MODEL HEALTH DISTRICTS

Dr. H. BhushanAdvisor & Head

PHA Division, NHSRC

MODEL HEALTH DISTRICTS – THE NEED… GoI rolled out several National Health Programs to improve

the health indicators (e.g. MMR, IMR, TFR) At present there is not even a single district in the country

which can be showcased as a Model where in all the RMNCH+A services and National Health Programs are delivered as per the protocols & guidelines of GoI or the State

District being the fulcrum of service delivery, it needs to deliver services as a role model which can be replicated

Some of the initiatives which can show quick results can be – MDR, CDR, NCD clinics etc.

Kayakalp is a good beginning and we need to build upon such initiatives and create models which can be replicated

MODEL HEALTH DISTRICTS (MHD)

Is a ConceptIs a Role Model

A hope for poor & vulnerable An effort to improve Quality Gives honor and prestige to the health personnel Develops good relations between client and

service providers Can be developed as Knowledge Hub

MHD – THE PERSPECTIVES AND PHASES

The Perspectives Client Supervisor Community

The Phases Ambience Protocols (technical and service delivery) Sustenance

MHD – THE PROCESS1. 2 Districts have been chosen in the selected States

Intervention District Collaborative District

2. A chain of service delivery and referral have been identified in the district from village to District Hospital (SC – 24x7 PHC – CHC – DH)

3. Situation analysis through available data in terms of RMNCHA and other disease control program indicators, district planning, financial expenditure, blood bank functionality, quality process, community linkages, assured referral was undertaken

5. Identification of local partners working in the state. All planning and improvement activity shall be undertaken in collaboration with them/State and MoHFW

MAJOR FOCUS AREAS IN MHD RMNCHA – MDR, CDR, JSY, JSSK, RBSK, RKSK Quality Assurance Standards Effective Community Process Non-Communicable Diseases Screening Operationalizing health facilities Strengthening District Hospitals Grievance redressal system Assured referral linkages

MHD – THE IMPLEMENTATION PLAN Gap identification and action points for strengthening - OPD, IPD,

LR, OT, Lab and infection prevention services, with an aim to get QA certification as per GOI guidelines

Developing facility and service area specific SOPs so as to reach the defined quality standards

Capacity building of HR for improving the clinical practices Advocacy with district authorities for improving infrastructure

related gaps Putting in place an assured and effective referral linkages and GRS Holding meeting at SC with ASHA/AWW and other relevant

community stakeholders for improving community processes Strengthening implementation of key national programs like JSY,

JSSK, RBSK,ARSH etc. Guidance in creating model MCH wing, if sanctioned in the district

MHD – SUSTENANCE

Supervision, review and corrective actionsConcurrent and periodic review of services being rendered Defined checklist Analyze against set protocolsFind gaps Make a time-bound roadmap (action plan) for gap filling with a nodal person to monitor the progressContinue review for timely implementation and sustenance of corrections achieved

PERFORMANCE INDICATORSMaternal Health

Percentage ANC registration against estimated pregnanciesPercentage of ANC 3 check up against reported ANC registrationNumber of cases of pregnant women with obstetric complications attended at public institutions ( HMIS )Percentage institutional deliveries reported against reported deliveriesProportion of C-sections per month at FRUs ( HMIS )

Child HealthBed occupancy rate at SNCUNeonatal mortality rate at SNCUNewborns breastfed within one hour of birth against reported live Births (HMIS )

PERFORMANCE INDICATORSFamily PlanningProportion of postpartum IUD inserted (PPIUD) in institutional deliveries (HMIS)

Facility FunctionalityIPD and OPD per 1000 populationMajor surgeries per 100000 population

HRGynecologists, Pediatricians and Anesthetists posted in non-FRUs

OtherNumber of patients transported per ambulances per monthPercentage of utilization of untied fundsPercentage of mothers who received JSY incentives, out of total institutional deliveries (in public health facilities) (HMIS)

EXPERIENCES FROM MHD IMPLEMENTATIONBiharState has identified nodal persons for monitoring of MHD activities and they are periodically monitoring the work at districtsState level orientation of all Dy.S and HM of Bihar on Junk disposal process has been completedAurangabad DH has prepared Room wise SOPsTraining of cleaning staff at DH, Aurangabad has been completed on infection prevention protocolsAmbience of Block CHC of Aurangabad has improved significantly. The improvement at DH, Aurangabad  is comparatively slow, the DM has formed a team for monitoring the work

EXPERIENCES FROM MHD IMPLEMENTATIONOdishaThe DM, Kandhamal has been sensitized and impressed upon the importance of the MHD initiative. Monthly review meetings under the chairmanship of DM are taking placeThe HM of the DH, Phulbani has been appointed as the nodal person by the DM to monitor the progress of MHD activities in all the identified facilitiesMassive cleanliness and junk disposal drive was organized in the DH involving the housekeeping staff, staff from ANM, GNM school and NGOs. Similar exercise was carried out at CHC and SDH under direct supervision of CMOBeautification of DH by creating small gardens is underway in collaboration with Horticulture dept.JharkhandAt DH, Jamshedpur room-wise SOPs have been prepared. The work on improving the ambience is moving at a slow pace at the DH, Jamshedpur

THANK YOU