Some thoughts on the National Rural Health Mission and on public health policy K. S. Jacob Christian Medical College, Vell...
NRHM <ul><li>Refocus on health </li></ul><ul><li>Prioritizing rural India </li></ul><ul><li>Major inputs </li></ul><ul><li...
Background and bias <ul><li>Academic </li></ul><ul><li>Recent convert to public health </li></ul>EPHP 2010
Basis of  my perspectives <ul><li>NRHM Common review missions </li></ul><ul><ul><li>Kerala </li></ul></ul><ul><ul><li>Andh...
Regional variation, inputs and governance <ul><li>High focus states </li></ul><ul><li>Health, utilization and governance <...
Convergence of diverse efforts <ul><li>State health service </li></ul><ul><li>NRHM </li></ul><ul><li>ICDS </li></ul><ul><l...
Assessment of the NRHM <ul><li>Process and outcome assessment and audit </li></ul><ul><ul><li>NRHM data process data </li>...
Parallel health systems and integration <ul><li>Project mode  </li></ul><ul><li>Parallel health systems and integration </...
New platforms and old programs <ul><li>VHND and ICDS </li></ul><ul><li>Anganwadis and ANMs </li></ul><ul><li>Mobile clinic...
Divided approach <ul><li>Health insurance and out sourcing </li></ul><ul><ul><li>Aarogyasri </li></ul></ul><ul><ul><li>KKT...
Old ethos and new inputs <ul><li>Inertia of system, discipline and morale of health staff </li></ul><ul><li>Myths to cover...
Social group variation and targeted input <ul><li>Scheduled caste and tribes </li></ul><ul><li>Specific district programs ...
Theory and practice <ul><li>Planning and implementation </li></ul><ul><li>Successful vertical programs and integration wit...
Determinants of health <ul><li>Curative medicine </li></ul><ul><li>Social determinants </li></ul><ul><ul><li>Poverty </li>...
Errors of the public health- 1 <ul><li>Urgency-driven curative medical interventions instead of long-term public health so...
Errors of the public health-2 <ul><li>Reducing health to a biomedical perspective </li></ul><ul><ul><li>Social determinant...
Public health <ul><li>Convergence of politics, finance, social science, cultural studies, engineering, science, education,...
The way forward <ul><li>Population health and national interest </li></ul><ul><li>Social and population interventions rath...
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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

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

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