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REFORM INITIATIVES IN HEALTH SECTOR : FEW STEPS

REFORM INITIATIVES IN HEALTH SECTOR : FEW STEPS. HEALTH & FAMILY WELFARE DEPARTMENT GOVERNMENT OF ASSAM. REFORMS INITIATED:. DECENTRALISATION: INTEGRATED “DISTRICT HEALTH AND FAMILY WELFARE SOCIETY” CONSTITUTED MERGING VERTICAL SOCIETIES IN DISTRICTS.

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REFORM INITIATIVES IN HEALTH SECTOR : FEW STEPS

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  1. REFORM INITIATIVES IN HEALTH SECTOR : FEWSTEPS HEALTH & FAMILY WELFARE DEPARTMENT GOVERNMENT OF ASSAM

  2. REFORMS INITIATED: • DECENTRALISATION: • 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.

  3. 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

  4. DECENTRALISATION: • SUB-CENTRE MANAGEMENT COMMITTEE UNDER GRAM -PANCHAYAT CONSTITUTED. • ORIENTATION OFPANCHAYAT MEMBERS ON HEALTH SECTOR RESPONSIBILITIES STARTED . • DEPLOYMENT OF MANPOWER WITHIN DISTRICT DELEGATED TO DISTRICT SOCIETIES.

  5. 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.

  6. REFERRAL SERVICES: • 11 FIRST REFERRAL UNITs(FRU) MADE OPERATIONAL IN CHC LEVEL UNDER SIP . • 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.

  7. 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

  8. SHORT TERM TRAINING FOR REFERRAL SERVICES: • SHORTAGE OF SPECIALISED MANPOWER IN ANAESTHESIA&PAEDIATRICS IS WELL UNDERSTOOD: • 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.

  9. PUBLIC-PRIVATE PARTNERSHIP: • MARWARI MATERNITY HOSPITAL, A NON-PROFIT 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

  10. BEHAVIOUR CHANGES NOTICED IN SLUMS COVERED: A POSITIVE NOTE April,02-March,03April,03-Dec.,03 Total sterilization: 352 427 Sterilization at P-2 136(38%) 224(50.2%) Sterilization with 04 23 2 Girls No. of Muslim Women 69(17.06%) 95(22%) Muslim Women at P-2 18(26%) 35(36.5%) Previous Contraception 178(50.4%) 266(59%) Literacy Rate(Wife) 128(37%) 152(36%)

  11. BOTTLENECKS ENCOUNTERED: • DECENTRALISATION: • 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.

  12. BOTTLENECKS ENCOUNTERED • HOSPITAL AUTONOMY: • 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.

  13. 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.

  14. 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

  15. 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

  16. THANK YOU

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