Keynote Address: Stewardship and Governance in Health Systems with special reference to the National Rural Health Mission.

1. NRHM – REINVENTING SYSTEMS Stewardship and Governance in Health Amarjeet Sinha

7. HUMAN RESOURCES - Community Workers. - Nurses and Doctors. - Public Health Cadre. - Multi skilling Specilaists. PRIMARY HEALTH CARE - Malaria, TB, NHPs - Doctor, drugs, diagnostics. - Nursing promotion. - women and child thrust. - Adolescent Health. PREVENTIVE HEALTH - Water and sanitation - Public Information - Immunization - Vector control WATER AND SANITATION AND NOT ANTIBIOTICS HEALTH PROMOTION - Sports and Yoga. - Healthy food. - Healthy habits. - Age at marriage. SECONDARY AND TERTIARY - Hospitalized care in government and private. - Cashless services. - Rational and ethical practice. NUTRITION - Key to good health - Link of childhood under- nutrition and adult diseases - Cultural aspects – oil use. Improving public health

10. BLOCK LEVEL HOSPITAL 30-40 Villages Strengthen Ambulance/ transport Services Increase availability of Nurses Provide Telephones Encourage fixed day clinics Ambulance Telephone Obstetric/Surgical Medical Emergencies 24 X 7 Round the Clock Services; BLOCK LEVEL HEALTH OFFICE –--------------- Accountant CLUSTER OF GPs – PHC LEVEL 3 Staff Nurses; 1 LHV for 4-5 SHCs; Ambulance/hired vehicle; Fixed Day MCH/Immunization Clinics; Telephone; MO i/c; Ayush Doctor; Emergencies that can be handled by Nurses – 24 X 7; Round the Clock Services; Drugs; TB / Malaria etc. tests GRAM PANCHAYAT – SUB HEALTH CENTRE LEVEL Skill up-gradation of educated RMPs / 2 ANMs, 1 male MPW FOR 5-6 Villages; Telephone Link; MCH/Immunization Days; Drugs; MCH Clinic VILLAGE LEVEL – ASHA, AWW, VH & SC 1 ASHA, AWWs in every village; Village Health Day Drug Kit, Referral chains 100,000 Population 100 Villages 5-6 Villages Accredit private providers for public health goals Health Manager Store Keeper NRHM – Illustrative Structure

16. MANAGEMENT OF HEALTH SYSTEM TASKS LEVEL TEAM Supervision of services Training of community Survey and mobilization Distribution of drugs Monitoring/Reporting Block Level Health Team Block Medical Officer Block Resource Group Accountant Data Entry Assistant Store Keeper Planning and MIS Capacity building Mapping NGOs Financial Management Procurement/Stores Technical/Community Planning and MIS Capacity building Financial Management Procurement/Stores Technical/Community District Level Health Team DM – DMHO Mgt. Expt. As ADHMO Finance/Data/Proc. Tech./NGO/Community State Level Health Team Mission Director Coordinators – Technical, Financial, MIS, M&E, Gender, NGO, Procurement,

17. BUILDING CAPACITY THROUGH RESOURCE GROUPS TASKS LEVEL TEAM Training of PRIs/CBOs Surveys/MIS Training ASHA/ANM Distribution/FM BLOCK LEVEL Block Health Office Block Resource Team RPs Surveys/MIS/NGO Procurement/Data Training/M&E Financial Mgt. Studies/Supervision Procurement/MIS Training/Planning FM/ M&E/NGOs DISTRICT LEVEL District Resource Group; PMU; Specially recruited skills ; DHM STATE LEVEL State level Mission SIHFW/Instns./NGOs Resource Centre Planning/supervision MIS/M&E/Proc./FM NGOs/Community Technical Skills NATIONAL LEVEL NHSRC/NIHFW MoHFW Institutions

18. COMMUNITIZATION OF HEALTH CARE TASKS LEVEL TEAM Community action Survey/Support Planning/implementn Village Health & Sanitation Committee ASHA/AWW/PRI SHG/CBO NGOs Planning/Survey Community action Implementation Planning/ Support Supervision Community action Sub Health Centre level, Gram Panchayat Samiti ANM/MPW PRI/NGO Women’s groups PHC level cluster level Committee PHC MO/Para Medics NGO/PRI Women’s Groups Planning/Implementation/ accountability Public Hearings Health Camps CHC/Block PHC/ BMO level Panchayat Samiti/ RKS BHO; RKS of CHC; Panchayat Samiti NGO/CBOs/ SHGs Planning/ M&E/ Supervision Accountability District level Health Mission under the Zila Parishad Zila Parishad; DM/CEO/DMHO PMU/NGOs

27. UHC – Essential framework

28. CRAFTING CREDIBLE PUBLIC SYSTEMS IN HEALTH NRHM - MAKING MDGs ACHIEVEABLE