Transcript Decentralisation

Decentralisation
Experiences from Haryana
Haryana Profile
Haryana
Population : 2.1crores
Districts:
20
Blocks:
116
Background
Health Sector Reforms: Need of the day
WHY?
Rising cost in health care
Rising expectations of community
Limited capacity to meet out of pocket expense.
Decentralisation
Why Reform Agenda?
Increased local ownership
Improved community participation and responsiveness to
local needs
Strengthening integration of services at local levels
Enhancing the streamlining of services
Promoting innovation and experimentation
Decentralisation
Defined as the transfer of authority and responsibility for
public functions from the Central Government to:
peripheral departments within the same agency,
intermediate and local government,
quasi-independent government organizations.
Depending on the types and scope of functions
transferred, as well as the level or agency to which the
functions are transferred, different political, fiscal and
administrative arrangements developed.
Decentralization and delegation of powers depend upon
the political will.
Decentralisation- Haryana
Structural changes
Constitution of
SCOVA – 1997
merged societies and Swasthya Kalyan Samities in 3
pilot districts- initiative under SIP: 2001-2002
merged Society at State and in all the districts of
State: 2004
SKS in all the health institutions (PHC and above)
2004
Delegation of powers financial and administrative- 1997
Reviewed, revised and implemented – 2005
Explains the time required
Structures
State Health Society
District Health and Family Welfare Societies (DHFWS).
Swasthya Kalyan Samities (SKS).
Program Committees
SubCommittees
Functional Arrangements
District Health & Family
Welfare Society
State Health
Society
Swasthya Kalyan Samiti
Governing Council
Executive Council
Program Committees
Purchase/
Procurement
Sub
Committees
As Per Need
Logistics
Civil works
Recruitment
Financial Arrangements
Transfer of program funds to DHFWS & SKS.
Retention and utilization of user fees at institutions.
Delegation of powers circulated.
Financial management manual introduced
Administrative Arrangements
Regular Governing Council meetings.
Regular Executive Council meetings.
Meetings of SKS and subcommittees as per need.
Administrative manual- yet to be introduced
Resource generation at Districts
Grant -in –Aid
User fee
Accepting donations
Leasing out of vacant land
BPL families, freedom fighters and Govt.
employees exempted
Services under national health program - free
PRIs
Management of Sub centers to PRIs - 3 pilot SIP
districts
Referral transport - RCH I.
Capacity building of PRI members -3 pilot
SIPdistricts.
Untied funds under NRHM with ANM and PRI
members for sub centre improvement.
Experiences – User Fee
G.O issued on retaining and utilising user fee at
SKS.
Very positive for infrastructural developmentmostly at district hospital.
Some Districts pool funds and redistribute.
Some institutions yet to take up SKS meetings for
execution of decisions
Some districts do not recognise the delegation of
powers to PHCs and CHCs
Lessons Learnt
Decentralization itself does not always improve the
efficiency, equity and effectiveness of the health sector.
Need to be careful as this poses a serious threat to
accessibility and delivery of reproductive health services,
some of which (e.g. family planning) are controversial
and thus susceptible to local pressures, and others of
which (e.g. emergency obstetric care) require a
functioning and effective health system.
Need to take account of the impact of non-health factors
as well as other reforms that interact with
decentralization to affect accessibility, affordability and
quality of services, included for reproductive health.
Experience also demonstrates….
Shared authority between the centre and local units to achieve national health objectives and respond to
local health needs.
Adjustments to be made during implementation to
correct for both emerging and pre-existing problems
and requirements.
Not easy to break the status quo as it always shifts
the power relations without providing understanding
on attached roles and responsibilities.
Understanding that rights and duties are the two sides
of the same coin, one from the other does not mean
anything- may help and facilitate the process.
Important
simultaneously build the capacities of health personnel
in team work, value orientation and rights based
approach.
capacity to delegate and use powers need to be built
at all levels.
Unfinished Agenda
Physical merger of societies and formation of
Management and Monitoring cell.
Capacity building of senior officers at Health directorate
and of 17 districts .
Capacity Building of PRIs.
Financial Merger of program committees – based on
experiences from other states.
Institutionalising administrative rules.