Decentralization of health services.pptx
- 1. Decentralization of Health Services MENTOR:- DR SHALINI SUNDERAM (PROFESSOR ) DR SAHIL NAYAN RAJNISH (SR) DEPARTMENT OF COMMUNITY MEDICINE RIMS RANCHI PRESENTED BY- DR ANUJ KUMAR ANIT JRA 1 DEPARTMENT OF COMMUNITY MEDICINE RIMS RANCHI
- 2. Contents • Introduction • Why Decentralization • Pillar of Decentralization. • Level of Decentralization . • Factors affecting Decentralization. • Decentralization Efforts in india. • Decentralization Efforts in Haryana.
- 3. Introduction • Decentralization is the distribution or transfer of power, control or authority form central government to local and regional authority. • Decentralization is the restructuring of authority so that there is system of co-responsibility between institutions of governance at the central, regional and local levels according to the principle of solidarity. • Thus, increasing the overall quality and effectiveness of the systems of governance, while increasing the authority and capabilities of sub-national levels.
- 5. Why Decentralization? • Better coordination and corporation at action level. • Improved implementation of health program. • Better transparency and accountability. • Ensures sustainability. • Improves equity and quality of care. • Reduction in duplication of health services. • Improves delivery and utilization of health service. • More community participation in health sector development activities. • Capacity for district health planning is improved.
- 6. Pillars of Decentralization De-concentration: (transfer of responsibility/ authority to lower administrative level) Devolution: (transfer of responsibility/ authority to lower political level) Delegation: (transfer of managerial responsibility) Privatization: (transfer of governmental function to private ownership
- 7. Level of Decentralization • Administrative Decentralization: Redistribution of administrative responsibilities, authority, and decision-making power from central government entities to regional or local levels. • Fiscal Decentralization : Involves the distribution of financial resources to lower levels of government. State and local governments receive funds from the central government, enabling them to allocate resources according to local needs. • Political Decentralization: Transfers decision-making power to elected local bodies, such as Panchayati Raj Institutions (PRIs) and Urban Local Bodies (ULBs).
- 10. Decentralization Efforts in India • The Government of India in 1957 had appointed The Balwant Rai Mehta Committee to study the functioning of the Community Development Programme (1952) and the National Extension Service (1953) and to recommend improvement measures . • The committee recommended formation of a system for “democratic decentralization”. This led to establishment of the Panchayati Raj Institution. • The Panchayat Raj is one of the oldest political system of local governance in the south Asian countries viz. India, Pakistan, Bangladesh and Nepal.
- 11. Cont .. • The 73rd and 74th Constitutional amendments in India led to creation of a three-tier system of local governance in rural and urban areas. • Respectively, giving local bodies significant powers and resources to manage local affairs, including health service delivery. • This Act provides for delegation of powers and responsibilities to the panchayats for the preparation of economic development plans and social justice
- 12. Local Self-Government in Rural Areas 1.Gram Panchayat .-The Panchayati Raj institution at the village level is called gram panchayat. Gram means a cluster. Here it means cluster of villages. • The population catered by Gram Panchayat differs between states ranging from 3,000 to 20,000. • 2. Panchayat Samiti/Janpada Panchayat: The Panchayati Raj Institution at the block level is called Panchayat Samiti. • It is representative of 100 villages of the block and covers a population of about 80,000-120,000. • 3. Zilla Parishad: The Panchayati Raj Institution at the district level is called Zilla Parishad • The number of members of Zilla Parishad vary from 40 to 70 in different states. One the member is elected as the chairperson of the Zilla Parishad.
- 13. Local Self-Government for Urban Areas 1.Nagar Panchayat or town area committee: The town area committee in areas with population of 5,000-10,000. • Town area committee primarily provides sanitation related services. 2.NagarPalika or Municipalities (municipal council, municipal board, municipal committee): Municipal boards in areas with population ranging from 10,000 to 200,000. 3.Nagar Nigam or Municipal Corporation: Corporations are for areas with more than 200,000 population. The corporation is headed by mayors elected from different wards of the city.
- 14. Policies and Initiatives for Decentralization • The first NHP was framed in 1983 to provide comprehensive and decentralized health care, accessible to all. • NHP 2002 focused on achieving an acceptable standard of good health for the population and ensuring an equitable access to health services across all strata. • National Health Policy (NHP) 2017: The NHP 2017 emphasizes decentralization as a key strategy to improve healthcare delivery. • It advocates for greater autonomy and flexibility for states and local governments in designing and implementing health programs. • The policy promotes the use of technology and data-driven decision- making to enhance local health governance
- 15. Cont .. • National Rural Health Mission (NRHM) : • Launched in 2005, the NRHM aimed to improve healthcare delivery across rural India by strengthening local health systems and infrastructure. Key aspects include: • Village Health and Sanitation Committees (VHSCs): These committees empower local communities to participate in planning and monitoring health services. • Accredited Social Health Activists (ASHAs): Community health workers are trained to act as a bridge between the community and the health system. • Decentralized Planning: States and districts are encouraged to create specific health plans based on local needs.
- 16. Cont .. • National Urban Health Mission (NUHM) : • Part of the National Health Mission (NHM) launched in 2013, the NUHM focuses on urban healthcare needs, particularly for the urban poor and vulnerable populations. • Urban Local Bodies (ULBs): These bodies play a crucial role in planning and managing urban health services. • Mahila Arogya Samitis (MAS): Women’s groups at the slum level facilitate community participation in health governance.
- 17. Cont .. • Ayushman Bharat (National Health Protection Scheme) : • Launched in 2018, Ayushman Bharat aimed at providing comprehensive healthcare through two components: • Health and Wellness Centers (HWCs): Upgrading existing sub-centers and primary health centers to provide comprehensive primary healthcare services, emphasizing local health needs. • Pradhan Mantri Jan Arogya Yojana (PM-JAY): Providing financial protection for secondary and tertiary care, involving state governments in implementation and customization based on regional needs.
- 18. District Health Societies (DHS) Roles and Functions :- 1. Local Governance and Decision-Making: DHS are responsible for planning and implementing health programs at the district level. They ensure that health services are tailored to local needs and priorities, allowing for more relevant and effective intervention. 2. Resource Allocation and Management: DHS manage financial resources allocated by the state and central governments. They have the autonomy to allocate funds to various health initiatives, procure equipment, and hire personnel as per district-specific needs. 3. Capacity Building :DHS are involved in training and capacity building of health workers, including frontline workers like ASHAs (Accredited Social Health Activists), ANMs (Auxiliary Nurse Midwives), and other health personnel. This enhances the quality of healthcare services provided at the grassroots level.
- 19. Public-Private Partnerships (PPPs) 1. Infrastructure Development : PPPs facilitate the development of healthcare infrastructure in remote and rural areas. • Private partners bring in capital, technical expertise, and efficient management practices, which are crucial for setting up and maintaining healthcare facilities such as hospitals, clinics, and diagnostic centers. 2. Improving Healthcare Access and Quality : Private entities often introduce advanced technologies, better management practices, and higher standards of care, which can significantly improve patient outcomes. 3. Capacity Building and Training : PPPs contribute to the training and capacity building of healthcare professionals at the local level. 4. Innovation and Technology Integration :PPPs encourage the adoption of innovative healthcare technologies, such as telemedicine, mobile health applications, and electronic health records.
- 20. Decentralization Efforts in Haryana
- 22. Comparing Decentralization efforts in Kerala, Bihar and Bhubaneswar • Health Service Delivery : • Kerala: Gram panchayats play an active role in health service delivery, ensuring availability of resources and introducing innovative practices. • Bihar: Improvements have been made in infrastructure and services, but there is a challenge in the availability of full-time health human resources. • Bhubaneswar: Namma Clinics and specialist clinics have been established for comprehensive primary health care services.
- 23. Cont.. • Financing and Autonomy: • Kerala: Gram panchayats receive funds from the state plan budget and generate their own funds, but there is a need to improve fund utilization. • Bihar: Health services are financed through national and state schemes, but there is a need to address the shortage of drugs and consumables. • Bhubaneswar: Financing is done through a corpus, NUHM support, and user charges.
- 24. Cont.. • Governance and Community Engagement: • Kerala: Gram panchayats actively engage in planning and implementation, involving the community in evaluating health activities. • Bihar: ULBs have limited roles in health, and there is a need to strengthen community engagement and awareness among elected representatives. • Bhubaneswar: Community structures and local councillors are involved in policy formulation and implementation.
- 25. Cont.. • Challenges and Recommendations: • Kerala: Weak governance, low fund utilization, and lack of resources are challenges. Recommendations include strengthening decentralization and improving governance. • Bihar: Human resource availability, limited ULB roles, and low community participation are challenges. Recommendations include expanding services and increasing awareness. • Bhubaneswar: Municipal financing and private sector engagement are challenges. Recommendations include improving finance systems and exploring innovative staffing models.
- 27. Challenges in Decentralization • Poorly-optimized policy design – Policy design severely impacts the transition from a centralized to a decentralized model. • Inadequate Funding: A decentralized system requires appropriate allocation of funds to lower levels of government. However, there's often a lack of resources at the district level, hindering effective implementation . • Capacity Building: Decentralization necessitates empowering local authorities for decision-making. However, building capacity at the district level to manage finances, human resources, and healthcare programs effectively is crucial . • Inadequate management – When a healthcare system transitions to decentralization, many people are placed into positions of authority without proper training. • Political Will: Devolving power and resources requires strong political commitment from the central government.
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