1. Dr. D. K. Panda Team Leader, SHSRC, NHM Odisha Improving Service Delivery through Decentralized Planning

2.  NHP (1983) –  Free health care in Govt. Institutions  An essential social service  Access to health care by 2000  Eighth FY–  Reduce inter-district disparities  Improving access for under privileged segments  NDC on Population (1993)– Recommends  Decentralised area based (RCH)  Special provisioning – minimise inter & intra- district differences Evolution

3.  10 th Plan–  Undertake realistic district based microplanning  Reduce inter & intra-district differences – need based strategy  Involve PRI for microplanning & monitoring  Ensuring Community participation  Achieve incremental improvement Evolution National Rural Health Mission – 2005

4.  Policy for Decentralised district based RCH planning  District Action Plan – evidence based & rational  Optimal utilisation of inputs & resources  Intersectoral convergence – specially Health, ICDS & FW RCH at District Level

5. Inter-district Variation Antenatal Care ANCJharsugudaKalahandi Any AN Checkup99.794 3 0r more AN Checkup 94.867 Full AN Checkup41.420.2 Source: AHS 2014

6.  Focus for Better performing  Improve content & quality  Early identification of high risk cases  Timely referral  Focus for poorly performing  Improve coverage  Improve awareness about need & importance of High risk cases  RCH camps/reaching unreached Antenatal Care

7. Decentrilised Principles 5 Ds Decentralizatio n of Management Functions Decentralizatio n of Administrative Authority Devolution of Power Distribution of resources Diffusion of power- Authority Nexus

8. Health Delivery Structure (Rural) Community GKS ASHA Facility DHH SDH CHC CHC* PHC (N)PHC (N)** SC SC*** PHC (N)

9. NHM Context Major Features:  Special Structures created at all levels- Gaon Kalyan Samiti (GKS), Rogi Kalyan Samiti (RKS), District Health Society(DHS)  Structures integrated with existing System-Village level ; GKS, Facility level; RKS, District level ;DHS  Ensured multi stake holders participation in each structure: PRI, SHG, Eminent Persons, representative from other Deptt.  Investment on capacity building- Orentation & refresher training every year  Provisioning of untied fund & autonomy for decision making – Varies from Rs10000/- to Rs.1000000/-, Performance based allocation etc.  Monitoring & Review- Review by Sarpanch, Jansmbad/Jan Sunani  Concurrent Process- Ongoing not time bound

10. Institutional Delivery

11. Districts <=50% of Institutional Delivery Boudh-42%, Koraput-49%, Puri -49% Districts whose Institutional Delivery is stagnant in comparison to last year Dhenkanal, Jharsuguda, Sambalpur Districts whose Institutional Delivery is in decline over last Year Balasore (-6%), Cuttack (-6%), Jagatsinghpur (-5%), Deogarh (-5%), Nayagarh (-5%), Kalahandi (-4%), Kendrapada (-4%), Sundaragrh (-4%), Jajpur (-3%), Kandhamal (-3%), Puri (- 3%), Mayurbhanj (-3%), Anugul (-2%), Bargarh (-2%), Ganjam (-2%), Keonjhar (- 2%), Bhadrak (-1%)

12. Planning for Improvement Inst. Delivery DistrictTotal SC SC with More than equal to 20% Home Delivery Kalahandi242121 Decentrilised Planning for improving ID: Step-1 :HMIS Data Analysis for identification of low performing SC Step-2 : Focus Group discussion with ANM for finding out solutions Step-3 : Linking with nearest DP though expansion plan Step-4 : Discussion with GKS members of feeding areas for case mobilisation

13.  Districts with poor indices have about 45% of the population  Contribute towards about 55% of population growth, 60% of under nutrition & IMR/MMR  Geographical inaccessibility  Socio-cultural & economic inequities  Better convergence for determinants of health including SDH starting from community to highest level Opportunities & Challenges

14. Thank U