National Rural Health Mission, Government of Arunachal Pradesh
 
 

           
 

 
 





 

 

 

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THE PROJECT

The project was for introduction of Public Private Partnership on a pilot basis for improving the health care delivery system in Arunachal Pradesh. The existing health delivery system in the state relies basically on the Government health infrastructure and requires improvement in terms of access, coverage and quality. In the light of the increasing expectations of the people, and with the main objective of improving and reforming the health delivery system, the state government envisaged the proposed model of Public Private Partnership. The strategic objective of the project was to provide to the people residing in the Primary Health Centre area with quality clinical and preventive health services, and at the same time effectively implementing the National Rural Health Mission programme. The objective was also use the services of reputed NGOs and Voluntary Organisations in 16 PHCs spread in 16 Districts of the state. Reputed NGOs and the Voluntary organisation would bring with them the expertise in running health institutions. The expectation was that Public Private Partnership will increase the people’s and the community’s participation in the community and public health management. The NGOs namely Karuna trust, Voluntary Health Association of India, JAC Prayas and Future Generations Arunachal were selected on a transparent manner on all India basis advertisement. This being a pilot project, the duration is envisaged for three years January 2006 to December 2008 and further on, continuing till date. Of late, with times, Voluntary Health Association of India decided to exit the project and new local NGOs were roped in to further the pilot project.

JUSTIFICATION    

Due to Arunachal Pradesh’s peculiar topography and difficult terrain, there is widely dispersed settlement pattern of the population that applies to both rural and urban areas giving density of 13 persons per Sq. Km (17 – in 2011 census). Availability of manpower in difficult and inaccessible areas is a big challenge.
     Though the Public-Private Partnership (PPP) is a new concept but has been adopted in the state by involving NGOs in providing quality service in the remote and difficult areas. PPP in the modern context is a term devoting business relationship in which public and private resources are combined for a social cause but not without mutual benefit. Public-Private Partnership has emerged as one of the options to influence the growth of private sector with public goals in mind.
      It is generally believed that the delivery of services in private sector is worked by efficiency and low management cost as compared to the public sector. For want of the staff and equipments, the PHCs are not working well in the district. Therefore, the NGOs were identified who is willing to run the PHCs. The Terms and Conditions for the hand over of the PHCs have been thoughtfully worked out and MoU signed. The PPP in Arunachal Pradesh would continue and more facilities may be included for outsourcing to NGOs.
      Considering the fact and the need for proper healthcare delivery System, In the year 2005, the Government of Arunachal Pradesh, in order to further improve the health facilities in the state decided to implement PPP as a pilot project. The Government of Arunachal Pradesh signed a MoU with the GoI to hand over the management of 16 PHCs of 16 districts to 4 non-profit organisations namely; Karuna Trust (Karnataka), Voluntary Health Association of India (VHAI), New Delhi; Prayas Juvenile Aid Centre (JAC) Society (New Delhi) and Future Generation Arunachal (Arunachal Pradesh).

OBJECTIVE    

      The strategic objective of the project is to provide quality clinical and preventive health services to the people residing in the Primary Health Centre area and at the same time effectively implementing National Rural Health Mission (NRHM) and other National programs including IEC activities, and promotion of community based disaster preparedness. The indicators would include, inter-alia, availability of doctors and Para-medical staff, inpatient and outpatient facility, 24 hours delivery facility, improvements in immunization and institutional   delivery coverage, availability of essential medicines, outreach activities such as health camps by mobile units etc.         

ACHIEVEMENTS    

       Following the implementation of PPP programme in the state, the manpower position tremendously increased from the past position when the State Government ran these health facilities. The accessibility of the health services have remarkably increased from near nil to full accessibility in 16 selected PHC areas. Moreover, 24 hrs availability of this manpower at the posted PHC has made the local population of the area make better use of the health facility. 

The details of the changes in manpower position are as follows:

Designation

Before PPP implementation

After PPP implementation

Medical Officer

14

32

SN

5

32

ANM

16

128

HA

9

32

Lab Technician

4

16

Pharmacist

10

16

Driver

9

16

Grade IV

63

64

LHV

0

16

Total

130

352

    This has led to an increase in the availability and utilisation of the health care services by the people. Achievements in the field of health care and delivery services have been observed. The results are evidence of synergy, achieved by merging efforts of the NGOs and the state Government. The most important achievement is the awareness among community for demand of quality health care. At the same time community started participating and contributing their invaluable inputs through agencies like RKS, leaders and individually.  With great effort and dedication the health status of the common people has shown satisfactory results. Health seeking behaviour of community has risen to a satisfactory level. Routine immunization was hardly reaching to 10% of the beneficiaries in the locality of these PHCs before the NGOs took to manage them and has now risen  up to certain extant of satisfaction but yet more to be achieved. ANC and PNC services have increased and so is the registration of pregnancies. The health indicators of the people in the concerned PHCs have shown improvement after these NGOs took over the management of these PHCs.
         
          Besides providing these facilities on a regular basis, the NGOs have also involved themselves in many outreach activities. Health Melas have been conducted. Many IEC/BCC activities have been carried out to raise the awareness level among the common people. Programs like school health, Adolescent health, Village health and nutrition Day etc. have been carried out. The NGOs have also taken up the ASHA training program in a very effective manner.  

NGO wise performance     

Challenges    

  • Difficult geographical terrain, communication bottlenecks, remote villages.
  • Attractive package difficult / limited due to resource constraints for staffs  
  • Recurrent turnover of Manpower 
  • NGO selection
  • Conflict with local NGOs
  • PPP Vs privatization
  • Re-deployment of existing staff
  • Compulsion of political system
  • Medico-Legal Cases / Post-Mortem
  • Procurement
  • Getting the correct key functionaries
  • Individual centric commitment (systems important)
  • Political commitment
  • Outsiders getting jobs vis-à-vis insiders
  • Monitoring / Review
  • Religious / Political Issues
  • Threat perception by Govt. systems
  • Expectation Vs performance

Fund released to NGOs    

Year 
Name of NGO
VHAI
Karuna Trust
FGA
JAC Prayas
M.M Charitable Society 
N.N. Charitable Trust
2005-06
     2,500,000.00
              4,500,000.00
         500,000.00
         500,000.00
                           -  
                           -  
2006-07
   14,565,080.00
            21,886,144.00
     2,913,016.00
     2,913,016.00
                           -  
                           -  
2007-08
   12,247,620.00
            20,425,716.00
     2,269,524.00
     2,269,524.00
                           -  
                           -  
2008-09
   15,928,529.00
            29,057,240.00
     4,506,107.00
     4,506,107.00
                           -  
                           -  
2009-10
   19,707,440.00
            24,367,846.00
     2,747,320.00
     2,747,320.00
                           -  
                           -  
2010-11
   17,072,688.00
            26,201,812.00
     2,673,535.00
     2,673,535.00
                           -  
                           -  
2011-12
                           -  
            32,745,600.00
     7,163,100.00
     3,069,900.00
                           -  
                           -  
2012-13
                           -  
            33,768,900.00
     5,116,500.00
         471,000.00
     1,534,950.00
         511,650.00
Total
   82,021,357.00
          192,953,258.00
   27,889,102.00
   19,150,402.00
     1,534,950.00
         511,650.00

 

 
   

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Arunachal Pradesh State Health Society, National Rural Health Mission , Govt. of Arunachal Pradesh, Naharlagun-791110
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Last Updated 02.08.2013