Alternative health system and public private partnership


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Alternative health system and public private partnership

  2. 2. INTRODUCTIONDepartment of Indian Systems of Medicine andHomoeopathy (ISM&H) was established. In 1995 andrenamed as Department of Ayurveda, Yoga &Naturopathy, Siddha, Unani and Homoeopathy(AYUSH) in November, 2003. There has been a threefold increase in the Plan budget of the Department in the10th as compared as 9th Plan, most of which was onaccount of scaling up of the budget provision in the lasttwo years of the 10th Five Year Plan i.e. 2004 –2005 and2005 – 2006 in line with the declared policy of theCentral Government to increase the budgetary provisionfor AYUSH sector for mainstreaming it in the nationalhealth care delivery
  3. 3. INTEGRATION OF AYUSHThe integration of Ayush is to be carried outat the State and district level:Membership of the State and District Missionand the Integrated State and District HealthSocieties of a person from Ayush so that they arepart of all the decision making processes. Theinfrastructure will be used for providing agreater availability of services. All the NationalProgrammes will also be implemented by Ayushwith regular reporting. Trainings also will bejointly carried out so that the skills of the Ayushpersonnel can carry out the Nationalprogrammes
  4. 4. MONITORING AND EVALUATIONManagement Information Systems under theNRHM will be web enabled for citizen scrutiny.Civil society organizations will collaborate with thehealth system in preparing a People‟ Health Report atthe district level. . State and National reports anonPeople‟s health to be tabled in assemblies andparliament. Each health facility will report to theirrespective Panchayats- sub centers to the GramPanchayat, Hospitals to the Rogi Kalyan Samiti, andDistrict Heath Mission to the Zila Parishad. Externalevaluations of the NRHM will be conducted throughprofessional organizations with involvement of
  5. 5. MAINSTREAMING AYUSH UNDER NRHMStrategies: Integrate and mainstream ISM &H in health caredelivery system including National Programmes. Encourage and facilitate in setting up of specialtycenters. Facilitate and Strengthen Quality Control Laboratory. Strengthening the Drug Standardization and ResearchActivities on AYUSH. Develop Advocacy for AYUSH. Establish Sectoral linkages for AYUSH activitiesBroad Objectives Mainstreaming of AYUSH in the health care servicedelivery system to strengthen the existing public
  6. 6. Activities: Improving the availability of AYUSH treatment facultiesand integrating it with the existing Health Care ServiceDelivery System. Integration of AYUSH services in 314 CHC / Block PHCwith appointment of contractual AYUSH Doctors. Appointment of 200 paramedics where AYUSH Doctorsshall be posted. Appointment of a Data assistant to support the ISM&HDirectorate. Strengthening of AYUSH Dispensaries with provision ofstorage equipments. Making provision for AYUSH Drugs at all levels. Establishment of specialized therapy centers in DistrictHead Quarter Hospitals & 3 Medical Colleges. AYUSH doctors to be involved in all National Health Careprogrammes, especially in the priority areas like IMR,MMR, Control of Malaria, Filaria, and othercommunicable diseases
  7. 7. INTEGRATION OF AYUSH WITH ASHA. Training module for ASHA and ANMs have to beupdated to incorporate information of AYUSH. Training & capacity building to be undertaken by theDirector, SIHFW, Bhubaneswar and necessarytraining material for the purpose to be modified andprovided accordingly. Drug kit that will be provided to ASHA will containone AYUSH preparation in the form of ironsupplement. But other drugs which are used in thetreatment of common diseases, control ofcommunicable diseases as well as drugs promotingthe maternal and child health as well as improvingquality of life could be included
  8. 8. DRUG MANAGEMENT:Priority will be given to manufacturedrugs in Govt. Sector Pharmacies as per theircapacity. In case of any surplus funds, drugs willbe procured from the market observing allfinancial formalities of the Government. Provision of Rs. 25,000/- to supply drugs perAYUSH dispensary has been projected as perNRHM norm. Provisions of medicines for District AYUSHwings and Specialty Therapy Centers proposedto be operated in the
  9. 9. SPECIAL INITIATIVES FOR MAINSTREAMINGAND STRENGTHENING OF AYUSHStrengthening the Quality Control Laboratory: The quantum of Ayurvedic and Homoeopathic medicinesused / procured in both public and private health sectors ishuge. There has been wide ranging concern about spurious,counterfeit and sub standard drugs. In order to prevent thespread of sub standard drugs and to ensure that the drugsmanufactured or sold or distributed throughout the state areof standard quality, drug regulation and enforcement unit hasto be established in the state. The drug regulatory mechanism to be strengthened at thestate level to improve the quality of drugs used in AYUSHand ensure proper standardization. The existing State DrugTesting and Research Laboratory (ISM) at Bhubaneswar shallalso be modernized and strengthened for the
  10. 10. STRENGTHENING THE DRUGSTANDARDIZATION AND RESEARCH ACTIVITIES ONAYUSH It has been proposed to evaluate the chemical,pharmacological and clinical efficacy of the plant drugs. The pharmacologically viable drugs will be screened clinicallyunder WHO guideline to establish the therapeutic activity. Clinical trial on different diseases like Psoriasis, Liverdisorders, Diabetics, Asthma will be conducted to establish theeffect of various drugs used for such diseases. It has also been proposed to conduct literary research liketranslation of manuscripts and its publications. Re-vitalization of the local health traditions and the knowledgeof traditional drugs used by experienced local healthtraditioners will be gathered and
  11. 11. STRENGTHENING OF THE STATE AND DISTRICTMANAGEMENT SYSTEM OF AYUSH: It is proposed to create necessary Managerial postin the State and District level for effectivesupervision and implementation of differentactivities. Necessary vehicles with supporting manpowerhas also been proposed to strengthen thesupervisory Joint monitoring visits to health centers to beundertaken by both AYUSH and Health CareOfficials at the District level‟s/State
  12. 12. CORE STRATEGIES OF NRHM INCLUDE: Decentralized village and district level healthplanning and management Appointment of Accredited Social HealthActivist (ASHA) to facilitate access to healthservices Strengthening the public health service deliveryinfrastructure, particularly at village, primaryand secondary levels, Mainstreaming AYUSH, Improved management capacity to organizehealth systems and services in public
  13. 13. TYPES OF AYUSH-AYURVEDAAyurveda - Concept and PrinciplesLife in Ayurveda is conceived as the union ofbody, senses, mind and soul. The living man is aconglomeration of three humours (Vata, Pitta &Kapha),seven basic tissues (Rasa, Rakta, Mansa, Meda, Asthi,Majja & Shukra) and the waste products of the bodysuch as faeces, urine and sweat. Thus the total bodymatrix comprises of the humours, the tissues and thewaste products of the
  14. 14. DIAGNOSISIn Ayuveda diagnosis is always done of thepatient 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 andauditory
  15. 15. TYPES OF TREATMENTThe treatment of disease can broadly beclassified as Shodhana therapy (Purification Treatment) Shamana therapy (Palliative Treatment) Pathya Vyavastha (Prescription of diet andactivity) Nidan Parivarjan (Avoidance of disease causingand aggravating factors) Satvavajaya(Psychotherapy) Rasayana therapy(use of immunomodulators andrejuvenation medicines)
  16. 16. a) Shodhana treatment aims at removal of the causative factors ofsomatic and psychosomatic diseases. The process involvesinternal and external purification. The usual practices involvedare Panchkarma (medically induced Emesis, Purgation, OilEnema, Decoction enema and Nasal administration ofmedicines), Pre-panchkarma procedures (external and internaloleation and induced sweating). Panchkarma treatment focuseson metabolic management.(b) Shamana therapy involves suppression of vitiated humours(doshas). The process by which disturbed humour subsides orreturns to normal without creating imbalance of other humours isknown as shamana. This treatment is achieved by use ofappetisers, 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 contraindicationsin respect of diet, activity, habits and emotional status. This isdone with a view to enhance the effects of therapeutic measuresand to impede the pathogenetic processes. Emphasis on do‟s anddon‟ts of diet etc is laid with the aim to stimulate Agni andoptimize digestion and assimilation of food in order to ensurestrength of
  17. 17. (d) Nidan Parivarjan is to avoid the known diseasecausing factors in diet and lifestyle of the patient.(e) Satvavajaya concerns mainly with the area of mentaldisturbances. This includes restraining the mind fromdesires for unwholesome objects and cultivation ofcourage, memory and concentration. The study ofpsychology and psychiatry have been developedextensively in Ayurveda and have wide range ofapproaches in the treatment of mental disorders.(f) Rasayana therapy deals with promotion of strengthand vitality. The integrity of body matrix, promotion ofmemory, intelligence, immunity against the
  18. 18. NATUROPATHYPrinciples 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. Chronicdiseases are the outcome of wrong treatment andsuppression of the acute diseases. Nature is the greatest healer. Body the capacity to preventitself from diseases and regain health if unhealthy. In Naturopathy patient is treated and not the disease. In Naturopathy diagnosis is easily possible. Long waitingfor diagnosis is not required for treatment. Patients suffering from chronic ailments are also treatedsuccessfully in comparatively less time in
  19. 19. The methods applied for cure in Naturopathy are thefollowing: - Water Therapy Air Therapy Fire Therapy: Existence of all the creatures and formsdepends upon “Agni” (Fire). Space Therapy: Congestion causes disease. Fasting isthe best therapy to relieve congestion of body and mind. Mud Therapy: Mud absorbs, dissolves and eliminatesthe toxins and rejuvenates the body. It is employed intreatment of various diseases like constipation, skindiseases
  20. 20.  Food Therapy Massage Therapy Acupressure Magneto Therapy: Magnets influence health. Southand North poles of different powers and shapes areemployed in treatment. Chromo Therapy: Sun rays have seven colours –violet, indigo, blue, green, yellow, orange andred. These colours are employed through irradiation orbody or by administering charged water, oil and pills
  21. 21. SIDDHAIntroduction and OriginSiddha system is one of the oldest systemsof medicine in India . The term Siddha meansachievements and Siddhars were saintly personswho achieved results in medicine. EighteenSiddhars were said to have contributed towards thedevelopment of this medical system. Siddhaliterature is in Tamil and it is practiced largely inTamil speaking part of India and abroad. TheSiddha System is largely therapeutic in
  22. 22. DIAGNOSIS AND TREATMENTThe diagnosis of diseases involve identifyingit causes. Identification of causative factors isthrough the examination of pulse, urine, eyes, studyof voice, color of body, tongue and the status of thedigestive system. The system has worked out detailsprocedure of urine examination which includes studyof it‟s color, smell, density, quantity and oil dropspreading pattern. It holistic in approach and thediagnosis involves the study of person as a whole aswell as his
  23. 23. The Siddha System is effective in treatingchronic cases of liver, skin diseases especially“Psoriasis”, rheumatic problems, anemia,prostate enlargement, bleeding piles and pepticulcer. The Siddha Medicines which containsmercury, silver, lead and sulphur have beenfound to be effective in treating certaininfectious diseases including venereal
  24. 24. UNANI Introduction and OriginUnani System of Medicines originated in Greeceand is based on the teachings of Hippocrates andGallen and it developed in to an elaborate MedicalSystem by Arabs, like Rhazes , Avicenna, Al-Zahravi , Ibne-Nafis and others. Unani System hasShown remarkable results in curing the diseases likeArthritis, Leucoderma, Jaundice, Liver disorders,Nervous system disorders, Bronchial Asthma, andseveral other acute and chronic diseases where othersystems have not been able to give desired
  25. 25.  Unani treatment is based on its natural and remarkable diagnosis methodsand is affordable. It is mainly dependent on the Temperament (Mizaj) ofthe patient, hereditary condition and effects, different complaints, signsand symptoms of the body, external observation, examination of thePULSE (Nubz), urine and stool etc. Unique and special treatmentmethods like Dieto therapy (Ilaj-bil-Ghiza), Climatic therapy (Ilaj-bil-Hawa), Regimental therapy (Ilaj-bit-Tadbir), make it a different andremarkable 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 byadministration of specific diets or by regulating the quantity and qualityof food. Pharmacotherapy (Ilaj-bid-Dawa) is mainly dependent upon localavailable herbal drugs which make the system indigenous. Similarly,surgery has also been in use in this system for quite long. In fact, theancient physicians of Unani Medicine were pioneers in this field and haddeveloped their own instruments and techniques. But at present onlyminor surgery is in vogue in this
  26. 26. YOGAThe tradition of Yoga was born in India severalthousand years ago. Its founders were great Saints andSages. The great Yogis gave rational interpretation of theirexperiences about Yoga and brought a practically sound andscientifically prepared method within every one‟s reach.Yoga philosophy is an Art and Science of living in tune withBrahmand- The Universe. Yoga has its origins in theVedas, the oldest record of Indian culture. It wassystematized by the great Indian sage Patanjali in the YogaSutra as a special Darshana. Although, this work wasfollowed by many other important texts on Yoga, butPatanjali‟s Yoga Sutra is certainly the most significantwherein no change is possible. It is the only book which hastouched almost all the aspects of human
  27. 27. STREAMS OF YOGA : There are a large numbers of methods of Yoga catering to theneeds of different persons in society. They are broadlyclassified into four streams. Swami Vivekananda puts them asWork, Worship, Philosophy and Psychic control. Karma Yoga, the path of work, involves doing action in askilful way. In other words, it can be said as a way of enjoyingwork, doing it effortlessly. The success or failure should not beallowed to cause ripples in the mind. „Bhakti Yoga‟ the path of worship is a systematic method ofengaging the mind in the practice of divine love. This attitutdeof love softens our emotions and tranquillises our mind. Jnana Yoga, the path of philosophy, is a systematic way oftutoring the mind about the realities of life by contemplation.This will strip off the garb of Avidya (ignorance) from ourmind and the mind goes to its natural state of
  28. 28. Principles Yoga means a holistic approach towards the cause and treatment ofdisease. According to Yoga, most of the diseases Mental, Psychosomatic andPhysical originate in mind through wrong way of thinking, living andeating which is caused by attachment. The basic approach of Yoga is to correct the life style by cultivating arational positive and spiritual attitude towards all life situation. Yoga does not treat gross body alone, it takes into consideration all thefive Kosa‟s (Sheaths) i.e. Manomaya Kosa, Annamaya Kosa, (grassSheath) 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 thebody as the first measure to fight disease. While Ayurveda performs itspancha karma through the help of ametics purgative Yoga performs themwithout the help of any drug i.e. by developing full efficiency and controlof eliminative systems of the body. Which no other system of health carecan do. All the systems of medicine at their best aim at curing the disease whereasYoga aims at preventing the disease and promoting health byreconditioning the psycho-physiological mechanism of the
  29. 29. PUBLIC PRIVATE PARTNERSHIP-VisionFacilitating and enhancing quality public service delivery by beinga catalyst for efficient, effective and value-for-money best practicesolutionsMission To enable National Treasury and provincial treasuries to effectivelyregulate PPPs To evolve as a dynamic and sustainable center of excellence for PPPs To drive PPP deal flow by identifying project opportunities that yieldvalue for all stakeholders To provide technical assistance to public institutions through projectfeasibility, procurement and management; and To promote an enabling environment for PPPs by:o facilitating certainty in the regulatory frameworko developing best practice guidelineso providing trainingo disseminating reliable information; ando driving black economic empowerment in
  30. 30. Values Fairness. Empowerment. Professionalism. Integrity.
  31. 31. DEFINITION-PPP as a contract between a public sectorinstitution/municipality and a private party, in whichthe 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 aninstitutional/municipal function where the private party acquires the use ofstate/municipal property for its own commercialpurposes PPP may also be a hybrid of these
  32. 32. CENTRALLY SPONSORED SCHEMESDEVELOPMENT AND UPGRADATION OF AYUSHINSTITUTES/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 modelInstitutes of
  33. 33. HOSPITALS AND DISPENSARIES The scheme has been designed with a view to makeavailable the benefits of Ayurveda, Unani, Siddha, Yoga &Naturopathy and Homoeopathy to the public at large. Through this scheme the Central Government intends toencourage setting up of general and specialized treatmentcenters of ISM&H in allopathic hospitals and support theefforts of State Governments to improve the supplyposition of essential drugs in dispensaries situated in ruraland backward areas, so that the faith of people in ISM&Hcould be
  34. 34. STATE OF PUBLIC HEALTH1) Union Government contribution to public healthexpenditure is 15% while States contribution about 85%2) Vertical Health and Family Welfare Programmes havelimited to operational levels.3) Lack of community ownership of public healthprogrammes impacts levels of efficiency, accountabilityand effectiveness.4) Lack of integration of sanitation, hygiene, nutrition anddrinking water issue.5) Population Stabilization is still a challenge, especially inStates with weak demographic
  35. 35. NATIONAL RURAL HEALTH MISSION –THE VISIONGOALS1) Reduction in Infant Mortality Rate (IMR) and MaternalMortality Ratio (MMR)2)Universal access to public health services such as Women‟shealth, child health, water, sanitation & hygiene, immunization,and Nutrition.3)Prevention and control of communicable and non-communicablediseases, including locally endemic diseases4)Access to integrated comprehensive primary healthcare5)Population stabilization, gender and demographic balance.6)Revitalize local health traditions and mainstream AYUSH7)Promotion of healthy life
  36. 36. Supplementary Strategies:• Regulation of Private Sector including the informal ruralpractitioners to ensure availability of quality service to citizensat reasonable cost.• Promotion of Public Private Partnerships for achievingpublic health goals.• Mainstreaming AYUSH – revitalizing local health traditions.• Reorienting medical education to support rural health issuesincluding regulation of Medical care and Medical Ethics.• Effective and viable risk pooling and social health insuranceto provide health security to the poor by ensuring accessible,affordable, accountableand good quality hospital
  37. 37. PLAN OF ACTION COMPONENT (A): ACCREDITEDSOCIAL HEALTH ACTIVISTS• Every village/large habitat will have a female AccreditedSocial Health Activist (ASHA) - chosen by and accountableto the panchayat- to act as the interface between thecommunity and the public health system. States to chooseState specific models.• ASHA would act as a bridge between the ANM and thevillage 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 ofhousehold toilets, and other healthcare delivery
  38. 38. • She will be trained on a pedagogy of public health developedand mentored through a Standing Mentoring Group atNational level incorporating best practices and implementedthrough active involvement of community health resourceorganizations.• She will facilitate preparation and implementation of theVillage Health Plan along with Anganwadi worker, ANM,functionaries of other Departments, and Self Help Groupmembers, under the leadership of the Village HealthCommittee of the
  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 jointBank Account of the ANM & Sarpanch and operated by theANM, in consultation with the Village Health Committee.• Supply of essential drugs, both allopathic and AYUSH, tothe Sub-centers.• In case of additional Outlays, Multipurpose Workers(Male)/Additional ANMs wherever needed, sanction of newSub-centers as per 2001 population norm, and upgradingexisting Sub-centers, including buildings for Sub-centersfunctioning in rented premises will be
  40. 40. COMPONENT (C): STRENGTHENING PRIMARY HEALTHCENTRESMission aims at Strengthening PHC for quality preventive,promotive, curative, supervisory and Outreach services,through:• Adequate and regular supply of essential quality drugs andequipment (including Supply of Auto Disabled Syringes forimmunization) to PHCs• Provision of 24 hour service in 50% PHCs by addressingshortage of doctors, especially in high focus States, throughmainstreaming AYUSH manpower.• Observance of Standard treatment guidelines & protocols.• In case of additional Outlays, intensification of ongoingcommunicable disease control programmes, new programmesfor control of non communicable diseases, up gradation of100% PHCs for 24 hours referral service, and provision of2nd doctor at PHC level (1 male, 1 female) would beundertaken on the basis of felt
  41. 41.  COMPONENT (D): STRENGTHENING CHCs FOR FIRSTREFERRAL CAREA key strategy of the Mission is:• Operationalizing 3222 existing Community Health Centers(30-50 beds) as 24 Hour First Referral Units, includingposting of anaesthetists.• Codification of new Indian Public Health Standards, settingnorms for infrastructure, staff, equipment, management etc.for CHCs.• Promotion of Stakeholder Committees (Rogi KalyanSamitis) for hospital management.• Developing standards of services and costs in hospital care.• Develop, display and ensure compliance to Citizen‟s atCHC/PHC level.• In case of additional Outlays, creation of new CommunityHealth Centers (30-50 beds) to meet the population norm asper Census 2001, and bearing their recurring costs for theMission period could be
  42. 42. COMPONENT (E): CONVERGING SANITATION ANDHYGIENE UNDER NRHM• Total Sanitation Campaign (TSC) is presently implementedin 350 districts, and is proposed to cover all districts in 10thPlan.• Components of TSC include rural sanitary marts, individualhousehold toilets, women sanitary complex, and SchoolSanitation Programme.• Similar to the TSC is also implemented through PanchayatiRaj Institutions (PRIs).• The District Health Mission would therefore guide activitiesof sanitation at district level, and promote joint for publichealth, sanitation and hygiene, through Village Health &Sanitation Committee, and promote household toilets andSchool Sanitation Programme. ASHA would be incentivizedfor promoting household toilets by the
  43. 43. COMPONENT (F): STRENGTHENING DISEASECONTROL PROGRAMMES• National Disease Control Programmes for Malaria , TB,Kala Azar, Filaria, Blindness & Iodine Deficiency andIntegrated Disease Surveillance Programme shall beintegrated under the Mission, for improved programmedelivery.• New Initiatives would be launched for control of NonCommunicable Diseases.• Disease surveillance system at village level would bestrengthened.• Supply of generic drugs (both AYUSH & Allopathic) forcommon ailments at village, SC, PHC/CHC level.• Provision of a mobile medical unit at District level forimproved Outreach
  44. 44. COMPONENT (G): PUBLIC-PRIVATE PARTNERSHIP FORPUBLIC HEALTH GOALS, INCLUDING REGULATIONOF PRIVATE SECTOR• Since almost 75% of health services are being currentlyprovided by the private sector, there is a need to refineregulation• Regulation to be transparent and accountable• Reform of regulatory bodies/creation where necessary• District Institutional Mechanism for Mission must haverepresentation of private sector• Need to develop guidelines for Public-Private Partnership(PPP) in health sector. Identifying areas of partnership, whichare need based, thematic and geographic.• Public sector to play the lead role in defining the frameworkand sustaining the partnership• Management plan for PPP initiatives: at District/State andNational
  45. 45. INSTITUTIONAL MECHANISMS• Village Health & Sanitation Samiti (at village level consisting ofPanchayat Representative/s, ANM/MPW, Anganwadi worker,teacher, ASHA, community health volunteers• Rogi Kalyan Samiti (or equivalent) for community management ofpublic hospitals• District Health Mission, under the leadership of Zilla Parishad withDistrict 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 byHealth Minister and with the State Health Secretary as Convener-representation of related departments, NGOs, private professionalsetc• Integration of Departments of Health and Family Welfare, atNational and State level• National Mission Steering Group chaired by Union Minister forHealth & Family Welfare with Deputy Chairman PlanningCommission, Ministers of Panchayat Raj, Rural Development andHuman Resource Development and public health professionals asmembers, to provide policy support and guidance to the Mission.• Empowered Programme Committee chaired by Secretary HFW, tobe the Executive Body of the
  46. 46. TECHNICAL SUPPORT• To be effective the Mission needs a strong component ofTechnical Support• This would include reorientation into public healthmanagement• Reposition existing health resource institutions, likePopulation 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 andsub-district.• Mission would require two distinct support mechanisms –Program Management Support Centre and Health Trust
  47. 47. A) PROGRAM MANAGEMENT SUPPORT CENTRE• For Strengthening Management Systems-basic programmanagement, financial systems, infrastructure maintenance,procurement & logistics systems, Monitoring & InformationSystem (MIS), non-lapsable health pool etc.• For Developing Manpower Systems – recruitment (inductionof MBAs/CAs /MCAs), training & curriculum development(revitalization of existinginstitutions & partnerships with NGO & private sector. Sectorinstitutions), motivation & performance appraisal etc.• For Improved Governance – decentralization &empowerment of communities, induction of IT based systemslike e-banking, social audit and right to
  48. 48. ROLE OF NGOs IN THE MISSION· Included in institutional arrangement at National, State andDistrict levels, including Standing Mentoring Group forASHA· Member of Task Groups· Provision of Training, BCC and Technical Support forASHAs/DHM· Health Resource Organizations· Service delivery for identified population groups on selectthemes· For monitoring, evaluation and social
  49. 49. MAINSTREAMING AYUSH· The Mission seeks to revitalize local health traditions andmainstream AYUSH infrastructure, including manpower,and drugs, to strengthen the public health system at alllevels.· AYUSH medications shall be included in the Drug Kitprovided at village levels to ASHA.· The additional supply of generic drugs for commonailments at Sub center/PHC/CHC levels under the Missionshall also include AYUSH formulations.· At the CHC level, two rooms shall be provided forAYUSH practitioner and pharmacist under the IndianPublic Health System (IPHS) model.· Single doctor PHCs shall be upgraded to two doctor PHCsby mainstreaming AYUSH practitioner at that
  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 HealthMission to Zilla Parishad· The District Health Mission to monitor compliance toCitizen‟s at CHC level· Annual District Reports on People‟s Health (to be preparedby Govt./NGO collaboration)· State and National Reports on People‟s Health to be tabledin Assemblies, Parliament· External evaluation/social audit through professionalbodies/
  51. 51. BIBLIOGRAPHY-1) K.Park,Park‟s textbook of preventive and social medicine/sbanarsides bhanot publishers,19th edition,2007;1,67-72.2) Stanhop.M,Community health nursing,3rd edition,mosbyUSA,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-AYUSH6) Search-AYUSH with
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