As per the Programme Implementation Plan for Latehar, the total allocation proposed was 32 crore in 2021-22. Against this, a budget of Rs 32.4 crore was approved. Figure 1 shows that the share of Latehar in the total budgetary allocation to Jharkhand under NHM was 3% in 2021-22.

Figure 1: Share of Latehar in Total Budgetary Allocation to Jharkhand under NHM (2021-22) (%)

Figure 2 shows that budget utilization in the district has increased in 2020-21, suggesting that funds are being channelized adequately to achieve desired health outcomes.

Figure 2: Utilisation of Funds under NHM in Latehar (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 allocation to the human resources component has been the highest in 2021-22 among all 18 NHM sub-components. This indicates that the provision of adequate staff has been prioritised to ensure effective healthcare delivery in the district. It was followed by allocations under community interventions and service delivery-facility based components of NHM.
• For the above major components, amounts approved exceeded the amounts proposed. This suggests there is an immediate need for provisioning of both human resources and infrastructural facilities to strengthen the healthcare delivery system in the district.

Figure 3: Budgetary Allocation for Major Sub-Components of NHM for Latehar (%)

Figure 4 shows the per capita health expenditure increased in 2020-21. This means that health needs of the district have been prioritised.

Figure 4: Per Capita Health Expenditure in Latehar under NHM (Rs)

Institutional deliveries: According to the Financial Management Report (2019-20) of Latehar, institutional deliveries accounts for around 11% of the total allocated funds to the NRHM-RCH Fexipool (which is very substantial as compared to other components). Probably, due to this, the share of institutional deliveries has increased in the district between 2015-16 and 2019-20, as well as the share of such deliveries in public institutions (Figure 5).

Figure 5: Institutional Deliveries in Latehar (%)

Ante-natal check-ups (ANCs): Figure 6 shows a significant increase in the share of pregnant women who registered for ANC and received 4 check-ups. This would have a significant impact on the wellbeing of expecting mothers in the district.

Figure 6: Pregnant Women Who Received Ante-Natal Check-ups (ANC) in Latehar (%)

Treatment of anemia: Figure 7 shows that anaemia among women of all age groups increased in the district, but reduced among pregnant women. However, still more than half of the female population is suffering from it, which is not good in a maternal health context and poses a high risk of maternal mortality. Adequate provision of funds should be a priority in this regard.

Figure 7: Incidence of Anaemia among Women in Latehar (Age group 15-49 years)

Out-of-pocket expenditure per delivery: Although average out-of-pocket expenditure per delivery has increased for the district between 2015-16 and 2019-20, it continues to trail state figures (Figure 8). This has been made possible by the high share of fund allocation to maternal health in the district. However, it needs to become more efficient to meet the desired health needs of the population and provide them with better infrastructural facilities.

Figure 8: Out-of-Pocket Expenditure Per Delivery in Public Health Institutions in Latehar (%)

Figure 9 shows that though the share of children who received vaccination at public health facilities in the district was already 99% in 2015-16, the coverage of children under full immunisation increased substantially from around 53% in 2015-16 to 75% in 2019-20.

Figure 9: Fully Immunized Children (12-23 Months) in Latehar (%)

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 10 lists essential NHM data points/information that are useful to various stakeholders for Latehar. 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.

• Budget utilisation under NHM in Latehar has consistently increased between 2018-19 and 2020-21, suggesting that the district has prioritised addressing the health needs of its inhabitants. This is also evident from the increase in per capita health expenditure in 2020-21 in the district as compared to the state.
• Although Latehar is a tribal-dominated district, the data available did not segregate scheduled tribe beneficiaries, which would aid understanding the situation of vulnerable communities.
• Some areas where the district has improved and performed well are facilitating institutional deliveries, ANC check-ups and child immunisation.
• One area where the district has not fared well is overall maternal healthcare. There is high incidence of anaemia among women, especially pregnant women, posing a high risk of maternal mortality.
• Under the major NHM sub-components, the largest share of budgetary allocation was made to strengthen human resources by building capacity of health workers. This measure, along with the high share of budgetary allocations under the community interventions component, has enabled the district to facilitate and improve health outcomes in the district.

Given the importance of MDM scheme in providing nutrition, and helping increase enrolment and hence education of students, data/information about the scheme should be readily available and accessible to the common masses. Figure 14 lists essential data points/information regarding MDM that will be useful to various stakeholders. The current level of information available has been evaluated for these indicators.

The data points /information regarding MDM have/has been taken from the Annual Work Plan and Budget Meeting Documents (AWB&PM) for the years from 2017-18 to 2020-21. These documents were accessed at https://pmposhan.education.gov.in/.

 Transparency and Accountability Parameters

Availability of Information and Comprehensiveness

 Information on funds available

• Yes

 Information on funds utilized

• Yes

 Information on number of students enrolled

• Yes

 Information on number of students availing MDM

• Yes

 Information on number of meals served

• Yes

 Gender-wise disaggregation of beneficiary data

• No

 Caste-wise disaggregation of beneficiary data

• Yes

 Geographical Granularity of the fiscal indicator

• District-wise

 Information on number of schools

• Yes

Accessibility

 Language in which information is available

• English

 Compatibility on devices

• Phone, tablet, laptop friendly

Timeliness

 How frequently are data updated?

• Real-Time

Relevance

 How relevant would users find it

• The data available in the MDM website can be used by researchers, scholars and policy makers. While the information on the website is vast, further disaggregation of data based on gender can help understand the ways MDM affects education and the nutritional status of girl children.

Reliability

 Are the data reliable?

• CAG audit reports are not available on the MDM website, hence authenticating the data with MIS and ground verification is essential.

Accountability and Citizen’s Participation

 Social Audit schedules

• Social auditing is mandated for all districts.
• While the account for the number of schools covered, organisations/institutions conducting the audit and expenditure is available, the reports on the website are not up to date for all the states and years.

 Availability of information on Grievance Redressal Mechanism for beneficiaries

• Contact details to lodge complaints are listed on the website for every state.
• Details on the number of complaints, status of complaints and action taken are also available.
• States follow different mechanisms for grievance redressal.