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(PDF) Reforming the health care delivery system

   

Added on  2021-04-17

11 Pages4160 Words94 Views
Health Care Delivery and Reform1

Introduction:National Rural Health Mission (NRHM) was initiated in 2005 by Government of India. Mainobjective of the NRHM was to provide affordable and quality healthcare services to thepeople in rural India. Strategy of this healthcare delivery system is to involve different sectorsand to achieve collaboration among these sectors and organisations to provide uniform healthand family welfare services through single window. This system aimed at providingsustainable healthcare delivery to the rural Indians; however, this system didn’t imaginepotential hurdles and challenges in its implementation. However, foundation laid down byNRHM can be taken forward to improve healthcare delivery system in India to the next level.It can be considered as the road map to achieve varied goals of health and welfare in India. Itis an appreciable effort by the Government of India to build the necessary infrastructure toprovide uniform health services to all classes of people in the rural India. NRHM should begiven full credit for initiating efforts for empowering healthcare system in rural Indiaspecifically in the poor states. NRHM gave importance to the community participation andinvolvement of different sectors to achieve health indicators in most of the sates. NRHM canbe taken forward by not only to give more attention for capacity building in terms ofinfrastructure and technical aspects but also to build skilled healthcare professionals whichare one of the important components for providing sustained healthcare services. Body :NRHM was aimed to improve the accessibility of the people in the rural region like poor,children and women for quality healthcare services and utilization of these healthcareservices in the sustained manner (Garg and Laskar, 2011). NRHM performs its functionsthrough different important national healthcare delivery programmes like Reproductive andChild Health II project (RCH II), the National Disease Control Programs (NDCP) and theIntegrated Disease Surveillance Project (IDSP). Aim of the NDCP is to provide preventiveand curative efforts for control of diseases like filarisis, encephalitis, dengue, kalazar,leprosy, tuberculosis, blindness, iodine deficiency disorders, and polio. Healthcare deliverywas planned through different centres like village health sub centres (VHSCs), recruitmentand functioning of ASHAs, constitution of registered Rogi Kalyan Samities at districthospitals (DHs), Sub-Divisional Hospitals (SDHs), community health centres (CHCs) andprimary health centres (PHCs) (NRHM, 2011).2

NRHM put future picture of involvement of communities in providing quality healthcareservices to the people of rural India. One of the most significant strategy of NRHM toimprove capacity and capability of Panchayati Raj Institutions to participate and contribute inpublic health services. NRHM involves both Government professional bodies andnongovernmental organizations (NGOs) to monitor and evaluate implementation of theNRHM scheme. It also depends on the community stakeholders for monitoring delivery ofhealthcare services and provision of healthcare services (Doke et al., 2015). District levelannual report preparation is the responsibility of Government departments and NGOs. Stateand national reports are being presented in the State Legislative Assemblies and theParliament. At national level activities are being controlled by joint Mission Steering Group,headed by the Union Minister of Health and Family Welfare and at state level activities arebeing controlled by Health Mission headed by the Chief Minister. At district level activitiesare being controlled by Chairman of the Zilla Parishad, and District Head of the HealthDepartment (NRHM, 2005).NRHM is also aimed at mainstreaming traditional system of medicine which is calledAYUSH which comprises of different systems of medicine like Ayurvedic, Yoga, Unani,Siddha and Homeopathy systems of health. Main focus was given to the maternal and childhealth and family welfare by improving participation from the different community membersand improving coordinated efforts by professional from different sectors like medicine,pharmacy, social, physiotherapy, nutrition and psychology. Healthcare services enabled bythe NRHM can be availed at primary, secondary and tertiary health care levels. Though,objective of the NRHM is provide affordable and accountable healthcare services to thepeople across the country main attention was given to the 18 states with low socioeconomicstatus. These states include 8 North Eastern states, 8 empowered action group (EAG) statesand 2 hilly states. Empowered action group (EAG) states include Bihar, Chhattisgarh,Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal and Uttar Pradesh. Two hillystates include Himachal Pradesh and Jammu & Kashmir.Public health expenditure in India reduced from 1.3 % of GDP in 1990 to 0.9 % in 1999.However, in NRHM it was aimed at improving public health expenditure from 0.9 % of GDPto 2-3 % of GDP. Aim of the improvement of the budget to improve health system and healthstatus of the rural people (NHA, 2005). There was major implementation issue whileimplementing NRHM. It was not uniformly implemented in different states of India.Different states had their healthcare delivery strategy. Hence, it was difficult to implement3

NRHM uniformly throughout the India. For example, Tamil Nadu has Tamil Nadu healthsystems project (TNHSP) as a health delivery system. Though TNHSP and NRHM togetherbrought improved results in improving health status and well being of the rural people; therewere few basic variabilities in NRHM implementation owing to existence of schemes andstrategies in the form of TNHSP. ASHA one of the components of the NRHM was notimplemented in the Tamil Nadu because presence of grass root workers namely village healthnurses (VHN). Primary health centres (PHCs) are one of the major components of the designof NRHM for providing healthcare services. PHCs are the primary resource centre for theaccessibility of healthcare services by rural people. In Tamil Nadu, it was evident that PHCload was augmented from 0.87 lakhs in 2005-2006 to 3.87 lakhs in 2008-2009. It indicatesthat NRHM played significant role in improving PHC load. From this it can be concludedthat incorporation of PHC in the design and strategy of NRHM proved to be beneficial.Children being immunized gone down from 11.2 lakhs in 2007-08 to 10.1 lakhs in 2008-09.However, analysis of the data indicated that this decline in immunization was not due toimplementation of NRHM; however, this decline was due to reduced fertility rate. Prior toimplementation of NRHM also, there was improved quality of health services in Tamil Nadu.However, due to implementation of NRHM proved to be significantly improved accessibilityand quality of care. This improvement was observed mainly due to design and functioning ofthe NRHM. Functioning of NRHM was implemented at three different levels like primary,secondary and tertiary healthcare centres. It helped in improving accessibility of healthcareservices by all classes of people. In NRHM multiple aspects were being incorporated;however, budget was not segregated effectively for different aspects. AYUSH system wasincorporated in NRHM; however sufficient budget was not allocated for AYUSH. Hence, itwas difficult to make proper plan for implementing AYUSH in rural areas. However, in latelyin 2008-09 budget was allocate for improvement of infrastructure and manpower in AYUSHsector (Samal, 2015). Proper design and functioning of the NRHM helped in effectiveutilization of budget allocated under NRHM scheme for Tamil Nadu. Supply chainfunctioning of the NRHM system in Tamil Nadu seems to be worked efficiently. It has beenobserved that drugs and other requirements were effectively supplied to PHCs afterimplementation of the NRHM (Gopalakrishnan and Immanuel, 2018; NRHM, 2011).NRHM proved to be effective in bringing face-lift in rural health in India. It enabled effectivehealthcare with uniform access to healthcare services to the rural population. Differentaspects of the healthcare were assigned to the different healthcare schemes and missions.4

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