"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.

Anns Issac,Bilal Iqbal Avan,Sanghita Bhattacharyya,Joanna Schellenberg,Mayukhmala Guha,Bhushan Girase

doi:10.3390/ijerph17218283

Abstract

Background: Effective coordination among multiple departments, including data-sharing, is needed for sound decision-making for health services. India has a district planning process involving departments for local resource-allocation based on shared data. This study assesses the decision-making process at the district level, with a focus on the extent of local data-use for resource allocation for maternal and child health. Methods: Direct observations of key decision-making meetings and qualitative interviews with key informants were conducted in two districts in the State of West Bengal, India. Content analysis of the data maintained within the district health system was done to understand the types of data available and sharing mechanisms. This information was triangulated thematically based on WHO health system blocks. Results: There was no structured decision-making process and only limited inter-departmental data-sharing. Data on all 21 issues discussed in the district decision-making meetings observed were available within the information systems. Yet indicators for only nine issues—such as institutional delivery and immunisation services were discussed. Discussions about infrastructure and supplies were not supported by data, and planning targets were not linked to health outcomes. Conclusion: Existing local data is highly under-used for decision-making at the district level. There is strong potential for better interaction between departments and better use of data for priority-setting, planning and follow-up.

Highlights

Decision-making in health systems involves stakeholders reaching consensus on a particular course of action from two or more possible options to address health service challenges
We developed an observation checklist to understand how the District Health Society (DHS) meetings were conducted; how interaction happened between departments, in terms of data sharing; and how decisions for planning and resource allocation were made
Resource allocation is based on a District Health Plan, which each district is expected to prepare annually, but districts in West Bengal develop the plans every three years

Summary

Introduction

Local decision-making depends on autonomy over resource allocation and in the planning process [1]. Effective coordination among multiple departments, including data-sharing, is needed for sound decision-making for health services. India has a district planning process involving departments for local resource-allocation based on shared data. This study assesses the decision-making process at the district level, with a focus on the extent of local data-use for resource allocation for maternal and child health. Content analysis of the data maintained within the district health system was done to understand the types of data available and sharing mechanisms This information was triangulated thematically based on WHO health system blocks. Data on all 21 issues discussed in the district decision-making meetings observed were available within the information systems. There is strong potential for better interaction between departments and better use of data for priority-setting, planning and follow-up

Methods

Results

Discussion

Conclusion