Health System Assessment of Gujarat: Findings and Recommendations
Health system assessment of Gujarat reveals positive aspects such as good coordination and synergy among various departments, satisfactory pace of NUHM implementation, robust IT monitoring systems, and effective PPP models. However, major issues include under-utilization of public health facilities, vacancies in specialist positions, and financial mismanagement. Key recommendations include expediting drug supply management, enhancing community participation, and capacity building of service providers. Action taken by the state includes gap analysis, recruitment drives, and monitoring mechanisms to address the issues identified.
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Positives Good coordination and synergy among NHM, directorate, medical education, urban health and other different departments. Pace of implementation of NUHM is satisfactory in the districts visited and there is good convergence of the State Health Dept./Mission with the Municipal Corporations implementing NUHM KAYAKALP being implemented at all levels and general maintenance of buildings was excellent. Robust IT monitoring systems including eMAMTA are in place. Working PPP models like Chiranjeevi Yojana, Bal Sakha yojana, EMRI_108 and robust private sector. State initiatives like Free Diagnostics under the Mukhya Mantri Nidan Yojana is being implemented well and national programmes like PM National Dialysis Programme , RNTCP & NLEP are performing well.
Major Issues Under-utilization of public health facilities at all levels SNCU (Gandhinagar) functioning in makeshift arrangement; NBSUs sub optimally functioning, Utilization of the NRC was very less. RBSK teams are placed in PHCs and are used for non- RBSK activities. There are considerable vacancies in Specialist positions which needs to be filled. JSY payments are being made at the 7thmonth of pregnancy. (court case cited as the reason) Interest earned from NHM funds at District and sub-district level; which amounts to around Rs.100 crores is not being used. Physical Reporting in FMR is not made by the State to GoI as it is a ROP conditionality.
Key Recommendation Drug supply management with real time monitoring system through e- Aushadhi needs to be expedited. Newer interventions under the Maternal, Newborn, Child Health and RKSK to be implemented with more vigor. The state should nurture PPP models so that it is able to complement rather than substitute the public health system. The implementation of Non-Communicable Diseases Programme like NPMH, Oral Health, NPHCE and NPCDCS were found to be in initial stages and need to percolate down for making an impact. To augment community participation in public health, VHSNCs need to be activated and Community Action for Health, whose funds have lapsed for the last three years needs to be addressed. Capacity Building of service providers across all the programs is urgently required to improve the quality of care being provided to the beneficiaries.
Issue: 1 Under-utilization of public health facilities at all levels 1. Gap analysis carried out : Infrastructure, Manpower and Performance 2. Mapping of poor performing health facilities 3. Recruitment of medical and paramedical staff 4. Capacity building on health interventions and their execution 5. Ensuring Free drugs and Free diagnostics schemes implementation 6. Strong monitoring through E-Mamta, HMIS & field visits 7. Monthly review of all districts/corporation health officers (CDHO/MOH/RDD)
Issue 2 : Optimal utilization of NBSU, NRC/CMTC and Arrangement of SNCU Gandhinagar Utilization of SNCU and NBSU: 1. Medical officer and staff nurses recruitment at FRU 2. Engagement of pediatricians through multi pronged approach; Regular, NHM, CM SETU, GSEDS, GIA, Bal Sakha 3. Capacity building and hand holding through EnMBC Training 4. Strengthening of HBNC and NBCC along with referral system 5. Strong monitoring of Facility based newborn care through SNCU Software and physical reports 6. Construction of SNCU in process
Cont.- Issue 2 Utilization of NRC/CMTC: 7. District Task force Team in coordination with ICDS 8. Mapping and Review of Poor Performing CMTC/NRC 9. Screening campaign Kuposhan Mukt Maha Abhiyan Phase-III will be initiated, CMAM Program 10. Strong Monitoring of SAM referral and admission through E-Mamta
Issue 3: Considerable vacancies in specialists 1. Special recruitment drive : walk in interview 2. Differential higher remuneration under NHM for HPTs and HPDs 3. Revised remuneration of experts under CM SETU 4. Rational deployment of in service PG doctors, CEmOC and LSAS Doctors at FRUs
Issue 4: Interest earned from NHM funds is not being used. 1. Unspent balance of bank interest earned of Rs. 100 crores is treated as equivalent to grant in aid 2. Same is utilized in for Approved State & District PIPs, subject to the same programme norms/guidelines as the Grants in aids for the programme 3. Same accounting treatment has been given in the books of accounts of DHS & Subcommittees for the FY 2016-17.
Issue 5 - Physical Reporting in FMR is not made 1. Guidance taken from Govt of India FMG on FMR preparation 2. Dissemination and orientation of finance officers; districts/corporations/regions 3. Physical and financial reporting of year 2016-17 will be submitted as per the instructions of GoI-FMG
