Dashboard India: Advocacy Planning and Budgeting

India Toolkit: Advocacy

Planning and Budgeting

Optimal Utilization of Budgets for Family Planning through the Program Implementation Plan of National Health Mission

Purpose: To provide guidance to district officials and NGO partners on the specific steps of planning and budgeting for Family Planning (FP) through the annual Program Implementation Plan (PIP) of the National Health Mission (NHM).

Audience

Chief Medical and Health Officers (CMHO/CDMO/CMO)
Chief Medical Superintendents (CMS)
Nodal Officers -Urban Health and FP
Persons In-Charge of Facilities
Medical Officers in Charge (MOIC)
District Program Managers (DPM)
NGO representatives

Background: Reduction of unmet need for FP can improve infant and maternal health and reduce the high levels of mortality. Understanding this linkage places FP within a broader context of health and creates the impetus to maximize the level of funding that is available for FP activities through the PIP. NHM’s Annual PIP is the mechanism through which districts can plan, budget and request for funds for FP.

Apart from the funds for District Women’s Hospitals, Medical Colleges and District Hospitals, the funds are especially required for a good functioning of the Urban Primary Health Centers (UPHCs) and the Urban Community Health Centers (UCHCs). These facilities require, but often lack adequate human resources, equipment, and supplies to support the provision of services to the urban population of the district. They also lack other required resources to implement innovative FP measures such as workplace interventions, strategies for male engagement in FP, induction training of private providers on sterilization and Post-Partum Intra Uterine Contraceptive Device (PPIUCD) insertion services. The mechanism of the NHM’s PIP can be used to allocate funds to meet the FP needs of the urban population.

Inadequate planning and under-utilization of available funds have been major reasons for the insufficiency of FP services in the public sector. This has resulted in low demand and barriers to access services especially for marginalized populations including the urban poor.

Evidence of the Impact

Support to district level officials through the Urban Health Initiative (UHI) in planning, budgeting and requesting for funds to support FP through the PIP produced substantially increased amount of funding being allocated and utilized for FP interventions.

Better planning at the city level and inclusion of listed and unlisted slums in UHI intervention cities helped increase the total amount of funds allocated for FP in the state and district PIPs, which allowed the following positive changes to be made:

Increased allocation of Urban Accredited Social Health Activities (ASHAs) in UHI intervention cities
Increased budget for male and female sterilization procedures and associated client incentives (wage loss compensation), resulting in an increased number of clients
Better utilization of the FP budget. For example, the Contraceptive Technology Updates (CTU) workshops were conducted in UHI cities with funding through the PIP
The PIP was also used to increase the number of contracted-in-doctors and counselors to provide services in the public sector hospitals
Procurement of additional supplies and commodities

SIFPSA and NHM-UP, with technical assistance from the EAQ project led by Population Services International (PSI): Facilitated the establishment of a Public Private Partnership model for strategic purchase of FP services. The districts were able to mobilize 180 million rupees from the PIP to reimburse the private sector for FP services over a period of one and a half years (2016-2017).

Guidance on Planning, Budgeting and Requesting FP Funding in the PIP

The details of the seven UHI trainings that were effective in strengthening the capacity of providers and staff are mentioned below:

Estimate the Need

Estimate the population of Married Women of Reproductive Age (MWRA) in need of FP services at the UPHC/District Women Hospital (DWH)/District Combined Hospital (DCH) level in urban areas, keeping in mind the slum population of the city (Refer to the TCIHC’s urban mapping and listing tool).

Estimate Required Resources

Based on the estimated population in need of FP services, calculate the requirement of human resources (including available government doctors trained on FP methods, number of counselors, ASHAs etc.), supplies and operating funds (which are presently available, as well as additional necessary requirements to be included in the PIP including those necessary for private accredited facilities) to provide essential services.

Prepare District PIP and Budget

Before any PIP is formulated, the CMHO/CDMO/CMO/CS should invite the Additional Chief Medical Officers (ACMOs), Nodal Officers – Urban Health and FP, Deputy CMHO/CDMO/CMO, CMSs, DPMs, Assistant Research Officers (AROs), Medical Officers In-Charge (MOICs) of UPHCs in the district, development partners (national and international NGOs) and representatives of the accredited private sector facilities. They should be explained the PIP process as per the PIP guidelines received from the State and the Central government. Their requests should be sought in a participatory manner, on areas /issues/activities to be continued in the coming PIP as well as additional budget required for new activities, such as renovation of facilities, additional facilities in urban areas, additional staff, equipment and supplies, IEC materials and their distribution, cost for Fixed Day Static (FDS) services, community activities related to FP and health and proposed innovations (Refer NUHM PIP Guideline final 2016-17).

Assess the Progress

In the subsequent meetings, assess the physical (program activities) and financial progress. This may include activities that were approved in the previous year’s Record of Proceedings (ROP) but have not been accomplished. Once this process is completed, the Nodal Officers – Urban Health and FP and DPM proceed with completing the relevant FP sections in the PIP and present these to the District Health Society (DHS) for approval. Once approved, the district PIP is sent to the state.

Complete and Submit the PIP Plan and Budget

Requests for funds should be submitted in the PIP format. For compilation, the CMO/CMHO may designate a dedicated officer or engage an external consultant through development partners to facilitate the district PIP process.

Disseminate Information on Approved Funds

Based on the approved PIP/ROP and funds allocated to the district, the CMHO/CDMO/CMO/CSshould convene a meeting of all concerned units to share the line item allocations to each thematic area of the PIP. The district officials and facility managers should be made aware of the line item allocations and they should have copies of the guidelines for making decisions for future planning and utilization of funds.

Based on the approved PIP and the guidelines received from the state, FP activities should be planned, implemented and monitored on monthly and quarterly basis.

Ensure Availability of Approved Funds

The CMHO/CDMO/CMO/CS in coordination with the Nodal Officer – Urban Health and FP, DPM, District Accounts Manager (DAM) and others should ensure availability of funds for FP activities prior to their planned implementation.

Roles and Responsibilities Towards PIP Development and Finalization

Role	Responsibility
CMHO/CDMO/CMO/CS	Conduct a meeting of all units of the health department with the support of DPM Before the PIP preparation, orient various stakeholders on FP and health outcomes and share GOI guidelines on the preparation of PIP Conduct a meeting with MOICs, Persons in-charge of facilities, CMS and heads of accredited facilities to estimate the needs for FP program implementation before commencing the PIP preparation Request all the concerned nodal officers including Nodal Officers – Urban Health and FP- to provide information on all the activities which are to be continued in the new financial year, the activities which need to be discontinued, and any innovative activity that needs to be included. Review the draft PIP and ensure that funds for FP services, logistics, supplies and HR requirements are included in the PIP Ensure that funds for new accreditations or empanelment of private facilities are included in the PIP Get approval for the finalized request forPIP activities and funds at the DHS meeting and send the DHS-approved PIP to the state for approval Inform all units about the approved PIP and activities Monitor the progress according to the planning and expenditure benchmarks
MOIC, CMS & Facility in-Charge	Conduct an assessment of the workload and the Expected Levels of Achievement (ELA) (Refer to the Community Needs Assessment Approach [CNAA]) for FP and share with the person who is compiling the PIP Conduct meetings with the field functionaries and the Auxiliary Nurse Midwives (ANMs) to discuss estimates on the resource requirements for FP services and logistics. Assess the HR requirements and send the request to the team compiling the PIP
ANM	Conduct an assessment of unmet needs with the support of ASHAs and provide data to the head of the facility/MoIC for additions to be made to the PIP

Monitoring Benchmarks for Planning and Expenditure

The CMHO/CDMO/CMO/CS, with assistance from the Nodal Officer Urban Health and FP / DPM or other team members, regularly monitors the following indicators:

Whether PIP completed and submitted on time
Whether at least three key city level stakeholders have been involved (e.g. ICDS, DUDA, Municipal Corporation, accredited private hospitals or ward level representatives)
Number of private facilities accredited for FP services and actively engaged
Monthly and quarterly review of physical and financial progress of all approved FP activities

Cost Elements

The unit cost of all existing FP activities is shared by the state. The following line items in the PIP can be used for requesting the FP funds:

Each city can also propose innovative FP activities, with allocation of unit costs and the proper justification for the same. Any innovations requested in FP proposals have to be budgeted under the Reproductive and Child Health (RCH) flexi-pool, and under the heading ‘Family Planning’.

Cost Element Chart

Cost Element	FMR Code	Source
Female Sterilization services	A.3.1.1	ROP 2017-18, NHM-UP
Male Sterilization (NSV) services	A.3.1.2	ROP 2017-18, NHM-UP
Compensation for FST services	A.3.1.3	ROP 2017-18, NHM-UP
Compensation for NSV services	A.3.1.4	ROP 2017-18, NHM-UP
Compensation for IUCD services	A.3.2.2	ROP 2017-18, NHM-UP
PPIUCD services	A.3.2.3	ROP 2017-18, NHM-UP
PAIUCD services	A.3.2.4	ROP 2017-18, NHM-UP
Orientation/Review of ASHA/ANM/AWW for FP services	A.3.2.6	ROP 2017-18, NHM-UP
Dissemination of FP manuals/guidelines	A.3.2.7	ROP 2017-18, NHM-UP
POL for Family Planning/Others	A.3.3	ROP 2017-18, NHM-UP
Orientation workshop, QAC meeting	A.3.5.1	ROP 2017-18, NHM-UP
Family Planning Review Meetings	A.3.5.2	ROP 2017-18, NHM-UP
Performance Rewards	A.3.5.3	ROP 2017-18, NHM-UP
World Population Day/Fortnight celebration	A.3.5.4	ROP 2017-18, NHM-UP
Vasectomy Fortnight Celebration	A.3.5.5	ROP 2017-18, NHM-UP
Printing of FP manuals/Guidelines	A.3.5.6.1	ROP 2017-18, NHM-UP
Enhance contribution of PRIs & Family members of eligible couple	A.3.5.6.2	ROP 2017-18, NHM-UP
FP Indemnity Scheme	A.3.6	ROP 2017-18, NHM-UP
Mission Parivar Vikas	A.3.7	ROP 2017-18, NHM-UP
Saas Bahu Sammelan	A.3.7.1	ROP 2017-18, NHM-UP
Nayi Pehel Kit	A.3.7.2	ROP 2017-18, NHM-UP
Injectable Contraceptive Initiative	A.3.7.3	ROP 2017-18, NHM-UP
Mission Parivar Vikas Campaign	A.3.7.4	ROP 2017-18, NHM-UP
Other activities (Demand generation strengthening service delivery etc)	A.3.7.5	ROP 2017-18, NHM-UP

*Refer to ROP 2017-18, NHM-UP

This table is indicative and illustrates the manner in which cost elements are provisioned in a govt. PIP, thus giving guidance to the audience on where to look for elements related to a particular task, such as the ‘Program Implementation Plan’.

Sustainability

Sustainability of FP activities is dependent on the CMHO/CDMO/CMO making the necessary requests in the PIP each year. To ensure proper utilization of the FP budget as laid out in the approved PIP, detailed monthly plans of the physical and financial progress should be prepared and monitored by the Nodal Officer – Urban Health and FP who should also update the CMHO/CDMO/CMO on the same. The CMHO/CDMO/CMO should share this physical and financial progress with the DHS in the monthly/quarterly meetings.

Disclaimer: This document is based on the learnings collated from Urban Health Initiative, Health of the Urban Poor (supported by USAID) and Expanded Access and Quality (EAQ) to broaden method choice in Uttar Pradesh. This document is not prescriptive in nature but provides overall guidance of how this particular aspect was dealt with in these projects for possible adoption and adaptation.

The downloadable versions of this document are slightly modified to make it state representative for Uttar Pradesh, Madhya Pradesh and Odisha, respectively.