1. State Institute of Health and Family Welfare, Rajasthan, Jaipur
Health Sector Reforms
Shiv Chandra Mathur
Director
State Institute of Health and Family Welfare, Rajasthan, Jaipur
Shiv Chandra Mathur is a public health specialist working for developing human resources for health. His current assignment involves him consistently in organizing in-service trainings for health professionals. Present paper is a conceptual analysis of the epidemiological transition occurring in the developing world with particular reference to India.
Viewers/Readers are welcome to share their observations/comments with author at
They may go through other lectures from the author in supercourse series on RCH, adolescent health, population policy, NRHM and violence against women in India (through topic, keywords, lecturers.... pages)
The current lecture is addressed to health professionals of India in particular, large number of whom in different states of India are involved in introducing and implementing health sector reforms in the public systems.
Shiv Chandra Mathur/

2. Challenges to the Health System
Stagnant public spending on health
Between 75-90% spending by states. Largely tied up in salaries expenditures
Curative public services favor the rich
Hospitalization frequently means financial catastrophe.
One of the major challenge to the reform process is to perceive the macroeconomics of investments in health in a right perspective.
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3. WDR Approaches
Fostering environment enabling households to improve health;
Improving Government spending on Health;
Promoting diversity and competition.
Whole process of reform started with implementing the recommendations of World Bank report on Investing in Health released in Three major recommendations of this report are highlighted here.
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4. Health Sector Reforms What do we mean by reforms?
What are the essential components of reforms?
How do reform differ from Normal evolutionary system changes?
Subsequent slides will now deal with these three major questions.
Shiv Chandra Mathur/

5. Health Sector Reforms definitions
Sustained, purposeful change to improve the efficiency, equity and effectiveness of the health sector.
Berman,1995
A process that seeks changes in health sector policies, financing, and organization of services, as well as the role of government, to reach national health objectives.
Population Council,1998
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6. HSR is concerned with Defining priorities Refining policies
Reforming Institutions
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7. HSR deals with Equity Efficiency Quality Financing
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8. Principles of Health Sector Reforms
*Overseeing the needs of the entire population – pro-poor; gender sensitive and client friendly.
*Looking forward to the health transition
*Removing the blind spot to the private sector
*Focusing efforts – by ensuring quality, efficiency and accountability of health services
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9. Functions covered by HSR
Governance
Provisions
Financing
Resource Generation
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10. Key elements of HSR
Structural rather than incremental/evolutionary change;
Change in policy objectives followed by institutional change, rather than redefinition of objectives alone;
Purposive rather than haphazard change;
Sustained and long term rather than one off change;
Political top down process led by national, regional or local government.
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11. Governance related HSR
Evolving standard protocols for care at P/S/T care settings
Quality assurance mechanism such as Consumer Protection Act and Citizens charter for hospitals;
Appropriate delegation of power to PRI’s.
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12. Classifying HSR- financing
User Charges
Insurance
Private sector Growth
Increasing resources to health sector
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13. Classifying HSR- health system organization and management
Decentralization;
Contracting out of services;
Reviewing the public-private mix.
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14. Classifying HSR - Public Sector Reforms
Downsizing the public sector;
Productivity Improvement;
Improving geographic coverage;
Increasing role of local government.
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15. Reforms attempted in Health and F.W.Sector in Rajasthan
Jan Mangal Project 1992
Strengthening FRU’s
Decentralized District Planning since
Creation of RMRS-user charges since
Reorganizing the Training System
Concurrent Evaluation in F.W.Program
Here is an example of Health Sector Reforms efforts made in an Indian state over aperiod of 1½ decade. They range from introducing a community based contraceptive distribution project to creating autonomous societies in a large number of hospitals.
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16. Reforms attempted in Health and F.W.Sector in Rajasthan - 2
Draft Training Policy
Devolution of Powers to PRI’s - 90’s
Population Policy 2000
Job Responsibilities specifications 2000
Preparation of EDL 2000
Health Vision Document 2025
Change introduced through reform process certainly changed the quality of health care services delivery but rising expectations of the community diluted the perception of change.
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