HEALTH BUDGET AND PLANS – CHALLENGES AND EXPERIENCES FROM AMRAVATI DISTRICT PRESENTATION BY KHOJ

PLANNING PROCESS – NRHM IS THE BIGGEST COMPONENT OF HEALTH IN THE DISTRICT  NRHM REQUIRES BOTTOM UP PLANNING  NRHM REQUIRES PARTICIPATION AT ALL LEVELS

 PLANNING PROCESS IS GIVEN A MONTH WHICH IS INSUFFICIENT TO REACH OUT TO THE NEEDS OF THE GRASSROOTS  THERE IS NO BUDGETARY INFORMATION ASKED FROM THE PHC OR SUB CENTRES BUT LIST OF DEMANDS

 FOCUS OF PLANNING HAS BEEN ON HUGE INFRA STRUCTURES  THERE IS NO PLANNING FOR EFFECTIVE MONITORING AND EVALUTION PROCESSES  THERE IS LITTLE FOCUS ON PEOPLE WHO PROVIDE THE SERVICE AND ON THOSE WHO ARE THE RECEIPENT OF THE SERVICE

 E.G. – PEOPLE WORKING IN THE BHARARI PATHAK(FLYING SQUADS) ARE PAID Rs 12000/- per month  THESE ARE ON ADHOC BASIS  THEY WORK IN THE REMOTEST PARTS OF THE AREAS OF MELGHAT  THEY DO NOT GET ANY HILLY OR TRIBAL AREA BENEFITS

 WHILE CONSTRUCTION OF LABOUR ROOMS (CALLED AS REPAIRS) AT 60 LOCATIONS COSTS RS 1.40CRORES  AND ON CONSTRUCTION OF WALL COMPOUNDS OF 17 PHC’S THE COSTS IS 1.74 CRORES

 THERE IS A Rs 10LAC BUS CALLED AS MOBILE HEALTH SQUAD WHICH HAS BEEN LYING WITHOUT USE IN 2 BLOCKS  THERE IS BLOOD COLLECTION VAN LYING AT AMRAVATI WITHOUT ANY VLAUABLE USES  ADOLESCENT SEXUAL REPORDUCTIVE HEALTH PROGRAMME HAS SEEN NOT EVEN 1% EXPENDITURE DESPITE A LOW BUDGET IN ITSELF IN THE LAST 2 YEARS

BUDGETING EXERCISE –  BUDGETING EXERCISE DOES NOT SEEMS TO TAKE INTO ACCOUNT THE ACTUAL NEED AND EXPENSES  IT IS ONLY A 10% ADDITION OVER LAST YEAR  IN THE MONTH OF FEBRUARY 2011, ONLY 52% FUNDS UNDER NRHM HAD BEEN UTILISED AND THE DISTRICT WAS CONFIDENT OF SPENDING 48 PERCENT IN 2 MONTHS.. NO ONE COULD ANSWER THE HOW

 EG. WHILE THERE ARE APPROXIMATELY 50,000 CHILDREN WHO ARE SEVERELY OR MODERATELY UNDEROURISHED, THE BUDGET FOR THE YEAR IS ONLY TO CATER TO 10,000 CHILDREN  THERE IS NO REASON WHY ONLY 10,000 CHILDREN WERE BUDGETED

 THERE IS NO HEALTH PLAN FOR THE STATE AND THERE IS NO STRATEGY TO FOCUS ON ANY LOCAL ISSUE  THE ONLY PLANNED, MONITORED PROGRAMME IS THAT OF PULSE POLIO AND MAY BE THE OTHER NATIONAL PROGRAMMES LIKE TB, LEPROSY AND MALARIA

 THERE IS NO MEANS OF TRACKING THE EXPESNES AT THE BLOCK LEVEL  THERE IS NO MECHANISM FOR TOP DOWN FLOW OF INFORMATION FROM THE MIS COMPILED AT THE DSITRICT OR THE STATE LEVEL  LAST, THERE ARE NO OFFICERS WITH FULL CHARGE – DD, DHO, ADHO, THO, ARE ALL ON DEPUTATION

 STRUGGLE IS TO REVERSE THE PROCESS TO MAKE IT PEOPLE CENTRED  THE FOCUS IS TO MAKE HEALTH AN ACCOUNTABLILTY OF THE STATE – OVER 4.5CRORES FROM THE DISTRICT HAS BEEN GIVEN TO PRIVATE HOSPITALS UNDER RSBY, COULD THIS FUNDS NOT HAVE BEEN INVESTED TO STRENGHTEN THE PUBLIC HEALTH SERVICES AND PROVIDE THESE SERVICES THROUGH THE STATE