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NRHM - Assam Issues for mid course learning. 2 nd CRM , NRHM Nov-Dec 2009. Positives. NRHM has stirred an almost non existent Public Health system More OPD, IPD, Procedures, referral connectivity Substantial upgradation of Physical infrastructure & Human R
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NRHM - AssamIssues for mid course learning 2nd CRM , NRHM Nov-Dec 2009
Positives • NRHM has stirred an almost non existent Public Health system • More OPD, IPD, Procedures, referral connectivity • Substantial upgradation of Physical infrastructure & Human R • The health facilities almost universally look brighter, cleaner and functional • New Blood in the form of PMUs has introduced new energy • Huge improvements in planning, budgeting, data mgmt etc • Enhanced funding has improved the morale of the system • Solutions can no w be paid for
Positives • Decentralised, untied funding have restored interest, improved morale. • steps to empower the doctor are giant leaps towards accountable systems • JSY has attracted huge response. • Wards are full and women are happy • Service provider as well as the citizen is coming back into the system. • Political ownership of the sector wide agenda ensures continuity.
Worries • Reform agenda is expanding too fast & therefore spreading energy too thin. Consolidate & Balance visibility Vs sustainability. • Parallel managerial, & financial system have emerged. • PMU staff is not empowered (because they are external). Public system is not accountable & is in need of major structural reform. NRHM is really surviving on temporary workers • Much of OPD/ IPD is RCH related. Gains of JSY are not always leading to better maternity care (pre or para or post natal) and therefore low impact on IMR/MMR. • ANC checks are flat or decreasing in both districts, as evidenced by institutional registers
Worries • Critical bottlenecks are being bypassed in the reform agenda: • Infrastructure rationalization (logical, sustainable and scalable upgradation plan needed) • Human Resource rationalization (Key service regulations, specialist cadre, Nursing cadre, service conditions, salaries, postings need to be addressed) • Equipment and supply chain rationalization (procurement, maintenance, monitoring of use) • Weak Data environment (Information rarely analyzed, interpreted or used for planning • Community enlightenment on health rights (empowerment of community, VHSC, RKS, DHM, SHM, NGOs)
Danger signs • Almost complete non involvement of the Health Directorate. • Non responsive behaviour of service providers. • Super low salaries with permit to practice – recipe for disaster • Almost negligible involvement of grass root NGOs. • Weak capacity for procurement and maintenance. • No capacity building of VHSCs, RKSs, elected representatives. • ASHA support, incentives and mentoring structures evolving. • Additional ANM at SC not expanding services. Home deliveries ?
NRHM needs to rethink on these issues • How to operationalise True delegation and ownership • How to attract HR on sustainable basis. • Rethink on ASHA roles/capacity building and mentoring • Thrust on SCs for expanded services – PHC be second port of call • Transparency and accountability • Real deployment of AYUSH services
The State Govt. is contributing to the construction of Health Institutes in the state. • 750 SC are being constructed by the State Govt. with support from 12th Finance Commission • 3 Medical Colleges are being constructed with state Govt. fund.
The State Govt. to counter pvt. Practice has started Evening OPD in all DH, CHCs/FRUs and BPHCs where the Doctors attending the OPD are getting incentive for their service. • Manpower posting is being rationalized. • Referral fund is being provided to Health Institutes for referral of pregnant women and sick children. The Hospitals are maintaining log book for referral
The State have procured all the medicines and consumables and have been distributed to the districts. • Integrated Drug Management and Supply system is implemented in all the districts. • To ensure regular flow of drugs and consumables, districts have been provided with Drug Store Manager and peripheral Institution have been provided with Pharmacist.
The State has prepared a perspective plan from 2009-10 in terms of population growth, disease burden, manpower requirement, logistic requirement and infrastructure development . • All the Health Institutions have been directed to operationalize their laboratories and to purchases the necessary items from RKS fund. • The maintenance and untied fund is used for necessary repair and maintenance of the Institute • The SCs will be provided with Hb detection kit
The DPMs are assisting the Joint Directors in the district for implementation of the programme. • Hospital Administrators are recruited in the District Hospitals for better management and functioning. • The Joint Directors are provided with monetary support for supervision and monitoring. • Dental Chairs and other equipments have been procured and provided in the Health Institutes where required and manpower have been posted
GoI resource envelope for 2008-09 under NRHM – Rs.58007.73 lakhs • Proposed 15% share – Rs.8701.16 lakhs • Actual contribution by the State Govt. in 2008-09 – Rs.9000.00 lakhs • The underserved areas in the districts are being covered with MMU and Boat Clinic • MIS data are being uploaded in the new software and data validation is taking. The Data Managers are being trained for data validation and analysis. • To monitor maternal death, in 2 districts MAPDIER have been started. • Malaria deaths are reported and 14523 ASHAs have been trained to use RDKs, ITBN have been provided
Additional incentive given to doctors under NRHM working in difficult areas. Similar consideration for employees under State Govt. working in difficult areas. • Incentive for para-medics working in difficult area proposed in 2009-10. • Till Dec,08, 297 PHCs are functional as 24x7 and emphasis has been laid upon to operationalize all the PHCs into 24x7 in phased manner • The SC will be operationalized for delivery once the PHCs are converted into 24x7 facilities.
SC are the first point of contact – all the SCs have ANMs. The ANMs along with ASHA and AWW are taking part in Village Health & Nutrition day (VH&ND) • ASHA Mentoring group formed and first meeting held on 24.01.09. The ASHA Resource centre will be operational from February 2009. • The District, Block and Sectoral level ASHA Nodal Officer have been identified. • The ASHA Supervisors will be in place shortly. • The ASHA drug kits are refilled from Sectoral PHC, Procurement of new ASHA drug kit going on. • Under JSY, for home delivery, payments are made to the beneficiaries meeting the requisite criterias.
