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Construction of Sub centre building through involvement of Panchayat Raj Institutions, Uttar Pradesh
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Subject Area="Infrastructure and Equipment." Objective="To improve performance of Sub Centres"
Details for Reform Option "Construction of Sub centre building through involvement of Panchayat Raj Institutions, Uttar Pradesh"
Summary

Background: Uttar Pradesh, one of the larger States in India, has fairly large public health care delivery infrastructure. But out of 20,521 Sub Centres (SCs) only 6581 SC were functioning from government building. Whereas 13940 SC were operating from rented building. Most of the SC were operating from poorly maintained buildings. They were facing operational difficulty either due to inadequate space or notice from their landlord to vacate the space in lieu of very low rent. Therefore, it was decided under Sector Investment Programme (SIP) to build new SCs for better functioning. As a traditional procedure, construction of the SCs is the whole sole responsibility of the Public Work Department (PWD), excluding involvement of end users (health care providers and community) in the construction process at any stage. In March 2005, SIP approved the construction of SCs building through involvement of Panchayat Raj Institutions (PRI) and Auxiliary Nurse Midwife (ANM). Action: In order to increase ownership in the maintenance of the health facilities, it was decided in the SIP to involve Panchayat Raj Institution (PRI) and Auxillary Nurse Midwife (ANM) together in the supervision and monitoring process of construction of SC building. Randomly 141 SCs in 46 districts were selected for the construction of building. Standard design of subcentre as mentioned under RCH II was approved with some region specific modification. To release money for construction a joint saving bank account was opened in name of Sarpanch and ANM. Chief Medical Officer was made responsible for release of fund. Release of fund was scheduled to be in two instalments. In the first instalment 80 percent of total cost calculated was released and second release of the instalment was on the basis of utilisation of 70 percent fund released in the first instalment. For technical assistance in the construction, a civil engineer posted at block level was appointed. Results: From the SIP office, the funds were released in one go for all 141 subcentres to respective district (CMO) in June 2005.Till June 2006, the physical progress of construction was as follows: Percent completion Number of SCs 100 percent : 04 76-99 percent: 07 51-75 percent 09 25-50 percent 14 less than 25 percent: 05 Work not yet started 102

Cost Total fund allotted for construction of 141 SCs is INR 607.45 Lakh.Distribution of fund was based on the type of the soil, found in particular region. Type of soil – Normal – Rs 4.25 lakhs per subcentre (total number – 107) Black soil – Rs 4.45 lakhs per subcentre (total number – 20) Salt peter – Rs 4.55 lakhs per subcentre (total number – 14) Provision was made that unutilised fund could be taken for maintenece of building in future.
Place One hundred and forty one SCs in 46 district in Uttar Pradesh.
Time Frame Prepration of district wise priority listing of SCs and development of operational frame work for flexible and decentralised system for construction of government health facilities took 12 months. Release of fund took another six to eight months due to ongoing panchayat election.
Advantages

Decentralised monitoring:Monitoring process is decentralised at the district level. Increased ownership: Involvement of community encouraged their ownership in the health facility.

Challanges

Lack of coordination: Coordination betweem the ANM and PRI members needs to institutionalise through proper guidelines. Ill defined authority: No clear cut guidelines were available for authority of Sarpanch and ANM in the supervision and monitoring of construction process, so decision to sort out local problems used to delay. Lack of PRI capacity: In order to get the involvement of PRI effectively, they need some basic training in the understanding of health care needs of the community and administrative procedures.

Prerequisites

Involvement of PRI Involvement of ANM Involvement of CMO

Who needs to be consulted

PRI and ANM

Risks

Sustainability

Elements of sustainability are region specific in terms of maintenance of the infrastructure but construction of building do need one time fund allocation.

Chances of Replication

Initiative is under process of replication on larger scale provided delineation of roles and responsibilities between Dept of Medical Health & Family Welfare, Dept of PRI and elected representative is completed.

Comments

Construction / strengthening of the SCs building through PRI is a one step forward in the process of decentralised management. But to make their involvement fully accountable the whole process needs to be institutionalised through clear cut guidelines; and need to raise their capacity through training; or else initiative will face a set back as unutilised fund.

Contact

Submitted By

Dr. Anuradha Davey, Research Consultant, National Institute of Medical Statistics, Sept 2006.

Status Active
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