Details for Reform Option "Improving access to healthcare in urban areas through re-structuring, community involvement and operational autonomy, Lucknow, Uttar Pradesh"
Uttar Pradesh (UP) is the most populous state in India. Lucknow, the capital of UP, has an estimated population of about 21.85 lakhs, with (2001 census) with some 500 odd slums accounting for about one-third of its population.
However, the existing healthcare infrastructure was set up in 1976 for a population of just 8 lakh. Even now, only about 38 - 47% of births take place in health care facilities.
In mid 2000, Lucknow was chosen as one of the cities to be taken up under the national component on urban Reproductive and Child Health (RCH) under the Sector Investment Programme being implemented in partnership with the European Union.
This programme sought to improve the Maternal and Child Health (MCH) indicators by:
(i) Using an existing network of resident volunteers in slum areas to provide counselling, first-aid and detection of emergencies. The members of this network, called Resident Community Volunteers (RCVs - one RCV for every 25 families), were given additional training under the project to improve their counselling and organisational skills.
After the 6-day training, the RCVs put together a Swasthya Ghar or health home - a small room in one of their homes where they stock supplies given to them and conduct meetings/consultations with the local women.
(ii) Strengthening existing maternity homes to provide essential and emergency obstetric and neonatal care on a round-the-clock basis. Merging smaller units and staff re-location were key initiatives to improve sustainability of additional investments made. Enhancing operational autonomy for the Chikitsa Sudhar Samities (facility level management committees set up by the state government before the project started) was another policy intervention.
(iii) Setting up of additional facilities to serve the outer parts of the city. Merger of smaller units and staff re-location were again the priority while determining the input needs.
These activities are supported by complimentary investments in Information, Education and Communication (IEC), training and capacity building.
The project started with the creation of an integrated District Health and Family Welfare Authority by merging existing vertical societies of national programmes.
Two types of NGOs are involved to support service delivery.
(i) The first type of NGO acts as a link between the slum population and the District Health and Family Welfare Agency through the network of RCVs. They provide performance-based compensation to the RCVs.
(ii) The second type of NGOs organise service delivery through charitable or private hospitals in slum areas that are not yet covered by the RCV network. The initial task in such areas is to hold health camps.
The progress has been slow but steady in the last six years. The initiatives are beginning to take root and the performance data indicate early signs of a positive impact.
Initial plan (in 2001) outlay of INR 165 lakh followed by roll-over plan (year 2002) outlay of INR 260 lakh and 2nd Roll Over Plan outlay of INR 321 lakh.
The funding mechanism is Performance-based Funding (PBF). For every agreed plan cycle, a set of milestones are agreed upon with the values assigned (to the individual milestones) on the basis of an assessment of requirement of funds.
Lucknow City, since early 2001.
Improved access to services: particularly for the poor, increase in institutional deliveries, increase in immunisation coverage levels and couple protection rate and improved management of obstetric emergencies.
Functional autonomy: For programme managers leading to better ownership, community participation in improving their healthcare and involvement of NGOs in service delivery.
Situational analysis, consultations with stake holders, involvement of policy makers in the government and technical assistance to the planners.
Who needs to be consulted
* Directorate General of Family Welfare, Government of Uttar Pradesh.
*Chief Medical Officer and Secretary, District Health & Family Welfare Authority, Lucknow.
* European Commission Technical Assistance.
The programme is sustainable.
Chances of Replication
It has been replicated and similar programmes are running in other states also.
J P Mishra, Programme Adviser, European Commission Technical Assistance, New Delhi. July 2004. Last Updated: November 2006.