Table . Unified methodology for assessing decision space, capacities and accountability Function / Illustrative Indicator Dimension Level of decision space (DS), capacity (CAP) or accountability (ACC) Narrow/Low Moderate Wide/High Planning Local involvement in planning DS Local health administrator mainly defer to central planning norms/targets Local health administrators make some local-level adaptations to central planning norms/targets Local health administrator mainly include locally defined strategies and targets CAP No training in planning for health administrators; no involvement of other sectors Some health administrators trained in planning; some involvement of other sectors All health administrators trained in planning; other sectors routinely involved ACC Locally elected officials play no or minimal oversight role (e.g., via Samitis) Locally elected officials play some oversight role but also defer to civil service administrators Locally elected officials exercise active oversight role alongside civil service administrators Budgeting Preparation of regular budget DS Budget line items conform mainly to central norms Local revisions made to budget line items but most allocative decisions made by higher authorities Local revisions made to budget line items with minimal revisions made by higher authorities CAP Previous year’s achievements not reviewed to inform budgeting process Previous year’s achievements reviewed to inform budgeting process ACC Locally elected officials not involved Locally elected officials involved but input restricted by other local administrators Locally elected officials provide significant inputs to and final authorization of budget HR Management of human resources DS All HRM functions handled centrally for permanent staff; no ability to contract non-permanent staff Some HRM functions handled locally for permanent staff (e.g., posting, promotion, incentive payment); ability to contract some cadres of staff (e.g., ancillary staff) Most/all functions handled locally (including salary levels); ability to contract most/all cadres of staff CAP No/few managerial staff trained in HRM; no performance evaluation mechanisms used Some managerial staff trained in HRM; performance evaluation mechanisms used variably Most/all managerial staff trained in HRM; performance evaluation mechanisms used regularly ACC Locally elected officials not actively involved in vested HRM powers (e.g., monitoring and certifying doctor Locally elected officials actively involved in some of their vested HRM powers Locally elected officials actively involved in most of their vested HRM powers
facility attendance) Service Organization DS Little local-level adaptation to services (e.g., no/few modifications to facility hours; no development of programs) Some local-level adaptation of services Significant local-level adaptation of services CAP No mechanisms in place to ensure quality of services (e.g., patient complaint procedures; inter-sectoral collaboration) Some mechanisms in place to ensure quality of services but not consistently used Mechanisms in place to ensure quality of services and consistently used ACC Locally elected officials not involved and/or involvement not acted upon (e.g., no action taken regarding service complaints) Locally elected officials somewhat involved and/or involvement sometimes acted upon Locally elected officials very involved and/or involvement usually acted upon Monitoring and Evaluation DS Local officials have no ability to influence monitorable performance parameters, which are set at the centre Some local adaptation of centrally set monitorable parameters Significant local-level adaptation of monitorable parameters CAP No/little local-level use of monitoring mechanisms (e.g., HMIS, budget execution, HRM); no/little performance feedback from above Some use of monitoring mechanisms/performance feedback from above Regular use of monitoring mechanisms/performance feedback from above ACC Locally elected officials are not involved/given any feedback about performance of health programs and facilities in their area Locally elected officials are involved/given feedback about performance of health programs and facilities but without formal authorities Locally elected officials are empowered to monitor and demand feedback/action related to performance of health programs and facilities mandated
SOD 0.05 65 -0.04 65 -0.23 * 65 M&E 0.34 ** 65 LS 0.19 65 HR & SOD 0.17 65 0.24 * 52 0.02 55 M&E 0.10 52 LS 0.25 * 55 SOD & M&E 0.22 * 65 LS 0.26 ** 65 Health Workers SOP & BUD 0.14 47 0.19 47 HR 0.14 22 0.10 40 SOD 0.54 ** 47 0.19 47 M&E LS BUD & HR 0.64 ** 22 -0.22 40 SOD 0.40 ** 47 0.15 47 0.22 33 M&E LS -0.27 33 HR & SOD 0.34 22 -0.12 40 M&E LS SOD & M&E LS 0.02 47 PRI Officials SOP & BUD 0.16 83 0.02 45 HR 0.10 83 SOD 0.20 * 83 0.08 83 M&E LS 0.30 ** 72 PRI 0.15 83 BUD & HR 0.21 45 SOD 0.04 83 0.46 ** 45 M&E LS 0.22 * 72 PRI 0.23 ** 83 HR & SOD 0.24 ** 83 M&E LS PRI 0.00 ## 0 0.00 ## 0 SOD & M&E LS 0.18 72 PRI 0.04 83 **: significant at p < 0.05; *: significant at p < 0.10 † SOP = Strategic/Operational Planning; BUD = Budgeting; HR = Human Resources; SOD = Service Delivery/Organization; M&E = Monitoring and Evaluation; LS = Local Support; PRI = PRI decision-making †† DS only applicable to health officials ¶ LS in CAP only applicable to PRI officials (see Section ) ¶¶ LS in ACC only applicable to health officials (see Section )
expenditure for the facility; b. Expenditure for any outreach/other aspects of health service delivery; c. Under the untied funds/Annual Maintenance Grant/any other funds for your facility Do you maintain the accounts of expenditure and/or bank a/c details? DS No 0 Yes Were you involved in decisions for heads of expenditure? If yes, please describe your role in the decision-making process. DS No Yes - follows guidelines Yes - provides active input Are you involved/consulted while deciding the planned expenditure under the untied funds received by your facility? DS No 0 Yes Who (or which committee/body) finally approves the expenditure for your facility/area under the funds received? ACC Anyone other than PRI body/member, DK 0 PRI body/member Human Resources Do you have in-position: a. 2nd ANM at SC/GPHQSC; b. ASHA CAP No Yes If [you have an in-position 2nd ANM/ASHA,] were you consulted/involved in the selection of a. 2nd ANM at SC/GPHQSC b. ASHA DS No Yes Service Organization 0 0 0 0 Have you taken any measures/planned any actions in view of the [3 most important public health problems/service delivery challenges in your GP/PS/ZP/ULB]? CAP Cannot identify any public health challenges Identifies any public health challenges but doesn't name any actions taken to redress problem(s) Can identify any public health challenges and names any actions taken to redress problem(s) In your opinion how interested/enthusiastic are the following in solving the [3 most important public health problems/service delivery challenges in your GP/PS/ZP/ULB]: 1. BMOH/CMOH/Suptdt./Health officials; 2. PRI/ULB functionaries CAP Not interested Somewhat interested Very interested Were you involved in the following activities in your health facility during 2008-09: a. Health day; b. Maternal death audits/follow-up; c. Prevalence/coverage survey under centrally sponsored schemes (TB, Leprosy, Blindness, Vector-borne diseases); d. Other Health surveys; e. Coverage surveys (Vit. A, pulse polio, UIP); f. Family planning; g. Reproductive/Sexual health (RTI/STI); h. CAP No Yes
Table . Likert scale coding criteria for PRI official survey items Question (PRI officials) Narrow/low Medium High PRI decision-making 0 0 0 0 How often do you have ZP/PS/GP/Council meetings? CAP Annually Between annually and monthly Monthly How often do you have Gram Sansad meetings? CAP Never/annually Not regularly but less than annually Regularly and less than annually How often do you have Ward Committee meetings? CAP Never/annually Not regularly but less than annually Regularly and less than annually How often do you have Sub-Committee meetings? CAP Never/annually Not regularly but less than annually Regularly and less than annually How many members of the ZP/PS/GP/Council regularly attend meetings? CAP <50% >=50% - < 100% 100% How do you decide on the meeting agendas? CAP Head alone decides 0 Members involved Do you regularly attend the meetings of PS/GP? CAP Never/rarely Not regularly Regularly Do you follow the directions/guidelines [that the political party you represent issues/communicates on health issues/administration/strategies related to health sector] while planning/ management/ monitoring health facilities and health issues in your area? DS Policy guidelines are issued for health sector activities and respondent usually/always follows them Policy guidelines are issued for health sector activities and respondent sometimes follows them Policy guidelines not issued (or respondent doesn't know) or guidelines issued but respondent doesn't follow them Strategic & Operational Planning 0 0 0 0 What is the basis of your assessment of the [top three problems/challenges in public health in your ZP/PS/GP/ULB]? CAP Self-experience only Informal consultation with others (in addition to or not) Based on evidence What is the normal frequency of assessing ZP/PS/GP/ULB health priorities? CAP Never Annually only or not at regular frequency At regular frequencies throughout the year Do you have a regular health plan for your district/block/GP/ULB? CAP DK/No plan NRHM plan stated Any local plan How would you describe the involvement of the following persons/officials in overall health sector planning exercise? CMOH/BMOH; Janaswasthya Karmadhyaksha/VHSC; DM/BDO CAP No role/not present Ok role/sometimes present Helpful role/usually/always present