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Proceedings
of a Workshop
India International Centre, New Delhi on September 4-5, 2003
Bureau of Planning, Ministry
of Health & Family Welfare, Government of India
in collaboration with
World Health Organization
The
Government of India has embarked on Health Sector Reform (HSR) initiatives in
varying degrees since the early 1990s. Along with the Centre, the State
governments continue to be vital stakeholders in the reform process.
Innovative experiments and initiatives are being embarked on across various
States in India.
However, there is insufficient and inadequate systematic documentation and
analysis of the same. With a view to address this aspect, the Bureau of
Planning, Ministry of Health & Family Welfare, Government of India, in
collaboration with the World Health Organization India Office organized a one
and half day experience sharing workshop India’s Health System: Role of
Health Sector Reforms, at the India International Centre, New Delhi on
September 4-5, 2003. The workshop provided a forum for policy makers
and other stakeholders to exchange experiences and information on health
systems reform, draw lessons and best practices from experiences of select
States and for the participants to gain a better understanding of the concept
of health sector reforms in India
and to determine the future steps to be taken.
The
participants included representatives from the Central Ministry and the
states of Punjab, Himachal Pradesh, Rajasthan, Uttaranchal and Gujarat, multi-lateral and bi-lateral agencies,
academia and others attended the workshop. Smt P. Jyoti Rao, Additional
Secretary Health, Shri Hota, Secretary Family Welfare, Dr S. Habayeb, WHO-WR
to India, Dr. S.P. Agarwal, Director General of Health Services and Dr. Prema
Ramachandran, Adviser Health, Planning Commission, shared their views at the
inaugural session.
Smt P.
Jyoti Rao, Additional Secretary Health, emphasized the need to evolve a well-defined
strategy for health sector reforms in India and to outline our
priorities along with a time frame for its achievement. In this context, she
stressed the need for evolving a workable definition of health sector reforms
in the Indian context and called for documentation of reform initiatives
undertaken, especially by the States. She envisaged a crucial role, both for
the States and the Centre in the reform process through a vibrant public
private partnership.
Shri. P.
Hota, Secretary Family Welfare, brought out the need for better scrutiny of
both Centre and State health and family welfare departments. He emphasized
the need for convergence of reforms across the various departments under the
MOH&FW. He also spoke of the need for better utilization of existing
funds, creating a balance amongst existing health personnel and involving
personnel from other disciplines such as economics, statistics in the health
sector reform process.
Dr Prema
Ramachandran, Adviser Health, provided the participants with an overview of
reforms prevailing at all levels of health care. She delved into
details outlined in the documents of the Ninth & Tenth Plan Steering
Committee in the area of health sector reforms.
Dr
Habayeb, WHO-WR to India,
outlined achievement of efficiency, improving quality, promoting equity and
generating new resources for health care as the goals of the health sector
reform process. He emphasized the fact that health sector reforms are a
highly political and fiercely contested process and the need to focus on
process of reforms along with its content. He reiterated the importance of
reviewing and measuring the process, impact and outcome of reforms. It was
conceived that the Ministry could play a key role in documenting reforms and
would provide platforms for learning from each other’s knowledge and
experience. The present workshop was seen as a step in this direction.
Dr. S.P.
Agarwal, Director General Health Services, stressed the need to ensure ‘good
health’ for all people and about the need to integrate all systems of
medicine under one umbrella in provisioning of health care. He also
emphasized the need to increase investments in the health sector in order to
achieve the targets set down in the National Health Policy 2002.
The
technical sessions began with a presentation by Dr. Rama Baru, Associate
Professor, Jawaharlal
Nehru University.
Dr Baru examined provided a political and economic context to health sector
reforms, at the global level and examined the emergence of various strategies
in this light. She provided a broad overview of international experiences
with health sector reforms, the role of donor funding. Reform experiences in India
were another area of focus. Dr Baru brought out the lack of evidence,
especially in terms of impact of health sector reforms in India and stressed the need to
document and to share the process and experience of HSR across states.
Thereafter,
representatives from the States of Punjab, Himachal Pradesh, Uttaranchal,
Rajasthan and Gujarat made presentations on
initiatives undertaken in their States. The presentations clearly brought out
the commonalities and differences in areas addressed. Resource mobilization
through user charges, decentralization, outsourcing of services,
public-private partnerships were areas of commonalities. The other
speakers who shared their analysis at the gathering included, Shri Javed
Chowdhary, former Secretary Health, Dr T Walia, Regional Adviser, Health
Systems Development WHO SEARO, Shri. Sunil Nandraj, WHO, Dr Indrani
Gupta, Institute of Economic Growth, Dr. Nandita Chhaterjee, WHO and Shri.
J.P. Misra, European Commission.
In course
of the discussions, pertinent questions were raised. The foremost
being, the need to define health sector reforms in the Indian context. Are we
really engaged in health sector reforms? Or are innovations being undertaken
in terms of health planning and provisioning of services? The criticality of
distinguishing normal incremental changes from reforms was emphasized. So
also was the importance of focusing on the process of reforms along its
content, incorporation of monitoring and evaluation mechanisms since the
initiation of reforms, incorporating adequate mechanisms for collecting data
for review and documentation, involving all the stakeholders in the reform
process and their capacity building. Lack of adequate process
documentation of health sector reforms in India was identified as one of
the gaps. Further studies would be required across various components of
health reforms to assess their impact and to emulate the ‘success’ stories
and learn from failures. Given the plurality of experiences among the states,
a suggestion was made to enable ongoing sharing of experiences across states
in a web-enabled format.
These
issues pertaining to evolving a conceptual framework for defining health
sector reforms in the Indian context, its content and process and the
probable next steps were central to the group work session held on the second
day of the workshop.
The
discussions clearly brought out the need for ensuring ongoing sharing of
reform initiatives between the Centre and the State as well as amongst the
States. It was felt that the Centre needs act as a nodal agency and play a
critical and proactive role in this regard. Having in-house sharing of views
and experiences in the Central Ministry itself could be a beginning. While
providing a platform for sharing of experiences, the Centre also needs to
engage in capacity building initiatives. At the State level, suggestions
relating to assigning a nodal officer to co-ordinate health sector reform
initiatives, holding workshops with officers, inclusion of health sector
reforms as part of the Five Year Plans were made. The need for co-ordinated
donor assistance was a common issue raised by the groups. The group also stressed
upon the urgent need for documenting and evolving a framework / methodology
to ensure comparison of reform initiatives across States.
In the
concluding remarks, the Ministry assured that such interactions would be held
at regular periodicity and detailed proceedings of the present workshop would
be made and widely disseminated.
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