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Decentralised Management of Primary Level Health Facilities, Punjab
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Subject Area="Management structures and systems." Objective="Effective decentralised management of services."
Details for Reform Option "Decentralised Management of Primary Level Health Facilities, Punjab"
Summary

Background: Punjab rural health facility was facing operational difficulty due to the fact that day to day complexity were not managed by the State government as health facilities are scattered in location and logistics and medicine to run the health facilities were not available on time. Realising the operational difficulties to manage the health facilities, it was decided by the Punjab Health Service Commission in June 2006 that management of the Subsidiary Health Centres (SHC) would be decentralise to the Zila Parishad (ZP), district level body of Panchayat Raj Institution (PRI). Action: Contractual appointment: On lump sum package of INR 0.36 million per annum, Service Provider (SP)-doctor will be contracted in each SHC. SP (doctor) engages the services of the para medical person to assist him for proper delivery of the national health programmes. Package includes INR 30000 per month. Out of the package the doctor also meet the recurring expenses of electricity bill, water supply, sanitation services and maintenance of building and furniture’s etc. Salary of one paramedics and one sweeper-cum-attendant that may be around INR 5000 pm and electricity bill is in between INR 500-1000 pm. The balance amount will be retained by the SP (doctor) as his/her service charges. Performance of the SP(doctor) is reviewed on the basis of set benchmarks. Based on that contract is renewed for every three year. (For the benchmarks of SP in rural area: please see PROD entry no 192 on accountability of performance of rural doctors by panchayat raj institution, Punjab). Availability of medicines: Based in the list, finalised by expert committee of the doctors, vital and essential drugs are made available in the SHCs. Special cell is created in the ZP which coordinate the placement of demand and indents for the drugs to PHSC. Whereas PHSC has a role for calling the tenders and distribution of the medicine on the basis of indents placed by ZP. Dispensing of the medicine at SHC is kept under the control of Gram Panchayat (GP) of that ZP. GP will issue the medicine to the doctor concerned on weekly / fortnightly basis and record is signed by Sarpanch and one of the Panchayat member jointly. Finance department of State Government also provide INR 7500 per month to each SHC for the purchase of medicines. This is the value of basic medicines which will be purchased by the Punjab Health System Corporation and given to the service provider through the Civil Surgeon of the district. A provision of INR 90 million for the current financial year has been made by the Finance Department of the State Government. Results: The scheme has become fully operational with effect from Ist June 2006. The recruitment of SPs (doctor) has been made and 90 % of them have joined for their work. The out door patient attendance has shown positive increase. Earlier it used to be 15-20 per day now it is over 100. This has happened partly due to availability of medicine which earlier was not available.

Cost The Break up of the budget is as under:Package cost of Service Providers @ INR 3.60 lakhs per annum for 1310 SPs; total INR 471.60 million. Medicine cost @ INR 7500 pm for 1310 SPs; total INR 117.90 million for one year. One time Repair and maintenance of 1310 health institutions INR 150million
Place 1301 subsidiary health centres in Punjab. These are located in rural areas including border and remote locations.
Time Frame Six months.
Advantages

Decentralised management: Management at the district level provide a better control on the operational aspect of the health facilities. Functional: Availability of manpower and medicine at the health facilities make then functional for the benefit of the patients.

Challanges

Political element: Direct control of the PRI in the management of health facilities has increased chance of their favouritism in the recruitment process as well as in the delivery of services.

Prerequisites

Involvement of PRI.

Who needs to be consulted

PRI membersState government.

Risks

Sustainability

Sustainability depends on the capacity of the PRI and management ability to make health facilities functional.

Chances of Replication

In remote areas where day-to-day monitoring of the health care delivery services is difficult, involvement of PRI can facilitate functioning of the health facilities.

Comments

Though involvement of PRI in the management of health facilities is an encouraging step in the process of decentralisation, but care need to be taken for mixing of political influence in the health care delivery.

Contact

Submitted By

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

Status Active
Reference Files
Existing model of Health Care Delivery, Punjab.doc
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