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Reforms in Health Sector

Implemented by Gujarat State

Dr. Amarjit Singh IASDr. Amarjit Singh IAS

Commissioner of HealthCommissioner of Health

Govt. Of GujaratGovt. Of Gujarat

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Some of the reforms covered in

the presentation PublicPublic--private partnershipprivate partnership

DecentralizationDecentralization Reforms related to human resourcesReforms related to human resources

ReRe--organization & reorganization & re--structuringstructuring

Special innovationsSpecial innovations

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Public Private Partnership

Entrusting Health Centers to NGOEntrusting Health Centers to NGO

Special features: 1 PHC and 3 CHCs handed over to NGOs

Finances managed by Govt.

Operations managed by NGO

Own employees / deputation from Gov.

MOU has made provision for

discontinuation

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Public Private Partnership

Problem of vacancies of specialistsProblem of vacancies of specialists:

Contracting-in

Samaydan Scheme

Part-time and honorary appointment of

Practitioners

ContractingContracting--outout

Contracting out of IECservices

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DECENTRALIZATION

Financial Decentralization for MedicinesFinancial Decentralization for Medicines

and Maintenanceand Maintenance

25% of allocated budget transferred

to facility

no prior approval required up to Rs.

10,000

Rate contract system to be followed

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DECENTRALIZATION

Delegation of powers to MedicalDelegation of powers to Medical

officersofficers

Power to MOs for civil work

Up to 10-15,000/- per work at a

time for minor work Maximum 25,000/- per year

District RCHSociety to fix agency and

execute work above 10,000

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Human Resources

Appointment of Contractual staffAppointment of Contractual staff

Interest free loan for two wheelers toInterest free loan for two wheelers to

ANMANM

Reorganization of the entire cadre ofReorganization of the entire cadre of

PMOAPMOA

All posts shifted to CHC/ Sub District

hospitals with operative facility

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Reorganization & Restructuring

Creation of Block(Taluka) Health OfficeCreation of Block(Taluka) Health Office

Span of control for DistrictHealth Office too large

BHO can assist DHO in planning, implementation

and review

Facilitate material supply

Facilitate Information system

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Reorganizing & Restructuring

Staff at block office Senior Medical Officer

- Block IECOfficer- Senior assistant cum store keeper

data entry operator

Zero budget with minimum recurringexpenditure redeployment of manpower

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Reorganizing & Restructuring

Grouping of CHCsGrouping of CHCs

Need Under utilization ofCHC- Unavailability of specialist

- Inaccessibility ofCHC

CHCs regrouped and motherCHCidentified.

Reallocating manpower and resourcesunderutilizedCHCs to MotherCHC.

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Urban Health careUrban Health care

Lack of health infrastructure in urban areas.

Project proposed for primary health care in

urban slums.

Towns with less than one lakh population to be

covered.1 FHW per 25,000 population and 1 FHV per

1,000 population in urban slums.

Reorganization & Restructuring

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Special innovations

WebWeb--based Integrated Disease Surveillancebased Integrated Disease Surveillance

ProgrammeProgramme

Improving MIS through ComputerImproving MIS through Computer

applicationsapplications

State Medical Relief SocietyState Medical Relief Society

PrePre--hospital Emergency Medical Servicehospital Emergency Medical Service

Indian System Of MedicineIndian System Of Medicine

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Special innovations

Web based Integrated Disease SurveillanceWeb based Integrated Disease Surveillance

ProgrammeProgramme

Successfully piloted in 8 Districts

Expansion to whole state in July 2004

Weekly reporting system

Integration with MedicalColleges, Muni. Corpor., grant-in-aid

hospitals Web based reporting making data accessible for analysis and

action. (compliance 98%).

Selected private hospitals in the network.

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Improving MIS through

computer applications. GIS applicationsGIS applications

Village-wise Data of Malaria

Utilized for micro-planning of malaria controlactivities

Village-wise data for RCHunder preparation

Web based reporting of RCHWeb based reporting of RCH Report is generated in Form no. 9

At state level computer generated reports arereceived

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State Medical Relief Society

4 Crore Rs. fixed deposited

Interest spent on medical expenditure of

BPL families

Limit of Rs. 15,000/- perPatient

80.5

4L

akhs utilized in 03-04

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State Medical Relief Society for

the BPL

Interest of Fixed Deposit used to cover medical care uptoRs15,000/patient.

The health minister chairs the society.

Illnesses covered

Major cardiac illnesses

Major nephrological problems

Major neurological problem

Major ophthalmological problem

Hospitals involved

Govt. Medical Colleges

Gujarat Cancer And Research Institute

U. N. Mehta Institute of cardiology

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Pre-hospital

Emergency Medical Services

NEEDNEED:

Fatalities due to accident highest in INDIA

death rate is 140 per 1000 vehicles in india Over 5,600 deaths in India every year

In public Hospital of Abad more than 50%death within 4 hour

Golden Hour Concept

40% deaths following injury instantaneous

30 % death within hours preventable ifappropriate treatment can be provided withinan hour

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Pre-hospital

Emergency Medical Services

Pilot project in Ahmedabad cityPilot project in Ahmedabad city

ComponentsComponents Multiple Level Trauma Centers

Centralized Ambulance Services

Trained Personnel

Injury Surveillance/information system

Training / Awareness of community

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School Health check-up Programme

Year 2003Year 2003 87 Lakh children examined

13

L

akh treated on the spot 46,000 treated at First Referral level

34,582 spectacle given

432 children operated at U.N.Mehta institute of

cardiology

Plan for 2004Plan for 2004 108 Lakh children will be involved

10.7 Lakh non-school going children

17 lakh children of Anganwadis

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Indian System of Medicine

Appropriate orientation and skills upgradationthrough CME

Mainstreaming & utilization to improve healthcare coverage

Preservation, promotion and cultivation ofmedicinal plants & herbs

To ensure local availability of good quality ISM& H drugs at affordable prices

Realizing the export potential of these drugs &formulations