October 19, 2013
Plan of Action: Developments in the Health Sector after Poriborton
In May 2011, when Ms. Mamata Banerjee took over as the Chief Minister of West Bengal, the Health sector in the state was in shambles. From crib-deaths to poor infrastructure in the hospitals, everything was in tatters due to mismanagement and policies of the previous governments. The Health sector needed a major revamp. It needed to be built from scratch. Under such a circumstance, a detailed Plan of Action was taken up under the guidance of the Chief Minister.
Chief Minister Ms. Mamata Banerjee started with sudden inspections to the hospitals, taking stock of the ground situation at hospitals, the role of the doctors and other staffs, the facilities available. She made it clear that there will be no compromise in ensuring medical service to all patients. She said that the Health Dept. will try its level best for optimum utilization of the existing infrastructure. She made it clear that the Government will provide maximum facilities at the district & sub‐district level to minimize the referral of patients to city hospitals; she also promised that the health administration will work impartially with a humane face.
The Chief Minister said that the Health Dept. will start field based monitoring and supervision. It will try to rope‐in funds apart from the budgetary allowance.
The primary vision of the Plan of Action was to provide affordable, accessible, sustainable, high quality essential health care for all in 5 years. It was decided to give special importance to the healthcare needs of the poor, mother, young kids and the elderly, along with those living in under-served areas. It emphasized on the development and maintenance of standards of service in hospitals and health care facilities.
The Health Department under the able leadership of the Chief Minister, who is also the Minister in Charge of Health, chalked out 10 Focus Areas with respective functions of each.
Focus Area 1
>> Set and achieve basic service standards for public sector health care
>> Decongest tertiary care hospitals
>> Reduce out‐of‐pocket expenditure for patients
>> Achieve Indian Public Health Standard 2010 norms of clinical service packages for each tier of institutions.
>> Establish the `hub & spoke model of care` with proper referral chain and transport system and satellite centre concept
>> Upgrade and optimize the facilities particularly diagnostic facilities
>> Ensure free and subsidized supply of drugs, and other medical supplies
>> Upgrade the standard of non‐clinical services and amenities for patient and relatives
>> Optimization of under‐utilized secondary care institutions in and around Kolkata
>> Initiate health administrative reforms including creation of 7 new health districts
>> Establish newer facilities like ICU/ITU, burn unit, trauma care units & blood banking facilities at district and sub‐divisional hospitals
>> Facilitate RSBY and other Insurance Schemes particularly for BPL and the unorganized section
Focus Area 2
>> Achieve universal coverage for routine immunization
>> Reduce Infant Mortality Rate below 25, Neonatal Mortality Rate below 15 and Maternal Mortality Ratio below 100
>> Strengthen population stabilization efforts to sustain the current Total Fertility Rate (1.9)
>> Establish the neonatal care units in secondary/primary care institutions: Purulia model
>> Strengthen the adolescent care services specially for girls
>> Scale up `Save the Girl‐child` campaign to improve the sex ratio
>> Establish additional sub‐centres based on 2011 census
>> Implement cashless delivery and free transport at all hospitals
>> Establish one functional Basic Emergency Obstetric Care Centre within 6 km radius and one functional Comprehensive Emergency Obstetric Care centre within 25 km radius
Focus Area 3
>> Eradicate polio & eliminate kala‐azar & leprosy
>> Reduce the burden of communicable Diseases ‐ 50% Reduction in mortality due to TB, Malaria, Dengue, Diarrheal Diseases and Measles.
>> Augment the polio eradication campaign
>> Strengthening of surveillance, case management and prevention (including vaccination) of communicable diseases
>> Scale up the medicated bed net coverage for malaria endemic population
>> Emphasis on treatment completion in TB, Leprosy & Kala‐azar
>> Enhance the case detection and district‐based management for multi‐drug resistant TB
>> Establish the public health laboratory network at district and state level
>> Establish regional centre for disease control
>> Strengthen the deformity prevention and reconstructive surgery for leprosy
Focus Area 4
>> Strengthen preventive, promotive & curative services for selected non-communicable diseases.
>> Screening at primary care, diagnosis & management at secondary tier and create centre of excellence at state level for Diabetes, Hypertension, Cardio‐vascular Diseases, stroke and Cancer
>> Screening and treatment at secondary tier in phased manner for Thalasaemia & Haemophilia
>> Community awareness, screening & referral at the primary care for Mental Health and upgrade psychiatric care at secondary/tertiary level
>> Establish the `vision centre` at primary care institutions and create super‐specialty care for management of diabetic retinopathy, childhood blindness glaucoma at district hospitals
>> Establish the new facilities like geriatric clinics at the district hospitals
Focus Area 5
>> Strengthen health system in urban and peri‐urban areas for marginalized and urban poor.
>> Strengthen health systems in underserved areas
>> Mobilize own/GoI resources and explore PPP for the state urban health programme.
>> Link up with existing municipal health structure and programmes
>> Rigorously implement the RCH & disease control programmes in urban areas
>> Set‐up dedicated project management unit and package including deployment of Mobile Medical Units for Jangalmahal, Sundarbans, tea garden, forest hamlets of North Bengal and coal mine areas.
>> Establish new PHC and upgrade the existing PHC/BPHC in a phased manner with priority to underserved areas
>> Increase the reach of health service delivery through ASHA and other mechanisms
Focus Area 6
>> Optimize utilization of existing resources
>> Innovate health financing mechanisms to minimize stress on state finance
>> Complete absorption of NRHM & other GoI Programme funds and commodity assistance.
>> Aggressive exploration of PPP & other resources
>> Integration of MP/MLA Development Fund in Action Plans
>> Exploration for sector support programmes by external Aid Agencies
>> Scaling‐up of `Planned Preventive Maintenance` programme for assets/equipment
>> E‐governance initiatives: Asset Management Database and Financial Monitoring Software
>> Strengthening of HMIS including Web‐based reporting, video‐conferencing
Focus Area 7
>> Expand and strengthen Medical & Dental Education and Research
>> Upgrade the specialty and super‐specialty care
>> Establish 10 new medical colleges in a phased manner
>> Establish at least two AIIMS like Institutions
>> Establish new schools & colleges for nursing & paramedical education
>> Explore the PPP model for setting up super‐specialty facilities and new medical colleges
>> All medical/paramedical Education including AYUSH under the same umbrella of MERT branch
>> Linkup Districts with medical colleges for supportive supervision
>> Develop the centre of excellence in selected areas like `School of Tropical Medicine` Regional Institute of Ophthalmology and Institute of Psychiatry etc.
Focus Area 8
>> Mainstream AYUSH, and integrate the AIDS control programme
>> Synergize with other departments like P&RD, Municipal & UD, PHE, WCD, School Ed, Labour (ESI), Pollution Control Board, State Disaster Management Authority etc.
>> Make available ayurvedic & homeopathic treatment including specialized care under the same roof at Secondary care hospitals
>> Strengthen the AYUSH facilities available at BPHC level and below under NRHM
>> Make public aware about counseling, diagnostic and treatment facilities available for HIV/AIDS
>> Establish the information sharing system with other departments and nodal agencies including early warning system for disaster
>> Strengthen the mitigation, surveillance, case management of Arsenicosis and flurosis in endemic areas.
>> Establish linkage with programmes in school education, water supply, sanitation, urban basic service etc.
>> Minimize adverse health impact due to disaster and climate changes
>> Implement food standard and safety act
Focus Area 9
>> Enhance accountability of public & private health sector
>> Enhance community involvement in health care
>> Establish & maintain patient friendly, prompt and responsive services
>> Ensure greater accountability of health personnel
>> Set & Publicize Citizen`s Charter about available service package, patients` rights & responsibilities etc.
>> Establish 24 x 7 Help‐line and grievance redressal system including `Rogi Sahayata Kendra` (May I help you) at Tertiary/Secondary Care Institutions
>> Bring out complete transparency and quality control in procurement of drugs/ equipment like e‐procurement
>> Empowerment of Rogi Kalyan Samity, Swasthya Samity and other decentralized bodies
>> Provide Health Cards for all
>> Establish and monitor strong & transparent regulation for private sector providers
>> Introduce external quality assurance and accreditation
Focus Area 10
>> Human resource development initiative
>> Rationalize the deployment of manpower
>> Flexible mode of engagement of staff
>> Ensure availability and retention of high quality medical/ para‐medical personnel through CME/ Skill development, re‐deployment and contractual employment
>> E‐governance initiatives: Develop on‐line Personnel Management Database
>> Performance based incentive/disincentive mechanisms
>> Compulsory one year service in primary care institutions for MBBS graduates
>> Capacity building of staff towards multi‐skilling/ multi‐tasking approach
>> Mainstream the contractual workers
In the past two years, the Health Department has been following the plan of Action thoroughly. There have been radical changes in every sphere. With the district hospitals being upgraded, patients with serious illness are now rarely transferred to the hospitals in Kolkata. The establishment of Fair Price Medicine Shops has brought a sigh of relief to many families, belonging to the financially backward status, across the state. The idea has been taken up by the Government of India and is now to be implemented in other states too.
Major Achievements
>> Seven new Health Districts have been formally announced by the State Government: Jhargram, Nandigram, Basirhat, Diamond Harbour, Rampurhat, Bishnupur and Assansol. Task Force formed to make these Health Districts operational.
>> Establishment of 571 Basic Emergency Obstetric Care Centres, 121 Comprehensive Emergency Obstetric Care Services, 49 Sick Newborn Care Units, 412 Sick Newborn Stabilization Units, 11 Special Mother-child complexes, and Newborn Care Corners at all delivery hubs. Already 20 new SNCUs are already in operation.
>> The State Government has initiated the formation of 35 fair price medicine shops across the state, of which 24 are already operational. Poor patients can avail upto 80% discount on medicines. The government is also selling stents, a vital device for cardiac patients, through these outlets offering a mammoth 67 % discount on the MRP of the life-saving device.
>> West Bengal government is also planning to launch Fair Price Diagnostic Centers early next year at the government hospitals in the state. Patients can avail important diagnostic procedures like Digital X-ray at minimal prices at these centers. Dialysis would cost between Rs 700 and Rs 500, whereas a CT scan would cost only Rs 525; MRI for the brain can be performed for just Rs 2250.
>> The State Government, in association with three private hospitals, is providing free pediatric cardiac surgery to 3,000 children each year under the initiative `Shishu Saathi`. All children are eligible for this scheme, which started on August 21 2013, irrespective of their family income. All expenses will be borne by the State Government.
Bottomline
Two and a half years is a short time for a radical change anywhere, let-alone a cash-strapped, debt-ridden state like West Bengal, where a major chunk of the revenues collected is utilized to pay-off interests. What the Maa, Mati, Manush Government achieved in the Health Sector in this little time is something that needs to be lauded, if not envied. Obviously, there are miles to go, but again, the journey of a thousand miles, begins with a single step.
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