Thursday, August 25, 2011

Decentralised Health Plan on the anvil

by C. Maya

Part of State proposals for 12th Five Year Plan
Decentralisation is once again poised to be the buzz word in the State, as the Health Department, along with the National Rural Health Mission (NRHM), proposes to roll out the first ever decentralised, three-tier Health Plan for the State.

The new plan, which will incorporate block-panchayat and district-level health plans, will be the State's roadmap to health for the next five years as it will be part of the State's proposals for the 12th Five Year Plan.

The first of the three regional training workshops organised in this connection concluded here on Thursday, in which health field workers and officials from Thiruvananthapuram, Kollam, Pathanamthitta, and Kottayam took part.

“When the National Rural Health Mission was launched in the country, Kerala's decentralised Plan was chosen as the model for its implementation so that health care delivery services could be improved at the grassroots. Unfortunately, we lost that edge when the NRHM was implemented,” says Rajeev Sadanandan, Principal Secretary, Health.

Even though a lot of money was available at the State's disposal with the launching of the NRHM, many of the health initiatives were taken up without much planning at the local level, with the result that many of the health projects have either remained under-utilised or are idling.

Fund utilisation

While the NRHM's annual Programme Implementation Plan (PIP) does have district and State-level components, the approach has always been top-down. The local bodies more often than not, failed to utilise the money made available to them.

Decentralised planning is not a new concept in the State but then it more or less remained as an activity of the Department of Local Self-Government. This time, the Health Department has recognised the need for a participatory planning approach so that a comprehensive health plan, which incorporates the health needs of every ward, can be formulated, says G. Vijayakumar, professor of Community Medicine, MCH, who is one of the key resource persons for the project.

“For the first time, the Health Department is talking about the social determinants of health (the economic and social conditions that may have a bearing on an individual's health) rather than just provision of medical care and adding more facilities in hospitals,” Dr. Vijayakumar points out.

This recognition that provision of safe drinking water, sanitation, garbage disposal, nutrition, welfare initiatives can do more to ensure a community's good health would be reflected in the proposed health plan. The Health Department itself is taking the lead to bring about the convergence of the activities of various other departments in the new plan, according to Mr. Sadanandan.

“The solution to most of the health problems in a locality is often beyond the capacity of the Health Department. There are several departments – Social Welfare, LSG, water supply – whose activities are so interlinked to health and whose schemes need to be dovetailed into our plan. All this will be reflected in the NRHM's PIP,” Biju Prabhakar, State Mission Director, NRHM, points out.

While the planning will be initiated at the ward-level, it would be summarised into a block-level plan and then consolidated into a district plan.

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