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Alternative health system and public private partnership

  2. 2. INTRODUCTION Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was established. In 1995 and renamed as Department of Ayurveda, Yoga & Naturopathy, Siddha, Unani and Homoeopathy (AYUSH) in November, 2003. There has been a three fold increase in the Plan budget of the Department in the 10th as compared as 9th Plan, most of which was on account of scaling up of the budget provision in the last two years of the 10th Five Year Plan i.e. 2004 –2005 and 2005 – 2006 in line with the declared policy of the Central Government to increase the budgetary provision for AYUSH sector for mainstreaming it in the national health care delivery network.
  3. 3. INTEGRATION OF AYUSH The integration of Ayush is to be carried out at the State and district level: Membership of the State and District Mission and the Integrated State and District Health Societies of a person from Ayush so that they are part of all the decision making processes. The infrastructure will be used for providing a greater availability of services. All the National Programmes will also be implemented by Ayush with regular reporting. Trainings also will be jointly carried out so that the skills of the Ayush personnel can carry out the National programmes effectively.
  4. 4. MONITORING AND EVALUATION Management Information Systems under the NRHM will be web enabled for citizen scrutiny. Civil society organizations will collaborate with the health system in preparing a People‟ Health Report at the district level. . State and National reports anon People‟s health to be tabled in assemblies and parliament. Each health facility will report to their respective Panchayats- sub centers to the Gram Panchayat, Hospitals to the Rogi Kalyan Samiti, and District Heath Mission to the Zila Parishad. External evaluations of the NRHM will be conducted through professional organizations with involvement of civil society.
  5. 5. MAINSTREAMING AYUSH UNDER NRHM Strategies:  Integrate and mainstream ISM &H in health care delivery system including National Programmes.  Encourage and facilitate in setting up of specialty centers.  Facilitate and Strengthen Quality Control Laboratory.  Strengthening the Drug Standardization and Research Activities on AYUSH.  Develop Advocacy for AYUSH.  Establish Sectoral linkages for AYUSH activities Broad Objectives  Mainstreaming of AYUSH in the health care service delivery system to strengthen the existing public health system.
  6. 6. Activities:  Improving the availability of AYUSH treatment faculties and integrating it with the existing Health Care Service Delivery System.  Integration of AYUSH services in 314 CHC / Block PHC with appointment of contractual AYUSH Doctors.  Appointment of 200 paramedics where AYUSH Doctors shall be posted.  Appointment of a Data assistant to support the ISM&H Directorate.  Strengthening of AYUSH Dispensaries with provision of storage equipments.  Making provision for AYUSH Drugs at all levels.  Establishment of specialized therapy centers in District Head Quarter Hospitals & 3 Medical Colleges.  AYUSH doctors to be involved in all National Health Care programmes, especially in the priority areas like IMR, MMR, Control of Malaria, Filaria, and other communicable diseases etc.
  7. 7. INTEGRATION OF AYUSH WITH ASHA.  Training module for ASHA and ANMs have to be updated to incorporate information of AYUSH.  Training & capacity building to be undertaken by the Director, SIHFW, Bhubaneswar and necessary training material for the purpose to be modified and provided accordingly.  Drug kit that will be provided to ASHA will contain one AYUSH preparation in the form of iron supplement. But other drugs which are used in the treatment of common diseases, control of communicable diseases as well as drugs promoting the maternal and child health as well as improving quality of life could be included subsequently.
  8. 8. DRUG MANAGEMENT: Priority will be given to manufacture drugs in Govt. Sector Pharmacies as per their capacity. In case of any surplus funds, drugs will be procured from the market observing all financial formalities of the  Government.  Provision of Rs. 25,000/- to supply drugs per AYUSH dispensary has been projected as per NRHM norm.  Provisions of medicines for District AYUSH wings and Specialty Therapy Centers proposed to be operated in the State.
  9. 9. SPECIAL INITIATIVES FOR MAINSTREAMING AND STRENGTHENING OF AYUSH Strengthening the Quality Control Laboratory:  The quantum of Ayurvedic and Homoeopathic medicines used / procured in both public and private health sectors is huge. There has been wide ranging concern about spurious, counterfeit and sub standard drugs. In order to prevent the spread of sub standard drugs and to ensure that the drugs manufactured or sold or distributed throughout the state are of standard quality, drug regulation and enforcement unit has to be established in the state.  The drug regulatory mechanism to be strengthened at the state level to improve the quality of drugs used in AYUSH and ensure proper standardization. The existing State Drug Testing and Research Laboratory (ISM) at Bhubaneswar shall also be modernized and strengthened for the purpose.
  10. 10. STRENGTHENING THE DRUG STANDARDIZATION AND RESEARCH ACTIVITIES ON AYUSH  It has been proposed to evaluate the chemical, pharmacological and clinical efficacy of the plant drugs.  The pharmacologically viable drugs will be screened clinically under WHO guideline to establish the therapeutic activity.  Clinical trial on different diseases like Psoriasis, Liver disorders, Diabetics, Asthma will be conducted to establish the effect of various drugs used for such diseases.  It has also been proposed to conduct literary research like translation of manuscripts and its publications.  Re-vitalization of the local health traditions and the knowledge of traditional drugs used by experienced local health traditioners will be gathered and documented
  11. 11. STRENGTHENING OF THE STATE AND DISTRICT MANAGEMENT SYSTEM OF AYUSH:  It is proposed to create necessary Managerial post in the State and District level for effective supervision and implementation of different activities.  Necessary vehicles with supporting manpower has also been proposed to strengthen the supervisory  Joint monitoring visits to health centers to be undertaken by both AYUSH and Health Care Officials at the District level‟s/State level.
  12. 12. CORE STRATEGIES OF NRHM INCLUDE:  Decentralized village and district level health planning and management  Appointment of Accredited Social Health Activist (ASHA) to facilitate access to health services  Strengthening the public health service delivery infrastructure, particularly at village, primary and secondary levels,  Mainstreaming AYUSH,  Improved management capacity to organize health systems and services in public health
  13. 13. TYPES OF AYUSH- AYURVEDA Ayurveda - Concept and Principles Life in Ayurveda is conceived as the union of body, senses, mind and soul. The living man is a conglomeration of three humours (Vata, Pitta &Kapha), seven basic tissues (Rasa, Rakta, Mansa, Meda, Asthi, Majja & Shukra) and the waste products of the body such as faeces, urine and sweat. Thus the total body matrix comprises of the humours, the tissues and the waste products of the body.
  14. 14. DIAGNOSIS In Ayuveda diagnosis is always done of the patient as a whole.  General physical examination  Pulse examination  Urine examination  Examination of the faeces  Examination of tongue and eyes.  Examination of skin and ear including tactile and auditory functions.
  15. 15. TYPES OF TREATMENT The treatment of disease can broadly be classified as  Shodhana therapy (Purification Treatment)  Shamana therapy (Palliative Treatment)  Pathya Vyavastha (Prescription of diet and activity)  Nidan Parivarjan (Avoidance of disease causing and aggravating factors)  Satvavajaya(Psychotherapy)  Rasayana therapy(use of immunomodulators and rejuvenation medicines)
  16. 16. a) Shodhana treatment aims at removal of the causative factors of somatic and psychosomatic diseases. The process involves internal and external purification. The usual practices involved are Panchkarma (medically induced Emesis, Purgation, Oil Enema, Decoction enema and Nasal administration of medicines), Pre-panchkarma procedures (external and internal oleation and induced sweating). Panchkarma treatment focuses on metabolic management. (b) Shamana therapy involves suppression of vitiated humours (doshas). The process by which disturbed humour subsides or returns to normal without creating imbalance of other humours is known as shamana. This treatment is achieved by use of appetisers, digestives, exercise and exposure to sun, fresh air etc. In this form of treatment, palliatives and sedatives are used. (c) Pathya Vyavastha comprises indications and contraindications in respect of diet, activity, habits and emotional status. This is done with a view to enhance the effects of therapeutic measures and to impede the pathogenetic processes. Emphasis on do‟s and don‟ts of diet etc is laid with the aim to stimulate Agni and optimize digestion and assimilation of food in order to ensure strength of tissues.
  17. 17. (d) Nidan Parivarjan is to avoid the known disease causing factors in diet and lifestyle of the patient. (e) Satvavajaya concerns mainly with the area of mental disturbances. This includes restraining the mind from desires for unwholesome objects and cultivation of courage, memory and concentration. The study of psychology and psychiatry have been developed extensively in Ayurveda and have wide range of approaches in the treatment of mental disorders. (f) Rasayana therapy deals with promotion of strength and vitality. The integrity of body matrix, promotion of memory, intelligence, immunity against the disease.
  18. 18. NATUROPATHY Principles  All disease, their cause and their treatment are one.  The basic cause of disease is not bacteria.  Acute diseases are our friends not he enemies. Chronic diseases are the outcome of wrong treatment and suppression of the acute diseases.  Nature is the greatest healer. Body the capacity to prevent itself from diseases and regain health if unhealthy.  In Naturopathy patient is treated and not the disease.  In Naturopathy diagnosis is easily possible. Long waiting for diagnosis is not required for treatment.  Patients suffering from chronic ailments are also treated successfully in comparatively less time in Naturopathy.
  19. 19. The methods applied for cure in Naturopathy are the following: -  Water Therapy  Air Therapy  Fire Therapy: Existence of all the creatures and forms depends upon “Agni” (Fire).  Space Therapy: Congestion causes disease. Fasting is the best therapy to relieve congestion of body and mind.  Mud Therapy: Mud absorbs, dissolves and eliminates the toxins and rejuvenates the body. It is employed in treatment of various diseases like constipation, skin diseases etc.
  20. 20.  Food Therapy  Massage Therapy  Acupressure  Magneto Therapy: Magnets influence health. South and North poles of different powers and shapes are employed in treatment.  Chromo Therapy: Sun rays have seven colours – violet, indigo, blue, green, yellow, orange and red. These colours are employed through irradiation or body or by administering charged water, oil and pills for treatment.
  21. 21. SIDDHA Introduction and Origin Siddha system is one of the oldest systems of medicine in India . The term Siddha means achievements and Siddhars were saintly persons who achieved results in medicine. Eighteen Siddhars were said to have contributed towards the development of this medical system. Siddha literature is in Tamil and it is practiced largely in Tamil speaking part of India and abroad. The Siddha System is largely therapeutic in nature.
  22. 22. DIAGNOSIS AND TREATMENT The diagnosis of diseases involve identifying it causes. Identification of causative factors is through the examination of pulse, urine, eyes, study of voice, color of body, tongue and the status of the digestive system. The system has worked out details procedure of urine examination which includes study of it‟s color, smell, density, quantity and oil drop spreading pattern. It holistic in approach and the diagnosis involves the study of person as a whole as well as his disease.
  23. 23. The Siddha System is effective in treating chronic cases of liver, skin diseases especially “Psoriasis”, rheumatic problems, anemia, prostate enlargement, bleeding piles and peptic ulcer. The Siddha Medicines which contains mercury, silver, lead and sulphur have been found to be effective in treating certain infectious diseases including venereal diseases.
  24. 24. UNANI  Introduction and Origin Unani System of Medicines originated in Greece and is based on the teachings of Hippocrates and Gallen and it developed in to an elaborate Medical System by Arabs, like Rhazes , Avicenna, Al- Zahravi , Ibne-Nafis and others. Unani System has Shown remarkable results in curing the diseases like Arthritis, Leucoderma, Jaundice, Liver disorders, Nervous system disorders, Bronchial Asthma, and several other acute and chronic diseases where other systems have not been able to give desired response.
  25. 25.  Unani treatment is based on its natural and remarkable diagnosis methods and is affordable. It is mainly dependent on the Temperament (Mizaj) of the patient, hereditary condition and effects, different complaints, signs and symptoms of the body, external observation, examination of the PULSE (Nubz), urine and stool etc. Unique and special treatment methods like Dieto therapy (Ilaj-bil-Ghiza), Climatic therapy (Ilaj-bil- Hawa), Regimental therapy (Ilaj-bit-Tadbir), make it a different and remarkable and popular system.  Regimental therapy includes venesection, cupping, diaphoresis, diuresis, Turkish bath, massage, cauterization, purging, emesis, exercise, leeching, etc.  Dieto therapy (Ilaj-bil-Ghiza) aims at treating certain ailments by administration of specific diets or by regulating the quantity and quality of food.  Pharmacotherapy (Ilaj-bid-Dawa) is mainly dependent upon local available herbal drugs which make the system indigenous. Similarly, surgery has also been in use in this system for quite long. In fact, the ancient physicians of Unani Medicine were pioneers in this field and had developed their own instruments and techniques. But at present only minor surgery is in vogue in this system.
  26. 26. YOGA The tradition of Yoga was born in India several thousand years ago. Its founders were great Saints and Sages. The great Yogis gave rational interpretation of their experiences about Yoga and brought a practically sound and scientifically prepared method within every one‟s reach. Yoga philosophy is an Art and Science of living in tune with Brahmand- The Universe. Yoga has its origins in the Vedas, the oldest record of Indian culture. It was systematized by the great Indian sage Patanjali in the Yoga Sutra as a special Darshana. Although, this work was followed by many other important texts on Yoga, but Patanjali‟s Yoga Sutra is certainly the most significant wherein no change is possible. It is the only book which has touched almost all the aspects of human life.
  27. 27. STREAMS OF YOGA :  There are a large numbers of methods of Yoga catering to the needs of different persons in society. They are broadly classified into four streams. Swami Vivekananda puts them as Work, Worship, Philosophy and Psychic control.  Karma Yoga, the path of work, involves doing action in a skilful way. In other words, it can be said as a way of enjoying work, doing it effortlessly. The success or failure should not be allowed to cause ripples in the mind.  „Bhakti Yoga‟ the path of worship is a systematic method of engaging the mind in the practice of divine love. This attitutde of love softens our emotions and tranquillises our mind.  Jnana Yoga, the path of philosophy, is a systematic way of tutoring the mind about the realities of life by contemplation. This will strip off the garb of Avidya (ignorance) from our mind and the mind goes to its natural state of rest.
  28. 28. Principles  Yoga means a holistic approach towards the cause and treatment of disease.  According to Yoga, most of the diseases Mental, Psychosomatic and Physical originate in mind through wrong way of thinking, living and eating which is caused by attachment.  The basic approach of Yoga is to correct the life style by cultivating a rational positive and spiritual attitude towards all life situation.  Yoga does not treat gross body alone, it takes into consideration all the five Kosa‟s (Sheaths) i.e. Manomaya Kosa, Annamaya Kosa, (grass Sheath) Pranamaya Kosa (Extral Body) (Psychic Body), Vijyanmaya Kosa (intellect Sheath) and Anandamaya Kosa (Bliss sheath).  Like Ayurveda and Naturopathy Yoga also takes up the cleansing of the body as the first measure to fight disease. While Ayurveda performs its pancha karma through the help of ametics purgative Yoga performs them without the help of any drug i.e. by developing full efficiency and control of eliminative systems of the body. Which no other system of health care can do.  All the systems of medicine at their best aim at curing the disease whereas Yoga aims at preventing the disease and promoting health by reconditioning the psycho-physiological mechanism of the individual.
  29. 29. PUBLIC PRIVATE PARTNERSHIP- Vision Facilitating and enhancing quality public service delivery by being a catalyst for efficient, effective and value-for-money best practice solutions Mission  To enable National Treasury and provincial treasuries to effectively regulate PPPs  To evolve as a dynamic and sustainable center of excellence for PPPs  To drive PPP deal flow by identifying project opportunities that yield value for all stakeholders  To provide technical assistance to public institutions through project feasibility, procurement and management; and  To promote an enabling environment for PPPs by: o facilitating certainty in the regulatory framework o developing best practice guidelines o providing training o disseminating reliable information; and o driving black economic empowerment in PPPs.
  30. 30. Values  Fairness.  Empowerment.  Professionalism.  Integrity.  Passion.
  31. 31. DEFINITION- PPP as a contract between a public sector institution/municipality and a private party, in which the private party assumes substantial financial, technical and operational risk in the design, financing, building and operation of a project. Two types of PPPs are specifically defined:  where the private party performs an institutional/municipal function  where the private party acquires the use of state/municipal property for its own commercial purposes PPP may also be a hybrid of these types.
  32. 32. CENTRALLY SPONSORED SCHEMES DEVELOPMENT AND UPGRADATION OF AYUSH INSTITUTES/COLLEGES- (i) Development of UG colleges. (ii) Assistance to P.G. Medical Education (iii) Re-orientation Training Programme for AYUSH Personnel. (iv) Renovation and strengthening of Hospital wards of Govt./ Govt. aided teaching (v) Establishment of computer laboratory. (vi)Up-gradation of academy institutes to the status model Institutes of AYUSH.
  33. 33. HOSPITALS AND DISPENSARIES  The scheme has been designed with a view to make available the benefits of Ayurveda, Unani, Siddha, Yoga & Naturopathy and Homoeopathy to the public at large.  Through this scheme the Central Government intends to encourage setting up of general and specialized treatment centers of ISM&H in allopathic hospitals and support the efforts of State Governments to improve the supply position of essential drugs in dispensaries situated in rural and backward areas, so that the faith of people in ISM&H could be enhanced.
  34. 34. STATE OF PUBLIC HEALTH 1) Union Government contribution to public health expenditure is 15% while States contribution about 85% 2) Vertical Health and Family Welfare Programmes have limited to operational levels. 3) Lack of community ownership of public health programmes impacts levels of efficiency, accountability and effectiveness. 4) Lack of integration of sanitation, hygiene, nutrition and drinking water issue. 5) Population Stabilization is still a challenge, especially in States with weak demographic indicators.
  35. 35. NATIONAL RURAL HEALTH MISSION – THE VISION GOALS 1) Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) 2)Universal access to public health services such as Women‟s health, child health, water, sanitation & hygiene, immunization, and Nutrition. 3)Prevention and control of communicable and non-communicable diseases, including locally endemic diseases 4)Access to integrated comprehensive primary healthcare 5)Population stabilization, gender and demographic balance. 6)Revitalize local health traditions and mainstream AYUSH 7)Promotion of healthy life styles
  36. 36. Supplementary Strategies: • Regulation of Private Sector including the informal rural practitioners to ensure availability of quality service to citizens at reasonable cost. • Promotion of Public Private Partnerships for achieving public health goals. • Mainstreaming AYUSH – revitalizing local health traditions. • Reorienting medical education to support rural health issues including regulation of Medical care and Medical Ethics. • Effective and viable risk pooling and social health insurance to provide health security to the poor by ensuring accessible, affordable, accountable and good quality hospital care.
  37. 37. PLAN OF ACTION COMPONENT (A): ACCREDITED SOCIAL HEALTH ACTIVISTS • Every village/large habitat will have a female Accredited Social Health Activist (ASHA) - chosen by and accountable to the panchayat- to act as the interface between the community and the public health system. States to choose State specific models. • ASHA would act as a bridge between the ANM and the village and be accountable to the Panchayat. • She will be an honorary volunteer, receiving performance- based compensation for promoting universal immunization, referral and escort services for RCH, construction of household toilets, and other healthcare delivery programmes.
  38. 38. • She will be trained on a pedagogy of public health developed and mentored through a Standing Mentoring Group at National level incorporating best practices and implemented through active involvement of community health resource organizations. • She will facilitate preparation and implementation of the Village Health Plan along with Anganwadi worker, ANM, functionaries of other Departments, and Self Help Group members, under the leadership of the Village Health Committee of the Panchayat.
  39. 39. COMPONENT (B): STRENGTHENING SUB-CENTRES • Each sub-centre will have an Untied Fund for local action @ Rs. 10,000 per annum. This Fund will be deposited in a joint Bank Account of the ANM & Sarpanch and operated by the ANM, in consultation with the Village Health Committee. • Supply of essential drugs, both allopathic and AYUSH, to the Sub-centers. • In case of additional Outlays, Multipurpose Workers (Male)/Additional ANMs wherever needed, sanction of new Sub-centers as per 2001 population norm, and upgrading existing Sub-centers, including buildings for Sub-centers functioning in rented premises will be considered.
  40. 40. COMPONENT (C): STRENGTHENING PRIMARY HEALTH CENTRES Mission aims at Strengthening PHC for quality preventive, promotive, curative, supervisory and Outreach services, through: • Adequate and regular supply of essential quality drugs and equipment (including Supply of Auto Disabled Syringes for immunization) to PHCs • Provision of 24 hour service in 50% PHCs by addressing shortage of doctors, especially in high focus States, through mainstreaming AYUSH manpower. • Observance of Standard treatment guidelines & protocols. • In case of additional Outlays, intensification of ongoing communicable disease control programmes, new programmes for control of non communicable diseases, up gradation of 100% PHCs for 24 hours referral service, and provision of 2nd doctor at PHC level (1 male, 1 female) would be undertaken on the basis of felt need.
  41. 41.  COMPONENT (D): STRENGTHENING CHCs FOR FIRST REFERRAL CARE A key strategy of the Mission is: • Operationalizing 3222 existing Community Health Centers (30-50 beds) as 24 Hour First Referral Units, including posting of anaesthetists. • Codification of new Indian Public Health Standards, setting norms for infrastructure, staff, equipment, management etc. for CHCs. • Promotion of Stakeholder Committees (Rogi Kalyan Samitis) for hospital management. • Developing standards of services and costs in hospital care. • Develop, display and ensure compliance to Citizen‟s at CHC/PHC level. • In case of additional Outlays, creation of new Community Health Centers (30-50 beds) to meet the population norm as per Census 2001, and bearing their recurring costs for the Mission period could be considered.
  42. 42. COMPONENT (E): CONVERGING SANITATION AND HYGIENE UNDER NRHM • Total Sanitation Campaign (TSC) is presently implemented in 350 districts, and is proposed to cover all districts in 10th Plan. • Components of TSC include rural sanitary marts, individual household toilets, women sanitary complex, and School Sanitation Programme. • Similar to the TSC is also implemented through Panchayati Raj Institutions (PRIs). • The District Health Mission would therefore guide activities of sanitation at district level, and promote joint for public health, sanitation and hygiene, through Village Health & Sanitation Committee, and promote household toilets and School Sanitation Programme. ASHA would be incentivized for promoting household toilets by the Mission.
  43. 43. COMPONENT (F): STRENGTHENING DISEASE CONTROL PROGRAMMES • National Disease Control Programmes for Malaria , TB, Kala Azar, Filaria, Blindness & Iodine Deficiency and Integrated Disease Surveillance Programme shall be integrated under the Mission, for improved programme delivery. • New Initiatives would be launched for control of Non Communicable Diseases. • Disease surveillance system at village level would be strengthened. • Supply of generic drugs (both AYUSH & Allopathic) for common ailments at village, SC, PHC/CHC level. • Provision of a mobile medical unit at District level for improved Outreach services.
  44. 44. COMPONENT (G): PUBLIC-PRIVATE PARTNERSHIP FOR PUBLIC HEALTH GOALS, INCLUDING REGULATION OF PRIVATE SECTOR • Since almost 75% of health services are being currently provided by the private sector, there is a need to refine regulation • Regulation to be transparent and accountable • Reform of regulatory bodies/creation where necessary • District Institutional Mechanism for Mission must have representation of private sector • Need to develop guidelines for Public-Private Partnership (PPP) in health sector. Identifying areas of partnership, which are need based, thematic and geographic. • Public sector to play the lead role in defining the framework and sustaining the partnership • Management plan for PPP initiatives: at District/State and National levels
  45. 45. INSTITUTIONAL MECHANISMS • Village Health & Sanitation Samiti (at village level consisting of Panchayat Representative/s, ANM/MPW, Anganwadi worker, teacher, ASHA, community health volunteers • Rogi Kalyan Samiti (or equivalent) for community management of public hospitals • District Health Mission, under the leadership of Zilla Parishad with District Health Head as Convener and all relevant departments, NGOs, private professionals etc represented on it • State Health Mission, Chaired by Chief Minister and co-chaired by Health Minister and with the State Health Secretary as Convener- representation of related departments, NGOs, private professionals etc • Integration of Departments of Health and Family Welfare, at National and State level • National Mission Steering Group chaired by Union Minister for Health & Family Welfare with Deputy Chairman Planning Commission, Ministers of Panchayat Raj, Rural Development and Human Resource Development and public health professionals as members, to provide policy support and guidance to the Mission. • Empowered Programme Committee chaired by Secretary HFW, to be the Executive Body of the Mission.
  46. 46. TECHNICAL SUPPORT • To be effective the Mission needs a strong component of Technical Support • This would include reorientation into public health management • Reposition existing health resource institutions, like Population Research Centre (PRC), Regional Resource Centre (RRC), State Institute of Health & Family Welfare (SIHFW) • Involve NGOs as resource organizations • Improved Health Information System • Support required at all levels: National, State, District and sub-district. • Mission would require two distinct support mechanisms – Program Management Support Centre and Health Trust of India.
  47. 47. A) PROGRAM MANAGEMENT SUPPORT CENTRE • For Strengthening Management Systems-basic program management, financial systems, infrastructure maintenance, procurement & logistics systems, Monitoring & Information System (MIS), non-lapsable health pool etc. • For Developing Manpower Systems – recruitment (induction of MBAs/CAs /MCAs), training & curriculum development (revitalization of existing institutions & partnerships with NGO & private sector. Sector institutions), motivation & performance appraisal etc. • For Improved Governance – decentralization & empowerment of communities, induction of IT based systems like e-banking, social audit and right to information.
  48. 48. ROLE OF NGOs IN THE MISSION · Included in institutional arrangement at National, State and District levels, including Standing Mentoring Group for ASHA · Member of Task Groups · Provision of Training, BCC and Technical Support for ASHAs/DHM · Health Resource Organizations · Service delivery for identified population groups on select themes · For monitoring, evaluation and social audit
  49. 49. MAINSTREAMING AYUSH · The Mission seeks to revitalize local health traditions and mainstream AYUSH infrastructure, including manpower, and drugs, to strengthen the public health system at all levels. · AYUSH medications shall be included in the Drug Kit provided at village levels to ASHA. · The additional supply of generic drugs for common ailments at Sub center/PHC/CHC levels under the Mission shall also include AYUSH formulations. · At the CHC level, two rooms shall be provided for AYUSH practitioner and pharmacist under the Indian Public Health System (IPHS) model. · Single doctor PHCs shall be upgraded to two doctor PHCs by mainstreaming AYUSH practitioner at that level.
  50. 50. MONITORING AND EVALUATION · Health MIS to be developed up to CHC level, and web- enabled for citizen scrutiny · Sub-centers to report on performance to Panchayats, Hospitals to Rogi Kalyan Samitis and District Health Mission to Zilla Parishad · The District Health Mission to monitor compliance to Citizen‟s at CHC level · Annual District Reports on People‟s Health (to be prepared by Govt./NGO collaboration) · State and National Reports on People‟s Health to be tabled in Assemblies, Parliament · External evaluation/social audit through professional bodies/NGOs.
  51. 51. BIBLIOGRAPHY- 1) K.Park,Park‟s textbook of preventive and social medicine/s banarsides bhanot publishers,19th edition,2007;1,67-72. 2) Stanhop.M,Community health nursing,3rd edition,mosby USA,27-28,112,115. 3) AYUSH, Medical journal, March 2006,4(14),41-57. 4) Public health ,Journal of india,April 2007,5(3),61-68. 5) Search-AYUSH 6) Search-AYUSH with PPP
  52. 52.