Decentralisation Initiatives in Gujarat

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• Decentralisation Initiatives in Gujarat
• Health Sector Reforms
• Department of Health FW
• Government of Gujarat

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Gujarat A Profile
The Planning Commission has set a target growth
rate of 10 p.a. for Gujarat
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• Background
• The Sector Investment Programme (SIP) started in
  Gujarat in January 2000, initially in two
  districts, Narmada and Rajkot
• Following the earthquake in January 2001, 9
  affected districts were also taken up to
  implement Reforms with Reconstruction
• In January 2005 the remaining 14 districts were
  also covered under the SIP, making a total of 25
  districts

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• Institutional mechanisms
• The State Health Sector Reform Cell constituted
  in 1999 for the EC supported SIP
• Standing Committee On Voluntary Action was
  created in early 2000 to expedite the
  disbursement of funds
• The Reconstruction Sub Committee constituted in
  2002 for post earthquake activities

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• Following the earthquake the State Programme
  Implementation Unit established to manage and
  administer the Repairs and Reconstruction of
  health facilities.
• DPIUs were established to monitor and supervise
  the Repair and Reconstruction works at local
  level.
• District Agencies at the district level to manage
  the reform component. They prepared their own
  District Action Plans in consultation with the
  community and the health functionaries to meet
  the local needs.
• Flexibility in re-allocation of funds at the
  State and the District level according to the
  need and priority.

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Government Policy Resolutions

• Delegation of Powers to Medical Officers PHCs,
  District Societies and Additional Director
  (Family Welfare)
• Delegation of financial and administrative powers
  to Medical Colleges, District Hospitals,
  Community Health Centres (CHCs) and PHCs
• Establishment of Block Health Offices (BHOs)
• Formation of Rogi Kalyan samities

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Decentralisational processes in repair and
reconstruction
Earlier
Total dependence on RB
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Major stakeholders involved and their role
Now
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Monitoring and Evaluation

• Monthly Physical and Financial Progress Report
  (SOE)
• Supervisory visits by state and district program
  managers
• Review in District RCH society meetings and
  review in state and district level meetings

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Issues

• Lack of trust and fear - Funds could not be
  utilized in a few districts where District RCH
  societies did not release fund to MO
• Fund flow to MOs delayed due to lack of Bank
  Account but now streamlined
• Proper orientation to stake holders on purpose,
  process and output required
• Delegation of powers only for donor agency fund,
  now being institutionalised

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Work carried out by PIU (RSRR)
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Progress Report NC -1
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POST EARTHQUAKE REDEVELOPMENT PROGRAMMENEW
CONSTRUCTION (Pipeline)
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• Chiranjivi

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OBJECTIVES- Vision 2010, Population Policy RCH
II

• Reduce MMR from 389 (in 1998) to 100 per
  100,000 live births by 2010
• Reduce IMR from 60 to 30 by 2010
• Stabilize population by reducing TFR
• from 3.0 to 2.1 by 2010

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Maternal Mortality UK 18401960
Improvements in nutrition, sanitation
Antibiotics, banked blood, surgical improvements
Antenatal care
Maine 1999.
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Maternal Mortality ReductionSri Lanka 19401985
85 births attended by trained personnel
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Three Delays Responsible for Maternal Deaths

• Delay in deciding to seek care (Individual
  family)
• Lack of understanding of complications
• Gender issues, Low status of women
• Socio-cultural barriers to seeking care
• Poor economic condition of the family
• Delay in reaching care ( Community System)
• Lack or underutilization of transport funds
• Non availability of referral transportation in
  remote places
• Lack of communication network
• Delay in receiving care (System)
• Poor facilities, personnel and Supplies
• Poorly trained personnel with indifferent attitude

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Service Charges for participating Gynecs
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Chiranjivi preliminary results
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HRD Reforms

• Grading of PHCs, CHCs and special training for
  poorly performing districts manual for MOs
  web site
• Three month PDP for district and block level
  officers
• Karma yogi motivational training program to
  change the attitude of government employees-
  conceptualized by Hon. Chief Minister
• PG seats reserved for admissions to doctors
  serving in rural areas - regular deputation for
  DPH programmes
• Computerised data base for doctors
• Filling up of vacant posts of MPHW by SI - three
  month Bridge course for sanitary inspectors

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Innovations

• Web based Integrated Disease Surveillance
  Programme
• Improved MIS through computer applications- RCH
  software
• Transparency - information sharing through web
  site
• CRS
• GIS application spatial distribution of health
  fcailities - Village wise data for malaria, and
  RCH
• Urban health
• NGOs

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Innovations 2

• Decentralised recruitment of Medical Officers
  Powers of ad-hoc appointment delegated to RDDs
• Chiranjivi
• Rogi kalyan Samiti
• Computerisation of hospitals
• Telemedicine
• MCCD

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Integrated Disease Surveillance
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Next phase of reforms

• Strategic planning cell
• Functional management
• Computerised financial management, budgeting, and
  auditing
• Monitoring and evaluation functions
• HRD systems
• Extensive use of IT
• Decentralised management through RDDs
• Outsourcing CHCs and DHs
• Revamped CMSO
• Communitisation - effectiveVillage health
  societies
• Ombudsman

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Further Information

• PROD reference number 2 Medical Officers
  authorised to arrange maintenance and repairs on
  Primary Health Centres, Gujarat.
• PROD reference number 31 Establishment of
  District Health Agencies to manage health
  services, Various States.
• www.prod-india.com

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Government of Gujarat and European Union a
fruitful partnership
THANK YOU
January 2006
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Trends in leading causes of deaths
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National RNTCP Status 2Q04/2Q05
Cure Rate
Case Detection Rate
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School health programme

• School check up for 10 million children annually
• 1.6 million students treated on site 75,000
  students referred for tertiary care more than
  70,000 children given spectacles
• More than 5000 children provided super specialist
  heart, kidney and cancer care at Government cost

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