Constructing a Reproductive Health Account Under National Health Accounts Framework at Sub-District Levels in Karnataka, India

Reproductive Health Account construction was a long-envisioned dream in the State of Karnataka, India, for capturing inter-actor fund flows in reproductive health. Previous attempts in few states lead to successful identification of enablers and disablers within this systemic context. A Reproductive Health Account was constructed using primary reproductive health expenditure data, collected from a pre-estimated sample size of 519 households spread across 15 villages, using probability proportional to size method, from two selected sub-districts Channapatna and Ramanagara, having mediocre performance indices, within Ramanagara District of Karnataka. Secondary data were extracted from public health websites. Expenditures incurred on six types of health services by respondents of reproductive age group (15–49) during financial year, 2017–2018, within two sub-districts was collected over financial year, 2018–2019. Processed data were then converted to four ‘origin to destination’ matrices each capturing fund movement among two actors, based on accounting principles of National Health Account to develop a contextual Reproductive Health Account. Study included four actors namely financial sources, financial agents, health providers and health activities, all pertaining to reproductive health domain. Matrices helped identify a massive 87.23% burden on households, majorly financed by mortgage bearing astronomical interests and sale of meagre assets. Public sector healthcare at 5.47% was found performing unsatisfactorily. Tertiary level was absorbing disproportional amount of 62.93% funds in conjunction with the laboratory and imaging services. Moreover, pharmaceutical bills at 22.97% caused prolonged distress to these households. Government intervention towards absence and shortage of quality infrastructure at the primary and secondary sector levels needs reviewing, for containment of the massive out-of-pocket expenditures.