2nd Common Review Mission Chhattisgarh

1. 2nd Common Review MissionChhattisgarh 16th - 22nd December 2009

2. 2 CRM Team Members Dr. R S Sharma, Joint Director, NVBDCP, Govt of India. Dr Kaushik Ray Barman, Senior Consultant - Public Health Planning, National Health System Resource Centre. New Delhi Dr. Pavitra Mohan, Health Specialist, UNICEF India Country Office. New Delhi. Dr. Joe Varghese, Senior Programme Coordinator, CMAI, New Delhi.

3. 3 Structure of presentation

4. 4 Health Service Delivery Significant service improvement at SCs, but PHCs are the missing link Increasing trend of OPD load, normal delivery at CHCs & SCs, decline of malaria deaths Instt. deliveries still is a concern though positive impact of JSY seen Marginal improvements in utilization of the facilities for MCH care (no plan for MTP activities) FRU, 24x7, FBNC, emergency drugs, laboratory & referral support at peripheral facilities are weak areas Centralized drug procurement system, RD kit & bednet availability, Block Leprosy Awareness Campaign, Sickle Cell test camps, Bal Hriday Suraksha Yojana

5. 5 Initiate facility survey at SC & PHC level by BPMU staff Facility improvement to meet out minimum Quality & service guarantees (HR, logistics, Infrastructure, management) Appropriate placement of multi-skilled providers, good referral & MCH services Integrated Lab services with RNTCP, NVBDCP and NACP (resources)

6. 6 Human Resource MAJOR LIMITING FACTOR is lack of Human Resources: ANM, SN, MO (IPHS is a distant dream) Clear responsibility for HR planning are not existing: plans are not commensurate with needs All regular and contractual appointment process are slow (shortage of supply & commitment) Over centralisation of manpower, improper positioning of LSAS, EmOC trained personnel, non utilization of SIHFW, RFWTC Recruitment of LT through JDS (RKS), Rural Medical Assistants in tribal districts are good initiatives

7. 7 Recommendation Definite HR policy & its implementation, co-location with AYUSH Intense focus for multi-skilled workforce, filling of vacant posts (regular cadre) Institutional strengthening & coordination among all training & capacity building instt. Sensitisation of directorate of medical education, nursing & paramedical Instt. for public health need

8. 8 Infrastructure ISO certification of district hospital, Equipment management system are good initiatives Basic requirement of SC, PHC, CHC, FRU, 24x7 criteria are yet to fulfilled (recommended standards) Delayed operationalisation of Blood storage facilities, Referral transport Establishing new infrastructure is SLOW (Many of them are at rented or inappropriate building) Over dependence on PWD for construction lead to delay (other options need to be explored) Fund disbursement for infrastructure upgradation are quite slow

9. 9 Recommendation Infrastructure development wing as an option other than PWD Urgent focus on PHCs and FRUs, AYUSH instt upgradation Rational fund utilisation from Flexipool, BRG funds & EUSPP for infrastructure Ensure fund disbursal from SHS and quick handover of newly constructed facilities Infrastructural strengthening for ANMTC and RFWTC and DTCs

10. 10 Decentralization & Communitisation Strong workforce of Mitanin with high degree of skills, Mitanin help desks and other support structures Formation of VHSC & account in place, But capacity building, utilisation of untied funds are weak JDS activities are on track with less involvement of communities & PRI, encouraging progress of fund utilisation but mainly for logistics Existing gaps between strong community processes (generated demand) and facility strengthening (provided input) Concerns- Incentive distribution to Mitanin, Drug replenishment of Mitanin Dawa Peti Participation of NGOs in Planning, training, implementation, monitoring and surveys but MNGO & FNGO activities are minimal. Sishu sanrakhsan mah, VHND, Swasth Panchayat Scheme are new initiatives

11. 11 Recommendation More decentralisation of financial power Sensitisation of PRI leaders in VHSC & JDS activities Streamline incentive distribution to beneficiaries and providers (JSY, immunisation, other programs) Strengthening and sensitization of Block & Village level planning process, social auditing, community monitoring Regulatory mechanism & monitoring of NGOs Widening the Scopes under Community monitoring & initiation of social audit

12. 12 Program Management issues SPMU, DPMU, BPMU are in place, training for BPMUs staff still incomplete Work & Accounts handing over process to BPMUs still to initiate separate sub-accounts, minimal financial disbursement from SHS, problem of UC generation, non transfer of state budgetary contribution are few concerned areas Audit process completed Poor utilisation of allocated flexipool funds Non release of Annual maintenance grant New formats of HMIS introduced, but feed back mechanism are weak

13. 13 Recommendation Enhance operationalising E banking from dist to block (on priority) Timely Fund disbursements from state to districts, proper expenditure plan and retrieval mechanism for U Certificate DHAP based financial disbursement with clear financial outlays for each districts & FLEXI FINANCING Immediate merger of sub accounts under SHS, transfer of state contribution to NRHM pool, more decentralization of financial power to peripheral Instt. More coordination between directorate, CMO office and program units, decentralised planning through BPMU Feed back process for HMIS need to be incorporated

14. 14 Governance & Planning process Frequent reshuffling of administrative and technical officials is a concern Implementation at district are not matching with plan documents Consider better reflection of previous CRM, JRM recommendation in planning process More clarity on roles and responsibilities to management units at all level More cohesion between Directorate, SHS and State Miission, rational distribution of work within the directorates Design definite path for budget utilisation through flexi financing

15. 15 Contd.. More focus to PHC in all areas More definite plan for outreach activities through MMU Sp Strategy for vulnerable groups & tribal groups More convergence with AYUSH and other Depts Strengthen DHAP & block planning & implementation process Utilise strong community process for village planning

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