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<ul><li>1.1/52 DISTRICT HEALTH ACTION PLAN 14/03/2014 Presenter-Dr. Priyamadhaba Behera Preceptor Dr. Arvind SinghTotal no.slides-34 1/ </li></ul> <p>2. 2/52 NRHM DISTRICT HEALTH ACTION PLANS PARTICIPATORY &amp; EVIDENCE BASED PLANNING PROCESS 2/ 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. 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&amp;E plan References- Broad framework for preparation of district health action plans, August 2006,NRHM 4 5. Introduction The DHAP will be guiding document for implementation, monitoring &amp; 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 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 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. 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. 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. 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. 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. 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. 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. 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 &amp; 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. Continued Organization of large scale activities like health camps, Public hearings Involvement of Womens 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. 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. 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. 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, womens empowerment 30 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. Situational Analysis - District profile Coverage of ICDS programmes Availability of elected representatives of panchayat raj institutions Presence of NGOs Logistics Training BCC infrastructure 32 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. 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. Force Field Analysis 36 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. 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. 39 Objective Strategy Activity 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. Resource Allocation for districts 42 Category Most vulnerable Vulnerable Least vulnerable Score 7 and above 4-6</p>


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