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 District
health plans have assumed a new centrality and urgency in the current
context of the National Rural Health Mission, which includes decentralisation
of health planning as a core strategy. The rationale for having
district health plans comes from the concept of addressing local
needs and local specificities of health and nutrition in a district.
Districts vary widely in their specific population needs and even
more in innovations for intervention and resources available. Strategies
therefore, have to be district specific, not only because health
needs vary, but because perceptions of people and capacities to
conduct programmes also vary. In a centrally designed and driven
plan there is little room for such adaptation and contextualisation,
hence district planning becomes critical. Other reasons for focusing
on district health planning are:
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Enabling decentralisation
and community participation. Community participation needs
to be seen as an important aspect for decision making in public
health spheres. District planning and even other more local
levels of planning, such as village level planning and block
level planning give the scope to do so.
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Convergence.
One major area which requires reform and a critical thrust is
the coordination between various departments contributing to
health. Currently they operate as distinct vectoral programmes,
delinked from each other, leading to wastage of resources, duplication
and various inefficient and suboptimal outcomes. There is a
need to have effective coordination between all health related
sectors like water and sanitation, nutrition and food security,
education, environment etc. to ensure health outcomes and for
close integration between the management of different health
facilities. Planning at the district level makes use of the
resources made available from numerous “vertical”
programmes into a single “horizontally integrated”
district plan.
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Improving accountability
of health systems: By clearly stating what the problems
and goals of the health sector are at the local level, the district
plan brings the whole process of health sector functioning into
public scrutiny.
Most importantly, it is at the district
level that large numbers of individuals, both within government
agencies and NGOs are currently working close to the ground and
where individual initiative in planning, administration, supervision
and service delivery can make significant impact even in a larger
context of institutional constraint. It is also precisely at this
level that a lack of technical knowledge and skills and a supportive
network of similarly motivated in individuals impede functionaries
from making improvements within their control and dishearten them
from pursuing effective strategies. Developing ways to reach out
to these motivated but often isolated individuals, whether they
are district programme managers, medical officers, NGO workers,
or ICDS Project Officers is a key challenge. This becomes especially
complex when one considers the need for strategies that are at
once linguistically and analytically accessible, professionally
actionable, and ultimately viable given the time constraints within
which district and block level functionaries operate.
The Public Health Resource Network
(PHRN) is an effort to interact with and empower district functionaries
both from within the government health system and civil society
to meaningfully participate in and strengthen district planning
processes and outcomes. ICCHN is supporting this initiative, led
by the State Health Resource Centre (SHRC), Chhattisgarh as a
partnership programme of a number of government and non-governmental
organisations and resource centres.
Structured as an innovative distance-learning
course, the PHRN is aimed at building in-service and field-based
capacity at the decentralised levels of districts and blocks in
the area of public health planning, management and implementation.
Spread over 12 to 18 months of course work and contact programmes,
the PHRN comprises of 14 core modules and 5 optional courses.
The themes cover a wide range of issues to equip district level
personnel to respond to the urgent need for addressing various
aspects of decentralised health planning. The technical content
and contact programmes have been specifically developed to build
perspectives and technical knowledge of participants and provide
them with a variety of options that can be immediately put into
practice within their work environments and everyday roles. The
course covers the following main themes:
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QUARTER 1 |
QUARTER
2 |
- Introduction to Public Health Systems
- Reduction of Maternal Mortality
- Accelerating Child Survival
- Community Participation and Community
Health Workers
- Behaviour Change Communication and
Training
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- Mainstreaming Women's Health Concerns
- Community Participation
- Disease Control Programmes
- Convergence
- District Health Planning
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QUARTER 3 |
QUARTER 4 |
- District Health Management
- Public-Private Partnership
- Legal Framework of Health Care
- Issues of Governance and Health Sector Reform
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Optional
Courses
- Tribal Health
- Urban Health
- Hospital Administration
- Non-Communicable Diseases and Mental Health
- Disaster and Epidemic Management
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The programme is concerned with
building a vibrant network of district resource persons, with the
hope of creating greater energy and multiple points from which to
leverage change. Currently, the PHRN has been launched in four states
- Chhattisgarh, Jharkhand, Bihar and Orissa in its first phase,
and includes over 400 participants with diverse backgrounds.
The network has received valuable support from the National Rural
Health Mission, the National Institute of Health and Family Welfare,
the state governments of the four focus states, and civil society
organisations.
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