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... (3)
The test statistic that is developed by Lo and Mackinlay for the variance ratio is as
follows;
) 1 , 0 ( ) 3 / ) 1 )( 1 2 ( 2 )( ( ) (
2 / 1
1
N q q q q M nq q Z
a
r
~ =
(4)
Where the variance ratio is,
1
) (
) (
2
2
a
c
r
q
q M
.(5)
And where the variance estimators are;
=
nq
k
k k a
X X
nq
1
2
1
2
) (
1
1
.(6)
And,
) (
2
q
c
=
=
nq
q k
q k k
q X X
m
2
) (
1
.(7)
- 135 -
Where,
m
=
) 1 )( 1 (
nq
q
q nq q +
.(8)
The tests are based on different aggregation levels, signalled by q.
Next to the homoskedastic test statistic, Lo and Mackinlay (1989) also developed a
test statistic that is robust to heteroskedasticity. They developed this test statistic with the
knowledge that volatilities change over time, and that the error terms of financial time series
are often not normally distributed.
Since still approaches zero, therefore we only have to calculate its asymptotic variance,
which is defined as .
The variance ratio estimate as defined before, is asymptotically equivalent to a weighted
sumof serial autocorrelation coefficient estimates, such that;
=
1
1
) (
) ( 2
) (
q
j
r
j
q
j q
q M
...(9)
Where is the estimator of the
th
autocorrelation factor.
Here, the asymptotic distribution of under the null hypothesis is defined as follows;
)) ( , 0 ( ) ( q V N q M nq
a
r
~
.(10)
Where is the asymptotic variance of and can be calculated as
=
=
1
1
2
), ( ) / ) ( 2 ( ) (
q
j
j q j q q V
(11)
Where
) ( j =
2
2
1
1
1
2
1
2
1
) (
) ( ) ( ) (
(
=
+ =
X X X
X X X X X X nq
nq
k
k k
nq
j k
j k j k k k
..(12)
- 136 -
And ( j) o is the estimator for the weighted sumof the variances of
The standard normal Z-statistic under heteroskedasticity is computed as:
| |
a
1/2
2 r
Z ( q) nqM ( q) V(q) N( 0, 1) .
= ~ ..(13)
AUTOMATIC VARIANCE RATIO TEST UNDER CONDITIONAL
HETEROSKEDASTICITY OF CHOI (1999)
While implementing the VR tests, the choice of holding period k is important. However,
this choice is usually rather arbitrary and ad hoc. To overcome this issue, Choi (1999)
proposed a data-dependent procedure to determine the optimal value of k. Choi (1999)
suggested a VR test based on frequency domain since Cochrane (1988) showed that the
estimator of V(k), which uses the usual consistent estimators of variance, is asymptotically
equivalent to 2 times the normalized spectral density estimator at the zero frequency, which
uses the Bartlett kernel.
However, Choi (1999) employed instead the quadratic spectral (QS) kernel because
this kernel is optimal in estimating the spectral density at the zero frequency (Andrews,
1991).The VR estimator is defined as
. (14)
Where R(i) is the autocorrelation function, and h(x) is the QS window defined as
.(15)
The standardized statistic is
(16)
Under the null hypothesis the test statistic VR
f
follows the standard normal distribution
asymptotically. Note that it is assumed that T ! , k ! and T /k !.Choi (1999) employed
the Andrews (1991) methods to select the truncation point optimally and compute the VR
test. Note that the small sample properties of this automatic VR test under heteroskedasticity
are unknown and have not been investigated properly
- 137 -
NON-PARAMETRIC VARIANCE RATIO TESTS USING RANKS AND SIGNS
BY WRIGHT (2000)
As already noted, the LoMacKinlay (1988) tests, which are asymptotic tests whose
sampling distribution is approximated based on its limiting distribution, are biased and right-
skewed in finite samples. In this respect, Wright (2000) proposed a non-parametric alternative
to conventional asymptotic VR tests using signs and ranks. Wrights (2000) tests have two
advantages over the LoMacKinlay(1988) test when sample size is relatively small: (1) as
the rank (R1 and R2) and sign (S1 and S2) tests have an exact sampling distribution, there is
no need to resort to asymptotic distribution approximation, and (2) the tests may be more
powerful than the conventional VR tests against a wide range of models displaying serial
correlation, including fractionally integrated alternatives.
The tests based on ranks are exact under the i.i.d. assumption, whereas the tests
based on signs are exact even under conditional heteroskedasticity. Wright(2000), defined
the R1 and R2 statistics af follows
.(17)
...(18)
Given a variable in first differences , let r(x) be the rank of among
( , . . . , ). Under the null hypothesis that is generated froman i.i.d. sequence, r() is
a randompermutation of the numbers of 1, . . . , T with equal probability, giving the distribution
of the test statistics as stated in proposition 1.
Proposition 1:Under the assumption of iid returns, R1 and R2 have the same
distribution as
and
where the standardized ranks and are given by
- 138 -
..(19)
.(20)
Where,
-1
(k) is the inverse of the standard normal cumulative distribution function, and
is any permutation of 1, 2,..., T each with equal probability. So,the exact sampling distriubution
of R1 and R2 may be simulated to an arbitrary degree of accuracy.
Because this distribution is free of nuisance parameters, it could be used to construct
an exact test. Wright (2000) reports the 2.5and 97.5 percentiles of the null distribution of R1
and R2 for some values of T and k.,which could used to construct a two-sided equal-tailed
exact test. If is a martingale difference sequence, but is not iid, then r() is not just a
randompermutation of the integers from 1 to T in which each permutation has equal
probability. Therefore, Proposition 1 does not apply and the proposed tests are not exact
under conditional heteroscedasticity. Wright (2000) ,showed that the size distortions of these
tests under conditional heteroscedasticity are small.
The tests based on the signs of first differences are given by
..(21)
..(22)
Where (k) is defined as above , s
t
=2u(x
t
, 0), s
t
( )=2u(x
t
, ) and
- 139 -
{ 0.5 if
0.5 otherwise
Similar to R1 and R2 tests, the critical values of the S1 and S2 tests can be obtained by
simulating their exact sampling distribution. Note that S1 assumes a zero drift value.
WALD TEST OF RICHARDSON AND SMITH (1991)
Richardson and Smith (1991) suggested a joint test based on the following Wald
statistic:
...(23)
where VR is the (k 1) vector of sample k VRs, is the (k 1) unit vector and is the
covariance matrix of VR. The joint RS(k) statistic follows a 2 distribution with k degrees
of freedom. The usefulness of this test relies on the fact that, whenever the VR tests are
computed over long lags with overlapping observations, the distribution of the VR test is
non-normal; then, neither the LoMacKinlay(1988) test nor ChowDenning(1993) procedure
is valid for drawing inference.
CHOW AND DENNING MULTIPLE VARIANCE RATIO TEST(1993)
The test developed by Lo and Mackinlay (1988) uses the property of the RWH to test
individual variance ratios for different values of the aggregation factor q. Chow and Denning
(1993) recognized that the test lacks the ability to test whether all the variance ratios of the
different observation intervals are equal to 1, simultaneously. This is a requirement of the
RWH, and since Lo and Mackinlay(1988) overlooked this requirement, they used the standard
normal tables to test the variance ratios on significance. Failing to control for the overall test
size, leads to a large probability of a Type 1 error.
To circumvent this problem, Chow and Denning developed a test that controls for the
joint test size, and also provides a multiple comparison of variance ratios. They used the
Studentized MaximumModulus (SMM) critical values to control for the overall test size and
to create a confidence interval for the Variance Ratio estimates. They used the same test
statistic of the Lo and MacKinlay (1988) Variance Ratio test. Only now they are simply
compared to the SMM critical values, instead of the standard normal critical values to look
for significance.
Since Chow and Denning(1993) consider multiple comparisons of the variance ratio
estimates, and all variance ratio estimates should be above the SMM critical value, they use
the following largest absolute value of the two test statistics as defined before in the Lo and
MacKinlay(1988) procedure
- 140 -
(K) = ............... (24)
(K) = ............... (25)
Z
1
(q) and Z
2
(q) is calculated same as above
In which are the different aggregation intervals for . The decision about whether to
reject the null hypothesis or not can be based on the maximumabsolute value of individual
variance ratio test statistics.
JOINT VARIANCE RATIO TEST OF CHEN AND DEO (2006)
Chen and Deo (2006) suggested a simple power transformation of the VR statistic
that, when k is not too large, provides a better approximation to the normal distribution in
finite samples and is able to solve the well-known right-skewness problem. They showed
that the transformed VR statistic leads to significant gains in power against mean reverting
alternatives. Furthermore, the distribution of the transformed VR statistic is shown, both
theoretically and through simulations, to be robust to conditional heteroscedasticity.
They defined the VR statistic based on the periodogramas
..(26)
Where,
..(27)
..(28)
and
j
=2j/T; while W
k
()=k
1
{sin(0.5k)/sin(0.5)}
2
is a weighting function. Chen and
Deo (2006) found that the power-transformed statistic (k) gives a better approximation
to a normal distribution than VR
p
(k), where
..(28)
Let (k
1
,,k
l
) be a vector of holding periods satisfying the conditions given in Theorem
5 of Chen and Deo (2006). Conditions (A1) to (A6) in Chen and Deo(2006) allow the
innovations to be a martingale difference sequence with conditional heteroskedasticity. .
They are explained below.
- 141 -
A1) is ergodic and =0 for all t, where is a sigma field, is measurable
And for all t.
(A2)
(A3) For any integer q, 2 and for q non negative integers , E( =0
when at least one is exactly one and
(A4) For any integer r, 2 and for r non negative integers , E( =0
when at least one is exactly one and
(A5) uniformly in j for every j>0
(A6)
Under the assumption that given time series Y
t
follows a conditionally heteroskedastic
martingale difference sequence Chen and Deo Showed that
....................(29)
approximately follows N(
). The details of
and
i
- 185 -
Where:
r
p
= the average rate of return for portfolio i during a specified time period
r
f
= the average rate of return on risk-free assets during the same time period
i
=the standard deviation of the rate of return for portfolio i during the time period
TREYNORS PERFORMANCE MEASURE
Treynors portfolio performance measure hypothesize on two components of risk: (1)
risk produced by general market fluctuations and (2) risk resulting fromunique fluctuations
in the portfolio securities. It is compute through
rp- rf
TM =
p
|
Where:
r
p
=the average rate of return for portfolio i during a specified time period
r
f
=the average rate of return on a risk-free investment during the same time period
|
p
=Theslopeofthefundscharacteristiclineduringthattimeperiod(thisindicates
the portfolios relative volatility)
JENSEN PORTFOLIO PERFORMANCE MEASURE
The J ensen measureis based on the Capital Asset Pricing Model (CAPM). All versions
of the CAPM states that the realized rate of return on a security or portfolio during a given
time period should be a linear function of the risk-free rate of return during the period, plus
a risk premiumthat depends on the systematic risk of the security or portfolio during the
period plus a randomerror term(e
jt
). It shows that risk premiumearned on the j
th
portfolio
is equal to
j
times a market risk premium plus a random error term.
E (r
p
) =r
f
+|
j
[E(r
m
) r
f
]+e
jt
Where:
E (r
p
) =the expected return on security or portfolio j
r
f
=the one-period risk-free interest rate
|
j
=thesystematicrisk(beta)forsecurityorportfolioj
E (r
m
) =the expected return on the market portfolio of risky assets
e
jt
=randomerror term
- 186 -
FAMAS MEASURE
J ensens measure computes excess returns over expected returns based on premium
for systematic risk. Eugene F Fama (1972) goes a step ahead, he suggests to measure fund
performance in terms of excess returns over expected returns based on premiumfor total
risk.
In other words, the excess returns are computed based on Capital Market Line (CML).
Fama breaks down the observed return into four components:
i) Risk-free return r
f
ii) Compensation for systematic risk (r
m
- r
f
)
iii) Compensation for inadequate diversification (r
m
- r
f
){(
p
/
m
)-()}
iv) Net superior returns due to selectivity (r
p
- r
f
.)-(p/m) (r
m
- r
f
)
The second and third measures indicate the impact of diversification and market risk.
By altering systematic and unique risk a portfolio can be reshuffled to get the desired return.
Fama says the portfolio performance can be judged by the net superior returns due to
selectivity. His performance measure denoted by F
P
is
F
p
= Portfolio turn Risk free return - returns due to all risks
F
P
= (r
p
- r
f
) {
p
/
m
} [r
m
- r
f
]
Where F
P
=Famas measure for portfolio,
r
P
=portfolio return,
r
f
=risk free return,
P
=standard deviation of the portfolio returns &
m
=standard deviation of the market returns.
A positive value for F
P
indicates that the fund is earned returns higher than expected
returns and lies above CML, and a negative value indicates that the fund is earned returns
less than expected returns and lies below CML. These measures identify the mistakes and
suggest a direction for the correction in portfolio of funds. A comparison of Sharpes and
Treynors ratios will help the fund managers to correct their actions fromrisk angle and
comparison of J ensens and Famas measures will help fromreturn angle.
- 187 -
DATA ANALYSIS
To analyse the importance of gold ETF and its performance and attempt has been
made by selecting some gold securities which are widely traded in the market. The selected
gold securities are Kotak Gold, SBIGETS, GOLDBEES, IDBIGOLD and RELGOLD. The
Risk and Return of these gold securities have been calculated and measured with the
performance of the Market. In our analysis we have taken NIFTY return and Risk as
Market Risk and Market Return. the performance of Market and gold securities is evaluated
with Sharpes evaluation method and interpreted.
Market Return = 2.09 (Expected Monthly return on Nifty J an 2012-Dec 2012)
Market Risk = 4.92 (Monthly Risk on Nifty J an 2012-Dec 2012)
1. Return and Risk calculations. CORRLEATION BETWEEN GOLD ETFS
AND NIFTY
TABLE: 1
GOLD ETF ANALYSIS
0.171 0.52 1.603 1.1301 RELGOLD
0.147 0.35 2.056 0.955 IDBIGOLD
0.119 0.34 1.719 1.094 GOLDBEES
0.051 0.17 1.52 1.074 SBIGETS
0.159 0.46 1.691 1.212 KOTAKGOLD
BETA CORRELATION RISK RETURN SECURITIES
0.171 0.52 1.603 1.1301 RELGOLD
0.147 0.35 2.056 0.955 IDBIGOLD
0.119 0.34 1.719 1.094 GOLDBEES
0.051 0.17 1.52 1.074 SBIGETS
0.159 0.46 1.691 1.212 KOTAKGOLD
BETA CORRELATION RISK RETURN SECURITIES
INTERPRETATION
1. Kotak gold having the risk of 1.691 and return is 1.212 ; SBIGOLD ETF risk is
1.52, return is 1.074 ; GOLDBEES risk is 1.719, return is 1.094; IDBIGOLD
risk is 2.056 ,return is 0.955; RELGOLD risk is 1.603 ,return is 1.1301. By
considering the above table G-ETFs having the good returns greater than the
market returns.
2. The Gold ETFs performance is very well than the market performance in terms
of returns and comparison to risk.
3. The relationship between the NIFTY and GOLD ETF are positively correlated
fromthis we can understand if NIFTY is increasing the GOLD ETF also increases
vice versa.
- 188 -
2. Comparision of Actual Returns and Expected Return through CAPM
approach of Gold ETFs
TABLE: 2
0.899 1.130 RELGOLD
0.865 0.955 IDBIGOLD
0.824 1.094 GOLDBEES
0.727 1.074 SBIGETS
0.882 1.212 KOTAKGOLD
CAPM ( Expected Return) ACTUAL RETURN SECURITIES
0.899 1.130 RELGOLD
0.865 0.955 IDBIGOLD
0.824 1.094 GOLDBEES
0.727 1.074 SBIGETS
0.882 1.212 KOTAKGOLD
CAPM ( Expected Return) ACTUAL RETURN SECURITIES
INTERPRETATION
Table 2 depicts the expected return on Gold etfs through CAPM model and the actual
returns of these securities. by observation it is clear that Gold ETFs have performed above
the expected returns. KOTAK GOLD expected return is 0.882 but we earned more than
that of expected returns i.e., 1.212; SBIGETF expected return is 0.727 actual return is
1.074;gold bees expected return is 0.824, actual return is 1.094; IDBIGOLD expected return
is 0.865, actual return is 0.955; relgold expected return is 0.899 ,actual return is1.130,
3. PERFORMANCE EVALUATION OF GOLD ETFS
TABLE : 3
+0.01 0.231 2.783 0.296 RELGOLD
-0.269 0.09 2.047 0.153 IDBIGOLD
-0.06 0.131 2.512 0.255 GOLDBEES
-0.023 0.347 8.235 0.276 SBIGETF
+0.07 0.33 3.509 0.330 KOTAKGOLD
FAMA JENSENS TREYNORS SHARPE SCRIPNAME
+0.01 0.231 2.783 0.296 RELGOLD
-0.269 0.09 2.047 0.153 IDBIGOLD
-0.06 0.131 2.512 0.255 GOLDBEES
-0.023 0.347 8.235 0.276 SBIGETF
+0.07 0.33 3.509 0.330 KOTAKGOLD
FAMA JENSENS TREYNORS SHARPE SCRIPNAME
INTERPRETATION
An attempt is made to study the performance of Gold Etfs with the help of evaluation
techniques like Sharpes measure, J ensens Measure, Treynors Measure and Fama Measure.
it is clear fromthe above analysis that the performance of the selected gold etfs is good.
- 189 -
4. Comparision of Gold ETFS Returns with Market Returns
TABLE : 4
0.291 0.296 RELGOLD
0.291 0.153 IDBIGOLD
0.291 0.255 GOLDBEES
0.291 0.276 SBIGETS
0.291 0.330 KOTAKGOLD
NIFTY (SHARPE) SHARPE MEASURE G-ETFS
0.291 0.296 RELGOLD
0.291 0.153 IDBIGOLD
0.291 0.255 GOLDBEES
0.291 0.276 SBIGETS
0.291 0.330 KOTAKGOLD
NIFTY (SHARPE) SHARPE MEASURE G-ETFS
INTERPRETATION
From table-4 it is vivid that the performance of Gold ETFS is better than the
performance of Market. it is proved fromSharpes Evaluation Measure where Kotakgold,
SBIGETS, GOLDBEES and Relgold value is greater that Niftys Evaluation measure
CONCLUSION
E-gold is the electronic mode of investing in gold. Investors across the country now
have another investment option where they can buy exchange traded funds of gold, the
returns generated correspond to the domestic price movement of physical gold. The above
analysis has proved that gold etfs have performed well by yielding good return with low
risk. Comparatively gold etfs have performed better that the market return. Thus it is an
opportunity for the investors to invest in gold and earn high returns out of it.
REFERENCES
1. Aggarwal, R., and Soenen, L., (1988). The nature and efficiency of the gold market,
2. J ournal of Portfolio Management, 1988, Spring, Vol 14, no.3 page 18 to 21
3. Anderson, S., Born, J ., and Schnusenberg, O., (2010). Closed-End Funds, Exchange
Traded Funds and Hedge Funds. Springer: New York.
4. Fama, E., (1970). Efficient Capital Markets: A Review of Theory and Empirical
Work. J ournal of Finance, May 1970, pp. 383-417
5. J ensen, Michael C. (1968), Problems in Selection of Security Portfolios - The
Performance of Mutual Funds in the Period 1945-1964, J ournal of Finance, Vol. 23
Issue 2, p389-416.
- 190 -
6. Murphy, Rob and Wright, Colbrin, (2010) An Empirical Investigation of the
Performance of Commodity-Based Leveraged ETFs Available at SSRN
7. Sharpe, WilliamF. Alexander, Gordon J . Bailey J effery V. (2003), Investments, 6th
edition, Prentice Hall of India Pvt. Ltd., New Delhi, ISBN-81-203-2101-4.
8. Sharpe, WilliamF. (1966), Mutual Fund Performance, J ournal of Business, Part 2
of 2, Vol. 39 Issue 1.
9. www.moneycontrol.com
10. www.nseindia.com
11. www.sebi.gov.in
- 191 -
EMERGING MERCHANT BANKS
Rahela Thanveer, Student M.B.A, School of Management Studies, J NTUH, Hyderabad,
A.P. she can be reached at email: rahelathanveer@yahoo.com
ABSTRACT
Merchant bankers play a vital role in financial system by providing their services.
In doing so, they face some issues and challenges. This paper presents the need for
merchant banking and its growth, particularly in India. It also includes their registration
under SEBI guidelines and their responsibilities. The services provided by the merchant
bankers affects the economy of the country. Corporate sectors need such services to
raise capital. Services of the merchant bankers in the Indian scenario are explained.
However, Indian economy is definitely having an impact by emerging merchant banking.
KEY WORDS
Financial System, Merchant Banking, SEBI
INTRODUCTION
Merchant bank is an Organization that underwrites corporate securities and advises
clients on issues like corporate mergers involved in the ownership of commercial ventures.
Merchant banker is a person who is engaged in the business of issue management either by
making arrangements regarding selling, buying, or subscribing to securities as manager,
consultant, advisor or rendering corporate advisory service in relation to such issue
management. They render all these services for a fee.
ORIGIN: The termmerchant banking originated from the London who started
financing foreign trade through acceptance of bills. Later they helped government of under
developed countries to raise long termfunds. Later these merchants formed an association
which is now calledMerchant Banking and Securities House Association.
In 1967, National Grindlays started merchant banking services followed by Citi bank
in 1970. The first Indian bank to set up merchant banking division is SBI in the year 1972.
Later, other commercial banks followed.
The need for specialized merchant banking service was felt in India with the rapid
growth in the number and size of the issues made in the primary market.
FUNCTIONS OF MERCHANT BANKERS: Merchant bankers assist mergers
and acquisitions on transaction structure, timing, pricing and funding options. They assess
potential targets and provide analysis. Merchant bankers assist with necessary documentation
to execute a successful capital rising. They advise on real estate opportunities in the public
and private market.
- 192 -
SERVICES OF MERCHANT BANKERS: Merchant bankers provide services
in project counseling, loan syndication, management and marketing of new issues, underwriting
of public issues, portfolio management, NRI investment, advisory service relating to mergers
and takeover, offshore finance, promotional activities, leasing and finance, servicing issues
and other specialized issues.
MERCHANT BANKING REGULATIONS
According to Securities and Exchange Board of India (Merchant Bankers) Rules,
1992, it is mandatory for a merchant banker to hold a certificate of registration granted by
the Securities and Exchange Board of India, no person can act as a merchant banker. If a
person/organization wants to carry or undertake any of the authorized activities, has to get
registered under the regulations. To obtain the certificate of registration, one has to apply in
the prescribed formand fulfill two set of norms
(a) Operational capabilities and
(b) Capital adequacy norms.
Merchant bankers are classified as four categories:
Category I to carry on the activity of issue management and to act as adviser,
consultant, manager, underwriter, portfolio manager.
Category II - to act as adviser, consultant, co-manager, underwriter, portfolio manager.
Category III - to act as underwriter, adviser or consultant only.
Category IV to act only as adviser or consultant to an issue of capital.
The minimum net worth requirement for acting as merchant banker is given below:
Category I Rs. 5 crores
Category II Rs, 50 lakhs
Category III Rs. 20 lakhs
Category IV Nil
A merchant banker has to pay to SEBI: Applicant fee of 25000, registration of Rs
10 lakh and renewal fee of Rs 5 lakh 3 years fromthe 4
th
year fromthe date of initial
registration.
GUIDELINES FOR MERCHANT BANKERS
SEBIs authorization is a must to act as merchant bankers. Authorization criteria
include: Professional qualification in finance, law or business management, infrastructure
like office space, equipment and man power, capital adequacy and past track of record,
experience, general reputation and fairness in all transactions.
- 193 -
Every merchant banker should maintain copies of balance sheet, Profit and loss account,
statement of financial position. Half-yearly unaudited result should be submitted to SEBI.
Merchant bankers are prohibited frombuying securities based on the unpublished price
sensitive information of their clients. SEBI has been vested with the power to suspend or
cancel the authorization in case of violation of the guidelines. Every merchant banker shall
appoint a Compliance Officerto monitor compliance of the Act.
SEBI has the right to send inspecting authority to inspect books of accounts, records
etc., of merchant bankers. Inspections will be conducted by SEBI to ensure that provisions
of the regulations are properly complied. An initial authorization fee, an annual fee and
renewal fee may be collected by SEBI. A lead manager holding a certificate under category
I shall accept a minimumunderwriting obligation of 5% of size of issue or Rs.25 lakhs
whichever is less.
CODE OF CONDUCT
According to the 13 Regulation of the SEBI of 1992 merchant bankers should protect
the interest of investors. They deliver best possible advice to their clients without any
discrimination among them. They should maintain high standards of integrity, dignity and
fairness in conduct of business. They should fulfill all obligations in a professional and ethical
manner. At the time of issue it is ensured that prospectus and letter of offer is made
available to investors. Any penal action taken by SEBI should be informed to its clients.
Merchant banks should informthe board about any legal proceedings initiated against it.
They should abide by the rules of Securities and Exchange Board of India Regulations,
2003 . They should ensure that any person it employs should have the capacity to be a
merchant banker. It is responsible for the act of its employees and agents and should not
create false market.
OBLIGATIONS AND RESPONSIBILITIES
Merchant bankers have the following obligations and responsibilities:
Merchant banker should maintain proper books of accounts, records and submit half
yearly/annual financial statements to the SEBI within stipulated period of time. No merchant
banker should associate with another merchant banker who is not registered in SEBI.
Merchant bankers should not enter into any transactions on the basis of unpublished information
available to themin the course of their professional assignment. Every merchant banker
must submit himself to the inspection by SEBI when required for and submit all the records.
Every merchant banker must disclose information to the SEBI when it requires any
information fromthem. All merchant bankers must abide by the code of conduct prescribed
for them. Every merchant banker who acts as lead manager must enter into an agreement
with the issuer setting out mutual rights, liabilities, obligations, relating to such issues with
particular reference to disclosures allotment, refund etc.
- 194 -
ROLE OF MERCHANT BANKERS IN THE PRIMARY MARKET ISSUE
MANAGEMENT
Merchant banker is the intermediary appointed by companies in the primary market
issue. It has to look at the entire issue management and work as the Manager to the Public
Issue. In includes vetting of prospects, appointment of underwriters, appointment of bankers,
appointment of registrars, appointment of brokers and principal brokers, printing and dispatch
of prospectus and application form, filing of initial listing application, promotion of the issue,
promotion of the issue, collection of applications, processing of applications, establishing the
liability underwriters, allotment of shares, listing of the issue, cost of public issue.
SOME PROBLEMS OF MERCHANT BANKERS
SEBI guidelines have authorized merchant bankers to undertake issue related activities
only with an exception of portfolio management these guidelines have made the merchant
bankers either to restrict their activities or think of separating these activities fromthe
present one and float new subsidiary and enlarge the scope of its activities. SEBI guidelines
stipulate a minimum net worth of Rs 1 crore for authorized of merchant bankers. Small but
professional and specialized merchant bankers who dont have a net worth of Rs 1 crore
may have to close down their business the entry is denied to young specialized professional
into merchant banking business. Non- co operation of the issuing companies in timely allotment
of securities and refund of application money is another problemof merchant bankers. The
guidelines have put the responsibility on the merchant bankers. They have to seek the co-
operation of the issuing company to shoulder the responsibility.
FACTORS ON WHICH GROWTH OF MERCHANT BANKING DEPENDS
In India growth of merchant banking depends upon planning and industrial policy of
the country. It also depends upon regulatory systemof the market and economy prevailing
in India. The confidence of the people, traders, buyers, marketers, business houses, financial
institutions etc go hand in hand with merchant banking. The economic environment of the
outside world is another factor on which its growth depends. There is always competition
among the existing players and the upcoming entrants. It also has an impact over merchant
banking.
SCOPE OF MERCHANT BANKING IN INDIA
The scope of merchant banking in India can be seen by growth of new issue market,
entry of foreign investors, changing policy of financial, institutions, development of debt
market, innovations in financial investments, corporate restructuring, disinvestment. Indian
market is growing. In fact India is one of the largest emerging markets. Public issues, FDI,
debt raising are on rise. Merchant bankers assist in decision making and hence their scope
increases. With significant market freedom, merchant bankers work has increased many
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folds. RBI prefers that commercial banks do not indulge in merchant banking business
directly. They should setup a subsidiary for the purpose. This limits scope of commercial
banks and gives space to merchant bankers. This policy also results in fair business practices.
Some countries allow commercial bankers to get involved in IPOs, placement of debentures,
etc. Indian scenario is favorable to merchant bankers. Corporate can do project appraisal,
strategic restructuring in house as well. If the corporate prefer third-party independent
assessment, then only they will engage merchant bankers. Otherwise merchant bankers
role is only statutory as in issue management. Mergers, takeover acquisition, new projects,
fund raising for government institutions, active money market are all providing better business
prospectus to merchant bankers.
REFERENCES
1. Financial Services by Eric Banks
2. http://www.sebi.gov.in/acts
3. Manual of merchant banking by Dr. V.C.Verma
4. Merchant Banking Principles and Practices by H.R. Machiraju
5. Sebi manual
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EQUITABLE HEALTH CARE FINANCING AND PRIMARY
HEALTHCARE INFRASTRUCTURE DEVELOPMENT
CHALLENGES IN THE INDIAN CONTEXT
1
Nenavath Sreenu, Assist Professor, Department of business management, Indira Gandhi
National Tribal University, Amarkantak. MP, INDIA. Reach me at: sri_cbm@yahoo.com.
Contact: 9966483998.
ABSTRACT
The issue of appropriate mechanisms for mobilising health care financing
resources and primary healthcare infrastructure development is a high on the policy
agenda of India governments. The objectives of this paper is to critically evaluate
how health services are currently funded, explore recent trends in health care financing
and primary healthcare infrastructure development in India. The paper shows that
even though the government sources of financing are mildly progressive, the large
proportions spent by the household on health care makes it overall regressive. Both
government and private expenditures are higher for higher income quintiles and for
people living in urban areas and working in organized sector. On the other hand,
people in lower income quintile and in rural areas bear higher burden of health
expenditure as a proportion of their income. Delivery of health care is also found to
be biased in favor of urban areas.
There is an urgent need to improve infrastructure at the health centres by mapping
the available services and supporting infrastructure for providing accessible and
affordable service in rural areas and reduce the load on district hospitals. Sanctioned
posts of medical and para-medical staff should be filled on priority basis. MMU should
be provided in every district to ensure outreach medical services in remote/ difficult
areas. Completion of construction projects should be ensured within the prescribed
timeframe, to avoid Escalation of cost.
The findings suggest that at state level governments have target of allocating
only about 0.43 per cent of SGDP to health and medical care. This does not include
the allocations received under central sponsored programmes such as family welfare.
Given this level of spending at current levels and fiscal position of state governments
the goal of spending 2 to 3 per cent of GDP on health looks very ambitious task. The
analysis also suggests that elasticity of health expenditure when SGDP changes in
only 0.68 which suggest that for every one percent increase in state per capita income
the per capita public healthcare expenditure has increased by around 0.68 per cent.
Health Financing and Management must be considered together to address issues of
equity, efficiency and effectiveness in health care services.
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KEY WORDS:
Expenditure And Public Healthcare, Financing, Infrastructure, Medical Services,
Phcs.
INTRODUCTION
The health systemin India has considerably improved during the past five decades
with the spread and accessibility of modern medicine and considerable improvements in two
important indicators of health status i) the life expectancy at birth and ii) infant mortality
rates. However, compared with other developing countries, the health status in India is not
only below the level for all developing countries but has also shown a lower level of
improvement. The life expectancy at birth in 1993 was 60.7 for India which is below 61.5
for all developing countries, and infant mortality rate for the same period was 81 which is
much higher than 70 for all developing countries. At the same time, the percentage decrease
in infant mortality rate in 1993 over 1960 was 51 per cent in case of India against 71 per cent
in China, 76 percent in Sri Lanka and 82 percent in Malaysia (UNDP, 1996) The health
status in India is low despite a significant amount of resources spent on health as compared
with similar income countries. According to the World Development Report (1993), India
spent 6 percent of its GDP or about $17,750 million on health in 1990 which is larger than the
expenditures in China, Sri Lanka and Indonesia (not only in absolute terms but also per
capita terms) but achieved a lower health status as compared to these countries.
The major objective of this paper is to study the financing of health care system and
PHCs infrastructure development fromthe viewpoint of equity. Equity in health care can be
examined with respect to i) equity in health care finance and ii) equity in the delivery of
health care. While former deals with the impact that health care financing and delivery
arrangements have on distribution of income, the latter deals with the impact that health
care and financing arrangements have on distribution of health care utilization (Doorslaer
and Wagstaff, 1998). In India, since financing of health is done fromboth private and public
sources, the progressivity of health care financing in public sector will have to be assessed
for different financing sources like direct tax, indirect tax, local tax, social insurance premiums
and for private payments like direct payments for fees and medicines or private insurance
premiums. In order to understand the redistributive effect, it is not only important to understand
the financing mix, that is the relative shares of taxes, social and private insurance premiums
and direct payments, but also find out to what degree a financing scheme is horizontally or
vertically equitable The paper is organized in three major sections i) financing of health care
ii) provision or delivery of services, and iii) primary healthcare Infrastructure. The paper
finally discusses the main findings and conclusion.
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LITERATURE REVIEW
Julian Schweitzer (2008). This study views the public healthcare finance and
decentralization as central to resolving Indias systemic public health crisis. However, some
states and districts have achieved success despite serious financial and administrative
constraints. This suggests that factors such as political commitment, community participation,
human resource management, womens empowerment, and governance may be as are
more important. The success of the national rural health mission will depend on state and
local institutional capacity, including strong partnerships with civil society organisations and
private-sector actors. Increased resources and decentralization will not be sufficient by
themselves. An examination of the failing districts will most likely reveal some systemic
failures in developing the institutions and systems needed to ensure delivery of an integrated
package of health services.
Ravi Duggal (2007). The author posits that the way in which healthcare is financed
is critical for equity in access to health-care. At present, the proportion of public health-care
resources committed to health-care in India is one of the lowest in the world, with less than
one-fifth of health expenditure being publicly financed. India has large-scale poverty. Yet,
the main source of financing health-care is out-of-pocket expenditure. This is a cause of the
huge inequities we see in access to health-care. The paper argues for strengthening public
investment and expenditure in the health sector and suggests possible options for doing this.
It also calls for a reformof the existing health-care system by restructuring it to create a
universal access mechanism which also factors in the private health sector. The paper
concludes that it is important to over-emphasize the fact that health is a public or social good
and so cannot be left to the vagaries of the market.
Stijn Claessens (2006). In this study, the author has reviewed the evidence on the
importance of rural health-care finance for economic well-being. It provides data on the use
of basic health-care financial services by households and firms across a sample of countries,
assesses the desirability of universal access, and provides an overview of the macro-level,
legal, and regulatory obstacles to access. Despite the benefits of health-care finance, the
data show that use of rural health-care financial services is far fromuniversal in many
countries, especially developing countries. Universal access to health-care financial services
has not been a public policy objective in most countries and would probably be difficult to
achieve. Countries can, however, facilitate access to financial services by strengthening
institutional infrastructure, liberalising markets and facilitating greater competition, and
encouraging innovative use of know-how and technology. Government interventions to directly
broaden access to rural health-care finance, however, are costly and fraught with risks;
among others, the risk of missing the targeted groups. The study concludes with
recommendations for global actions aimed at improving rural health-care data on access
and use and suggestions on areas of further analysis to identify constraints to broadening
access.
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K. Kananatu (2000). This review presents an overview of the India health-care
systemand its method of financing. The development of the health-caredelivery systemin
India is commendable. However, the strengthand weaknesses of the public health-care
systemand the financingproblems encountered are also discussed. Cost of health-careand
funding of both the public and private sectors were alsorevealed. One must optimise the
advantages of operating a healthfinancing scheme which is affordable and controllable
whichcontribute towards cost-containment and quality assurance. Thus,
there is a need for
the establishment of a national healthcarefinancing, a mechanismto sustain the health-care
delivery networkand operate it as a viable option. A model of the national healthfinancing
has been proposed.
Saltman and Ferroussier-Davis (2000). This study examines the determinants of
financial protection, health, and social inclusions supply in health systemand related sectors.
There is a hierarchy of interest fromnon-health sector factors in improving financial protection.
These factors include: GDP, prices, inflation, availability of insurance markets, effective tax
systems, credit, and savings programmes to more traditional parts of the health system (a)
preventive and curative health services, (b) health financing, (c) input markets, and (d)
access to effective and quality health services (preventive, ambulatory, and in-patient). In
respect to the latter, organisational and institutional factors contribute to the incentive
environment of health-financing and service delivery systems in addition to the more commonly
examined determinants such as management, the health-care policy actions by governments,
civil society, and the private sector. Finally, through their stewardship function, governments
have a variety of policy instruments that can be used to strengthen the health system, the
financing of services, and the regulatory environment within which the system functions.
These include: regulation, contracting, subsidies, direct public production, and ensuring that
information is available. In countries with weak government capacity, civil society and donors
can be encouraged to play a similar role.
STUDIES RELATED TO HEALTH FINANCING IN INDIA
In India there are few studies which have touched upon the issue of healthcare financing
and its nature. First study was R.B. Lals Singpur study of private household expenditure,
which talked about private expenditure on health in Singpur area and also what was the
government healthcare expenditure for the same area (GOI, 1946). The Indian Institute of
Management, Ahmedabad had carried out a study of health finance covering all the levels
of health expenditure state, municipal, corporate and household (IIM, 1987). Another
study of state health financing in India is that by Roger J efferey. He looked at state health
expenditure fromthe perspective of planning the administrative process involved in making
allocations and in context of policy changes. Tulasidhar and Sarma (1993) did a comparative
study of different states of India with respect to public expenditure, medical care at birth
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and infant mortality. They found that in all the states per capita real public spending grew
faster than real per capita state domestic product. Recently a number of studies have been
done on the healthcare financing in India. Duggal (1996) discusses the public-private
participation in health sector and how this can be optimised for best results. Bhat (1996,
2000) discusses about the importance of regulating the private sector in India and how
publicprivate partnership can bring needed resources while also taking care that the vulnerable
groups the poor and rural populations have access to health facilities. These studies
suggest that Indias dependence on private sector in healthcare is very high. Utilisation
studies show that a third of in-patients and three fourths of outpatients utilise private healthcare
facilities (Duggal and Amin 1989; Yesudian 1990; Visaria and Gumber 1994).
In another study Mahal et al. (2000) tried to find the distribution of public health
subsidies in India in different states. Despite a considerable desire for equity in public
policy documents, they found that public subsidies on health are distributed quite unequally
across different socio-economic groups in India. At the all-India level, the share of the
richest 20 per cent of the population in total public sector subsidies is nearly 31 per cent,
nearly three times the share of the poorest 20 per cent of the population. In rural areas this
inequality was much greater where the share of the top 20 per cent in public subsidies was
nearly four times that of the poorest 20 per cent. Mahal et al. (2000) find that 31 per cent of
public subsidies on health accrued to urban residents, somewhat higher than their share in
the total population of about 25 per cent. If we look at the state level then there also they
found substantial differences in the degree of inequality, with southern states such as Kerala,
Tamilnadu and Andhra Pradesh, and the western states of Maharashtra and Gujarat enjoying
a much more equal distribution than the north Indian states. Some of this inequality in the
allocation of public health subsidies can be explained by income-related differences in
utilisation patterns of public facilities, with the rich using more care, if health care is a normal
good. But if, however, promoting equity is a key objective of the state, there is no doubt that
substantial scope for improvement remains, whether in terms of interstate equity, or within
state distributions of public subsidies.
SOURCES OF DATA
The Primary source of data has been collected through survey method with the help
of a questionnaire. The questionnaire included the question drafted for the enquiry about the
beneficiaries and the level of satisfaction. The questionnaire was structured. The question
selected was open ended and close ended. The Secondary data was taken fromthe literature
available on the subject, information available on internet, published articles and different
books on healthcare reports.
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STATISTICAL TOOLS & HYPOTHESIS
Relevant statistical and analytical tools of ANOVA, Correlation and multi-regression
other tools appropriate for the study was used. Appropriate hypothesis relevant with the
objectives of the study were formulated and tested for significance.
HEALTHCARE FINANCING IN INDIA
The study examines the health-financing scenario in India. According to him, India
spends only 1.5 per cent of GDP on health as against the recommended 5 per cent by
W.H.O. for equity and universal coverage. He opines that (i) States have a high share
(89%) of funding their health care activities as against 9 per cent by the centre and 2.8 per
cent by the Union Territories; (ii) Increasing proportion of health expenditure on salaries
(60%-90%) and a markedly reduced (29%-5%) proportion on non-salary components is
reflected in low-level of utilization of health services; (iii) Committed involvement by others
in selected crucial areas is lacking; (iv) Health financing seems to be directed towards the
urban sector with maximumoutlays to curative care; (v) There are high inter-State variations
in health expenditure and health status; (vi) Higher share of SDF on public health does not
guarantee a better health status; (vii) Health services sectors urgently and legitimately need
additional resources; (viii) There is a need to set up technical committees and research cells
to sensitize policy makers, academicians and others; and (ix) Health Financing and
Management must be considered together to address issues of equity, efficiency and
effectiveness in health care services.
The WHO in its Alma Ata Declaration had recommended that public health care
expenditures should be at least 5 per cent of GDP if equity and universal coverage are to be
realised. Most socialist countries spend 3.5 per cent while OECD countries spend over 6
per cent of GDP on health care. In India 1.5 per cent of GDP is spent on health and family
welfare (excluding water supply and sanitation, nutrition, etc.) which includes health
expenditure by municipal bodies. At the State level, departments of health (excluding family
welfare and water supply) are spending around 5 per cent of the total government expenditure,
plan and non-plan on revenue account on medical and public health programme. While
health sectors share in the major States is around 3 per cent of the total plan outlay. CSSR-
ICMR has recommended that a minimumof 6 per cent should be spent on health services in
India. However, the Central Council of Health and Family Welfare in 1989 had recommended
seven per cent of the total plan funds for health sector.
Health care is in need of additional resources due to increasing need and expectation
of the user while increasing the efficiency and effectiveness of the existing resources. In
1989, the Planning Commission constituted a working group on health financing and
management for better utilisation of funds in the eighth Five-Year plan. The working group
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observed that (i) the efficiency of health services in India is low; (ii) there is a need for
careful scrutiny of existing allocation of resources; and (iii) health services sector legitimately
needs additional resources which must be planned in a scientific manner.
STRUCTURE OF HEALTHCARE FINANCING IN INDIA
Public spending in health care is very low at 17 percent and the National Health
Policy has stressed upon this issue. More than 86 percent of healthcare financing is through
unplanned (out-of-pocket) spending. The majority of healthcare services in India are provided
by the private sector. Private sector comprises of around 80 percent of healthcare
expenditure, with various levels of government covering the remaining 20 percent. In the
government sector, the states provide the bulk of healthcare services. The scope for higher
public spending on healthcare will be limited, as long as Indias combined central and state
government deficit remains at around 7 percent of GDP. The healthcare spending will be
sustained by two demographic trends: increase life expectancy and an ageing population.
Life expectancy which averaged 66.5 years in 2002-06, is expected to increase to an average
of 70 years in 2007-11. The proportion of the population aged 65 years and over is also rising
and will increase from4.9 percent in 2006 to 5.4 percent in 2011. These levels are far lower
than most of the developed countries. Medical tourism characterized by patients traveling to
India for medical treatment, will continue to grow. India has established as a leading destination
for medical tourismand expected to grow by 30 percent a year over the next 5 years and
will be a market of around US $2 billion by 2012. Many private hospitals in India, today, have
the medical technology to match the standards of US and UK hospitals. India will continue
to offer high levels of personal medical care and significantly cheaper costs than hospitals in
the US and Western Europe.
CURRENT STATUS OF HEALTH FINANCING-ISSUES
The review of the present situation reveals multiple sources of financing of health
care in India. The Central Government assists the States in the delivery of health care by
giving 100 per cent financial support to family welfare, maternal and child health, immunisation
and some of the national health programmes. However, the main financial responsibility for
the health services rests with the States. Another source of health financing is fromvoluntary
organisations and professional bodies. In urban areas, the municipal corporations and
municipalities are manning a network of health care services. There are urban based schemes
such as ESIS and CGHS. Large government establishments like defence, railways and
organised public and private sector institutions have their own separate financing of health
care. It is very difficult to estimate the aggregate expenditure because of numerous sources
of health financing which is complex and intricate. The plan investments on health and
family welfare sector have increased considerably over the successive plan periods. In the
first Five Year plan, investment was of Rs. 98 crore, which increased to Rs. 6,700 crore in
the seventh Five Year plan and Rs. 14,075 crore in the eighth Five Year plan respectively.
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Besides, it is very difficult to estimate the aggregate expenditure on health care in the
country because of numerous sources of health financing. One available estimate (IIMA
study, 1987) indicates that contribution of public sector expenditure is about 37 per cent and
the rest came fromprivate sector. Break up of these estimates are Central Government
7.82 per cent, State Government 22.72 per cent, local bodies 6.55 per cent, household sector
59.62 per cent and private non-house-hold sector 3.29 per cent. A serious problem in sectoral
allocation of public health spending has been the large and increasing proportion of expenditure
on salaries (60 % to 90%) and a markedly reduced (29% to 5%) proportion on non-salary
components like medicines, equipment, fuel, etc. This has led to a waste of resources because
the health personnel in place cannot work effectively without other supportive expenditure.
It is equally difficult to indicate the pattern of funding in curative and preventive care since
they are often provided in an integrated manner. Besides, Indian economy is a mixed economy
where private sector is contributing in financing health care. In addition, there are insurance
schemes, ESIS and CGHS, which are subsidised facilities. There is mediclaiminsurance
scheme for reimbursement of expenses for policy holders. Besides, there are high interstate
variations in health expenditure and health status. Thus, there is a clear need to examine in
detail the (i) health expenditure by the Central and State Governments; (ii) their real (price
adjusted) growth; (iii) temporal variations both in per capita and as share real / nominal GDP
or SDP; (iv) distribution of finance between rural and urban and by nature of health care
activities like preventive, curative and (v) the nature of relationship between health status
and health expenditure.
HEALTHCARE EXPENDITURE IN INDIA
The Indian constitution charges the states with the raising of the level of nutrition
and the standard of living of its people and the improvement of public health. Central
government efforts at influencing public health have focused on the five-year plans, on
coordinated planning with the states, and on sponsoring major national health programs. For
most national health programmes government expenditures are jointly shared by the central
and state governments. Healthcare expenditure is a very necessary social expenditure for
any country. Like any other social expenditure health expenditure also requires a significant
contribution fromthe Government. Whether it is a developed country or a developing one
states role in developing a good health infrastructure and assuring good health to everybody
becomes very critical and important. The spending on health has major contributions coming
fromprivate households (75 per cent). State governments contribute 15.2 percent, the central
government 5.2 percent, third-party insurance and employers 3.3 percent, and municipal
government and foreign donors about 1.3 (World bank 2005). Of these proportions, 58.7
percent goes toward primary health care (curative, preventive, and promotive) and 38.8
percent is spent on secondary and tertiary inpatient care.
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HEALTH EXPENDITURE BY THE STATES
Analysis of the health expenditure by the States, relating to two points of time 1996-
2000 and 2001-2005, conducted both at the nominal and adjusted figures (using appropriate
price deflators) showed two distinct patterns5. The non-plan expenditure is devoted largely
to medical care viz. highest was 86 per cent for Kerala and the lowest was 50 per cent for
Rajasthan in 1996-2000. The maximumallocation of plan expenditure goes to water supply
and sanitation followed by family welfare. This is true for both the years and for all the
States. The growth pattern of health expenditure by the States revealed an interesting trend.
Out of 16 States, ten (Andhra Pradesh, Asam, Bihar, Kerala, Orissa, Punjab, Rajasthan,
Tamil Nadu, Uttar Pradesh and West Bengal) have registered a faster growth in their health
expenditures then their State Domestic Product (SDP) and a few major States (Haryana,
Karnataka, Madhya Pradesh, Maharashtra and Gujarat) had a negative growth in their
health budget, though all of themare developed both economically as well as by the level of
their health status. The highest growth in the health budget during this period was seen in
Uttar Pradesh a State with low health status. Thus, allocative efficiency of budgetary
resources in U.P. needs close scrutiny.
ISSUES IN HEALTH FINANCING
The group recommended that health planning should be decentralized with less budget
heads and more delegation of financial powers. There should be proper distribution between
plan and non-plan allocation. Part of plan outlay needs to be converted into non-plan outlay
for funding increased maintenance liabilities. Alternate community financing schemes must
address equity of access while mobilising community participation for raising finances. For
making health care financing a shared responsibility and economic support a collective
commitment, effective co-ordination between different sectors viz. health, education,
agriculture, industry, housing, environment and sanitation should be developed and encouraged.
The government should develop clear policies, structure and mechanismto co-ordinate,
collate and optimise the use of financial resources i.e., community, voluntary organisations,
private and public institutions for promoting primary health care. The total plan outlay for
family welfare and health programmes is inadequate and needs to be raised substantially.
Higher allocations should be considered. Employers in the organised sector should contribute
more to health financing of their employees. Health insurance, which is coming up in urban
areas should be extended to rural population without any government subsidy. The research
areas identified and recommended by the group include:
(i) Evaluation of health financing effect on primary health care;
(ii) Provision of health
(iii) Care to different income groups; and
(iv) Economics of health planning.
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There is an urgent need to set up a technical committee or advisory group on health
economics and financing, comprising policy makers, economists, public health specialists
and academicians to address the following areas of concern:
(i) To outline research areas and develop necessary infrastructure for research on health
and related issues.
(ii) To provide updated and comprehensive information on individual researchers and
institutions.
(iii) To organise seminars and workshops to disseminate health data analysis and sensitise
policy makers, academicians and other concerned personnel.
(iv) To promote health economics and financing as an important research area of academic
excellence for colleges and institutions.
It is proposed that research cells may be set-up to review selected literature on health
financing and related issues. Regional repositories of selected journals and publications may
be established for use by researchers. National or international agencies would need to be
tapped for raising necessary finances for all these activities.
RURAL HEALTH INFRASTRUCTURE AND MANPOWER
FUNCTIONS
The Primary Health Care Infrastructure has been developed as a three tier system
with Sub Centre, Primary Health Centre (PHC) and Community Health Centre (CHC)
being the three pillars of Primary Health Care System. Progress of Sub Centres, which is
the most peripheral contact point between the Primary Health Care Systemand the community,
is a prerequisite for the overall progress of the entire system. A look at the number of Sub
Centres functioning over the years revealed that at the end of the Sixth Plan (1981-85) there
were 84,376 Sub Centres, which increased to 1,30,165 at the end of Seventh Plan (1985-90)
and to 1,45,272 at the end of Tenth Plan (2002-2007). As on March, 2011, 1,48,124 Sub
Centres are functioning in the country.
Similar progress can be seen in the number of PHCs which was 9115 at the end of
sixth plan (1981-85) and the figure almost doubled to 18671 at the end of Seventh Plan
(1985-90) and rose to 22669 at the end of Tenth Plan (2002-2007). As on March, 2008,
there were 23458 PHCs functioning in the country. In accordance with the progress in the
number of SCs and PHCs, the number of CHCs has also increased from761 at the end of
Sixth Plan (1981-85) to 1910 at the end of Seventh Plan (1985-90) and 4045 at the end of
Tenth Plan (2002-2007). As on March, 2008, 4510 CHCs were functioning. According to
the figures of population based on 2001 Population Census, the shortfall in the rural health
infrastructureis to the tune of 20486 Sub Centres, 4477 PHCs and 2337 CHCs, ignoring
surplus in some States / UTs.
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Presents the number of Sub Centres, PHCs and CHCs existing in 2011 as compared
to those reported existing in 2005. As may be seen from the Statement 1, at the national
level there is an increase of 2098 Sub Centres, 651 PHCs and 1463 CHCs in 2011 as
compared to those existing in 2005. This implies an increase of about 43% in number of
CHCs, about 2.8% in number of PHCs and about 1.4% in number of Sub Centres in 2011 as
compared to 2005. There is significant increase in the number of Sub Centres in the States
of Chhattisgarh, Haryana, J ammu & Kashmir, Maharashtra, Orissa, Punjab, Rajasthan,
Tamil Nadu, Tripura and Uttarakhand. Significant increase is also observed in the number of
PHCs in the States of Andhra Pradesh, Assam, Bihar, Chhattisgarh, Haryana, J ammu &
Kashmir, Karnataka, Maharashtra, Nagaland, Uttarakhand, Uttar Pradesh. In case of CHCs,
significant increase is observed in the States of Arunachal Pradesh, Chhattisgarh, Gujarat,
Haryana, Himachal Pradesh, J ammu & Kashmir, J harkhand, Kerala, Madhya Pradesh,
Odisha, Punjab, Rajasthan, Tamil Nadu, Uttarakhand, Uttar Pradesh and West Bengal. The
average population covered by a Sub Centre, PHC and CHC was 5624, 34876 and 173235,
respectively.
MANPOWER
The availability of manpower is one of the important prerequisite for the efficient
functioning of the Rural Health services. As on March, 2011 the overall shortfall (which
excludes the existing surplus in some of the states) in the posts of HW(F) / ANM was 3.8%
of the total requirement as per the normof one HW(F) / ANM per Sub Centre and PHC.
The overall shortfall is mainly due to shortfall in States namely, Chhattisgarh, Gujarat, Himachal
Pradesh, Kerala, Tamil Nadu, Tripura and Uttar Pradesh. The State-wise variation in shortfall
of ANMs
Similarly, in case of HW(M), there was a shortfall of 64.7% of the requirement. In
case of Health Assistant (Female)/LHV, the shortfall was 38% and that of Health Assistant
(Male) was 43.3%. For allopathic Doctors at PHC, there was a shortfall of 12.0% of the
total requirement. This is again mainly due to significant shortfall in Doctors at PHCs in the
States of Chhattisgarh, Gujarat, Karnataka, Madhya Pradesh, Nagaland, Orissa, Rajasthan
and Uttar Pradesh. Even out of the sanctioned posts, a significant percentage of posts are
vacant at all the levels. For instance, 5% of the sanctioned posts of HW (Female)/ ANM
were vacant as compared to 42.2% of the sanctioned posts of Male Health Worker.
PUBLIC HEALTH INFRASTRUCTURE FRAMEWORK
The foundation of public health infrastructure in the country rests on its three tiers-
the Sub-Centre (SC), Primary Health Centre (PHC) and Community Health Centre (CHC).
NRHM seeks to strengthen this infrastructure as shown below:
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At the grass-root level, the Anganwadi worker (AWW) of Integrated Child
Development Services (ICDS) works with the Auxiliary Nurse Midwife (ANM) in the SC.
The ANM is responsible for primary medical care with focus on maternal and child care
and disease surveillance. District hospitals formthe top-end of the public health infrastructure.
PRIMARY HEALTHCARE INFRASTRUCTURE DEVELOPMENT
TEST OF HYPOTHESIS CORRELATION COEFFICIENT ANALYSIS
There is significant association between primary health-care centre service delivery
associate with infrastructure development in PHCs. The independent variables have been
cross checked with the beneficiaries to identify those variables that are important in their
day to day primary health-care delivery services and community participation. Primary
health-care delivery services and community participation (y) is the major dependent variable
which is influenced by the nine independent variables (x1 to x9). Primary services and
community participation (Y) it is a dependent variable to measure and evaluate the overall
performance of Primary health-care delivery services and community participation. It is
considered as a key performance indicator of rural health-care services while assessing the
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overall performance of the health services. This performance is influenced by the number
of independent variables in Primary health-care delivery services and community participation.
The relationship between the dependent variable and independent variables is expressed as
follows.
Primary services and community participate (Y) =f X1, X2, X3.X9}
Independent variables (x1 to x9): Primary services and community participate of the
rural health-care services influence with the delivery services variables such as frequency
of services, adequate of availability doctors. Recovery/ cure, Adequacy of rooms, adequate
medical equipment, Promoting universal immunization, construction household toilets,
coordination panchayat_self groups, Coordination with anganwadi and Providing Primary
medical care.
X1 =adequate availability of doctors
X2 =Recovery/ cure
X3 =Adequacy of rooms
X4 =adequate medical equipment,
X5 =Promoting universal immunization
X6 =construction household toilets
X7 =Coordination panchayats and _self help groups
X8 =Coordination with anganwadi workers
X9 =providing primary medical care.
Prior to running of regression model, the Pearsons correlation statistic has been run
to determine the variability among the dependent and independent variables for which the
correlation matrix (Table 5.79) has been generated. The Pearson correlation coefficient
indicates that there is no incidence of strong correlation that exists positively with the coefficient
value ranging from 0.6 to 1.0 among the independent variables. It indicates that there is an
absence of multi-colinearity among the variables. Consequently, a multivariate statistical
technique, multiple regression method has been run to analyse the cause and effect
relationship. After running the multiple regression analysis, it is observed that Eigen values
in 146 the multi-colinearity diagnostic matrix were found to be more than 1.0 for all the
variables hence no independent variable is dropped fromthe regression model.
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Table No 1
Correlations of Primary healthcare services and infrastructure
development variables
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).
1 0.021 -0.48 -.011 -.094 0.164 0.122 -0.177 0.614* Provi_Prim_medi_care
1
0.292*
*
-.199 0.185 -0.211 -.035 -0.076 0.606* Coor_anganwadi
1 -.137 -.109 -0.092 -.133 0.236 0.683* Coor_panch_self_grou
1 0.032 0.014 0.021
0.273*
*
0.773* Con_hous_ toil
1 -.062 0.137 0.43 -.639* Abaialbilityof beds
1 -0.15 0.342* 0.096 Medical equipment
1 -.627* 0.694* Adequacy of rooms
1 0.636* Recovery/ cure
1 Availability of doctors
P_P_M C_AN C_P_G C_H_T P_U_I ME_EQ AD_RO RE_CU AV_DO
Primary services and
community
participation
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).
1 0.021 -0.48 -.011 -.094 0.164 0.122 -0.177 0.614* Provi_Prim_medi_care
1
0.292*
*
-.199 0.185 -0.211 -.035 -0.076 0.606* Coor_anganwadi
1 -.137 -.109 -0.092 -.133 0.236 0.683* Coor_panch_self_grou
1 0.032 0.014 0.021
0.273*
*
0.773* Con_hous_ toil
1 -.062 0.137 0.43 -.639* Abaialbilityof beds
1 -0.15 0.342* 0.096 Medical equipment
1 -.627* 0.694* Adequacy of rooms
1 0.636* Recovery/ cure
1 Availability of doctors
P_P_M C_AN C_P_G C_H_T P_U_I ME_EQ AD_RO RE_CU AV_DO
Primary services and
community
participation
(Note: AV_DO =availability of doctors, RE_CU =Recovery/ cure, AD_RO=
Adequacy of rooms, ME_EQ =medical equipment, P_U_I =Promoting universal
immunization, C_H_T =construction household toilets, C_P_G =Coordination panchayats
and _self help groups, C_AN =Coordination with anganwadi workers, and P_P_M =
providing primary medical care.)
From the Table 1, it is observed that the coefficient of multiple determinations (R) is
0.742. The variation in the dependent variable is explained by 69.6 percent through the
quadratic relationship with the predictor which appears to be significant for making predictions.
From Table 5.80, DurbinWatson value of 2.036 indicates there is no presence of
autocorrelation among the independent variables.
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Table No 2
Multiple Regression
b Dependent Variable: Primary health-care delivery services
Predictors: (Constant), avail_doct, reco_cure, adey_room, medi_equp, promo_immu,
coo_hou, coo_pan, coo_anga, pro_medica
2.036 .507 .648 .696 .742a 1
Durbin-
Watson
Std. Error of the
Estimate
Adjusted R
Square
R Square R Model
b Dependent Variable: Primary health-care delivery services
Predictors: (Constant), avail_doct, reco_cure, adey_room, medi_equp, promo_immu,
coo_hou, coo_pan, coo_anga, pro_medica
2.036 .507 .648 .696 .742a 1
Durbin-
Watson
Std. Error of the
Estimate
Adjusted R
Square
R Square R Model
The Table 2 reveals that there is a significant contribution of predictors(Note: AV_DO
=availability of doctors, RE_CU =Recovery/ cure, AD_RO=Adequacy of rooms, ME_EQ
=medical equipment, P_U_I =Promoting universal immunization, C_H_T =construction
household toilets, C_P_G =Coordination panchayats and _self help groups, C_AN =
Coordination with anganwadi workers, and P_P_M =providing primary medical care.) on
Primary services and community participate performance which is denoted by ANOVA
statistic value of 26.873 and explained by the probability value, i.e., 0.000.
Table No 3
ANOVA
b Dependent Variable: Primary health-care delivery services
Predictors: (Constant), avail_doct, reco_cure, adey_room, medi_equp,
promo_immu, coo_hou, coo_pan, coo_anga, pro_medica
74 78.812
Total
.264 65 18.020
Residual
.000(a) 26.873 5.088 12 64.792 Regression
Sig. F
Mean
Square
Df
Sum of
Squares
b Dependent Variable: Primary health-care delivery services
Predictors: (Constant), avail_doct, reco_cure, adey_room, medi_equp,
promo_immu, coo_hou, coo_pan, coo_anga, pro_medica
74 78.812
Total
.264 65 18.020
Residual
.000(a) 26.873 5.088 12 64.792 Regression
Sig. F
Mean
Square
Df
Sum of
Squares
In regression with multiple independent variables, the coefficient tells how much the
dependent variable is expected to increase when that independent variable increases by
one, holding all the other independent variables constant. Table 5.81 lists all the coefficients
of variables which indicate construction of household toilets, Coordination panchayat_self
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groups and coordination with anganwadi workers that are observed to be statistically significant
at 0.05 level which indicates that these variables will influence the performance of primary
services and community participation in the rural health-care services.
Table 4
Coefficients
b Dependent Variable: Primary health-care delivery services
0.003 2.200 0.214 .083 0.295 Provi_Prim_medi_care
0.005 -2.277 0.211 .094 0.421 Coor_anganwadi
0.004 1.950 0.294 .084 0.233 Coor_panch_self_grou
0.876 0.157 0.025 .103 0.046 Con_hous_ toil
0.694 0.397 0.046 .077 0.134 Prom_uni_immuniz
0.368 0.912 0.083 .070 0.073 medical equipment
0.345 9.504 0.769 .066 0.608 Adequacy of rooms
0.466 -0.737 0.061 .141 -0.082 Recovery/ cure
.232 -3.285 .274 0.180 -.161 availability of doctors
0.785 0.274 0.530 0.273
(Constant)
Beta Std. Error B
Sig. T
Standardised
Coefficients
Unstandardised Coefficients
Model
b Dependent Variable: Primary health-care delivery services
0.003 2.200 0.214 .083 0.295 Provi_Prim_medi_care
0.005 -2.277 0.211 .094 0.421 Coor_anganwadi
0.004 1.950 0.294 .084 0.233 Coor_panch_self_grou
0.876 0.157 0.025 .103 0.046 Con_hous_ toil
0.694 0.397 0.046 .077 0.134 Prom_uni_immuniz
0.368 0.912 0.083 .070 0.073 medical equipment
0.345 9.504 0.769 .066 0.608 Adequacy of rooms
0.466 -0.737 0.061 .141 -0.082 Recovery/ cure
.232 -3.285 .274 0.180 -.161 availability of doctors
0.785 0.274 0.530 0.273
(Constant)
Beta Std. Error B
Sig. T
Standardised
Coefficients
Unstandardised Coefficients
Model
From Table 5.106, the multiple regression model is depicted as:
Y =0.273 - 0.161 x1 - 0.082 x2 +0.608 x3 +0.073 x4 +0.134 x5 +0.046 x6 +0.233 x7 +
0.421 x8+0.295x9
The other independent variables, such as availability of doctors, recovery and cure,
and adequacy of rooms and medicines, have negative regression coefficients. The
performance of the Primary health-care delivery services and community participation is
high when the promoting universal immunization, coordination with anganwadi workers and
providing primary medical care is significant. The rest of the independent variables have
insignificant effect on the primary healthcare services performance as the P-value is higher
than 0.05. Since the calculated value is more then the tabulated value, the alternative
hypothesis is rejected. There is no significant Association between the respondents opinion
about variables of PHCs delivery services and community participation. Majority of variables
indicated in-significant.
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FINDINGS AND SUGGESTIONS
The evaluation study clearly brings out the fact that PHCs have not been able to
render specialised health care services for which these were established. The constraints to
utilisation of their services as identified are the inadequacies in infrastructure, non-availability
of medical specialists and Para-medical staff and non-functional complementary facilities.
Notwithstanding these constraints and sub-optimal utilisation , the majority of the beneficiaries
expressed their preference for the services of public health care institutions to those of
other alternatives. For improvement in access to public health care services, the following
measures can be suggested:
1. As only 43% of the required number of PHCs have been established, a significant
increase in the allocation of plan resources for the health sector is needed to close the
supply gap. It seems unlikely that the resources required for closing the gap will be
available from budgetary provisions alone. Alternative sources of funds and /or
alternative modes of delivery of health care services need to be explored to meet the
demand for specialised health care services in the rural areas.
2. As the effective utilisation of a PHCs as a referral centre depends on its ability to
provide the complete package of services required for specialised health care, efficient
utilisation of available resources warrants its use in closing the supply gap in
infrastructure and manpower of the existing PHCs. The complementarity of facilities
and manpower of health care institutions should get primacy over other considerations
in allocation of resources, as thin spread of resources over a large number of health
care institutions has led to sub-optimal utilisation of facilities created. It is advisable to
make in each district a few PHCs fully equipped with all complementary facilities
and manpower to discharge the intended functions of PHCs and disseminate the
information about their functionality among the villages of the district through PRIs so
that the people in the district can take full advantage of these well-equipped PHCs.
3. For some people, even a distance of more than 50 kms was not a constraint, while for
some others, a distance of a little over 10 kms was inconvenient. However, what
comes out clearly fromthe survey is that, wherever some medical specialists and
the rudimentary infrastructure are available and functional, people have braved all
inconveniences and made use of the services available in PHCs. Thus, what is of
utmost importance is whether a PHC is equipped to deliver specialised health care
services.
4. The monitoring of the functioning of PHCs and removal of constraints to utilization
are important issues that need to be addressed for improvement in access to health
care services. Non-availability of doctors (in position) for consultation and non-
functionality of existing equipments have been noted in PHCs which are otherwise
equipped to deliver the intended services Perhaps, the routinised departmental
monitoring can be supplemented by a Monitoring Committee (at the district level)
comprising the CMO/DHO and representatives of the Panchayati Raj Institutions.
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CONCLUSION
The profession of healthcare management is challenging and requires that persons in
managerial positions at all levels of the organization possess sound conceptual, technical,
and interpersonal skills in order to carry out the required managerial functions of planning,
organizing, staffing, directing, controlling, and decision making. In addition, managers must
maintain a dual perspective where they understand the external and internal domains of
their organization, and the need for development at the self, unit/team, and organization
levels. Opportunities exist for managerial talent at all levels of a healthcare organization,
including supervisory, middle management, and senior management levels. The role of
manager is critical to ensuring a high level of organizational performance, and managers are
also instrumental in talent recruitment and retention as well as succession planning.
How to finance and provide health care for the more than 1.3 billion rural and urban
poor in low and middle-income countries is one of the greatest challenges facing the
international development community. The underlying causes of many of todays health
problems in lower income countries are often well known, and effective and affordable
drugs, surgical procedures and other interventions often exist. But, because of a number of
problems related to resource mobilization, revenue pooling, resource allocation/purchasing
arrangements, as well as problems in the provision of goods and services to rural and low
income populations potentially effective policies and programs often fail to reach households
and communities that need themthe most.
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