DM1.ppt

1. National Rural Health Mission for Primary Health Care? Dr. Dhruv Mankad Sr. Consultant, School of Health Science, YCMOU, Nashik

2. Thursday, June 18, 2009 YSP5-IGIDR Primary Health Care – Indian vision, 1946 ‘If it were possible to evaluate the loss, which this country annually suffers through the avoidable waste of valuable human material and the lowering of human efficiency through malnutrition and preventable morbidity, we feel that the result would be so startling that the whole country would be aroused and would not rest until a radical change had been brought about' (Bhore Committee Report 1946).

3. Thursday, June 18, 2009 YSP5-IGIDR What is primary health care? VI • Primary health care is essential health care based on practical, scientifically sound • socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and • at a cost that the community and country can afford Alma Ata Declaration, International Conference on Primary Health Care, Alma-Ata, USSR* , 6-12 September 1978 * Now Almaty, Kazhakstan

4. Thursday, June 18, 2009 YSP5-IGIDR Primary Health Care – an Alma Ata product VI • It forms an integral part both of the country's health system, of which it is the central function and main focus, and of the overall social and economic development of the community. • It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

5. Thursday, June 18, 2009 YSP5-IGIDR Primary Health Care – an Alma Ata product • VII Primary health care: 1.reflects and evolves from the economic conditions and sociocultural and political characteristics of the country and its communities and 2.is based on the application of the relevant results of social, biomedical and health services research and public health experience;

6. Thursday, June 18, 2009 YSP5-IGIDR Alma Ata Declaration 1978 3. addresses the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly; 4. includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs;

7. Thursday, June 18, 2009 YSP5-IGIDR Alma Ata Declaration, 1978 5. involves, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communications and other sectors; and demands the coordinated efforts of all those sectors; 6. requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate;

8. Thursday, June 18, 2009 YSP5-IGIDR Alma Ata Declaration, 1978 6. should be sustained by integrated, functional and mutually supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need; 7. relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.

9. Thursday, June 18, 2009 YSP5-IGIDR Features of PHC -1 •Primary Health Care = a paradox, it is complex

10. Thursday, June 18, 2009 YSP5-IGIDR Factorspectrum of Health

11. Thursday, June 18, 2009 YSP5-IGIDR Primary Health Care Spectrum

12. Thursday, June 18, 2009 YSP5-IGIDR Features of PHC - 2 •Primary Health Care involves community, evolves from its social, cultural, political context

13. Thursday, June 18, 2009 YSP5-IGIDR Factorspectrum of Health

14. Thursday, June 18, 2009 YSP5-IGIDR Features of PHC - 3 • Primary Health Care has multidimensional, multidisciplinary, multiagency approach

15. Thursday, June 18, 2009 YSP5-IGIDR Content Activities Ministries/Agencies involved Food Supply Grains, Cereal, Tuber, Vegetables and Fruit production Agriculture, Animal Husbandry, Fisheries Proper Nutrition Milk and dairy products, meat and fish Animal Husbandry, Dairies - pvt/cooperatives, FDA Food supply Agricultural Produce Markets Ration Shops Food quality, safety FDA ICDS, Women and Child Development Safe Water Drinking Water Resources, Sewage drainage and disposal, Water purification, Forest and Water Conservation, Irrigation PWD, Sewage drainage and disposal, Water purification agencies, water purifier producers Sanitation Solid waste disposal PWDs, Urban Planning, Environmental Mother (Women) Care Marriage registration, ANC, PNC, CaCx detection, family planning Public Health and Family welfare, FDA, Pharmaceutical and Health device industry, Gynaecological and Obstetric public and private hospitals, fertility clinics Child care Trained Birth Attendant, Institutional delivery, Birth registration, early Breast feeding, Immunization, treatment of illnesses, early child care Public Health and Family welfare, FDA, Pharmaceutical and Health device industry, Paediatric clinics/hospitals, vaccine industry

16. Thursday, June 18, 2009 YSP5-IGIDR Content Activities Ministries/Agencies involved Endemic Disease NHPs Public Health departments, Integrated surveillance system, Public and Private health care providers, Pharmaceutical and Health device industry, Preventing methods Pollution Control, Occupational Hazards All of above, Environmental Board, Traffic Control, Disaster Management Treatment of common illnesses and injuries Diagnose and treat illnesses Public Health departments, Integrated surveillance system, Public and Private health care providers, Pharmaceutical and Health device industry, Essential drugs Treat common illnesses Public Health departments, Integrated surveillance system, Public and Private health care providers, Pharmaceutical and Health device industry, Health Education For about all of the above IEC bureau, Education ministry and institution, ICT, ISRO, telecommunication, communication media incl internet, radio, television and film industry, advertisement

17. TRENDS IN RURAL PRIMARY HEALTH CARE SERVICES

18. Thursday, June 18, 2009 YSP5-IGIDR PHC Status in India • ''In rural areas, there are no doctors. They (PHCs) are functioning only on paper. There is no facility at PHCs. Hospitals function without any doctor,'' − a SC bench comprising Chief Justice K G Balakrishnan and Justices Ashok Bhan and P Sathasivam * * ToI 2nd October 2008

19. Thursday, June 18, 2009 YSP5-IGIDR STATUS OF RURAL HEALTH SERVICES • Greater Burden of Diseases • Lower coverage of public health services • Inequality in workforce distribution/ accessibility – globally, nationally

20. Thursday, June 18, 2009 YSP5-IGIDR

22. Thursday, June 18, 2009 YSP5-IGIDR What about our villages, city wards? • Is there an equal distribution of HWs in villages? Trend is – NO! • One HW per 16 villages – Nasik survey • Situated at market towns, In towns, at marketplaces • Shift from residential to market, from family health care to consultancy!

23. Thursday, June 18, 2009 YSP5-IGIDR Health Workforce in villages Districts 1 doctor per no. of villages 1 doctor per rural Population Jalna 8 11346 Khammam 6 10340 Kozhikode 0.2 3180 Nadia 4 10820 Udaipur 4 4006 Ujjain 4 3612 Vaishali 6 10549 Varanasi 3 3979 Total 4 5963

24. Thursday, June 18, 2009 YSP5-IGIDR PHC – Demand v/s Supply

25. Thursday, June 18, 2009 YSP5-IGIDR PHC Economics – Current Scenario* • RURAL (Primary/ Secondary) per 1000 Beds 0.2 Doctors 0.6 PE 80,000 OoPs! 750,000 IMR 74/1000 LBs U5MR 133/1000 LBs Births Attended 33.5% Imm. 37% ANC median 2.5 • URBAN (Secondary/ Tertiary) per 1000 Beds 3.0 Doctors 3.4 PE 560,000 OoPs!! 1,150,000 IMR 44/1000 LBs U5MR 87/1000 LBs Births Attended 73.3% Imm. 61% ANC median 4.2 * www.vatsalya.com based on CII McKinsey Study, 2001

26. Thursday, June 18, 2009 YSP5-IGIDR PHC Current Scenario Public Private Rural Existing, Low public exp, Inaccessible, Weak performance Sporadic, Inaccessible, un/affordable, Weak performance Urban Low existence, High public exp, accessible, Mod. performance Strong existence, Un/affordable, Accessible, Good and Limited performance

27. Thursday, June 18, 2009 YSP5-IGIDR WHY NRHM? PROBLEM 1 • High and Static IMR • High Out of pocket expenses • Population Stabilization unstable • Public Health System thinning down

28. Thursday, June 18, 2009 YSP5-IGIDR WHY NRHM – PROBLEM 2 • Community involvement low • Health structure run with saline- syringes • NGO involvement also low • Pvt sector though large not linked with public health programmes

29. Thursday, June 18, 2009 YSP5-IGIDR WHY NRHM – PROBLEM 3 • Budgetary Allocation to Health had declined 1999 – 2002 • GoI contributing less than State • Health care services not for poor • 10% covered under insurance • Hospitalized patients pay about 58% of their annual income, 40% borrow ALL THESE WHEN WE HAD COMMITTED IN 1946!

30. Thursday, June 18, 2009 YSP5-IGIDR A Rural Primary Health Care package  Universal Health Care  Accessibility and Affordability  Quality and Equity Reduce IMR, MMR, TFR NRHM - GOALS

31. Thursday, June 18, 2009 YSP5-IGIDR NRHM - THE VISION • Architectural correction in health care delivery • Special focus on 18 states with weak indicators. • Improve availability of quality health care in rural areas • Synergy between health and determinants of good health • Mainstream the Indian Systems of Medicine. • Capacity Building. • Involve the community in the planning process.

32. Thursday, June 18, 2009 YSP5-IGIDR EXPECTED OUTCOMES 2005 - 12 • Universal Quality Health care. • IMR reduced to 30/1000 live births • MMR reduced to 100/100,000 live births • TFR reduced to 2.1 • Malaria Mortality Reduction Rate – 60% • 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

33. Thursday, June 18, 2009 YSP5-IGIDR Indicator 2005-06 2006- 07 2007- 08 2008- 09 2009- 10 Institutional Deliveries 54.1 56.6 59.1 61.6 64.1 Skilled birth Attendants 58.8 61.8 65.8 69.8 74.3 Fully Immunized Children 80.6 83.6 88.6 90.6 93.6 Couple Protection Rates 59.7 61.7 64.7 66.7 69.7 Full ANC care Received 50.8 55.8 62.8 69.8 78.8 Unmet Need for Family Planning 4.2 3.2 2.7 1.7 1.0 Goal Indicators

34. Thursday, June 18, 2009 YSP5-IGIDR NRHM components A RCH II B Innovation under NRHM C National Health Programs D Disease Surveillance Programs E Inter-sectoral convergence

35. Thursday, June 18, 2009 YSP5-IGIDR • Public Health expenditure - 2 – 3 % of GDP • Merger of societies at District level • Integration of existing schemes • Decentralized planning • Intersectoral convergence with other Health determinants • Community ownership of Health facilities • Upgradation of CHCs / PHCs to IPHS • Mainstreaming of AYUSH • Partnership with non Government providers. • Risk Pooling • Fully trained ASHA in each village. What’s New

36. Thursday, June 18, 2009 YSP5-IGIDR NRHM-5 MAIN APPROACHES COMMUNITIZE IMPROVED MANAGEMENT THROUGH CAPACITY BUILDING MONITOR PROGRESS AGAINST STANDARDS INNOVATION IN HUMAN RESOURCE MANAGEMENT FLEXIBLE FINANCING

37. Thursday, June 18, 2009 YSP5-IGIDR State and District Health Mission • State Health Mission led by CM – • SPMU - Mission Directorate, SHRC • Prepare and approve State Health Action Plan

38. Thursday, June 18, 2009 YSP5-IGIDR State and District Health Mission • District health mission led by chair ZP, DHO, dept reps, • DPMUs • Prepares and implements DHAP

39. Thursday, June 18, 2009 YSP5-IGIDR Village Empowerment • Village Health, Nutrition, Water & Sanitation Committee (VHNWSC) • Village level revolving funds • Preparation of village specific plans • Convergence of all developmental activities

41. Thursday, June 18, 2009 YSP5-IGIDR Reproductive and Child Health (RCH) programme Major component of NRHM • Maternal Health – 24x7 hrs services – JSY – Additional ANMs – On contract Experts – Infrastructure upto IPHS std • Child Health • Reproductive Health of Men and Women

42. Thursday, June 18, 2009 YSP5-IGIDR Reproductive and Child Health (RCH) programme Major component of NRHM • Child Health – Immunization: BCG,OPV, DPT, TT, HepB • Reproductive Health of Men and Women – Family Planning • OP, Tubectomy, CuT for women • Condom, Non scalpel vasectomy for men – Safe Abortion – STD – Adolescent RCH

43. Thursday, June 18, 2009 YSP5-IGIDR Reduce maternal and infant death thru’ institutional deliveries JSY – AN INTEGRATED PACKAGE:  Tracking entire pregnancy period Adopt Micro- birth plan  Providing appropriate referral and transport assistance,  Building an effective link between service provider and pregnant woman, through ASHA PLUS CASH ASSISTANCE RCH II Janani Suraksha Yojana

44. Thursday, June 18, 2009 YSP5-IGIDR • PROVISION FOR CAESAREAN SECTION : – Empanel private/Govt. doctors, – up to Rs. 1500/- per case for hiring services of experts from private sector, – If private doctors are not available, utilize this amount for providing honorarium to Govt. specialist. RCH II Janani Suraksha Yojana

45. Thursday, June 18, 2009 YSP5-IGIDR N H Ps • Revised National TB Control program • National Vector Borne Diseases Programs, eg Malaria, Urban Malaria, Dengue, Chikunguniya, Filaria, Japanese Encephalitis, Swine Flu • National Leprosy Eradication Program • National AIDS control Programme • National STD Control Programme

46. Thursday, June 18, 2009 YSP5-IGIDR N H Ps • National Blindness Control Program eg Cataract Operations, Refractory Errors in school children • National Leprosy Eradication Program • National Iodine Deficiency Control Program by promoting iodated salt • National Mental Health Programme • National Cardio-vascular Diseases Control Programme • National Cancer Control Program • National Occupation Disease Control Program • National Diabetes Control Program

47. Thursday, June 18, 2009 YSP5-IGIDR Revised National TB Control Programme (RNTCP) • Operational Structure – Central Govt : Dy DGHS (TB) – State Govt : State TB Cell with STO – District: DTU with DTO – Sub District – MO – TC ( 1 per 5/2.5 lakhs) – Designated Microscopy Centre (DMC): for Med College, NGO, Pvt Hospital nodal point for record report at Sub District Level – Peripheral Health Inst • Diagnostic Laboratory Services • Drug Stores

48. Thursday, June 18, 2009 YSP5-IGIDR Revised National TB Control Programme (RNTCP) – Lab/DOTS • Central Laboratories with international recognition at Chennai, Bangalore and Delhi • DMC and Sputum Collection Centres networks – Case Detection, finding and Diagnosis of Lung TB • DOTS

50. 53  OPERATIONALIZE 24/7 SERVICES – PHC & FRU ACCREDIT PRIVATE INSTITUTIONS:  Empanel atleast two accessible private health institutions in each Block,  Draw up a protocol of services to be delivered at these recognized health centers,  Give wider publicity to such institutions by displaying names of such institutions in every PHC/CHC/District Hospital and the sub-center, Constant monitoring of the Quality of services Infrastructure Improvement

51. Thursday, June 18, 2009 YSP5-IGIDR 24 X 7 PHCs Pre requisites for 24 x 7 PHC delivery services Sterilization services STI / RTI management Safe Abortion services (MVA) 24 x 7 services  Identify gaps & address appropriately Repair of physical structure – labour room & OT Skill enhancing training of MO, SBA Transport & referral Logistic support Provision of 24X7 delivery services at least in 50% PHCs

52. Thursday, June 18, 2009 YSP5-IGIDR PHCs Strengthening PHCs • Supply of essential drugs to PHCs • Upgrading single-doctor PHC to two-doctor PHC by posting AYUSH practitioner • Providing standard treatment protocols and training medical officers / paramedics in their use Repairs for SC / PHC: • Sub-center upto Rs. 50,000/- • PHC upto Rs.1.00 lakh

53. Thursday, June 18, 2009 YSP5-IGIDR New and Old Construction • Additional 2627 SCs, 394 PHCs, 95 FRUs • Improvement Training Centers • Maintenance of existing and new construction (35 DHs, 500 FRUs, 2200 PHCs)

54. Thursday, June 18, 2009 YSP5-IGIDR Strengthening Sub-centres •Untied fund @Rs.10,000/- •Supply of essential drugs •Additional outlays: local ANMs on contract etc.

57. Thursday, June 18, 2009 YSP5-IGIDR Workforce Planning Political Commitment Motivational Environment CRITICAL FACTORS Long term •recruitment •training •Pre service training •Sustained Long term efforts •High Investment •Information • Incentive and Motivating work environment TRAINING POLICY Quick Fix Medium term Long term ODL, On Job, Flexi Curriculum reform Outsource trg, Build Instt KMC More Primary Care Providers More Nurse, MPH More Spl Dr, MDG 6 MDG 5 MDG 4 CHR ILLNESSES

58. Thursday, June 18, 2009 YSP5-IGIDR ASHA (NRHM) •Accredited (Trained through recognized institution) •Social (NGO-SHG-PRI network) •Health (managing biomedical and social determinants of health) •Activist (non-profit based services, and community active model)

59. Thursday, June 18, 2009 YSP5-IGIDR ASHA: TASKLIST • Village microplanning with others • Improvement of hygiene and sanitation through IEC-BCC • Maternal and child health, helping AWW and ANM, for preventing malnutrition • Basic medical care • Referral and JSY • Depot holder for DOT and malaria • Helping in all National Health Programmes (NHP). • Reporting outbreaks and keeping basic health records

60. Thursday, June 18, 2009 YSP5-IGIDR ASHA: TRAINING • Home based neonatal care • Treatment of common childhood illnesses like diarrhea, ARI • Identification of high risk mother & child & appropriate referral • Health & nutrition education

61. Thursday, June 18, 2009 YSP5-IGIDR ASHA – YCMOU’s Arogyamitra • Woman selected by GP/ SHG/ Youth • VII std • 21 years age • Training 28 days (32 CPs) • Fee = 800 YCMOU, 2500 SC • 5 books+Wkbk+exam

62. Thursday, June 18, 2009 YSP5-IGIDR Arogyamitra Program 2007-08 Results Women Learners Men Learner Total No. % No. % No. % Passed 305 77 224 78 529 78 0-49.99 (Failed) 90 23 63 22 153 22 Total 395 100 287 100 682 100

63. Thursday, June 18, 2009 YSP5-IGIDR CHW measuring respiratory rate

64. Thursday, June 18, 2009 YSP5-IGIDR CHWs trained for treatment for minor ailments

66. Thursday, June 18, 2009 YSP5-IGIDR Strengthening Nursing • Strenghtening SCs with 12000 ANMs • Strengthening 21 Training Schools • Strengthening PHCs with about 1500 staff nurses, Blocks with a PHN • Nursing Cell at the state

67. Thursday, June 18, 2009 YSP5-IGIDR Rogi Kalyan Samiti • People’s reps, Health Officials, Local District Officials, community Leaders medical Supdt, IMA Rep, donors • Flexi fund available DH, RH and PHC level. Can raise addl. Funds to – Improve existing services, facilities – Introduce new services – Can procure medicines, equipments, recruit addl staff, have PPP MoU etc.

69. Thursday, June 18, 2009 YSP5-IGIDR Services guaranteed in CHC with IPHS • New born care • Routine and emergency care of sick children • National Health Programmes • Blood storage facility • Essential laboratory services • Referral services

70. Thursday, June 18, 2009 YSP5-IGIDR Quality Assurance • Regulation • Accreditation • IPHS • Revised PHC Manual and Treatment Protocol • RKS as Quality Assurance Mechanism • Citizen’s Charter and Guarantee Scheme

71. Thursday, June 18, 2009 YSP5-IGIDR Quality Assurance Area Specific Activities Technical Quality Improvement • Standard Treatment Protocols. • Grading of PHC done by state government Technical parameters • Grading of public health institutions (CHC/FRU/DH) • Accreditation scheme for private sector hospitals • CME for Private Medical Practitioners. • Refresher's skill training to ANM, MO for building confidence , training in IMNCI etc. • Management Development trainings for program managers at all levels

72. Thursday, June 18, 2009 YSP5-IGIDR Area Specific Activities Managerial Quality Improvement • Random visits to check humane approach and 3rd delay in treatment • Developing a procurement and distribution system • Improved monitoring of infrastructure, staff availability, functionality of equipment, institutions • Equipment maintenance contract (AMC) • Inter-departmental convergence • Client satisfaction surveys • Special training package • Financial management and audit • Use of MIS analysis and feedback • Sensitization on gender and equity issues, • Feedback and follow-up of trainings Quality Assurance

73. Thursday, June 18, 2009 YSP5-IGIDR District Health Action Plan • Microplanning • DHAP built up on Monthly Plan • HH facility periodic survey as basis • PPP with NGO, professionals

74. Thursday, June 18, 2009 YSP5-IGIDR Next funds will be released on receipt of SOEs for atleast 50% of previous releases Expenditure & physical performance (no. of beneficiaries) should match Ensure grants are used for the purpose for which grants given All activities in the PIP should be initiated Diversion of grants not permitted PERFORMANCE BASED FUNDING FOR RCH

75. Thursday, June 18, 2009 YSP5-IGIDR State Resource Center • An agency to pool the technical assistance from all the Development Partners • A single window for consultancy support • for capacity building not only for SRHM but for improving health sector service delivery

77. Thursday, June 18, 2009 YSP5-IGIDR I D S Program • Integrated Disease Surveillance Program – decentralized, state based – improve information about communicable and non communicable diseases – identify major risk factors incl. environmental, social and political

78. Thursday, June 18, 2009 YSP5-IGIDR I D S Program It would also – Improve laboratory support; – Train stakeholders in disease surveillance and action; – Coordinate and decentralize surveillance activities – Involve private sector

79. Thursday, June 18, 2009 YSP5-IGIDR Monitoring & Evaluation • Habitation/ Village Health Register • Periodic Health Facility Survey at SHC, PHC, CHC, District level • Formation of Health Monitoring and Planning Committees at PHC, Block, District and State levels • Sample household and facility surveys • Community based monitoring

80. Thursday, June 18, 2009 YSP5-IGIDR Monitoring & Evaluation Outputs/ Outcomes Objectively verifiable indicator (OVI) I) General goals and objectives of NRHM Reduction in IMR, TFR and MMR MMR reduced to 200 by 2010 IMR reduced by 20 by 2010 Neonatal mortality rate reduced to 10 by 2010 TFR brought down to 2.0 by 2010

81. Thursday, June 18, 2009 YSP5-IGIDR Monitoring & Evaluation Sr.No. Overall Results Indicators Expected level of achievements Indicators Baseline 2006-7 2007-08 2010-11 1 Contraceptive prevalence rate (Current use of any contraceptive method among currently married women) 61.6 70 75 2.75 % Eligible couples using IUD for more than 12 months 57 60 3.6 % of mothers who delivered during past 3 years & who received IFA for 3+ months 36% 90 95 4.95 % Deliveries assisted by skilled attendants at birth One-fourth home births (36%) 83 95 5.95 % of 24hr PHCs conducting minimum 10 deliveries/ months All 7 currently conducting >10 del 35 50 6.5 No. of Upgraded FRUs offering 24hr. emergency obstetric care services 28? 150 7.15 % of 12-23 months of age fully immunized children 84% 90 95 8.95 % of mothers and newborn children visited within 1 week of birth among non institutional deliveries NA 50 60 9.6 % of children under 3 years of age with diarrhea in the previous 2 weeks who received oral dehydration salt NA 45 60 10.6 % of children under 3 years of age with diarrhea in the previous 2 weeks who received oral dehydration salt NA 45 60 11.6 Polio free status achieved since when Not yet Polio-free Polio-free 12 No. of institutions upgraded to IPHS Process begun 198 360 Selection and training of ASHA Starting year 1300

83. Thursday, June 18, 2009 YSP5-IGIDR Interdepartment Convergence • WCD for Nutrition, Women Empowerment • TDD for Tribal Health Monitoring, Pada Swayamsevak, Shabari taxi Yojana • Water and Sanitation • Rural Development for EGS, Income Gen Schemes • Urban Development for RCH • PWD for construction • Med Education Dept for IDSP, Medical Audits • MUHS for CME • DoEdu for Annual health check up • Missions – RJCHNMission, HDMission for Nutrition

84. Thursday, June 18, 2009 YSP5-IGIDR Public Private Partnership PPP in health is an approach to solving public health problems by complimentary efforts of public, private and NGOs by contributing or sharing their core competency Synergy is the spirit of better health outcomes

85. Thursday, June 18, 2009 YSP5-IGIDR Current Focus of PPP in Health • Develop strategies to utilize untapped strengths of the NGO sector • Enhance the capacity to meet growing health needs • Sharing responsibilities of public health activities by the government with NGO • Reaching remote areas; target specific group of populations • Improving efficiency through evolving new management structures

87. Thursday, June 18, 2009 YSP5-IGIDR State Specific Innovative Schemes Eg in Maharashtra 1. Sickle Cell Anemia 2. State Nutrition Bureau 3. State Public Health Institute 4. Action research project eg HBNC in 4 districts 5. Computerization of HMIS 6. Arogya Jaal - DIGITAL CHC WITH TELE DIAGNOSTICS 7. Untied funds for awards, scholarship, study tour etc.

88. Thursday, June 18, 2009 YSP5-IGIDR Proposed District Specific Innovations Eg Nashik DHAP • Management by alliance • Transportation with Taxi

89. Thursday, June 18, 2009 YSP5-IGIDR Innovations To be Tapped • Convergence of TDD’s Taxi scheme and referral transport for BPL /ST patients • Collaboration with dai for antibleeding medicines

90. Thursday, June 18, 2009 YSP5-IGIDR Lateral Thinking Options in NRHM • Technology Options – Water Sources, GPRS-Internet, simplify technology – auto-destructive syringe for gentamycin (test level), solar disinfections, ppt as trg mode, cell phone or FM • Structural-managerial Options – RKS in designing, financing and constructing, managing health units, flexi funds, local procurement/ purchase • Collaborative Options – with NGOs, CBOs, religious, political, social, professional organizations, military, corporate sector, experts and volunteers

91. Thursday, June 18, 2009 YSP5-IGIDR NRHM Is it a ‘Mission Impossible IV’ ?? Workable but highly ambitious mission, bcoz… • Mindsets ready for some U turns? • Staff availability? • Decentralization nebulous • ASHA – training, supervising plan? no economic incentive? • Workforce training plan? • HR environment – motivation, recruitment, transfer, punishment posting • Incentives to staff for retention, motivation? • Intra department Convergence - Does the left hand knows what the right hand is doing?

92. Thursday, June 18, 2009 YSP5-IGIDR NRHM Make it a ‘Mission Impossible IV’ !! • Insuring Health, Ensuring Equity - Which Health Insurance model to work? • Is community/govt prepared for innovations? • Political Will – for? – Will for a Visionary plan – Will for High human/financial investment – Will for real PPP : within govt., with civil society, corporate – Will for effective regulation

93. Thursday, June 18, 2009 YSP5-IGIDR PHC ‘Economics’ “The important thing for government is not to do things which individuals are doing already, and to do them a little better or a little worse; but to do those things which at present are not done at all” - J. M. Keynes 1926

94. Thursday, June 18, 2009 YSP5-IGIDR People’s Health Watch Report – General Findings • No evidence of infrastructure improvement • Shortage of Medicines, staff and so IPHS facilities a far cry • ASHA selection, training, performances and payment distorted • RKS defunct/ disfunctional

95. Thursday, June 18, 2009 YSP5-IGIDR People’s Health Watch Report – General Findings • Institutional delivery incentives – a problem – competition between ASHA, ANM, AWW etc. – ID does not = delivery by trained or EmOC • No decentralization/communitization • DHAP is really TD DHAP • Insufficient, inadequate Monitoring and analysis documentation • Corruption !? Reports from orissa, MP, Maharashtra • Political will NOT for reforms but for repackaging SO WHAT IS THE OPTION ?

96. Our Arogyabank A proposed model of Health Information and Care Kiosk For A healthy life, bank upon us…

97. Thursday, June 18, 2009 YSP5-IGIDR Why AB? • Developing a first contact cae model where there is no primary health care provider • Addressing common health problems of community • Promoting activities for healthy lifestyle • Providing referral services, pre and post referral counseling to patients • Managing emergency and disaster management services • Facilitating home based health care services

98. Thursday, June 18, 2009 YSP5-IGIDR What do people need? – Simple treatment for simple illnesses – Monitoring health problems eg Heart attack, Brain hemorrhage, Diabetes, T.B., AIDS, Cancer, Malaria, Chikunguniya etc – Actions/steps during any outbreak – Home based caring services for elderly, post illness recuperating, temporarily disabled, long term health monitoring services – Effective health commnication – Screening illnesses – Health counseling

99. Thursday, June 18, 2009 YSP5-IGIDR The AB Model • A Shelter – existing building, a shop or a kiosk with adequate space, scrap vehicle, a locally made shelter like these…

100. Thursday, June 18, 2009 YSP5-IGIDR The AB Model – a multiowned model • With logos – of implementing agency, concept developer agency, supporting agency: a multi logo with a logo of Arogyamitra • like these…

101. Thursday, June 18, 2009 YSP5-IGIDR The AB Model – what all it can have • Furniture/Equipmen ts • Chair, table, cupboard • Stetho, BP, trays, dressing material • Boxes for storing medicines • Bandages, slings, splints

102. Thursday, June 18, 2009 YSP5-IGIDR The AB Model – what all it can have • OTC medicines, medicines for MPWs • First Aid material • Ayurvedic Medicines • Homeopathic medicines • Home remedies • Reagents/strips for Sugar,protein and Hb tests • Massage oil

103. Thursday, June 18, 2009 YSP5-IGIDR The AB Model – what all it can have • PC with printer, CD drive • Internet connectivity • Learning Material CD • Health Education CD • Print materials, books etc. • Cellphone

104. Thursday, June 18, 2009 YSP5-IGIDR The AB Model – what all it can do • Provide First Contatct care through ASHA/ USHA/MPW • Participate in Public Health Programmes • 0-5 child care • Provide emergency first aid • Provide support care • Screen illnesses like BP, Diabetes, disabilities etc

105. Thursday, June 18, 2009 YSP5-IGIDR The AB Model – what all it can do • Provide HE, School Health • Provide information through internet, print material • Contact referral units through email, cellphone, • Can escort patient to secondary/ tertiary care level • Self learning centers

106. Thursday, June 18, 2009 YSP5-IGIDR The AB Model – other possible uses • Health Insurance Agency • Healthy food, Health and beauty product outlet • Non medical equipment outlet • Computer Literacy Centre

107. Thursday, June 18, 2009 YSP5-IGIDR Expected Impact • Improved quality of life of vulnerable population • Improved responses from community in personal and collective emergencies • An innovative primary health care model

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