EQUITY, ACCOUNTABILITY & QUALITY HEALTH CARE SERVICES IN ORISSA Ms Anu Garg, I.A.S

1. EQUITY, ACCOUNTABILITY & QUALITY HEALTH CARE SERVICES IN ORISSA Ms Anu Garg, I.A.S Commissioner-cum-Secretary, Dept of Health and Family Welfare Govt. Of Orissa

2. NRHM Goal The Goal of the Mission is to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children.

3. EVIDENCES OF DISPARITY Source: Calculated from unit level data, NSS 61st round, 2004-05, based on URP

4. EVIDENCES OF DISPARITY

5. EVIDENCES OF DISPARITY

6. Equity Strategy Orissa (2009-2012) “To improve the health of the poor and excludedin the state, and to reduce disparities in health that currently exist between them and the rest of the population” Six Thematic Areas Leadership : Cross Sector Equity Task force Systems : Social protection mechanisms Services : Quality health care services Accountability : Entitlements, Public access to information & redressal mechanism Citizen’s capacity : Strengthening community participation KBK+ : Reduction in health disparity

7. Approach to address inequity Reaching the unreached Increasing access to Services Addressing Gender in-equity Reducing out of pocket spending Incentivisation

8. Reaching the Unreached Mobile Health Units of different models1. Mobile Medical Van with medical team (AYUSH doctor, Pharmacist, ANM & Attendant) visit to selected villages on fixed day fixed time in each fortnight 2. Ambulance boat for people in cut-off reservoir areas 3. MHU visit to difficult villages on motor cycles 4. Periodic visit of Health Team on walk to most difficult areas

9. Reaching the Unreached • Health Camps in identified difficult villages in regular interval • ANM Visit to most difficult villages on 5th week for Immunization • Provision of test kits (RDK, Nischaya etc.) to ASHA and MHU in difficult areas

10. Reaching the Unreached through PPP mode • 22 PHC(N)s managed in 11 districts • 88 FNGOs in 352 difficult Sub Centres of 22 districts • Urban Health Slum Projects (PPP mode at 12 slums) - focusing on RCH components Accreditation of Private hospitals (17) for JSY • Benefits to ST/SC & BPL beneficiaries

11. Increased access to ServicesJanani Express/Ambulance located at difficult Health Units • Quantitative achievement: • Operational in 30 districts • Case Load- 45 per month • Qualitative achievement : • Mothers from primitive tribal community (Bonda) have attended institution for delivery

12. Increased access to Services • Utilization of referral transportation cost from SC untied fund (43 %) • Quarterly/Monthly award to private vehicle carrier for transportation of highest no. of cases to selected hospitals in KBK districts from RKS fund • Local Volunteer hired by ANM to visit selected difficult villages utilizing Sub centre untied fund

13. Increased access to Services Maternity Waiting Home • Temporary Home (5 beded) for expectant mothers of most difficult areas • Piloted in 4 districts • Implementing through PPP mode Facilities ensured • Accommodation • Food for expectant mother & escorts • Counseling services • Regular health checkup • Medicine • Loss of wages

14. For Physically Challenged • Ramp at all health institutions - Drive initiated • Wheel Chair and Trolley stretcher at entrance

15. For gender equity • Initiatives at Institution level • Female Sweepers at Labour room • Partition at labour room • Partition Screen for examining Patients • Separate Lavatories – for male & Female • Attendant rest shed • Separate user fees collection counter for women

16. Reducing out of pocket spending • Diet to attendant of indoor patients on subsidized rate • Free Medicine • Lab Investigation for children during Pustikar Divas free of cost • Relaxation/Exemption of user charges for blood transfusion from RKS/Red Cross • Referral transportation cost from RKS • RastriyaSwasthyBimaYojana - initiated in 12 districts

17. Incentivisation Enhancement in remuneration of contractual doctors (Special Package for KBK + districts) • Consultant Physician (MBBS) @ Rs.18,000/- PM (Rs.12,000/- in other districts) • Consultant Physician (PG) DHH/SDH @ Rs.20,000/- PM (Rs.15,000/- in other areas) Peripheral health institutions @ Rs.25,000/- PM (Rs.20,000/- in other areas) • Incentive for regular doctors DHH/SDH @ Rs.4,000/- PM Peripheral Institution @ Rs.8,000/- PM • Remuneration of contractual Staff Nurse Increased from Rs.4,000/- to Rs.6,000 /- in coastal areas and to Rs.6,500/- in KBK areas.

18. Institutional Delivery 23% Increase in 2 years 72 % 23% Increase in 2 years 25% Increase in 13 years 25% Increase in 13 years

19. Accountability: A core value Approach: • Governance - Changing institutional arrangements (decentralization, Community Participation, Public Private Mix) • Transparency – Information sharing, Feedback Mechanism

20. Institutionalization 1.Gaon KalyanSamiti in action

21. Institutionalization 2. RogiKalyanSamiti in action • Merger of all committees with RKS • Closure of user fees account and merger with RKS • Tripartite agreement for civil work-RKS, Mission Directorate and Executing Agency

22. Accountability to the Community • Initiatives for grievance redressal • ASHA Divas • Suggestion Box at institution • JSY feed back through Post card - proposed • Grievance day – At CDMO level

23. Transparency - Payment System • Payment through cheque, e-transfer in ASHA bank account • Other payments through cheque - JSY, Sterilization

24. Transparency : Fixed Day Approach Fixed day Programmes • VHND – Fixed day (Tuesday / Friday) • Pustikar Divas on 15th of every month • Fixed immunization day – Every Wednesday • Fixed day Family planning services – Block level Fixed day payment • ASHA Payment day-10th of every month • Spot Payment –JSY, Sterilization, Pustikar Divas

25. Quality Approach: • ISO Certification • Lab Accreditation • Healthy Hospital and Hygienic Hospital - Drive initiated • Innovation in Community Initiatives • Bottom-up Planning • Sensitization of Programme Officers • M&E dimensions for Quality implementation

26. ISO Certification • DHH, Puri – 1st Government-run health care centre in the State • received ISO 9001-2008 • Proposed Hospitals for ISO Certification 2009-10 • Capital Hospital, Bhubaneswar • DHH, Jajpur • DHH, Koraput • DHH, Balasore • DHH, Baripada • DHH, Sambalpur

27. Upgrading Clinical Service Standards Standardization of Lab and accreditation • All DHH Lab in focus in this year 2009-2010 • Biochemistry department of 3 Medical colleges - Lead agency • Action Plan developed for accrediting to NABL Accreditation of Intermediate Reference Laboratory(RNTCP) by GoI

28. Innovation in Community Initiatives ASHA Programme - Quality Focus • Training for maximizing functional effectiveness of ASHA - First Aid training in 3 districts, PNC training in 3 districts, FTD training - ongoing, involvement of freelancer & NGO in conducting Module - 5 training • Streamlining Incentive payment through cheque/e-transfer on a fixed day (10th of every month) • Support provisions like Rest Shed, Bi-Cycle, Diary, Uniform

29. Innovation in Community InitiativesStrengthening RI Programme: Alternative Vaccine Delivery • TIKA Express • Vaccine Transportation – PPP mode

30. Bottom-up Planning • StrengtheningInstitutions at various levels (GKS, RKS,ZSS) for preparing plan • Facilitation by Consultants, Sr. Officers from Directorate & Partners • Annual PIP developed – Village(1055), Block-314, District-30, State • PIP Booklet printed, unveiled by RKS & circulated

31. Sensitization of Programme Officers • PIP dissemination Workshop –Sensitization of Programme Officers at all levels • District Collectors’ Meeting organized • Color coding of components in the PIP Book let for easy reference

32. Strengthening Programme Implementation • Comprehensive guidelines developed and circulated for all approved activities • Compendium of Guidelines - available with Programme Officers up to block level • Online Test on guidelines – for Consultants/Programme Officers of DPMU and BPMU

33. M&E Dimensions… • Nodal Officers appointed (Sr. & Jr.) for every District • PIP Based Reporting – District Ranking • E-Governance initiatives with web-based circulars and GOs with SMS alert • IT strengthening and introduction of programmes software (HosMIS, HRMIS, ProMIS etc.) • Integrated M&E Cell (hub of information with all available sources) at State/District level

34. Thank You