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Barabanki (Uttar Pradesh)

National Health Mission

This factsheet presents an analysis of the performance of the National Health Mission (NHM) for the district of Barabanki (Uttar Pradesh).

Barabanki lies in the central part of the Middle Ganga Plain. It consists of 15 blocks. While the district is mainly dependent on agriculture, major industries in the region include spinning and agro-based units. Read more about Barabanki

National Health Mission (NHM) is a flagship programme of the Government of India, launched in 2005. It has two sub-missions subsumed under it: the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM). Read more about NHM

01.

What are the Trends in NHM Budgetary Allocation to the District?

Section titled What are the Trends in NHM Budgetary Allocation to the District?

Funds are made available for districts based on employment demand and the need for material. Figure 1 presents the trend of fund availability and expenditure in the district.

Figure 1: Fund Available and Expenditure (Rs Crore)

  • Between 2017-18 and 2021-22, funds available increased by Rs 135 crore, while expenditure increased by Rs 136 crore.
  • The sudden increase in expenditure in 2020-21, when it almost doubled compared to the preceding year, indicates high level of work demand because of the pandemic-induced lockdown and the subsequent economic slowdown.
  • In 2021-22, expenditure fell 16% over 2020-21, but it was still 67% higher than the pre-pandemic level in 2019-20. This perhaps indicates that the overall employment situation in places other than MGNREGS might have improved slightly compared to 2020-21, but it is still much below pre-pandemic levels.

Figure 2 shows the total funds available and total expenditure at the block level for the period from 2017-18 to 2021-22.

Figure 2: Cumulative Fund Available and Expenditure Between 2017-18 and 2021-22 (Rs Crore)

  • In this period, blocks with the highest expenditure are Nindura, Suratganj and Siddhaur.
  • Blocks with the lowest expenditure are Banki, Harakh and Masauli.
  • Out of the 15 blocks, only four (Nindura, Siddhaur, Fatehpur and Masauli) had more funds available than expenditure incurred. In the remaining 11 blocks, expenditure exceeded fund availability in varying degrees.

02.

What are the Trends in Utilization of NHM Funds in the District?

Section titled What are the Trends in Utilization of NHM Funds in the District?

Of the total funds available with a district, some amount can remain unspent at the end of a financial year for various reasons. The extent of funds spent out of the total funds available is called the ‘rate of utilisation’.  
Figure 3 shows out of the total MGNREGS funds available with Barabanki, how much was unspent at the end of the financial year and its annual rate of utilisation.

Figure 3: Unspent Balance and Rate of Utilisation

  • After peaking in 2018-19, unspent balance has been coming down.
  • In 2021-22, there was a shortage of funds—expenditure exceeded fund availability.
  • Rate of utilisation, which is the amount spent as a percentage of available funds, has seen a continuous improvement.

Figure 4: Unspent Balance/ Fund Shortage in Blocks (Rs lakh)

  • At the aggregate block level, there has been a fund shortage in 2017-18, 2020-21 and 2021-22.
  • In 2017-18 and 2020-21, while there was a shortage of funds at the block level, there were unspent funds at the district level. This is because funds were lying with the ‘district level line department’ and the ‘district programme coordinator (DPC)’
  • At the end of 2021-22, Dariyabad, Bani Kodar and Suratganj had the highest level of fund shortages.

03.

What are the Trends in Budgetary Allocation Under Different Components of NHM for the District?

Section titled What are the Trends in Budgetary Allocation Under Different Components of NHM for the District?

Total expenditure under MGNREGS occurs on four components: wages, material, taxes paid on buying materials, and lastly the administration. The last two are small components. Hence, only wages and material expenses have been analysed below. 

Figure 5: Components of Expenditure

  • From 2018-19 onwards, expenditure on wages has increased continuously.
  • During 2020-21, when there was sudden increase in demand for MGNREGS, the total increase in expenditure was equally distributed between wages and material. This is different from most districts, where a much larger portion went towards increased wage payment.
  • The other two components (taxes and administration expenses) are in the range of a combined Rs 4-9 crore in this period.

04.

What is the Per Capita Allocation Under NHM to the District?

Section titled What is the Per Capita Allocation Under NHM to the District?

Sometimes, either because of excess expenditure over funds available or because of procedural delays, payment for the work done can be due at the end of the period. This amount is called ‘payment due’. This amount is generally paid in the subsequent period. Figure 6 shows the trend of total payment due and its breakup across two major components, wages and material.

Figure 6: Total Payment Due (Rs Lakh)

  • Between 2017-18 and 2019-20, ‘payment due’ has remained at a minimal level.
  • In 2021-22, dues increased by Rs 13.3 crore over 2020-21, of which Rs 11 crore was towards material.
  • At the end of 2021-22, Suratganj, Sirauli Gauspur and Dariybad were the blocks with the highest payment due.

05.

Where does the District Stand on Availability of Healthcare Infrastructure?

Section titled Where does the District Stand on Availability of Healthcare Infrastructure?

Under the scheme, all rural households whose adult members are willing to do unskilled manual work, and demand the same, are to be given such work. In this context, there are three datapoints: how many persons demanded (applied for) work; of those who demanded, how many were offered work; of those who were offered work, how many availed the work. These indicators are presented below.

Figure 7: Trends in Employment Demanded, Offered and Availed (No. of Persons in 1,000)

  • The number of persons demanding work increased by 76% in 2020-21 compared to 2019-20, which again points to the impact of the COVID-19 induced crisis in the job market.
  • In 2021-22, demand for work declined 9%, but the number of persons availing work remained the same.
  • In all five years, almost everyone who demanded employment under the scheme was offered employment.
  • However, in all five years, the number of persons who availed employment was much lower than the number that were offered employment.
  • The average number of days a person was working in a year ranged from 34 (in 2017-18) to 41 (in 2019-20).
  • In 2021-22, when demand for work was high, the average number of days a person worked fell to 39. This is much below the 100 days guaranteed under the scheme. Further investigation is needed to identify reasons for this.
  • Of the total families that were offered employment, the proportion of families that completed 100 days of work in a financial year increased from 0.6% in 2017-18 to 18.2% in 2021-22.

Figure 8 compares the district with the state on the percentage of people who availed employment out of those who were offered employment.

Figure 8: Out of All Who Were Offered Employment, What Proportion Availed It (%)

  • Before the pandemic, this proportion was steady for both the district and the state, with the district having a slightly higher level than the state.
  • In 2020-21, the proportion fell for both the district and the state. This is on account of increased demand in 2020-21, with the number of persons demanding employment increasing more sharply than the number of persons availing employment.

06.

How has the District Performed in Maternal Healthcare?

Section titled How has the District Performed in Maternal Healthcare?

Figure 9 presents the employment data divided by gender.

Figure 9: Gender Disaggregated Data

  • Compared to 2017-18, both men and women saw a higher number of employed days in 2020-21.
  • In 2021-22, while the number of person-days declined for men, it increased for women.
  • After declining for the first four years of our study period, the share of women in work-days increased in 2021-22. This is largely because of a decline in work-days for men and an increase for women.
  • From the data available, it is not possible to infer if the increase in work-days for women is due to more women working or an increase in the average number of days that women are working. Data availability in this regard would be helpful on the scheme MIS.

07.

How has the District Performed in Family Planning?

Section titled How has the District Performed in Family Planning?

Figure 10 represent the person-days availed, in absolute and relative terms, by the three social groups: Scheduled Tribes (STs), Scheduled Castes (SCs) and others.

Figure 10: Employment for STs and SCs

  • Barabanki has a very small population of Scheduled Tribes. Hence their share in MGNREGS work is also almost negligible.
  • The two remaining groups, SCs and others, both saw an increase in work-days between 2017-18 and 2021-22.
  • The share of SCs in total person-days of work has ranged from 38.7% to 40.3%. This is higher than the 26.5% share of SCs in the district population.

08.

How has the District Performed in Neo-Natal, Infant, Child and Adolescent Health?

Section titled How has the District Performed in Neo-Natal, Infant, Child and Adolescent Health?

Given the importance of the scheme in generating livelihoods for a large number of people, different data points/information related to the scheme should be available and accessible by the common masses. Figure 11 compiles a list of essential data points/information regarding MGNREGS that would of interest to various stakeholders, and hence must be available and accessible for the district. 
The data points/information regarding MGNREGS is available on the MIS of the scheme: (http://mnregaweb4.nic.in/netnrega/MISreport4.aspx). The Data accessed on 20th June, 2022.

 Transparency and Accountability Index for MGNREGS in Barabanki

Availability of Information and Comprehensiveness

  • Information on funds available
    • Yes
  • Information on funds utilized
    • Yes
  • Delays in compensation and the reasons thereof'
    • Yes
  • Status of beneficiaries’ accounts (frozen or unfrozen)
    • Details on number of frozen accounts is available, but beneficiaries may not be able to check their status.
  • Information on ‘number of person-days’ of jobs generated
    • Yes
  • Gender-wise disaggregation of beneficiaries’ data
    • Yes
  • Disaggregation of beneficiaries’ data by social groups
    • Yes
  • Availability of information on work/project undertaken
    • Yes
  • Geographical granularity of the fiscal indicator
    • Houeshold

Accessibility

  • Language of availability of information
    • English only (Addition of Hindi and other regional languages may be more useful to beneficiaries)
  • Compatibility on devices
    • Phone, tablet, laptop friendly. But there’s no back button due to Captcha, which makes it a little cumbersome for users.

Timeliness

  • Frequency of data updation
    • Real-Time

Relevance

  • How relevant would users find it
    • It is largely useful and relevant for policymakers, civil society organizations (CSOs) and researchers. It can be made more relevant to beneficiaries. For instance, data on the number of projects, job-card holders, etc. is useful for researchers and CSOs; information on convergence of MGNREGS with other schemes and so on will be useful for policymakers and administrators, etc. However, beneficiaries cannot check their particular account status or delayed compensations, etc. 

Reliability

  • Whether the data is reliable
    • While Comptroller and Auditor General (CAG) audit reports for MGNREGS are available, authenticating with MIS as well as ground-truthing is essential. 

Accountability and Citizen’s Participation

  • Social Audit schedules
    • Social audit calendars are available.
  • Availability of social audit reports
    • Gram Panchayat social audit reports are available for some Panchayats in some years, based on selection for social audit.
  • Participation of beneficiaries in Gram Sabhas
    • Although details on action taken after social audits are available, information on the number of beneficiaries as participants is not available; just the total number of participants in the Gram Sabhas is given.
  • Availability of details on financial misappropriation and recovery
    • Yes
  • Availability of information on Grievance Redressal Mechanism for beneficiaries

09.

Where does the District Stand on Information Available for NHM?

Section titled Where does the District Stand on Information Available for NHM?

Given the importance of NHM in providing affordable healthcare to a large section of the populace, different data/information about the scheme should be readily available and accessible to the common masses. Figure 13 lists essential NHM data points/information that are useful to various stakeholders for Barabanki. Hence, their availability and accessibility would be useful.

 Transparency and Accountability Index

Availability of Information and Comprehensiveness

Information on funds available

Yes; Information about availability of funds is available in PIP but some indicators such as opening balance, funds released, funds refunded and closing balance is compiled from RTI.

Information on funds utilized

Yes

Information on eligible beneficiaries under various sub-components of NHM

Yes

Gender-wise disaggregation of beneficiary data

No

Caste-wise disaggregation of beneficiary data

No

Geographical granularity of the fiscal indicator

Fund availability: Available Block/PHC-wise and component-wise

Expenditure of funds: Available only Block/PHC-wise and not component-wise

Information on number of PHCs/DH/SDH

Yes

Accessibility

Language in which information is available

English only

Compatibility on devices

Phone, tablet, laptop friendly

Timeliness

How frequently is data updated?

Yearly

Relevance

How relevant would users find it?

(i) Fiscal information pertaining to the budget approved/allocated is extensively available in state/district PIPs and RoPs for various years by components, but it is not aligned with the geographical granularity of the district. Expenditure data for various years is available only by geography and component, making it difficult to arrive at an aggregate picture of health sector spending in the district.

(ii) Data sources pertaining to various health outcomes, such as NFHS and HMIS, are quite extensive in their coverage and in providing adequate information in the public domain.

Reliability

Is the data reliable?

Relevant audit reports are not available on the NHM website. Hence, reliability of data has remained an issue.

Accountability and Citizens' Participation

Availability of information on social audit

Provisions for the same are not available on the NHM website.

Availability of information on grievance redressal

Provisions for the same are not available on the NHM website.

  • Budget utilisation under NHM was 71% in 2018-19 in Barabanki, which shows an inadequate amount of utilisation. This resulted in accumulation of large unspent balances.
  • Some areas where Barabanki has performed fairly well are facilitating of institutional deliveries, institutional sterilisation and child immunisation. The indicators for these have improved over time.
  • Areas in which Barabanki has not performed well are overall maternal healthcare (high incidence of anaemic women and unsafe home deliveries), which poses a high risk of maternal mortality in the district.
  • Overall availability of health infrastructure in Barabanki is inadequate given its population. Greater funds should be provided for while laying out the resource envelope for the district. Additionally, more funds should be allocated to build capacity among health workers and equip public health institutions with state-of-the-art facilities in the district so as to further improve health outcomes in the district.

CREDITS

Author: Ujala Kumari, Tushar Kapoor

Series Edited by: Nilachala Acharya, Subrat Das

Editorial Inputs: Mitali Gupta, Suraj Prasad Jaiswal

Designed by: Flying Saints

Graphics by: How India Lives

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