Kishanganj District Public Private Partnership Project

Prasannakumar PN

Director Programme Operations

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Bihar- Fact Sheet

Population about 104 million; 90% rural & 54% BPL (Source: Bihar Fact Sheet, UNDP)

State HDI Rank(out of 23) - 21 ( 2007-8) (Source: Bihar Fact Sheet, UNDP)

Health Care: Government 20% Non-Government 80%

(Source: Ananya Programme, June 2013)

Highest Out-of-Pocket exp. on private health services

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The Transition in Bihar

Eye health projects with NGOs till 2008

Revised programme strategy in 2009 – moving away from service delivery to system

strengthening

Working with and within the government system

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Rationale of PPP approach

• 14 District hospitals out of 37 districts did not have eye

surgeon

• 69 out of 70 Referral hospitals did not have eye surgeon

• 17 out of 37 District hospitals had no Para Medical

Ophthalmic Assistant

• 434 out of 533 Primary Health Centres did not have Para

Medical Ophthalmic Assistant

Why Kishanganj? • Poorest of the 7 identified Districts • Farthest from Patna, State capital of Bihar • Priority of Govt. of Bihar for intervention • People going to Nepal for eye surgeries; poor outcomes

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The Kishanganj journey

2009:

Pilot project initiated in PPP

model in Kishanganj

2010:

Growth in surgical output in Kishanganj

district

2011:

Review of Kishanganj

performance by NPCB

2012:

Vision Centers set up in

Bhagalpur & Munger; OT refurbished

2013:

Cataract surgeries

started; ASHAs trained in Bhagalpur

2014:

GoB orders full-time

Ophthalmologist in

Kishanganj

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Kishanganj – then and now Systems & Services 2009 2014

No. of regular PMOAs in OPD in

District Hospital

0(visiting twice a

week)

2

OPD/Month 80(avg) 1100(avg.)

OPD Equipment in Dist. Hospital Torch & Trial Set All equipment as per VISION 2020

protocols

Eye Department Non-existent OPD & IPD (in sync)

Operation Theatre Non-existent Eye OT as per VISION 2020

protocols

Eye IPD Non-existent 25 bedded Eye IPD

Vision Centre Non-existent VCs in 7 PHCs functional at least

twice a week

Disease Specific

Intervention(cataract)

None since year

2000

1000/year

District Coverage Kishanganj Kishanganj, Katihar, Purnea,

Araria, Khagaria, Begusarai, W.

Dinajpur(WB) (Kishanganj DM’s

testimonial)

Post-Operative Follow-up Not Applicable Follow-up in Hospital and VC by

PMOAs of Govt.

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The impact

Increase in OPD from 80/month in 2009 to 1100/month(avg) in 2014

Increase in surgeries from zero in 2009 to 1000/year in 2014

Trained manpower in place: No PMOA in 2009 to 2 PMOAs in 2014

Lessing of out of pocket expenditure for the common man- Cataract Surgery @ Rs.2 from Rs. 3000/ in 2009 at Nepal

Government order on posting of ophthalmologist

Sustainable system in place

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Learnings

• Strong political will & government ownership critical

for initiation

• Involvement & ownership of government critical for

success

• Considerable time required for advocacy

• Short-term review for monitoring progress

- allow room for mid-course corrections

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Challenges

• Coordination between State-level and District-level.

• Acceptance and understanding of concept of

Systems Strengthening- concerned only with

service delivery to meet govt. targets

• Varying involvement of District-level government

leadership- changes with leadership change.

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Challenges

• Lack of interest of Govt. to sustain the initiative-

e.g. deputation of Ophthalmologist.

• Even after 5 years the Govt. takes this as a NGO

supported programme- not a collaborative effort.

• Lack of interest of the Government in scaling up

such initiative

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Way forward

Withdrawal from Kishanganj

Strengthening systems in

Bhagalpur, Munger, Begusarai and

Samastipur

State-level health systems

development initiatives focussing on systems change

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Thank

You!