Transcript REFORM INITIATIVES IN HEALTH SECTOR

REFORM INITIATIVES IN
HEALTH SECTOR :
FEW STEPS
HEALTH & FAMILY WELFARE
DEPARTMENT
GOVERNMENT OF ASSAM
REFORMS INITIATED:
 DECENTRALISATION:
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INTEGRATED “DISTRICT HEALTH AND
FAMILY WELFARE SOCIETY”
CONSTITUTED MERGING VERTICAL
SOCIETIES IN DISTRICTS.
MANAGEMENT OF HEALTH
INSTITUTIONS DECENTRALISED TO
DISTRICTS.
BLOCK LEVEL HEALTH
MANAGEMENT COMMITTEES
CONSTITUTED INVOLVING PRIs.
DECENTRALISATION:
 PROGRAMME MANMAGEMENT AND
HEALTH INSTITUTIONS SUPERVISION AT
BLOCK LEVEL BY LOCAL COMMITTEE.
 PLANNING AND IMPLEMENTATION OF
PROGRAMME THROUGH
DECENTRALISED MECHANISM AT
DISTRICT
 DECENTRALISED REPAIR/RENOVATION
OF HEALTH FACILITIES BY
MANAGEMENT COMMITTEES
DECENTRALISATION:
 SUB-CENTRE MANAGEMENT
COMMITTEE UNDER GRAM -PANCHAYAT
CONSTITUTED.
 ORIENTATION OF PANCHAYAT
MEMBERS ON HEALTH SECTOR
RESPONSIBILITIES STARTED .
 DEPLOYMENT OF MANPOWER WITHIN
DISTRICT DELEGATED TO DISTRICT
SOCIETIES.
HOSPITAL AUTONOMY AND
USER FEES:
 “HOSPITAL MANAGEMENT SOCIETY”
CONSTITUTED IN MEDICAL COLLEGE,
DISTRICT AND SUB-DISTRICT HOSPITALS.
 USER FEES COLLECTED AND RETAINED IN THE
FACILITITES TO MAINTAIN AND IMPROVE
SERVICES.
 QUALITY OF HOSPITAL SERVICES IMPROVING
ALONG WITH INCREASE IN COLLECTION OF
USER FEES.
 USER FEES ENHANCED WITH SAFE GUARD TO
BELOW POVERTY LINE (BPL) FAMILIES.
REFERRAL SERVICES:
 11 FIRST REFERRAL UNITs(FRU) MADE
OPERATIONAL IN CHC LEVEL UNDER SIP
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PHYSICAL INFRASTRUCTURES
RENOVATED/REFURBISHED UTILISING
RCH/MLALAD /PMGY /SIP/PRI FUNDS.
EQUIPMENT SUPPLIED THROUGH
CSSM/RCH/NACO RE-ALLOCATED and
PROCURED FOR IDENTIFIED FRUs.
MANPOWER(SPECIALISTS) ARRANGED
RATIONALISING EXISTING SPECIALIST
WITHIN DISTRICT.
REFERRAL SERVICES:
 NURSING AND SUPPORT STAFF
IMPARTED HANDS ON TRAINING
 DRUGS AND CONSUMABLE SUPPLIED
UNDER GENERAL BUDGET
 SUSTAINABILITY OF SERVICES ENSURED
THOUGH USER CHARGES
 QUALITY OF SERVICES CERTIFIED BY
FACULTY OF MEDICAL COLLEGE
 POLITICAL COMMITMENT TO
REPLICATE REFERRAL CARE IS THE
DRIVING FORCE
SHORT TERM TRAINING
FOR REFERRAL SERVICES:
 SHORTAGE OF SPECIALISED
MANPOWER IN
ANAESTHESIA&PAEDIATRICS IS WELL
UNDERSTOOD:
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FOR THE UPCOMING FRUS , SHORT TERM
(SIX MONTHS) TRAINING FOR NON-PG
MEDICAL OFFICERS IN MEDICAL COLLEGES
ARE GOING ON.
ALREADY TRAINED MEDICAL OFFICERS ARE
POSTED IN FRUS AND PROVIDING REQUIRED
SPECIALISED SERVICES WHERE PG
HOLDERS ARE NOT AVAILABLE.
PUBLIC-PRIVATE
PARTNERSHIP:
 MARWARI MATERNITY HOSPITAL, A NONPROFIT TRUST CONTRACTED FOR RCH
SERVICE DELIVERY IN SLUMS OF GUWAHATI
CITY.
 OPERATIONAL SUPPORT FOR SESSIONS AND
VACCINCE SUPPLIED FROM HEALTH DEPT.
 REFERRAL CARE FOR OUTREACH PATIENTS
IN HOSPITAL IN SUBCIDISED RATE.
 OUTREACH SESSIONS ARE ATTENDED BY
SENIOR DOCTORS.
 IMMUNIZATION, FAMILY PLANNING
COVERAGE INCREASING IN THESE SLUMS
BEHAVIOUR CHANGES NOTICED IN
SLUMS COVERED: A POSITIVE NOTE
April,02-March,03
Total sterilization:
Sterilization at P-2
Sterilization with
2 Girls
No. of Muslim Women
Muslim Women at P-2
Previous Contraception
Literacy Rate(Wife)
352
136(38%)
04
69(17.06%)
18(26%)
178(50.4%)
128(37%)
April,03-Dec.,03
427
224(50.2%)
23
95(22%)
35(36.5%)
266(59%)
152(36%)
BOTTLENECKS
ENCOUNTERED:
 DECENTRALISATION:
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NEW ENVIRONMENT OF INTEGRATED MANAGEMENT, PRI’s
CONTROL OVER HEALTH INSTITUTIONS, WORKFORCE
RESULTING CONFLICT WITH SERVICE ORGANISATION.
OVER RELIANCE ON DISTRICT ADMINISTRATION FOR
PROGRAMME MANAGENT CREATING CONFUSION
AMONGST HEALTH OFFICIALS.
REFERRAL CARE :
SHORTAGE OF SPECIALISED MANPOWER THREATENING
SUSTAINABILITY OF SERVICES
LACK OF FACILITIES IN RURAL AREAS CAUSING PROBLEM
TO RETAIN SPECIALISTS IN FRUS
NUMBER OF SANCTIONED POSTS IN FRUS NOT ADEQUATE
TO PROVIDE ALL SERVICES OF FRUS.
BOTTLENECKS
ENCOUNTERED
 HOSPITAL AUTONOMY:
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MANAGEMENT SOCIETY FUNCTIONS ARE NOT
UNIFORM THROUGHOUT THE STATE.
NO ADEQUATE MONITORING SYSTEM FOR USER FEE
COLLECTION AND UTILISATION.
EXEMTION SYSTEM FOR BPL FAMILIES UNRELIABLE.
TRAINED MANPOWER IN HOSPITAL ADMINISTRATION
NOT AVAILABLE IN FACILITIES.
INTRODUCTION OF USER FEES IN ALL HEALTH
INSTITUTIONS INVITING PUBLIC CRITICISM.
MANAGERIAL POSTS ARE FILLED FOR SHORT
DURATION OR IN THE FAG END OF SERVICE.
LESSION LEARNT FROM
URBAN HEALTH INITIATIVE
 SERVICE DELIVERY IS POSSIBLE INVOLVING PRIVATE
PROVIDERS WHERE PUBLIC FACILITIES LACKING.
 TASK NETWORKING OF INSTITUTIONS BOTH PUBLIC &
PRIVATE IS ESSENTIAL
 REGULARITY AND TIMINING OF SESSIONS ARE
IMPORTANT TO GAIN FAITH OF COMMUNITY.
 COMMITMENT OF STAFF TO SERVE IN SLUMS .
 COMMUNITY SUPPORT FOR HOLDING SESSIONS IN
PRIVATE ESTABLISHMENT.
 INVOLVEMENT OF LOCAL VOLUNTEERS/NGO TO REACH
COMMUNITY.
 PERMANENT COMMUNITY CONTACT AS
MOTIVATOR/INFORMANTS.
 BASELINE INFORMATION TO ASSESS PERFORMANCES.
STEPS INITIATED TO OVERCOME
BOTTLENECKS :
 ORGANIZATIONAL REVIEW IN HEALTH
SECTOR
 RATIOALISATION OF INFRASTRUCTURES AND
MANPOWER
 ORIENTATION OF PRIs ON HEALTH ISSUES
 SPECIALIST CADRE FOR SUSTAINABILITY OF
STAFFING IN FRUS AS PER RECOGNISED POST
 HOSPITAL ADMINISTRATION TRAINING FOR
MANEGERIAL POST IN HOSPITALS
 MANUAL FOR STREAMLINING COLLECTION
AND UTILISATION OF USER FEES
 MORE NON-PROFIT TRUST TO INVOLVE IN
URBAN HEALTH SERVICE
Expenditure Statement till 31.12.03
 Fund received from Govt. of India (SIP) =
846.09
 Rs 450 lakh received during this month (under
MOU)
 Total expenditure = 350.09
 Disbursement to District = 38.62
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