india healthcare rch2 - sean doolan & ruma tavorath, oct 2004
TRANSCRIPT
DFID Department forInternationalDevelopment
Reproductive & Child Health 2 - India
Infection management & environment
Sean Doolan, DFID India
Ruma Tavorath, World Bank South Asia
November 2004
DFID Department forInternationalDevelopment Outline
National context
RCH2 outline
Para-SEA
Scoping volumes, activities & phasing
WHO & SWAPs frameworks
Integration into outputs & outcomes
Focusing on most vulnerable
Establishing process
DFID Department forInternationalDevelopment Government of India
“Sustainability is not an option but an imperative. … the environment is not to be seen as a stand-alone concern. It cuts across all sectors of development” (Three environmental targets)
GoI Tenth Plan
National Environmental Policy (in prep.)
Constitution of India: Articles 21 (right to life –food, water, environment), 47 (food & health), 48A (protection of environment), 51A (fundamental duties)
Variable capacity, MoEF, CPCB, SPCBs
DFID Department forInternationalDevelopment
Environment MDG -
challenged in India
Ranks 116th of 149 countries in 2002 Environmental Sustainability Index (WEF)
120th of 122 countries for water quality (2003 World Water Assessment)
Environmental degradation costs 4.5-8% GDP (in line with growth)
Natural disasters - 50 million people a year
185 million people living in slums
300 million below $1 a day
Waste management weak
DFID Department forInternationalDevelopment Why environment screening?
Identify and exploit environmental
opportunities e.g. synergies & savings
Identify and manage environmental risks
e.g. historical problems, reputational risks
Ensure that activities are consistent with
policy & international best practice
Bank procedures – do no harm to do good
DFID Department forInternationalDevelopment RCH 2
Sector Wide Approach (SWAp)
Many development partners – DFID,
World Bank, EC, GTZ, USAID, UNICEF,
UNFPA, WHO …
Government of India, Ministry of Health
& Family Welfare (2 departments)
State governments
DFID Department forInternationalDevelopment Why strategic?
Scale - £4.5 billion, 5 years
Like-minded partners? – harmonisation, SWAp
Political will - injection safety, GAVI, AD syringes
Health systems development projects
National Rural Health Mission – new govt
Merging H & FW – single Secretary
Alignment vertical health programmes
Inter-sectoral convergence
DFID Department forInternationalDevelopment Objectives?
Communities utilize and benefit from
responsive, equity-sensitive and quality-
based Reproductive- and Child/Newborn
Health Care services
IMEP underpins RCH 2 operations to deliver
better health outcomes for most vulnerable
groups – meet national legislative
requirements
DFID Department forInternationalDevelopment Methods
Logframe components
WHO tools - www.healthcarewaste.org
Formal appraisal schedule
Working groups
Special studies – linkages, not integration
Consultancy
MoHFW working group
Backstaging & advocacy
DFID Department forInternationalDevelopment Logframe outputs
1. Decentralised
management
2. Training/HR
3. M&E – barriers to
equitable service &
outcomes
4. Gender-sensitive family
planning
5. Maternal health &
institutional deliveries
6. Adolescents
7. New-born &
child health
8. Urban slums
9. Tribal health
DFID Department forInternationalDevelopment Logframe outputs
Planning guidelines & training
Standards for services
Infrastructure
Asset management
Utilities
Procurement & logistics
Immunisation
Infection management policies & strategies
Institutional mechanisms
Training & BCC / IEC
DFID Department forInternationalDevelopment Issues
Immunisation & institutional deliveries
Behaviour change, sharps safety, training
Infection control & quality of care, provision of services
Construction & asset management
Cold chain, utilities, watsan
Immunisation & injection safety
POPs, incineration, distribution
Public private partnerships
Biomedical waste handling rules, compliance
DFID Department forInternationalDevelopment WHO Rapid Assessment Tool
Health care facilities Storage
Staff Collection &
transport
Waste generation Off-site transport
Segregation &
handling
Waste treatment
Containers Final disposal
DFID Department forInternationalDevelopment WHO Rapid Assessment Tool
Policy & regulations Institutions
Policy & budget
Sanitation &
wastewater
Water – drinking &
other uses
Energy
DFID Department forInternationalDevelopment Scoping
63% injections unsafe in India
69% public hospitals
74% immunisation clinics
60% private sector facilities
2 million new Hepatitis B cases a year
400,000 new Hepatitis C cases
30,000 new HIV-positive cases
1.5 million deliveries PHCs, CHCs
DFID Department forInternationalDevelopment Scoping
280 million AD syringes
550,000 outreach sites
2,150 tonnes plastic
615 tonnes needles
1.25 million sq m construction
62,000 tonnes construction waste
2,700 blood storage facilities
DFID Department forInternationalDevelopment Outputs
Infection Management & Environment
Plan
IMEP cross-referenced in PAD, aide
memoires, indicators, studies
Awareness within MoHFW, States,
development partners
Recognition of infection management
Working group established
Process for operational guidance
DFID Department forInternationalDevelopment Successes
Equity focus – worker, ragpicker & patient safety
EAG & NE states
Allocation for HCWM
Needle-cutters for immunisation
Duty of care – healthcare without harm
Growing awareness in Governments
World Bank & DFID partnership
Technical assistance recognition
DFID Department forInternationalDevelopment Successes
Framing in appropriate language
Backstaging
NGO & practitioner linkages
DFID Department forInternationalDevelopment Barriers
Overlapping institutions
Vertical silos
Crowded space to operate
Access to information
Effective linkages
Champions
Not business as usual
DFID Department forInternationalDevelopment Remaining challenges
Sourcing expertise
Participation
Capacity & capacity building
Scale
Supervision
Behavioural change
Institutional linkages