterilizations (Tubectomies and Vasectomies) Conducted in Barabanki (%)

Figure 12 shows an improvement in child immunization in Barabanki by 14.7 percentage points between 2015-16 and 2019-20. However, adequate provisioning of funds for ASHA Workers still needs to be prioritised. Incentives for ASHAs under the immunization programme declined from Rs 1.57 crore in 2019-20 to 1.49 crore in 2020-21.

Figure 12: Fully Immunized Children (9-11 Months) in Barabanki (%)

Given the importance of NHM in providing affordable healthcare to a large section of the populace, different data/information about the scheme should be readily available and accessible to the common masses. Figure 13 lists essential NHM data points/information that are useful to various stakeholders for Barabanki. Hence, their availability and accessibility would be useful.

 Transparency and Accountability Index

Availability of Information and Comprehensiveness

Information on funds available

Yes; Information about availability of funds is available in PIP but some indicators such as opening balance, funds released, funds refunded and closing balance is compiled from RTI.

Information on funds utilized

Yes

Information on eligible beneficiaries under various sub-components of NHM

Yes

Gender-wise disaggregation of beneficiary data

No

Caste-wise disaggregation of beneficiary data

No

Geographical granularity of the fiscal indicator

Fund availability: Available Block/PHC-wise and component-wise

Expenditure of funds: Available only Block/PHC-wise and not component-wise

Information on number of PHCs/DH/SDH

Yes

Accessibility

Language in which information is available

English only

Compatibility on devices

Phone, tablet, laptop friendly

Timeliness

How frequently is data updated?

Yearly

Relevance

How relevant would users find it?

(i) Fiscal information pertaining to the budget approved/allocated is extensively available in state/district PIPs and RoPs for various years by components, but it is not aligned with the geographical granularity of the district. Expenditure data for various years is available only by geography and component, making it difficult to arrive at an aggregate picture of health sector spending in the district.

(ii) Data sources pertaining to various health outcomes, such as NFHS and HMIS, are quite extensive in their coverage and in providing adequate information in the public domain.

Reliability

Is the data reliable?

Relevant audit reports are not available on the NHM website. Hence, reliability of data has remained an issue.

Accountability and Citizens' Participation

Availability of information on social audit

Provisions for the same are not available on the NHM website.

Availability of information on grievance redressal

Provisions for the same are not available on the NHM website.

• Budget utilisation under NHM was 71% in 2018-19 in Barabanki, which shows an inadequate amount of utilisation. This resulted in accumulation of large unspent balances.
• Some areas where Barabanki has performed fairly well are facilitating of institutional deliveries, institutional sterilisation and child immunisation. The indicators for these have improved over time.
• Areas in which Barabanki has not performed well are overall maternal healthcare (high incidence of anaemic women and unsafe home deliveries), which poses a high risk of maternal mortality in the district.
• Overall availability of health infrastructure in Barabanki is inadequate given its population. Greater funds should be provided for while laying out the resource envelope for the district. Additionally, more funds should be allocated to build capacity among health workers and equip public health institutions with state-of-the-art facilities in the district so as to further improve health outcomes in the district.