Figure 1 shows the distribution of the NHM budget for Durg between NRHM (National Rural Health Mission) and NUHM (National Urban Health Mission). Since Durg is a relatively urban agglomeration (65% urban population), it would also be worthwhile to analyse the NUHM component in its case. Figure 1 shows that a substantial portion of the NHM budget goes to the NUHM component, though this has been declining.

Further, budget allocation under the NRHM component increased by around 43% in 2019-20— funds available increased from Rs 26.52 crore in 2018-19 to Rs 37.88 crore in 2019-20.

Figure 1: Availability of Funds under NHM for Durg and Chhattisgarh (%)

igure 2 shows the average budget utilization rate of NHM in Durg has been around 66% in the last two years. Expenditure increased by around 36% from Rs 18.15 crore in 2018-19 to Rs 24.68 crore in 2019-20, broadly keeping pace with the increased allocation of funds for the district.

Figure 2: Utilisation of Funds under NHM in Durg (Rs crore)

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 service delivery-human resources component saw the biggest increase in the district, followed by community interventions and service delivery-facility based. In other words, services facing a shortage in human resources have been a focus area.
• Budgetary allocation under community interventions grew at a slower pace due to a decrease in allocation for ASHA workers (particularly in JSY incentives).

Figure 3: Budgetary Allocation for Major Sub-Components of NHM for Durg (Rs lakhs)

Figure 4 shows the per capita fund allocation for both the district and the state increased continuously, coinciding with the Covid-19 and the health challenges posed by the pandemic across the country. However, Durg trails Chhattisgarh in per capita allocation.

Figure 4: Per Capita Allocation of Funds for Durg under NHM (Rs)

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 5 represents per capita availability of various types of health centres in Durg for 2021, and it shows that the district trails the state on availability of health facilities.

Figure 5: Per Capita Availability of Various Types of Health Centres in Durg

Institutional deliveries: Figure 6 shows that institutional deliveries conducted at public health facilities have increased in the district between 2015-16 and 2019-21, probably due to various incentives and budget provisioning made at the district level. However, a cause of concern is the safety of home deliveries. Only 2% of home deliveries in 2019-21 were conducted by a skilled birth attendant (SBA), against 11% in 2015-16.

Figure 6: Institutional Deliveries and Safety of Home Deliveries in Durg (%)

Ante-natal check-ups (ANCs): Figure 7 shows that the share of pregnant women who have undergone ante-natal check-ups (ANCs) in their first trimester has dropped significantly in Durg in the last 5 years. Overall, Chhattisgarh too has a seen a drop. This increases the risk of higher maternal mortality in the district arising from complexities during pregnancy.

Figure 7: Pregnant Women Who Received Ante-Natal Check-ups (ANC) in Durg (%)

Treatment of Anemia: Figure 8 shows that female anemic cases have increased in Durg, though at a slower rate than for the state of Chhattisgarh as a whole. This indicates that more resources has not led to an improvement in the overall health of women in the district.

Figure 8: Prevalence of Anaemia among Women in Durg (age group 15-49) (%)

Figure 9 shows that, in child vaccination, more than 90% of children in Durg received all three doses of polio and the DPT vaccine.Its figures are higher than that for the state as a whole. This indicates that fund utilisation in this regard has been efficient. Also, this has been done in public health institutions in the district (Figure 10).

Figure 9: Children Aged 12-23 months Who Received all 3 doses of Polio and DPT Vaccine (%)

Figure 10: Children Aged 12-23 months Who Received Most of their Vaccinations in Public Health Institutions (%)

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 11 lists essential NHM data points/information that are useful to various stakeholders for Durg. Hence, their availability and accessibility would be useful. The current level of information available has been evaluated as under:

 Transparency and Accountability Index

Availability of Information and Comprehensiveness

Information on funds available

Yes

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-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 in Durg has stayed constant, around the 60% mark. In absolute terms, while allocation increased, so did expenditure in commensurate terms.
• In spite of an increase in allocation, per capita allocation for the district trails the state figure. So, greater provisioning of resources can be a priority for the district administration.
• Some areas where the district has performed fairly well are the facilitating of institutional deliveries and child immunisation.
• Areas where the district has not performed well, and remain a cause of concern, are high instances of anaemia among women (age group 15-49 years) and a decrease in ANC check-ups of pregnant women during pregnancy. These tend to compromise the overall health of women in the district.
• This is in spite of the fact that overall availability of health infrastructure in Durg is better than the state, as well as adequate provisioning for service delivery-human resources component of NHM. Thus, for Durg, efficient utilisation and channelization of funds where required may be a bigger issue than the adequacy of funds.