The document discusses capacity building in the public health sector of Chhattisgarh, India. It notes that capacity building refers to creating, expanding, or upgrading desired capabilities that can be drawn on over time, rather than just managing existing resources. It provides statistics on Chhattisgarh's population and health infrastructure, noting a large rural population and shortage of facilities. It also outlines issues with training capacity, quality, and rationalizing trained human resources. It discusses the state's policy decisions around strengthening training institutions and prioritizing certain programs to build capacity in the public health workforce.

1. People for Health: Advancing Human
Resources for Public Health
“Capacity Building”
3rd Feb. 2012
Bhubaneswar
Dr Saurabh Jain
MD, PGD-Health Econ, MPH
State Health Resource Centre, Raipur
Chhattisgarh 1

2. “capacity building refers to the creation,
expansion or upgrading of a stock of desired
qualities and features called capabilities that
could be continually drawn upon over time. . .
The focus of capacity building therefore tends
to be on improving the stock rather than on
managing whatever is available.”
- Paul (1995),
Capacity building for health sector reform, WHO
2

3. Capacity building
vs
Training
vs
Human resource development
3

4. Chhattisgarh, ninth largest state of India -25.5 *(census
2011) million population
4

5. 80% of people living in villages/hamlets
32% of Population are Tribal- 7 of India’s primitive tribal groups live here
(Abujhmaria, Baiga, Bharia Saharia, Hill Korwa, Kamar , Birhor)

6. Lush green Forests-44% of land area- is our asset and liability
with Mines –Tin,Coal,Iron

7. State Profile
• Population of the State = 2.5 Crore No of Districts =27
• No of Blocks = 146 No of villages = 20,126
Health Facilities Number of functioning Population covered per
facilities facility
Sub-centres 5,076 3,862
PHC 741 26,400
CHC level hospitals 148 CHC +17 CH=165 1.54 Lakh
District Hospitals 17 15.02 Lakh
Medical colleges 3 85.13 Lakh
7

8. Health systems framework
Interaction with context:
* with national policies, culture, values
Leadership & governance: * with international context
* policy – making * with other sectors and actors
* regulation
* coordination 3 10
Organisation of resources: 8
1
Organisation and delivery of Outcomes:
* universal access
human financing health care services:
* quality of care
resources * primary health care – specialised
4 5 * health problem specific – general
* prevention – curative care
6 7Monitoring & * public – private, for profit – not for profit,
Medical supplies
evaluation / formal - informat
& technologies
information
Goals: 1
* improved health
* responsiveness
Interaction with population: * social & financial
* demand generation protection
9
* participation of individuals and groups in community
* accountability
Guiding by values and principles:
* health care as a right
* autonomy <> security
* protection of public <> response to individual suffering
* effectiveness <> efficiency
* participation, accountability, trust 2
* social justice and equity
* global social responsibility
* sustainability: at which level?
Source: Josefien et al, Inst. Trop. Med., Antwerp

9. Training norms of GoI
Sn. Category Training programme Duration GoI Norm
Maternal Health
1 Medical LSAS (*) 18 weeks One anaesthetist per FRU
Officers EmOC/CEmOC(*) 16 weeks One Ob./Gy. per FRU
(doctors) Management. Of 15 days One doctor per 24x7 PHC and CHC
Common Obstetric
Complications
(SBA)(*)
Blood Storage (*) 3 days One Doctor per FRU
MTP (*) 15 days One doctor per 24x7 PHC and CHC
RTI/STI (*) 2 days One doctor per 24x7 PHC and CHC
2 ANM and SBA (**) 15 days All ANMs and Staff Nurses per 24x7
SNs PHC(all sanctioned post of ANM’s &
SN’s taken in account for calculation)
3 LTs Blood Storage(*) 3 days All LT's posted at FRU
9

10. Training norms of GoI (contd.)
Sn. Category Training Duration GoI Norm
programme
Child Health
4 Medical F- IMNCI (**) 11 days One trained doctor per PHC and CHC
Officers FBNC(*) 3 days One Trained doctor per dist hospital
(doctors) NSSK (**) 2 days All doctors at PHC
Immunisation (*) 2 days One trained doctor per PHC and CHC
5 ANM/ IMNCI (*) 8 days All ANMs, Staff Nurses, AWW(all sanctioned
LHV and post of ANM’s, SN & AWW taken in account
SNs for calculation)
FBNC (*) 3 days All staff nurses
NSSK (*) 2 days All ANM's, LHV & SN(all sanctioned post of
ANM’s, LHV & SN taken into account for
calculation)
Immunisation 2 days All ANM's
(***)
Family Planning, ARSH, IMEP, and Disease Control Programmes……………………so on and so forth
10

11. Capacity building pyramid
11
Source: Christopher Potter, Systemic capacity building, Health Pol and Planning

12. Systemic capacity building
12

13. 13

14. Issues & Challenges
• Training capacity/infrastructure- state/dist.
• Training need assessment
• Quality
– functional status
– faculty/resource pool
– training plan
– database
14

15. Issues & Challenges (contd.)
• Quality
– rationalization of trained HRH
– training material in local language
– fund flow
– tapping other resources (medical college..)
– monitoring tools
– evaluation
15

16. Policy decisions
• Efforts to strengthen SIHFW & RIHFW
• Focus pvt public (nursing training)
• Private sector allowed to use public health
facilities for training
• RMA MBBS bridge course
• Bridge course for AYUSH
16

17. Policy decisions (contd.)
• PHRN engaged for ‘fast-track’ training of MOs
and others
• Mapping under MCH plan
• EmOC and LSAS initiated for MOs
• RMAs being trained for BEmOC and others
• Mitanins promoted for ANM and B.Sc nursing
course
17

18. Policy decisions (contd.)
• ANMs promoted for B.SC nursing course
• MOs working in hardest areas given
preference in PG seats
18

19. Training institutions in the State
Facility 2007-08 Current Status
Govt. Pvt. Total Seats Govt. Pvt. Tota Seats
l
SIHFW 1 0 1 NA 1 0 1 NA
HFW-TC 1 0 1 NA 1 0 1 NA
Dist.TC 6 0 6 NA 14 0 14 NA
B.Sc. Nursing 1 10 11 450 6 41 47 2220
GNM-TC 4 2 6 161 4 25 29 981
ANM-TC 7 1 8 320 13 57 70 2404
MPW(Male) 3 0 3 180 3 41 44 2450
TC 19

20. Health Indicators: (as per *SRS and AHS 2011)
India Chhattisgarh
Indicators 2000 2008 2011
Changes
(2000- 2000 2008 2011
Changes
(2000-
2011) 2011)
IMR Total 68 55 50 88 59 51
-18 -37
IMR Rural 74 61 55 94 61 55
-19 -39
IMR Urban 43 37 34 54 49 40
-9 -14
Birth Rate Total 25.8 23.1 22.5
-3.3 31.2 26.5 23.9
-7.3
Birth Rate Rural 27.5 24.7 24.1
-3.4 33.2 28 24.8
-8.4
Birth Rate Urban 20.7 18.6 18.3
-2.4 23.5 19.9 20.6
-2.9
Death Rate Total 8.5 7.4 7.3
-1.2 10.2 8.5 7.6
-2.6
Death Rate 9.3 8 7.8 11 8.5 8
-1.5 -3
Rural
Death Rate 6.3 6 5.8 7.5 6.5 6.2
-0.5 -1.3
20
Urban

21. Thanks
21