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NRHM Second Common Review Mission ORISSA

NRHM Second Common Review Mission ORISSA. November-December 2008. OVERVIEW of 2 nd CRM FINDINGS NRHM has brought a significant improvement in the state and district health system JSY and ASHA are the most visible faces of change

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NRHM Second Common Review Mission ORISSA

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  1. NRHMSecond Common Review MissionORISSA November-December 2008

  2. OVERVIEW of 2nd CRM FINDINGS • NRHM has brought a significant improvement in the state and district health system • JSY and ASHA are the most visible faces of change • The State & District Project management teams are active and dynamic • Untied/ RKS funds are being used effectively for facility improvement and public credibility • Effective Decentralization, Community participation & other management & governance paradigm shifts

  3. Overview contd… • Appreciable steps have been taken to improve: • The Human Resources situation • Drug availability • Strengthen Community Processes • Financing system and Fund flows • HMIS & GIS; IDSP • Gaps remain & need to be addressed if efforts are to be sustained and outcomes maximised

  4. Facility Strengthening & Service Delivery Achievements Areas for Improvement Overcrowding in CHC/DH PHC and SC services by-passed; to be strengthened. Quality of ANC, PNC and deliveries by ANMs needs priority attention 25% of malaria deaths. Anti-malaria activities strengthening Toilets, Casualty services, New born care, OT, Waste Management. Inadequate budget for Drugs still puts “out of pocket” burden on patients Non-resident Drs./SNs • Service Utilisation increased at Secondary level-SDH/DH /CHCs • Improved drug availability • Improvements in infrastructure, cleanliness, waste disposal, electrification, water supply, but inadequate • AYUSH Doctors contributing effectively to OPD services in PHC (N) & MMUs • Janani Express facilitating access; NGO partnership

  5. Human Resources Achievements Areas for Improvement Shortage of Specialists (Anesthesia, Ob&Gyn), Staff Nurses, MBBS doctors, LT and MPW (M) Long term Strategy should include: Increased reservation for in-service candidates for PG Reservation of seats for Nursing and ANMs for KBK plus districts Nursing colleges and ANM training centers in KBK plus districts Enhance Training for SBA & IMNCI Sensitisation of all Healthcare providers for cross-referral with AYUSH Creating and nurturing a public health cadre • Vacancy gap decreased: M.O.s/ AYUSH doctors recruited; Increase in No. of ANMs, 2nd ANMs in some SCs • Pro-active Efforts to attract doctors & specialists • Special allowance for underserved areas • Multi-skilling of MOs for Anaesthesia, EmOC

  6. Community Participation Achievements Areas for Improvement Active involvement of SC/ST/BPL members to be encouraged; Vulnerable social groups have been included in the GKS but participation limited State specific strategies for vulnerable groups should be enhanced in State PIP • Community Processes Resource Centre set up at state level recently, incorporating the ASHA resource centre • ASHA programme running well; Good team work with ANM, AWW & SHG • VHND good forums for increasing community ownership • Gram KalyanSamitis (VHSC) have been formed recently & active • District and block level health committees, RKS are meeting regularly • Community monitoring taken up in 4 Districts as a pilot

  7. Management & Governance Achievements Areas for Improvement Adopting Good Governance Practices E-Governance: Computerize recruitment, transfers, promotions, e-procurement, for transparency and accountability Effective Monitoring of residence of health personnel at the HQ (Private practice, absenteeism,…) Strengthening Drug Control department - Immediate withdrawal of sub-std. drugs, black listing and debarring of companies/suppliers Strengthening Hospital & Health Committees – Citizen’s Charter, Report card system, Public grievance redressal mechanisms • State PMU has strong leadership and good working ethos • District PMU are active, professional and vibrant • Good team work and integration with district and block medical team exists • State and district Health societies functional • Good cooperation between General and Health administrators, PRI, NGOs and SHGs at all levels

  8. Summary: The thrust on Public System Strengthening is well on its way & must be sustained Primary Level Services to receive greater attention; Improvements in secondary level to be taken further Malaria: Initiate Integrated Vector Control; Fill posts of District Programme Officers, LTs & MPW(M); Strengthen laboratory services. Good HMIS/GIS to be now used for planning and monitoring at district & state levels. Strong management capacities have been built up. Good Governance practices to be adopted.

  9. THANK YOU

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