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Meeting People's Health Needs: Workshop on Financial & MIS Monitoring

This workshop provides an overview of the current health system in India and highlights the challenges faced in meeting people's health needs. It discusses the strengths of the health system, the burden of disease, and the need for a holistic approach. The workshop also introduces the National Rural Health Mission (NRHM) and its expected outcomes. Strategies and tools for implementation, as well as the institutional framework, are also discussed.

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Meeting People's Health Needs: Workshop on Financial & MIS Monitoring

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  1. Meeting People’s Health Needs Overview Workshop on Financial & MIS monitoring Mussoorie, May 2007 Ministry of Health & Family Welfare, Government of India

  2. Overview

  3. It has been over seven years since we turned one One billion

  4. overview • Total Population : ~ 113 crore • Rural Population : ~ 75 crore • States : 35 Districts : 609 Blocks : 6345 Villages : 638,588 • Total doctors in country : 767,500 • Number of doctors at PHCs : 22,273 • Number of specialists in public system : 3979 • Number of ANMs : 149,695 • Medical Colleges : 262 • Nursing Colleges (GNM) : 979

  5. + Health delivery apparatus • Public Sector facilities • Private Practitioners • ESI, CGHS, PSU Hospitals • Railways Hospitals • Armed Forces Medical Services • Corporate Hospitals • Indian System of medicine • Informal providers • Quacks/Crooks & magico religious practitioners

  6. Strengths of the Health System • Extensive framework and reach even in many difficult areas. • Established procedures in State Health Directorates • Presence of active Non Governmental service providers • Recent Achievements • Leprosy eliminated at National level • Neonatal Tetanus eliminated from 9 States. • TB cure rate sustained at more than global target of 85% • Efficient response to Avian flu • Medical Tourism Why NRHM ?

  7. + HEALTH INDICATORS * : SRS

  8. NATIONAL GOALS & MDG

  9. - THE CITIZEN’S PERSPECTIVE Lack of Holistic Approach Health not a priority. Under funded, yet not utilised. Shortage of infrastructure & human resources Lacks community ownership and accountability Non integration of Disease Controlprogrammes Non responsivenessto Citizen

  10. Burden of Disease • Demographic transition • Communicable diseases still major burden. • Additional burden of non-communicable diseases. • Sedentary lifestyle and unhealthy diets. • Future reforms and initiatives to strengthen the health care system must give priority to the primary sector.

  11. - Public Health - Concerns • Sustainable Systems • Financing Spending 5.2 % of GDP ( Private 4.3 %, Public 0.9%) • Infrastructure (over 2,00,000 facilities) • Manpower • Logistics • Management • Evaluation • Responsive & Equitableto citizens

  12. National Rural Health Mission launched in April, 2005 • Rejuvenate the Health delivery System • Universal Health Care • Access • Affordability • Equity • Quality • Reduce IMR, MMR,TFR • Improve Disease control

  13. EXPECTED OUTCOMES 2005 - 2012 • Universal Health care, well functioning health delivery system. • IMRreduced to 30/1000 live births by 2012 • MMRreduced to100/100,000 live births by 2012 • TFR reduced to 2.1 by 2012 • Malaria Mortality Reduction Rate – 60% upto 2012 • Kala Azar eliminated by 2010, Filaria reduced by 80 % by 2010 • Dengue Mortality reduced by 50% by 2012 • TB DOTS series – maintain 85% cure rate • Responsive Health System

  14. The Formative Years

  15. The formative years • Original approval for NRHM in January 2005 • Country wide Launch by Prime Minister, 12 April 2005 • 2005-06 was formative year during which • Strategies & Guidelines firmed up • Merger of Deptt of Health & family welfare • State & District Health Missions constituted • MoU signed by all the states • Specific Activities funded on Normative basis • Untied funds to Sub centres • Selection & Training of ASHAs • Preliminary renovations at CHCs • Preparation of District Plans

  16. The formative years • Framework for Implementation approved July 2006 • Highest institutions of NRHM empowered • Mission Steering Group • Empowered Programme Committee • Financial envelopes to states (no schematic prescriptions ) • National Programme Coordination Committee • State Programme Implementation Plans appraised. • Monitoring systems put in place. • SPMUs/ DPMUs positioned.

  17. The Strategies

  18. Strategies • Improve Infrastructure • Augment manpower • Improve management • Flexibility to states to deploy funds • Decentralisation • Communitization Old wine in new bottle ?

  19. The Tools • Substantially larger funding • Financial envelop to state (districts?) • PIP based releases (IDHAP) • Untied funds (Untied?) • Annual maintenance Grants (Sanctions?) • Decentralised procurement (capacity) • Contractual recruitment (facility specific) • Outsource as per need (RKS) • Integrate training, IEC, Training, procurement (turfs) • Financial management Group. • PIP appraisal – generic norms – EPC/MSG

  20. The Institutional Framework • Mission Steering Group • Empowered Programme Committee • State Health Missions • District Health Missions • Rogi Kalyan Samitis • Village Health & Sanitation Committees • ASHA Mentoring Group • Advisory Group on Community Action • National / State Health System resource Centre

  21. The Tools • Infrastructure upgradation • Sub Centres made functional • Additional contractual ANMs • Untied funds for local action • Community link worker • Village Health Nutrition committees • Expanded Medicines supply • PHCs made 24 x7 • Three staff nurses • Annual maintenance grant • Untied funds • AYUSH Integration • Rogi Kalyan Samiti • IPHS

  22. The Tools • Infrastructure upgradation • CHCs upgradation • First Referral Units • Facility survey • Not more than 33% of NRHM outlay in high focus & 25% in non-high focus States for infrastructure. • IPHS • Untied funds/Annual mainta grant • Rogi Kalyan Samiti • District Hospital upgradation • Facility survey • IPHS • Rogi Kalyan Samiti • During XI Plan 2 : 2 : 6 ratio State : Internal : GOI

  23. The Tools • Manpower augmentation • Multi skilling all MOs • Developing MOs as Health Manager • Filling up vacant posts/Creating more posts • Contractual positions to fill gaps • Trainings / expanding training capacity • Rational transfer and posting policy • Health sector planning • Household surveys & Village Health Plans. • Integrated District Health Action Plans. • Annual PIPs / Perspective Plans - Flexibility. • SPMUs/ DPMUs/ Block PMUs • NHSRC/ SHSRC

  24. The Tools • Improved service delivery • Citizen’s charter • Monthly Health & Nutrition Day • Outsourcing critical service gaps • Catch up rounds of Immunisation • Improved IP & OP utilisation • Mobility Support / Mobile Medical Units • Maternity Benefit Schemes • Systemic improvements • Improved logistics. • Rational / Optimal positioning of manpower • Rational delegation (financial & Administrative) • Decentralised procurement • Partnerships with Non Government Stakeholders • Alternate Health Financing • Improved disease surveillance

  25. The Tools Accredited Social Health Activist • Link between community and delivery system. • Chosen by and accountable to Panchayat. • Performance linked incentives. • Anchored in the Anganwadi system. • Provided with a basic drug kit. • Depot holder for contraceptives and IEC materials. • Supported by VHSC, AWW / ANM / SHG. • Linkages with functional facilities. Monitoring & Evaluation • Review meetings, State visits – evaluation teams, RDs • Integrated MIS • External Surveys • Immunisation - UNICEF • ASHA & JSY – UNICEF, UNFPA, GTZ • Financial protocols- Institute of Public Auditors • Comprehensive External Evaluations • Community monitoring

  26. Health Planning

  27. Planning under NRHM • Indication of resource envelope to Districts and Blocks • Perspective Plan 2005-2012. Annual Work Plan. • Broad norms and indicative resource envelope. • 70% of resources utilized at Block/sub Block • 20% at the district level. IDHAP • Convergent action with wider determinants of health • Household surveys for local use. • Facility Survey – essential requirement

  28. Money Matters

  29. Direction & Administration Integrated District Health Society RCH NVBDCP NPCB RNTCP IDD NLEP IDSP New In. Integrated District Health Action Plan State Programme Implementation Plan

  30. Streamlining Fund Flow • Funds transfer to States taking 1 – 3 Months. • Electronic Transfer of Funds to States started • New system introduced wef 1st January 2006. • Cuts down security risk in funds transfer. • Business process, both within the Ministry and in the banking system, was reengineered.

  31. Deliverables 07-08

  32. Key deliverables 2007-08

  33. Key deliverables 2007-08

  34. Key deliverables 2007-08

  35. Key deliverables 2007-08

  36. CHALLENGES & ISSUES • Complexity of the sector (Cross linkages with poverty, illiteracy, social customs) • Governance issues • Involvement of states • Assured availability of incremental Outlays for Mission period. • Shortage of manpower / lack of capacity • Empowerment of PRIs & community

  37. UnlearnUnlearnUnlearnUnlearn

  38. NRHM is not a scheme/project/programme • It is a overarching umbrella which seeks to strengthen the health system and improve efficiency of constituent initiatives • NRHM is not ‘new improved RCH II’ • Cross cutting / common strategies • Expanded paradigm for Health sector reform • NRHM is not about substitution of state funding by GoI funding • Performance & milestone based funding • 15 % funding by state in XI plan • Increase state budget by 10 % annually • Rationalise administrative and financial sanction powers • NRHM is not about contractual workers • Decentralised articulation of need and local site solutions instead of centrally driven recruitment/procurement/planning. • Residency criteria- recruitment against a facility-remunerate as per requirement-fill up state vacancies if they exist

  39. The Explanatory notes

  40. 18 High Focus states which include : • 8 Empowered Action Group States : • Bihar, Jharkhand, Madhya Pradesh, • Chhattisgarh, Uttar Pradesh, • Uttaranchal, Orissa and Rajasthan • 8 NE States • Himachal Pradesh and Jammu & Kashmir. • High Focus states are entitled to : • Fund allocation with weightage of 1.3 (for NE states 3.2) • support for all ASHAs • 30 % of allocation may be deployed for civil construction • Other than High Focus states are entitled to : • Fund allocation with weightage of 1.3 (for NE states 3.2) • Support for ASHAs in tribal and underserved areas • Support for Link workers under RCH II • 25% allocation may be deployed for civil construction • All other strategies are applicable in the same manner uniformly across all states

  41. Annexures • Composition of • Mission Steering Group • Empowered Programme Committee • State Health Mission • District Health Mission • Rogi Kalyan Samitis • Advisory Group on Community Action • Asha Mentoring Group • Explanatory Notes • Illustrative State Innovations

  42. THANK YOUwww.mohfw.nic.intarun.seem@nic.in

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