Accountability of the Health System Dr. H Sudarshan

Recommendations for Community Monitoring IssueActionsMethodology / strategy By whom

Community Monitoring – funding and political support is reduced There are various models available and also being tried out today – need to be studied/scaled up with more support to CSOs Budget allocation conditionality – like at least 2 % for all monitoring and accountability work; long term financial commitment is essential since it is a slow process The system needs to clearly incorporate the findings into the planning process at various levels

Maternal Death Review – not everywhere and not published Must be carried out at facility and community levels; also start near-miss/morbidity reviews Teams must include both social workers and bio-medically trained Findings must be shared publicly (without breaching confidentiality ) Lapses need to be identified for the health system with a pledge for corrective action (with timeline)

Grievance Redress mechanisms – not accessible for the poor RKS must be made aware of this function and take it up Ombudsperson at district level Linking up with justice system No reprisals for those who make complaints/ whistle-blowers Not to identify the scapegoat (lowest functionary) but to also address system lapses

Good governance for the health system NRHM Societies at district and state level also need to be made accountable to NRHM Missions Policy makers/planners and implementers all need to be made answerable: like the RTI Act has a penalty clause Need transparency at ALL levels (like gram panchayat) for disclosure of budgets and expenditure; information about entitlements Need better impact assessment, evaluations and make the health system/facilities providers etc accountable for maternal outcomes Need for administrative reforms with incentives for good work and penalties for poor performance

Research and data – lacking on accountability!! We need to study government’s own figures/ data and analyze To improve data in terms of quality, equity (gender, caste, economic status, etc), etc Fund independent policy research; at least 1 % Need more data on Health systems management, Human resource deployment, etc Need to study effective models that can ensure accountability