spmg ii mtef report 2015-16 - department of health & family welfare - final

Deloitte Touche Tohmatsu India Private LimitedDecember 2014

MTEF for Department of Health and Family Welfare– 2015-16Strengthening Performance Management in Government Phase–II December 2014

333


Table of Contents

1. Executive Summary........................................................................................................61.1 Project background..............................................................................................................6

1.2 MTEF Process..................................................................................................................... 6

1.3 Bottom up Budgeting............................................................................................................7

1.4 Top Down Estimation.........................................................................................................11

1.5 Reconciliation..................................................................................................................... 11

1.6 Way Forward...................................................................................................................... 12

2. Background...................................................................................................................132.1 SPMG Project.................................................................................................................... 13

2.2 Medium Term Expenditure Framework..............................................................................14

3. Bottom Up Budgeting...................................................................................................153.1 Sector Overview................................................................................................................. 16

3.2 Department Review............................................................................................................30

3.3 Scheme Review................................................................................................................. 34

3.4 Scheme Prioritization.........................................................................................................38

3.5 Expenditure Review...........................................................................................................42

3.6 Trend Projections...............................................................................................................48

4. Top Down Estimation...................................................................................................53

5. Reconciliation...............................................................................................................54

6. Way Forward.................................................................................................................55

7. Annexures:....................................................................................................................56Annexure 1. Allocation of funds across plan schemes during the period from 2009-10 to 2014-15 (BE) (Rs. In Crores) - 70 schemes..........................................................................................56

Annexure 2. Allocation of State Plan funds across the schemes during the period from 2009-10 to 2014-15 (BE) (Rs. In Crores) - 42 schemes............................................................................58

Annexure 3. Mapping of all plan schemes with Departmental objectives.................................60

Annexure 4. Distribution of Non-Plan expenditure of DoHFW by object (Rs. in crore).............62

Annexure 5. Distribution of Plan expenditure of DoHFW by object (Rs. in crore).....................62

Annexure 6. Revenue expenditure of DoHFW by objects (Rs. in crore)...................................63

Annexure 7. Capital expenditure of DoHFW by objects (Rs. in crore)......................................63

Annexure 8. Projected expenditure of DoHFW by schemes (Rs. in crore)...............................64

Annexure 9. Projected total expenditure for DoHFW by object (Rs. in crore)...........................66

Annexure 10. Projected Plan expenditure of DoHFW by schemes (Rs. in crores)...................67


Annexure 11. Projected Plan expenditure of DoHFW by objects (in crores).............................70

Annexure 12. Projected Non-Plan expenditure of DoHFW by Schemes (Rs. in crore).............70

Annexure 13. Projected Non-Plan expenditure of DoHFW by Objects (Rs. in crore)................73

MTEF for Department of Health and Family Welfare – 2015-16Strengthening Performance Management in Government Phase–II December 2014

List of TablesTable 1 : Trend Projections for DoHFW (Rs. in crore).........................................................................10Table 2: Top down estimates for DoHFW for FY 2015-16 (in crores)..................................................11Table 3: Projected resource and expenditure growth of DoHFW (in Rs. Crore)..................................11Table 4: Number of Diarrheal cases and deaths during 2010-11.........................................................26Table 5: Identified Cataract cases and achievements 2007-08 to 2009-10.........................................26Table 6: Case detection and treatment of Leprosy cases in MP 2010-11............................................26Table 7: Status of Malaria in MP..........................................................................................................26Table 8: Case detection and Treatment success rate of TB cases......................................................27Table 9: Health Infrastructure in MP....................................................................................................27Table 10: Human Resources for Health – December 2013.................................................................27Table 11: Objectives of the Department..............................................................................................32Table 12: Scheme prioritization summary - all plan schemes of DoHFW............................................38Table 13: Scheme prioritization summary - all state plan schemes of DoHFW....................................39Table 14: Scheme prioritization summary - all active schemes of DOHFW.........................................40Table 15: Description of the Demand Numbers under DoHFW...........................................................42Table 16: Government expenditure by sector (Rs. in crore)................................................................42Table 17: Trends in expenditure of DoHFW (Rs. in crore)...................................................................43Table 18 : Revenue & capital-wise expenditure trends of DoHFW by demand numbers (Rs. in crore)............................................................................................................................................................. 44Table 19 : Plan and Non-Plan expenditure trend of DoHFW by demand numbers (Rs. in crore)........45Table 20: Expenditure by DoHFW (Rs. in crore)..................................................................................46Table 21: Assumptions for Trend Based Projections...........................................................................48Table 22: Percentage distribution of total expenditure by object..........................................................49Table 23: Percentage distribution of plan expenditure by object..........................................................50Table 24: Percentage distribution of non-plan expenditure by object..................................................51Table 25: Plan and Non-Plan Expenditure projections of DoHFW (Rs. in crore).................................52Table 26: Top down estimates for DoHFW for FY 2015-16.................................................................53Table 27: Projected resource and expenditure growth of DoHFW (in Rs. Crore)................................54


AcronymsAcronym DefinitionAAGR Annual Average Growth RateACA Additional Central AssistanceALOS Average Length of StayBCC Behavior Change CommunicationBE Budget EstimatesBGTRR Bhopal Gas Tragedy Relief and RehabilitationBMI Body Mass IndexBOR Bed Occupancy RateBTR Bed Turnover RateCBR Crude Birth RateCDR Crude Death RateCP Central PlanCSS Centrally sponsored schemesD. No Demand NumberDFID Department for International DevelopmentDME Directorate of Medical EducationDoHFW Department of Health and Family WelfareDoL Department of LabourDWCD Department for Women and Child DevelopmentEAPs Externally Aided ProjectsGIA Grants-in-AidGoI Government of IndiaGoMP Government of Madhya PradeshGPI Gender Parity IndexGSDP Gross State Domestic ProductICT Information and Communication TechnologyIMR Infant Mortality RateMCR Miscellaneous Capital ReceiptsMIS Managed Internet ServiceMP Madhya PradeshMPSACS Madhya Pradesh State AIDs Control SocietyMTEF Medium- Term Expenditure FrameworkNRHM National Rural Health MissionOBC Other Backward ClassesOBE On Budget ExpenditureRE Revised EstimatesSC Scheduled CasteSCP Special Component PlanSOs Scheme OutputsSP State PlanSPC State Planning CommissionSPMG Strengthening Public Financial Management in GovernmentST Scheduled TribeST Scheduled TribesTFR Total Fertility RateTGE Total Government ExpenditureUNICEF United Nations International Children's Emergency Fund


Disclaimer

This document is strictly private and confidential and has been prepared by Deloitte Touché Tohmatsu India Private Limited (“DTTIPL”) specifically for the Directorate of Institutional Finance, Government of Madhya Pradesh (“DIF”) for the purposes specified herein. The information and observations contained in this document are intended solely for the use and reliance of DIF and are not to be used, circulated, quoted or otherwise referred to for any other purpose or relied upon without the express prior written permission of DTTIPL in each instance.

Deloitte has not verified independently all of the information contained in this report and the work performed by Deloitte is not in the nature of audit or investigation.

This document is limited to the matters expressly set forth herein and no comment is implied or may be inferred beyond matters expressly stated herein.

It is hereby clarified that in no event DTTIPL shall be responsible for any unauthorized use of this document, or be liable for any loss or damage, whether direct, indirect, or consequential, that may be suffered or incurred by any party.


1. Executive Summary1.1 Project background Government of Madhya Pradesh (GoMP) seeks to further strengthen the fiscal performance of the State through fiscal reforms. Through the Phase II of the DFID funded Strengthening Performance Management in Government project, GoMP intends to bring about systemic reforms in public financial management. GoMP has engaged Deloitte Touche Tohmatsu India Private Limited as Long Term Consultants for strengthening Public Financial Management in Madhya Pradesh. The project commenced on 1st March 2013.

In most of the states, Medium Term Expenditure Frameworks (MTEFs) have been attempted with limited success. Most of them are attempted on pilot basis by line departments to access budgetary support provided by international funding agencies. GoMP is attempting to go beyond these kinds of attempts. During second phase of SPMG, starting March 2013, MTEF is being implemented in 15 departments in a phased manner.

The following is the scope of work of MTEFs:

Review of MTEF methodology Update MTEF Manual prepared under SPMG I Conduct workshop to validate and finalize MTEF Methodology Support select departments in preparation of MTEF for 3 budget cycles

The present report is prepared for the Department of Health and Family Welfare (DoHFW) for the year 2015-16.

The report is organized into following sections:

Section 1: Executive Summary Section 2: Background of the SPMG ProjectSection 3: Bottom Up Budgeting Section 4: Way ForwardSection 5: Annexures

The present section provides a detailed summary of MTEF for DoHFW for the year 2015-16.

1.2 MTEF Process Medium Term Expenditure Framework provides estimates for multi-year expenditure requirements and makes the budget more strategic and performance oriented. The preparation of MTEF for DoHFW, involved following steps:

Bottom up budgeting Top down budgeting Reconciliation and Reprioritization

The current report focuses on the bottom up budgeting of MTEF for DoHFW. Top down estimates for DoHFW have been carried out and a separate report has been prepared and submitted to Finance Department for suggestions. Post approval of the top down methodology by the Finance Department, the multi-year budget ceilings arrived through the approved methodology would be reconciled with the bottom up resource requirements.


1.3 Bottom up Budgeting The ‘bottom up’ estimates are arrived through a set of sequential steps as elucidated below:

Step 1: Sector Review – evaluation and identification of the performance and problems of the sector in terms of various quantifiable indicators used by the department

Step 2: Scheme Review – identification, prioritization and mapping of primary and secondary objectives of the department with the schemes and preparation of prioritization matrix

Step 3: Scheme Prioritization – segregation of schemes with zero and non-zero (active) budget allocation, grouping of schemes based on primary objectives. Subsequently, prioritization according to sources of funds through application of prioritization principle

Step 4: Expenditure Review – analysis of the flow of resources for various schemes at object head level during past 5 / 6 years

Step 5: Expenditure Projections – projection of the expenditure on the basis of past trend and as per the Medium Term Fiscal Policy Statement presented under the Fiscal Responsibility and Budget Management (FRBM) Act for 2014-15

1.3.1 Sector Review A review has been undertaken for Health Sector, as DoHFW primarily focuses on improving the performance of this sector. The key observations are given below:

A. Demographic Issues: 1. In absolute terms, the population of the state is growing at a faster rate. The decadal growth rate of

the population in MP is higher than the all India average002E2. Larger segment of the population are people within the age group of 15-49 years followed by the

population within the age group of 0-14. Therefore, adequate provision needs to be made for them in order to address the health and other related issues of these groups.

3. The life expectancy is low in the state as a whole. The life expectancy of females is more compared to males. This needs more attention on chronic diseases and geriatric care

4. A large proportion of populations are adults. Therefore there is a need for expanding the awareness generation activities, especially related to sexual and reproductive health in order to prevent them from various sexual infectious diseases.

B. Key Issues related to CBR, CDR, IMR and MMR: 1. Desire to have more children due to high infant mortality, and low coverage of family planning

services are two major factors responsible for high birth rate in the state. 2. The CDR of Madhya Pradesh is relatively high compared to national average. This is mostly due to

lack of quality of care and appropriate infrastructure in the government health care facilities. 3. Lack of proper attention to provide ANC, PNC and immunization services are the key factors that

contribute to higher Infant deaths, thus contributing to IMR and MMR4. Low institutional deliveries that stems from the lack of trained manpower and timeliness of handling

the complicated delivery cases are the major causes of high MMR. 5. Lack of inter sectoral coordination is also one of the most important factors for high infant and

maternal deaths C. Key Issues related to Family Welfare activities:1. The TFR of Madhya Pradesh is significantly high compared to national average. This is mostly due

to inadequate attention on family welfare activities in the state. This has ultimately led to high population growth in the state

2. A major chuck of the population in the state is tribal. Various awareness activities coupled with better education in tribal dominated areas would help mitigating the problem to a large extent

3. The unmet need for family planning need to be addressed on a priority basis

MTEF for Department of Health and Family Welfare – 2015-16Strengthening Performance Management in Government Phase–II December 20144. There is a high need for increasing awareness of the tribal population on the temporary methods of

family planning.D. Key Issue related to maternal and child care: 1. The ANC activities in the state, especially in remote and tribal dominated areas, are extremely

poor. It is therefore necessary that appropriate policy measures are initiated to cover the all pregnant mothers for ANC care. This would help in reducing the maternal mortality to a large extent

2. Childhood immunization plays a most important role in reducing the IMR. It is therefore necessary that special provisions are made to increase the immunization coverage so that the majority of child populations are completely immunized as per the government norm.

3. The institutional deliveries need to be increased in order to reduce the complications during child birth

4. The Post Natal Care is abysmally low and need to be improved in order to reduce the complications arising immediately after the delivery

5. The major reason for all these are the negligence of the department to carry out their activities properly / lack of proper coordination between DoHFW and NRHM

E. Key Issues related to nutritional status: 1. Poor nutritional status of the children.2. Low awareness of the population on the effect of appropriate nutrition on the future health of the

children and adults3. Increasing number of stunted and wasted children4. Lack of awareness of the population on the importance of appropriate diet during pregnancy5. Low awareness of the reproductive age group on appropriate diet leading to low BMI and

overweight F. Key issues related to other diseases:1. High prevalence of diarrheal diseases and the consequent deaths2. High prevalence of leprosy in the state due to low case detection3. High incidence of malaria and other vector borne diseases4. High prevalence of Tuberculosis and drug resistance

The status of some of the selected key indicators is given in Sector Review section of the report.

1.3.2 Scheme ReviewScheme review has been undertaken to identify the major schemes that are being implemented by DoHFW for improving health status of the population. The main objective of scheme review is to identify important schemes accounting for more than 90 per cent of the department budget.

Following observations are made through scheme review:

Out of a total of 70 plan schemes, 8 schemes accounted for more than 90 per cent of the plan budget.

Out of 34 state plan schemes, 7 schemes garner more than 90 per cent of the state plan budget Out of the total 34 state plan schemes of DoHFW, there are 9 schemes that have zero budget

allocation in the last 4 years (Inactive schemes) and 25 schemes are active schemes.

1.3.3 Scheme Prioritization All plan schemes of DoHFW for the financial year 2014-15 are mapped with the department’s primary and secondary objectives.

Plan schemes that are considered for mapping are Central Sector Schemes (CS), Centrally Sponsored Schemes (CSS), Externally Aided Projects (EAPs) and State Plan Schemes (SPs)

Based on scheme guidelines and nature of scheme, each scheme is mapped with the objectives (Primary & Secondary) of the department


o Primary objective refers to the key objective for which the scheme has been specifically designed

o Secondary objective refers to any additional objective met by scheme (if any), other than the primary objective

Following are the results of scheme prioritization of all state plan schemes:

There are 16 schemes with single objective. Rest 54 schemes have multiple objectives. Six schemes have Human Resources for Health (HRH) as primary objective. This objective is

associated with the secondary objective such as Institutional strengthening (5 schemes) and quality (4 schemes). Most of the schemes have more than two objectives. However, for the present report only primary and secondary objectives are taken into consideration.

Out of total 28 schemes associated with institutional strengthening, 3 of them have institutional strengthening as their sole objective, 17 are combined with access and 8 with quality.

Out of 16 schemes whose objective is prevention and control of different diseases, 6 have access and 7 have quality as additional objectives.

1.3.4 Expenditure ReviewExpenditure review has been undertaken for analyzing the past trend of expenditure based on actuals till 2012-13, revised estimates (RE) for 2013-14 and budget estimates (BE) for 2014-15. Following are the observations based expenditure trend analysis, for the period 2009-10 to 2014-15:

During 2009-10 the expenditure by DoHFW was around 2.6 per cent of the total state budget. There is a steady increase in expenditure over past 6 years.

As per revised estimate of 2013-14 the expenditure is around 3.35 per cent of the total government budget and as per budget estimate 2014-15 the expenditure is around 4.24 percent of the total government expenditure.

Expenditure on health as percentage of GSDP shows slight fluctuation during 2009-10 and 2011-12. From 2012-13 onwards the expenditure shows a consistent trend (i.e. grown from 0.69 per cent of GSDP to 1.03 percent of GSDP).

1.3.5 Trend Based Expenditure ProjectionsTrend based projection is the process of arriving at expenditure projections for the Medium term (3 years) on the basis of past expenditure trends of the department. For DoHFW, trend projections are made for the period 2015-16 to 2017-18 in consultation with the finance division of DoHFW. The assumptions and methodology for arriving at trend projections for the department is presented below.

The assumptions used for trend projections are presented below:

AssumptionsObject Heads Object description Assumptions

11 Salary, Allowances As per FRBM statement – 27.52% of 2013-14 RE for 2014-15. Growth rate of 15 per cent for 2015-17 onwards.

12 Wages AAGR 15 per cent (As discussed with department)14 Reward, Award Honours AAGR of 7 per cent (Equivalent to Inflation / Price Indices)19 Salary of contractual employees AAGR of 12 per cent increase over the year 2013-1421 Travel Allowance AAGR of 12 per cent22 Office Expenditure AAGR of 12 per cent23 Purchase Vehicles AAGR 7 per cent (only maintenance cost included)24 Examination & Training 12 per cent over the previous year.31 Payment for professional

services12 per cent per annum

33 Maintenance Work AAGR + 7 per cent Inflation (varies depending on AAGR)34 Materials & Supplies AAGR of 5 + 7 Percent over the period 2013-14


Object Heads Object description Assumptions35 Advertisement & Broadcasting Increase by 7 percent over the previous year41 Scholarship & Fellowship AAGR + 7 per cent Inflation42 Grant-in-Aid AAGR for 2013-14 RE Calculated and the growth rate is used for

projection. If no growth rate is observed, the grant amount is kept constant for the projected period.

43 Contribution Kept constant during the projection period44 Subsidy As per the AAGR51 Other Charges Kept constant during the projection period53 Payment of Decree Kept constant during the projection period63 Machines Assuming that the machine will last for 10 years, a maintenance cost

of 10 per cent of the total cost is assumed64 Large Construction Work No specific method. If the construction was started in recent past the

same growth rate is continued for the year 2015-16 onwards. In case the construction work was started at some earlier point of time AAGR is taken as the base for projection.

MethodologyThe methodology for arriving at trend projections for the years 2015-16 to 2017-18 is presented below:

First, object wise projections of plan as well as non-plan expenditure are made in order to arrive at object level estimations. The projected scheme level expenditures (by plan and non-plan) are arrived at by summing up of the object level expenditures for each individual scheme.

Second: The object wise expenditure trends for the past 6 years are used to arrive at appropriate growth rates. The growth rates, thus arrived, are used for object wise projections. The figures are then discussed with the department and the final projection estimates are made1. The base year used for the projection is 2013-14 RE.

Trend projections for the period 2015-16 to 2017-18 based on the above methodology are presented in Table 1. It may be pointed out that off budget schemes that existed before 2013-14 are now merged with on budget schemes and form a part of the demand for grants presented in Assembly. The plan for the off budget expenditure was made by the societies2.

Table 1 : Trend Projections for DoHFW (Rs. in crore)

Expenditure RE BE Projections2013-14 2014-15 2015-16 2016-17 2017-18

Plan 1226.66 2448.02 2834.30 3163.16 3553.69Non-Plan 1757.26 2380.36 2604.31 2966.12 3379.89Off budget 1508.03 0.00 0.00 0.00 0.00Total 4491.95 4828.38 5438.61 6129.28 6933.58Growth rate 0.07 0.13 0.13 0.13

1.4 Top Down EstimationThe top down estimates for DoHFW for Financial Years 2015-16, 2016-17 and 2017-18 are arrived at based on top down estimation methodology that is submitted separately to the finance department. The results are presented in Table 2. As per the top down estimates the resources that are likely to be

1 It may be noted that for the projection of some of the items, the department officials were not in opinion of taking the trend growth rate as they expected that for some of the schemes the growth rate of expenditure will be higher/lower in the future years. Therefore, instead of taking trend growth rates we have taken the growth rate as given by finance section of DoHFW. This has been discussed and agreed during the validation discussions. 2 The off budget funds are directly transferred to the departments through the independent societies formed by them. For the health sector two independent societies are NRHM and MP State Aids Control Society (MPSACS). The off budget money is directly transferred to the account of the societies formed by the departments and not channelized through the state treasury. State does not take any direct responsibility on this fund management. At present (from the financial year 2014-15), the government has removed the concept of ‘off budget’ and merged them with the on budget (i.e., the budget channelized through state treasury). The off budget money are now spent on the state government schemes existing in the department. The government has also introduced some additional schemes.

MTEF for Department of Health and Family Welfare – 2015-16Strengthening Performance Management in Government Phase–II December 2014available to the DoHFW for State Plan Schemes are Rs.341 crores, Rs.391 crores and Rs.448 crores for the FYs 2015-16, 2016-17 and 2017-18 respectively. In case of surplus (as in the present case) the plan funds will be allocated to the State Plan Schemes across each objective based on the application of Scheme Prioritization Framework after making any provision for any additional matching contribution to the CSS (if required). If the DoHFW receives a lower plan expenditure ceiling compared to its plan requirements arrived based on their past expenditure trends, then the funds allocation would be reduced, by allocating lesser resources to the low priority State Plan Schemes, arrived at using Scheme Prioritization Framework.

Table 2: Top down estimates for DoHFW for FY 2015-16 (in crores)

2011-12(A)

2012-13(A)

2013-14(RE)

2014-15(BE)

Projections2015-16 2016-17 2017-18

a. State Plan Sch. in DoHFW 279 678 265 226 341 391 448b. CSS in DoHFW 9 16 366 1397 1537 1690 1859c. CS in DoHFW 309 346 479 624 750 940 1179d. EAPs in DoHFW 0 26 53 81 96 118 139e. CFC in DoHFW 11 30 63 111 125 152 179f. NABARD (General) 5 10 2 10 11 12 13g. On- Budget resources (sum of a to g) 613 1107 1227 2448 2859 3303 3818h. Budgetary Plan Resource Envelope for DoHFW 613 1107 1227 24483 2859 3303 3818

1.5 Reconciliation The bottom-up estimates arrived at based on trend projections and top down estimates derived from top down estimation methodology for DoHFW for FY 2015-16 are presented in Table 3. These projections have been carried out assuming the department intends to continue with the current schemes and progress at the current rate.

Table 3: Projected resource and expenditure growth of DoHFW (in Rs. Crore)2015-16 2016-17 2017-18

I. PLAN EXPENDITUREI. A. Top DownResource Envelope for DoHFW computed through top down estimates 2859 3303 3818I. B. Bottom UpTrend Scenario based on the actual data and assumptions accepted by the department 2834.30 3163.16 3553.69Trend deficit (+)/ surplus (-) with respect to resource envelope (-)24.7 (-)139.84 (-)264.31II. NON PLAN EXPENDITURE 2604.31 2966.12 3379.89

It is pertinent to note that the top down ceilings are indicated to the line departments by the State Planning Commission in consultation with Finance Department before they prepare their budget proposals for the next year budget cycle. Therefore, if the DoHFW receives a lower plan expenditure ceiling compared to its plan requirements arrived based on their past expenditure then the funds allocation would have to be reduced from the low priority State Plan Schemes arrived at based on the application of Scheme Prioritization Framework.

1.6 Way ForwardIn taking forward the MTEF and for institutionalization of MTEFs, the following actions are proposed:

3 The Budgetary Plan Resource Envelope for DoHFW for FY 2014-15 includes off budget expenditure as well. From FY 2014-15 off budget expenditure of the department is routed via treasury mode making it on-budget.


The bottom up resource estimates and the top down estimates will be reconciled during budget discussions.

Post obtaining the resource gap from top down and bottom-up estimates, the principle of prioritization will be used to allocate resources to different schemes.


2. Background

2.1 SPMG Project The Government of Madhya Pradesh (GoMP) seeks to further strengthen the fiscal performance of the State through fiscal reforms. Some of the reforms have been initiated under the Department for International Development (DFID), United Kingdom funded Strengthening Performance Management in Government Phase I (SPMG) project. Through the Phase II of this project, the Government intends to bring about systemic reforms in public financial management. This is expected to assist GoMP to effectively implement policies for higher growth and attract private investment, strengthen accountability for effective public service delivery and respond to challenges of environment sustainability.

GoMP has engaged Deloitte Touché Tohmatsu India Private Limited as Long Term Consultants for strengthening Public Financial Management in Madhya Pradesh. Deloitte has commenced work on 1 st

March 2013.

2.1.1 Scope of WorkScope of work of Deloitte include tasks that are aimed at effective implementation of systemic reforms in public financial management (PFM) and establishing Project Development Facility (PDF) in Department of Finance (DoF) for development and operationalization of PPP (Public Private Partnership) projects in different sectors. Various tasks under PFM include institutionalization of government wide monitoring and evaluation system, reforms aimed at enhancing tax revenue of state, broadening MTEF usage in more departments incorporating elements of performance budgeting, value for money audit for select departments, institutional strengthening of Directorate of Institutional Finance (DIF) and provide program management support for SPMG II project.

2.1.2 Budget and Expenditure ManagementDuring the Inception phase, the broad approach agreed towards preparation of MTEF has been finalized. The overview of the approach that has been agreed for implementing MTEF is provided in the figure below:

Based on review of the existing methodology, issues have been identified in implementing MTEF. The identified issues along with existing methodology have been shared with all 15 departments during the MTEF workshop held on 2nd August 2013. MTEF action plan and MTEF guideline was discussed and agreed upon during the workshop.

Based on the agreed MTEF action plan and methodology, support is being provided during the 1st year of the project (i.e., 2013-14) for DoHFW. In the 2nd year of the project (i.e., 2014-15), selected departments are being provided support in implementing MTEF. During the 3 rd year of the project

MTEF for Department of Health and Family Welfare – 2015-16Strengthening Performance Management in Government Phase–II December 2014(2015-16), all the 15 departments are expected to be in a position to prepare MTEF for 2015-16 on their own with limited support from the expert team.

2.2 Medium Term Expenditure Framework 2.2.1 Introduction

Medium Term Expenditure Framework (MTEF) is a modern process of planning and budgeting that links the objectives and expenditure of the department with the respective outputs over a medium term, preferably for 3 years. The process entails a detailed analysis of schemes and their objectives and linking them with appropriate outputs / outcomes, thus making the budgetary process more realistic, accountable and transparent, and outcome based. Thus, in implicit terms, the MTEF can be called as a process of outcome informed budgeting, which is rolled over a period of 3 years, with the current year being the most recent budget.

2.2.2 Objectives of MTEFMedium Term Expenditure Framework (MTEF) is defined as a budgetary framework over a medium term (3 year) planning horizon.

The main objectives of the MTEF are:

Create a predictable and consistent State policy and budget framework Departments estimate the budgetary resource required over a three-year period to achieve

explicit strategic objectives Foster development of budget estimates based on priorities of GoMP that are backed by

proper costing of schemes and sub-schemes i.e. at the level of outputs and activities. Improved budget discipline through effective financial management and accountability, so that

budget execution is consistent with budgetary appropriations. Develop a comprehensive, integrated budget that captures all public expenditures in an

integrated format, where investment and recurrent budgets are comprehensively covered.

2.2.3 MethodologyMTEF is a tool to enhance efficiency and effectiveness in Budget management. Adoption of MTEF is deemed an efficient way of linking Strategic Plans and Budgets. A sound MTEF serves as a tool for economic and financial management, accountability and also serves as a mechanism to bring in outcome orientation in departments.

Preparation of MTEF involves the following 3 steps:

Top Down Budgeting - Top Down Resource Estimation

Bottom Up Budgeting - Bottom-Up Resource Estimation

Reconciliation and Reprioritization

Top down estimation has been presented in a separate report submitted to Finance and Planning Departments for their suggestions and approval. In the current report, bottom up budgeting as may be applicable to DoHFW is presented in next section for arriving at resource requirement for the department for the period 2015-16 to 2017-18.


3. Bottom Up Budgeting Bottom up budgeting is the process through which resource requirements of the department are arrived at based on past trends in expenditure and attainment of objectives of the department.

This entails assessment of the sector in terms of status of key indicators to identify issues of concern, followed by overview of department objectives and review of schemes that are currently being implemented.

A conceptual framework is used to logically link the issues of the sector, objectives of the department with the schemes being implemented. This process leads to identification of resource requirements, driven by outputs to be achieved by the department. Further, over and above current interventions, additional interventions would also be identified to address sector issues.

The sequential steps involved in arriving at bottom up estimation for DoHFW are as follows:

(i). Sector Review(ii). Department Review(iii). Scheme Review(iv). Expenditure Review(v). Trend Projection

The above steps are followed in arriving at resource requirements for DoHFW for the period 2015-16 to 2017-18, which are presented in the subsequent sections.


3.1 Sector Overview DoHFW of MP has as it major objective of improving status of key health parameters of the State. The sector performance is assessed through a detailed analysis of various performance indicators over the years. The analysis provides us an insight into the underlying reasons for the observed trends and help in identifying the issues plaguing the health sector. A brief overview of the structure of health sector and department in MP is provided in the next sub-section.

3.1.1 Health Status in Madhya PradeshKey demographic and health Indicators

Demographic characteristics of the population are key determinants of health status. This is measured by using key indicators as given below:

(A) Demographic Indicators: The demographic indicators related to health are: total population and its growth rate, population by gender, population by age, life expectancy etc. The status of Madhya Pradesh in terms of the above indicators is given below:

Growth Rate: In absolute terms the total population of India as well as Madhya Pradesh has increased over the decades. Figure 1 shows the decadal growth rate of the population.

Figure 1: Decadal growth rate population – India and MP (1911-2011)

Figure 2 depicts the distribution of population by age. It is observed that a large portion of the population (38.6 per cent males and 38.5 per cent females) falls within the age group 5-14, indicating that the population is skewed towards the younger age groups. This warrants the health system to give more emphasis on child health – as they form the basis of human capital and overall economic growth of the state.


Figure 2: Percentage distribution of total population of Madhya Pradesh by age groups4

Figure 3 depicts the population by sex across different age groups. It is observed that the percentage of male population till the age group 50-54 is more compared to their female counterparts. The sex ratio of the state during 2011 is 930 as against the national average 940.

Figure 3: Percentage distribution of population by age and sex

The population within the age group of 15-49 (i.e., reproductive age group) is the major target group as far as the maternal and adolescent health care services are concerned. Out of total population, nearly 35 million of the total population falls under this age group. Out of 35.19 million, nearly 49 per cent are females. This puts huge burden on the health system, as provision of health infrastructure (i.e., manpower and buildings) is basic responsibility of the state. Is it also observed that there is a high need for providing pre as well as post-delivery care to this segment of the population (Figure 4)

4 As the age wise distribution of male and female population was not available, the percentage figures of 2001 census has been used


Figure 4: Number of males and females (reproductive age group 15-49 emphasized) in Madhya Pradesh – Figures in millions

(B) Health IndicatorsVital Health Statistics – India and MP

Among the major statistics that are used to assess the health status of population, and alternatively reflects the performance of health sector are: Crude Death Rate (CDR), Crude birth Rate, Infant Mortality Rate (IMR), Maternal Mortality Ratio (MMR) and Total Fertility Rate5.

(a) Crude Death Rate (CDR): Crude death rate (CDR) of males and females of India along with MP and other comparable states is depicted in Figure 5 and Figure 6. It is evident from the figures that the CDR for males is more than the females – thus implying higher life expectancy of females compared to their male counterparts. The CDR for MP for males has declined from 9.2 to 9.1 per thousand during the year from 2005 to 2011. The CDR for females has declined from 8.6 to 7.5 during the same period. A comparison of CDR with the all India average indicates that CDR is slightly higher for MP for both the sexes. A comparison across the states indicates that CDR is highest for Orissa compared to other states.

Figure 5: Crude death rate (Male) - India, MP along with comparable states 2005-2011

(Source: Census, 2011)

5(a) Crude Death Rate (CDR) is number of deaths during the year divided by midyear population and multiplied by 1000(b) Infant Mortality Rate (IMR) is the ratio of infant deaths to live births during the year multiplied by 1000(c ) Total Fertility Rate (TFR) is the number of live births during a year per 1000 female population aged 15-49 years at the midpoint of the same year (d) Maternal Mortality Ratio (MMR) is the number of maternal deaths in the age group 15-49 years per one 100,000 live birth. Source: Sample Registration System (SRS) : www.censusindia.gov.in


Figure 6: Crude death rate (Female) - India, MP along with comparable states 2005-2011


(b) Crude Birth Rate (CBR)6

Crude birth rate is another key indicator of health and linked to aspects such as provision of family planning, child immunization at appropriate age etc. In terms of CBR, the status of the state is slightly higher than the national average. This is mostly due to more number of births in rural as well as urban areas Figure 7.

Figure 7: Crude Birth Rate – India and Madhya Pradesh

(Source: Census of India 2011, Annual Health Survey 2011-12)

(c) Infant mortality rate (IMR)

The infant mortality rate for Madhya Pradesh along with all India average and comparable states is shown in Figure 8 and Figure 9. It may be highlighted that the IMR for females is much higher than their male counterpart. Same trend is observed for the country as well as across the states. As far as the status of the indicator is concerned, the IMR in MP for male children has come down from 72 to 57 during 2005 and 2011. For female children it has come down from 79 to 62 per 1000 live births. This is much higher than the national average during the same period.

A comparison across the states indicates that Orissa has the highest infant mortality followed by Madhya Pradesh and Rajasthan. The status is slightly better for Chhattisgarh and Jharkhand which were the part of Madhya Pradesh and Bihar during the earlier part of this decade. This is exceptionally a serious issue and needs urgent intervention

6 CBR = (N / TP) x 1000 where N represents the number of births in a specific time period, and TP is the total population during this period- usually a year.


Figure 8: Infant mortality rate (male) - India, MP along with comparable states 2005-2011


Figure 9: Infant mortality rate (female) - India, MP along with comparable states 2005-2011

(Source: NSSO, Census, 2011)

(d) Maternal Mortality Ratio (MMR)

The MMR for MP along with all India average and comparable states is depicted in Figure 10. It may be noted that the MMR is much higher in MP compared to national average. At the national level, the MMR has declined from 398 per 100,000 live births during 2005 to 212 during 2011. In MP the MMR appears to be high. As the figures indicate, it has fallen from 441 in 2005 to 269 during 2011. Though the rate of decline is higher than the national average, in absolute terms the figure is much higher. Orissa, Bihar and Rajasthan have brought down their MMR substantially during the same period.

Figure 10: Maternal Mortality Ratio (MMR) - India, MP along with comparable states 1997-98 to 2007-09



(C)Family Welfare Indicators (e)Total Fertility Rate (TFR)7: The TFR of Madhya Pradesh along with all India average and comparable states is shown in Figure 11.

Figure 11: Total Fertility Rate (TFR) - India, MP along with comparable states 2005-2011

(Source: Census 2011)

It is observed that the TFR in MP is substantially higher compared to national average and other comparable states (Orissa, and Jharkhand). The TFR for Bihar is highest followed by Rajasthan, Madhya Pradesh, Jharkhand and Chhattisgarh. Orissa has the lowest TFR. The TFR of India has declined from 2.9 to 2.4 per women, whereas, the TFR for MP has declined from 3.6 to 3.1, thus indicating at least 3-4 children per women during their reproductive age. High TFR is the major reason for growth of population in India.

(f) Status of Family Planning

Following few sections of the report is heavily dependent on the data from National Family Health Survey (NFHS-1, 1992-93), NFHS-2 (1998-99) and NFHS-3 (2005-2006). It is observed that the major contributing factor to high TFR is the lack of use of modern family planning methods. This is evident from Figure 12 and Figure 13.

Figure 12: Status of Family Planning (currently married women, age 15–49) in India (%) – NFHS1, 2 and 3

7 Total Fertility Rate may be defined as average number of children that would be born to a woman if she experiences the current fertility pattern throughout her reproductive span (15-49 years). The total fertility rate is a more direct measure of the level of fertility than the birth rate, since it refers to births per woman. This indicator shows the potential for population change in a country. A TFR of 2.1 i.e., two children per women is considered the replacement rate for a population, resulting in relative stability in terms of total population numbers. Rates above two children per woman indicate population growing in size and whose median age is declining. Rates below two children per woman indicate population decreasing in size and growing older.


Figure 13: Status of Family Planning (currently married women, age 15–49) in MP (%) – NFHS1, 2 and 3

As far as family planning is concerned, for all India, the percentage of eligible couples using any family planning method has increased from 40.7 per cent to 56.3 per cent during the reference period. Madhya Pradesh also has shown similar progress as far as overall figure is concerned. Therefore the percentage of eligible couples using any modern method of family planning is well comparable with the national average.

(D) Indicators on Maternal Health (i) Maternal Health – ANC care

The status of Ante Natal Care (ANC -care during the pregnancy) is presented in Figure 14 and Figure15. During NFHS-1 data on ANC for MP is not available for the state. Therefore, we have made a comparison based on the data obtained from NFHS-2 and 3 only. Only 27.1 per cent of the pregnant mothers in MP had 3 ANC visits (complete ANC checkup) during 1998-99. There is substantial improvement in ANC care (44.2 per cent) during 2005-06 (NFHS-3).

These figures are substantially lower compared to national average (Figure 14). Similar observation is made when we compare the state figures with national average. As far as the consumption of IFA tablets, births attended by trained personnel, institutional delivery and Post Natal Care (PNC) concerned there is substantial improvement in the status of the state. However, the figures are not comparable with national figures.

Figure 14: Maternity care for the deliveries (for births within last 3 years of survey) % - India


Figure 15: Maternity care for the deliveries (for births within last 3 years of survey) % - MP

(E) Indicators on Child Health (i) Immunization and Vitamin-A supplementation

In so far as the health status of children is concerned the status of Madhya Pradesh lags behind in several aspects. Out of total children only 22.6 per cent of the children within age group of 12-23 months were fully immunized in the state as against the national average of 42 per cent (NFHS-2). As per NFHS-3, the situation is substantially improved but still lies below the national average of 43.5 per cent (Figure 16 and Figure 17).

During NFHS-2 the children between 12-23 months who received BCG vaccination is around 62 per cent, received 3 polio doses is around 57 percent, received 3 DPT doses is around 36 per cent and received measles vaccine is around 34 per cent. These figures lie much below the national average which is around 72 per cent for BCG, 63 per cent for polio, 55 per cent for DPT and 51 per cent for measles respectively.

Figure 16: Status of child immunization (%) – All India

Figure 17: Status of child immunization (%) – Madhya Pradesh

MTEF for Department of Health and Family Welfare – 2015-16Strengthening Performance Management in Government Phase–II December 2014As per NFHS-3 results there seems to be substantial improvement in number of children who received various vaccinations (BCG, Polio, DPT and Measles). These numbers are substantially below the national average.

No doubt, substantial improvements are being made to increase the coverage of fully immunized children. The figures still lie below the national average (Source: NFHS 1, 2 and 3; Annual Health Survey 2011-12)

(F) Issues related Nutritional Status(i) Child Feeding Practices and Nutritional status

As per the norm prescribed by the Government of India every newborn child should be breast fed within 1 hour of their birth. As far as such practice is concerned the status of MP appears to be poor compared to national average (Source: NFHS-2 and 3). Similarly, exclusive breast feeding till 5 th month and practice of breast feeding along with semi solid or solid food is comparatively lower for the state compared to national average.

As a result, the percentage of stunted8 and wasted9 and underweight (<3 years) children has remained as high as 46.5, 39.5 and 57.9 per cent respectively (Figure 18).

8 Stunted: Low height for age. This is caused by long-term insufficient nutrient intake and frequent infections. Stunting generally occurs before age two, and effects are largely irreversible. These include delayed motor development, impaired cognitive function and poor school performance9 Wasted: Low weight for height. This is a strong predictor of mortality among children under five. It is usually the result of acute significant food shortage and/or disease.

9.5 16

.0 23.4

0 0

46.3

0 0.0

55.8

0

51.0

44.9

0

19.7 22

.9

51.5

42.7

40.4

0

20

40

60

NFHS1 NFHS2 NFHS3

India

<3 years breast fed within one hour ofbirth0-5 months exclusively breast fed

6-9 months with breast milk and semisolid food< 3 years stunted

0

8.9 14

.9

0 0

21.6

0 0.0

51.9

0

55.1

46.5

0

25.2

39.5

0.0

50.8 57

.9

010203040506070

NFHS1 NFHS2 NFHS3

MP

<3 years breast fed within one hour of birth

0-5 months exclusively breast fed

6-9 months with breast milk and semi solidfood< 3 years stunted


Figure 18: Child feeding practices and nutritional status of children below 3 years (%) – India and MP

The nutritional status of the women and men within the reproductive age group is usually measured by Body Mass Index (BMI10) and Overweight. As per NFHS-2, in MP the percentage of women with <normal BMI are around 35.2 per cent as against the national average of 32.2 per cent.

As per NFHS 3, in MP the women with less than normal BMI is around 40 percent and men with less than normal BMI is around 37 per cent. The figures are still higher than the national average Figure 19.

Figure 19: Nutritional status of men and women within reproductive age (15-49) – India and MP

(G) Status of other diseases(i) Diarrhea10 Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women. The formula for calculation of BMI = (Weight in Kilograms/ (Height in meters)2 BMI below 18.5 – Underweight, BMI from 18.5 - 24.9 Normal Weight, BMI from 25 - 29.9 Overweight, BMI from 30 - 34.9 Obese, BMI from 35 - 38.9 Very Obese, BMI 39 and above Morbidly Obese

MTEF for Department of Health and Family Welfare – 2015-16Strengthening Performance Management in Government Phase–II December 2014Table 4: Number of Diarrheal cases and deaths during 2010-11

Number of Cases and Deaths Due to Acute Diarrheal Diseases in Madhya Pradesh 2010-2011

StateMale Female Total Reference

PeriodCases Deaths Cases Deaths Cases DeathsMP 153655 56 137050 36 290705 92 Dec.’11India 5300955 731 4930094 538 10231049 1269

Source: Indiastat.com

Table 4 gives the details of the identified diarrheal cases and deaths during 2010-11. Out of total 1269 deaths due to diarrheal diseases in India, MP contributed around 7.2 per cent to it. This appears to be to be markedly higher. This may be due to bad hygienic conditions and inadequate attention of the health authorities during the outbreak of the disease and the preparedness of the health authorities to tackle the condition in time.

(ii) Cataract

Table 5 gives the achievement of the state in identification and successful operation of cataract cases in the state as well as the country. During 2007-08 out of 3.5 lacks identified cataract cases, 92.23 per cent of the cases were successfully operated. Similarly out of 3.8 and 4.1 lakh cases who were identified during 2008-09 and 2009-10, 83.6 and 90.8 per cent of the cases were successfully operated. The achievement of Madhya Pradesh is lower than the national average.

Table 5: Identified Cataract cases and achievements 2007-08 to 2009-10

2007-08 2008-09 2009-10

TargetAchievemen

t

% Achiev

e TargetAchievemen

t

% Achiev

e TargetAchievemen

t%

AchieveMP 350000 322822 92.23 450000 376143 83.59 450000 408518 90.78India

5000000 5404406 108.09

6000000 5810336 96.84

6000000 5906016 98.43

(Source: Indiastat.com)

(iii) Leprosy

Table 6 depicts the number of new leprosy cases detected, treated and under treatment for the year 2010-11. As could be observed from the table, out of total population of 72.6 million, a total of 5708 cases were newly detected. A total of 5631 cases completed their treatment and 4391 cases are on the record and undergoing the treatment for the disease. This gives a prevalence of 0.6 cases per 10,000 people which is slightly lower than the national average of 0.69 per 10,000 persons.

Table 6: Case detection and treatment of Leprosy cases in MP 2010-11State Provisional Total New

CasesCases

DischargedCases on Record

Prevalence Rate / 10,000

Population (Census 2011)

Detected as Cured Under Treatment

Rate/10,000

MP 72597565 5708 5631 4391 0.6India 1210193422 126800 132105 83041 0.69(Source: Indiastat.com)

(iv) Malaria As can be seen from Table 7, during 2011-12 and 2012-13 (figures are up to December 2012) the total number of malaria cases detected works out to be 91,851 and 45,200. The deaths due to malaria were 71, which is nearly 0.07 per cent of the total deaths due to malaria during 2011. A comparison with the national figures indicates that only 0.03 per cent of the malaria cases were died during the same period. The status of MP is extremely poor in this case.

MTEF for Department of Health and Family Welfare – 2015-16Strengthening Performance Management in Government Phase–II December 2014Table 7: Status of Malaria in MP

Number of Malaria Cases and Deaths in Madhya Pradesh (2011 and 2012)State 2011 2012*

Cases Death CasesMadhya Pradesh 91851 71 45200India 1310656 430 736875(Source: Indiastat.com)

(v) TuberculosisTable 8 depicts the scenario of Tuberculosis cases in the state. As could be seen from the table, during 2008, out of total registered TB cases in India, 5.4 per cent of them were from Madhya Pradesh. Similarly during 2009 and 2010, out of total registered TB cases in the country, 5.4 and 5.7 per cent were from Madhya Pradesh. This indicates high prevalence of TB in the state.

Table 8: Case detection and Treatment success rate of TB casesStat

e2008 2009 2010

No. of Patients

Registered

No. of Patients Treated

TSR No. of Patients

Registered


TSR No. of Patients

Registered


TSR

MP 80929 67866 84% 83276 70921 85% 87823 7586486%

India 1517333 1299296 86% 1533309 1320387 86% 1522147 131032486%

(TSR: Treatment success rate, Source: Indiastat.com)

(G) Health Infrastructure: Table 9: Health Infrastructure in MP

Type of hospital Sanctioned bed

(general)

SanctionedBed (SCP)

Sanctioned Bed (TSP)

TotalBeds

Total Hospitals / Health care Delivery centres*

District Hospital 6100 (21) 4900 (18) 2400 (11) 13400 50Civil Hospitals 1649 (25) 1622 (30) 260 (3) 3631 58CHCs 9960 332PHCs 6936 1156SCs 284 8765Civil Dispensary (U) 92Urban FW Centre 96Urban Health Centre (HP)

83

TB Hospital 07TB Sanitarium 02Chest Centre 01Poly Clinic 06Regional Diagnostic Centers

11

Trauma Centre 0734211 10666

* Excludes the tertiary level health care institutions and medical college hospitals and institutions related to them. (December 2013)

Table 9 shows the status of the MP in terms of health infrastructure. As table indicates, there are nearly 10,666 health care institutions in the state and total beds available at various levels (excluding tertiary and medical colleges) are 34211. The bed population ratio works out to be 1:2122 as against all India average of 9 beds per 10,000 populations, which is abysmally lower than the national average.

(H) Human Resources for Health

MTEF for Department of Health and Family Welfare – 2015-16Strengthening Performance Management in Government Phase–II December 2014Table 10: Human Resources for Health – December 2013

Type Type of appointment Sanctioned Working VacanciesSpecialists Regular 3057 1251 1916Medical officer Regular 4265 2789 1476

RCH (PG) 108RCH (MBBS) 326

Total Doctors 7322 4474 3392(Source: Annual Administrative Report, 2013)

The information about the number of allopathic doctors presently working in the state is given in Table10. It is observed that against the total sanctioned posts only 61 per cent of the posts are filled and rest of them are vacant. The doctor population ratio (allopathic doctors) works out to be 1:16227 which is lower than the national average of 1:13531

3.1.2 Summary of the Issues related to Health Sector

A. Demographic Issues: 1. In absolute terms, the population of the state is growing at a faster rate. The decadal growth rate of

the population in MP is higher than the all India average.2. Larger segment of the population are people within the age group of 15-49 years followed by the

population within the age group of 0-14. Therefore, adequate provision needs to be made for them in order to address the health and other related issues of these groups.

3. The life expectancy is low in the state as a whole. The life expectancy of females is more compared to males. This needs more attention on chronic diseases and geriatric care

4. A large proportion of populations are adults. Therefore there is a need for expanding the awareness generation activities, especially related to sexual and reproductive health in order to prevent them from various sexual infectious diseases.

B. Key Issues related to CBR, CDR, IMR and MMR: 1. Desire to have more children due to high infant mortality, and low coverage of family planning

services are two major factors responsible for high birth rate in the state. 2. The CDR of Madhya Pradesh is relatively high compared to national average. This is mostly due to

lack of quality of care and appropriate infrastructure in the government health care facilities. 3. Lack of proper attention to provide ANC, PNC and immunization services are the key factors that

contribute to higher Infant deaths, thus contributing to IMR and MMR4. Low institutional deliveries that stems from the lack of trained manpower and timeliness of handling

the complicated delivery cases are the major causes of high MMR. 5. Lack of inter sectoral coordination is also one of the most important factors for high infant and

maternal deaths C. Key Issues related to Family Welfare activities:1. The TFR of Madhya Pradesh is significantly high compared to national average. This is mostly due

to inadequate attention on family welfare activities in the state. This has ultimately led to high population growth in the state

2. A major chuck of the population in the state is tribal. Various awareness activities coupled with better education in tribal dominated areas would help mitigating the problem to a large extent

3. The unmet need for family planning need to be addressed on a priority basis 4. There is a high need for increasing awareness of the tribal population on the temporary methods of

family planning.D. Key Issue related to maternal and child care: 1. The ANC activities in the state, especially in remote and tribal dominated areas, are extremely

poor. It is therefore necessary that appropriate policy measures are initiated to cover the all pregnant mothers for ANC care. This would help in reducing the maternal mortality to a large extent

MTEF for Department of Health and Family Welfare – 2015-16Strengthening Performance Management in Government Phase–II December 20142. Childhood immunization plays a most important role in reducing the IMR. It is therefore necessary

that special provisions are made to increase the immunization coverage so that the majority of child populations are completely immunized as per the government norm.

3. The institutional deliveries need to be increased in order to reduce the complications during child birth

4. The Post Natal Care is abysmally low and need to be improved in order to reduce the complications arising immediately after the delivery

5. The major reason for all these are the negligence of the department to carry out their activities properly / lack of proper coordination between DoHFW and NRHM

E. Key Issues related to nutritional status: 1. Poor nutritional status of the children.2. Low awareness of the population on the effect of appropriate nutrition on the future health of the

children and adults3. Increasing number of stunted and wasted children4. Lack of awareness of the population on the importance of appropriate diet during pregnancy5. Low awareness of the reproductive age group on appropriate diet leading to low BMI and

overweight F. Key issues related to other diseases:1. High prevalence of diarrheal diseases and the consequent deaths2. High prevalence of leprosy in the state due to low case detection3. High incidence of malaria and other vector borne diseases4. High prevalence of Tuberculosis and drug resistance


3.2 Department Review 3.2.1 Structure of Health Department in MP

The Health Department consists of several Directorates. Apart from DoHFW there are other directorates: Directorate of Medical Education (DME), Directorate of Ayush, National Rural Health Mission (NRHM), Madhya Pradesh State Aids Control Society (MPSACS), and Directorate of Food and Drug Control.

The Principal Secretary is assisted by Secretaries / Commissioners, who are responsible for each of these Directorates/Societies. As the present document deals with the Department of Health and Family Welfare only, the structure of the department is presented in detail. The commissioner of health is responsible for overall management of DoHFW. He is assisted by 5 Directors. At present the nomenclature of the Directors depend on the responsibility bestowed on them. The Director of Health Services is directly responsible for the health care delivery activities by DoHFW at the state level. He/she is assisted by several officials. The health care activities at the district level are looked after by Chief District Medical officers of respective districts. They are directly responsible for the implementation of health programs at the district level. At the block level there are Community Health Centers (CHC) and Primary Health Centers (PHC) are the lowest level health care institutions of the public sector. Below PHCs, there are Sub Centers (SCs) which serves 7-10 villages at the grass root level. Block Medical officers and Medical officers are directly responsible for the health care delivery at the CHC and PHC level. The SCs are managed by health workers.

Apart from the above, the health care in the state is also managed by other line departments: Department of Labor, Public relations Department, Department of Tribal welfare (TSP), Department of Women and Child Development etc. A detailed list of all the departments and the demand numbers through which the budget is allocated is presented in subsequent sections of the report.

The organogram of DoHFW as well as NRHM is presented in Figure 20 and Figure 21.

MTEF for School Education Department - 2014-15Strengthening Performance Management in Government Phase–II 31December 2014

Figure 20: Structure of DoHFW in Madhya Pradesh


Figure 21: Structure of National Rural Health Mission (NRHM) in Madhya Pradesh

3.2.2 Objectives of the Department In this section we make a detailed review of the Department of Health and Family Welfare (DoHFW) in order to get inputs that would help understand the roles and responsibilities of the department. This would help us to bring a link concerning the objectives of DoHFW with the overall objective of the health sector. It may be recalled that the health sector consists of several directorates and societies and each of them have their own roles and responsibilities. In this report we focus on the roles and responsibilities of DoHFW. Based on the mandate of the department and consultations with the department officials, following six objectives (not in order of priority) are identified as the key objectives of DoHFW presented in Table 11 below:

Table 11: Objectives of the Department

Sr. no Objectives of the Department Description

1 Access

• Access has been taken as the secondary objective for most of the schemes. All the schemes that aim at increasing the access to the health services are included within this. As Institutional strengthening aims at increasing access to health care, both the objectives goes together.

• Services such as emergency ambulance services, mobile health clinic etc.• Additional sub health centers,

2 Awareness Generation• Information Education and Communication (IEC) activities related to different health

programs: i.e., disease control programs and family welfare programs etc.• Teenager reproductive health programs, information and broadcasting

3 Human Resources for Health (HRH)

• The main objective is to fill up existing posts, creation of new posts of specialists/doctors and other supportive staff necessary to provide the health care and manage the existing infrastructure. Moreover this also includes timely release of the salaries and other allowances to the regular staff recruited by DoHFW.

4 Institutional Strengthening

• Strengthening and maintenance of physical infrastructure at state, district, block levels and below. This is done through the construction / renovation / expansion / up-gradation of the existing physical infrastructure on behalf of the DoHFW as well as management of the same.


Sr. no Objectives of the Department Description

• This also includes administrative/ governance reforms, modernization of hospitals, monitoring and evaluation etc.

5 Prevention and control

• National Health Programs: Control of communicable and non-communicable diseases• Immunization activities for the children and pregnant mothers• Old age health care program• Prevention of adulteration of foods and drugs• Programs related to iodine deficiency, HIV, Anemia etc.

6 Quality• Drug Control, Establishment of radiation safety unit• The secondary objective for most of the schemes with Institutional strengthening and

HRH as primary objective.


3.3 Scheme Review3.3.1 Introduction

In order to meet the objectives of the department, DoHFW has been implementing several schemes. There are a total of 102 schemes implemented by the department. The schemes are classified into two categories – plan schemes and non-plan schemes. However, there are certain schemes which are funded by multiple sources which have both ‘plan’ and ‘non-plan’ component. The expenditure under the non-plan schemes is usually non-negotiable as it involves salaries and wages which are usually increased every year as per the rules laid in FRBM. The planned schemes are sourced from different agencies: Centrally Sponsored Schemes (CSS), Externally Aided Projects (EAP) and Centrally Funded Schemes (CP) and State Plan Schemes (SP). Scheme review involves the analysis of important schemes that are currently being implemented by DoHFW and account for 90 percent or more of the plan expenditure.

3.3.2 Scheme AnalysisA detailed analysis of the plan schemes with specific emphasis on state plan schemes that are being implemented by DoHFW is being undertaken to identify those that account for the major proportion (90 per cent or more) of total plan budget in general and the state plan budget in particular.. The analysis is used to examine the possibility of prioritization and preparation of the scheme prioritization matrix.

Plan Schemes and Expenditure (Total plan)In this section we have analyzed all plan schemes. The analysis would help in prioritizing the plan schemes. The scheme analysis has been undertaken through following approach:

i. Sorting all the planned schemes that are being implemented by the department in descending order on the basis of expenditure incurred under the schemes during the most recent year i.e., 2014-15 BE.

ii. Detailed analysis of schemes that account for 90 percent or more of plan expenditureiii. Separate the state plan schemes from total plan schemes and follow the similar procedure as

described above

It may be noted that for the initial analysis of all the planned schemes, the following sources of fund are considered:

(a) Foreign Assisted Projects ( For general / ST and SC population)(b) Funds from Central Finance Commission (For general / ST and SC population)(c) Funds from NABARD (For general / ST and SC population)(d) State Plan Funds (For general / ST and SC population)(e) Centrally Sponsored Schemes (For general / ST and SC population)(f) Central Plan Funds (For general / ST and SC population)

As could be observed from Annexure 1, only 8 schemes account for 92.2 per cent of the entire planned budget out of a total of 70 planned schemes. The name of the schemes along with their respective shares in the total budget is presented in Figure 22 below.


Figure 22: Name and percentage distribution of the plan schemes consuming more than 90 per-cent of the plan budget

Following inferences could be made from the above figure.

1. National Rural Health Mission (NRHM) accounts for more than half of the plan budget. This indicates the emphasis of the government on rural health care. When we link the sources of funding with the expenditure, it is observed that the major source of funding is Government of India and a small portion of state’s share towards the program.

2. Nearly one fourth of the sub centers in the state are operated from rented houses or buildings that are extremely poor. Therefore the government’s second priority is renovation of existing sub centers and construction of modernized sub centers that can handle complicated deliveries and provide appropriate maternal and child health care and immunization services.

3. Excessive load on the existing infrastructure is one of the key features of the public hospitals of the state – leading to high bed occupancy and turnover. This affects the quality of care to a large extent. In order to maintain an acceptable quality standard in the government hospitals, attempts are in the process to renovate/expand the existing infrastructure and modernize them to fulfill the increasing needs.

4. Part of the plan expenditure is intended to meet the recurrent expenses such as salaries and wages. These are basically expenses which are non-plan in nature.

Plan Schemes and Expenditure (State Plan)State plan expenditures are the expenses that are exclusively met by the state and are under the control of the state authorities. State can make appropriations and re-appropriation of this fund. As could be observed from Annexure 2, out of 34 state plan schemes 7 schemes consume more than 90 per cent of the state plan budget. This is depicted in Figure 23. Out of the total budget allocated under state plan 44.34 per cent of the total amount is allocated for elevation / up gradation of the existing hospitals. As is evident from the figure, more than 90 per cent of the state plan expenditure is devoted for construction / renovation / modernization of the hospitals / health centers. Details of expenditure made from the state plan budget are presented in Annexure 2.

MTEF for School Education Department - 2015-16Strengthening Performance Management in Government Phase–II 36December 2014Figure 23: Name and percentage distribution of the state plan schemes consuming 93.4 per cent of the state plan budget

Following conclusions could be drawn from the plan expenditure and schemes given in Figure 23:

1. A chunk of the expenditure is devoted towards the elevation / up-gradation of the major hospitals located at district or major cities of the state.

2. Attempts are also in the progress to construct new PHC/CHC/SCs. This gives an indication that the current emphasis of the government is mostly on the access of the population for the health facilities.

3. It is also observed that modernization of the existing health facilities is also another focused area of the department. This would help the rural people to avail the modern facilities at their respective areas.

4. More than 90 per cent of the state plan funds are on the activities that are capital intensive.

As mentioned above there are more than 85 per cent of the plan schemes which can be rationalized. Thus, there is a huge scope for rationalization of schemes by merging the schemes aiming at similar objectives. For example, the major objective of bulk of the schemes is to reduce maternal and infant mortality. The schemes aiming at similar objectives can be merged together in order to reduce the number of schemes. There is also possibility of grouping the schemes that account for 10 per cent of the plan budget but many in number. This would help the state government to minimize the number of schemes and ease the process of linking scheme objectives with their respective outputs.

Thus, the two possible ways suggested for streamlining the bottom 10 percent and top 90 percent of plan expenditure is:

Convergence – Merging up of the schemes with similar objectives that come under top 90 per cent of plan expenditure

Grouping - within schemes in bottom 10 per cent of plan expenditure

However, the limiting factor in this exercise is that the state does not have much leverage on the schemes that are implemented through NRHM as it acts as an independent society. It is hoped that the removal of off budget schemes by the government might bring some changes in the management of

MTEF for School Education Department - 2015-16Strengthening Performance Management in Government Phase–II 37December 2014funds. Therefore, rationalization among the State Plan (SP) schemes could be explored. The finance department along with the DoHFW has a major role to play in this decision making process.

3.3.3 Mapping of schemes with objectivesAll the planned schemes are mapped with the 6 objectives of the department mentioned in previous section. For the purpose of mapping following exercise were carried out:

1. The scheme guidelines and their details are reviewed on the basis of the documents of Government of India and state government. Further, detailed discussions where held with the finance section officials of DoHFW and NRHM.

2. It was observed that there are several schemes aiming at multiple objectives of the department. Keeping in view of the limitations of our methodology, maximum of two objectives per scheme have been taken into consideration. This is presented in Annexure 3.

3. The objectives are mapped with the schemes on the basis of priority. (Most important objective is taken first, followed by the next and so on.)

3.3.4 Scheme Prioritization MatrixA separate note on the methodology followed for the preparation of scheme prioritization matrix have already been submitted to the Directorate of Institutional Finance and a workshop on this topic was conducted on 23rd May 2014 in the presence of the department officials. In brief, a scheme prioritization matrix is a matrix of the objectives of the department mapped with schemes. A schematic presentation of the process is presented below:


3.4 Scheme Prioritization 3.4.1 Introduction

As mentioned in the previous section, there are 70 plan schemes and 6 objectives of DoHFW. Based on the departmental objectives, the scheme prioritization matrix is prepared. First all the plan schemes are enlisted and mapped with the objectives. All the state plan schemes are segregated and are taken up for prioritization. As a next step, the schemes are further segregated into active and inactive schemes (inactive schemes are those schemes which have no allocation of funds since past 4 years). The details are given in sub sequent sections.

3.4.2 Mapping of the existing schemes with objectives of the department

All plan schemes for the financial year of DoHFW are mapped with the department’s primary and secondary objectives.

Plan schemes that are considered for mapping are Central Sector Schemes (CS), Centrally Sponsored Schemes (CSS), Externally Aided Projects (EAPs) and State Plan Schemes (SPs)

Based on scheme guidelines and nature of scheme, each scheme is mapped with the objectives (Primary & Secondary) of the departmento Primary objective refers to the key objective for which the scheme has been specifically

designedo Secondary objective refers to any additional objective met by scheme (if any), other than the

primary objective

Please refer to Annexure 3 for details.

As is evident from the Annexure 3, there are currently 70 plan schemes in DoHFW (2014-15). A summary of mapping of all these plan schemes with the corresponding primary and secondary objectives that they aim at is provided in Table 12.

Table 12: Scheme prioritization summary - all plan schemes of DoHFWPrimary

ObjectiveSecondary Objective Only

primary objective

Total(Number of Schemes)

Access Awareness

Generation

HRH Institutional Strengthenin

g

Prevention and Control

Quality

Access 1 2 2 5Awareness Generation

1 2 3

HRH 5 4 6 15Institutional Strengthening

17 8 3 28

Prevention and control

6 1 7 2 16

Quality 2 1 3Grand Total 23 0 0 10 0 21 16 70

A summary of the mapping of the schemes with their corresponding objectives suggests the following:

There are 16 schemes with single objectives. Rest 54 schemes have some or other objective combined with them.

MTEF for School Education Department - 2015-16Strengthening Performance Management in Government Phase–II 39December 2014 Six schemes have HRH as primary objective. This objective is associated with the secondary

objectives such as Institutional strengthening for 5 schemes and quality in 4 schemes. Most of the schemes have more than two objectives. However, for the present report only primary and secondary objectives are taken into consideration.

Out of total 28 schemes associated with institutional strengthening, 3 of them have institutional strengthening as the sole objective, 17 are combined with access and 8 with quality.

Out of 16 schemes whose objective is prevention and control of different diseases, 6 are combined with access and 7 with quality.

3.4.3 Segregation of schemes based on Source of Funds (SoFs)

All the plan schemes mapped to the corresponding primary and secondary objectives in the previous step are further segregated on the basis of their source of funds, i.e., CS, CSS, EAP, SP and others.


It is observed that out of the total 70 plan schemes of DoHFW, 34 plan schemes are exclusively funded by the State. A summary of mapping of all these 34 state plan schemes of DoHFW along with the corresponding primary and secondary objectives is provided in Table 13 below:

Table 13: Scheme prioritization summary - all state plan schemes of DoHFWPrimary

ObjectiveSecondary Objective Only

primary objective


Access Awareness Generation

HRH Institutional Strengthening

Prevention and Control

Quality

Access 1 1 2 4Awareness Generation

1 1

HRH 3 3 1 7Institutional Strengthening

7 5 3 15

Prevention and control

4 4

Quality 2 1 3Grand Total 7 0 0 6 0 13 8 34

It is evident from Table 13 that the emphasis of the state plan is mostly been on Strengthening of Health Infrastructure - which helps in meeting the key objective of the DoHFW. Provision of adequate manpower, especially in rural in-accessible places, appears to be the next priority of the state plan schemes as 7 of them aim at this objective. The details of the mapping of schemes are as follows:

Out of total 34 schemes 8 schemes have only primary objectives and rest of them are associated with some or other objective as given in the table.

Three schemes have Institutional Strengthening and 2 schemes have access as their sole objectives. No secondary objective is associated with these 5 schemes. This implies that provision of adequate infrastructure, especially at the grass root levels is one of the key objectives of state plan schemes.

Among other objectives, HRH, prevention and control of diseases and access appear to be in the priority areas of DoHFW.


3.4.4 Segregation of schemes based on zero & non-zero budget allocation (active schemes)

All the state plan schemes identified in the previous step have then been segregated into zero & non-zero budget allocation

All state plan schemes are segregated into two categories. These are:

Category 1 (Inactive Schemes) – Schemes with zero budget allocation in the last 4 years Category 2 (Active Schemes) – All schemes other than those in Category 1

Schemes only in Category 2 are considered for prioritization exercise.


It can be observed from Table 14 that out of the total 34 state plan schemes of DoHFW, there are 9 schemes that have zero budget allocation in the last 4 years (Inactive schemes) and 25 schemes are active schemes. A summary of mapping of all these 25 active state plan schemes of DOHFW with the corresponding primary and secondary objectives is provided in Table 14.

Table 14: Scheme prioritization summary - all active schemes of DOHFWPrimary Objective Secondary Objective Only

primary objectiv

e


Access Awareness

Generation

HRH Institutional Strengthenin

g

Prevention and

Control

Quality

Access 1 2 3Awareness Generation 0HRH 2 2 1 5Institutional Strengthening

6 3 2 11

Prevention and control 3 3Quality 2 1 3Grand Total 6 0 0 5 0 8 6 25

As mentioned above the emphasis of the state plan schemes has mostly been on building of basic health infrastructure, strengthening of existing hospitals and dispensaries i.e., their renovation and new constructions. As mentioned in Sector Review, there are nearly 50 per cent of the posts lying vacant in the state. The results of scheme mapping and prioritization matrix indicate the same, with 5 live state plan schemes giving adequate attention on HRH. Objectives of access, quality and prevention of communicable and non-communicable diseases appear to get the same weightage as each of these objectives has 3 schemes each.

3.4.5 Grouping of schemes based on primary objective

This needs to be done by the department during the budget discussion.

Plan schemes that have a common primary objective have to be clubbed together into a group in order to enable the department to carry out prioritization exercise between schemes within each group.

This prioritization of objectives is expected to guide allocation of additional resources available annually and further serve as a bridge between Five Year Plan & annual budgeting exercise and will lead to:

Strengthen existing schemes and Help in planning new interventions


3.4.6 Segregation for each group based on Source of Funds (SoFs)

Schemes within each group are segregated on the basis of source of funds.

Central Sector Schemes Centrally Sponsored Schemes Externally Aided Program / Schemes State Plan Schemes Others

Since, State Government does not have much leverage in GoI schemes (CSS/ CS) and makes provisions for the same on priority basis, only State Plan schemes are considered for the prioritization exercise.

3.4.7 Prioritisation for each group based on SoFs

This will be done after consultation with the department.

First priority is to be given to high priority State Plan Schemes (as mentioned in Five Year Plan document, Annual Plan)

Second priority is to be given to schemes catering to more than one objectives Within this, top priority is to be given to those schemes which meet objectives having indicators and

have significant gap between national and state values Third Priority is to be given to schemes catering to single objective Within this, top priority is to be given to those schemes which meet objectives having indicators and

have a significant gap between national and state values Fourth Priority is to be given to the schemes catering to single objective and low priority (residual

schemes)


3.5 Expenditure Review3.5.1 Introduction

In this section an analysis of the expenditure by DoHFW in Madhya Pradesh during the past 6 years is undertaken.

Section 3.5.2 provides a review of allocation of the entire state budget across the 11 Developmental Heads / Sectors over past 6 years i.e., (from 2009-10 to 2014-15 BE). This is undertaken because each of the departments of GoMP is classified and aligned to one of the developmental heads.

Post review of the sector wise expenditure of the state, analysis of DoHFW expenditure across the demand numbers is presented in section 3.5.3. Expenditure of DoHFW is spread across 9 demand numbers. These demand numbers are presented in Table 15.

Table 15: Description of the Demand Numbers under DoHFW Demand No. Demand Title

19 Department of Health and Family Welfare41 Tribal Welfare Department (TSP)64 Special component plan for Scheduled Castes (SCP)18 Department of Labor (Employees State Insurance Schemes) (ESIS)55 Department of Women and Child Development (DWCD)32 Department of Public Relations38 Department of AYUSH73 Department of Medical Education (DME)72 Bhopal Gas Tragedy Relief and Rehabilitation

(Source: Demand for Grants, GoMP)

A detailed analysis of three demand numbers i.e., demand number 19 (DoHFW), 41 (TSP under DoHFW), and demand number 64 (SCP under DoHFW), that are specific to the department are presented in section 3.5.4.

Expenditure analysis over past 6 years of DoHFW has been undertaken across these 3 demand numbers for the following categories of expenditure:

Non plan and Plan Revenue and Capital

3.5.2 Sector expenditure Government expenditure at the aggregate level is classified under different developmental heads. The past expenditure of Government of Madhya Pradesh under different development heads for the years 2009-10 to 2014-15 is presented in Table 16.

Table 16: Government expenditure by sector (Rs. in crore)

Sectors Accounts Accounts Accounts Accounts RE BE2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Agriculture and Allied Services 2903.33 4243.93 5525.84 6677.01 7447.13 10172.68Rural Development 2699.93 3562.62 3896.59 5192.04 5528.60 12044.00Irrigation & Flood Control 2649.63 4043.94 3971.82 4489.07 5482.64 5313.67Energy 7228.88 5538.34 18196.91 8583.37 9316.16 7904.21Industry & Minerals 374.20 419.79 1396.69 2610.12 1357.16 2134.06Transport 2515.56 2660.11 2620.29 3393.56 3882.57 3554.62Science, Technology & Environment 54.10 54.64 50.69 92.33 144.37 220.31General Economic Services 143.97 204.22 213.64 230.54 431.23 568.16


Sectors Accounts Accounts Accounts Accounts RE BE2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

General Services 12178.05 14850.32 16397.80 17954.71 21237.61 24676.00Social Services 14341.09 19067.90 22035.90 26126.34 32941.79 45209.10Others 2552.69 2883.19 3206.83 4570.91 1389.87 2076.01Total Expenditure 47641.43 57529.00 77513.00 79920.00 89159.10 113872.82 (Source: Report of the Account General; Annual Financial Statement 2014-15, GoMP)

The expenditure of the State Government on Agriculture Sector has increased from 2903.33 crores during 2009-2010 to 6677.01 crores in 2012-13. Though the figures for the year 2013-14RE and 2014-15 BE are indicative, it is imperative that a substantial amount of government fund is allocated for Agriculture during this period. The expenditure trend shows a higher emphasis on the rural economy. This is depicted through more than two fold increase in allocated expenditure during 2014-15 compared to 2013-14. The expenditure on General Economic Services shows a steady growth over the reference period and a similar trend is observed in the case of social services as well. The expenditure figure for the year 2014-15 (BE) is substantially higher compared to 2013-14 because the entire off budget items have now been shown as on budget during 2014-15.

3.5.3 DoHFW expenditure across demand numbers

The expenditure trend in DoHFW with respect to the total Government expenditure is presented in Table 17.

Table 17: Trends in expenditure of DoHFW (Rs. in crore)

Expenditure by DoHFWAccounts Accounts Accounts Accounts RE BE2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Total DoHFW Expenditure 1231.78 1498.88 1914.83 2500.42 2983.92 4828.38Total Government Expenditure 47641.43 57529 77513 79920 89159.1 113872.82DoHFW Expenditure as % of Government Expenditure 2.59 2.61 2.47 3.13 3.35 4.24

GSDP 194427.26 271681 315387 361874 409877 466976DoHFW Expenditure as % of GSDP 0.63 0.55 0.61 0.69 0.73 1.03(Source: Report of the Account General; Annual Financial Statement 2014-15, GoMP)

Table 17 presents the DoHFW expenditure as percentage of total government expenditure. During 2009-10 the expenditure by DoHFW was around 2.6 per cent of the total state budget. There is a steady increase in expenditure over past 6 years. As per revised estimate of 2013-14 the expenditure is around 3.35 per cent of the total government budget and as per budget estimate 2014-15 the expenditure is around 4.24 percent of the total government expenditure. Expenditure on health as percentage of GSDP shows slight fluctuation during 2009-10 and 2011-12. From 2012-13 onwards the expenditure shows a consistent trend (i.e. grown from 0.69 per cent of GSDP to 1.03 percent of GSDP). It may be noted that the expenditure by DoHFW in the above table is not the total expenditure on health sector. The expenditure will be substantially higher if all the demand numbers contributing to health are taken into consideration. Therefore, the figures presented in the table need to be interpreted with due precaution.

3.5.4 DoHFW expenditure – Capital and Revenue

Between 2009-10 and 2014-15, the total expenditure of DoHFW increased substantially. This has been as result of increase in total expenditure primarily under demand number 19 as can be seen from Table18.

MTEF for School Education Department - 2015-16Strengthening Performance Management in Government Phase–II 44December 2014Demand number wise analysis of capital and revenue expenditure indicates the following:

Under demand number 19 (the major demand number for DoHFW), the revenue expenditure constitutes around 97-98 per cent of the budget. The capital expenditure is around 2-3 per cent.

Under demand number 41 (TSP component of health), the revenue expenditure has increased from 75 per cent to 91 per cent during the reference period (2009-10 to 2014-15). During the initial years i.e. 2009-10 the capital expenditure was slightly more than 25 per cent. This has declined to nearly 10 per cent during 2014-15. Higher capital expenditure under TSP indicates higher emphasis on the infrastructure component in Tribal areas of the state.

The scenario under demand number 64 is almost similar to demand number 41. The revenue expenditure during 2009-10 to 2014-15 has increased from 77 to 86 per cent with slight fluctuations in between. The capital expenditure during this period has declined from nearly 23 per cent to 14 per cent, with highest peak of 46 per cent during 2011-12. This also implies the expansion of health infrastructure in Schedule and backward class communities.

Taking all the three demand numbers (19, 41, 64) together, the revenue expenditure of the department has remained between 95 to 97 per cent of the expenditure by DoHFW

However, in absolute terms the capital expenditure under the above demand numbers has increased to a large extent. Same is the case with the revenue expenditure.

Table 18 : Revenue & capital-wise expenditure trends of DoHFW by demand numbers (Rs. in crore)Demand Number

Revenue & Capital

Accounts Accounts Accounts Accounts RE BE2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

19 Capital 31.02 22.40 21.55 60.58 86.12 95.25Revenue 1135.89 1391.25 1724.60 2044.32 2591.90 4014.97Total for 19 1166.92 1413.65 1746.15 2104.89 2678.02 4110.22As % of TE 94.73 94.31 91.19 84.18 89.75 85.13



Total Capital 46.61 43.25 89.28 130.22 133.02 177.60Revenue 1185.17 1455.64 1825.55 2370.20 2850.90 4650.78Total for All 1231.78 1498.88 1914.83 2500.42 2983.92 4828.38As % of TE 100.00 100.00 100.00 100.00 100.00 100.00

(Source: Demand for Grants, GoMP)

3.5.5 DoHFW expenditure – non plan and planA detailed analysis of the expenditure of the department on the basis of plan and non-plan expenditure has been undertaken. The results are presented in Table 19. As is already known, the expenditure under demand number 41 and 64 are plan expenditures. As far as the expenditure under demand number 19 and total expenditure (i.e., 19, 41, 64) by DoHFW is concerned following observations are made:

Under demand number 19 (the major demand number for DoHFW), the Non-Plan expenditure has come down from 71.3 during 2009-10 to 57.9 during 2014-15. The plan expenditure has increased from 28.7 per cent to 42.1 per cent during the same period. The highest growth of plan expenditure observed during the year 2014-15. This is mostly due to the merger of off budget schemes during


the financial year 2014-15. However, the rate of growth appears to be slow compared to plan figures.

Across the demand numbers (19, 41, and 64), the revenue expenditure of the department appears to fluctuate between 95 to 97 per cent of the expenditure for DoHFW. The rate of growth of plan expenditure is high compared to the non-plan counterpart. However, in absolute terms the non-plan expenditure has remained higher for the reference period except for the year 2014-15.

Table 19 : Plan and Non-Plan expenditure trend of DoHFW by demand numbers (Rs. in crore)Demand Number

Non-Plan/Plan l

Accounts Accounts Accounts Accounts RE BE2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

19 Non-Plan 831.66 1003.82 1222.46 1393.87 1757.26 2380.36Plan 335.26 409.83 523.68 711.02 920.76 1729.85Total for 19 1166.92 1413.65 1746.15 2104.89 2678.02 4110.22As % of TE 94.73 94.31 91.19 84.18 89.75 85.13



Total Non-Plan 831.66 1003.82 1222.46 1393.87 1757.26 2380.36Plan 400.12 495.06 692.37 1106.55 1226.66 2448.02Total for All 1231.78 1498.88 1914.83 2500.42 2983.92 4828.38As % of TE 100.00 100.00 100.00 100.00 100.00 100.00

Non Plan Expenditure by ObjectThe detail of non-plan expenditure by object is given in Annexure 4. Following inferences could be made from the table.

Salary and allowances constitutes a major chunk of the expenditure and has been increasing over the years. Salary constituted around 79 -80 per cent of the total non-plan budget except for the year 2011-12, 2012-13 and 2013-14.

Next to salary, “materials and supplies” is the next item that consumes around 9-12 per cent of the budget. The major item that is included under this category is medicines and other consumables. Taking into consideration the demographic composition of the population, the expenditure on this object is low.

Grants-in-Aid is the next item that constitutes 4-6 per cent of the non-plan budget. It may be noted that the expenditure under this head started from 2011-12 onwards.

Office expenditure is the fourth item in the series that consumes nearly 2-3 per cent of the non-plan expenditure.

Plan Expenditure by ObjectThe detail of plan expenditure by object is given in Annexure 5. Following inferences could be made from the table.

Salary and allowances constitutes a major chunk (but less than 50 per cent) of the plan expenditure. As could be seen from Annexure 5, absolute expenditure has increased from 183 crores during 2009-10 to 599 crores in 2014-15. In percentage terms, the expenditure has declined from 46 per cent in 2009-10 to 24 per cent during 2014-15 except for the year 2013-14.

MTEF for School Education Department - 2015-16Strengthening Performance Management in Government Phase–II 46December 2014 There appears to be an inverse relationship between salary and Grants-in-Aid that constituted

28.44 per cent of the total plan expenditure during 2009-10. The expenditure has increased to 61.46 per cent during 2014-15.

Large construction work constituted around 9 per cent of the total plan expenditure and increased to 13 per cent during 2011-12. There is a downward trend in the expenditure and during 2014-15 it stands at 7.25 per cent. However in absolute terms there is an increasing trend.

The objects like machines, office expenditure and materials and supplies also account for a major share of plan expenditure.

3.5.6 DoHFW expenditure – Revenue and Capital

A detailed analysis of the expenditure of the department on the basis of revenue and capital expenditure has been undertaken.

Revenue Expenditure The distribution of revenue expenditure among different objects is given in Annexure 6. Following inferences are made from the table:

In absolute terms the expenditure on salary and allowances has been increasing over the period from 2009-10 and 2014-15. When we consider the total expenditure on salary and allowances as percentage of total revenue expenditure, the share has fallen from 71.15 per cent in 2009-10 to 53.89 during 2014-15. As is known, the capital expenditure does not contain any salary component. Therefore it may be concluded that the department is spending in creating assets.

Grants-in-Aid (GIA) constitute the second largest item on which the government spends. It is observed from Annexure 6 that the expenditure on GIA has increased from nearly 135 crores in 2009-10 to 1505 crores in 2014-15, a 12 fold increase. In percentage terms the expenditure shows an increase from 11.45 per cent in 2009-10 to 32.38 per cent in 2014-15. This is mostly due to the merger of off and on budget schemes during 2014-15.

Materials and supplies is the third item that constitutes 8-10 per cent of the revenue expenditure. This includes medicines and other consumables that are necessary for quality health care. Unfortunately, as per the budget estimate for 2024-15 the share is likely to come down to 5.27 per cent of the total revenue expenditure. In absolute terms the expenditure shows an increasing trend.

Office expenditure is the next item that shows an increasing trend, both in percentage as well as absolute terms from 2009-10 to 2013-14. For the year 2014-15 there is a slight decline in expenditure in percentage terms.

Capital ExpenditureAs could be seen from Annexure 7, the only object of expenditure on capital account is ‘large construction work’. The volume of capital expenditure on large construction work has been increasing continuously over the period from 2009-10 and 2014-15.

3.5.7 Summary of Expenditure Review A summary of the total expenditure of DoHFW over past 6 years i.e., 2009-10 to 2014-15 (BE) is presented in Table 20.

Table 20: Expenditure by DoHFW (Rs. in crore)

Expenditure Type Accounts RE BE2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Non-plan Expenditure 831.66 1003.82 1222.46 1393.87 1757.26 2380.36


Expenditure Type Accounts RE BE2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Plan Expenditure 400.12 495.06 692.37 1106.55 1226.66 2448.02Revenue Expenditure

1185.17 1455.64 1825.55 2370.20 2850.90 4650.78

Capital Expenditure 46.61 43.25 89.28 130.22 133.02 177.60Total Expenditure 1231.78 1498.88 1914.83 2500.42 2983.92 4828.38 (Source: Demand for grants, GoMP)

Though the absolute expenditure on non-plan component has increased from Rs. 831.66 cores during 2009-10 to Rs. 2380.36 crores in 2014-15, in percentage terms the expenditure has declined from 67.52 per cent to 58.89 per cent during the reference period.

The volume of plan expenditure has been increasing in absolute as well as percentage terms. In percentage terms there is no significant change in the volume of revenue as well as capital

expenditure.


3.6 Trend Projections3.6.1 Introduction

Trend based Projection on DoHFW during the medium term (3 years) is arrived at on the basis of past expenditure of the department. In this context discussions were held with the finance division of DoHFW and assumptions are finalized.

The methodology and assumptions that are used for arriving at trend projection are described in the next section. The projections are made for DoHFW only – not for other departments contributing to the health sector.

3.6.2 Assumptions and Methodology for projection

Plan as well as non-plan expenditure projections have been made at object level. Subsequently, the object level projected figures are aggregated in order to arrive at the scheme level projections. Details of the methodology and the assumptions used for the projection are given below:

Assumptions for ProjectionFirst, the projected scheme level expenditures (by plan and non-plan) are arrived at by summing of the object level expenditures for each scheme. These trends are used to arrive at appropriate growth rates which are used for arriving at projections for each of the objects. The figures thus arrived were discussed with the department and the final estimates of the projections are made. The base year used for the projection is 2013-14 (RE).

The assumptions that are used for arriving at trend based projections are described below (Table 21).

Table 21: Assumptions for Trend Based Projections Object Heads Object description Assumptions

11 Salary, Allowances As per FRBM statement – 27.52% of 2013-14 RE for 2014-15. Growth rate of 15 per cent for 2015-17 onwards.

12 Wages AAGR 15 per cent (As discussed with department)14 Reward, Award Honours AAGR of 7 per cent (Equivalent to Inflation / Price Indices)19 Salary of contractual employees AAGR of 12 per cent increase over the year 2013-1421 Travel Allowance AAGR of 12 per cent22 Office Expenditure AAGR of 12 per cent23 Purchase Vehicles AAGR 7 per cent (only maintenance cost included)24 Examination & Training 12 per cent over the previous year.31 Payment for professional

services12 per cent per annum

33 Maintenance Work AAGR + 7 per cent Inflation (varies depending on AAGR)34 Materials & Supplies AAGR of 5 + 7 Percent over the period 2013-1435 Advertisement & Broadcasting Increase by 7 percent over the previous year41 Scholarship & Fellowship AAGR + 7 per cent Inflation42 Grant-in-Aid AAGR for 2013-14 RE Calculated and the growth rate is used for

projection. If no growth rate is observed, the grant amount is kept constant for the projected period.

43 Contribution Kept constant during the projection period44 Subsidy As per the AAGR51 Other Charges Kept constant during the projection period53 Payment of Decree Kept constant during the projection period63 Machines Assuming that the machine will last for 10 years, a maintenance cost

of 10 per cent of the total cost is assumed


Object Heads Object description Assumptions64 Large Construction Work No specific method. If the construction was started in recent past the

same growth rate is continued for the year 2015-16 onwards. In case the construction work was started at some earlier point of time AAGR is taken as the base for projection.

3.6.3 Trend Projections for DoHFW Scheme wise Projection of total expenditure by

DoHFWBased on the above assumptions, the total expenditure for DoHFW is projected to increase from 7 per cent during 2014-15 to 13 per cent during 2015-16. The growth rate is likely to remain the same during 2016-17 and 2017-18. In absolute terms the expenditure will increase from Rs.4491.95 crores (includes the off budget expenditure) during 2013-14 to 4828.38 during 2014-15. The expenditure during 2015-16 is estimated to be Rs.5438.61 crores. The expenditure is likely to grow to Rs.6933.58 crores during 2017-18. A detail of the scheme wise projection of total expenditure is given in Annexure 8.

Object wise Projection of total expenditure by DoHFW

The distribution of total expenditure by object indicates that the expenditure on salary and allowances is likely to decline from 59.76 per cent to 53.99 per cent during 2013-14 and 2017-18. The Grants in Aid is likely to increase from 14.02 per cent of total expenditure during 2013-14 to 27.46 per cent during 2015-16. A declining trend is observed from the year 2015-16 onwards. Expenditure on materials and supplies is likely to decline from 8.41 per cent (excluding off budget expenditure) of the total expenditure during 2013-14 to 4.74 per cent of the total expenditure during 2017-18 Table 22. The expenditure on large constructions (both in absolute as well as percentage terms) is likely to increase substantially over the years. In absolute terms the expenditure is likely to increase for almost all the items Annexure 9.

Table 22: Percentage distribution of total expenditure by object

Objects Object DescriptionRE BE Projections

2013-14 P+NP

2014-15 P+NP

2015-16 P+NP

2016-17P+NP

2017-18P+NP

11 Salary , Allowances 59.76 51.91 52.05 53.11 53.9912 Wages 0.52 0.31 0.36 0.36 0.3514 Reward & Award 0.00 0.00 0.00 0.00 0.00

16 Salary , Allowances - Akhil Bhartiya Seva 0.01 0.01 0.01 0.01 0.01

19 Salary of contractual employees 1.02 0.74 0.70 0.70 0.69

21 Travel Allowance 0.43 0.27 0.30 0.30 0.2922 Office Expenditure 3.76 2.03 2.59 2.57 2.5523 Purchase Vehicles 0.02 0.00 0.00 0.00 0.0024 Examination & Training 0.06 0.03 0.04 0.04 0.04

31 Payment for professional services 1.64 1.05 1.13 1.12 1.11

33 Maintenance 0.41 0.31 0.30 0.32 0.3334 Materials & Supplies 8.41 5.07 5.28 5.02 4.7435 Advertisement & Broadcasting 0.08 0.04 0.05 0.05 0.0441 Scholarship & Fellowship 0.27 0.17 0.18 0.18 0.1842 Grant-in-Aid 14.02 31.18 27.46 25.27 23.5643 Contribution 0.20 0.08 0.12 0.12 0.11



2013-14 P+NP

2014-15 P+NP

2015-16 P+NP

2016-17P+NP

2017-18P+NP

44 Subsidy 2.48 1.76 1.72 1.69 1.6651 Other Charges 0.71 0.34 0.45 0.42 0.4063 Machines 1.76 1.01 1.17 1.14 1.1164 Large Construction Work 4.46 3.68 6.08 7.59 8.83

Grand Total in Crores 2983.92 4828.38 5438.61 6129.28 6933.58

Scheme wise Projection of Plan ExpenditureAn analysis is made in order to understand the trend in expenditure by plan and non-plan. The plan expenditure for DoHFW is projected to be Rs.2834.30 crores during 2015-16. The growth of expenditure is around 16 per cent during the year 2015-16 compared to the year 2014-15 BE. The plan expenditure is likely to grow at 12 per cent per annum during 2016-17 and 2017-18. In absolute terms the plan expenditure during the year 2016-17 and 2017-18 is likely to be Rs.3163.16 and Rs.3553.69 crores respectively. Scheme wise projected figures of plan expenditure are presented in Annexure 10.

Object wise Projection of Plan ExpenditureThe distribution of plan expenditure by object indicates that the expenditure on salary and allowances is likely to decline from 37.64 per cent to 27.94 per cent during 2013-14 and 2017-18. The Grants in Aid is likely to increase from 34.04 per cent in 2013-14 to 52.62 per cent of the plan expenditure during 2015-16. The expenditure is likely to decline during 2016-17 and 2017-18 to 48.91 and 45.91 per cent respectively. Expenditure on materials and supplies is likely to decline from 3.50 of the plan expenditure during 2013-14 to 1.16 per cent during 2017-18 (Table 23). The expenditure on large constructions is likely to increase substantially over the years. The percentage of expenditure on large constructions is likely to increase from 10.84 per cent of total expenditure during 2013-14 to 11.67 per cent in 2015-16 and 17.14 per cent during 2017-18. In absolute terms the expenditure is likely to increase for almost all the items Annexure 11.

Table 23: Percentage distribution of plan expenditure by object


2013-14 P 2014-15 P 2015-16 P 2016-17 2017-1811 Salary , Allowances 37.64 24.45 26.49 27.30 27.9412 Wages 0.44 0.20 0.24 0.24 0.2421 Travel Allowance 0.64 0.31 0.35 0.35 0.3522 Office Expenditure 6.15 2.54 3.34 3.35 3.3424 Examination & Training 0.08 0.03 0.04 0.04 0.0431 Payment for professional services 1.69 0.70 0.92 0.92 0.9233 Maintenance 0.26 0.12 0.16 0.16 0.1734 Materials & Supplies 3.50 1.30 1.74 1.66 1.5835 Advertisement & Broadcasting 0.12 0.05 0.06 0.06 0.0641 Scholarship & Fellowship 0.33 0.16 0.18 0.18 0.1842 Grant-in-Aid 34.04 61.46 52.65 48.91 45.9143 Contribution 0.48 0.16 0.24 0.23 0.2251 Other Charges 1.64 0.49 0.81 0.78 0.7463 Machines 2.14 0.76 1.12 1.10 1.0864 Large Construction Work 10.84 7.25 11.67 14.71 17.24

Total 1226.66 2448.02 2834.30 3163.16 3553.69

Scheme Wise Projection of Non-Plan Expenditure

MTEF for School Education Department - 2015-16Strengthening Performance Management in Government Phase–II 51December 2014The non-plan expenditure of DoHFW is projected to increase from Rs.1757.26 crores during 2013-14 to Rs.2604.31 crores during 2015-16, Rs.2966.12 crores during 2016-17 and Rs.Rs.3379.89 crores during 2017-18. The growth rate of non-plan expenditure during 2015-16 is projected to be 9 per cent of the total expenditure. The expenditure is expected to rise at the rate of 14 per cent per annum during 2016-17 and 2017-18. Detailed projection of non-plan expenditure by schemes is presented in Annexure 12.

Object wise Projection of Non-Plan ExpenditureThe percentage distribution of non-plan expenditure by object is presented in Table 24. It is projected that the expenditure on salary and allowances is likely to increase from 75.20 per cent to 81.38 per cent during 2013-14 and 2017-18. Expenditure on materials and supplies is likely to decline from 11.84 per cent of the non-plan expenditure during 2013-14 to 8.07 per cent during 2017-18 (Table 24). The subsidy is likely to decrease from 4.21 per cent in 2013-14 to 3.60 per cent during 2015-16. The expenditure is likely to further decline 3.40 per cent during 2017-18. In absolute terms the expenditure is likely to increase for almost all the items Annexure 13.

Table 24: Percentage distribution of non-plan expenditure by objectObject head Object Description

2013-14 NP-RE

2014-15 NP-BE

2015-16 NP

2016-17 NP

2017-18 NP


16Salary , Allowances - Akhil Bhartiya Seva 0.02 0.01 0.02 0.02 0.02

19 Salary of contractual employees 1.73 1.51 1.47 1.44 1.4221 Travel Allowance 0.29 0.22 0.25 0.24 0.2422 Office Expenditure 2.09 1.50 1.77 1.74 1.7123 Purchase Vehicles 0.03 0.00 0.00 0.00 0.0024 Examination & Training 0.04 0.03 0.03 0.03 0.03

31Payment for professional services 1.60 1.41 1.35 1.33 1.31

33 Maintenance 0.51 0.50 0.47 0.48 0.4934 Materials & Supplies 11.84 8.95 9.14 8.59 8.0735 Advertisement & Broadcasting 0.05 0.04 0.04 0.04 0.0341 Scholarship & Fellowship 0.22 0.18 0.19 0.19 0.1842 Grant-in-Aid 0.05 0.05 0.05 0.06 0.0743 Contribution 0.00 0.00 0.00 0.00 0.0044 Subsidy 4.21 3.57 3.60 3.50 3.4051 Other Charges 0.06 0.19 0.05 0.04 0.0453 Payment of Decree 0.00 0.00 0.00 0.00 0.00

62Purchase / Acquisition of land or Buildings 0.00 0.00 0.00 0.00 0.00

63 Machines 1.49 1.27 1.22 1.17 1.1364 Large Construction Work 0.00 0.00 0.00 0.00 0.00

Total 1757.26 2380.36 2604.31 2966.12 3379.89

Projection of expenditure by Capital and Revenue The capital expenditure constitutes a part of plan expenditure. As is observed the capital expenditure constituted around 11 per cent of total plan expenditure during 2013-14. The expenditure is projected to increase to 12 per cent in 2015-16. The capital expenditure is expected to increase to 17.24 per cent of the total plan expenditure during 2017-18. It may be recalled that a chunk of the plan expenditure comes under the demand number 41 and 64 (TSP and SCP). Therefore it may be inferred that huge

MTEF for School Education Department - 2015-16Strengthening Performance Management in Government Phase–II 52December 2014chunk of the capital expenditure will come from these two demand numbers. This indicates higher emphasis of the government in tribal and other backward areas in the provision of health care services.

3.6.4 Summary of DoHFW Trend ProjectionsThe projected figures that are presented in Table 25 below are computed on the basis of past expenditure trends. These projections reflect the expenditure that will be required by DoHFW, if they intend to continue with the current schemes / projects and progress at the current rate. The total expenditure of DoHFW is estimated to increase from Rs.4491.95 crores in 2013-14 (RE) to Rs.6933.58 crores in 2017-18, which works out to be 54.36 percent increase in the expenditure during 2013-14.

Table 25: Plan and Non-Plan Expenditure projections of DoHFW (Rs. in crore)

ExpenditureBE Projections

2013-14 2014-15 2015-16 2016-17 2017-18Plan Expenditure 1226.66 2448.02 2834.30 3163.16 3553.69Non-Plan Expenditure 1757.26 2380.36 2604.31 2966.12 3379.89Off budget Expenditure 1508.03 0.00 0.00 0.00 0.00Total Expenditure 4491.95 4828.38 5438.61 6129.28 6933.58Expenditure growth (%) 7% 13% 13% 13%

(Source: Demand for grants, GoMP)


4. Top Down EstimationTop Down Budgeting is an integral part of MTEF process, which entails the estimation of plan resources, likely to be available to a line department in the ensuing 3 years. In order to arrive at department-level plan resource envelope, resources likely to be available at the development head / sector level and State level, which are consistent with FRBMA, have been projected. For meeting the fiscal targets as set out in the FRBMA, the concerned departments are expected to contain their plan expenditure in the medium term within the limits set by resource envelope worked out through top down budgeting. Since major proportion of non-plan expenditure constitutes salary and allowances expenditure which is committed in nature therefore the top down ceilings have been arrived for the plan expenditure component only.

The top down estimates for DoHFW across various SoFs (indicated as SMIHs (sub minor heads)) in the budget books) for FYs 2015-16, 2016-17 and 2017-18 are arrived based on top down estimation methodology and are presented in Table 26.The resources that are likely to be available to the DoHFW for running their State Plan Schemes are Rs.341 cr., Rs. 391 cr. and Rs. 448 cr. for the FYs 2015-16, 2016-17 and 2017-18 respectively. In case of surplus (as in the present case) the plan funds will be allocated to the State Plan Schemes across each objective based on the application of Scheme Prioritization Framework after making any additional matching contribution to the CSS ( if required). In case of deficit, funds allocation would be reduced from the low priority State Plan Schemes across each objective based on the application of Scheme Prioritization Framework.

Table 26: Top down estimates for DoHFW for FY 2015-16

2011-12(A)

2012-13(A)

2013-14(RE)

2014-15(BE)

Projections2015-16 2016-17 2017-18

a. State Plan Sch. in DoHFW 279 678 265 226 341 391 448b. CSS in DoHFW 9 16 366 1397 1537 1690 1859c. CS in DoHFW 309 346 479 624 750 940 1179d. EAPs in DoHFW 0 26 53 81 96 118 139e. CFC in DoHFW 11 30 63 111 125 152 179f. NABARD (General) 5 10 2 10 11 12 13g. On- Budget resources (sum of a to g) 613 1107 1227 2448 2859 3303 3818h. Budgetary Plan Resource Envelope for DoHFW 613 1107 1227 244811 2859 3303 3818

11 The Budgetary Plan Resource Envelope for DoHFW for FY 2014-15 includes off budget expenditure as well. From FY 2014-15 off budget expenditure of the department is routed via treasury mode making it on-budget.

MTEF for Department of Health and Family Welfare – 2015-16Strengthening Performance Management in Government Phase–II 54December 2014

5. Reconciliation

Reconciling plan requirements with resourcesThe bottom-up estimates arrived at based on trend projections for DoHFW are presented in Table 27. These projections have been carried out assuming the department intends to continue with the current schemes and progress at the current rate. The ‘top down’ estimate of plan resource availability have been arrived at for select 15 line departments in a separate report and are presented in following table for MTEF exercise for DoHFW for the year 2015-16.

Table 27: Projected resource and expenditure growth of DoHFW (in Rs. Crore)2015-16 2016-17 2017-18

I. PLAN EXPENDITUREI. A. Top DownResource Envelope for DoHFW 2859.00 3303.00 3818.00I. B. Bottom UpTrend Scenario 2834.30 3163.16 3553.69Trend deficit (+)/ surplus (-) with respect to resource envelope (-)24.7 (-)139.84 (-)264.31II. NON PLAN EXPENDITURE 2604.31 2966.12 3379.89


6. Way ForwardDuring the phase of implementation of MTEF a series of activities were carried out. The activities include the identification of major schemes, mapping of schemes with the department objectives, preparation of scheme prioritization matrix. Following activities are of prime importance to the department in the future years:

The department should use the scheme prioritization framework for allocating funds to its schemes and reconcile its bottom-up estimates with top down estimates during budget discussions.

The schemes with low performance but high priority need to be identified and the budget provisions are to be made accordingly.

The inactive schemes can either be merged with the schemes with similar objectives or may be removed. This will help the department to bring down the schemes to a manageable numbers which can be linked to their respective outputs. This will make the present budgetary process as an output linked budget.

The Deloitte team will help the department in carrying out this exercise during the budget finalization.


7. Annexures:Annexure 1. Allocation of funds across plan schemes during the period from 2009-10 to 2014-15 (BE) (Rs. In Crores) - 70 schemes

Scheme No Scheme Description

2009-10P

2010-11P

2011-12-P

2012-13P

2013-14P

2014-15P Cumulative % Difference

5724 National Rural health Mission

97.75 114.38 116.10 432.98

350.00 1389.46 1389.46 56.76 56.76

0621 Additional Sub Health Center

143.43 173.57 244.18 251.59

341.15 417.08 1806.54 73.80 17.04

6453 Strengthening of Health Infrastructure (13th Finance Commission)

0.00 0.00 11.03 30.50 62.50 110.50 1917.04 78.31 4.51

8798 Elevation of Hospitals 9.40 13.34 33.81 64.42 86.89 100.00 2017.04 82.39 4.081508 District Level Staff 27.17 35.68 40.07 45.27 62.65 89.55 2106.59 86.05 3.667197 E.A.P. Cast Sharing 0.00 0.00 0.00 21.60 52.50 81.30 2187.89 89.37 3.322703 Direct Expenses 13.52 18.13 0.00 22.09 31.71 35.03 2222.92 90.81 1.435056 Construction of Buildings

for CHC/PHC/ SC5.05 7.23 19.61 17.12 6.40 34.10 2257.02 92.20 1.39

8132 Prevention and control of aids

0.00 0.00 0.00 0.00 0.00 30.00 2287.02 93.42 1.23

0336 Training to Auxiliary Nurse, Mid wife and health visitors for family welfare

9.07 15.31 14.58 16.03 25.88 28.09 2315.11 94.57 1.15

7317 Elevation of Rural Health Institutions

6.51 6.68 33.91 28.93 29.42 27.50 2342.61 95.69 1.12

6036 Grant for Operational of Ambulance for Emergency Treatment services

0.00 3.00 4.19 12.58 15.00 16.00 2358.61 96.35 0.65

6882 Construction of Buildings for CHC/PHC/ SC (NABARD)

1.32 2.01 5.77 15.66 5.00 15.00 2373.61 96.96 0.61

7648 Construction of Hospital and Dispensary Building

6.49 6.67 3.01 13.06 12.00 12.00 2385.61 97.45 0.49

2880 Multipurpose Worker Scheme

3.77 4.63 6.33 6.88 9.97 11.08 2396.68 97.90 0.45

3704 State Level Family Welfare Organization

1.49 1.80 2.11 2.11 3.48 8.70 2405.38 98.26 0.36

4245 Cold Fever 5.27 7.48 12.89 10.13 11.70 7.50 2412.88 98.56 0.316271 Modernization of J P

Hospital0.00 5.00 0.55 4.05 12.00 6.00 2418.88 98.81 0.25

7124 Construction of Sub Health Centre with Modern Technology

0.00 0.00 0.00 26.23 30.52 5.00 2423.88 99.01 0.20

1007 Regional Training Center for Family Welfare

1.60 1.74 2.05 2.37 3.58 4.41 2428.29 99.19 0.18

5613 National Health Insurance Scheme

0.00 0.00 5.50 0.00 5.00 4.00 2432.29 99.36 0.16

4224 Education & Training 0.00 0.00 6.06 2.57 4.00 3.00 2435.29 99.48 0.127205 Dindayal Mobile Hospital 0.00 0.00 0.00 3.50 5.00 3.00 2438.29 99.60 0.126229 Strengthening of Hospitals 0.00 23.94 14.33 31.74 2.42 2.00 2440.29 99.68 0.080750 Drug Control 0.42 0.46 1.56 0.48 1.39 1.48 2441.77 99.74 0.068808 Information technology

related work0.08 0.11 0.00 0.02 0.16 1.14 2442.91 99.79 0.05

6624 Establishment of Solar 0.00 0.00 22.50 0.00 0.46 1.01 2443.92 99.83 0.04



2009-10P

2010-11P

2011-12-P

2012-13P

2013-14P


Photovoltaic device6214 Operate Mobile Health

Clinic0.00 0.00 0.00 1.28 5.70 1.00 2444.92 99.87 0.04

1070 Prevention of adulteration in food items

0.17 0.19 0.00 0.40 0.80 0.91 2445.83 99.91 0.04

7194 Special State Incentive plan for Family Welfare

0.00 0.00 0.00 0.37 3.00 0.50 2446.33 99.93 0.02

7203 Establishment of Paramedical College

0.00 0.00 0.00 0.00 3.00 0.50 2446.83 99.95 0.02

6451 Establishment of Radiation Safety Unit

0.00 0.00 0.05 0.23 2.27 0.50 2447.33 99.97 0.02

6837 National program for control of cancer, Diabetes & Heart disease

0.00 0.00 0.00 0.32 0.45 0.45 2447.78 99.99 0.02

6037 Formation for Blood bank Council

0.00 0.10 0.08 0.15 0.19 0.19 2447.97 100.00 0.01

7131 Strengthening & Elevation of Nursing Services

0.00 0.00 0.00 5.26 5.00 0.01 2447.98 100.00 0.00

6840 National old age health care program plan

0.00 0.00 0.00 3.14 3.00 0.01 2447.99 100.00 0.00

7132 National Iodine Deficient control program

0.00 0.00 0.00 0.12 0.50 0.01 2448.00 100.00 0.00

7202 Establishment of Nursing college

0.00 0.00 0.00 0.00 10.00 0.01 2448.01 100.00 0.00

1320 Strengthening and elevation of nursing infrastructure

0.00 0.00 0.00 0.00 0.00 0.00 2448.01 100.00 0.00

7178 Maternity Leave 0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.004510 Information Education and

Communication0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

8150 Multi-Purpose Workers Scheme

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

0264 Other services and Supplies

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

5451 Establishment & Upgrading of Food Laboratory

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

2498 Supply of traditional Contraceptive

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

6106 Universal Immunization 0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.007242 Iodine deficiency program 0.00 0.00 0.00 0.10 0.00 0.00 2448.02 100.00 0.007119 Teenager reproductive and

sexual health programs0.00 0.00 0.00 0.40 0.00 0.00 2448.02 100.00 0.00

7121 Encourage the quality of family planning communication

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

6745 Operation and Experimental search

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

6746 To strength Mother & Infant Health Services

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

7122 Communication Quality for effective Counseling

0.00 0.00 0.00 1.79 0.00 0.00 2448.02 100.00 0.00

6744 Strengthening of Filaria control Program

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

6747 Encourage for Use of Zink O.R.S.

0.00 0.00 0.00 0.10 0.00 0.00 2448.02 100.00 0.00

7120 Strengthening of Malaria control Programme

0.00 0.00 0.00 2.00 0.00 0.00 2448.02 100.00 0.00

7123 Prevention of infection in 0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00



2009-10P

2010-11P

2011-12-P

2012-13P

2013-14P


Children from Mothers6742 Janlok Bhagandi Scheme 0.00 0.00 0.00 0.00 0.88 0.00 2448.02 100.00 0.007200 Health examination of

hostel students0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

6743 I.E.C. (Information & Broadcasting)

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00


0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

7198 Swablamban Plan for B.S.C Nursing Training

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

7199 Special Allowance to Officers

0.00 0.00 0.00 0.00 8.00 0.00 2448.02 100.00 0.00

5893 Establishment of treatment unit and Modern labor room for New born Baby

20.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

6920 Construction of Primary health Centers Building with NABARD Support

1.88 0.92 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

7201 Special Support to SC/ST maternity

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

7204 Construction of pre-Fabricated Sub Health Centers

0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

7871

Basic Services for Construction of Primary Health Centers, sub Health Center and Public Health Centers 13.24 12.39 12.52 27.65 11.60 0.00 2448.02 100.00 0.00

6845 I.D.S.P. Project 0.00 0.60 0.30 0.00 0.30 0.00 2448.02 100.00 0.00

7195Prevention plan for Sickle cell Anemia Thalassemia 0.00 0.00 0.00 1.32 1.20 0.00 2448.02 100.00 0.00

7196 Treatment of T.B. Disease 0.00 0.00 0.00 0.00 0.00 0.00 2448.02 100.00 0.00

Annexure 2. Allocation of State Plan funds across the schemes during the period from 2009-10 to 2014-15 (BE) (Rs. In Crores) - 42 schemes

Scheme Scheme Description 2009-10P

2010-11P

2011-12-P

2012-13P

2013-14P

2014-15P

Cumulative % Difference

8798 Elevation of Hospitals 9.40 13.34 33.81 64.42 86.89 100.00 100.00 46.59 46.595056 Construction of Buildings

for CHC/PHC/ SC5.05 7.23 19.61 17.12 6.40 34.10 134.10 62.48 15.89

7317 Elevation of Rural Health Institutions

6.51 6.68 33.91 28.93 29.42 27.50 161.60 75.29 12.81

6036 Grant for Operational of Ambulance for Emergency Treatment services

0.00 3.00 4.19 12.58 15.00 16.00 177.60 82.74 7.45

7648 Construction of Hospital and Dispensary Building

6.49 6.67 3.01 13.06 12.00 12.00 189.60 88.33 5.59

6271 Modernization of J P Hospital

0.00 5.00 0.55 4.05 12.00 6.00 195.60 91.13 2.80

7124 Construction of Sub Health Centre with Modern Technology

0.00 0.00 0.00 26.23 30.52 5.00 200.60 93.46 2.33

4224 Education & Training 0.00 0.00 6.06 2.57 4.00 3.00 203.60 94.86 1.407205 Dindayal Mobile Hospital 0.00 0.00 0.00 3.50 5.00 3.00 206.60 96.25 1.406229 Strengthening of Hospitals 0.00 23.94 14.33 31.74 2.42 2.00 208.60 97.19 0.93


Scheme Scheme Description 2009-10P

2010-11P

2011-12-P

2012-13P

2013-14P

2014-15P

Cumulative % Difference

0750 Drug Control 0.42 0.46 1.56 0.48 1.39 1.48 210.08 97.88 0.698808 Information technology

related work0.08 0.11 0.00 0.02 0.16 1.14 211.22 98.41 0.53

6214 Operate Mobile Health Clinic

0.00 0.00 0.00 1.28 5.70 1.00 212.22 98.87 0.47

1070 Prevention of adulteration in food items

0.17 0.19 0.00 0.40 0.80 0.91 213.13 99.30 0.42


0.00 0.00 0.00 0.37 3.00 0.50 213.63 99.53 0.23

7203 Establishment of Paramedical College

0.00 0.00 0.00 0.00 3.00 0.50 214.13 99.76 0.23

6451 Establishment of Radiation Safety Unit

0.00 0.00 0.05 0.23 2.27 0.50 214.63 100.00 0.23

7202 Establishment of Nursing college

0.00 0.00 0.00 0.00 10.00 0.01 214.64 100.00 0.00

1320 Strengthening and elevation of nursing infrastructure

0.00 0.00 0.00 0.00 0.00 0.00 214.64 100.00 0.00

7178 Maternity Leave 0.00 0.00 0.00 0.00 0.00 0.00 214.64 100.00 0.006742 Janlok Bhagandi Scheme 0.00 0.00 0.00 0.00 0.88 0.00 214.64 100.00 0.007200 Health examination of

hostel students0.00 0.00 0.00 0.00 0.00 0.00 214.64 100.00 0.00

6743 I.E.C. (Information & Broadcasting)

0.00 0.00 0.00 0.00 0.00 0.00 214.64 100.00 0.00


0.00 0.00 0.00 0.00 0.00 0.00 214.64 100.00 0.00

7198 Swablamban Plan for B.S.C Nursing Training

0.00 0.00 0.00 0.00 0.00 0.00 214.64 100.00 0.00

7199 Special Allowance to Officers

0.00 0.00 0.00 0.00 8.00 0.00 214.64 100.00 0.00

5893 Establishment of treatment unit and Modern labour room for New born Baby

20.00 0.00 0.00 0.00 0.00 0.00 214.64 100.00 0.00


1.88 0.92 0.00 0.00 0.00 0.00 214.64 100.00 0.00

7201 Special Support to SC/ST maternity

0.00 0.00 0.00 0.00 0.00 0.00 214.64 100.00 0.00

7204 Construction of pre-Fabricated Sub Health Centers

0.00 0.00 0.00 0.00 0.00 0.00 214.64 100.00 0.00

7871 Basic Services for Construction of Primary Health Centers, sub Health Center and Public Health Centers

13.24 12.39 12.52 27.65 11.60 0.00 214.64 100.00 0.00

6845 I.D.S.P. Project 0.00 0.60 0.30 0.00 0.30 0.00 214.64 100.00 0.007195 Prevention plan for Sickle

cell Anemia Thalassemia0.00 0.00 0.00 1.32 1.20 0.00 214.64 100.00 0.00

7196 Treatment of T.B. Disease 0.00 0.00 0.00 0.00 0.00 0.00 214.64 100.00 0.00

Annexure 3. Mapping of all plan schemes with Departmental objectivesSOF1 Row

Labels

Scheme Description Objective 1 Objective 2 Status

CS 4510 Information Education and Communication Awareness Generation Inactive


SOF1 Row Label

s


CS 0336 Training to Auxiliary Nurse, Mid wife and health visitors for family welfare

HRH Live

CS 1007 Regional Training Center for Family Welfare HRH LiveCS 1508 District Level Staff HRH LiveCS 2880 Multipurpose Worker Scheme HRH LiveCS 3704 State Level Family Welfare Organization HRH Institutional

StrengtheningLive

CS 8150 Multi-Purpose Workers Scheme HRH InactiveCS 0264 Other services and Supplies Institutional Strengthening Access InactiveCS 0621 Additional Sub Health Center Institutional Strengthening Access LiveCS 2703 Direct Expenses Institutional Strengthening Access LiveCS 5451 Establishment & Upgrading of Food Laboratory Institutional Strengthening Access InactiveCS 6453 Strengthening of Health Infrastructure (13th

Finance Commission)Institutional Strengthening Access Live

CS 6882 Construction of Buildings for CHC/PHC/ SC (NABARD)

Institutional Strengthening Access Live

CS 2498 Supply of traditional Contraceptive Access Quality InactiveCS 6106 Universal Immunization Prevention and control Institutional

StrengtheningInactive

CS 7242 Iodine deficiency program Prevention and control LiveCS 8132 Prevention and control of aids Prevention and control Live

CSS 7131 Strengthening & Elevation of Nursing Services HRH Institutional Strengthening

Live

CSS 5724 National Rural health Mission Institutional Strengthening Access LiveCSS 6037 Formation for Blood bank Council Institutional Strengthening Access LiveCSS 6624 Establishment of Solar Photovoltaic device Institutional Strengthening Access LiveCSS 4245 Cold Fever Prevention and control Access LiveCSS 5613 National Health Insurance Scheme Prevention and control Access LiveCSS 6837 National program for control of cancer,

Diabetics & Heart diseasePrevention and control Access Live

CSS 6840 National old age health care program plan Prevention and control Access LiveCSS 7132 National Iodine Deficient control program Prevention and control Access LiveEAP 7119 Teenager reproductive and sexual health

programsAwareness Generation Institutional

StrengtheningLive

EAP 7121 Encourage the quality of family planning communication

HRH Quality Inactive

EAP 6745 Operation and Experimental search Institutional Strengthening Quality InactiveEAP 6746 To strength Mother & Infant Health Services Institutional Strengthening Quality InactiveEAP 7122 Communication Quality for effective

CounselingInstitutional Strengthening Access Inactive

EAP 7197 E.A.P. Cast Sharing Institutional Strengthening Quality LiveEAP 6744 Strengthening of Filarial control Program Prevention and control Access InactiveEAP 6747 Encourage for Use of Zink O.R.S. Prevention and control Quality LiveEAP 7120 Strengthening of Malaria control Program Prevention and control Quality LiveEAP 7123 Prevention of infection in Children from

MothersPrevention and control Quality Inactive


SOF1 Row Label

s


SP 6036 Grant for Operational of Ambulance for Emergency Treatment services

Access Live

SP 6214 Operate Mobile Health Clinic Access Institutional Strengthening

Live

SP 6742 Janlok Bhagandi Scheme Access LiveSP 7200 Health examination of hostel students Access Quality InactiveSP 6743 I.E.C. (Information & Broadcasting) Awareness Generation InactiveSP 4224 Education & Training HRH Quality LiveSP 7193 Special State Incentive plan for Family Welfare HRH Quality InactiveSP 7194 Special State Incentive plan for Family Welfare HRH Quality LiveSP 7198 Swablamban Plan for B.S.C Nursing Training HRH Institutional

StrengtheningInactive

SP 7199 Special Allowance to Officers HRH LiveSP 7202 Establishment of Nursing college HRH Institutional

StrengtheningLive

SP 7203 Establishment of Paramedical College HRH Institutional Strengthening

Live

SP 1320 Strengthening and elevation of nursing infrastructure


SP 5056 Construction of Buildings for CHC/PHC/ SC Institutional Strengthening Access LiveSP 5893 Establishment of treatment unit and Modern

labor room for New born BabyInstitutional Strengthening Quality Inactive

SP 6229 Strengthening of Hospitals Institutional Strengthening LiveSP 6271 Modernization of J P Hospital Institutional Strengthening Quality LiveSP 6920 Construction of Primary health Centers

Building with NABARD SupportInstitutional Strengthening Inactive

SP 7124 Construction of Sub Health Centre with Modern Technology

Institutional Strengthening Live

SP 7201 Special Support to SC/ST maternity Institutional Strengthening Access InactiveSP 7204 Construction of pre-Fabricated Sub Health

CentersInstitutional Strengthening Quality Inactive

SP 7205 Dindayal Mobile Hospital Institutional Strengthening Access LiveSP 7317 Elevation of Rural Health Institutions Institutional Strengthening Quality LiveSP 7648 Construction of Hospital and Dispensary

BuildingInstitutional Strengthening Access Live

SP 7871 Basic Services for Construction of Primary Health Centers, sub Health Center and Public Health Centers


SP 8798 Elevation of Hospitals Institutional Strengthening Quality LiveSP 8808 Information technology related work Institutional Strengthening Access LiveSP 1070 Prevention of adulteration in food items Prevention and control Quality LiveSP 6845 I.D.S.P. Project Prevention and control Quality LiveSP 7195 Prevention plan for Sickle cell Anemia

ThalassemiaPrevention and control Quality Live

SP 7196 Treatment of T.B. Disease Prevention and control Quality InactiveSP 0750 Drug Control Quality Institutional

StrengtheningLive

SP 6451 Establishment of Radiation Safety Unit Quality Institutional Strengthening

Live


SOF1 Row Label

s


SP 7178 Maternity Leave Quality Live

Annexure 4. Distribution of Non-Plan expenditure of DoHFW by object (Rs. in crore)

Head No Object Heads - DescriptionAccounts RE BE

2009-10 2010-11

2011-12

2012-13

2013-14

2014-15

11 Salary , Allowances 660.27 807.35 934.651052.7

71321.4

01907.9

312 Wages 4.77 5.87 7.85 5.83 10.21 10.2914 Reward & Award 0.00 0.00 0.00 0.00 0.01 0.01

16Salary , Allowances - Akhil Bhartiya Seva 0.08 0.11 0.14 0.18 0.27 0.30

19 Salary of contractual employees 0.04 0.05 17.71 22.13 30.44 35.8621 Travel Allowance 4.91 3.91 4.28 5.08 5.08 5.2722 Office Expenditure 17.65 22.79 24.45 29.73 36.80 35.7923 Purchase Vehicles 0.00 0.04 11.96 6.42 0.50 0.0024 Examination & Training 0.34 0.22 0.29 0.12 0.67 0.6131 Payment for professional services 2.85 4.42 4.80 6.49 28.13 33.4833 Maintenance 2.89 3.58 3.52 3.66 8.88 11.9134 Materials & Supplies 105.18 98.94 113.20 140.12 207.99 212.9435 Advertisement & Broadcasting 1.12 2.43 1.51 2.41 0.88 0.8841 Scholarship & Fellowship 1.65 1.74 1.84 2.87 3.88 4.1842 Grant-in-Aid 21.96 30.85 0.14 0.18 0.90 1.1144 Subsidy 0.00 0.00 65.00 77.87 74.00 85.0051 Other Charges 2.77 9.37 9.43 16.18 1.06 4.5553 Payment of Decree 0.00 0.00 0.00 0.12 0.00 0.0063 Machines 5.19 12.15 19.72 21.69 26.17 30.27

Total 831.661003.8

21222.4

61393.8

71757.2

62380.3

6

Annexure 5. Distribution of Plan expenditure of DoHFW by object (Rs. in crore)Head No Object Heads - Description

Actuals RE RE

2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

11 Salary , Allowances 182.98 210.10 285.23 328.19 461.69 598.5812 Wages 1.61 3.36 2.28 2.22 5.42 4.8219 Salary of contractual employees 0.00 0.00 0.00 0.00 0.06 0.0721 Travel Allowance 5.75 9.96 6.69 7.52 7.80 7.6422 Office Expenditure 17.06 33.40 44.30 55.48 75.38 62.2624 Examination & Training 0.00 0.02 0.05 0.11 1.01 0.6931 Payment for professional services 0.00 0.00 0.00 0.00 20.77 17.0233 Maintenance 1.28 1.37 1.80 1.77 3.23 3.0234 Materials & Supplies 12.99 35.65 58.77 39.15 42.96 31.9335 Advertisement & Broadcasting 0.20 0.21 0.63 5.29 1.50 1.1141 Scholarship & Fellowship 2.23 2.04 2.20 1.59 4.03 4.03


Head No Object Heads - Description

Actuals RE RE

2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

42 Grant-in-Aid 113.78 129.28 130.74 462.54 417.56 1504.6243 Contribution 0.00 0.00 5.50 0.00 5.88 4.0051 Other Charges 1.51 6.30 17.87 41.77 20.14 12.1053 Payment of Decree 0.03 0.00 0.00 0.00 0.00 0.0063 Machines 25.39 23.71 47.04 30.69 26.22 18.5164 Large Construction Work 35.33 39.66 89.28 130.22 133.02 177.60

Total 400.12 495.06 692.37 1106.551226.6

6 2448.02

Annexure 6. Revenue expenditure of DoHFW by objects (Rs. in crore)Head

No Object Heads - DescriptionActuals RE BE

2009-10 2010-11 2011-12 2012-13 2013-14 2014-1511 Salary , Allowances 843.25 1017.45 1219.88 1380.97 1783.09 2506.5212 Wages 6.37 9.23 10.13 8.04 15.63 15.1214 Reward & Award 0.00 0.00 0.00 0.00 0.01 0.0116 Salary , Allowances - Akhil

Bhartiya Seva0.08 0.11 0.14 0.18 0.27 0.30

19 Salary of contractual employees 0.04 0.05 17.71 22.14 30.50 35.9321 Travel Allowance 10.66 13.87 10.96 12.61 12.88 12.9022 Office Expenditure 34.70 56.19 68.75 85.21 112.18 98.0623 Purchase Vehicles 0.00 0.04 11.96 6.42 0.50 0.0024 Examination & Training 0.34 0.24 0.33 0.23 1.68 1.3031 Payment for professional

services2.85 4.42 4.80 6.49 48.90 50.50

33 Maintenance 4.17 4.95 5.32 5.44 12.11 14.9234 Materials & Supplies 118.17 131.00 171.97 179.27 250.95 244.8735 Advertisement & Broadcasting 1.32 2.65 2.14 7.70 2.38 1.9941 Scholarship & Fellowship 3.88 3.77 4.03 4.46 7.91 8.2142 Grant-in-Aid 135.74 160.13 130.88 462.72 418.46 1505.7343 Contribution 0.00 0.00 7.50 0.00 5.88 4.0044 Subsidy 0.00 0.00 65.00 77.87 74.00 85.0051 Other Charges 4.28 15.67 27.29 57.95 21.19 16.6553 Payment of Decree 0.03 0.00 0.00 0.12 0.00 0.0063 Machines 19.30 35.87 66.76 52.38 52.38 48.78

Total 1185.171 1455.6357 1825.5547 2370.1992 2850.897 4650.7786

Annexure 7. Capital expenditure of DoHFW by objects (Rs. in crore)Object Code

Description of the Object Actuals RE BE2009-10 2010-

112011-

122012-

132013-

142014-

1534 Materials & Supplies 0.00 3.59 0.00 0.00 0.00 0.0063 Machines 11.27 0.00 0.00 0.00 0.00 0.0064 Large Construction Work 35.33 39.66 89.28 130.22 133.02 177.60

Total 46.61 43.25 89.28 130.22 133.02 177.60


Annexure 8. Projected expenditure of DoHFW by schemes (Rs. in crore)


RE BE Projection2013-

14 P+NP

2014-15

P+NP

2015-16

P+NP

2016-17

P+NP

2017-18

P+NP1007 Regional Training Center for Family Welfare 7.28 8.41 10.31 11.70 13.281070 Prevention of adulteration in food items 10.84 14.62 17.18 19.71 22.621104 Goiter Disease Control 0.41 0.00 0.47 0.50 0.541171 Extension of Rural families welfare centers 3.10 0.00 4.24 4.97 5.811320 Strengthening and elevation of nursing infrastructure 0.00 0.00 0.00 0.00 0.001351 Medical Store, Indore, Gwalior 0.00 0.00 0.00 0.00 0.001473 District Hospital 586.45 862.04 823.85 938.56 1069.741508 District Level Staff 62.65 89.55 94.54 107.90 123.182283 Direction & Administration 43.29 55.66 68.55 78.77 90.522498 Supply of traditional Contraceptive 0.00 0.00 0.00 0.00 0.002502 Training to Nurses 7.25 9.30 11.50 13.20 15.142703 Direct Expenses 31.71 35.03 50.11 59.75 72.242777 Primary Health Center 487.50 735.40 759.99 868.93 993.812818 Filaria 5.84 0.00 8.76 9.99 11.402880 Multipurpose Worker Scheme 9.97 11.08 14.89 16.92 19.253281 Minor Construction work & Repairs 0.00 0.00 0.00 0.00 0.003463 Training for Women Health Workers 0.18 0.18 3.63 4.16 4.773704 State Level Family Welfare Organisation 3.48 8.70 5.43 6.23 7.154224 Education & Training 4.00 3.00 4.73 5.15 5.614245 Cold Fever 148.27 212.69 227.69 259.90 296.774510 Public Education 0.00 0.00 0.00 0.00 0.004602 Sterilization 2.50 0.00 3.14 3.51 3.935056 Construction of Buildings for CHC/PHC/ SC 6.40 34.10 38.28 40.11 42.605451 Establishment & Upgrading of Food Laboratory 0.00 0.00 0.00 0.00 0.005613 National Health Insurance Scheme 5.00 4.00 5.72 6.13 6.555719 Destruction of medical waste 3.25 5.90 4.08 4.57 5.11

5724 National Rural health Mission 350.001389.4

61328.8

01328.8

0 1328.805868 State Level Support Fund for Patient 70.00 80.00 88.00 96.80 106.48

5893Establishment of treatment unit and Modern labour room for New born Baby 0.00 0.00 0.00 0.00 0.00

5894 Mental Treatment 0.00 0.00 0.00 0.00 0.005989 Health Management Institute & Training Center 6.99 8.47 11.12 12.76 14.645998 Community Health Centre 37.14 46.96 56.69 64.55 73.54

6036Grant for Operational of Ambulance for Emergency Treatment services 15.00 16.00 18.82 21.07 23.60

6037 Formation for Bloodbank Council 0.19 0.19 0.35 0.48 0.65

6050Establishment of District Level blood bank and Cemank blood storage unit 3.50 0.00 4.24 4.66 5.12

6051 Generator for Hospitals 7.25 0.00 8.83 9.74 10.756096 I.E.C. Training Scheme 1.06 1.21 1.60 1.82 2.086105 Pension 20.00 22.00 22.90 24.50 26.226106 Universal Immunization 0.00 0.00 0.00 0.00 0.006214 Operate Mobile Health Clinic 5.70 1.00 7.15 8.01 8.976229 Strengthening of Hospitals 2.42 2.00 2.82 3.04 3.286271 Modernization of J P Hospital 12.00 6.00 16.35 19.21 22.66




14 P+NP

2014-15

P+NP

2015-16

P+NP

2016-17

P+NP

2017-18

P+NP6451 Establishment of Radiation Safety Unit 2.27 0.50 2.83 3.13 3.47

6453Strengthening of Health Infrastructure (13th Finance Commission) 62.50 110.50 143.54 188.48 174.24

6623 Beti Bachao Abhyan 0.75 0.75 1.16 1.44 1.796624 Establishment of Solar Photovoltaic device 0.46 1.01 0.56 0.61 0.676668 Grant to Indian Red Cross Society 0.20 0.20 0.31 0.39 0.496742 Janlok Bhagadi Scheme 0.88 0.00 1.01 1.08 1.166743 I.E.C. (Information & Broadcasting) 0.00 0.00 0.00 0.00 0.006744 Strengthening of Filaria control Programme 0.00 0.00 0.00 0.00 0.006745 Operation and Experimental search 0.00 0.00 0.00 0.00 0.006746 To strength Mother & Infant Health Services 0.00 0.00 0.00 0.00 0.006747 Encourage for Use of Zink O.R.S. 0.00 0.00 0.00 0.00 0.00

6837National programme for control of cancer, Diabetes & Heart disease 0.45 0.45 0.70 0.88 1.10

6840 National oldage health care programme plan 3.00 0.01 4.69 5.86 7.326845 I.D.S.P. Project 0.30 0.00 0.47 0.59 0.736882 Construction of Buildings for CHC/PHC/ SC (NABARD) 5.00 15.00 38.57 75.37 148.46

6920Construction of Primary health Centers Building with NABARD Support 0.00 0.00 0.00 0.00 0.00

7119 Teenager reproductive and sexual health programs 0.00 0.00 0.00 0.00 0.007120 Strengthening of Malaria control Programme 0.00 0.00 0.00 0.00 0.007121 Encourage the quality of family planning communication 0.00 0.00 0.00 0.00 0.007122 Communication Quality for effective Counseling 0.00 0.00 0.00 0.00 0.007123 Prevention of infection in Children from Mothers 0.00 0.00 0.00 0.00 0.00

7124Construction of Sub Health Centre with modern Technology 30.52 5.00 41.21 48.39 57.19

7131 Elevation and strengthening of nursing home 5.00 0.01 7.81 9.77 12.217132 National Iodine Deficient control programme 0.50 0.01 0.78 0.98 1.227178 Maternity Leave 0.00 0.00 0.00 0.00 0.007193 Special State Incentive plan for Family Welfare 0.00 0.00 0.00 0.00 0.007194 State Incentive Plan specifically for glaucoma 3.00 0.50 4.69 5.86 7.327195 Prevention plan for Sickle cell Anemia Thalassemia 1.20 0.00 1.41 1.53 1.667196 Treatment of T.B. Disease 0.00 0.00 0.00 0.00 0.007197 E.A.P. Cast Sharing 52.50 81.30 107.30 152.53 220.117198 Swalamban Plan for B.S.C Nursing Training 0.00 0.00 0.04 0.05 0.057199 Special Allowance to Officers 8.00 0.00 13.01 14.96 17.207200 Health examination of hostel students 0.00 0.00 0.00 0.00 0.007201 Special Support to SC/ST maternity 0.00 0.00 0.00 0.00 0.007202 Establishment of Nursing college 10.00 0.01 12.12 13.35 14.707203 Establishment of Paramedical College 3.00 0.50 3.61 3.94 4.307204 Construction of Pre Fabricant sub health centre 0.00 0.00 0.00 0.00 0.007205 Dindayal Mobile Hospital 2.15 1.15 2.46 2.63 2.827228 Sanjeevani treatment Scheme for child heart 4.00 5.00 5.76 6.91 8.297242 Iodine deficiency programme 0.00 0.00 0.00 0.00 0.007317 Elevation of Rural Health Institutions 29.42 27.50 40.68 46.73 57.237558 Civil Hospital 0.00 0.00 0.00 0.00 0.007648 Construction of Hospital and Dispensary Building 12.00 12.00 41.52 77.22 143.63




14 P+NP

2014-15

P+NP

2015-16

P+NP

2016-17

P+NP

2017-18

P+NP

7871Basic Services for Construction of Primary Health Centers, sub Health Center and Public Health Centers 11.60 0.00 19.91 26.08 34.16

7892 Guaranteed Treatment Scheme 42.22 34.22 48.52 52.01 55.778132 Prevention and control of aids 0.00 30.00 30.00 30.00 30.008150 Multi Countries Workers Scheme 108.91 256.35 176.17 202.43 232.628798 Elevation of Hospitals 86.89 100.00 119.85 134.34 150.718808 Information technology related work 0.16 1.14 0.21 0.24 0.279360 Mobile Health Clinics 1.18 0.00 1.54 1.70 1.889812 Sub health Centre 17.57 20.86 27.21 31.06 35.470077 Blind Disease Prevention and Treatment Unit 34.86 0.00 55.26 63.31 72.550264 Other services and Supplies 0.00 0.00 0.00 0.00 0.00

0336Training to Auxiliary Nurse, Mid wife and health visitors for family welfare 25.88 28.09 37.49 42.54 48.28

0621 Additional Sub Health Center 341.15 417.08 543.32 623.65 715.900748 Medical Store 0.00 0.00 0.00 0.00 0.000750 Drug Control 10.32 14.44 16.47 18.91 21.710859 Leprosy Control Programme 52.91 0.00 82.07 93.67 106.960993 Tuberculosis Therapy 49.69 0.00 76.38 87.10 99.377205 Dindayal Mobile Hospital 2.85 1.85 3.26 3.49 3.74

Grand Total2983.9

24828.3

85438.6

16129.2

8 6933.58

Annexure 9. Projected total expenditure for DoHFW by object (Rs. in crore)Object

s Object DescriptionRE BE Projections

2013-14 P+NP

2014-15 P+NP

2015-16 P+NP

2016-17 P+NP

2017-18 P+NP


16 Salary , Allowances - Akhil Bhartiya Seva 0.27 0.30 0.43 0.55 0.71

19 Salary of contractual employees 30.50 35.93 38.26 42.85 47.9921 Travel Allowance 12.88 12.90 16.17 18.11 20.2922 Office Expenditure 112.18 98.06 140.75 157.64 176.5623 Purchase Vehicles 0.50 0.00 0.07 0.07 0.0824 Examination & Training 1.68 1.30 2.11 2.36 2.6431 Payment for professional services 48.90 50.50 61.34 68.70 76.9433 Maintenance 12.11 14.92 16.57 19.38 22.6734 Materials & Supplies 250.95 244.87 287.34 307.45 328.9735 Advertisement & Broadcasting 2.38 1.99 2.72 2.92 3.1241 Scholarship & Fellowship 7.91 8.21 9.97 11.16 12.5042 Grant-in-Aid 418.46 1505.73 1493.69 1548.90 1633.5943 Contribution 5.88 4.00 6.73 7.21 7.7144 Subsidy 74.00 85.00 93.76 103.71 114.7751 Other Charges 21.19 16.65 24.26 25.96 27.7863 Machines 52.38 48.78 63.38 69.72 76.6964 Large Construction Work 133.02 177.60 330.83 465.41 612.48

Grand Total 2983.92 4828.38 5438.61 6129.28 6933.58


Annexure 10. Projected Plan expenditure of DoHFW by schemes (Rs. in crores)Scheme

No.Scheme Description RE BE Projections

2013-14 RE P

2014-15 BE P

2015-16 P 2016-17 P 2017-18 P

1007 Regional Training Center for Family Welfare 3.58 4.41 5.67 6.50 7.461070 Prevention of adulteration in food items 0.80 0.91 1.19 1.36 1.561104 Goiter Disease Control 0.00 0.00 0.00 0.00 0.001171 Extension of Rural families welfare centers 0.00 0.00 0.00 0.00 0.001320 Strengthening and elevation of nursing

infrastructure0.00 0.00 0.00 0.00 0.00

1351 Medical Store, Indore, Gwalior 0.00 0.00 0.00 0.00 0.001473 District Hospital 0.00 0.00 0.00 0.00 0.001508 District Level Staff 62.65 89.55 94.54 107.90 123.182283 Direction & Administration 0.00 0.00 0.00 0.00 0.002498 Supply of traditional Contraceptive 0.00 0.00 0.00 0.00 0.002502 Training to Nurses 0.00 0.00 0.00 0.00 0.002703 Direct Expenses 31.71 35.03 50.11 59.75 72.242777 Primary Health Center 0.00 0.00 0.00 0.00 0.002818 Filaria 0.00 0.00 0.00 0.00 0.002880 Multipurpose Worker Scheme 9.97 11.08 14.89 16.92 19.253281 Minor Construction work & Repairs 0.00 0.00 0.00 0.00 0.003463 Training for Women Health Workers 0.00 0.00 0.00 0.00 0.003704 State Level Family Welfare Organisation 3.48 8.70 5.43 6.23 7.154224 Education & Training 4.00 3.00 4.73 5.15 5.614245 Cold Fever 11.70 7.50 14.32 15.85 17.564510 Public Education 0.00 0.00 0.00 0.00 0.004602 Sterilization 0.00 0.00 0.00 0.00 0.005056 Construction of Buildings for CHC/PHC/ SC 6.40 34.10 38.28 40.11 42.605451 Establishment & Upgrading of Food

Laboratory0.00 0.00 0.00 0.00 0.00

5613 National Health Insurance Scheme 5.00 4.00 5.72 6.13 6.555719 Destruction of medical waste 0.00 0.00 0.00 0.00 0.005724 National Rural health Mission 350.00 1389.46 1328.80 1328.80 1328.805868 State Level Support Fund for Patient 0.00 0.00 0.00 0.00 0.005893 Establishment of treatment unit and Modern

labour room for New born Baby0.00 0.00 0.00 0.00 0.00

5894 Mental Treatment 0.00 0.00 0.00 0.00 0.005989 Health Management Institute & Training

Center0.00 0.00 0.00 0.00 0.00

5998 Community Health Centre 0.00 0.00 0.00 0.00 0.006036 Grant for Operational of Ambulance for

Emergency Treatment services15.00 16.00 18.82 21.07 23.60

6037 Formation for Bloodbank Council 0.19 0.19 0.35 0.48 0.656050 Establishment of District Level blood bank

and Cemank blood storage unit0.00 0.00 0.00 0.00 0.00

6051 Generator for Hospitals 0.00 0.00 0.00 0.00 0.006096 I.E.C. Training Scheme 0.00 0.00 0.00 0.00 0.006105 Pension 0.00 0.00 0.00 0.00 0.006106 Universal Immunization 0.00 0.00 0.00 0.00 0.006214 Operate Mobile Health Clinic 5.70 1.00 7.15 8.01 8.976229 Strengthening of Hospitals 2.42 2.00 2.82 3.04 3.286271 Modernization of J P Hospital 12.00 6.00 16.35 19.21 22.66


Scheme No.

Scheme Description RE BE Projections2013-14

RE P2014-15

BE P2015-16 P 2016-17 P 2017-18 P

6451 Establishment of Radiation Safety Unit 2.27 0.50 2.83 3.13 3.476453 Strengthening of Health Infrastructure (13th

Finance Commission)62.50 110.50 143.54 188.48 174.24

6623 Beti Bachao Abhyan 0.00 0.00 0.00 0.00 0.006624 Establishment of Solar Photovoltaic device 0.46 1.01 0.56 0.61 0.676668 Grant to Indian Red Cross Society 0.00 0.00 0.00 0.00 0.006742 Janlok Bhagadi Scheme 0.88 0.00 1.01 1.08 1.166743 I.E.C. (Information & Broadcasting) 0.00 0.00 0.00 0.00 0.006744 Strengthening of Filaria control Programme 0.00 0.00 0.00 0.00 0.006745 Operation and Experimental search 0.00 0.00 0.00 0.00 0.006746 To strength Mother & Infant Health Services 0.00 0.00 0.00 0.00 0.006747 Encourage for Use of Zink O.R.S. 0.00 0.00 0.00 0.00 0.006837 National programme for control of cancer,

Diabetes & Heart disease0.45 0.45 0.70 0.88 1.10

6840 National oldage health care programme plan 3.00 0.01 4.69 5.86 7.326845 I.D.S.P. Project 0.30 0.00 0.47 0.59 0.736882 Construction of Buildings for CHC/PHC/ SC

(NABARD)5.00 15.00 38.57 75.37 148.46


0.00 0.00 0.00 0.00 0.00

7119 Teenager reproductive and sexual health programs

0.00 0.00 0.00 0.00 0.00

7120 Strengthening of Malaria control Programme 0.00 0.00 0.00 0.00 0.007121 Encourage the quality of family planning

communication0.00 0.00 0.00 0.00 0.00


0.00 0.00 0.00 0.00 0.00

7123 Prevention of infection in Children from Mothers

0.00 0.00 0.00 0.00 0.00

7124 Construction of Sub Health Centre with modern Technology

30.52 5.00 41.21 48.39 57.19

7131 Elevation and strengthening of nursing home

5.00 0.01 7.81 9.77 12.21

7132 National Iodine Deficient control programme 0.50 0.01 0.78 0.98 1.227178 Maternity Leave 0.00 0.00 0.00 0.00 0.007193 Special State Incentive plan for Family

Welfare0.00 0.00 0.00 0.00 0.00

7194 State Incentive Plan specifically for glaucoma

3.00 0.50 4.69 5.86 7.32

7195 Prevention plan for Sickle cell Anemia Thalassemia

1.20 0.00 1.41 1.53 1.66

7196 Treatment of T.B. Disease 0.00 0.00 0.00 0.00 0.007197 E.A.P. Cast Sharing 52.50 81.30 107.30 152.53 220.117198 Swalamban Plan for B.S.C Nursing Training 0.00 0.00 0.00 0.00 0.007199 Special Allowance to Officers 8.00 0.00 13.01 14.96 17.207200 Health examination of hostel students 0.00 0.00 0.00 0.00 0.007201 Special Support to SC/ST maternity 0.00 0.00 0.00 0.00 0.007202 Establishment of Nursing college 10.00 0.01 12.12 13.35 14.707203 Establishment of Paramedical College 3.00 0.50 3.61 3.94 4.307204 Construction of Pre Fabricant sub health

centre0.00 0.00 0.00 0.00 0.00

7205 Dindayal Mobile Hospital 2.15 1.15 2.46 2.63 2.82


Scheme No.

Scheme Description RE BE Projections2013-14

RE P2014-15

BE P2015-16 P 2016-17 P 2017-18 P

7228 Sanjeevani treatment Scheme for child heart 0.00 0.00 0.00 0.00 0.007242 Iodine deficiency programme 0.00 0.00 0.00 0.00 0.007317 Elevation of Rural Health Institutions 29.42 27.50 40.68 46.73 57.237558 Civil Hospital 0.00 0.00 0.00 0.00 0.007648 Construction of Hospital and Dispensary

Building12.00 12.00 41.52 77.22 143.63


11.60 0.00 19.91 26.08 34.16

7892 Guaranteed Treatment Scheme 0.00 0.00 0.00 0.00 0.008132 Prevention and control of aids 0.00 30.00 30.00 30.00 30.008150 Multi Countries Workers Scheme 0.00 0.00 0.00 0.00 0.008798 Elevation of Hospitals 86.89 100.00 119.85 134.34 150.718808 Information technology related work 0.16 1.14 0.21 0.24 0.279360 Mobile Health Clinics 0.00 0.00 0.00 0.00 0.009812 Sub health Centre 0.00 0.00 0.00 0.00 0.000077 Blind Disease Prevention and Treatment

Unit0.00 0.00 0.00 0.00 0.00

0264 Other services and Supplies 0.00 0.00 0.00 0.00 0.000336 Training to Auxiliary Nurse, Mid wife and

health visitors for family welfare25.88 28.09 37.49 42.54 48.28


Grand Total 1226.66 2448.02 2834.30 3163.16 3553.69

Annexure 11. Projected Plan expenditure of DoHFW by objects (in crores)

Objects Object Description 2013-14

RE2014-15

BE2015-16

P2016-17

P 2017-18

P11 Salary , Allowances 461.69 598.58 750.77 863.39 992.9012 Wages 5.42 4.82 6.79 7.61 8.5214 Reward & Award 0.00 0.00 0.00 0.00 0.00


19 Salary of contractual employees 0.06 0.07 0.08 0.08 0.1021 Travel Allowance 7.80 7.64 9.78 10.96 12.2722 Office Expenditure 75.38 62.26 94.56 105.90 118.6123 Purchase Vehicles 0.00 0.00 0.00 0.00 0.0024 Examination & Training 1.01 0.69 1.27 1.42 1.5931 Payment for professional services 20.77 17.02 26.06 29.18 32.6833 Maintenance 3.23 3.02 4.41 5.17 6.0434 Materials & Supplies 42.96 31.93 49.18 52.62 56.3135 Advertisement & Broadcasting 1.50 1.11 1.72 1.84 1.9741 Scholarship & Fellowship 4.03 4.03 5.06 5.66 6.3442 Grant-in-Aid 417.56 1504.62 1492.28 1547.14 1631.3943 Contribution 5.88 4.00 6.73 7.21 7.71


Objects Object Description 2013-14

RE2014-15

BE2015-16

P2016-17

P 2017-18

P44 Subsidy 0.00 0.00 0.00 0.00 0.0051 Other Charges 20.14 12.10 23.05 24.67 26.3953 Payment of Decree 0.00 0.00 0.00 0.00 0.00



Grand Total 1226.66 2448.02 2834.30 3163.16 3553.69

Annexure 12. Projected Non-Plan expenditure of DoHFW by Schemes (Rs. in crore)

Scheme No.

Scheme Description 2013-14 NP-RE

2014-15 NP BE

2015-16 NP

2016-17 NP

2017-18 NP

1007 Regional Training Center for Family Welfare 3.70 4.00 4.64 5.20 5.821070 Prevention of adulteration in food items 10.04 13.71 15.99 18.35 21.061104 Goiter Disease Control 0.41 0.00 0.47 0.50 0.541171 Extension of Rural families welfare centers 3.10 0.00 4.24 4.97 5.811320 Strengthening and elevation of nursing

infrastructure0.00 0.00 0.00 0.00 0.00

1351 Medical Store, Indore, Gwalior 0.00 0.00 0.00 0.00 0.001473 District Hospital 586.45 862.04 823.85 938.56 1069.741508 District Level Staff 0.00 0.00 0.00 0.00 0.002283 Direction & Administration 43.29 55.66 68.55 78.77 90.522498 Supply of traditional Contraceptive 0.00 0.00 0.00 0.00 0.002502 Training to Nurses 7.25 9.30 11.50 13.20 15.142703 Direct Expenses 0.00 0.00 0.00 0.00 0.002777 Primary Health Center 487.50 735.40 759.99 868.93 993.812818 Filaria 5.84 0.00 8.76 9.99 11.402880 Multipurpose Worker Scheme 0.00 0.00 0.00 0.00 0.003281 Minor Construction work & Repairs 0.00 0.00 0.00 0.00 0.003463 Training for Women Health Workers 0.18 0.18 3.63 4.16 4.773704 State Level Family Welfare Organisation 0.00 0.00 0.00 0.00 0.004224 Education & Training 0.00 0.00 0.00 0.00 0.004245 Cold Fever 136.57 205.19 213.37 244.05 279.224510 Public Education 0.00 0.00 0.00 0.00 0.004602 Sterilization 2.50 0.00 3.14 3.51 3.935056 Construction of Buildings for CHC/PHC/ SC 0.00 0.00 0.00 0.00 0.005451 Establishment & Upgrading of Food

Laboratory0.00 0.00 0.00 0.00 0.00

5613 National Health Insurance Scheme 0.00 0.00 0.00 0.00 0.005719 Destruction of medical waste 3.25 5.90 4.08 4.57 5.115724 National Rural health Mission 0.00 0.00 0.00 0.00 0.005868 State Level Support Fund for Patient 70.00 80.00 88.00 96.80 106.485893 Establishment of treatment unit and Modern

labour room for New born Baby0.00 0.00 0.00 0.00 0.00

5894 Mental Treatment 0.00 0.00 0.00 0.00 0.005989 Health Management Institute & Training

Center6.99 8.47 11.12 12.76 14.64

5998 Community Health Centre 37.14 46.96 56.69 64.55 73.546036 Grant for Operational of Ambulance for

Emergency Treatment services0.00 0.00 0.00 0.00 0.00


Scheme No.


2014-15 NP BE

2015-16 NP

2016-17 NP

2017-18 NP

6037 Formation for Bloodbank Council 0.00 0.00 0.00 0.00 0.006050 Establishment of District Level blood bank

and Cemank blood storage unit3.50 0.00 4.24 4.66 5.12

6051 Generator for Hospitals 7.25 0.00 8.83 9.74 10.756096 I.E.C. Training Scheme 1.06 1.21 1.60 1.82 2.086105 Pension 20.00 22.00 22.90 24.50 26.226106 Universal Immunization 0.00 0.00 0.00 0.00 0.006214 Operate Mobile Health Clinic 0.00 0.00 0.00 0.00 0.006229 Strengthening of Hospitals 0.00 0.00 0.00 0.00 0.006271 Modernization of J P Hospital 0.00 0.00 0.00 0.00 0.006451 Establishment of Radiation Safety Unit 0.00 0.00 0.00 0.00 0.006453 Strengthening of Health Infrastructure (13th

Finance Commission)0.00 0.00 0.00 0.00 0.00

6623 Beti Bachao Abhyan 0.75 0.75 1.16 1.44 1.796624 Establishment of Solar Photovoltaic device 0.00 0.00 0.00 0.00 0.006668 Grant to Indian Red Cross Society 0.20 0.20 0.31 0.39 0.496742 Janlok Bhagadi Scheme 0.00 0.00 0.00 0.00 0.006743 I.E.C. (Information & Broadcasting) 0.00 0.00 0.00 0.00 0.006744 Strengthening of Filaria control Programme 0.00 0.00 0.00 0.00 0.006745 Operation and Experimental search 0.00 0.00 0.00 0.00 0.006746 To strength Mother & Infant Health Services 0.00 0.00 0.00 0.00 0.006747 Encourage for Use of Zink O.R.S. 0.00 0.00 0.00 0.00 0.006837 National programme for control of cancer,

Diabetes & Heart disease0.00 0.00 0.00 0.00 0.00

6840 National oldage health care programme plan 0.00 0.00 0.00 0.00 0.006845 I.D.S.P. Project 0.00 0.00 0.00 0.00 0.006882 Construction of Buildings for CHC/PHC/ SC

(NABARD)0.00 0.00 0.00 0.00 0.00


0.00 0.00 0.00 0.00 0.00

7119 Teenager reproductive and sexual health programs

0.00 0.00 0.00 0.00 0.00

7120 Strengthening of Malaria control Programme 0.00 0.00 0.00 0.00 0.007121 Encourage the quality of family planning

communication0.00 0.00 0.00 0.00 0.00


0.00 0.00 0.00 0.00 0.00

7123 Prevention of infection in Children from Mothers

0.00 0.00 0.00 0.00 0.00

7124 Construction of Sub Health Centre with modern Technology

0.00 0.00 0.00 0.00 0.00

7131 Elevation and strengthening of nursing home 0.00 0.00 0.00 0.00 0.007132 National Iodine Deficient control programme 0.00 0.00 0.00 0.00 0.007178 Maternity Leave 0.00 0.00 0.00 0.00 0.007193 Special State Incentive plan for Family

Welfare0.00 0.00 0.00 0.00 0.00

7194 State Incentive Plan specifically for glaucoma 0.00 0.00 0.00 0.00 0.007195 Prevention plan for Sickle cell Anemia

Thalassemia0.00 0.00 0.00 0.00 0.00

7196 Treatment of T.B. Disease 0.00 0.00 0.00 0.00 0.007197 E.A.P. Cast Sharing 0.00 0.00 0.00 0.00 0.007198 Swalamban Plan for B.S.C Nursing Training 0.00 0.00 0.04 0.05 0.05


Scheme No.


2014-15 NP BE

2015-16 NP

2016-17 NP

2017-18 NP

7199 Special Allowance to Officers 0.00 0.00 0.00 0.00 0.007200 Health examination of hostel students 0.00 0.00 0.00 0.00 0.007201 Special Support to SC/ST maternity 0.00 0.00 0.00 0.00 0.007202 Establishment of Nursing college 0.00 0.00 0.00 0.00 0.007203 Establishment of Paramedical College 0.00 0.00 0.00 0.00 0.007204 Construction of Pre Fabricant sub health

centre0.00 0.00 0.00 0.00 0.00

7205 Dindayal Mobile Hospital 0.00 0.00 0.00 0.00 0.007228 Sanjeevani treatment Scheme for child heart 4.00 5.00 5.76 6.91 8.297242 Iodine deficiency programme 0.00 0.00 0.00 0.00 0.007317 Elevation of Rural Health Institutions 0.00 0.00 0.00 0.00 0.007558 Civil Hospital 0.00 0.00 0.00 0.00 0.007648 Construction of Hospital and Dispensary

Building0.00 0.00 0.00 0.00 0.00


0.00 0.00 0.00 0.00 0.00

7892 Guaranteed Treatment Scheme 42.22 34.22 48.52 52.01 55.778132 Prevention and control of aids 0.00 0.00 0.00 0.00 0.008150 Multi Countries Workers Scheme 108.91 256.35 176.17 202.43 232.628798 Elevation of Hospitals 0.00 0.00 0.00 0.00 0.008808 Information technology related work 0.00 0.00 0.00 0.00 0.009360 Mobile Health Clinics 1.18 0.00 1.54 1.70 1.889812 Sub health Centre 17.57 20.86 27.21 31.06 35.470077 Blind Disease Prevention and Treatment Unit 34.86 0.00 55.26 63.31 72.550264 Other services and Supplies 0.00 0.00 0.00 0.00 0.000336 Training to Auxiliary Nurse, Mid wife and

health visitors for family welfare0.00 0.00 0.00 0.00 0.00


Grand Total 1757.26 2380.36 2604.31 2966.12 3379.89

Annexure 13. Projected Non-Plan expenditure of DoHFW by Objects (Rs. in crore)

Object Head Object Description 2013-14 NP-

RE2014-15 NP-

BE2015-16

NP2016-17

NP2017-18

NP11 Salary , Allowances 1321.40 1907.93 2079.84 2391.82 2750.5912 Wages 10.21 10.29 12.82 14.35 16.0814 Reward & Award 0.01 0.01 0.01 0.01 0.01


19 Salary of contractual employees 30.44 35.86 38.18 42.77 47.9021 Travel Allowance 5.08 5.27 6.39 7.15 8.0122 Office Expenditure 36.80 35.79 46.19 51.74 57.9523 Purchase Vehicles 0.50 0.00 0.07 0.07 0.0824 Examination & Training 0.67 0.61 0.84 0.94 1.05


Object Head Object Description 2013-14 NP-

RE2014-15 NP-

BE2015-16

NP2016-17

NP2017-18

NP31 Payment for professional services 28.13 33.48 35.28 39.51 44.2633 Maintenance 8.88 11.91 12.15 14.21 16.6234 Materials & Supplies 207.99 212.94 238.16 254.83 272.6735 Advertisement & Broadcasting 0.88 0.88 1.01 1.08 1.1541 Scholarship & Fellowship 3.88 4.18 4.91 5.50 6.1642 Grant-in-Aid 0.90 1.11 1.41 1.76 2.2043 Contribution 0.00 0.00 0.00 0.00 0.0044 Subsidy 74.00 85.00 93.76 103.71 114.7751 Other Charges 1.06 4.55 1.21 1.29 1.3853 Payment of Decree 0.00 0.00 0.00 0.00 0.00



Grand Total 1757.26 2380.36 2604.31 2966.12 3379.89


Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee (“DTTL”), its network of member firms, and their related entities. DTTL and each of its member firms are legally separate and independent entities. DTTL (also referred to as “Deloitte Global”) does not provide services to clients. Please see www.deloitte.com/about for a more detailed description of DTTL and its member firms.This material and the information contained herein prepared jointly by Deloitte Touché Tohmatsu India Private Limited (DTTIPL) is intended to provide general information on a particular subject or subjects and is not an exhaustive treatment of such subject(s) and accordingly is not intended to constitute professional advice or services. The information is not intended to be relied upon as the sole basis for any decision which may affect you or your business. Before making any decision or taking any action that might affect your personal finances or business, you should consult a qualified professional adviser.None of DTTIPL, Deloitte Touché Tohmatsu Limited, its member firms, or its and their affiliates shall be responsible for any loss whatsoever sustained by any person who relies on this material.

©2014 Deloitte Touché Tohmatsu India Private Limited

spmg ii mtef report 2015-16 - department of health & family welfare - final

Documents