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Health Sector Reforms

Health Sector Reforms. Shiv Chandra Mathur Director State Institute of Health and Family Welfare, Rajasthan, Jaipur. Challenges to the Health System. Stagnant public spending on health Between 75-90% spending by states. Largely tied up in salaries expenditures

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Health Sector Reforms

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  1. Health Sector Reforms Shiv Chandra Mathur Director State Institute of Health and Family Welfare, Rajasthan, Jaipur

  2. Challenges to the Health System • Stagnant public spending on health • Between 75-90% spending by states. Largely tied up in salaries expenditures • Curative public services favor the rich • Hospitalization frequently means financial catastrophe.

  3. WDR 1993 - Approaches • Fostering environment enabling households to improve health; • Improving Government spending on Health; • Promoting diversity and competition.

  4. Health Sector Reforms • What do we mean by reforms? • What are the essential components of reforms? • How do reform differ from Normal evolutionary system changes?

  5. Sustained, purposeful change to improve the efficiency, equity and effectiveness of the health sector. Berman,1995 A process that seeks changes in health sector policies, financing, and organization of services, as well as the role of government, to reach national health objectives. Population Council,1998 Health Sector Reformsdefinitions

  6. HSR is concerned with • Defining priorities • Refining policies • Reforming Institutions

  7. HSR deals with • Equity • Efficiency • Quality • Financing

  8. Principles of Health Sector Reforms *Overseeing the needs of the entire population – pro-poor; gender sensitive and client friendly. *Looking forward to the health transition *Removing the blind spot to the private sector *Focusing efforts – by ensuring quality, efficiency and accountability of health services

  9. Functions covered by HSR • Governance • Provisions • Financing • Resource Generation

  10. Key elements of HSR • Structural rather than incremental/evolutionary change; • Change in policy objectives followed by institutional change, rather than redefinition of objectives alone; • Purposive rather than haphazard change; • Sustained and long term rather than one off change; • Political top down process led by national, regional or local government.

  11. Governance related HSR • Evolving standard protocols for care at P/S/T care settings • Quality assurance mechanism such as Consumer Protection Act and Citizens charter for hospitals; • Appropriate delegation of power to PRI’s.

  12. Classifying HSR- financing • User Charges • Insurance • Private sector Growth • Increasing resources to health sector

  13. Classifying HSR- health system organization and management • Decentralization; • Contracting out of services; • Reviewing the public-private mix.

  14. Classifying HSR - Public Sector Reforms • Downsizing the public sector; • Productivity Improvement; • Improving geographic coverage; • Increasing role of local government.

  15. Reforms attempted in Health and F.W.Sector in Rajasthan • Jan Mangal Project 1992 • Strengthening FRU’s 1994-2001 • Decentralized District Planning since 1995-96 • Creation of RMRS-user charges since 1995-96 • Reorganizing the Training System 1995-96 • Concurrent Evaluation in F.W.Program 1996-97

  16. Reforms attempted in Health and F.W.Sector in Rajasthan - 2 • Draft Training Policy 1997-98 • Devolution of Powers to PRI’s - 90’s • Population Policy 2000 • Job Responsibilities specifications 2000 • Preparation of EDL 2000 • Health Vision Document 2025

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