Improving nutrition budgeting in health sector plans: Evidence from India's anaemia control strategy.

In India, 15 nutrition interventions are delivered and financed through the National Health Mission (NHM). Programmatic know-how, however, on tracking nutrition budgets in health sector plans is limited. Following the four phases of the budget cycle-planning, allocations, disbursements and expenditure, this paper presents a new method developed by the authors to track nutrition budgets within health sector plans. Using the example of the Anemia Mukt Bharat (AMB) or Anemia Free India strategy, it reports preliminary findings on the application of the first two phases of the method, that is, to track and act for improved planning and allocations, covering 12 states. The paper lists out the budget heads, cost norms and developed tools to plan adequately. Supportive action was undertaken through sharing trends and trainings for AMB's budgeting to create opportunities for improvements. It was observed that the AMB budget increased over 3 years despite the COVID situation. It increased from INR 6184 million in FY 2019-2020 to INR 6293 million, a 2% increase in FY 2020-2021, and to INR 7433 million, an 18% increase in FY 2021-2022. The difference in allocations and planned budgets were low (16%, 4% and 11%, respectively) while the difference in required budgets and planned budgets were significant but reduced consistently (41%, 31% and 22%, respectively). The paper concludes that the methods adopted for tracking and acting for improved nutrition budgets helped in informing national and state governments regarding yearly trends. Such methods can be effective and be developed for other nutrition interventions.

Chronic exposure of mice to phthalates enhances TGF beta signaling and promotes uterine fibrosis.

Phthalates are synthetic chemicals widely used as plasticizers and stabilizers in various consumer products. Because of the extensive production and use of phthalates, humans are exposed to these chemicals daily. While most studies focus on a single phthalate, humans are exposed to a mixture of phthalates on a regular basis. The impact of continuous exposure to phthalate mixture on uterus is largely unknown. Thus, we conducted studies in which adult female mice were exposed for 6 months to 0.15 ppm and 1.5 ppm of a mixture of phthalates via chow ad libitum. Our studies revealed that consumption of phthalate mixture at 0.15 ppm and 1.5 ppm for 6 months led to a significant increase in the thickness of the myometrial layer compared to control. Further investigation employing RNA-sequencing revealed an elevated transforming growth factor beta (TGF-ß) signaling in the uteri of mice fed with phthalate mixture. TGF-ß signaling is associated with the development of fibrosis, a consequence of excessive accumulation of extracellular matrix components, such as collagen fibers in a tissue. Consistent with this observation, we found a higher incidence of collagen deposition in uteri of mice exposed to phthalate mixture compared to unexposed controls. Second Harmonic Generation (SHG) imaging showed disorganized collagen fibers and nanoindentation indicated a local increase in uterine stiffness upon exposure to phthalate mixture. Collectively, our results demonstrate that chronic exposure to phthalate mixture can have adverse effects on uterine homeostasis.

Methods and Lessons From Costing a Large mHealth Intervention at Scale in India.

The use of mobile devices to deliver public health interventions is rapidly increasing, particularly in low resource settings. Despite their proliferation, several mHealth interventions in developing countries fail to reach geographical scale, and long-term sustainability for most remains uncertain. There is a need to cost for such programs, to enable better planning and budgeting and tailor programs as required. Cost estimates can contribute to a more informed debate on resource allocation priorities and help make choices clearer for policymakers. This paper has two main objectives: (1) present a detailed protocol on determining the costs of a large national mHealth job aid and behavior change communication tool known as Integrated Child Development Services - Common Application Software (ICDS-CAS) in India, and (2) to present lessons for policymakers on how to ensure financial planning for scaling mHealth interventions. The study uses the Activity Based Costing-Ingredients (ABC-I) method. The major advantage of the ABC-I method is the clarity it brings to costs for each input and activity, across levels and geographies. It also accounts for indirect costs. There are five key lessons while costing for mHealth programs. First, that there are many activities and ingredients that must be budgeted for and discussed while planning and implementing mHealth programs. Second, the ABC-I method described in this paper provides great clarity on costs, yet its major limitation is the availability of data, which must be mitigated with the careful use of assumptions. Third, mHealth technology life cycles have financial implications which must be accounted for. Fourth, determining cost locations and all sources of funding including non-government sources is crucial. Fifth, since costing estimates are subject to a set of assumptions, a disaggregation of costs allows for scenario-building, which is useful while planning ahead and accounting for program changes. The evidence generated can be used for more informed debate on resource allocation priorities, given competing priorities in low- and middle-income countries.

Public finance management and data availability for nutrition financing in India.

For investments to translate into improved public service delivery, having a strong public finance management (PFM) system that lays out the rules, institutions and processes by which public funds are managed is critical. To enable a better understanding of the nutrition financial landscape, this paper seeks to determine whether the current PFM system in India allows for capturing required nutrition data. It does this by mapping the availability and comparability of data for a set of key nutrition-specific interventions through the budget cycle: from budget formulation, to execution, and finally, evaluation. The study finds significant gaps in data availability including absence of financial data by level of governance, geography and intervention components. These challenges relate to gaps in PFM design in India from weak planning processes, line-item budgeting, unavailability of time costs, inefficient fund release processes, difficulties in estimating target populations and the lack of output costing. These gaps in the PFM system and consequent data issues have several implications which may lead to strained delivery. This in turn impacts quality and the possibility of course correction. Some of these challenges can be overcome by ensuring planning processes are enforced, expanding existing data systems, making more data available in the public domain, using existing research better and using assumptions carefully to cover data gaps.