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DISTRICT HEALTH ACTION PLAN
14/03/2014
Presenter-Dr. Priyamadhaba BeheraPreceptor –Dr. Arvind SinghTotal no.slides-34
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NRHM DISTRICT HEALTH ACTION PLANS
PARTICIPATORY & EVIDENCE BASED PLANNING PROCESS
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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
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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
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
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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
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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
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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
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
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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
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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
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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
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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
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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
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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
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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 hamlets26
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
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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
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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
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Situational Analysis - District profile
• Coverage of ICDS programmes• Availability of elected representatives of panchayat raj
institutions• Presence of NGO’s• Logistics• Training• BCC infrastructure
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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 diarrheaInterventions under NRHM•ASHA•JSY•IPHS•AYUSHPerformance of National Health ProgrammesLocally endemic diseases
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
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Force Field Analysis
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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
Work plan
• Model Work Plans – either month-wise or quarterly for 1 and 2 year respectively
• Work Plan of Activities of each health componentTime of initiation of the activityThe 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
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Objective
Strategy
Activity
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%
Resource Allocation for districts
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Category Most vulnerable Vulnerable Least vulnerable
Score 7 and above 4-6 <4
Allocation Weightage
1.3 1.1 Rest
Fund Flow
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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 services44
Critical appraisal-1VHSNC 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
Critical appraisal-2Appropriate 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
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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
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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)
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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
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THANK YOU
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Untied funds
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VHSNC
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VHSNC
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