Contracting-out of Reproductive and Child Health (RCH) Services through Mother NGO Scheme in India: Experiences and Implications

Partnership with NGOs in delivering and provision of Reproductive and Child Health (RCH) services through mother NGO (MNGO) in the un-served and under-served regions is one of the important initiatives in India. The scheme involves large number of contracts between government and the NGOs. As of April 2006, 215 MNGOs were working in 324 districts of the country. In addition to this there are about 3 to 4 Field NGOs attached with each MNGO in a district. This paper discusses this scheme with an objective to understand the make up of the partnership and the development of management capacity in the system. MNGO scheme is a central sponsored scheme. This scheme faces management challenge to implement it in all states in India. Further, the case study of three states presented in this paper suggests that this challenge emanates several factors. Inter alia, these include delay and uncertainty of funding and contract renewal, lack of partnership orientation in the scheme, lack of trust among the key stakeholders, capacity constrain in the district and state health system, weak monitoring system, procedural delays and multiple points of authority and reporting relationships. It is also observed that the capacity of field NGOs to deliver in the programme is constrained due to non-availability of financial and human resources. The scheme demands a strong leadership at local levels and ownership from the state health system. This can be achieved through effective decentralisation, flexibility in decision-making and creating adequate accountability systems. Regional Resource Centres has to play an important role in coordination between state/district RCH society and the NGOs and strengthening their capacities. The central government instead of focusing on micro-management of the scheme at state level should focus on developing and strengthening the enabling environment and capacity of various stakeholders to implement the scheme. Also, they need to address various systemic issues including development of accountable and performance oriented system, ensuring financial autonomy and decentralisation, delegation of authority, building trust and accountability in the system, effective integration, continuity of the scheme and fostering true sense of partnership between the state and non-state sector.

Treating HIV/AIDS patients in India with antiretroviral therapy: a management challenge

India stands at a critical junction of HIV pandemic. Controlling spread of HIV is critical. Ignoring this will lead millions of Indians in grip of this pandemic. Ever since HIV/AIDS was acknowledged as a problem, the strategies to address the issue have focused on prevention, treatment and research. This paper discusses the treatment aspect. With currently available antiretroviral agents, eradication of HIV infection is not likely. The aim of treatment is thus to prolong and improve the quality of life by maintaining maximal suppression of virus replication for as long as possible. Brazil has shown how to implement antiretroviral therapy programme. India has embarked upon an ambitious programme to introduce antiretroviral therapy in six high prevalent states and the national capital. The paper discusses the technical, management and financing challenge in implementing this intervention.

Provision of Reproductive Health Services to Urban Poor through Public-Private Partnerships: The Case of Andhra Pradesh Urban Health Care Project

Andhra Pradesh had initiated the Urban Slum Health Care Project to provide basic primary healthcare and family welfare services to urban poor living in slums in 2002. As of now, the project has established 192 Urban Health Centres (UHCs) in 74 municipalities of the state through contracting-out process to the NGOs. These UHCs cover population of about 3 million. State government has played pivotal role in creating capacities to monitor and supervise the functioning of these UHCs. This project was started with the World Bank support and the state has effectively managed the transition from a donor-funded project to government programme and at the same achieving demonstrable impact on health status among its target population. The scheme ensures people’s participation in management of the UHCs and placing the power for identifying the health priority in the hand of the community. The case study identifies emerging challenges in the scheme implementation relating to (a) involvement of NGOs as partners in service delivery, (b) financing and financial management system, and (c) need to reposition the UHCs in view of changing epidemiological scenario. Some of the areas needing attention to address the challenge include: need to refine the service mix to better respond to the health needs of the population served; evolving a financial management practices to increase efficiency in disbursement; motivating NGOs to actively participate in the scheme; developing management capacity and competencies of both partners; and repositioning relationship between the state and non-state actors away from a contractual basis to an effective partnership.

Maternal Health Financing – Issues and Options: A Study of Chiranjeevi Yojana in Gujarat

Government of Gujarat announced a “Chiranjeevi Yojana” in April 2005. The objective of this scheme is to encourage private medical practitioners to provide maternity health services in remote areas which record the highest infant and maternal mortality and thereby improve the institutional delivery rate in Gujarat. The scheme was finally launched as a one year pilot project in December 2005 in five districts viz., Banaskantha, Dahod, Kutch, Panchmahal, and Sabarkantha. The private empanelled providers are reimbursed on capitation payment basis according to which they are reimbursed at a fixed rate for deliveries carried out by them. The payments are made for a batch of 100 deliveries. This is expected to take care of case-mix differences (i.e., normal or complicated deliveries) and help the providers to keep the costs below the reimbursed amounts. The scheme proposes to use a voucher system to target the people living below poverty line. The objective of this paper is to document the experience in implementing this scheme and discuss the issues in up-scaling it further.

Third Party Administrators and Health Insurance in India: Perception of Providers and Policyholders

The advent of Third Party Administrators (TPAs) is expected to play an important role in health insurance market in ensuring better services to policyholders. In addition, their presence is expected to address the cost and quality issues of the vast private healthcare providers in India. However, the insurance sector still faces challenge of effectively institutionalising the services of the TPA. A lot needs to be done in this direction. Towards this the present paper describes the findings of a survey study, which was carried out with the objective to ascertain the experiences and challenges perceived by hospitals and policyholders in availing services of TPA in Ahmedabad, Gujarat. The major findings from the study are: (i) low awareness among policyholders about the existence of TPA; policyholders mostly rely on their insurance agents; (ii) policyholders have very little knowledge about the empanelled hospitals for cashless hospitalisation services; (iii) TPAs insist on standardisation of fee structure of medical services/procedures across providers; (iv) healthcare providers do experience substantial delays in settling of their claims by the TPAs; (v) hospital administrators perceive significant burden in terms of effort and expenditure after introduction of TPA and (vi) no substantial increase in patient turnover after empanelling with TPAs. However, there is an indication that hospital administrators foresee business potential in their association with TPA in the long-run. There is a clear indication from the study that the regulatory body need to focus on developing mechanisms, which would help TPAs to strengthen their human capital and ensure smooth delivery of TPA services in emerging health insurance market.

Directions for Reforms in the Health Sector: Reflections from a State in a Developing Country

Meeting the health care needs of population goes beyond mere budget allocations. The organisation of programmes and commitment of people working in the health sector has significant bearing on sector performance and its reform process. The reform process, among other things, intrinsically makes some fundamental assumptions: high organisational commitment of health care providers, high professional commitment of health care providers and adequate skills of health care providers. The current paper attempts to analyse the HR practices in Madhya Pradesh and its implications on commitment of the health officials. The findings of the study indicate that district health officials do not share strong emotional bond with the department which is likely to affect their willingness to take initiative. The findings suggest the need to consult senior doctors in staffing decisions in order to develop a sense of belongingness in the mind of the health officials. The study suggests investing in development of multiple strategies for the growth and career development of health professionals. The study also advocates the need for intense socialisation among health professionals to facilitate the effective implementation of reforms. Finally the study advocates the need to develop informal channels of communications and networking among various health providers.

Human Resource Practices and Commitment of Senior Officials in Health System: Reflections from a Progressive State in a Developing Economy

It is widely recognised that the commitment and competencies of people working in the health sector has significant bearing on sector performance and its reform process. The current paper attempts to analyse the commitment of the health officials and its implications for HR practices in Maharashtra. The study suggests that the district health officials do not share a strong emotional bond with their department. The state needs to reform its Human Resource Management practices to effectively strengthen the functioning of the health system. The study shows that there is a need to involve senior doctors in staffing decisions that affect their work units. There is a need to develop a proper tribal/remote area posting plan for the health officials, failing which creates a sense of frustration among the health officials. The study also suggests investing in development of multiple strategies for the growth and career development of health professionals. Finally the study advocates the need to develop areas of public private partnership and community participation in making the public health programme successful.

Spin-phonon coupling suppressing the structural transition in perovskite-like oxide

Multifunctional properties in quantum systems require the interaction between different degrees of freedom. As such, spin-phonon coupling emerges as an ideal mechanism to tune multiferroicity, magnetism, and magnetoelectric response. In this letter, we demonstrate and explain, based on theoretical and experimental analyses, an unusual manifestation of spin-phonon coupling, i.e., prevention of a ferroelastic structural transition, and locking of high-temperature R-3m phase in a magnetically frustrated perovskite-like oxide Ba2NiTeO6. We present Ba2NiTeO6 as a prototype example among its family where long-range antiferromagnetic structure couples with a low-frequency Eg mode (at 55 cm-1) that exhibits a large anharmonicity. Our findings establish that spin-phonon coupling clearly suppresses the phonon anharmonicity preventing the structural phase transition from the R-3m to the C2/m phase in Ba2NiTeO6