2 nd Common Review Mission Chhattisgarh

1. 2nd Common Review MissionChhattisgarh 16th - 22nd December 2009

2. CRM Team Members • Dr. R S Sharma, Joint Director, NVBDCP, Govt of India. • Dr Kaushik Ray Barman, Senior Consultant - Public Health Planning, National Health System Resource Centre. New Delhi • Dr. Pavitra Mohan, Health Specialist, UNICEF India Country Office. New Delhi. • Dr. Joe Varghese, Senior Programme Coordinator, CMAI, New Delhi. Districts visited: Bilaspur, Dhamteri, Raipur

3. Structure of presentation • Health Service Delivery • Human Resources • Infrastructure • Program Management structures & activities • Decentralisation & Communitisation • Governance and planning process

4. Health Service Delivery • Significant service improvement at SCs, but PHCs are the missing link • Increasing trend of OPD load, normal delivery at CHCs & SCs, decline of malaria deaths • Instt. deliveries still is a concern though positive impact of JSY seen • Marginal improvements in utilization of the facilities for MCH care (no plan for MTP activities) • FRU, 24x7, FBNC, emergency drugs, laboratory & referral support at peripheral facilities are weak areas • Centralized drug procurement system, RD kit & bednet availability, Block Leprosy Awareness Campaign, Sickle Cell test camps, Bal Hriday Suraksha Yojana

5. Initiate facility survey at SC & PHC level by BPMU staff Facility improvement to meet out minimum Quality & service guarantees (HR, logistics, Infrastructure, management) Appropriate placement of multi-skilled providers, good referral & MCH services Integrated Lab services with RNTCP, NVBDCP and NACP (resources) Recommendation

6. Human Resource • MAJOR LIMITING FACTOR is lack of Human Resources: ANM, SN, MO (IPHS is a distant dream) • Clear responsibility for HR planning are not existing: plans are not commensurate with needs • All regular and contractual appointment process are slow (shortage of supply & commitment) • Over centralisation of manpower, improper positioning of LSAS, EmOC trained personnel, non utilization of SIHFW, RFWTC • Recruitment of LT through JDS (RKS), Rural Medical Assistants in tribal districts are good initiatives

7. Recommendation • Definite HR policy & its implementation, co-location with AYUSH • Intense focus for multi-skilled workforce, filling of vacant posts (regular cadre) • Institutional strengthening & coordination among all training & capacity building instt. • Sensitisation of directorate of medical education, nursing & paramedical Instt. for public health need

8. Infrastructure • ISO certification of district hospital, Equipment management system are good initiatives • Basic requirement of SC, PHC, CHC, FRU, 24x7 criteria are yet to fulfilled (recommended standards) • Delayed operationalisation of Blood storage facilities, Referral transport • Establishing new infrastructure is SLOW (Many of them are at rented or inappropriate building) • Over dependence on PWD for construction lead to delay (other options need to be explored) • Fund disbursement for infrastructure upgradation are quite slow

9. Recommendation • Infrastructure development wing as an option other than PWD • Urgent focus on PHCs and FRUs, AYUSH instt upgradation • Rational fund utilisation from Flexipool, BRG funds & EUSPP for infrastructure • Ensure fund disbursal from SHS and quick handover of newly constructed facilities • Infrastructural strengthening for ANMTC and RFWTC and DTCs

10. Decentralization & Communitisation • Strong workforce of Mitanin with high degree of skills, Mitanin help desks and other support structures • Formation of VHSC & account in place, But capacity building, utilisation of untied funds are weak • JDS activities are on track with less involvement of communities & PRI, encouraging progress of fund utilisation but mainly for logistics • Existing gaps between strong community processes (generated demand) and facility strengthening (provided input) • Concerns- Incentive distribution to Mitanin, Drug replenishment of Mitanin Dawa Peti • Participation of NGOs in Planning, training, implementation, monitoring and surveys but MNGO & FNGO activities are minimal. • Sishu sanrakhsan mah, VHND, Swasth Panchayat Scheme are new initiatives

11. Recommendation • More decentralisation of financial power • Sensitisation of PRI leaders in VHSC & JDS activities • Streamline incentive distribution to beneficiaries and providers (JSY, immunisation, other programs) • Strengthening and sensitization of Block & Village level planning process, social auditing, community monitoring • Regulatory mechanism & monitoring of NGOs • Widening the Scopes under Community monitoring & initiation of social audit

12. Program Management issues • SPMU, DPMU, BPMU are in place, training for BPMUs staff still incomplete • Work & Accounts handing over process to BPMUs still to initiate • separate sub-accounts, minimal financial disbursement from SHS, problem of UC generation, non transfer of state budgetary contribution are few concerned areas • Audit process completed • Poor utilisation of allocated flexipool funds • Non release of Annual maintenance grant • New formats of HMIS introduced, but feed back mechanism are weak

13. Recommendation • Enhance operationalising E banking from dist to block (on priority) • Timely Fund disbursements from state to districts, proper expenditure plan and retrieval mechanism for U Certificate • DHAP based financial disbursement with clear financial outlays for each districts & FLEXI FINANCING • Immediate merger of sub accounts under SHS, transfer of state contribution to NRHM pool, more decentralization of financial power to peripheral Instt. • More coordination between directorate, CMO office and program units, decentralised planning through BPMU • Feed back process for HMIS need to be incorporated

14. Governance & Planning process • Frequent reshuffling of administrative and technical officials is a concern • Implementation at district are not matching with plan documents • Consider better reflection of previous CRM, JRM recommendation in planning process • More clarity on roles and responsibilities to management units at all level • More cohesion between Directorate, SHS and State Miission, rational distribution of work within the directorates • Design definite path for budget utilisation through flexi financing

15. Contd.. • More focus to PHC in all areas • More definite plan for outreach activities through MMU • Sp Strategy for vulnerable groups & tribal groups • More convergence with AYUSH and other Depts • Strengthen DHAP & block planning & implementation process • Utilise strong community process for village planning

16. THANK YOU