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HEALTH CARE FINANCING under NHM. 13 th Common Review Mission. National Health Policy 2017. Increase in State Health Budget by 10% every year. State Health Expenditure. State Health Budget Status for FY 2019-20. Budgetary Allocations under NHM and DoHFW. Rs. in Crore.
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HEALTH CARE FINANCING under NHM 13th Common Review Mission
National Health Policy 2017 Increase in State Health Budget by 10% every year
Budgetary Allocations under NHM and DoHFW Rs. in Crore
Department-wise Budget Estimate (Gross) 2019-20 Rs. in Crore
Flexible Pools under NHM NATIONAL HEALTH MISSION
` 2 Sub-Missions NRHM NUHM • NRHM –Flexible pool- • RCH Pool, RI, PPI, NIDDCP • (II) Health System Strengthening • Pool • (a) Other Health System Strengthening • (b) AB –HWC • (c) ASHA Benefit Packages Communicable Disease Pool Health System Strengthening Ayushman Bharat - Health and Wellness Centres Health System Strengthening- includes components -- NPCD, NOHP, Burns & Trauma, NPCF and other New Initiatives under NCD
PLAN WISE ALLOCATION & RELEASE UNDER NHM (Rs. in crore) • R.E. (2019-20) is not available. Therefore, utilization is compared with BE. • ** Release is updated up to 30.09.2019
Absorption capacity of States (Release including State Share) Rs.incrore
issues • Delay in Transfer of Central Grants from State Treasury to State Health Society (SHS) account, varies with a minimum delay of 18 days to maximum delay of 313 days against the stipulated 15 days. • States Expenditure on Health ranging from 4.2%to 11.6% of State budget. • Delays in contribuation of State share – State of Nagaland and Delhi have not received first instalment due to shortage of state share. • The Performance Based Financing gives opportunity to sates to earn incentive up to 20% of allocation.
Parameters for CRM Review • Finance & Administration - Status on Human Resources, delegation of financial power etc. • Funds Flow - E-transfer of funds, Frequency of funds transfer, Implementation of PFMS • Financial Management - Maintenance of Records /Books of Accounts, Monitoring & Reporting. • Accountability- Internal control mechanisms, Audits (Statutory /Concurrent/ AG Audit). • Cost of Care – User Charges, Health Services coverage, Out-of-pocket expenditure etc. • Other financial management matters including best practices if any.
Finance & Administration- At state level • Human Resources (HR) – Status on in-position and vacancy in Finance, Trainings on Financial Management at State & Districts and its impact in improving financial management, Delegation of Financial & Administrative Powers, Integration of Finance Staff of all programmes under NHM. • Dissemination of District ROPs. If not, the reasons thereof. • Delay in transfer of funds for programme implementation and reasons thereof.
Finance & Administration • Allocation of funds to HPDs : Higher allocation of 1.3 times for HPDs in comparison to other districts. • Mechanism for responsive funding/ differential funding of Untied Funds. • Status Registration of Societies and Meetings of GB, Ex. Bodies etc. • Instances of diversion of NHM funds to other State Specific Programmes and its impact on NHM activities.
Fund Flow • Transfer of funds from Treasury (e-transfer/Chq./DD/PLA to SHS. • Mode of transfer of funds from SHS to DHS and Peripheries. • Status of Implementation of DBT and REAT module of PFMS. • Release of funds to districts and peripheries (pool wise or activity wise). • Problems encountered by the facilities while receiving and utilizing NHM funds. • User Charges under RKS (provision of digital collection)
Financial Management- Facility level • Verify the maintenance of records and books of accounts and timeliness. • Authentication of books of accounts by DDO. • Timeliness of payment made to JSY beneficiaries, ASHA, salary of staff, compensation under family planning schemes and their modalities (DBT or any other mode). • Frequency of bank reconciliation including peripheries. • Maintenance of advance registers and age wise analysis of advances. • Maintenance of Fixed Assets registers.
PFMS • PFMS has been implemented in all 36 states/UTs under NHM to capture exp expenditure and fund flow on real time basis. • NHM Scheme has been chosen as pilot project for implementation of REAT module by the office of CGA. • REAT module to be implemented beyond block level.
Financial Management -PFMS • Whether all accounts are registered with PFMS application. • Status of Agency Registration and in case of shortfall (if any) the reasons thereof. • Whether all payments are made through PFMS. • No. of districts/Blocks have started filing expenditure (DBT & Non-DBT) on PFMS and whether FMR is generated through PFMS. • Status of all the bank accounts under NHM to be mapped in PFMS portal at all levels (State, District and Sub-District level. • Status of Internet connectivity and power supply. • Implementation of REAT module beyond block level under NHM. • Whether training under PFMS is adequate or further training is required. • Comment on Problem areas under PFMS and resolution required.
Accountability • Adequacy of Internal control mechanism in the State to unearth any error or mis-appropriation of funds. • Adherence of accepted modalities for procurement of articles. Ensure competitive bidding. • Joint signatories for all banking operations and one of which must be a regular employee. • Maintenance of duly approved documents and records. • Expenditure is incurred in the approved activities of ROP. • Timely submission of UCs by the State. • In case of poor utilization of funds – Ask the reasons.
Accountability • Implementation on findings of CAG’s Performance audit and Action taken thereon by the State. • Status on submission of Statutory Audit for 2018-19. • Compliance of last year Statutory audit findings. • Laying of Statutory Audit Report in the meeting of GB for approval. • Status of Concurrent Audit- Effectiveness and facilitate in improving the Financial management. Quarterly reports and its adherence by the Audit Committee.
Accountability • Instances of parking of funds and its impact on Programme implementation. • Compliance with respect to i) Income tax, ii) action on audit observations. • Status of In-operative/Idle bank accounts. • Mapping of all Bank accounts into PFMS. • Monthly BRS for all NHM bank accounts at all levels. • Utilization on State specific programmesnot to be included under NHM.
Cost of Care • Out of pocket expenditure (OOPE) for outpatient and inpatient care at facility level from OPD patients and IPD patients at each facility. • Measures taken by the public facility to reduce OOPE.
Other matters • Ascertain the constraints faced by the facilities in utilisation of funds. • Whether the facilities use any output or outcome indicators. • Measures taken for capacity building i.e. Trainings held and its impact in improving the capacity of finance staff. • E-Governance measures under Financial management. • Expenditure incurred on ASHA Benefit Package and NVHCP. • Interest on delayed transfer of funds as per the rate of Interest provided by the Ministry of Finance.
Common Findings • Non preparation of Bank Reconciliation Statement (BRS) by Block units. • Non-maintenance of Fixed Assets Registers/Stock Registers. • Splitting of Invoices to avoid competitive bidding – Procurement Processes. • Booking of expenditure over PIP approvals. • Books of accounts not closed at year end. • Delay in deposit of TDS, delay in filing of TDS returns.
