Health sector reform initiatives in Gujarat

1. Health sector reform initiatives in Gujarat Dr Amarjit Singh Principal Secretary (FW) & Commissioner Health, Medical Services & Medical Education Gujarat

2. Structural

3. Pre reform model

4. Integrated structure

5. Department of Health & Family Welfare: Govt. of Gujarat

6. Other Initiatives • DPCs • AHAs • Using ISM professionals • Mentoring • TCS • HMIS • Autonomy • Capacity building • Governance • Communitisation

7. Clear goals

8. Our Goals • Reduce maternal and child mortality • Address adverse sex ratio • Stabilize population • Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia • Provide state of the art health and medical education relevant to local needs • Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services • Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals • Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

9. Reducing Maternal and child mortality Chiranjeevi

10. MMR Over Time

12. Health care facilities available

13. Availability of OBGYs in CHCs

14. Bonus - saving neonates

15. SERVICE PACKAGE

16. Gynecologist involvement in Chiranjeevi

17. Chiranjeevi Yojana Report June -08 Ending (20 Districts)

18. Chiranjeevi Yojana Report June -08 Ending (20 Districts)

19. Chiranjeevi State 2007-08 & 2008-09

20. Outcome of Chiranjeevi Scheme: Mothers & New Born babies saved • Normal Deliveries: 175805 • C-Section: 12414 (6.17%) • Complicated Deliveries: 13092 (6.50%) • Private specialist enrolled: 872/2000

22. Institutional deliveries trend

24. Extended Chiranjeevi andBal Sakha

25. Our Goals • Reduce maternal and child mortality • Address adverse sex ratio • Stabilize population • Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia • Provide state of the art health and medical education relevant to local needs • Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services • Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals • Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

26. Mass Media Takes keen Interest

27. Political commitment on the floor of the house.

28. Sex ratio at birth as per CRS records

29. 4 Districts showing deterioration in sex ratio State average: 870 (2006)

30. Our Goals • Reduce maternal and child mortality • Address adverse sex ratio • Stabilize population • Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia • Provide state of the art health and medical education relevant to local needs • Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services • Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals • Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

32. Special Initiatives for NSV

35. Crude birth rate

36. Our Goals • Reduce maternal and child mortality • Address adverse sex ratio • Stabilize population • Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia • Provide state of the art health and medical education relevant to local needs • Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services • Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals • Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

37. Effective Implementation of national health programmes in PPP • Working with IMA • Outsourcing CD4 testing • MNGOs, SNGOs and FNGOs • Working with Rotary and Lions • GIA institutions • Outsourcing staff • Working with private OBGYs

38. Cure Rate Vs Case Detection Rate (3Q06/3Q07)

39. Cataract Surgical Rate (CSR) (2003-08)

40. NLEP – Gujarat Endemicity as on May.08 P.R. > 5 3 - 5 2 - 3 1 - 2 < 1 P.R.-0.78 PM Dahod 2.36 1.80 Vadodara 1.31 Bharuch Narmada 2.80 1.91 Surat 1.50 Dang Navsari 3.49 2.58 Valsad 2.81

43. Specialist services under school health programme

44. Route Map through Satellite based monitoring system Max. distance Desert Start

45. Curative services through MHUs Retrospective Status Satellite based Monitoring System implemented

46. Our Goals • Reduce maternal and child mortality • Address adverse sex ratio • Stabilize population • Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia • Provide state of the art health and medical education relevant to local needs • Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services • Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals • Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

47. PPP in ME • Medical colleges in PPP with Bombay hospital; United phosphorous; Narayan Rudalaya and Fortis • Setting up of PHFI Gujarat • Nursing colleges • Outsourcing staff; security; laundry • Outsourcing diagnostics • Outsourcing lab work

49. MOU s SIGNED VIBRANT GUJARAT

50. Our Goals • Reduce maternal and child mortality • Address adverse sex ratio • Stabilize population • Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia • Provide state of the art health and medical education relevant to local needs • Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services • Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals • Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles