Published on

Published in: Health & Medicine, Technology
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • State Health resource center
  • Vet- make a careful and critical examination
  • So far 8.06 lakhs ASHAs have been engaged across the country between community and health
    system. 83% of them have been trained up to 5th Module and more than 75 % have been given drug kits. Following information should be provided on ASHAs in the PIP
  • Pro-rata basis –proportion
  • For example, if
    institutional deliveries are targeted to increase from say 45% to 55%, most States do not
    attempt to estimate the required increase in absolute number of institutional deliveries,
    assess capacity of different facilities and hence the number of facilities which need to be
    operationalised. Subsequently, targets for institutional deliveries would need to be set for
    each facility and closely monitored

    1. 1. 1/52 DISTRICT HEALTH ACTION PLAN 14/03/2014 Presenter-Dr. Priyamadhaba Behera Preceptor –Dr. Arvind SinghTotal no.slides-34 1/
    3. 3. Outline of presentation •Introduction •Planning process •Strategy for Technical Assistance •Framework for District Health Action Plan •Critical areas for concerted action •Component of District Health action plan •Critical appraisal 3
    4. 4. Introduction •DHAP is the Principle instrument for planning, implementation and monitoring, formulated through a participatory and bottom up planning process •Broad contour •Situational analysis of the district •Objectives and interventions •Work plan •Budgets •M&E plan References- Broad framework for preparation of district health action plans, August 2006,NRHM 4
    5. 5. Introduction •The DHAP will be guiding document for implementation, monitoring & evaluation of NRHM •It is envisaged that decentralized programme management is likely to be more responsive to the health care needs of local community •Will be a step towards ultimate communitization - a hallmark of NRHM 5
    6. 6. 6 Why emphasis on district action plans? •Mechanism to partner with community •Planning based on local evidence and needs •Area specific strategies to achieve NRHM goals •Cost effective and practical solutions •Move from budget based plans to outcome oriented plans •Requirement of GoI – no funds if no plans
    7. 7. 7 Why emphasis on participatory planning •Promote community ownership •Greater ownership of health functionaries •Harness benefits of community action •Bring accountability of health functionaries to community members •Draw together elements that are determinants of health •Share resources and opportunities with partnering departments – convergent action
    8. 8. 11 Planning Process… V GP GP GP GP BLOCK BLOCK BLOCK DIST DIST STATE Integrate Integrate Integrate Integrate VV VVVV V V V V V PHC PHC PHC PHC Integrat
    9. 9. The Planning Process •Setting up of planning teams and committees at various levels •Village •Gram Panchayat (SHC) •PHC (Cluster level) •CHC/Block level •District level •Orientation of planning team and contractual engagement of professionals as per need has to be the starting point for the planning process 12
    10. 10. The Planning Process •Planning teams have to conduct •Household surveys •Help select ASHAS •Organize training for community groups •NGOs have a role in the entire planning process 14
    11. 11. The Planning Process •Village Health Plans are likely to take time •Therefore District, Block and Cluster level consultation may have to form the basis for initial District Plans ( ad-hoc and for a year) •The perspective plans must be on the basis of Village Health Plan but Block will be the key level for development of decentralized plans 15
    12. 12. Strategy for Technical Assistance •Development partners, department of community medicine in medical colleges, NGOs with expertise in this area •10-15 member District Plan Appraisal Team under the SHRC for appraisal of the Draft District Plan for checking Quality, Standards, Normative criterions before being sent to the State for approval 22
    13. 13. Strategy for Technical Assistance •State Resource Centre would also finalize survey formats and formats for preparation of plans at various levels •Finalize the criteria for prioritization and indication of resources likely to be available for each Block and convey these to the district 23
    14. 14. Essential requirements for preparation for Village, Block, and District Health Plans • Constitution of planning team and committees at each level • Engagement of professionals on contract at State, District and Block level urgently to meet planning needs • Broad norms for planning activities & Space for diversity and innovations • Preparation of training modules for household survey, Family Health Cards, Village Health Register, • Mapping of non-governmental providers, and Health facility surveys • Survey of non-governmental health providers to assess their possible role in the District Health Plan 24
    15. 15. Continued •Organization of large scale activities like health camps, Public hearings •Involvement of Women’s groups and Community based organizations in planning activity •Release of untied grants to SHCs/ Gram Panchayats to facilitate activities •Recruitment and relevant training of ASHAs/ANMs •Orientation of existing health department functionaries on new ways of working •Convergent local action along with other departments 25
    16. 16. Framework for District Action Plan • Assessing the present situation • Resources – human power, logistics and supplies, community resources and financial resources, Voluntary sector health resources • Access to services – including public and private services and informal health care services • Utilisation of services – including outcomes, continuity of care; factors responsible for possible low utilization • Quality of Care – including technical competence • Community needs, perceptions and economic capacities, PRI involvement in health • Socio-epidemiological situation: Local morbidity profile, adivasis, migrants, very remote hamlets 26
    17. 17. Critical areas for concerted action • Functional facilities • Improving human resources in rural areas • Accountable health delivery • Decentralization and Flexibility for local action • Reducing maternal, child deaths and population stabilization • Preventive and promotive health • Disease Surveillance • Hamlet to hospital linkage • Health Information System • Planning and monitoring • Women empowerment, securing entitlements of SCs /STs /OBCs • Convergence of various health programmes • Chronic disease Burden • Social security to poor to cover for ill health 27
    18. 18. Components of the District Health Plan •New interventions under NRHM •RCH II •Strengthening of Immunisation •Disease Control / Surveillance Programmes such as NVBDCP, RNTCP, NPCB, IDD, NLEP and IDSP •Inter- sectoral convergence activities •Nutrition, Safe Drinking Water, sanitation, female literacy, women’s empowerment 30
    19. 19. Situational Analysis - District profile •Background characteristics •Geographic area •Number of blocks •Size of villages •Number of towns •% urban population •Birth and death rate •Fertility rate •Growth rate •Sex ratio •Population density •Literacy •% SC/ST population •Health facilities •Number and level (also private) •Functionality •Human resources •Health Indicators •Common morbidities •IMR, MMR, NNMR •Nutritional indicators •Infrastructure •Safe drinking water •Sanitation facility •Primary schools 31
    20. 20. Situational Analysis - District profile •Coverage of ICDS programmes •Availability of elected representatives of panchayat raj institutions •Presence of NGO’s •Logistics •Training •BCC infrastructure 32
    21. 21. Situational Analysis – Analysis of health indicators Maternal Health •% who availed complete package of ANC services •% of institutional, safe deliveries •Maternal mortality •% of Maternal deaths audited Family planning •Contraceptive use •Unmet needs •Implementation of National FP insurance scheme Child health •Immunization •Breast feeding •Malnutrition •ARI and diarrhea Interventions under NRHM •ASHA •JSY •IPHS •AYUSH Performance of National Health Programmes Locally endemic diseases
    22. 22. Setting Objectives of the DHAP •The inputs for this matrix will largely come from the situational analysis conducted and the block-level consultations should guide you in deciding what a district can achieve in the given time frame •Quantifiable objectives •Force Field Analysis to determine the pros and cons of achieving each of the objectives •Interventions and Activities 35
    23. 23. Force Field Analysis 36
    24. 24. Work-plan District Level Planning Workshop •To review and vet objectives of the DHAP •To assess appropriateness and adequacy of suggested strategic interventions/and activities to meet the objectives of the DHAP •Participants - District Collector , NRHM officials, PRI representatives, District and block level officials from dept. of health and other sectors, NGOs, private providers
    25. 25. Work plan •Model Work Plans – either month-wise or quarterly for 1 and 2 year respectively •Work Plan of Activities of each health component Time of initiation of the activity The tentative duration of implementation and Persons/Agency responsible •Overview of activities against which monitoring can be undertaken •Tracking the status of each of the defined activities - Enhance accountability
    26. 26. 39 Objective Strategy Activity
    27. 27. Budget Allocation •Equity based resource allocation •Scoring based on socio-demographic indicators •% of urban population •% of SC/ST population •% of skilled birth attendance •Based on score – weightage allocation is given to districts •Identification of accountable person •Administrative expenses should not exceed 6%
    28. 28. Resource Allocation for districts 42 Category Most vulnerable Vulnerable Least vulnerable Score 7 and above 4-6 <4 Allocation Weightage 1.3 1.1 Rest
    29. 29. Fund Flow 43
    30. 30. Monitoring and Evaluation • Input and Process indicators of each activity • Performance evaluation mechanism will mostly rely on baseline (RHS reports at district level, DLHS), concurrent, mid- term and end-line surveys • Monthly review meetings held at different levels of the health system • Community monitoring and reporting • Assessing quality of services 44
    31. 31. Critical appraisal-1 VHSNC have been formed in 76% villages under NRHM , but orientation for planning process and capacity building of community leaders in village level planning needs a deep look Number of ASHAs (8.06 lakhs)1 but capacity building was lacking (relevant training and monitoring of their training) Community empowerment –Though VHSNC is lacking At various level, proper utilisation Untied Funds needs be looked into 1.Framework for preparation of annual programme Implementation plan of NRHM 2012-13 47
    32. 32. Critical appraisal-2 Appropriate situation analysis vital for DHAP which is component lacking District health action -plans still do not address the local issues/requirements fully1 Though DHAP are prepared, they are not fully incorporated into the state PIP  District allocation is made on population/ pro-rata basis and often does not cater to the priorities of the district and health facilities 1.Framework for preparation of annual programme Implementation plan of NRHM 2012-13 48
    33. 33. Critical appraisal-3 States still seem to have difficulties in preparing an internally consistent PIP i.E. Where the situation analysis, goals, strategies, activities, work plan, and budget all tell the same story Basis for setting targets could be more robust/ evidence based 49
    34. 34. Critical appraisal-4 •JSY has brought over a crore pregnant women into public health facilities but the delivery load is unevenly distributed across facilities. The fund flows however are evenly spread across all the facilities1 •With help of JSY though the institutional deliveries had increased-but there is a concern about quality of health care provided through it Report of the Working Group on National Rural Health Mission (NRHM) for the Twelfth Five Year Plan (2012-2017) 50
    35. 35. Critical appraisal-5  Functional RKS against constituted facilities Performance of RKS and pace of utilization of funds and appropriate heads under which RKS funds are being utilized is to be weighted 51
    36. 36. 52 THANK YOU 52
    37. 37. Untied funds 53
    38. 38. VHSNC 54
    39. 39. VHSNC 55
    40. 40. 56
    41. 41. 57
    42. 42. 58