people for health capacity building-final
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People for Health: Advancing Human Resources for Public Health
“Capacity Building”
Dr Saurabh Jain MD, PGD-Health Econ, MPH
State Health Resource Centre, Raipur
Chhattisgarh1
3rd Feb. 2012Bhubaneswar
“capacity building refers to the creation, expansion or upgrading of a stock of desired qualities and features called capabilities that could be continually drawn upon over time. . . The focus of capacity building therefore tends to be on improving the stock rather than on managing whatever is available.”
- Paul (1995), Capacity building for health sector reform, WHO
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Capacity building
vs
Training
vs
Human resource development
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Chhattisgarh, ninth largest state of India -25.5 *(census
2011) million population
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80% of people living in villages/hamlets 32% of Population are Tribal- 7 of India’s primitive tribal groups live here
(Abujhmaria, Baiga, Bharia Saharia, Hill Korwa, Kamar , Birhor)
Lush green Forests-44% of land area- is our asset and liability
with Mines –Tin,Coal,Iron
State Profile
Health Facilities Number of functioningfacilities
Population covered per facility
Sub-centres 5,076 3,862
PHC 741 26,400
CHC level hospitals 148 CHC +17 CH=165 1.54 Lakh
District Hospitals 17 15.02 Lakh
Medical colleges 3 85.13 Lakh
• Population of the State = 2.5 Crore No of Districts =27
• No of Blocks = 146 No of villages = 20,126
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Health systems framework
Leadership & governance:* policy – making
* regulation
* coordination
Organisation and delivery of
health care services:* primary health care – specialised
* health problem specific – general
* prevention – curative care
* public – private, for profit – not for profit,
formal - informat
Guiding by values and principles:* health care as a right
* autonomy <> security
* protection of public <> response to individual suffering
* effectiveness <> efficiency
* participation, accountability, trust
* social justice and equity
* global social responsibility
* sustainability: at which level?
Outcomes:* universal access
* quality of care
Goals:* improved health
* responsiveness
* social & financial
protection
Interaction with context:* with national policies, culture, values
* with international context
* with other sectors and actors
Interaction with population:
* demand generation
* participation of individuals and groups in community
* accountability
human
resources
Organisation of resources:
financing
Medical supplies
& technologies
Monitoring &
evaluation /
information
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Source: Josefien et al, Inst. Trop. Med., Antwerp
Training norms of GoISn. Category Training programme Duration GoI Norm
Maternal Health
1 Medical
Officers
(doctors)
LSAS (*) 18 weeks One anaesthetist per FRU
EmOC/CEmOC(*) 16 weeks One Ob./Gy. per FRU
Management. Of
Common Obstetric
Complications
(SBA)(*)
15 days One doctor per 24x7 PHC and CHC
Blood Storage (*) 3 days One Doctor per FRU
MTP (*) 15 days One doctor per 24x7 PHC and CHC
RTI/STI (*) 2 days One doctor per 24x7 PHC and CHC
2 ANM and
SNs
SBA (**) 15 days All ANMs and Staff Nurses per 24x7
PHC(all sanctioned post of ANM’s &
SN’s taken in account for calculation)
3 LTs Blood Storage(*) 3 days All LT's posted at FRU
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Training norms of GoI (contd.)
Sn. Category Training
programme
Duration GoI Norm
Child Health
4 Medical
Officers
(doctors)
F- IMNCI (**) 11 days One trained doctor per PHC and CHC
FBNC(*) 3 days One Trained doctor per dist hospital
NSSK (**) 2 days All doctors at PHC
Immunisation (*) 2 days One trained doctor per PHC and CHC
5 ANM/
LHV and
SNs
IMNCI (*) 8 days All ANMs, Staff Nurses, AWW(all sanctioned
post of ANM’s, SN & AWW taken in account
for calculation)
FBNC (*) 3 days All staff nurses
NSSK (*) 2 days All ANM's, LHV & SN(all sanctioned post of
ANM’s, LHV & SN taken into account for
calculation)
Immunisation
(***)
2 days All ANM's
Family Planning, ARSH, IMEP, and Disease Control Programmes……………………so on and so forth
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Capacity building pyramid
11Source: Christopher Potter, Systemic capacity building, Health Pol and Planning
Systemic capacity building
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Issues & Challenges
• Training capacity/infrastructure- state/dist.
• Training need assessment
• Quality
– functional status
– faculty/resource pool
– training plan
– database
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Issues & Challenges (contd.)
• Quality
– rationalization of trained HRH
– training material in local language
– fund flow
– tapping other resources (medical college..)
– monitoring tools
– evaluation
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Policy decisions
• Efforts to strengthen SIHFW & RIHFW
• Focus pvt public (nursing training)
• Private sector allowed to use public health facilities for training
• RMA MBBS bridge course
• Bridge course for AYUSH
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Policy decisions (contd.)
• PHRN engaged for ‘fast-track’ training of MOs and others
• Mapping under MCH plan
• EmOC and LSAS initiated for MOs
• RMAs being trained for BEmOC and others
• Mitanins promoted for ANM and B.Sc nursing course
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Policy decisions (contd.)
• ANMs promoted for B.SC nursing course
• MOs working in hardest areas given preference in PG seats
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Training institutions in the State
Facility 2007-08 Current Status
Govt. Pvt. Total Seats Govt. Pvt. Total
Seats
SIHFW 1 0 1 NA 1 0 1 NA
HFW-TC 1 0 1 NA 1 0 1 NA
Dist.TC 6 0 6 NA 14 0 14 NA
B.Sc. Nursing 1 10 11 450 6 41 47 2220
GNM-TC 4 2 6 161 4 25 29 981
ANM-TC 7 1 8 320 13 57 70 2404
MPW(Male) TC
3 0 3 180 3 41 44 2450
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Health Indicators: (as per *SRS and AHS 2011)
Indicators India Chhattisgarh
2000 2008 2011
Changes (2000-2011)
2000 2008 2011
Changes (2000-2011)
IMR Total 68 55 50 -18 88 59 51 -37IMR Rural 74 61 55 -19 94 61 55 -39IMR Urban 43 37 34 -9 54 49 40 -14
Birth Rate Total 25.8 23.1 22.5 -3.3 31.2 26.5 23.9 -7.3Birth Rate Rural 27.5 24.7 24.1 -3.4 33.2 28 24.8 -8.4Birth Rate Urban 20.7 18.6 18.3 -2.4 23.5 19.9 20.6 -2.9Death Rate Total 8.5 7.4 7.3 -1.2 10.2 8.5 7.6 -2.6
Death Rate Rural
9.3 8 7.8 -1.5 11 8.5 8 -3Death Rate
Urban
6.3 6 5.8 -0.5 7.5 6.5 6.2 -1.320
Thanks21