Utilization of Intergovernmental Funds to Implement Maternal and Child Health Plans of a Multi-Strategy Community Intervention in Haryana, North India: A Retrospective Assessment

INTRODUCTION: 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.

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.