DHUNDALWADI PHC Dahanu Block, Thane District:

Objective of the study: To explore the various reasons for problematic expenditure of NRHM facility based flexible funds in the selected Rural Hospitals and Primary Health Centers in Maharashtra. Specific objectives related to Dhundalwadi PHC: To find out whether the expenditure has been made appropriately as per the needs expressed in the meetings of the civil society organizations in the selected facilities. To understand the reporting to the state government for the utilization of NRHM flexible funds in the selected facilities. To understand the decision making process under the RKS including participation of civil society members in the selected facilities. To check whether the physical infrastructure as shown in the expenditure of the NRHM flexible funds is in place and whether it is being utilized or not in the selected facilities. To scrutinize the documented proof of the problematic expenditure made under the NRHM flexible funds based on the availability of data in selected PHCs. In UF our statistics showed that equipments & instruments were purchased of Rs. 16794. UF expenditure file had bills for 1. Lan cable Rs. 270 2. DVD writer, windows office installation Rs. 2150 3. Quickheal Antivirus Rs. 1000 4. Fridge Rs. 10000 5. 8 CFL lamps Rs. 1250 6. Fan repairing, winding & capacitor changing Rs. 990 7. Digital banner Rs. 640 Total of this expenditure comes near about Rs.16300. All of these things were present & in working condition. In BMF/AMG our main objections were on amount of PHC maintenance & infrastructure i.e. Rs. 27700 & PHC cleaning Rs.6100. In AMG/BMF expenditure file following bills were present 1. Tiles (floor) Rs. 10000 2. Tiling (wall) Rs.10000

3. Chairs Rs. 6100 4. Beautification Rs.1540 Total of this expenditure comes to Rs. 27640, I have personally noticed tiles, tiling & revolving chairs which are shown in this expenditure. In which conditions are they nw? In RKS expenditure our data showed expenditure mainly on linen. MO in-charge was not able to give sufficient explanation for this expenditure. Main expenditure for linen in this year was mainly possible because of arrangement of medical camps for other nearby PHCs & some new purchases of linen. Annually 600 to 650 patients are admitted in IPD, so this much expenditure seems to be inappropriate. On medicines Rs. 23680 were spent in year. For that appropriate bills were present & split of expenditure was given as Rs. 8147 for local purchase of medicines, Rs. 12104 for surgical & other apparatus. Any details On referral services Rs. 21100 were spent. Out of that amount near about Rs. 8000 was spent on single patient who had heart disease & was student of Ashram school. For remaining expenditure there were bills of fuel refill to the ambulance. FOR WHAT PURPOSE VEHICLE USED? INTERVIEW WITH MO in-charge Dhundalwadi PHC: Current situation of PHC is very poor. Slab on PHC has started leaking in this rainy season. Though PHC can provide services but it has restrictions because of weak infrastructure. New MO in-charge has taken the charge since 1st of July 2011. Regarding decision making Guidelines - Proper guideline book is available for utilization of NRHM flexible funds. Frequency of the meetings - Meetings of both the bodies of RKS (i.e. governing & executive) are held once in three months. Attendance of the meetings - On an average 8 to 9 (80 to 90%) members attend the meeting. Level of participation in decision making - Level of participation of civil society members in decision making is good. Problems faced in consensus making - Members of RKS are very cooperative so there are no problems faced in consensus making on any particular decision. Priority setting - Priority setting is done basically on basis of patients needs. Reporting format of expenditure - Monthly reporting is done by accountant & health assistant. These reports are submitted to TMO office as well as DHO office.

 Better utilization of funds - According to current MO in-charge it is good that funds come in small parts, because it is easier to plan for small amounts. Sufficiency of funds - Funds are sufficient & decision making process is always maintained transparent. WHAT IS UR COMMENT?

INTERVIEW WITH RKS (civil society) MEMBER Dhundalwadi PHC: Awareness about the guidelines - RKS member was a female. She was member of PRI & well aware about the guidelines of expenditure of NRHM flexible funds. Regarding decision making - Earlier MO in-charge had specifically taken efforts for making members of RKS understand the guidelines for expenditure. For every meeting letters are sent to the RKS members in advance. Frequency of meetings - In every two or three months there is one meeting of RKS. Average attendance of meeting - 70 to 80% Level of participation - Level all members who are present are very involved in meeting. Problems faced in consensus making - No problems were faced in consensus making for particular decision making as the decisions were made for benefits of patient. Priorities are always set as per the majority & needs felt by community. Problems & obstacles faced in decision making - There were no problems & obstacles faced in decision making as the MO in-charge was very good. He was pro active in taking decisions for benefits of the patient. Before posting of earlier MO in-charge the condition of PHC was very bad. He was here for the period of 2008 to 2010. In this phase number of services & quality of services has improved drastically. He was the best doctor this PHC has ever had. Better utilization of funds - Funds are efficiently utilized. Sufficiency of funds Funds are sufficient. Transparency in decision making - Process of decision making & expenditure is very transparent. Awareness about expenditure in PHC - We can demand for statement of expenditure in any meeting. CONCLUSION for Dhundalwadi PHC: It is confirmed from PHC- in charge & RKS member, that expenditure was done according to the appropriate needs & decisions taken in meetings were taken with majority consensus & good participation from civil society members. PHC reports the expenditure or funds utilization details to the superior authorities at the end of each month, which is exactly according to the guidelines. Physical infrastructure which was mentioned in report was really present in PHC & was in good condition.

Only MO in-charge was not able to explain why in year 2009-10, the major expenditure was done on linen i.e. Rs. 31500/- . MO in-charge had taken the charge from 1st of July 2011so it was not possible for her to tell the exact reason for the expenditure on linen. Hospital staff was very co-operative. According to our records UF showed expenditure under the head of equipment & infrastructure, but proper split of the amount was available with bills & quotation. PHC in-charge & RKS member both agreed on that, when priority setting is done the patient is given the utmost importance. Decision making was always transparent in this PHC as per told by RKS member, she is a female who is member of RKS since last five years.