Antony Annu, Singh Arvind K, Sahu Dinesh P, Mishra Abhisek, Parida Swayam P
Department of Community Medicine and Family Medicine, All India Institute of Medical Science (AIIMS), Bhubaneswar, Odisha, India.
WHO Consultant, National Tuberculosis Elimination Program (NTEP), Bhubaneswar, Odisha, India.
Indian J Community Med. 2024 Jan-Feb;49(1):131-137. doi: 10.4103/ijcm.ijcm_120_23. Epub 2024 Jan 12.
The untied funds at sub-centers provided flexibility for local action at block and down below levels. Effective utilization of untied fund can strengthen the healthcare. So, our study aims at assessing the knowledge of health workers, male/female (HWF/M), and effectiveness of utilization of untied funds at the sub-center (SC) level.
A mixed method (cross-sectional study and qualitative study) was conducted at Tangi Block, Khordha district, Odisha, in the year 2020. Health workers, male and female in sub-centers, and local stakeholders were interviewed using a structured interview schedule. The tool comprises financial records, a semi-structured questionnaire, and an in-depth interview guide. Universal sampling was adopted. For the cross-sectional study, 24 health workers were male/female, and for the qualitative study, all local stakeholders and 24 health workers female/male were interviewed. The study was conducted as a part of an academic program, and ethics approval was approved by AIIMS Bhubaneswar Institute Ethics Committee.
Seven out of 24 sub-centers did not spend any money, with a median unspent amount of 4260 INR (Q1-0, Q3-17300). As many as 36.8% of sub-centers had a delay of 9 months to get the untied fund, which significantly affected the utilization of funds. 37% of HWF/M utilized the fund inappropriately. None of the health workers had complete knowledge regarding the appropriate usage of untied fund. Communication gap, multiple engagements, non-cooperation from officials, delay in technical processing, and irregular Garam Sabha meetings were found to be barriers.
Our study found out under-utilization of money in untied fund. Communication gap, non-cooperation form village leaders, poor knowledge, overburdened health workers, improper reporting, and lack of felt need were found to be barriers for prompt utilization.
分中心的未捆绑资金为基层及以下层面的地方行动提供了灵活性。有效利用未捆绑资金可加强医疗保健。因此，我们的研究旨在评估卫生工作者（男性/女性）对未捆绑资金的了解情况以及分中心层面未捆绑资金的使用效果。
2020年在奥里萨邦科德哈区的坦吉街区开展了一项混合方法（横断面研究和定性研究）。使用结构化访谈提纲对分中心的男女卫生工作者以及当地利益相关者进行了访谈。该工具包括财务记录、半结构化问卷和深入访谈指南。采用了普查抽样。横断面研究中，有24名男女卫生工作者参与；定性研究中，访谈了所有当地利益相关者以及24名男女卫生工作者。该研究是作为一个学术项目的一部分进行的，并获得了布巴内斯瓦尔全印医学科学研究所伦理委员会的伦理批准。
24个分中心中有7个没有支出任何资金，未支出金额的中位数为4260印度卢比（第一四分位数-0，第三四分位数-17300）。多达36.8%的分中心在获取未捆绑资金方面延迟了9个月，这严重影响了资金的使用。37%的卫生工作者（男性/女性）对资金使用不当。没有一名卫生工作者完全了解未捆绑资金的正确使用方法。发现沟通障碍、多项事务缠身、官员不合作、技术处理延迟以及村委会会议不定期是阻碍因素。
我们的研究发现未捆绑资金存在利用不足的情况。沟通障碍、村委会领导不合作、知识匮乏、卫生工作者负担过重、报告不当以及缺乏迫切需求被发现是迅速使用资金的障碍。
