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Medical Officers authorised to arrange maintenance and repairs on Primary Health Centres, Gujarat
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Subject Area="Infrastructure and Equipment." Objective="Maintenance of health facilities."
Details for Reform Option "Medical Officers authorised to arrange maintenance and repairs on Primary Health Centres, Gujarat"
Summary

Background: Minor civil works and repairs (including replacement of window panes and repair of taps) at Primary Health Centres (PHCs) and Community Health Centres (CHCs) were being held up because the power to authorise such work and the funds are held at state, not district, level - with the Roads and Buildings (R&B) Department. The R&B Department is more interested in major, not minor, works, leaving PHC and CHC buildings in a dilapidated state. Action: Under the European Commission's Sector Investment Programme (SIP), Medical Officers (MOs) at PHCs and Medical Superintendents at CHCs were given the authority to commission and select contractors and carry out up to INR 25,000 per year of minor repairs (each work costing no more than INR10,000 ) on buildings. This was initially piloted in two districts and then rolled out to all 25 districts in the State, using funds provided by the SIP, the World Bank-supported Reproductive Child Healthcare (RCH) programme and UNFPA's Integrated Population and Development Programme. Funds are released to the MO by the District RCH Societies who were given the power to appoint local agencies to carry out the work, to authorise works above INR 10,000 with an upper ceiling of INR 10 lakh. A Government Order (GO) to this effect was obtained on the recommendation of the Narmada and Rajkot District Agencies (DAs) on 30 September 2000. Results: There has been a quick and appreciable improvement in facilities as well as an efficient utilisation of the funds available. The State Government is now considering a proposal to to sustain this initiative by using the Government funds allocated to the R&B department for repairs and maintenance of health facilities.

Cost No added cost implication.
Place Gujarat. Initially in Rajkot district from late 2000 and Narmada district from July 2002. Extended in January 2005 to cover all 25 districts.
Time Frame Three months but would vary depending on the size of the district.
Advantages

Speed: Minor works are undertaken quickly. Quality: Improved service delivery. Morale: Boosts staff morale and gives district agencies and MOs a sense of ownership.

Challanges

Corruption: Possible abuse of funds - needs careful auditing. Clarity: Proper guidelines were not provided to MOs so not all properly understood the procedures they had to follow. In addition some District RCH societies were not confident enough to release funds to the MOs. Funds flow: Held up initially because there was no bank account for the District RCH society to pay the money into. This has now been rectified.

Prerequisites

GO to empower MOs to take up civil works and identify contractors. Resolution of the DA to implement the GO. Training of PHC MOs to select cost-effective and efficient contractors to carry out necessary repairs. Guidelines for MOs and DAs.

Who needs to be consulted

State Government. District Agency.

Risks

None Identified.

Sustainability

Has functioned for the last six years and it is now planned to extend the decentralisation initiative to Government funds which will make it sustainable in the long term.

Chances of Replication

Judged to be good.

Comments

The Additional Director (Family Welfare) has also been given financial powers of up to INR 5,00,000 per activity per annum and administrative powers to appoint contractual staff to carry out building works. They can also appoint staff on deputation for project activities bringing more flexibility into the system.

Contact

Submitted By

Dr Uma Vyas, State Facilitator, Gujarat, for Health and Family Welfare Sector Programme in India, supported by the European Commission. July 2002.

Status Active
Reference Files
MO describes the work carried out at the PHC.mpg MO describes the work carried out at the PHC
PHC Garudeshwar, Narmada District September 2001.jpg
Decentralised administrative and financial powers enabled a painter to be employed.jpg
PHC Medical Officer showing the wall and windows at Samarpada Sub-Centre.jpg
PROD Gujarat delegated powers.doc
Presentation AJ Gujarat.ppt Powerpoint Presentation on Decentralisation, State Government of Gujarat, January 2006.
Reference Links
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