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Involving National NGOs in Health Service delivery, Arunachal Pradesh
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Subject Area="Public / private partnership (including NGOs)." Objective="To functionalise remote PHCs of Arunachal Pradesh"
Details for Reform Option "Involving National NGOs in Health Service delivery, Arunachal Pradesh"
Summary

Background: Due to Arunachal Pradesh’s peculiar topography and difficult terrain, there is widely dispersed settlement pattern of the population that applies to both rural and urban areas. The rural population constitutes around 80% of the population. There are 16 Districts and around 3862 villages in the state. The health sector is weak in different remote inaccessible areas in almost all districts of the state. Availability of manpower in such areas is a big challenge. Common people had been shouldering the burden of poor healthcare delivery system.Action: Government of Arunachal Pradesh handed over the management of 16 PHCs of 16 districts to 4 non-profit organisations: Karuna Trust (Karnataka), Voluntary Health Association of India (VHAI), New Delhi; Prayas Juvenile Aid Centre (JAC) Society (New Delhi) and Future Generations (Arunachal Pradesh). Name of NGO Name of PHC District No. of PHCs Karuna Trust Bameng East Kameng 9 Mengio Papum Pare Sangram Kurung Kumey Jengging Upper Siang Dambuk Lower Dibang Valley Etalin Dibang Valley Walong Anjaw Khimyong Changlang Wakka Tirap Voluntary Health Association of India Lumla Tawang 5 Thrizino West Kameng Nacho Upper Subansiri Deed Neelam Lower Subansiri Gensi West Siang Prayas Juvenile Aid Centre (JAC) Society Wakro Lohit 1 Future Generations Arunachal (FGA) Sille East Siang 1 In January 2006, a pilot case study for three years was conducted. A State level Steering Committee on PPP Project was formed to monitor the progress of this pilot. Results: Following the implementation of PPP programme in the state, the manpower position tremendously increased from the past position when the State Government ran the health facilities. The accessibility of the health services has increased from near nil to full accessibility in 16 selected PHC areas. The details of this change is as follows: Designation Before PPP implementation After PPP implementation Medical Officer 14 32 SN 5 32 ANM 16 128 HA 9 32 Lab Technician 4 16 Pharmacist 10 16 Driver 9 16 Grade IV 63 64 LHV 0 16 Total 130 352 The main services that are delivered by the NGOs are as follows: 1. 24 hours Emergency / Casualty Services. 2. OPD service for six days per week 3. 5 to 10 bed inpatient facility. 4. 24 hrs labour Room and Essential Obstetrics facility. 5. Minor Operation Theatre facility 6. 24 hrs Ambulance facility 7. Make available essential medicines 8. Participation in and implementation of National 9. Programmes of Health & Family Welfare including the National Rural Health Mission. 10. Outreach / IEC activities by conducting medical camps. This has led to an increase in the availability and utilisation of the health care services by the people. As this is a fairly recent initiative quantitative evaluation is yet to be recorded.

Cost Estimated around INR 23 lakhs per year per PHC and 10% contribution (whatever the amount) from the NGO with which the PHC is.
Place 16 PHCs in Arunachal Pradesh.
Time Frame One year to review & decide the NGOs to be involved and allocate the PHCs
Advantages

1. Availability of manpower under management control of NGOs, regular service delivery to the community. 2. Opportunities of the project can be counted, as sizable populations are becoming the beneficiaries of the project. 3. Community is now gradually becoming aware about modern health facilities and also started adopting preventive measures for healthy life. 4. Availability of ASHA (Accredited Social Health Activists) is crucial for effective coverage of deliveries, institutional/home and immunisation especially in remote areas. 5. The fusion of management skill of NGOs and reformed work frame of RKS can turn a PHC as a model PHC. 6. Demand of quality health care has increased as the awareness levels have also improved.

Challanges

1. Population density: average population density per square kilometre is 13 people. 2. Communication problems: Due to difficult geographical terrain, communication with the remote and distant villages is a major challenge.

Prerequisites

The national NGOs should have experience in managing health care delivery system

Who needs to be consulted

PPP program managers of NGOs, Nodal Officer (PPP) of Govt. of Arunachal Pradesh.

Risks

Sustainability

Cost benefit analysis is required before deciding

Chances of Replication

There is chance of replication to more PHCs and even to few CHCs in Arunachal Pradesh. Chances of replication are there in hilly states of India.

Comments

Securing ownership by all stakeholder (State Govt, NGOs, Local Community) will be the key to the success of this PPP.

Contact

Submitted By

Dr. P. J. Sarma, State Facilitator (NRHM) Manisha Ghose, Research Consultant, CBHI Paromita Ukil, Research Consultant, ECTA January 2007

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