Decentralisation

Experiences from Haryana

HaryanaHaryana Profile

Population : 2.1crores

Districts: 20

Blocks: 116

Background

Health Sector Reforms: Need of the day

WHY?

Rising cost in health care

Rising expectations of community

Limited capacity to meet out of pocket expense.

Decentralisation Why Reform Agenda?

Increased local ownership

Improved community participation and responsiveness to local needs

Strengthening integration of services at local levels

Enhancing the streamlining of services

Promoting innovation and experimentation

Decentralisation

Defined as the transfer of authority and responsibility for

public functions from the Central Government to:

peripheral departments within the same agency,

intermediate and local government,

quasi-independent government organizations.

Depending on the types and scope of functions

transferred, as well as the level or agency to which the

functions are transferred, different political, fiscal and

administrative arrangements developed.

Decentralization and delegation of powers depend upon

the political will.

Decentralisation- HaryanaStructural changes

Constitution of

SCOVA – 1997

merged societies and Swasthya Kalyan Samities in 3 pilot districts- initiative under SIP: 2001-2002

merged Society at State and in all the districts of State: 2004

SKS in all the health institutions (PHC and above) 2004

Delegation of powers financial and administrative- 1997

Reviewed, revised and implemented – 2005

Explains the time required

Structures

State Health Society

District Health and Family Welfare Societies (DHFWS).

Swasthya Kalyan Samities (SKS).

Program Committees

SubCommittees

Functional ArrangementsState Health

Society

SubCommittees

Purchase/ Procurement

Civil works

Recruitment

Logistics

As Per Need

District Health & Family Welfare Society

Swasthya Kalyan Samiti

Program Committees

Governing CouncilExecutive Council

Financial Arrangements

Transfer of program funds to DHFWS & SKS.

Retention and utilization of user fees at institutions.

Delegation of powers circulated.

Financial management manual introduced

Administrative Arrangements

Regular Governing Council meetings.

Regular Executive Council meetings.

Meetings of SKS and subcommittees as per need.

Administrative manual- yet to be introduced

Resource generation at Districts

Grant -in –Aid

User fee

Accepting donations

Leasing out of vacant land

BPL families, freedom fighters and Govt.

employees exempted

Services under national health program - free

PRIs

Management of Sub centers to PRIs - 3 pilot SIP

districts

Referral transport - RCH I.

Capacity building of PRI members -3 pilot

SIPdistricts.

Untied funds under NRHM with ANM and PRI

members for sub centre improvement.

Experiences – User Fee

G.O issued on retaining and utilising user fee at SKS.

Very positive for infrastructural development- mostly at district hospital.

Some Districts pool funds and redistribute.

Some institutions yet to take up SKS meetings for execution of decisions

Some districts do not recognise the delegation of powers to PHCs and CHCs

Lessons LearntDecentralization itself does not always improve the efficiency, equity and effectiveness of the health sector.

Need to be careful as this poses a serious threat to accessibility and delivery of reproductive health services, some of which (e.g. family planning) are controversial and thus susceptible to local pressures, and others of which (e.g. emergency obstetric care) require a functioning and effective health system.

Need to take account of the impact of non-health factors as well as other reforms that interact with decentralization to affect accessibility, affordability and quality of services, included for reproductive health.

Experience also demonstrates….Shared authority between the centre and local units - to achieve national health objectives and respond to local health needs.

Adjustments to be made during implementation to correct for both emerging and pre-existing problems and requirements.

Not easy to break the status quo as it always shifts the power relations without providing understanding on attached roles and responsibilities.

Understanding that rights and duties are the two sides of the same coin, one from the other does not mean anything- may help and facilitate the process.

Importantsimultaneously build the capacities of health personnel in team work, value orientation and rights based approach.

capacity to delegate and use powers need to be built at all levels.

Unfinished AgendaPhysical merger of societies and formation of Management and Monitoring cell.Capacity building of senior officers at Health directorate and of 17 districts .Capacity Building of PRIs.Financial Merger of program committees – based on experiences from other states.Institutionalising administrative rules.