Figure 1 shows that NHM funds released to the district have increased from Rs 28 crore in 2018-19 to Rs 36 crore in 2019-20. This means the district had more funds at its disposal to improve health outcomes prior to the pandemic year itself.

Figure 1: Availability of Funds Under NHM in Pune

Figure 2 shows that budget utilisation under NHM in Pune increased by 4 crore between 2018-19 and 2019-20. The utilisation rate fell marginally from 92% in 2018-19 to 88% in 2019-20, which was the first pandemic year.

Figure 2: Utilisation of Funds under NHM in Pune

Per capita health expenditure for Maharashtra increased from Rs 177 in 2018-19 to Rs 203 in 2019-20. By comparison, for Pune, it declined from Rs 114 to Rs 104 (Figure 3). This decline was due to cuts in immunization heads like IEC/BCC activities (from Rs 2.41 lakh in 2020-21 to Rs 0.75 lakh in 2021-22). Similarly, the Asha incentive under immunizations also declined from Rs 2.94 crore in 2020-21 to Rs 1.10 crore in 2021-22 (PIP, Pune 2020-21 and 2021-22).

Figure 3: Per Capita Health Expenditure Under NHM in 2018-19 (Rs)

NHM has 18 sub-components under which allocations are made to cater to the needs of different sections of the population in a holistic manner and ensure last-mile service delivery by strengthening the overall health infrastructure in the country. These are: (1) Service Delivery (Facility Based), (2) Service Delivery (Community Based), (3) Community Interventions, (4) Untied Funds, (5) Infrastructure, (6) Procurement, (7) Referral Transport, (8) Human Resources, (9) Training and Capacity Building, (10) Review, Research, Surveillance and Surveys, (11) Information Education Communication (IEC)/Behaviour Communication Change (BCC), (12) Printing, (13) Quality Assurance, (14) Drug Warehousing and Logistics, (15) Public-Private Partnership (PPP), (16) Programme Management, (17) IT Initiatives for strengthening Service Delivery and (18) Innovations (if any). Figure 4 shows the approved budget for major sub-components under NHM for 2020-21 and 2021-22.

• There has been a general decline in budget allocation across various components of NHM in the last two years. However, there is an increase in allocation for facility-based service delivery component of NHM, from 7% in 2020-21 to around 13% in 2021-22. This shows the district administration’s priority to achieve better health outcomes for child and maternal healthcare.
• The highest allocation among components was to the human resources segment, followed by community interventions and infrastructure components.

Figure 4: Trends in Budgetary Allocation for Major Sub-Components of NHM in Pune

As per the Indian Public Health Standards (IPHS) guidelines, a population of 3,000-5,000 should be covered by Sub Centres (SCs), 20,000-30,000 by Primary Health Centres (PHCs), 80,000 by Community Health Centres (CHCs) in tribal/hilly and 1,20,000 in plain areas. Figure 5 represents per capita availability of various types of health centres in Pune for 2020-21.

Figure 5: Per Capita Availability of Various Types of Health Centres

• Availability of CHCs in the district is far from the standard, as compared to state figures.
• In PHCs and Sub-Centres, the situation is better than CHCs in the district, indicating that the district has fared well in terms of provision of primary healthcare facilities to the general masses.

Institutional deliveries: Figure 6 shows there is a consistent decline in the share of institutional deliveries conducted at public health facilities in both the district and the state between 2015-16 and 2019-20. This points to either public health facilities not keeping pace with population growth or an increase in standard of living, due to which people can afford to pay for better medical facilities in private institutions. As such, the scope of Janani Suraksha Yojana (JSY) also happens to be very low in the district (from 6.4% in 2015-16, the coverage of beneficiaries under JSY declined to 5% in 2019-21, as per NFHS).

Figure 6: Institutional Deliveries in Pune and Maharashtra (%)

Ante-natal checkups (ANCs): Figure 7 shows that though the share of pregnant women receiving complete ante-natal checkups (ANC) is Pune is lower than state averages, the trend in the last five years is upwards. This is probably due to the thrust given to maternal healthcare under facility-based service delivery component of NHM in the last two years (Figure 4).

Figure 7: Pregnant Women who received Ante-Natal Check-ups (ANC) in Pune and Maharashtra (%)

Treatment of anemia: Figure 8 shows a high presence of anemia among both children (age group 6-59 months) and women (age group 15-49 years), and is a cause for concern in developed districts like Pune. This also raises the risk of high mortality among children and women in the district. Timely reduction of such cases in the district should have high budgetary priority.

Figure 8: Incidence of Anemia among Children and Women in Pune and Maharashtra (%)

The use of family planning measures declined significantly between 2015-16 and 2019-20 (Figure 9), pointing to either a decrease in the share of unmet needs or a lack of adequate medical supplies. The latter is a cause for concern.

Figure 9: Use of Family Planning Measures in Pune and Maharashtra (%)

Adolescent health: Figure 10 shows an increase in awareness among adolescent girls in the district on the use of hygienic methods of protection during their menstrual periods—from around 85% in 2015-16 to around 95% in 2019-20 (also much above than the state average).

Figure 10: Use of Hygienic Methods of Protection among Adolescent Girls in Pune and Maharashtra (in %)

Child immunisation: The decline in child vaccination in the district raises a concern to prioritize fund allocation towards child immunization (Figure 11). This is in spite of the fact that most child vaccination services in the district are conducted at public health facilities (Figure 12).

Figure 11: Incidence of Child Immunization in Pune and Maharashtra (%)

Figure 12: Child receiving Immunisation at Public vs Private Health Facilities in Pune and Maharashtra (%)

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 11 lists essential NHM data points/information that are useful to various stakeholders for Pune. Hence, their availability and accessibility would be useful. The current level of information available has been evaluated as under:

Transparency and Accountability Index

Availability of Information and Comprehensiveness

Information on funds available

Yes

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.