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Management of Primary Health Centres by NGO, Gujarat
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Subject Area="Public / private partnership (including NGOs)." Objective="Scope and quality of primary health centre services."
Details for Reform Option "Management of Primary Health Centres by NGO, Gujarat"
Summary

Background: Jhagadia block of Baruch district is a poor, tribal area which did not have even basic government health services in its rural areas. 95% of deliveries were home-based and done by Traditional Birth Attendants (TBAs) and there were high mortality (IMR 172 & MMR >1500) and morbidity rates. Action: NGO SEWA-Rural collaborated with the state government under the USAID scheme to demonstrate a model where the state government and an NGO worked as partners in implementing community health interventions. Consequently, the government decided to entrust the management of the Primary Health Centre (PHC) at Jhagadia to SEWA-Rural for 10 years from 1989-99. Official resolutions were passed by the state government and the NGO took over total healthcare responsibility including implementation of all national programmes. Results: During this period (1984 to 1999-2000), there was a reduction in mortality (IMR down from 172 to 46.4) and morbidity rates and immunisation rates increased to 98%. There was an increase in area covered (11 villages and 11,000 population in 1981-82 increased to 30 villages and 40,213 population in 1998-99) and an overall increase in health awareness.

Cost In a standard government PHC budget, more than 80 per cent is spent on salaries while only the remaining part is available for delivery of services and related programmatic activities, which is found to be inadequate. SEWA Rural saved money on salaries of approved field staff by managing with a smaller number of full-time field staff with relatively low salary and utilising services of more village level workers without compromising the quality of the services. SEWA Rural required additional funds for other important aspects including field operational research studies and documentation, which it believed to be crucial for the success of the programmes and it was able to mobilise extra funding from other sources. Hence, the SEWA Rural experiment demonstrates that if reallocation of budgetary heads is allowed at the local level with organised and decentralised planning and management, efficient service delivery by a PHC can be ensured within the existing financial allocations. (For more on the break up of costs over the years see the document below).
Place Jhagadia in Bharuch District, Gujarat, since April 1984 but formally from 1989-90 onwards for a period of 10 years.
Time Frame Six months to one year.
Advantages

Decentralisation: Effective decentralisation of powers to NGO running the PHC.

Challanges

Conflict: Problems in the relationship between NGO and the state government could take place. In this case the NGO faced some difficulties in the form of irregular and short supply of medicines, delays in grants and over emphasis on target achievements.

Prerequisites

Government Resolution.

Who needs to be consulted

State Government, NGO, PRI (local Panchayati Raj Institutions).

Risks

Sustainability

Variable. Has already been extended to three other community health centres within Gujarat and nine other proposals are under consideration (as of August 2004). The idea has also proved successful in Karnataka where 31 PHCs (August 2004) have been handed over to NGOs or private medical colleges for maintenance. However a similar project in Orissa was unsuccessful, largely because the terms of reference were inadequate and the NGO did not have the resources or the ability to run the institutions.

Chances of Replication

The direct responsibility of managing the PHC was returned back to the government in 2000 mainly because the NGO had been managing the PHC for 15 years (on an informal and later formal basis) and sought fresh challenges. However a hospital run by the NGO was recognised by the state government as the First Referral Unit (FRU) for all 7 PHCs in the Taluk and therefore it continued its association with the area.

Comments

None

Contact

Submitted By

Sara Joseph, Researcher, ECTA, New Delhi. August 2004.

Status Active
Reference Files
Corrigendum - management of villages of Jhagadia for providing health services.doc
Resolution No MIS-1084-2265 867-b, June 10, 1986.doc
Resolution No PHC-1087-8096-88 GH Feb 14,1989.doc
Resolution No PRCH-1084-590-89-B April 13,1989.doc
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