Display options
Share it on

Int J Health Plann Manage. 2021 Nov;36(6):2248-2262. doi: 10.1002/hpm.3290. Epub 2021 Aug 04.

Putting the local back into planning-experiences and perceptions of state and district health functionaries of seven aspirational districts in India on an innovative planning capacity building approach.

The International journal of health planning and management

Enisha Sarin, Nitin Bisht, Jaya Swarup Mohanty, Naresh Chandra Joshi, Arvind Kumar, Surajit Dey, Harish Kumar

Affiliations

  1. Department of Health, Nutrition and WASH, IPE Global, New Delhi, India.

PMID: 34350636 DOI: 10.1002/hpm.3290

Abstract

District functionaries have ostensibly a major responsibility to develop evidence based plans. However, this responsibility is not commensurate with skills and expertise among functionaries in many Indian states. Vriddhi project-technical partner of the government, developed a planning tool for maternal and neonatal health programmes, called RMNCH + A Action Agenda using Strategic Approach (RAASTA), which was introduced in a workshop format in two states and attended by program officers. Qualitative feedback was obtained from selected participants to understand their experience of the workshop and of the planning tool. It emerged that previous planning process had little application of local evidence based solutions. Participants appreciated the alternative approach as RAASTA equipped them to use local evidence. Several action plans derived at the workshop were included in the state plan. At the same time, apprehension was expressed by participants about translating their learnings to practical application as planning was not a central priority in their scheme of duties and tasks. Enhanced support from states in refreshing district planners' skills would be an important step. One state government has scaled up the RAASTA tool while an electronic version is being developed for future use as it demonstrates great potential to equip and aid district officials in developing evidence based plans.

© 2021 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

Keywords: India; decentralization; district health planning; maternal and child health; planning capacity

References

  1. Gayathri K. District level NRHM finds flow and Expenditure; sub national evidence from the state of Karnataka. Working paper 278. Bangalore, India: Institute for Social and Economic Change. - PubMed
  2. Shukla A, Khanna R, Jadhav N. Using community-based evidence for decentralized health planning: insights from Maharashtra, India. Health Pol Plann. 2018;33(Issue 1):e34-e45. doi:10.1093/heapol/czu099 - PubMed
  3. Reerink HL, Campbell BB. Improving Reproductive Health Care within the Context of District Health Services: A Hand on Manual for Planners and Mangers. KIT Publishers; 2004. - PubMed
  4. Kapiriri L, Norheim OF, Martin DK. Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda. Health Pol. 2007;82(1):78-94. - PubMed
  5. Chitama D, Baltussen R, Ketting E, Kamazima S, Nswilla A, Mujinja PG. From papers to practices: district level priority setting processes and criteria for family planning, maternal, newborn and child health interventions in Tanzania. BMC Womens Health. 2011;11:46. doi:10.1186/1472-6874-11-46 - PubMed
  6. Mitton C, Donaldson C. Health care priority setting: principles, practice and challenges. Cost Eff Resour Allocation. 2004;2(1):3. - PubMed
  7. Odaga J, Henriksson DK, Nkolo C, et al. Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods. Glob Health Action. 2016;9:30983. - PubMed
  8. Curtale F, Musila T, Opigo J, Nantamu D, Ezati IA. District health planning at a time of transition: a critical review and lessons learnt from the implementation of regional planning in Uganda. Int Health. 2016;8(3):162-169. - PubMed
  9. Wickremasinghe D, Hashmi IE, Schellenberg J. District decision-making for health in low income settings: a systematic literature review. Health Pol Plann. 2016;31:ii12-ii24. doi:10.1093/heapol/czv124 - PubMed
  10. Maluka SO. Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania. Glob Health Action. 2011;4:7829. doi:10.3402/gha.v4i0.7829 - PubMed
  11. Liwanag HJ, Wyss K. Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines. Health Res Pol Syst. 2019;17(1):4. doi:10.1186/s12961-018-0402-1 - PubMed
  12. Sharma A, Rana SK, Prinja S, Kumar R. Quality of health management information system for maternal & child health care in Haryana state, India. PLoS One. 2016;11(2):e0148449. doi:10.1371/journal.pone.0148449 - PubMed
  13. Bhattacharyya S, Berhanu D, Taddesse N, et al. District decision-making for health in low-income settings: a case study of the potential of public and private sector data in India and Ethiopia. Health Pol Plann. 2016;31(Suppl 2):ii25-ii34. doi:10.1093/heapol/czw017 - PubMed
  14. Hawkes S, K Aulakh B, Jadeja N, et al. Strengthening capacity to apply health research evidence in policy making: experience from four countries. Health Pol Plann. 2016;31(2):161-170. doi:10.1093/heapol/czv032 - PubMed
  15. Maluka S, Kamuzora P, San Sebastian M, et al. Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework. Soc Sci Med. 2010;71(4):751-759. - PubMed
  16. Henriksson DK, Ayebare F, Waiswa P, Peterson SS, Tumushabe EK, Fredriksson M. Enablers and barriers to evidence based planning in the district health system in Uganda; perceptions of district health managers. BMC Health Serv Res. 2017;17(1):103. doi:10.1186/s12913-017-2059-9 - PubMed
  17. Kapiriri L, Arnesen T, Norheim OF. Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda. Cost Eff Resour Allocation. 2004;2(1):1. - PubMed
  18. Ashford LS, Smith RR, De Souza RM, Fikree FF, Yinger NV. Creating windows of opportunity for policy change: incorporating evidence into decentralized planning in Kenya. Bull World Health Organ. 2006;84(8):669-672. doi:10.2471/blt.06.030593 - PubMed
  19. Youngkong S, Kapiriri L, Baltussen R. Setting priorities for health interventions in developing countries: a review of empirical studies. Trop Med Int Health. 2009;14(8):930-939. - PubMed
  20. Henriksson DK, Peterson SS, Waiswa P, Fredriksson M. Decision-making in district health planning in Uganda: does use of district-specific evidence matter? Health Res Pol Syst. 2019;17(1):57. doi:10.1186/s12961-019-0458-6 - PubMed
  21. Seshadri SR, Hebbare L, Kotte S. Decentralisation and decision space in the health sector, Karnataka, India. BMC Proc. 2012;6(Suppl 5):O5. doi:10.1186/1753-6561-6-S5-O5 - PubMed
  22. Kalita A, Zaidi S, Prasad V, Raman VR. Empowering health personnel for decentralized health planning in India: the Public Health Resource Network. Hum Resour Health. 2009;7:57. doi:10.1186/1478-4491-7-57 - PubMed
  23. Gautham M, Spicer N, Subharwal M, et al. District decision-making for health in low-income settings: a qualitative study in Uttar Pradesh, India, on engaging the private health sector in sharing health-related data. Health Pol Plann. 2016;31(Suppl 2):ii35-ii46. doi:10.1093/heapol/czv117 - PubMed
  24. Srivastava A, Gope R, Nair N, et al. Are village health sanitation and nutrition committees fulfilling their roles for decentralised health planning and action? A mixed methods study from rural eastern India. BMC Publ Health. 2016;16(59). doi:10.1186/s12889-016-2699-4 - PubMed
  25. Seshadri SR, Parab S, Kotte S, Latha N, Subbiah K. Decentralization and decision space in the health sector: a case study from Karnataka, India. Health Pol Plann. 2016;31(2):171-181. PMID: 25967105. doi:10.1093/heapol/czv034 - PubMed
  26. National Health Mission. National health mission, Government of India Operational guidelines for improving health and nutrition status in aspirational districts; 2018. https://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCHA/ADP/Operational_Guidelines_for_Aspirational_Districts_Print_Ready_File_18icts.th_October.pdf - PubMed
  27. Morse JM. Determining sample size. Qual Health Res. 2000;10(1):3-5. - PubMed
  28. Creswell JW. Qualitative Inquiry and Research Design, Choosing among Five Traditions. Sage Publication Inc. - PubMed
  29. Halai N. Making use of bilingual interview data: some experiences from the field. Qual Rep. 2007;12(3):344-355. https://nsuworks.nova.edu/tqr/vol12/iss3/1 - PubMed
  30. Miles MB, Huberman AM. Qualitative Data Analysis. SAGE Publications; 1994. - PubMed
  31. Bossert T. Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance. Soc Sci Med. 1998;47(10):1513-1527. PMID:9823047. doi:10.1016/s0277-9536(98)00234-2 - PubMed
  32. Bossert TJ, Beauvais JC. Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space. Health Pol Plann. 2002;17(Issue 1):14-31. doi:10.1093/heapol/17.1.14 - PubMed
  33. Bossert, T, Larranñaga J, Osvaldo, G, et al. Decentralization and equity of resource allocation: evidence from Colombia and Chile/Thomas J. Bossert… [et al.]. Bulletin of the World Health Organization: Int J Public Health. 2003;81(2):95-100. https://apps.who.int/iris/handle/10665/71718 - PubMed
  34. Kigume R, Maluka S. Health sector decentralisation in Tanzania: how do institutional capacities influence use of decision space? Int J Health Plann Manag. 2018 Oct 6. https://onlinelibrary.wiley.com/doi/abs/10.1002/hpm.2587 - PubMed
  35. Bossert TJ, Mitchell AD. Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan. Soc Sci Med. 2011;72(1):39-48. doi:10.1016/j.socscimed.2010.10.019 - PubMed
  36. Bossert TJ. Decision space and capacities in the decentralization of health services in FijiComment on "decentralisation of health services in Fiji: a decision space analysis. Int J Health Pol Manag. 2016;5(7):443-444. doi:10.15171/ijhpm.2016.51 - PubMed
  37. Rudan I, Kapiriri L, Tomlinson M, Balliet M, Cohen B, Chopra M. Evidence-based priority setting for health care and research: tools to support policy in maternal, neonatal, and child health in Africa. PLoS Med. 2010;7(7):e1000308. - PubMed
  38. Allmendinger P. Planning Theory. 2nd ed. Palgrave Macmillan; 2009. - PubMed
  39. Innes JE, Booher DE. A turning point for planning theory? Overcoming dividing discourses. Plan Theory. 2015;14(2):195-213. doi:10.1177/1473095213519356 - PubMed
  40. Friedmann J. Planning in the Public Domain: From Knowledge to Action. Princeton University Press; 1987. - PubMed
  41. Mutale W, Chintu N, Amoroso C, et al. Improving health information systems for decision making across five sub-Saharan African countries: implementation strategies from the African Health Initiative. BMC Health Serv Res. 2013;13(Suppl 2):S9. - PubMed
  42. Avan BI, Berhanu D, Umar N, Wickremasinghe D, Schellenberg J. District decision-making for health in low-income settings: a feasibility study of a data-informed platform for health in India, Nigeria and Ethiopia. Health Policy Plan. 2016;31(Suppl_2):ii3-ii11. - PubMed
  43. O'Meara WP, Tsofa B, Molyneux S, Goodman C, McKenzie FE. Community and facility-level engagement in planning and budgeting for the government health sector--a district perspective from Kenya. Health Pol. 2011;99(3):234-243. doi:10.1016/j.healthpol.2010.08.027 - PubMed
  44. La Vincente S, Aldaba B, Firth S, Kraft A, Jimenez-Soto E, Clark A. Supporting local planning and budgeting for maternal, neonatal and child health in the Philippines. Health Res Pol Syst. 2013;11(3). doi:10.1186/1478-4505-11-3 - PubMed
  45. Access Health International. Diagnostic report: Strengthening public financial management system for resource efficiency and health outcomes in Assam; 2021. https://pdf.usaid.gov/pdf_docs/PA00XBZX.pdf - PubMed
  46. Tsofa B, Molyneux S, Gilson L, Goodman C. How does decentralisation affect health sector planning and financial management? a case study of early effects of devolution in Kilifi County, Kenya. Int J Equity Health. 2017;16(1):151. doi:10.1186/s12939-017-0649-0 - PubMed
  47. Zon H, Pavlova M, Groot W. Decentralization and health resources transfer to local governments in Burkina Faso: a SWOT analysis among health care decision makers. Health Sci Rep. 2019;2(6):e119. doi:10.1002/hsr2.119 - PubMed
  48. Kigume R, Maluka S. Decentralisation and health services delivery in 4 districts in Tanzania: how and why does the use of decision space vary across districts? Int J Health Pol Manag. 2019;8(2):90-100. doi:10.15171/ijhpm.2018.97 - PubMed
  49. Nyamtema AS. Bridging the gaps in the Health Management Information System in the context of a changing health sector. BMC Med Inf Decis Making. 2010;10:36. doi:10.1186/1472-6947-10-36 - PubMed
  50. Abajebel S, Jira C, Beyene W. Utilization of health information system at district level in jimma zone oromia regional state, South west Ethiopia. Ethiop J Health Sci. 2011;21(Suppl 1):65-76. - PubMed
  51. Nabyonga-Orem J. Monitoring Sustainable Development Goal 3: how ready are the health information systems in low-income and middle-income countries? BMJ Glob Health. 2017;2(4):e000433. doi:10.1136/bmjgh-2017-000433 - PubMed

MeSH terms

Publication Types

Grant support