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Uttar Pradesh Health System Strengthening Project

Uttar Pradesh Health System Strengthening Project

  • The larger state context within which the UPHSSP is proposed to be undertaken is as follows: Uttar Pradesh is the most populous (close to 200 million as per current estimates) state in India with widespread poverty and illiteracy. Infant mortality rate, maternal mortality rate, and under 5 child mortality are one of the highest in the country . A very high incidence of avoidable morbidity and mortality is indicative of the inherent inadequacy of available public health services and their efficacy to deliver positive health outcomes. The fact that this situation continues despite huge annual investments (to the tune of around 10000 crores) in the health sector in the state underlines the need to strengthen the health systems further in a manner that makes them truly efficient and effective in the delivery of public health services. More than 70% of the total investment in the health sector reportedly goes in the payment of salaries to the large workforce of doctors, nurses, and paramedics. But more than 80% of the people, particularly in the rural areas, prefer to go to private health providers including faith healers and quacks, instead of accessing public health facilities. This suggests that the public health institutions do not enjoy the desired credibility and confidence of people. The public health delivery system in that sense is still in some kind of a crisis of credibility. This calls for radical re-thinking and re-organizing of the health systems in order to make the health services more accessible and affordable to people.

  • Rationale

    Uttar Pradesh Health System Strengthening Project (UPHSSP) is conceived as a strategic initiative to enhance people’s access to quality health care services in the state of Uttar Pradesh (UP). The project seeks to strengthen systems and institutions and their capacity to deliver quality services further in a manner that makes them accessible to people in general and to the poor in particular with a focus on women and un-served people in remote areas. The proposed initiative is intended to build on the achievements of the UPHSDP Phase I project and complement the on-going initiatives under National Rural Health Mission (NRHM). The first phase of UPHSDP, launched in 2000, covered 28 districts (out of total 71 districts) and 117 facilities (out of total 4339 facilities). The Project made a significant contribution towards increasing the utilization of health facilities by focusing on improvement in physical infrastructure (civil works and equipments). It also carried out the implementation of training programs for various health sector personnel in the state. In addition there were areas of system strengthening and innovations which the project addressed, including the development of quality circles, improving information systems, NGO contracting in rural areas etc. These impacted the efficiency and quality of health services delivery in the state in a positive manner. The initial phase of the project that lasted till 2005 and concentrated mainly on improving the basic health infrastructure was followed up by an extension phase which attempted to consolidate on the improved infrastructure by following a population based approach to improve health outcomes. The project was re-aligned in the year 2006 to focus on only 4 districts (out of 28) wherein intensive management innovations and improvements were introduced in the pilot districts. Systems strengthening activities such as piloting a Beneficiary Tracking System (BTS), organizational development study, establishment of a Policy Analysis Unit (PAU), accreditation of facilities, development of NGO contracting mechanisms, community mobilization and action and district planning were undertaken during the extension phase that lasted till recently. UPHSDP I focused on facilities mainly in terms of physical up-gradation of existing hospitals and other health facilities such as primary health centers (PHCs) and community health centers (CHCs), along with the procurement of equipments and ambulances. The shift in focus from facilities to people was made in the wake of an independent evaluation carried out by the World Bank. The key learning from these two projects is that good quality health care is a combination of a set of factors that include institutions, infrastructure, human resource capacity, accountability mechanisms and culture of care. All these need to be addressed in an integrated manner to achieve effective health service delivery and positive health outcomes on the ground. National Rural Health Mission (NRHM), launched by Government of India (GOI) in 2005, aims at a comprehensive re-vamping of the public health service delivery systems and services in the rural areas across 18 high focus states including Uttar Pradesh. The stated goal of the NRHM is to improve the availability of and access to quality basic health care, especially for people residing in rural areas, the poor, women and children. The scope of the program is vast and flexible enough to encompass almost all the conceivable aspects of public health service delivery. The core strategies of NRHM include: increasing participation and ownership by the community; improved management capacity; flexible financing; innovations in human resources development for the health sector; and setting of standards and norms with monitoring Thus, a majority of UPHSDP I initiatives have expanded both in scope and scale under the NRHM. However, there are areas such as organizational development and systems strengthening, improving quality in service delivery at institutional and providers level and strengthening accountability systems that need to have a sharper focus and a more strategic orientation in order to strengthen NRHM initiatives and prepare a sound systemic basis for improved health service delivery in the state. The UPHSSP is intended to complement NRHM by focusing on areas, which are either not being directly or adequately addressed by it, but are of critical importance for creating an enabling environment to pursue NRHM goals. It is envisaged that the activities under UPHSSP will also help India achieve the related Millennium Development Goals (MDGs), indirectly, but in an overall sense, by improving the health system delivery in the most populated state in the country.