Marching Ahead for. Workshop on Fiscal Management in Disadvantaged States January 05,2005. Presentation by: Dr. Shivendu, Secretary to Government

Transcription

1 Marching Ahead for Workshop on Fiscal Management in Disadvantaged States January 05,2005 Presentation by: Dr. Shivendu, Secretary to Government Ministry of Health, Family Welfare, Medical Education and Research Government of Jharkhand

2 At a glance Jharkhand Total population : 26.9 million Population Density : 338persons/Sq. KM Sex Ratio : 941 per thousand male Literacy Rate: 67.9% males, 39.4% females It has a higher degree of urbanisation than Bihar - about 22.3 % population lives in urban area. Source: Census 2001

3 Health Status Item India Jharkhand Best Performing State Full ANC 18.6% 10.5% 66% (Kerala) Institutional (kerala) Delivery Safe Delivery (kerala) Source: RHS

4 Infrastructure Gaps & Institutional Challenges -> 37% of Sub-Health Centres were never constructed in the State -> 67% of the Primary Health Centres were never constructed in the State -> 82% of the Community Health Centres were never constructed in the State -> Poor status of the Sub-Divisional and District Hospitals. -> Inadequate Blood Banks in the Districts -> Poor mobility support to the Health Service providers

5 Financial Management Process Treasury Mechanism Budgeting Operating expenses (non-plan) New investment (plan) Allocation to cost centers Sanction orders and allotments (expense limits) Review and reallocations Reforms Budgeting through COBT (State level) New investments are approved before being part of COBT (State level) Yearly allocations to cost centers On-line monitoring of expense accounts and timely reallocations

6 Financial Management Process (Contd.) Bank Mechanism :Through Societies, Boards, Autonomous Institutions Project Implementation Plan (PIP) Operating expenses (revenue) New investment (capital) Allocation to cost centers PIP approval orders and release of funds Review, Statement of expenditure and fresh release Reforms Cost center PIPs consolidated at state level Mid term review and re-adjustment Monthly monitoring and concurrent evaluation of outcome variables

7 Operational Flexibility through health facility management society Key institutional constraint in 24X7 quality health services in government facilities: lack of flexibility at local level to meet operational expenses Each government health facility is having FMS (facility management society) Ministry of Health (MOH) provides grants to the FMS FMS empowered to set user charges with in the guidelines set by MOH FMS authorized to enter in partnership with Private sector and NGOs

8 Health voucher scheme Poor performance of public sector using supply side financing Option: Demand side financing Increase the demand of health services by poor Increase the access of poor to health services Provide choices to the poor to select service provider Increase private sector presence in rural areas Quality assurance through market competetion

9 Health voucher scheme (contd.) Four Types of vouchers -> Early Registration Rs. 100/= to the Expectant mother. To encourage the ANC/TT/IFA consumption -> Rs. 700/= coupon for the institutuitiuonal delivery in the third Trimester ( for Cesarean cases, as per the norms) -> Rs. 300/= to Mother, after completion of 10 weeks with full immunization -> Rs.100/ case to AWW as performance based incentive counter signed by ANM & paid by MOI/C -> Rs.100/case to ANM as performance based incentive counter signed by AWW paid by MOI/C

10 Health voucher scheme (contd) Implementation Process Enrollment of confirmed Pregnant Woman from BPL by AWW at AWC, (confirmation by ANM) After Registration AWW to hand over Rs.100/ - to the woman and get signed or thumb impression on the Voucher AWW to track at least the three ANC (TT+100 tabs of IFA)

11 Health for all: Sarva Swastha Mission (SSM) Need for alternative mechanism for health security to poor: Low capacity to spend on health Poor Public sector infrastructure, manpower and maintenance Dominant private sector uncontrolled cost and quality Susceptibility of the community to fall in the trap of Vicious Circle of poverty

12 SSM : WORKING PRINCIPLES (Contd.) REACHING OUT TO POOR THROUGH ACTIVE PRIVATE SECTOR INITIATIVES COMPLIMENTARY TO THE PUBLIC HEALTH SYSTEM PROVIDING CHOICE FOR HEALTH CARE TO THE POOR SETTING UP THE STANDARDS FOR THE PRIMARY & SECONDARY HEALTH CARE SYSTEM CO-PAYMENT FOR THE SERVICES (NO FREE SERVICES) CASHLESS HEALTH CARE SERVICES TO POOR STRONG COMMUNITY & PRIVATE SECTOR PARTICIAPATION IN MANAGEMENT & SERVICE DELIVERY

13 Sarv Swasthya Mission Sarv Swasthya Mission Trust Headed by Industrialist IMO MMG Full Provider Health Care Govt. H & F Deptt. GOJ Roles: *Facilitator *Conflict Resolution *Friend, Philosopher & Guide Non-Poor Families Poor Families

14 Information Technology in Budgeting and Control On-line submission of expenditure reports All works stations in the secretariat getting connected through LAN New Directorate of Health is fully wired and networked All cost centers will be networked by the end of 2006 as JHARNET goes live.

15 Rating Mechanism based budgeting Independent Rating agency to undertake quality audit of all government health facilities. Rate all facilities through a composite index budgetary allocations will be based on these ratings and improvement agreements signed by the facility managers No transfers on the basis of tenures: Only performance based transfers Incentives-disincentives based on ratings to the team working at the cost center

16 Looking forward: Thank you

17 Community participation Sahiyya movement Around 1000 Village health committees have been formed and same number of sahiyya have been identified. 7 lead NGOs (TSRDS, KGVK, Vikas Bharati, RKS Mission, Badlao foundation, NBJK, SJVK) have been finalised and they are working in 34 blocks for formation of VHCs and sahiyaa Convergence amongst Health, Social welfare, PHED, education and rural development departments.

18 New Initiatives: 5 new Mobile Hospitals (MOU is being signed with the BIT, as has been done for Uttranchal) Health City in Brombay is being planned Computer based HMIS being tested in Ranchi, one of its kind for the implementation Medical university to streamline the medical education (Medical, nursing, para-medical) Health Help Line as a tool for problem solving (Ph. No & )

19 Contd. Project designing, planning, implementation cell (for integrated approach) for the Infrastructure development Start-up work for the National Rural Health Mission District, Block and Village wise Health Project Implementation Plan Tele Medicine Project Integrating AYUSH in the Health System

20 Challenges: Health department has low credibility & confidence in the community Weak community participation in the health programme Weak infrastructure and Human Resources Too much System and Procedures delays the decision making process Not yet fully functional Directorate Weak logistic system Lack of good NGOs/faith based Organisations in the 60% of the area of the State Concentration of Good NGOs/Faith Based Organisations in the southern part of the State only Lack of Systems, procurement processes & Project approach.