Evaluation of NRHM in Karnataka
The National Rural Health Mission (NRHM) was introduced in the year 2005, as a flagship programme of the United Progressive Alliance (UPA) government, to rejuvenate the public system of health care in the country. As the drafted time frame of NRHM comes to an end, significant challenges remain in translating all the expected outcomes of NRHM into realities. Mainly, the targeted increase in budgetary allocation and the expected decline in IMR and MMR are not met. Decentralised planning, budgetary allocation and the expected decline in IMR and MMR are not met. Decentralised planning, community monitoring and governance and the reduction of regional disparities in health have not been effectively achieved.
The Karnataka Evaluation Authority (KEA) commissioned GRAAM for an evaluation study aimed at thoroughly analysing NRHM’s planning, fund flow and its implementation. This evaluation assessed the planning and design of the funds allocation and expenditure under NRHM in Karnataka. Regional disparities and the role of fund allocation, expenditure on physical and human infrastructure and development indicators on the health were analyzed. The results of this analysis were validated across representative districts of the state.
|Sample field sites||Districts: 13, Taluks: 48, PHCs: 150|
|Partner Agency/Client||Karnataka Evaluation Authority, GoK|
The evaluation was carried out in two phases. In Phase 1, analysis of relevant literature and planning documents of representative districts was carried out. This was followed by analysis of fund flow and expenditure patterns of the districts of the state and correlation tests to relate the trends in various expenditure heads under NRHM with the status of health indicators at state and district levels. In the second phase, field validation was carried out to confirm the principal findings of the first phase. Further, attempt was made to understand local NRHM related processes, perspectives and interpretations of service providers on bottom up planning fund allocation and expenditures processes. Community involvement in public health at the grassroots level was also explored.