Objective="Facilitate formulation, implementation and monitoring of health reforms in Chhattisgarh."
Details for Reform Option "State Health Resource Centre, Chhattisgarh."
Carving out the new state of Chhattisgarh in 2000 from Madhya Pradesh led to splitting up of resources between the two states including human resources. During this transition a considerable gap was felt in terms of states’ capacity for planning, implementing and monitoring health reforms. In order to ease the situation, the state envisaged a State Health Resource Centre (SHRC) that would give technical inputs to the State on structural changes in the health sector so that the health services became more accessible. The SHRC was also needed to make the health programmes more community centered, a key element of the health sector reform agenda. Parallel to setting up of the SHRC, a state advisory committee was also formed.
Initially, a memorandum of understanding (MoU) was signed between the existing Reproductive and Child Health (RCH) society and Action Aid, India (AAI) in March 2002 for a period of three years. At the end of the MoU period the performance of SHRC was reviewed and in March 2005 the State Health Society signed a contract with SHRC, now registered as a society for next three years.
A management team and operational guidelines for starting the resource centre was put in place by Action Aid, India at the start. The management team included the Director and three programme coordinators, who were supported by an accountant and two office assistants. Currently, the SHRC has 11 regular staff—the director, three programme coordinators, three programme associates, two accounts staff and two office assistants.
The following manuals were developed for smooth functioning of SHRC:
•Accounting and auditing standard
•Human resource policies and procedure manuals
•Gender policy manual
•Terms of reference for consultancy contract with individuals and institutions
A workshop was organised to identify the initial work domain of SHRC jointly by Government of Chhattisgarh (GoC) and Action Aid, India in consultation with leading health activists and NGOs working in Chhattisgarh as well as in other parts of India. The workshop identified 15 reform areas clearly specifying the role of SHRC.
Assisted formulation of health sector reform programme.
SHRC developed the training modules and programme design for Mitanin programme, involving a community-based health activist. It formed a state training team, helped evolve an operational strategy and has been providing monitoring and evaluation support for the Mitanin programme. (See PROD entry no. 49.) Today, the Mitanin programme has reached all the 54,000 hamlets in the state; it serves as a precursor to the Accredited Social Health Activist (ASHA), a village-based health worker, who is a key component of the National Health Rural Mission (NHRM).
The SHRC has also done a series of studies, some of which are:
1. Human Resource Development Policy
2. Behavioural Change Communication Implementation Framework
3. Integrated State Health and Population Policy
4. Draft Drug Policy
5. Standard Treatment Guidelines
6. State Drug Formulary
7. Essential Drug List
These have led to a number of policy changes in workforce management, human resource development and rationalisation of services. The SHRC has fostered partnership between various stakeholders, including government and non-government organisations, panchyati raj institutions, public health system and development partners in designing and implementing community based interventions and other projects.
During the last three years, SHRC also provided technical support to the government in formulating the RCH-2 programme and in negotiating new projects with Government of India and development partners.
Operational cost of SHRC, including salaries, workshops, office equipment, travel and contingency, is given below:
First phase budget covering a period of three years: INR. 82, 75,756.
The current annual budget is INR 40 lakhs (4 million).
State Health Training Centre Campus, Kalibari, Raipur.
4 months. SHRC was established in March 2002, but it became fully functional around October 2002.
Think tank: Provides the state with requisite support to develop programmes.
Pooling strengths: The institution fosters unique civil society partnership that brings together special capacities from diverse groups to provide additional technical support to the directorate. Also, brings special capacities needed for a large community participation and social mobilisation programme.
Building hype: Considerable advocacy and synergy for health sector reforms.
Autonomy: SHRC needs to ensure autonomy so that it can effectively function as advisor for health initiatives.
Implementation: Pursue the goals of health sector reforms by taking into account the political environment and constant change of leadership at different levels.
Orientation: The line department staff at different levels needs orientation for implementing the reform programme.
Ownership: SHRC does not belong to the system and therefore its recommendations may not be followed by the government.
Capacity building in SHRC team.
Who needs to be consulted
Secretary, Health and Family Welfare, GoC.
Directorate of Health Services, GoC.
Good as both the government and non-government sector depend on it for vital support for implementing health reforms.
Chances of Replication
NHRM has approved a proposal to establish an SHRC in the focused states and also a National Health Resource Centre. (Core document National Implementation framework on NRHM).
The SHRC can rope in civil societies and assign them a larger role to improve delivery of health care services.
Dr. Nandini Roy, HS-PROD Consultant, NIMS, May, 2006.