Gupta Madhu, Angeli Federica, Bosma Hans, Prinja Shankar, Kaur Manmeet, van Schayck Onno C P
Department of Community Medicine, Room No. 130, School of Public Health, PGIMER, Chandigarh, India.
Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands.
Pharmacoecon Open. 2017 Dec;1(4):265-278. doi: 10.1007/s41669-017-0026-3.
A multi-strategy community intervention known as the National Rural Health Mission (NRHM) was implemented in India from 2005 to 2012 in an attempt to reduce maternal and child mortality.
This study examined the extent to which the NRHM's maternal and child health (MCH) sector plans were implemented. We observed trends in how intergovernmental (use of central government funds by state governments) budgets were allocated and used to implement MCH plans in Haryana, India.
We conducted a retrospective assessment of programme implementation plans, MCH budget allocation and expenditure and financial monitoring reports during the NRHM implementation period. The yearly budget utilization rate was calculated for each MCH strategy implemented. On the basis of this budget utilization rate, we classed the extent of MCH strategy implementation as fully, partially or not implemented. The status of MCH indicators before, during and after the NRHM period was obtained from national demographic surveys. The budget utilization rate was correlated with MCH outcomes.
The overall budget allocated for MCH plans increased from $US6.6 million during the 2005-2006 period to $US66.7 million in the 2012-2013 period. The rate of budget utilization increased from 20.6% in 2007-2008 to 89% in 2012-2013. Expenditure exceeded the initially allocated budget for patient referral services (111.5%), human resources (110.1%), drugs and logistics (170%), accredited social health activists (133.3%) and immunization (106.4%). Additional budget was obtained from the state health budget. Plans for referral services, human resources, drug provision, accredited social health activists and immunization were fully implemented, few schemes (<1%) were not implemented, and all other schemes were only partially implemented. MCH indicators improved significantly (p < 0.05). The rate of institutional childbirth was highly and positively correlated with rates of budget utilization for implementing accredited social health activists (r = 0.96) and financial incentives for hospital delivery schemes (r = 0.5).
The trend for increasing use of the allocated budget for MCH strategies, improvement in MCH indicators and their positive correlation indicate better and more effective implementation of NRHM MCH strategies than in the past in Haryana, India. However, overall, the NRHM was only partially implemented.
2005年至2012年期间，印度实施了一项名为“国家农村卫生使命”（NRHM）的多策略社区干预措施，旨在降低孕产妇和儿童死亡率。
本研究考察了NRHM的母婴健康（MCH）部门计划的实施程度。我们观察了印度哈里亚纳邦政府间（邦政府使用中央政府资金）预算的分配和使用方式，以实施MCH计划。
我们对NRHM实施期间的项目实施计划、MCH预算分配与支出以及财务监测报告进行了回顾性评估。计算了每项实施的MCH策略的年度预算利用率。基于该预算利用率，我们将MCH策略的实施程度分为完全实施、部分实施或未实施。NRHM实施前后的MCH指标状况来自全国人口调查。预算利用率与MCH结果相关。
MCH计划的总体预算分配从2005 - 2006年期间的660万美元增加到2012 - 2013年期间的6670万美元。预算利用率从2007 - 2008年的20.6%提高到2012 - 2013年的89%。患者转诊服务（111.5%）、人力资源（110.1%）、药品和物流（170%）、经认可的社会健康活动家（133.3%）和免疫接种（106.4%）的支出超过了最初分配的预算。额外预算从邦卫生预算中获得。转诊服务、人力资源、药品供应、经认可的社会健康活动家及免疫接种计划得到了充分实施，极少有计划（<1%）未实施，其他所有计划仅部分实施。MCH指标有显著改善（p < 0.05）。机构分娩率与实施经认可的社会健康活动家的预算利用率（r = 0.96）以及医院分娩计划的财政激励（r = 0.5）呈高度正相关。
用于MCH策略的分配预算使用增加的趋势、MCH指标的改善及其正相关表明，与过去相比，印度哈里亚纳邦NRHM的MCH策略实施得更好、更有效。然而，总体而言，NRHM仅得到部分实施。
