1. REFORM INITIATIVES IN HEALTH SECTOR : FEW STEPS HEALTH & FAMILY WELFARE DEPARTMENT GOVERNMENT OF ASSAM

2. REFORMS INITIATED: §DECENTRALISATION: l INTEGRATED “DISTRICT HEALTH AND FAMILY WELFARE SOCIETY” CONSTITUTED MERGING VERTICAL SOCIETIES IN DISTRICTS. l MANAGEMENT OF HEALTH INSTITUTIONS DECENTRALISED TO DISTRICTS. l BLOCK LEVEL HEALTH MANAGEMENT COMMITTEES CONSTITUTED INVOLVING PRIs.

3. DECENTRALISATION: §PROGRAMME MANMAGEMENT AND HEALTH INSTITUTIONS SUPERVISION AT BLOCK LEVEL BY LOCAL COMMITTEE. §PLANNING AND IMPLEMENTATION OF PROGRAMME THROUGH DECENTRALISED MECHANISM AT DISTRICT § DECENTRALISED REPAIR/RENOVATION OF HEALTH FACILITIES BY MANAGEMENT COMMITTEES

4. DECENTRALISATION: § SUB-CENTRE MANAGEMENT COMMITTEE UNDER GRAM - PANCHAYAT CONSTITUTED. § ORIENTATION OF PANCHAYAT MEMBERS ON HEALTH SECTOR RESPONSIBILITIES STARTED. §DEPLOYMENT OF MANPOWER WITHIN DISTRICT DELEGATED TO DISTRICT SOCIETIES.

5. HOSPITAL AUTONOMY AND USER FEES: §“HOSPITAL MANAGEMENT SOCIETY” CONSTITUTED IN MEDICAL COLLEGE, DISTRICT AND SUB-DISTRICT HOSPITALS. §USER FEES COLLECTED AND RETAINED IN THE FACILITITES TO MAINTAIN AND IMPROVE SERVICES. §QUALITY OF HOSPITAL SERVICES IMPROVING ALONG WITH INCREASE IN COLLECTION OF USER FEES. §USER FEES ENHANCED WITH SAFE GUARD TO BELOW POVERTY LINE (BPL) FAMILIES.

6. REFERRAL SERVICES: § 11 FIRST REFERRAL UNITs(FRU) MADE OPERATIONAL IN CHC LEVEL UNDER SIP. l PHYSICAL INFRASTRUCTURES RENOVATED/REFURBISHED UTILISING RCH/MLALAD /PMGY /SIP/PRI FUNDS. l EQUIPMENT SUPPLIED THROUGH CSSM/RCH/NACO RE-ALLOCATED and PROCURED FOR IDENTIFIED FRUs. l MANPOWER(SPECIALISTS) ARRANGED RATIONALISING EXISTING SPECIALIST WITHIN DISTRICT.

7. REFERRAL SERVICES: §NURSING AND SUPPORT STAFF IMPARTED HANDS ON TRAINING §DRUGS AND CONSUMABLE SUPPLIED UNDER GENERAL BUDGET §SUSTAINABILITY OF SERVICES ENSURED THOUGH USER CHARGES §QUALITY OF SERVICES CERTIFIED BY FACULTY OF MEDICAL COLLEGE §POLITICAL COMMITMENT TO REPLICATE REFERRAL CARE IS THE DRIVING FORCE

8. SHORT TERM TRAINING FOR REFERRAL SERVICES: §SHORTAGE OF SPECIALISED MANPOWER IN ANAESTHESIA&PAEDIATRICS IS WELL UNDERSTOOD: l FOR THE UPCOMING FRUS, SHORT TERM (SIX MONTHS) TRAINING FOR NON-PG MEDICAL OFFICERS IN MEDICAL COLLEGES ARE GOING ON. l ALREADY TRAINED MEDICAL OFFICERS ARE POSTED IN FRUS AND PROVIDING REQUIRED SPECIALISED SERVICES WHERE PG HOLDERS ARE NOT AVAILABLE.

9. PUBLIC-PRIVATE PARTNERSHIP: §MARWARI MATERNITY HOSPITAL, A NON- PROFIT TRUST CONTRACTED FOR RCH SERVICE DELIVERY IN SLUMS OF GUWAHATI CITY. l OPERATIONAL SUPPORT FOR SESSIONS AND VACCINCE SUPPLIED FROM HEALTH DEPT. l REFERRAL CARE FOR OUTREACH PATIENTS IN HOSPITAL IN SUBCIDISED RATE. l OUTREACH SESSIONS ARE ATTENDED BY SENIOR DOCTORS. l IMMUNIZATION, FAMILY PLANNING COVERAGE INCREASING IN THESE SLUMS

10. BEHAVIOUR CHANGES NOTICED IN SLUMS COVERED : A POSITIVE NOTE April,02-March,03 April,03-Dec.,03 Total sterilization: 352 427 Sterilization at P-2 136(38%) 224(50.2%) Sterilization with 04 23 2 Girls No. of Muslim Women 69(17.06%) 95(22%) Muslim Women at P-2 18(26%) 35(36.5%) Previous Contraception 178(50.4%) 266(59%) Literacy Rate(Wife) 128(37%) 152(36%)

11. BOTTLENECKS ENCOUNTERED: §DECENTRALISATION: l NEW ENVIRONMENT OF INTEGRATED MANAGEMENT, PRI’s CONTROL OVER HEALTH INSTITUTIONS, WORKFORCE RESULTING CONFLICT WITH SERVICE ORGANISATION. l OVER RELIANCE ON DISTRICT ADMINISTRATION FOR PROGRAMME MANAGENT CREATING CONFUSION AMONGST HEALTH OFFICIALS. l REFERRAL CARE : l SHORTAGE OF SPECIALISED MANPOWER THREATENING SUSTAINABILITY OF SERVICES l LACK OF FACILITIES IN RURAL AREAS CAUSING PROBLEM TO RETAIN SPECIALISTS IN FRUS l NUMBER OF SANCTIONED POSTS IN FRUS NOT ADEQUATE TO PROVIDE ALL SERVICES OF FRUS.

12. BOTTLENECKS ENCOUNTERED §HOSPITAL AUTONOMY: l MANAGEMENT SOCIETY FUNCTIONS ARE NOT UNIFORM THROUGHOUT THE STATE. l NO ADEQUATE MONITORING SYSTEM FOR USER FEE COLLECTION AND UTILISATION. l EXEMTION SYSTEM FOR BPL FAMILIES UNRELIABLE. l TRAINED MANPOWER IN HOSPITAL ADMINISTRATION NOT AVAILABLE IN FACILITIES. l INTRODUCTION OF USER FEES IN ALL HEALTH INSTITUTIONS INVITING PUBLIC CRITICISM. l MANAGERIAL POSTS ARE FILLED FOR SHORT DURATION OR IN THE FAG END OF SERVICE.

13. LESSION LEARNT FROM URBAN HEALTH INITIATIVE SERVICE DELIVERY IS POSSIBLE INVOLVING PRIVATE PROVIDERS WHERE PUBLIC FACILITIES LACKING. TASK NETWORKING OF INSTITUTIONS BOTH PUBLIC & PRIVATE IS ESSENTIAL REGULARITY AND TIMINING OF SESSIONS ARE IMPORTANT TO GAIN FAITH OF COMMUNITY. COMMITMENT OF STAFF TO SERVE IN SLUMS. COMMUNITY SUPPORT FOR HOLDING SESSIONS IN PRIVATE ESTABLISHMENT. INVOLVEMENT OF LOCAL VOLUNTEERS/NGO TO REACH COMMUNITY. PERMANENT COMMUNITY CONTACT AS MOTIVATOR/INFORMANTS. BASELINE INFORMATION TO ASSESS PERFORMANCES.

14. STEPS INITIATED TO OVERCOME BOTTLENECKS : §ORGANIZATIONAL REVIEW IN HEALTH SECTOR §RATIOALISATION OF INFRASTRUCTURES AND MANPOWER §ORIENTATION OF PRIs ON HEALTH ISSUES §SPECIALIST CADRE FOR SUSTAINABILITY OF STAFFING IN FRUS AS PER RECOGNISED POST §HOSPITAL ADMINISTRATION TRAINING FOR MANEGERIAL POST IN HOSPITALS §MANUAL FOR STREAMLINING COLLECTION AND UTILISATION OF USER FEES §MORE NON-PROFIT TRUST TO INVOLVE IN URBAN HEALTH SERVICE

15. Expenditure Statement till 31.12.03 §Fund received from Govt. of India (SIP) = 846.09 §Rs 450 lakh received during this month (under MOU) §Total expenditure = 350.09 §Disbursement to District = 38.62

16. THANK YOU