Indian Institute of Public Health, Bhubaneswar, India.
National Health Authority, Ministry of Health Family Welfare, Government of India, New Delhi, India.
Int J Health Plann Manage. 2022 Jul;37(4):2135-2148. doi: 10.1002/hpm.3455. Epub 2022 Mar 14.
Planning, budgeting and utilisation of resources at the district level are critical issues for strengthening district health systems. The objectives of this study are to examine budget making, budget execution and budget monitoring processes at the district level; analyse the trend and pattern of public health expenditure at district level. Two districts based on district development index were selected. A mixed-method study design, both quantitative and qualitative, was used. Quantitative data on resource allocations and utilisation by the government for health were collected and analysed. Qualitative interviews were conducted with government officials to examine budget making, execution and monitoring processes. Resources are transferred through treasury and state health society (SHS) to public health institutions at the district level. Bottom-up planning process is mainly followed for money routed through SHS constituting 36%-40% of total district spending. It takes around 21 days to transfer funds from the treasury to the SHS and the district gets a major proportion of total funds within 10-15 days. Overall, utilisation of resources is around 80%-85% under treasury and 71%-85% under National Health Mission. However, utilisation for specific programmes, non-communicable diseases, is extremely low. Multiple bank accounts, number of rules and regulations at each layer of administration make the system complex. There is a lack of integration of different programmes at the district and below. This study suggests to get rid of input-based budgeting gradually and introduce outcome-based budgeting to increase efficiency.
规划、预算编制和资源利用是加强地区卫生系统的关键问题。本研究旨在检查地区层面的预算编制、预算执行和预算监测过程；分析地区层面公共卫生支出的趋势和模式。选择了两个基于地区发展指数的地区。采用了混合方法研究设计，包括定量和定性方法。收集和分析了政府为卫生分配和利用资源的定量数据。对政府官员进行了定性访谈，以审查预算编制、执行和监测过程。资源通过财政部和州卫生协会（SHS）转移到地区一级的公共卫生机构。主要遵循自下而上的规划过程，通过 SHS 分配的资金占总地区支出的 36%-40%。从财政部向 SHS 转移资金大约需要 21 天，而地区在 10-15 天内获得总资金的大部分。总体而言，在财政部下，资源利用率约为 80%-85%，在国家卫生使命下，资源利用率为 71%-85%。然而，特定方案（非传染性疾病）的利用率极低。多层管理中的多个银行账户和众多规则和条例使系统变得复杂。地区及以下层面不同方案之间缺乏整合。本研究建议逐步摆脱基于投入的预算编制，引入基于成果的预算编制以提高效率。
