Stewardship and Governance in Health

Stewardship and Governance
Last Date Aug 11,2015 00:00 AM IST (GMT +5.30 Hrs)
Submission Closed.

This discussion theme is in continuance to our first discussion titled ‘Health System in India: Bridging the Gap between Potential and Performance’. To review what others have ...

This discussion theme is in continuance to our first discussion titled ‘Health System in India: Bridging the Gap between Potential and Performance’. To review what others have commented on this subject earlier in the first discussion, visit our Blog.

How can we maximize health returns through strengthening Stewardship and Governance?

1. Issues

1.1. Existing governance and accountability mechanisms focus on inputs rather than outcomes.

1.2. There are insufficient mechanisms and opportunities for interaction between ministries and departments of Health and its determinants, especially the Integrated Child Development Services programme (operates Anganwadi centres), water and sanitation and school education.

1.3. Health programmes are centrally managed, with little flexibility and decentralisation of powers for States. This is reflected in the following examples (i) Approval of State Project Implementation Plans (PIPs) takes place at the Centre, subjecting all State strategies to a prior approval from the Centre. (ii) Mid-term modifications/revisions in State PIPs also require to be approved at the Centre (iii) Decisions such as the monetary incentives to be paid to the Accredited Social Health Activist (ASHA-community health workers) are made at the level of the Empowered Programme Committee and Mission Steering Group, which are Central bodies under the NHM, limiting the ability of States to take local decisions on such matters.

2. Suggestions

2.1. The instrument of Memorandum of Understanding (MoU) may be used to formalize mutual commitments between the Centre and States. Such a mechanism would increase outcome based accountability for States’ actions on system wide reforms.

2.2. The MoU can be subjected to concurrent external evaluation, whose reports can be placed before the Mission Steering Group at the national level and Governing body of the State and District health societies to encourage commitment to reforms.

2.3. Accountability of health service providers may be increased by providing a choice to patients to access services through either public or private sector within models of prepaid care.

2.4. In order to identify and plug leakages in health spending, public spending tracking surveys may be undertaken.

2.5. In order to increase convergence, the Anganwadi centre may be developed as a hub for health service delivery.

2.6. States may be encouraged to observe Village Health, Sanitation and Nutrition Days in complete convergence mode.

2.7. A Health impact assessment cell may be developed that will coordinate the measurement of the health impact of policies and programmes of non-health Departments.

2.8. The Panchayats may be empowered to play a meaningful role in convergence within the social sector.

2.9. The lack of flexibility to States may be addressed by allowing programmatic decisions to be taken at the state level by the Chief Secretary of State Level Sanctioning Committees as in the Rashtriya Krishi Vikas Yojana (RKVY), a national programme for agricultural development.

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5380
Saji Namboothiri 4 years 4 months ago

Sir, Large number of fraud charity appeals are appearing in facebook every day with some bank account number with intention of cheating the public, mostly asking for 40 or 50 Lakh rupees as surgery expense, creating some sensational story. Having done a lot of social work, I know that in most of the cases, they get many many times larger amounts. Police should verify to know if the case is genuine. If the public comes to know that all are cheaters, then even genuine people will not get any help.

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AMMU PRAMEELA NANDAKUMAR 4 years 4 months ago

"THE MEDICAL DEVICE REGULATIONS BILL, 2006".
The past decade alone accounts to about 1,00,000 medical device failures involving 2,300 deaths and 22,000 injuries including the much talked about cases like the death of babies in Allahabad and Vijayawada due to incubator failure. Though these incidents raised serious concerns on the safety and quality standards of medical devices in India, "THE MEDICAL DEVICES REGULATION BILL, 2006" is not passed even after 9 years.

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Chanchal MAl Chordia 4 years 5 months ago

अहिंसक चिकित्सा पद्धतियों के प्रति स्वास्थ्य मंत्रालय का दृष्टिकोण-

45080
Preetha Premjith 4 years 5 months ago

Facilities and shortage of staff and lifesaving medicines are not available in primary health centers in remote areas. Moreover doctors and staff are reluctant to work in remote areas. In order to overcome this those who are willing to work in that areas were given special remuneration and all modern facilities were provided to that health centers. Monitor the working of health centres periodically.

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Preetha Premjith 4 years 5 months ago

Make the existing Govt. hospitals more patient friendly with more facilities.Make sure that the doctors, staff and the instruments are working properly/timely.Supply enough medicines and staff to the hospitals.Monitor the functioning of the hospitals regularly.Provide registers for putting complaints/suggestions and also online to health ministry.Give awareness programme to the public especially in the rural/remote areas.

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Chanchal MAl Chordia 4 years 5 months ago

Government must clarify why they consider Allopathy as Original Therapy and all other therapies as an Alternative.