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An exploration of district-based health decision-making in West Bengal, India

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Research Snapshot1

Since 2005, health planning has been increasingly decentralised in India, through the Health Sector Reform Programme and the National Health Mission, leading to increased district-level health decision-making and the integration of health plans into multiple sectors. This qualitative study aimed to assess health decision-making processes in two districts in West Bengal, exploring the extent to which local data is used for decision-making, planning and resource allocation for maternal and child health across health-related sectors.

Direct observations of four key decision-making meetings and qualitative interviews with 16 key informants from multiple departments were conducted between June and October 2015. Data templates contributing to the Health Management Information System (HMIS) were also collected to understand the types of data available and data-sharing mechanisms. Findings were subsequently triangulated thematically based on the World Health Organization’s health system building blocks.

Findings revealed that, despite decentralised planning being one of the pillars of India’s Health Sector Reform Programme, health plans and resource allocations have remained structured around the State and Central Government’s core agenda rather than district-level priorities. The contribution to decision-making by other departments is limited as programmes are already planned according to the State Government’s health agenda. The analysis of data templates revealed no harmonisation or sharing of data across departments. In observed district health meetings, 21 issues were discussed and action plans developed. Yet, despite data being available for all of these issues, decisions on only nine (such as institutional delivery and immunisation services) were based on available data. Discussions about infrastructure and supplies were not supported by data and planning targets were not linked to health outcomes. Findings show that existing local data is underutilised for decision-making. This highlights the need for strengthening the use of data for priority-setting and follow-up at district-level in India.

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1Bhattacharyya, S, Issac, A, Girase, B, Guha, M, Schellenberg, J, Iqbal Avan, B (2020) "There Is No Link Between Resource Allocation and Use of Local Data": A Qualitative Study of District-Based Health Decision-Making in West Bengal, India. Int J Environ Res Public Health. 2020;17(21):8283. Published 2020 Nov 9. doi:10.3390/ijerph17218283

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An exploration of district-based health decision-making in West Bengal, India. Field Exchange 65, May 2021. p67. www.ennonline.net/fex/65/datausewestbengal

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