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

2

Capacity building

vs

Training

vs

Human resource development

3

Chhattisgarh, ninth largest state of India -25.5 *(census

2011) million population

4

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

7

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

1

2

3

4 5

6 7

8

9

10

1

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

9

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

10

Capacity building pyramid

11Source: Christopher Potter, Systemic capacity building, Health Pol and Planning

Systemic capacity building

12

13

Issues & Challenges

• Training capacity/infrastructure- state/dist.

• Training need assessment

• Quality

– functional status

– faculty/resource pool

– training plan

– database

14

Issues & Challenges (contd.)

• Quality

– rationalization of trained HRH

– training material in local language

– fund flow

– tapping other resources (medical college..)

– monitoring tools

– evaluation

15

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

16

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

17

Policy decisions (contd.)

• ANMs promoted for B.SC nursing course

• MOs working in hardest areas given preference in PG seats

18

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

19

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