Figure 1 shows that budget allocation and fund utilization under NHM for Gajapati has consistently increased between 2018-19 and 2020-21. However, allocation grew at a faster rate than fund utilization in 2020-21.

Figure 1: Availability of Funds under NHM for Gajapati (Rs crore)

Figure 2 shows that in two of the three years to 2020-21, the rate of utilisation of NHM funds in Gajapati trailed that for the state as a whole. In this three-year block, fund utilization by the district peaked in 2019-20, only to fall about 8 percentage points in 2020-21.

Figure 2: Rate of Utilisation of Funds under NHM in Gajapati (%)

Figure 3 shows the high per capita allocation to the district in 2018-19 did not translate into high levels of per capita expenditure the same year. Fund allocation was reduced in the subsequent year, seemingly due to low utilization levels. In 2020-21, adequate expenditure on various health needs was observed to have been incurred, that too better than state figures.

Figure 3: Per Capita Allocation and Expenditure of Funds under NHM

Institutional Deliveries: The rate of institutional births has progressively increased in both the state and the district. More importantly, institutional deliveries in public health facilities increased by 11 percentage points in Gajapati, as compared to 3 percentage points in Odisha, from 2015-16 to 2019-20. In spite of the increase in institutional deliveries in public health institutions, out-of-pocket expenditure has increased in the district, but fallen at the state level (Figure 5).

Figure 4: Institutional Deliveries in Gajapati (%)

Figure 5: Out-of-Pocket Expenditure per Delivery in Gajapati (Rs)

Treatment of Anemia: Figure 6 shows high prevalence of anemia among women in the district. Nearly two-thirds of women in the age group 15-49 years were anemic in 2019-21, and this figure had increased over 2015-16. This situation is even more severe for pregnant women in the district as compared to the state (Figure 7). A reduction in funding for ASHA support could hurt, with more cases of anaemia in women and higher cost of public expenditure on maternal and child health.

Figure 6: Prevalence of Anaemia among All Women in Gajapati (age group 15-49) (%)

Figure 7: Prevalence of Anaemia among Pregnant Women in Gajapati (%)

Efforts have been made to distribute iron folic acid tablets to pregnant mothers. However, the situation does not seem to be very optimistic in the district, as the average consumption of such tablets is very low for the district as compared to the state (Figure 8). This highlights a huge gap at the district level between prescribed and actual consumption of IFA tablets.

Figure 8: Average consumption of iron folic acid in Gajapati and Odisha in NFHS 4 and NFHS 5 (%)

Figure 9: Consumption of iron folic acid by mothers in Gajapati and Odisha (%)

As evident from Figure 10, the rate of immunisation, measured by full vaccination, has doubled in Gajapati, from 46.6% in 2015-16 to 92.6% in 2019-21, even topping the state average. Further, an essential role for NHM in vaccination can be seen, with a 100% rate of vaccination in public health facilities and about 98% at the state level. NFHS data shows that children aged 12-23 months mostly received vaccinations in public health institutions in the case of both Odisha as well as Gajapati.

Figure 10: Fully Immunized Children (12-23 months) in Gajapati (%)

Given the importance of the scheme 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 Gajapati. 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/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.

• During the three-year clock from 2018-19 to 2020-21, budget utilisation under NHM in Gajapati is fairly commensurate with funds allocated in the last two years. However, timely release of adequate funds has been an issue, possibly contributing to declining health outcomes in the district.
• Some areas where the district has improved and performed well are institutional deliveries and child immunisation.
• Maternal healthcare is one area in which the district has not fared well. There is a high prevalence of anaemia among women (both overall and pregnant), increasing the risk of maternal mortality. Also, though more funds have been allocated to the district, out-of-pocket expenditure per delivery has increased. This raises questions of efficiency related to channelization of funds to meet health needs of the people.
• In order to further improve health outcomes in the district, adequate funds should be allocated to build capacity among health workers and equip public health institutions in the district with state-of-the-art facilities.