Rajiv Gandhi Mission on Community Health

 

What is the Swasth Jeevan Sewa Guarantee Yojana?

Implementing the Swasth Jeevan Sewa Guarantee Yojana

Development of a Village Health Register and a Village Health Plan

Implementation Committee 

Implementation of District Health Plan by the District Committee

 

What is the Swasth Jeevan Sewa Guarantee Yojana?

Swasth Jeevan Sewa Guarantee Yojana shifts the paradigm in public health service delivery in Madhya Pradesh, and for that matter in India, by conceiving action for health as the provision of a bundle or an essential Linkage of services of health and the determinants of health. It does this by identifying a set of services within the health sector and some key determinants of health like safe water supply, sanitation and nutrition to be provided within a rights-based "framework of a guarantee by the government to be operationalised at the district, panchayat and village level. While doing so, it moves health sector management away from the Central and State levels to the district and below-district levels and gains from the fusion of funds and energies.

 

The effective operation of the Swasth Jeevan Sewa Guarantee Yojana is expected to result in demonstrable outcomes in health in the areas of reduction of infant mortality, reduction of maternal mortality. universal immunization, reduction of birth rate, universal safe water coverage, universal sanitation c overage and universal nutrition coverage to young children.

The implementation of the Swasth Jeevan Sewa Guarantee Yojana will lead to increased control of the community in the management of basic health care, creation of community level skills in basic health care and disease prevention, effective management and utilization of current resources and facilities provided for health dispensing, and augmenting resources to meet health-related tasks. It will put in place a District-Ievel Programme for Health. This district level programme will be built on the basis of a collective problem definition through a Peoples' Survey of Health which will also indirectly build a grassroots-level alliance for health action. The survey will map the current status of health provision, providers, burden of disease and the status of the key determinants of health. These will form the basis of a Village Health Register that could be actionable at the village level and the Panchayat level. Village-level health indicators contained in the Village Health Register will be aggregated to form district level Health Plans that will be actionable at the level of the district. The district level institutional arrangement to implement the Swasth Jeevan Sewa Guarantee Yojana will be headed for policy guidance by the Chairperson of the District Government and will have an Implementation Committee under the District Collector with the District Health Official being the Convener of both Committees. In addition to the pooled resources that become available by (a) convergence within health sector and (b) by targeting investments available for determinants of health, there could be (c) an additional stream of funds available as a District Level Community Health Action Fund for the Swasth Jeevan Sewa Guarantee Yojana to be provided.

 

Implementing the Swasth Jeevan Sewa Guarantee Yojana

Key components of the Swasth Jeevan Sewa Guarantee Yojana are the following:

A Core set of services ought to be guaranteed by the state government within a specified time-frame

The Swasth Jeevan Sewa Guarantee is modest in attempting to guarantee only those services that have universal coverage norms as of today (except sanitation which is expected to be done through household and community investment). The organisation structure to make this happen at the village level has been put in place by the Gram Swaraj system by conceiving a Health Committee at the Village level or a Gram Swastya Samiti which has a mandate for health action as well action for safe water supply, sanitation and nutrition.

   

Implementation Agency : Gram Swastha Samiti

 

Gram Swastya Samiti is a "stakeholders' committee constituted by the Gram Sabha under the Panchayat Raj Act that incorporates Gram Swaraj. Gram Sabha will determine the number of members of the standing committee on health. The number of members prescribed under the Act is 12 of which fifty percent of the members shall belong to Scheduled Castes, Scheduled Tribes and Other Backward Classes, two third of which shall be from Scheduled Castes, Scheduled Tribes and remaining one third from other Backward Classes. The standing committee on health shall have at least one-third women members.

 

The Health committee under the Act shall have a president who shall be elected by the members of the committee form amongst themselves. The president shall be elected amongst the members belonging to Scheduled Castes, Scheduled Tribes, Other Backward Classes, Other Category and from amongst women members by rotation. The term of president shall be one year.

 

The Act also provides that the health committee shall elect from amongst the members of Gram Sabha a Secretary by two-third majority of members of the committee. If there is " resident Jan Swasthya Rakshak in the village he shall be nominated as Secretary of the Health Committee.

 

Development of a Village Health Register and a Village Health Plan

 

An attempt at putting together comprehensive data base on the health status of each village was undertaken through the comprehensive Peoples Health Surveyor the Lok Sampark Abhiyan on Health held in February. It will not be fair to assume that a survey of this magnitude would have been carried out as diligently in all the 51,806 villages. It still becomes a good starting point. This has been an effort at problem definition from below and has captured for the first time information on the status of health, health provision and status of determinant services. This has been put together in the Village Health Register which has become the base document that can support a plan for community health. With the Government of Madhya Pradesh having put in place a system of Gram Swaraj, an implementation arrangement has also come into place. The Government has rightly conceived the Village Health Committee as having a broader mandate on health that covers safe water supply, sanitation and nutrition.

 

In addition to resource support from above, the Village Health Committee can also access resources that are collected by the Gram Vikas Kosh.

 

Development and Implementation of a District Community Health Mission Plan

 

The comprehensive information collected on health and determinants of health at the village level through the Village Health Registers will be aggregated at the district level to form the District community Health Action Plan. The points for action in the District level Community Health Action Plan would be the following:

 

Implementation Committee

1. Collector (Chairperson and Mission Leader)

2. Chairperson Health sub-Committee of Zila Yojana Samiti

3. Chairperson Health Committee of the Zila Panchayat

The district level implementation arrangement is one that can bring in inter-sectoral action. Once the Community Health Action Plan is finalized, the action plan will have the first claim on resources of determinant services like PHED (for safe water supply), WCD ( for nutrition) etc. Additional resources are expected to be made available through a District Community Health Action Fund. This Community Health Action Fund will be seen as a fund to be spent as a gap filling fund or to undertake an activity for which an existing budget line does not exist. ,

 

Implementation of District Health Plan by the District Committee

 

At the district level, Goals can be set as health improvement objectives. operational targets, health infrastructure targets, and citizen/community-based health outcome targets.

 

People's Health in People's Hands

 

The Government of Madhya Pradesh has, in the last seven years. taken a series of steps to empower citizens and communities to effectively manage basic services. A system of decentralised governance has been put in place which gives people the chance to like control of activities that affect their daily lives. On the one hand it becomes un opportunity to reengineer existing models of delivery of services and effectively mediate the supply-demand dichotomies. These units of decentralised governance being frameworks for inter-sectoral action, sectors like health management stand to gain significantly by getting incorporated into these structures of decentralised governance.

 

The Swasth Jeevan Sewa Guarantee Yojana is a model by which the health sector is sought to be repositioned within the decentralised framework.

 

The decentralized model of basic health delivery discussed here will move peoples' health Into peoples' hands by creating skills for basic health tasks within the community, effectively relating community health activists to the lower units of health delivery, effecting inter-sectoral action on determinants of health und by fusing energies and funds for effectiveness. This entire transition is sought to be supported through a Fund for Community Health action provided at the district level. This additional fund actually helps leverage the sector from the current situation of weak state-level management to one of strong district and below-district management. The determinant sectors having been decentralized. the decentralisation in the health sector is only a timely move to get it in line with them.