Integrated District Health Society

SOUTH DISTRICT

NRHM

Dr. JYOTI SACHDEVAPO, NRHM

• Launched by the Prime Minister on 12th April, 2005.

• Focuses on 18 states (EAG) including eight Empowered Action Group (EAG) States, the North-Eastern States, Jammu & Kashmir and Himachal Pradesh.

• Aims to focus on the 18 states having weak public health indicators (Arunachal Pradesh, Assam, Bihar, Chhattisgarh, H.P, Jharkhand, J&K, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh).

• Enhancing the commitment of the government to raise expenditure on public health from 0.9 % to 2-3 % of GDP

NRHM

• Quality Care

• Rural & Vulnerable

• Equitable

OBJECTIVES

Accessibleccountablecceptableffordable

All Levels

1) Primary

2) Secondary

3) Tertiary

• Strengthening

• Communitization

• IEC

GOALSUniversal AccessPrevention and Control of CD &NCDAccess to integrated comprehensive Primary

Health CareReduction in IMR & MMRPopulation Stabilization, Gender and

Demographic BalanceRevitalize local health traditions and

mainstreaming AYUSH

STRATEGIESDecentralized Planning (Inter State &

Inter District Profile)ASHAStrengthening of Primary Health Care

InfrastructureEnsuring QualityPromotion of Non Profit SectorNew Health Financing SchemesIntegration of ongoing disease control

Programs

SUPPLEMENTARY STRATEGIESRegulation of Private Sector

Promotion of PPP

Mainstreaming AYUSH

Reorienting Medical Education

Effective and Viable Risk Pooling and Social Health Insurance

Convergence

GOALS (NPP - Immediate)

Maternal Mortality Rate (MMR) reduced from 407 to 100 per 1,00,000 live births.

Infant Mortality Rate (IMR) reduced from 60 to 30 per 1000 live births.

Total Fertility Rate (TFR) reduced from 3.0 to 2.1

Effective healthcare to rural population.

Increase public spending on health from 0.9% GDP to 2-3%.

NRHM – 5 MAIN APPROACHESCOMMUNITIZE

1. Hospital Management Committee/PRIs at all levels

2. United grants to community/PRI Bodies

3. Funds, functions & functionaries to local community organizations

4. Decentralized planning, Village Health & Sanitation Committees

IMPROVED MANAGEMENT

THROUGH CAPACITY

1. Block & District Health Office with Management Skills

2. NGOs in capacity building

3. NHSRC/SHSRC/DRG/BRG

4. Continuous skill development support

FLEXIBLE FINANCING

1. United grants to institutions

2. NGO sector for public Health goals

3. NGOs as implementers

4. Risk Pooling – money follows patient

5. More resources for more reforms

MONITOR, PROGRESS AGAINST

STANDARDS

1. Setting IPHS Standards

2. Facility Surveys

3. Independent Monitoring Committees at Block, District & State levels

INNOVATION IN HUMAN RESOURCE

MANAGEMENT

1. More Nurses – local Resident criteria

2. 24 X 7 emergencies by Nurses at PHC, AYUSH

3. 24 X 7 medical emergency at CHC

4. Multi skilling

HEALTH

NUTRITION

EDUCATIONWATER SUPPLY

SANITATION

CONVERGENCE

Convergence with ICDS Malnutirtion / anemia --

planning Commission parameters.

Identification of malnourished and anemic children / woman and targeted supplementation / counseling / monitoring .

Provision of

• Weighing machines.

• IEC Material .

• Training of 257 CDPOs / Supervisors.

Involving the Community (Communitisation)

ASHA

ROGI KALYAN SAMITI

HEALTH AND SANITATION COMMITTEES

COMPONENT ASHA (ACCREDITED SOCIAL HEALTH ACTIVISTS)Chosen by and accountable to the panchayat.Functions of ASHAAdvice rural community regarding Immunization, ANC registration, institutional delivery

contraception and sanitation, hygiene, etc.

Treatment forMinor ailments like- diarrhea, minor injuries and fever.

Accompany patientsTo health facilities.Deliver DOTs Overall bridge between the ANM and the village.Facilitate preparation & implementation of the Village Health

Plan.Eye Care

FLOW CHART

NRHMCELL/NHFW

SPMU

DPMU

BPMU

NATIONAL MISSION

DIRECTOR

STATE MISSION

DIRECTOR

DISTRICT MISSION

DIRECTOR

BLOCK PUBLIC HEALTH

MISSION

NHSRC

SHSRC

DHSRC

BHSRC

PROGRAMME MGT.PROG. SUPPORT TEC.

SUPPORT

National Level

State Level

District Level

Block Level

Decentralization

State specific

District specific

CNAA

PLANNeeds

Assessment

Ex-ante Evaluation

(Evaluaability / Design Assessment)

Decision of Implementation

Do

Implementation

Process

EvaluationMid- term

Evaluation

Terminal

Evaluation

See

Post Implementation

Ex- post

Evaluation

Feedback

State Health Society

GOI / State

Additionalities

DHS DSHM DFW

NPCB

NVBDCP

NIDDCP IDSP

Convergence with agencies /

Departments /Programs

Standardization & Strengthening of Health Infrastructure to address heterogenity / multiplicity/ and give quality

healthcare.

Community involvement RKS / ASHAs

IDHS

PPIPNLE

PRCH

Department of Health & Family Welfare

RNTCP

Decentralization levels• Planning

• Accounts

• Implementation

• Procurement

• Recruitment

• Reporting

• Monitoring

Faster/ More logical solutions

Chairman District Health Society

(Deputy Commissioner)Mission Director

(Chief District Medical Officer) ACDMO

IDSP Officer

District Immunizati

on, NVBDCP &

NIDDCP Officer

NLEP Officer

DNBCP Officer

District RCH

Officer

District NRHM/ ASHA

PC PHDT & QAC

District Programme Management Unit

DPM DTC MIS BCC DAM

SpecialistsMO Paramedics

ASHA, MCD, IPP – VIII

(Nodal Officers)MonitoringCommittees

PIP approvedby GOI

Fundstransferred to States

Fundstransferred to

Districts

Funds transferredto PHC/CHC/OtherImpl. agencies

Reporting Back of Exp.from PHC/CHC/OtherImp. Agencies to District

Reporting Backof Exp. To State

Reporting Back ofExp. To Centre WithUC and Audit Report

Strengthening of District Infrastructure

DISTRICT BCC

CELL

DISTRICT STORE

DPMU

DISTRICT TRAINING CENTRE

Strengthening of Primary Infrastructure

Potential PUHCs

• Every PUHC is to cater to a population 50,000 each.

• The essential elements of a PUHC are Preventive, Promotive, Curative and Rehabilitative Primary Health Care

• The PUHC has to upgraded as per the Public Health Standards laid down by Department of Health & Family Welfare

• It aims at Community Participation and Community Linkage through Rogi Kalyan Samiti and ASHA respectively.

Strengthening of Primary Infrastructure Potential PUHCs

DGD (18) MCD ( Including IPPVIII)

Health centers attached to Maternity Homes

Non ASHA ASHAUnits

ASHAUnits

Non ASHA ASHAUnits

Non ASHA

9 9 10 M &CW +2 IPP VIII =12

1+0 0+1 3+0

Chaterpur Molarband

Sangamvihar K-II

Sangam vihar D Block

Tajpur Batla House

Sarai kalekhan Kalkaji

Begampur

Ber Sarai, Chirag Delhi,

Garhi, Khanpur, Madangir,

Sriniwaspuri, Sunlight

Colony Dakshinpuri

Jonapur

M&CW Center Madanpur Khadar

Fatehpur Beri Meharauli Tugklabad Nehru nagar

Jaitpur Dakshinpuri Block –

F 5 Madangir Kalkaji

Badarpur (IPP VIII)

Okhla Phase1 Nehru place

M&CW Center Defence

Colony

IPP VIII Badarpur Jungpura

Shri Niwaspuri

Defence Colony

Total Potential PUHC = 32 (18 DGD +11 M&CW +3 IPP VIII)

Strengthening of Maternity Home

Strengthening of Secondary Health Care

Coverage of Unserved/Underserved Areas

SEED PUHC

2008-09 2009-10

Projected – 13 (in 2009-10)

Functional - 7

Under Process – 2

Functional -1, (D5 Sangam Vihar) MOU done for -3 Seed PUHCs (Tughlakabad, Sangam Vihar H-Block, Aaya Nagar)

Harkesh Nagar, Meethapur Extn, Sangam Vihar L2, ABC Block, Abul Fazal Enclave

Projected – 2 (in 2010-11)

Madanpur Khadar Extn.

Public Private Partnership

MAMTA

• BPL/SC/ST• Move with private nursing home Mamta

Friendly Hospital• Antenatal/Intranatal Services/Postnatal/Early

Neonatal• Rs 4000/- per centre

ARPANA TRUST - NGO

HMIS• Decentralization of Reports- District -

Facility

• Tracking System

• Eye Related Activities

THANK YOU