Governance in the National Rural Health mission: Perspectives of a steering group member-K.S. Jacob
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Governance in the National Rural Health mission: Perspectives of a steering group member-K.S. Jacob Presentation Transcript

  • 1. Some thoughts on the National Rural Health Mission and on public health policy K. S. Jacob Christian Medical College, Vellore EPHP 2010
  • 2. NRHM
    • Refocus on health
    • Prioritizing rural India
    • Major inputs
    • Revitalized health infrastructure
      • A success
    EPHP 2010
  • 3. Background and bias
    • Academic
    • Recent convert to public health
    EPHP 2010
  • 4. Basis of my perspectives
    • NRHM Common review missions
      • Kerala
      • Andhra Pradesh
    • NRHM Mission Steering Group
    • Central Council of Health and Family Welfare
    EPHP 2010
  • 5. Regional variation, inputs and governance
    • High focus states
    • Health, utilization and governance
    • Unutilized funds, technology and training
    • NRHM governance and governance of the state/region
    EPHP 2010
  • 6. Convergence of diverse efforts
    • State health service
    • NRHM
    • ICDS
    • MNREGA
    EPHP 2010
  • 7. Assessment of the NRHM
    • Process and outcome assessment and audit
      • NRHM data process data
      • Systemic lack of outcome data
        • Janani Suraksha Yojana and maternal and neonatal outcome
        • Hospital deliveries and duration of stay, monitoring, facilities
        • ? Correlation to National Sample Survey and National Family Health Survey data
      • Lack of mechanism for correction/targeting
    EPHP 2010
  • 8. Parallel health systems and integration
    • Project mode
    • Parallel health systems and integration
        • - Medical colleges, district hospitals, PHC
    • Systems or building and infrastructure
    EPHP 2010
  • 9. New platforms and old programs
    • VHND and ICDS
    • Anganwadis and ANMs
    • Mobile clinics and sub-centers
    EPHP 2010
  • 10. Divided approach
    • Health insurance and out sourcing
      • Aarogyasri
      • KKT
    • Impact on state health systems
    EPHP 2010
  • 11. Old ethos and new inputs
    • Inertia of system, discipline and morale of health staff
    • Myths to cover up problems
    • Internal correction and external assessments
    EPHP 2010
  • 12. Social group variation and targeted input
    • Scheduled caste and tribes
    • Specific district programs
    EPHP 2010
  • 13. Theory and practice
    • Planning and implementation
    • Successful vertical programs and integration with horizontal infrastructure
    EPHP 2010
  • 14. Determinants of health
    • Curative medicine
    • Social determinants
      • Poverty
      • Caste
      • Gender
    EPHP 2010
  • 15. Errors of the public health- 1
    • Urgency-driven curative medical interventions instead of long-term public health solutions
      • Antibiotics instead of clean water for cholera
      • DOTS only instead of nutrition and housing
    • Mistaking primary care for public health
      • Extension clinics in villages/towns
    EPHP 2010
  • 16. Errors of the public health-2
    • Reducing health to a biomedical perspective
      • Social determinants of health
    • Biased use of evidence
    EPHP 2010
  • 17. Public health
    • Convergence of politics, finance, social science, cultural studies, engineering, science, education, religions, legal studies, medical
    • Different frameworks, language
    • Shared objectives, divergent agenda
    • Ownership and delivery
    EPHP 2010
  • 18. The way forward
    • Population health and national interest
    • Social and population interventions rather than medical approaches
    • General health infrastructure rather than vertical programs
    • Capitalism and regulation
    EPHP 2010