|
Given that the most sizeable progress in
reducing infant mortality and malnutrition – through immediate
initiation and exclusive breastfeeding, hygiene practices, home-based
newborn care, complementary feeding, and prompt use of ORS in diarrhoeal
episodes – can be achieved at the community-level, increasing
innovation and investment in developing and implementing scaled
efforts in this direction are vital. In addition, CHWs, AWWs and
community facilitators also play important roles in increasing community-level
demand for health services, improving timely and appropriate health
seeking behaviour, and facilitating access to essential services,
such as immunization, family planning services, antenatal care,
institutional delivery and emergency obstetric care, and necessary
medical and therapeutic attention for sick and severely malnourished
children. Strengthening the provision of these outreach and referral
services through appropriately trained and motivated paramedical
and medical functionaries and a network of accessible and adequately
equipped health facilities is therefore a clear priority.
The question confronting health systems in India and internationally
is how best to reform, revitalise and resource primary health systems
to deliver different levels of service, ensuring coverage, access,
effectiveness, and equity. In India, this is in the current context
of very weak public primary health systems across most of the country,
with the government’s network of sub-centres, primary health
centres (PHCs) and community health centres (CHCs) confronting large
gaps in infrastructure, human resources, organizational structures,
governance and management. In such a scenario, the need is to conceptualise
and implement cohesive health system strengthening programmes at
the state-level and within districts – with a mix of nurses,
paramedical providers and medical doctors, a rationalized network
of facilities, decentralised planning and management, well-regulated
engagement with the private sector and appropriate financing mechanisms
that protect the poor.
Drawing on the key strategies adopted by the NRHM, ICCHN has identified
the following key areas for context-specific action-research and
resource partnerships:
-
Increasing investments in nurses and paramedics and developing models of multi-skilling to maximize existing resources.
-
Building capacities for district planning and engaging health functionaries in creating viable contextual solutions.
-
Developing streamlined and responsive Management Information Systems (MIS) at different levels
-
Strengthening community-based monitoring and accountability mechanisms.
-
Evaluating different financing and partnership models for provision of services, especially in underserved areas.
-
Strengthening primary health services and referral systems in urban areas.
|
