IEC-CH15: Planning & Budgeting

The preparation of a research and evidence-based Programme Implementation Plan (PIP) is vital for conducting effective Advocacy, Communication and Social Mobilisation (ACSM) activities under the National TB Elimination Programme (NTEP). The plan for ACSM activities should be made based on the needs of the community.

Needs Assessment through Situation Analysis

Situation analysis should start at the TB Unit (TU) level. The Senior Treatment Supervisor (STS) should take the initiative under the guidance and supervision of the District TB Officer (DTO).

STEP 1: Identify the priority population/ geographic area

• Prepare a performance matrix for all TUs and Designated Microscopy Centres (DMCs) in the district on the basis of presumptive TB examination rate, case detection, case adherence, treatment success rate and private notification.

 

Table 1: Example of performance matrix (district X in state Y)

Tuberculosis Unit (TU)	Presumptive TB Examination Rate %	Case notification %	Case adherence %	Treatment Success Rate %	Private notification %
TU 1
TU 2
TU 3
TU 4

• Identify the  TUs/DMCs with lower performance indicators and prioritize them for ACSM activities with targeted solutions to existing challenges. Work out the likely budget and time constraints for ACSM intervention in the current financial year and in the next two years or so, in these.
• Sustain ACSM activities in other DMCs

STEP 2: Identifying key program challenges

Ascertain the main program issues in the low-performing DMCs that have been identified as priority areas by asking the following guiding questions to Medical Officer - Tuberculosis Control (MO-TC), Senior TB Laboratory Supervisor (STLS), and other concerned health staff like Accredited Social Health Activist (ASHA).

a. What are the reasons for low case detections?

i. Lack of awareness about TB

ii. High stigma and discrimination

iii. Poor access to services

 

b. What are the reasons for low case adherence?

i. Economic hardship

ii. Lack of care and support

iii. Lack of awareness about the importance of completing treatment

 

c. What are the reasons for low private notification?

i. Lack of information about the need for TB notification

ii. Lack of knowledge about TB, its diagnosis, and treatment

iii. Lack of motivation and fear of patient loss

Responses to these questions will help in identifying the various program challenges and in planning appropriate ACSM activities.

 

Step 3:  Identify the barriers for utilisation of services

The Cough to Cure Pathway barrier analysis is a useful tool to discuss key barriers at every level in the journey from symptom to treatment. This approach is suitable to differentiate the barriers at the individual, group, and system levels.

Figure: The Cough to Cure Pathway Barrier Analysis Tool; Source: Advocacy, Communication & Social Mobilisation (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.

STEP 4: Identifying and defining the target audience

The target audience for advocacy . communication and social mobilisation activities need to be decided based on the requirement

 

Resources

1. Advocacy, Communication & Social Mobilization (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.
2. Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

 

Assessment:

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Cough to cure pathway tool helps in identifying:	The audience for ACSM activities	Barriers to ideal behaviours	Communication strategy	None of the above	2	The Cough to Cure Pathway barrier analysis is a useful tool to discuss key barriers at every level in the journey from symptom to treatment. This approach is suitable to differentiate the barriers at the individual, group, and system levels.	​	Yes	Yes

 

 

 

 

 

The State Programme Implementation Plan (PIPs) for health and family welfare services under National Health Mission (NHM) funding spell out the strategies to be deployed, budgetary requirements and aimed health outcomes.

PIPs are the most crucial documents in NHM through which the states/ Union Territories (UTs), identify and quantify the targets required for programme implementation for the proposed year.

PIPs are prepared by states annually as a document which is then finalised in the National Programme Coordination Committee (NPCC) meeting for administrative approval.

On finalisation of the budget in the NPCC meeting, it becomes an official document available in the Ministry's site for general viewing.

 

Importance of PIP

• Its a plan according to which the different activities are carried out and performance of each activity can be monitored against it.
• Approval of PIP implies that states/districts can carry out the activities mentioned in the plan.
• It is the indicator of the total budget requirement of the state for carrying out the programme activities

 

PIP Preparation Process under NHM

A bottom-up approach is followed for preparing the State PIP wherein the inputs are taken from blocks, cities, Community Health Centre (CHC)/ Peripheral Health Centre (PHC), and village level to prepare a DHAP. These DHAPs are then consolidated to prepare a State PIP.

 

Budget Heads

A total of 18 different budget heads comprises the PIP. These include:

1. Service Delivery – Facility-based	10. Review, Research, Surveillance & Surveys
2. Service Delivery – Community-based	11. Information, Education. Communication (IEC)/ Behaviour Change Communication (BCC)
3. Community Interventions	12. Printing
4. Untied Funds	13. Quality Assurance
5. Infrastructure	14. Drug Warehousing & Logistics
6. Procurement	15. Public Private Partnership (PPP)
7. Referral Transport	16. Programme Management
8. Service Delivery – Human Resource	17. IT Initiatives for strengthening service delivery
9. Training & Capacity Building	18. Innovations

Each budget annexure is linked to the budget summary sheet and the corresponding budget abstracts.

National Tuberculosis Elimination Programme (NTEP) is one of the many National Health Programmes that have come under the umbrella of the NHM. NTEP is now a flagship component of NHM and provides technical and managerial leadership to anti-tuberculosis activities in the country. NHM, in turn, is responsible for making funds available to carry NTEP related activities. The budget heads of NTEP may differ from other programmes. Hence, after the activities to achieve TB-elimination based on the Detect-Treat-Prevent Build strategies under National Strategic Plan (NSP) for TB Elimination 2017-2025 are planned, they have been aligned with the Financial Management Report (FMR) codes of NHM. This facilitates district, state, and central NHM to consolidate the individual PIPs for necessary approvals.

 

Resources

• E-Training Module on Budget/ PIP Preparation. National Health Mission. Ministry of Health and Family Welfare, Government of India.
• PIP Guidance Note 2018-19. National Health Mission, Ministry of Health and Family Welfare, Government of India.
• Training Modules (5-9) for Programme managers & medical officers, Central TB Division, Ministry of Health and Family Welfare, Government of India.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Budget heads of NTEP and other programmes under NHM are same.	True	False			2	The budget heads of NTEP may differ from other programmes.		Yes	Yes

The National TB Elimination Programme (NTEP) expenditures are organised under 19 heads. These are:

 

1. Civil works - Initial establishment/ refurbishment costs and maintenance of civil works costs for Designated Microscopy Centres (DMC), Tuberculosis Units (TU), District TB Centres (DTC), Drug-resistant TB (DR-TB) centres and State Drug Stores (SDS).

2. Laboratory materials - Lab consumables for DMCs, Nucleic Acid Amplification Testing (NAAT), Culture and Drug Susceptibility Testing (C& DST) labs, State TB Training and Demonstration Centres (STDCs), National Reference Laboratories (NRLs) and Intermediate Reference Laboratories (IRLs).

3. Honorarium/ Counselling charges - Honorarium for community volunteers facilitating TB patient counselling and treatment.

4. Advocacy, Communication, Social Mobilisation (ACSM) - Various Information, Education and Communication (IEC) activities, patient-provider meetings, Active Case Finding (ACF)/ Intensive Case Finding (ICF) campaigning, etc. are budgeted under this head.

5. Equipment Maintenance - Maintenance and up-gradation costs for laboratory and office equipment.

6. Training - Training of State TB Officers (STOs), District TB Officers (DTOs), STDC faculty and all other cadres of NTEP staff (hiring of venue, organisation charges, honorarium for trainers, travel & dearness allowance, course material charges, refreshments, any other activities of training).

7. Vehicle Operation (POL and Maintenance)- Maintenance costs for all vehicles used for supervisory visits under NTEP. However, vehicle operation costs will not be available for hired vehicles. This will be applicable only for the department vehicles used under NTEP.

8. Vehicle Hiring - Vehicle hiring costs for supervisory visits by NTEP staff.

9. Public Private Mix (Patient-provider (PP) & Non-government Organisation (NGO) Support) - Payments of NGO/ PP schemes grant-in-aid, state and district level Public Private Mix (PPM) coordinators, TB health visitors, cost of pilots/ innovations for improving TB control.

10. Medical Colleges - Funds for referral, treatment, operational research, sensitization and advocacy among staff, faculty and medical students through state/ district health - TB control societies, funding for national, zonal and state task forces in medical colleges, their supervisory visits, etc.

11. Office Operation (Miscellaneous) - Funds for miscellaneous activities like electricity, janitorial expenses, internet cost, stationery, furniture, recruitment/ procurement advertisements, etc.

12. Contractual Services - For recruitment of various contractural staff under NTEP.

13. Printing - Printing of treatment cards, patient identity cards, TB register, lab form, referral form, notification form, health establishment registration form, research reports, action plans, training modules, other reporting formats, etc.

14. Research Studies and Consultancy - Proposals for research studies in specific domains, capacity building programs, consultancy charges for procurement of consumables, web-based reporting system development, etc.

15. Procurement of Drugs - Drugs for TB treatment.

16. Procurement of Vehicles - For purchase and replacement of four-wheelers and two-wheelers for field activities.

17. Procurement of Equipment - For procurement of various laboratory and office equipment.

18. Patient Support and Transportation Charges - Travel costs to patients from tribal/ hilly/ difficult areas, charges for sputum collection and transportation, multidrug-resistant TB suspect travel to District TB Centre (DTC) or collection centre for culture and drug sensitivity testing, etc.

19. Supervision and Monitoring - All activities for supervision, monitoring, evaluations, appraisals, and review meetings.

 

All activities a district could plan to achieve TB elimination based on the Detect-Treat-Prevent Build strategies under the National Strategic Plan for TB Elimination (2017-2025) can be described and budgeted under one of these heads.

 

Resources

1. NTEP Training modules (5-9) for Programme Managers & Medical Officers, Central TB Division, Ministry of Health & Family Welfare, GoI, 2020.
2. Financial Norms of RNTCP, Central TB Division, MoHFW, GoI.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
ACSM activities have a separate budget head under NTEP.	True	False			1	ACSM activities have a separate budget head under NTEP. ACSM Annual action plan is an integral part of the annual district action plan for NTEP.		Yes	Yes

It is important to create a realistic Advocacy, Communication and Social Mobilisation (ACSM) budget.

General principles which would be helpful in creating a realistic budget are:

• Enlist the goals intended to be achieved in the given time period
• Include pre-planning and intended activities
• Include break down of steps involved in each activity along with the resources required
• Partners should understand the overall budget for the activities as well as the budget for the respective components in which they are involved.
• Prioritise programme activities in case funding is reduced
• Follow the ACSM financial guidelines which are issued by the Central TB Division (CTD)

 

Make sure adequate funds are allocated for:

1. Meeting and work space
2. Formative research
3. Material and product development (including pre-testing) and production
4. Material distribution and storage
5. Staff and consultants (specify the amount of time needed)
6. Revisions to materials and activities, based on feedback from implementers
7. Process and outcome evaluation
8. Payment of external technical or creative experts as needed
9. Miscellaneous costs of the partner organizations such as transportation, telephone and postage.

 

• Partner organizations can augment existing resources in various ways. For example, some partners might be able to contribute by photocopying materials while others may be able to donate office space for meetings. When planning ACSM activities, draw up a checklist of activities, products and other resources that might be needed. If the National TB Elimination Programme (NTEP) does not already have some of these services or items, identify potential organizations that might be willing to donate them.
• Both ACSM financial guidelines and the previous year’s budget utilisation should be kept in view as only 10–15 percent increase in budget allocation is the general norm. Bigger increases are uncommon and have to be explained with full justification. Hence, it is important to prioritise ACSM activities and prepare a realistic plan and budget estimation.

Table: Example of an Implementation Plan Format

The reason/ purpose for undertaking the ACSM activities is recorded in the last column of the Performance Improvement Plan (PIP) format.

 

Resources

1. Advocacy, Communication & Social Mobilisation (ACSM) for Tuberculosis Control - A Handbook for Country Programmes, WHO, 2007.
2. Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
A realistic ACSM budget includes allotment for process and outcome evaluation.	True	False			1	A realistic ACSM budget includes allotment for process and outcome evaluation.	​	Yes	Yes

 

Components of Advocacy, Communication and Social Mobilisation (ACSM) Planning Format

• Activity - The number of planned activities is mentioned against the timeline (for every quarter). Common activities listed in the format include community meetings, patient-provider meetings, school activities and outreach activities.
• Timeline - Timelines are divided into four quarters, but one must ensure that activities are spread across all the quarters and not aggregated in the last quarter of January–March.
• Budget - Budgeting for ACSM activities should cover materials, events, training, monitoring, evaluation, etc.
• Justification - The reason/ purpose for undertaking the ACSM activities is recorded.

The planning format also collects historical budgets proposed, allotted and spent for previous years to see if allotted budgets were properly utilised. The current allocation depends on the historical trend of spending. 

Table: Example of ACSM Implementation Plan Format  

 

Activity	Timeline				Budget	Justification/ Remarks
	Q1	Q2	Q3	Q4
	(Apr - June)	(July - Sep)	(Oct - Dec)	(Jan - Mar)

 

 

1. State Level

2. District Level

 

Advocacy, Communication and Social Mobilisation								Justification/ Remarks
Activity	Budget Proposed in last annual action plan (2012 – 2013)	Amount available in this Head (2012 – 2013)	Amount spent by district (2012 - 2013)	Approved ACSM Plan for 2013 -2014	Amount spent in 2013-2014 (till Sep 2013)	Permissible Budget as per population norm for 2014 - 2015	Budget proposed for 2013 - 2014
Total						0

 

 

 

 

Name of Activity	Number of activities undertaken in 2012-2013	Number of activities undertaken in 2013-2014 (till Sep 2013)	Number of Activities Proposed in 2014-15					Budget Proposed for Next FY 2014-2015
			Apr-Jun	Jul-Sep	Oct-Dec	Jan-Mar	Total
Community meeting							0
Patient – provider meeting							0
School activity							0
Outreach activity							0
CME							0
							0
							0
							0
Total	0	0	0	0	0	0	0	0

 

Resources

• Operational Handbook on Advocacy, Communication & Social Mobilisation for RNTCP, Central TB Division, MoHFW, GoI, 2014.

Assessment

 

Question​	Answer  1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​
How many components are there in the ACSM planning format?	3	4	5	2	2	Activity, Timeline, Budget and Justification are the key components of PIPs for ACSM.

Three Levels of Advocacy, Communication and Social Mobilisation (ACSM) Activities 

 

• Preparation of district- and state-level Project Implementation Plans (PIPs) is an important component of the National TB Elimination Programme (NTEP) under the umbrella of the National Health Mission (NHM).
• State PIP is prepared annually which helps states in identifying and quantifying their targets for programme implementation during the year.
• This takes a bottom-up participatory approach that promotes need-based and decentralised planning.

 

Figure 1: Bottom-up approach used in developing ACSM annual action plan

Steps in Planning ACSM PIP

• Draft of district PIPs are discussed in groups of 4–5 districts and ‘finalised’ as district PIPs.
• The district PIPs are consolidated into one document as the draft of state PIP by the IEC officer, in consultation with the STO and other concerned staff.
• In the process, the district PIPs and the state PIP are finalised and sent to Central TB Division (CTD) for approval.
• Once the state ACSM PIP and budget are approved by the CTD, the State IEC Officer (SIECO) should rework the state and district PIPs to reprioritise ACSM activities based on the allotted budget.