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Financial autonomy to hospital through Chikitsa Prabandhan Samiti, Uttarakhand
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Subject Area="Management structures and systems." Objective="Decentralisation."
Details for Reform Option "Financial autonomy to hospital through Chikitsa Prabandhan Samiti, Uttarakhand"
Summary

Background: Decisions in the better functioning of hospital as well as for welfare of community were delayed due to lack of financial power to the hospital management. Therefore, government of Uttarakhand promulgated the concept of hospital autonomy through government order in March 2003. Activities: In order to provide greater flexibility to the hospital management in solving facility level problems through local level decision-making Chikitsa Prabandhan Samiti (CPS) was constituted in all 29 major hospitals (district hospitals & Few Community Health Centres) in Uttarakhand. CPS has been constituted at two levels. One is Executive Committee (EC) under the chairmanship of District Magistrate (DM). The Chief Medical Superintendent (CMS) functions as the secretary of the CPS of Executive Committee as Co Chair Person and of Management Committee as Chairperson. The second level is management or functional committee headed by CMS. CMS is made responsible for utilization of user charges to improve and smooth functioning of the hospital. The EC has been empowered to review the financial account at least once in a financial year, review income & expenditure statements and approve the budget for the next year. It also have powers to appoint chartered accountant and can constitute sub committees for specific purposes such as new construction & commercial use of land. Results:Though evaluation of the functioning of CPS has not been conducted but it has definitely given financial flexibility to the facility manager and has increased sense of ownership among them.Performance monitoring of the CPS need to be evaluated in due course of time to improve its functioning.

Cost Need to provide government order and clear-cut guidelines to take decisions. Resources are generated locally through user charge and community participation
Place 29 major hospitals in the State of Uttarakhand. List of hospital is given under reference section.
Time Frame Approximately one year.
Advantages

Decentralised decision-making: Financial power at the hospital facility level has given decision-making authority up to a limit. Efficiency: Quick decision at the facility level has inbuilt arm to improve efficiency.

Challanges

Accountability: In terms of expenditure for the income generated, accountability can be checked through financial audit.

Prerequisites

Government order.

Who needs to be consulted

State government

Risks

Sustainability

Samiti formed at the hospital level are self-sustainable due to income generated at the local level.

Chances of Replication

Good, as has been replicated in other state also successfully.

Comments

Initiative has received a welcome note from the providers as well as from public but need a continuous quality circle and monitoring cell to improve client satisfaction.

Contact

Submitted By

Dr. Anuradha Davey, Research Consultant, NIMS, February 2006.

Status Active
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