1. Health sector reform initiatives in Gujarat
Dr Amarjit Singh
Principal Secretary (FW) &
Commissioner Health, Medical Services &
Medical Education
Gujarat

2. Structural

3. Pre reform model

4. Integrated structure

5. Department of Health & Family Welfare: Govt. of Gujarat

6. Other Initiatives DPCs AHAs Using ISM professionals Mentoring TCS HMIS
Autonomy
Capacity building
Governance
Communitisation

7. Clear goals

8. Our Goals Reduce maternal and child mortality
Address adverse sex ratio
Stabilize population
Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia
Provide state of the art health and medical education relevant to local needs
Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services
Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals
Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

9. Reducing Maternal and child mortality
Chiranjeevi

10. MMR Over Time Source Time Period Urban Rural NFHS 1992-93 (424) 397
448
NFHS - 2
(540)
267
619

12. Health care facilities available

13. Availability of OBGYs in CHCs
Rural Popu
OBGYs
Reqd In
place
Gap
Popu/gynec AP
167 73 94
7.59
C'garh
118 26 92
6.4
Gujarat
273 7
266
45.5
M’ashtra
407
202
205
2.7 MP
229 13
216
3.41
Raj
325
109
3.9
India
3910
1338
2010
5.55

14. Bonus - saving neonates

15. SERVICE PACKAGE Service No. of cases Rate Per Case Cost
Normal delivery 85
800
68000
Complicated cases
Eclampsia
1000
Forceps/vacuum/breech 3
3000
Episiotomy
Septicemia 2
6000
Blood transfusion
Cesarean (7%) 7
5000
35000
Predelivery visit
100
10000
Investigation 50
Sonography 30
150
4500
Dai
Transport
200
20000
Grand total
179500

16. Gynecologist involvement in Chiranjeevi
District
Total OBGY
Specialists
in the district
# enlisted
under
Chiranjeevi scheme
Total # of
deliveries
Performed
Average
delivery per
Doctor BK 50 65
19407
299
Dahod 18 10
24038
2404
Kutch 47
11302
628
P'mahal 29 34
30509
897 SK 73
23818
476
Total
217
177
109074
616

17. Chiranjeevi Yojana Report June -08 Ending (20 Districts)
Sr #
District Name
Normal
LSCS
Complicated
Total
% LSCS
# of Doctors Enrolled 1
Gandhinagar
2070
303
165
2538
11.94 24 2
Mehsana
10905
953
772
12630
7.55 42 3
Patan
11780
1089
357
13226
8.23 36 4
Ahmedabad
20494
803
21297
3.77
195 5
Kheda
3545
489
109
4143
11.80 31 6
Anand
4691
882 17
5590
15.78 32 7
Surendranagar
5676
335 80
6091
0.00 27 8
Vadodara
5143
441
5779
3.37 52 9
Bharuch
1856
264
176
2296
11.50 21 10
Narmada
825 51 59
935
5.45 11
Surat
2471
157 60
2688
5.84 69 12
Navsari
2270
353 96
2719
12.98 18

18. Chiranjeevi Yojana Report June -08 Ending (20 Districts)
Sr #
District Name
Normal
LSCS
Complicated
Total
% LSCS
# of Doctors Enrolled 13
Valsad
2110
238 63
2411
9.87 21 14
Ahwa-Dang
407 36 5
448
8.04 4 15
Rajkot
3461
178 81
3720
4.78 49 16
Jamnagar
1100 31 7
1138
2.72 17
Bhavnagar
1824
206 38
2068
9.96 10 18
Amreli
383 41 19
443
9.26
Junagadh
973
157 40
1170
13.42 20
Porbandar
703
188
907
20.73
20 District Total
82687
6949
2601
92237
7.53
695 22
5 District Total
93118
5465
10491
109074
5.01
177 23
25 District Total
175805
12414
13092
201311
6.17
872

19. Chiranjeevi State &

20. 201311 805 39 766 7650 829 6820 Outcome of Chiranjeevi Scheme:
Mothers & New Born babies saved
Total Deliveries under Chiranjeevi scheme
Expected Maternal Death
Maternal death reported under Chiranjeevi scheme
Mothers saved under Chiranjeevi scheme
Expected New born death
New born death reported under Chiranjeevi scheme
New born saved
201311
805 39
766
7650
829
6820
Normal Deliveries:
C-Section: (6.17%)
Complicated Deliveries: (6.50%)
Private specialist enrolled: 872/2000

22. Institutional deliveries trend

24. Extended Chiranjeevi and Bal Sakha

25. Our Goals Reduce maternal and child mortality
Address adverse sex ratio
Stabilize population
Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia
Provide state of the art health and medical education relevant to local needs
Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services
Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals
Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

26. Mass Media Takes keen Interest

27. Political commitment on the floor of the house.

28. Sex ratio at birth as per CRS records

29. 4 Districts showing deterioration in sex ratio
Name of the Talukas
Sex Ratio -2004
Sex
Ratio- 2006
Ahmedabad City
850
818
Amreli
826
801
Kukavav Vadia
807
707
Bagasara
883
785
Anand
813
790
Sujitra
930
855
Petlad
849
779
Visnagar
789
Mehsana
814
774
Kadi
854
843
Chansama
758
751
Rajkot
852
773
Upleta
860
811
Jetpur
897
767
Dhoraji
842
832
Surat City
786
781
Wadhvan
865
815
4 Districts showing deterioration in sex ratio
Name of the Districts
Sex Ratio -2004
Sex
Ratio- 2005
Ratio- 2006
Surat
815
794
796
Kutch
877
930
920
Jamnagar
860
871
Kheda
830
904
878
State average: 870 (2006)

30. Our Goals Reduce maternal and child mortality
Address adverse sex ratio
Stabilize population
Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia
Provide state of the art health and medical education relevant to local needs
Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services
Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals
Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

32. Special Initiatives for NSV

35. Crude birth rate

36. Our Goals Reduce maternal and child mortality
Address adverse sex ratio
Stabilize population
Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia
Provide state of the art health and medical education relevant to local needs
Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services
Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals
Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

37. Effective Implementation of national health programmes in PPP
Working with IMA
Outsourcing CD4 testing
MNGOs, SNGOs and FNGOs
Working with Rotary and Lions
GIA institutions
Outsourcing staff
Working with private OBGYs

38. Cure Rate Vs Case Detection Rate (3Q06/3Q07)

39. Cataract Surgical Rate (CSR) (2003-08)

40. NLEP – Gujarat Endemicity as on May.08
P.R.-0.78 PM
Dahod
1.80
2.36
Vadodara
1.31
Bharuch
Narmada
> 5
2 - 3
1 - 2
< 1
P.R.
3 - 5
2.80
1.91
Surat
1.50
Dang
Navsari
3.49
2.58
Valsad
2.81

43. SECONDARY & HIGHER SECONDARY SCHOOL
Specialist services under school health programme
INSTITUTE
HEART
KIDNEY
CANCER
ANGANWADI CENTERS
473 60 23
PRIMARY SCHOOL
3703
484
159
SECONDARY & HIGHER SECONDARY SCHOOL
TOTAL
4176
544
182

44. Route Map through Satellite based monitoring system
Max. distance
Desert
Start

45. Curative services through MHUs
Retrospective Status
Satellite based Monitoring System implemented

46. Our Goals Reduce maternal and child mortality
Address adverse sex ratio
Stabilize population
Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia
Provide state of the art health and medical education relevant to local needs
Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services
Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals
Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

47. PPP in ME
Medical colleges in PPP with Bombay hospital; United phosphorous; Narayan Rudalaya and Fortis
Setting up of PHFI Gujarat
Nursing colleges
Outsourcing staff; security; laundry
Outsourcing diagnostics
Outsourcing lab work

49. MOU s SIGNED VIBRANT GUJARAT

50. Our Goals Reduce maternal and child mortality
Address adverse sex ratio
Stabilize population
Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia
Provide state of the art health and medical education relevant to local needs
Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services
Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals
Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

51. NOVEL INITIATIVES
Institute of Kidney Diseases and Research Centre (IKDRC), U.N.Mehta
Institute of Cardiology and Research Centre and Gujarat Cancer
Research Institute are government funded institutes, administered by
various private organizations. RKSs
EMRI 108
To increase utility and performance of various government health
facilities they are being run by private and local CBOs.
Project Implementation Unit (PIU) a novel venture by Gujarat Government to undertake infrastructure development aggressively
NABH/NABL
HMIS

52. EMRI

53. EMRI
EMRI is a non-profit organization based on the Public Private Partnership (PPP) model in Gujarat.
The service is currently available in parts of Gujarat through the toll free number By August end 400 ambulances will serve the whole state.
The pre hospitalization emergency care provided by EMRI is free and the patient is admitted to a hospital of his or her choice.
More than 400 hospitals in the state collaborating with EMRI to stabilize the patient brought in, free of charge.
Massive capacity building
Setting up of EMS authority and EMS Act

54. Trauma care EMS act EMS authority Extensive planning for trauma care
Trauma care services
A total of emergencies have been attended
39% trauma related
16% pregnancy related
291 pregnancies handled in the ambulance.
181 trauma care units already operational
4.4 dispatches per ambulance daily
All 400 to be operational by August 2008.

55. Running CHCs and PHCs in partnership with CBOs

56. PERFORMANCE INDICATORS
Name of Facility
Pre PPP Performance
Post PPP Performance
Community Health Center
O.P.D.
I.P.D.
CHC Shamlaji Dist Sabarkantha 75 9
175 20
CHC Mota Pophalia Dist Baroda 65 10 69
CHC Malav Dist Panchmahal 35 3
149 23
Primary Health Center
PHC Chansad Dist Baroda
1015
1155 14
PHC Dahej Dist Bharuch
1236
5461
134
PHC Matano Mad Dist Kutch
239 5
290

57. Better infrastructure with PIU

58. PROJECT IMPLEMENTATON UNIT GUJARAT
Project Implementation Unit is setup for repairs, strengthening, retrofitting and new construction work of Healthcare Structures.
High level expertise in hospital design & structural engineering aspects available on an outsourcing basis.
Rigorous management information system with Gantt charts to ensure that the completion schedule are followed.
The quality of the construction maintained through third party monitoring & supervision agency.
Consultants / Experts are appointed for various services i.e. architectural planning, structural design, sanitary & plumbing design, electrical design, landscaping etc.

59. Repair, Strengthening, Retrofitting &
Reconstruction (RSRR)
Name of Work
RSRR Works
Number of Structures
1023
Details of Structures (Type) GH
CHC
PHC
Disp SC SQ
Total
No of Structures 4 50
121 7
300
541
Cost
68.30 Crores
Present Status
Completed

60. New Construction Works ( Health Facilities + ICDS)
New Construction of Health Care & ICDS Facilities
Name of Work
New Construction Works
( Health Facilities + ICDS)
Number of Structures
904
Total Structures
CHC
PHC AH
Disp SC SQ TB
Clinic
CDPO + Angan.
CMSO
Total 1 28 3 7 48
329
484 4
Cost
Crores
Present Status
76% of work completed

61. NABH/NABL ACCREDITATION
1ST PHASE ( )
Food and drugs administration lab already accredited by NABL 8 District Hospitals (NABH)
1 Medical Colleges (NABH)
6 Medical Colleges (NABL)
2ND PHASE ( )
18 District Hospitals
5 Medical Colleges

62. PATIENT SATISFACTION

63. Making sense of data Enhanced patient care and effective use of resources with HMIS

64. Technical Architecture [Three Tier ]
Network Architecture - Health & Family Welfare Department Govt. of Gujarat
Topic :
Technical Architecture [Three Tier ]
The screen shows the manner in which the network works for HMIS.
There is a central server which connects the local servers of each location to itself.
The firewall will restrict the anonymous access to the central site.
HMIS Technical Architecture
Think Life ...

65. Hospital Management & Information System (HMIS)
Patient Care Services
Clinical Services
Hospital Admin
Ancillary Services
Registration
Wards
Pharmacy
Billing
Patient Education
Information Kiosk
Nursing Care
Clinical/EMR (Gynecology, Ophthalmic, Orthopedic, ENT, Gastro Medicine, General Medicine, Nephrology, Pediatric, Surgery, Urology, Skin etc…)
Laboratory (Pathology, Microbiology, Bio Chemistry, Radiology)
Blood Bank
Imaging
Hospital Admin
Human Resource
Payroll
Financial Accounting
Stores/Inventory
Purchase
Complaints & Redresses
Transportation
MIS Reports
EIS Reports
National Programs
Linen Management
Equipment Maintenance
Resource Scheduling
Special Camp & Training
Bio Medical Waste
Application Security

66. Management Information System - Data Flow
State Level Monitoring
Expected Users : Health Minister, Commissioner, Secretary
Top Management
All Programs like D & E, Malaria, etc…
Expected Users: Program Owner
Health Department
Data
Daily Dashboard
Expected Users: Hospital Superintendent
Hospital Senior Management
Disease Report, Death Report
Expected Users: Doctors, Nurses, Admin Staff
Users Of HMIS at District Hospital

67. Blocks performing poorly

68. Institutional Deliveries – Vadodara Region
Bharuch
Vagra
Narmada
Nandod
Dediapada
Sagbara
Vadodara
Nasvadi
Kawant
Chota Udaipur
Dahod
Halol
Panchmahal
Ghoghamba

69. Institutional Deliveries – Panchmahal District

70. Institutional Deliveries in the PHCs in a Block in Panchmahal District

71. Our Goals Reduce maternal and child mortality
Address adverse sex ratio
Stabilize population
Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia
Provide state of the art health and medical education relevant to local needs
Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services
Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals
Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

72. Capacity building Reservation of seats in PG seats Sri Chitra AMA TISS
PHFI
CORT
SIDA
UNICEF
WHO fellowships
Mentoring
Awards for PP partners and our own staff

73. Our Goals Reduce maternal and child mortality
Address adverse sex ratio
Stabilize population
Effectively implement National Health Programmes and address locally endemic diseases like leptospirosis, sickle cell anemia and thalesemia
Provide state of the art health and medical education relevant to local needs
Work with the citizens to make the health system more equitable, accessible, accountable, transparent, and cost-effective to enhance overall satisfaction with health services
Provide an environment in which the health teams blossom fully to lead a fulfilling life and effectively achieve the above goals
Develop public health capacities and systems, to effectively address determinants of good health such as potable water, sanitation, nutrition and healthy environment as well as to promote healthy life styles

74. Integrated disease surveillance
Response
begins
PRIM HC
REP
SAMP
RES
Potential
cases prevented
CASES
DAY

77. Issues Malnutrition Neonatal health Unmet need for FW Sex ratio
PPP initiatives
Filling up of places
Improving satisfaction with health care facilities
Health infrastructure development corporation
Capacity building

78. Thank you
Thank you
Department of Health
Government of Gujarat