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Rajasthan Health Systems Development Project

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Problem Identification Implementation of best solutions at the facility/district ... Services (Medical, Health care ... Smart Card- 50,000 ... – PowerPoint PPT presentation

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Title: Rajasthan Health Systems Development Project


1
Rajasthan Health Systems Development Project
  • 19th June,08
  • Sustainable Replicable Interventions for Health
    Sector Reforms

2
Brief Overview
  • Agreement between IDA State of Rajasthan- June
    03, 2004
  • Project period - 5 years up to 2009
  • Estimated cost of the Project- 4725.7 millions
  • Investment Cost of the Project- 3979.3 millions
  • Recurring Cost of the Project- 746.4 millions
  • W B Share 83.98 Loan 70 Grant 30
  • State Share 16.02

3
Project Development Objectives
  • To increase access and equity of the
    below poverty line(BPL) and underserved
    population to health care.
  • To improve the effectiveness of health
    care through institutional development and
    increase in the quality of the health care.

4
Initiatives under RHSDP
  • ---addressing Quality component
  • Implementation of Hospital Systems Performance
    Improvement Program
  • Strengthening of HCWM
  • Strengthening of Referral System
  • Hospital Administrators
  • Behavior Change Communication Training
  • Development of STG and EML
  • PPP model contracts developed-Facility out
    sourcing, pharmacy, ambulance, diagnostics
    Mobile clinics
  • Human resource development

5
Quality Initiatives
  • Hospital Administrators (HA)
  • 33 Administrators appointed for assistance to
    the PMOs at District Hospitals.
  • Role
  • To develop and administer, with staff
    assistance, policies directions of the
    hospital governing.
  • Discharge of support services -finance,
    personnel, materials and property,
    housekeeping, laundry, security, transport,
    engineering, maintenance of building including
    landscaping, matters pertaining to patient care
    and welfare

6
Behavior Change Communication Training
  • BCC was organized for medical and paramedical
    staff, as they are the crucial contact point
    between the public healthcare services and the
    community.
  • Objective
  • To improve the Client Orientation, Service
    Behavior and Communication Skills of the medical
    and paramedical staff with the patient and
    community so as to improve the quality of health
    services delivered by the State Health Care
    Facilities.
  • To increase the sense of team spirit among
    providers.
  • To increase the sense of Organizational Belonging
    and Ownership of the system among providers.
  • Cont.

7
  • Cont.
  • Phase 1
  • 30 project facilities of six priority districts
    (Jhalawar, Bharatpur ,Chittorgarh, Dungarpur,
    Jodhpur and Tonk) were covered.
  • 1645 service providers trained.
  • Phase 2 (Proposed)
  • At remaining 19 project facilities in same 6
    priority districts.
  • Refresher training at phase 1 facilities.
  • ToT for sustainability of activity.
  • Total 2200 medical personnel will be trained.

8
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9
Health System Performance Improvement Process
(HSIP) (Basis Fundamentals)
  • Holistic approach for Internalization of
    performance assessment.
  • Problem Identification
  • Implementation of best solutions at the
    facility/district and state level through HSITs
    /HSICs /and HSRT.
  • Trainings, Supplies quality related issues.
  • Monitoring evaluation (ME)Systems.
  • Analysis and internalization of client/community
    feedback on services being offered .
  • Internalization by the department for scaling
    strengthening

10
  • HCWM Interventions
  • Cradle to Grave Management of Hospital Waste at
    343 secondary level facilities as per Bio
    Medical Waste (Management Handling) Rules 1998
    amended in 2000 03
  • Sensitization Trainings ,Workshops IEC
  • Training
  • Training of trainers conducted at the State
    level, two from each district
  • Hands-on training at facilities
  • Total Personnel Trained on Site -13233 persons
    (CHC above)
  • 2nd Round of Training planned -reorientation of
    above Staff at PHCs
  • IEC- Dissemination of HCWM practices related CDs,
    Posters, Flexi Sheets, Protocols Guidelines.
  • Facilitating authorization of Hospitals for HCWM
    from RPCB
  • Authorization - 306 obtained, others applied
  • Civil Works - Construction of Bio Medical
    Waste storage / Burial Pits
  • Procurement - Hospital Supplies and Equipment,
    Protective Gear
  • Common Treatment Facilities (CTFs) - CTF charges
    reimbursed by the project
  • Presently operating CTFs - 9 Districts
    connected to the CTF - 17

11
HCWM-Challenges
  • PRIMARY STAKEHOLDERS
  • Internalization of the concept by all
    stakeholders both within from outside
  • Responsibility Accountability By Whom to
    Whom
  • Trainings as an on going activity.
  • Frequent Changes (transfers of staff) affects
    operations.
  • SECONDARY STAKEHOLDERS
  • C.T.Fs Sustainability- Distances, Volume of waste
    generation the pricing model
  • Multiplicity of agencies Pollution Control
    Board, Local Self Government / Local Bodies,
    Nagar Nigam / Parishad, Hospitals.
  • Accountability of CTFs towards MH department.

12
Referral System
  • Concept
  • Reduce workload at tertiary level institutions.
  • Optimum Utilization of Secondary level hospitals.
  • Rationalize referrals.
  • Identifying gaps in services.

13
Key Interventions -Referral System
  • Development of norms for management of illness
    episodes at different levels
  • Printing and dissemination of referral protocols
  • Printing and distribution of Referral Registers
    and Referral Cards
  • Workshops at State and District level
  • Trainings-Doctors Nurses
  • IEC activities-Signboards, advertisement through
    bus Panels, talks on T.V. Radio, Local Media
    activities.

14
Referral loop
Referral Cards
Green
PHC
Card
Yellow
Green
CHC
Card
Yellow
Green
SDH
Green
Card
Yellow
DH
Feed Back Cards
Card
Red
Teaching Hospital (Medical Colleges)
15
  • ---addressing Access component
  • Health Camps in Outreach areas.
  • Placement of Patient Counselors
  • Emergency Response Services.
  • Implementation of Health insurance Scheme for
    BPL

16
Initiatives for increasing Access
                               
VCD
  Health Camps
  ANC Campaign
 
Patient Counselor
BCC
CBHI
IEC
PPP
ERS
17
Health Camps.
  • Project Objective of Increasing Access is
    being addressed
  • through Health Camps in outreach areas (Tribal
    Desert).
  • Target Population- BPL, Poor and underserved (
    Women, Adolescent Children)
  • Activities-
  • Extensive IEC
  • OPD Consultation- Gynae, Pead, Medicine
    Diagnostics
  • Referrals including free referral transport on
    camp day
  • Number of Camps each month in identified
    districts
  • 5 RCH camps supported by RHSDP
  • 1 individual camp by RHSDP
  • Total Camps (Nov07 to March 08) - 225
  • Total beneficiaries
  • Total OPD 83076

18
Patient Counselor (Rogi Mitra)
  • Total 74 patient Counselors have been appointed
    at 50 Bedded above hospitals.
  • Guide the patients especially BPL underserved
    to avail the health services without difficulty.
  • For better utilization of the government medical
    health services, by BPL under privileged
    patients.

19
Emergency Response Services
  • PPP Initiative
  • State responsibility to provide emergency care
    with private sector efficiencies.
  • MoU signed on 23rd May, 2008, between the
    Department of Medical and Health, GoR and EMRI,
    Hyderabad.
  • Comprehensive Emergency Response Services
    (Medical, Health care, Police, Fire) using single
    toll free number(108) accessed from any mobile or
    landline, a call centre equipped to immediately
    respond to emergency calls, state of art
    ambulances and trained emergency technicians and
    drivers to manage the emergency.
  • Objectives
  • To assist the state in achieving the Millennium
    Development Goals (MDGs) of health sector.
  • To improve increase access to Medical, health
    care, police and fire services.
  • To address emergencies particularly related to
    pregnancy, neonates, parents of neonates, infants
    and children.
  • To reduce IMR ,MMR Deaths due to accidents.

20
Rajasthan Swasthaya Bima Yojna
  • OBJECTIVE
  • To improve access of BPL families to
    quality medical care for treatment of diseases
    involving hospitalization and surgery through an
    identified network of health care providers
  • Launched on 8thDec.07.in 5 Districts (Udaipur,
    Chittorgarh, Dungarpur, Banswara, Sri
    Ganganagar)
  • Nodal Department-Medical Health Department
  • Insurer-State Insurance Provident Fund
    Department (SI PF)
  • Total BPL families-787616
  • Premium Rs 480Service Tax i.e. 539.33 per year
    per family
  • Mediclaim coverage Rs. 30,000
  • Critical illness coverage up to Rs. 1.35 Lacs per
    family
  • Transportation Rs. 100 per visit in case of
    hospitalization up to the limit or Rs. 1000 per
    year
  • Per and post hospitalization up to 1 day prior to
    hospitalization and up to 5 days from the date of
    discharge.
  • Facility to BPL family is cash less
  • 15,199 patients, benefited till April 2008.
    Expenditure incurred 6.38 Crores

21
Rashtriya Swasthya Bima Yojana
  • Labour Ministry GOI scheme, in the 8 districts
    i.e. Barmer, Bikaner, Jalor, Jhalawar, Karauli,
    Sawaimdhopur, Rajasmand and Tonk District from 1
    April 2008.
  • Total BPL Families Covered - 608986
  • The highlights of the scheme are as follows -
  • Facility to BPL family will be cash less.
  • Implementation through Smart Card- 50,000 issued
  • Mediclaim coverage Rs. 30,000
  • Transportation Rs. 100 per visit in case of
    hospitalization upto Rs. 1000. This is a part of
    packages.
  • Pre and post hospitalization upto 1 day prior to
    hospitalization and upto 5 days from the date of
    discharge.
  • Registration fees Rs. 30 per BPL family world be
    covered from Beneficiaries
  • Premium Rs 573.00Service Tax i.e. Rs. 644.00
    Per family per year ( Contribution of
    GOIGOR- 7525)
  • Remaining 22 District are in process of inclusion
    in the above scheme

21
22
Sustainability
  • I. Infrastructure
  • Civil work Specification and norms developed
  • Hospital Equipment specifications Procurement
    procedures established
  • II. Human Resource
  • Trainings undertaken Clinical/technical, HCWM,
    HMIS, Referral, BCC, Managerial, Equipment
    Management Maintenance, Rational Use of drugs
  • Training Methodology and evaluation system
  • Consultants professional services
  • DPCs Services for Coordination, Convergence and
    Integration

23
  • III. Policy Making Institutional Development
  • Workshops/ Studies/evaluation
  • HMIS/IISP study useful for finalization of
    department HMIS
  • Developing contracting mechanisms IEC,
    Counselor, Specialist services ,Ambulance,
    Mobile,Diagnostics,Facility Outreach, Pharmacy
  • Availability and uses of Pharmaceuticals ,HCWM
    ,supplies and furniture training for drug and
    logistic management.
  • Availability and usage of equipments-use, mgmt
    and maintenance M/s Center for research planning
    and action (CERPA), New Delhi
  • Workshop on maternal death audit
  • Workshop on Quality Improvement
  • Workshops on HCWM, STG, HMIS, Procurement,
    Referral, IEC, PRI,
  • IV. Scalability
  • HCWM Observance of Protocols
  • HMIS Feedbacks for monthly reporting formats,
    Rationalization of Hospital Activity Format
  • HSIP- to be scaled to other institutions across
    the state
  • I E C Interventions

24
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