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Social Equity_ Access and Gender - Ministry of Health and Family

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Social Equity_ Access and Gender - Ministry of Health and Family Powered By Docstoc
					Workshop on Quality, Equity & Accountability
       National Rural Health Mission
             Madhya Pradesh
             6 September 2009
              Bhubaneshwar
What good does it serve to treat people’s illnesses
and…………… send them right back to the conditions which
made them sick in the first place
Why Health Equity?

 ………………..Poor health is not confined to those worst
 off. In countries at all levels of income, health and illness
 follow a social gradient: the lower the socio-economic
 position, the worse the health……It doesn’t have to be this
 way and it isn’t right that should be like this. Where
 systematic differences in health are judged to be avoidable by
 reasonable action they are, quite simply, unfair…….Putting
 right these inequities, between and within countries-is a
 matter of social justice…….an ethical
 imperative……….Social injustice is killing people on a
 grand scale………………..
Some Definitions:


 “Inequities are differences in health that are
  unnecessary, avoidable, unfair and unjust.” –
  Margaret Whitehead
 “Equal opportunity of use of health services for
  equal need” – Newbrander and Collins
 NRHM provides the oppurtunity:
 Exercising Principle of Subsidiarity
 Putting Money where the mouth is:
   Financing Innovations
   Evaluations in the most challenging locales
Service Provision Challenges in Madhya Pradesh

 Distance: 3.3kms/health worker
 Road penetration of MP: 52/100 km2 Vs All India Av
  75/100 km2
 Scarcity of Qualified HR
 Infrastructure (Bed strength has been increased by 8000)
  since launch of NRHM
 Tribal Areas
 Data Dissagregation
 Planning Capacity at district and sub-district level
 Convergence with determinant departments
 Lack of Awareness-Real Access Barrier
Though GoMP has initaited specialised
programmes for specific vulnerable groups, we
do not believe in:

 Categories of Inequity
 Creating competition between the
  vulnerable
 Gate-keeping criteria which results in
  exclusion
GoMP responses:
 Deen Dayal Mobile Health Clinic: 91 blocks (all
 tribal blocks)
     Package of services
     Malaria Diagnostics
     Sputum test for TB
     Health IEC
     27 difficult blocks had no response to tenders

 Janani Express: Emergency Transport: 298/313
 blocks running in all 50 districts
   Referral Transport for pregnant women
   Referral Transport for malnourished children
GoMP responses continued…
 Deen Dayal Antyodaya Upchaar Yojana: Family
 Health Benefit Scheme to the cap of Rs
 20,000/family for indoor treatment:
     Reducing Out of pocket expenditure
     Cross-subsidizing diagnostics’

 State Illness Assistance Fund:
   Free medical treatment for 13 major illnesses requiring surgical
    procedures
   Hospitalisation to the cap of Rs 150,000
GoMP responses contd…..
 Data disagregation of JSY beneficiaries initiated:
  SC/ST and BPL
 State PIP and DHAP planning has centre-staged
  equity into the planning (facilitation guidelines
  formalised)
 ANMTCs’ capacity and graduates increased
 HR deployment in difficult areas: Building
  consensus on definition
GoMP responses:
 TAST supported composite revised health index
 Weighted Composite of HDI + JSK + Sex ratio + Tribal and
  SC population + Malnutrition prevalence + Population
  density
 10 most marginalized districts identified for focused action
  to strengthen the systems
 10/30 CEmONCs and 76/94 BEmONCs functional.
     Mapping of Districts as per Selected parameters


S. District    JSK    depriv   Tribal     SC     Popul     Sex    Malnu Total
N Name                ation    Popul    Popula   ation    Ratio   trition Weig
o                     Index    ation     tion    Densit                   htag
                                                   y                       e
1.   Jhabua   28.84   12.04    10.42    0.23     0.00     0.07    6.77    58.36
2. Dindori    26.56   8.70     7.74     0.47     0.03     0.05    11.09   54.63
3. Sidhi      29.85   8.22     3.59     0.95     0.01     0.34    11.24   54.19
4. Panna      29.09   10.42    1.85     1.60     0.02     0.50    9.93    53.40
5. Badwani    23.17   11.48    8.04     0.51     0.00     0.15    9.04    52.38
District in relation to different parameters
                                                                                                              Jansankhya Sthirta Kosh       30
                                                                                                              Deprivation index             20
    Districts with High Weightage Scale                                                                       Malnutrition                  20
    Districts with Low Weightage Scale                                    B HD                                Tribal Population             12
                                                             MRN
                                                                                                              SC Population                 8
                                                                   GL R                                       Population Density            5
                                                                          DTA                                 Sex Ratio                     5
                                             S OP
                                                          Shivpuri

                                                                            Tikamgarh
                                                                                    Chattarpur                                RWA
            Neemuch                                          AKN
                                                    GUN
                                                                                                  Panna        S TN
                                                                                                                                    Sidhi
                 MDS
                                S JP     RJ G               VDS           S AG          DMH
                                                                                                       K TN      Umaria S DL
          R TM         Ujjain                        Bhopal
                                                                                                J BP
                                                                   RS N                                         Dindori
                                             S heopur                                                                         ANP
                                                                                 NS P
Jhabua                  Indore
            DHR                        DWS                 Hosangabad                                     MDL
                                                                                         S NI
                                                HR D
                                                                           C DW
         Barwani       KR G             KND                                                            B LG
                                                            B TL

                                 B HP
  Accessibility Challenge - Janani Express Yojana
             Year         Physical Target         Physical Achieved
         2008-09            313 Blocks           298 Blocks With 3 Call
                                                        centers

         2009-10               313               313 Blocks with 10 Call
                                                   centers (43.45% of
                                                       ID)July 09
     Janani                     Janani Express
    Express ,                        , 30
       1




Institutio
    nal
                                                                Institutional
 delivery                                                      delivery, 66.33
  , 45.2

                2006-07
                                                         2008-09
  Only in 10 Districts
CHALLENGES
 Acute Malnutrition prevalence
 Domestic Violence Prevalence rates 45.8/37.2
 Lack of convergence amongst determinant departments
 Inadequate water sanitation coverage esp sanitation
 Citizens’ Engagement in the Sector
NRC – Institution for Management of
            SAM children
      150 NRCs – 2000 Beds – 40,000 SAM children Treated


          No. of children cured in NRCs




Total NRCs          No. of NRCs in        No. of NRCs in SC Districts(9)
                   Tribal Blocks (89)
   150                    44                           36
         More than 50% NRCs in vulnerable populations
   Malnourished Children Treated at NRCs

Gender wise distribution



      52%
                 Boys

      Girl
                 48%
                                   SNCU


Sick babies being treated at SNCU




  20 bedded level II Unit at 13 districts hospital
                                   Sick New Born Care Units

                                                                                                              ST Dominated
                                                         MR N          B HD
                                                                                                              SC Dominated
                                                                GL R
                                                                       DTA
                                                                                                               General
                                          S OP

                                                         S VP


                                                                             TK M     C TP                             R WA
         N MC                                            AK N
                                                 G UN
                                                                                                P AN       S TN
                                                                                            G
                                                                                                                              S DH
              MD S
                             SJP      RJG                VD S           SA           D MH
                                                                                                    K TN      U MR   S DL
       R TM          UJ N                         B PL
                                                                                              JBP
                                                                RSN
                                          S HE                                                                         ANP
                                                                              NS P                             DDR
JBA                   ID R
        DHR                        D WS                                                                MD L
                                                          HS B
                                                                                       S NI
                                             HR D
                                                                        C DW
      BRW            KRG             K ND                                                           BLG
                                                         B TL

                              B HP
Way Forward
 Convergence of Grassroots Committees: Swastha Gram
  Samiti with the mandate of health and health-determinants
  issues
   Investing in their capacity building for informed engagement:
    10,60,000 absolute number of trainees
 Nutrition Rehabilitation Centres:
   Convergence of Health and Nutrition line Depts and frontline
    workers
   Monetization of access costs to encourage uptake
 Enabling System Responsiveness: Taking grievance redressal
  to district and sub-district levels
 Service Provider Attitude: Encouraging Empathy in the
  rubric of Medical Ethics
Public Policy is an inexact science
 Citizens engagement in the sector
   Community Monitoring
   Greivance redressal at district/sub-district levels
 Chronology of opening the sector: Tendering & contract
  management capacity
 Reclaiming RKS for patient welfare
 Billing & Outcomes’ transparency
 Communicating health entitlements
 Service Provider empathy: Not from morality grounds
  but from treatment efficiency & litigation loads’ issues
 Evaluation of schemes in the most challenging locales
Thank You

				
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