The state of Madhya Pradesh is one of the Empowered Action Group states of the National Health Mission. These states have struggled to contain population growth at manageable levels and have poorer quality of life indicators than other states. The central government has released significant funds to address issues such as human resources, social challenges, and family planning for these states. Madhya Pradesh struggles with health problems that contribute to high maternal and child mortality rates. These problems include anemia, malnutrition among adults and children, early childhood illnesses, and several infectious diseases (NFHS-3, 2006). The state health infrastructure and human resources do not measure up against the standard guidelines (National Health Mission, 2015).
According to the Eighth Common Review Mission Report of the National Health Mission, the major challenges for the state have been large gaps in healthcare infrastructure, lack of timely transportation for maternal care, and weak referral linkages to the district level. At the subdistrict level, lack of specialists and of blood storage units create challenges for maternal care. Guidelines for maternal and child care exist but are not followed or are not updated. Many of the nutrition rehabilitation centers for undernourished mothers and children at the subdistrict level are nonfunctional (NRHM, 2014.
Access to and affordability of care are challenges for Madhya Pradesh. The seventy first round of the National Sample Survey found that the average out of pocket hospital expenditure in Madhya Pradesh of 24,085 Indian rupees (approximately 360 US dollars) is higher than the national average of eighteen thousand Indian rupees (approximately 268 dollars). These expenditures in Madhya Pradesh are also higher than they are in states where care is dominated by the private sector, such as Andhra Pradesh, Tamil Nadu, and Karnataka, and most of the country. Out of pocket expenditures are higher in Madhya Pradesh despite a nearly equal balance between public and private facilities (NSSO, 2014).
Health infrastructure
Like the rest of the country, the state of Madhya Pradesh has also tended to focus more on selective vertical programmes aimed at specific diseases, rather than comprehensive health care at the Primary level. The state has focused on Reproductive and Child Health and other National Programmes aimed at controlling TB, Blindness, Malaria etc. However, there is a growing realization at the national as well as state level, that such an approach, though successful in terms of specific diseases such as Polio and Leprosy, has not yielded desired results in many cases. It has also kept the community involvement away from health care. The National Rural Health Mission aims at integrating the vertical programmes and providing horizontal linkages that will strengthen the health delivery system and lead to greater involvement of the community. The state of Madhya Pradesh is also moving in a similar direction.
Health care delivery options are available in the public sector as well as the private sector. These include allopathic, Indian system of medicine (Ayurvedic, Unani) and Homeopathy. However, Allopathy is the dominant system in both public and private sectors.
The health care delivery system in rural areas is based on a network of 8835 sub health centres, 1194 private health centres and 227 community health centres. These have been set up in accordance with GoI policy/guidelines:
Sub Health Centre (SHC): staffed by a MPW (male) and a MPW(female)/ANM, the SHC is envisaged to cater to a population of 5000 (3000 in hilly areas), provide limited primary care and act as a stock point for basic medical and family welfare supplies. In MP, a population of 5000 could be scattered across 6 villages. There is minimal curative service at the SHC.
Primary Health Centre (PHC): is envisaged to have a qualified medical officer, cater to a population of 30,000 (20,000 in hilly areas), provide in patient services (6 beds) and act as a referral unit for 6 SHCs
Community Health Centre (CHC): is envisaged to have 4 medical specialists (including surgeon, physician, gynecologist, pediatrician), 30 beds, operating theatre, laboratory facilities and act as a referral centre for 4 PHCs.
In urban areas there are 48 district and 57 civil hospitals, which are also expected to act as referral centres for CHCs. In addition, there are specialized hospitals (TB, leprosy, mental) as well as hospitals attached to medical colleges.
Tertiary health care is provided almost exclusively by specialist and medical school teaching hospitals and by the district and civil hospitals in the larger cities.
Policy
The Department of Public Health and Family Welfare, Government of Madhya Pradesh (GoMP) has taken a decision to develop a medium term health strategy, intended to serve the State for next five years.
The Department of Health and Family Welfare will:
- Ensure that the population has access to a range of affordable essential health promotion and preventive services, and simple curative and emergency services of acceptable quality.
- Promote appropriate health seeking behaviour by all citizens.
- Ensure that the poor have access to a safety net to cope with adverse economic and social impacts of serious illness.
- Promote partnerships with civil society groups, Panchayati Raj Institutions, NGOs, donor agencies, the private sector and other development partners to achieve its aims
- Improve accountability and cost effectiveness of the public sector.
Public private partnership for health infrastructure
Although the government employs qualified health care practitioners and in many rural areas, the government staff is the only source of qualified health care, the less than qualified providers (non registered practitioners) predominate in rural areas and this trend is also increasing in some urban and semi-urban areas. On an average, 70% of the first contacts for health care take place in private sector and private sector is the predominant provider of curative health care. Rich and poor often use private health care; poor often using the care from less than qualified private providers.
Given the numbers and spread of private health care providers in rural areas (often the less than qualified providers) and substantial presence of qualified and less than qualified providers in urban areas, it is obvious to explore possibilities of the role the private sector can play for improved public health in the state. So far, the private health services have operated in isolation, with no or minimum control for quality. In general, the technical qualities of care in government facilities are far better than in the private sector (particularly in the rural areas). To address the issues related to access and quality of health care in private sector, government proposes strategies and interventions to use the potential of the private health care sector for improvement in population (public) health. Government puts forward specific measures for encouraging public – private collaboration in the fields of immunization, reduction of maternal mortality and control of infectious diseases (tuberculosis, leprosy etc.). Further, measures are suggested to use the human and financial resources of non-government organizations (NGOs) and private sector for management of some government owned facilities.
State health policy
The policy identifies some core issues to improve the access, quality and coverage of health care in MP. The financing for health care is inadequate and should be increased particularly from the public sources. Further, the financing, as out of pocket payment at the time of receiving services is regressive from equity perspective, and is also against the interest of the poor. The present management system for the government institutions is inefficient mainly due to lack of financial and managerial (e.g. management of personnel) autonomy. Thus, innovative thinking in financing, financing mechanism for health care and modern management (financial, personnel) with defined autonomy, responsibility, output and outcome orientation, will go a long way to improve the health of the people in the state of MP.
Vision
All people living in the state of Madhya Pradesh will have the knowledge and skills required to keep themselves healthy, and have equity in access to effective and affordable health care, as close to the family as possible, that enhances their quality of life*, and enables them to lead a healthy productive life.
Characteristics of policy
- Ensuring geographic and economic access to primary and secondary quality health care and family welfare services to all people of Madhya Pradesh within a span of five to seven years.
- Prevention of disaster, to the extent possible, and preparedness for disaster management as and when necessary.
- Reducing the MMR to 220 by 2011 from the level of 498 (1997 level).
- Reducing the IMR to 62 by 2011 from the level of 97 (1997 level).
- Total Fertility Rate to reach replacement level fertility (i.e. a TFR of 2.1) by the year 2011.
- Address problems related to mental health and initiate action to create information base and preventive intervention for improved mental health in the state.
Health programmes
Janani Express Yojna
The Janani Express Yojana (JEY) is providing emergency transportation facility to expectant mothers, sick infants in rural Madhya Pradesh so as to enable them to avail adequate healthcare facilities on time 24 X 7. It was introduced in the year 2006 as a pilot basis in 10 districts of Madhya Pradesh which implemented throughout the state in 2009 later covered all the districts in 2012.
The Deendayal Mobile Hospital Scheme
Deendayal Mobile Hospital Scheme was launched in June 2006 with a view to providing quality health facilities in the remote areas of the state. Under the scheme, a mobile van is equipped with a doctor, staff, necessary appliances and medicines. This van provides medical treatment to patients in tribal-dominated villages and Haat-Bazaars free of cost.
Tribals residing in remote rural and forest areas cannot generally go to the hospital. They also avoid going there due to lack of facilities. This scheme has provided them quality healthcare and treatment facilities in their villages as well as haat bazaars, which is nothing less than a boon for them.
Deendayal Antyoday Upchar Yojna
The scheme launched in September 2004 aims at providing medical treatment to patients belonging to BPL families of all the categories. Under the scheme, medical checkup and treatment worth up to Rs 20 thousand is given to a family in one financial year. Every beneficiary family is given a health card in which family’s details are entered. Entries in the card are also made on a patient undergoing treatment by getting admitted to a hospital.
Vijayaraje Janani Kalyan Bima Yojana
Scheme was launched as a part of efforts to bring down maternal and infant mortality rates in Madhya Pradesh.
Under the scheme women are provided a financial assistance of Rs 1,000 for antenatal tests, institutional delivery and hospitalisation in a Government health institution after the delivery. However, assistance will be provided for up to three deliveries only.
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