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Developing District Health Action Plan in Rajasthan, India Shiv Chandra Mathur Professor of Preventive and Social Medi

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Developing District Health Action Plan in Rajasthan, India Shiv Chandra Mathur Professor of Preventive and Social Medi

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    1. 13.10.2008 Shiv Chandra Mathur 1 Developing District Health Action Plan in Rajasthan, India Shiv Chandra Mathur Professor of Preventive and Social Medicine S.M.S.Medical College, Jaipur, India

    2. 13.10.2008 Shiv Chandra Mathur 2 District Health Action Plan have assumed a new centrality in the context of National Rural Health Mission in India

    3. 13.10.2008 Shiv Chandra Mathur 3 Decentralized health planning present special program planning challenges. Case study of one State in India i.e. Rajasthan highlights the challenges and draws lessons for effective implementation of District Health Action Plans.

    4. 13.10.2008 Shiv Chandra Mathur 4 Why this Case in 3rd AAAH? This case reflects the efforts made in the direction of Public Sector Reforms, Decentralization, and Privatization. It also reflects the implications for Human Resources in Health when a critical component is contracted out.

    5. 13.10.2008 Shiv Chandra Mathur 5 District Health Action Plan Address local needs and specificities Enable decentralization and public participation Facilitate inter-departmental convergence Improve accountability of health systems

    6. 13.10.2008 Shiv Chandra Mathur 6 RAJASTHAN A state of distances and diversities Western Rajasthan (60 % land area and 34 % population ) – (Thar) Desert with low density Southern Rajasthan (11 % land area and 14 % population ) – (Aravali) Hilly terrain with tribal population Eastern Rajasthan - Plains

    7. 13.10.2008 Shiv Chandra Mathur 7 Total Population*:63.28 million Rural Population*:47.90 million Land Area: 0.32 m. sq. km Administrative Divisions:7 Districts:33 Rural Blocks:237 Inhabited Villages:>41000 Urban Agglomeration:222 *As of March 2008

    8. 13.10.2008 Shiv Chandra Mathur 8 Hospitals* including Medical college Hospitals - 120 CHC - 352 PHC - 1503 Sub center - 10742 No. of Beds - 40187 No. of Doctors including Dentists - 6553 Population per Sub-centre - 4557 Population per PHC - 32193 Population per CHC - 147394 Doctor : Population Ratio1:10500   *As on 30th June 2007

    9. 13.10.2008 Shiv Chandra Mathur 9 Outcomes of DHAP Builds a good database Helps identify priorities Estimates total resource requirements Better planning for implementing national programmes Promote Public Participation Promote accountability of Health sector Enhance Institutional capacity Can enhance inter-sectoral coordination

    10. 13.10.2008 Shiv Chandra Mathur 10 DHAP through NGO Second phase of RCH Project catalyzed the decentralized plans Unicef and GOR prepared a framework for DAP at the outset in 2004-05 A NGO i.e. Social Policy Research Institute (SPRI) was assigned eight districts on pilot basis Cost of Rs.100,000/- per district allocated SPRI convened planning workshop in one rural development blocks in each district Solicited the participation from different social development sectors

    11. 13.10.2008 Shiv Chandra Mathur 11 Evolution of DHAP in Rajasthan Post-ICPD “Target Free Approach” - 1995-96 Determining “Expected Level of Achievement” through consistent ‘Community Need Assessment’ – 1996-2000 EC supported Health Sector Reforms Project 01-05 Contract out district plans to NGO’s 2005-06

    12. 13.10.2008 Shiv Chandra Mathur 12 Inputs with NRHM-2005 DPMU created in each district by hiring managerial expertise from open market Additional funds provided for decentralized planning Commitment to bring all public facilities on IPHS norms Eliciting Community Participation through involving Panchayati Raj systems

    13. 13.10.2008 Shiv Chandra Mathur 13 State Government’s conviction with passage of time seems to have grown strong on the limited capacity of districts in ‘planning’

    14. 13.10.2008 Shiv Chandra Mathur 14 Agencies involved in Preparing DAP

    15. 13.10.2008 Shiv Chandra Mathur 15 Budget allocated for DHAP

    16. 13.10.2008 Shiv Chandra Mathur 16 Revisit to DAP of 8 districts (SPRI)

    17. 13.10.2008 Shiv Chandra Mathur 17 Promoting District Planning Ensure Administrative Support for the Plan Consider Implementation details as an integral part of DAP Encourage Planning to begin with small and feasible plan Make client needs the focus of the district plan Periodically undertake surveys in the district to assess client needs

    18. Thank You

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