Regional Resource Centre for Northeastern States (RRC-NE)
The North Eastern region of India is considered one among the most complex regions of the country in terms of its diverse culture, language, ethnicity, accessibility,development etc. Despite of many years of effort, the region remains under developed in terms of health care facilities, health indicators and many others.
The launch of Reproductive & Child Health II and National Rural Health Mission in April , 2005 brought in a paradigm shift in the planning process in the health sector in the country with significant rise in the investments in the health sector. These programmes entail upon the state governments to undertake participatory planning starting from the grass root level to strengthening of its managerial capacities so as to effectively plan interventions and execute the same.
Considerable amount of funds have already been released to all the 8 NE states. Over the last few years with the support of NRHM, these states have achieved many milestones but many more are to be achieved. In these states, efficient managerial functioning with sound technical back up is seen as an issue, which many a time results inadequate absorption of funds released to the state. That was the time, It was at his point of time, I joined the Ministry of Health & Family Welfare as Joint Secretary. I was mandated to set up the North East Division so that special attention and focus could be given to this region
Accordingly, the Ministry in association with the Development Partners like European Commission, UNFPA, DFID etc set up the Regional Resource Centre for Northeastern States (RRC -NE) at Guwahati in September,2005 in order to handhold the the region by augmenting the technical and managerial capacities of the NE states at all levels.
The main objective of the RRC is to provide technical assistance to the North Eastern States, help identify core areas to be focused in the short, medium and long run and plan for providing the missing technical and managerial capacities to these states. The major tasks of the RRC-NE included preparation of Situational Analysis on various aspects of the Health Sector and prepare policy proposals, re-structuring of the health system at the State, District and sub-district levels, institutionalization of integrated planning and management, taking stock of the financial resources available and the critical gaps and strengthening and streamlining of financial management systems, devolution of financial and administrative powers, strengthening and streamlining of procurement and logistics ,standardization of norms (services, staffing and infrastructure) at the primary and secondary levels, strengthening and streamlining of health management information systems (HMIS) , development of drug policy,advise on inter-sectoral convergence etc.,
In addition to the above, the Regional Resource Centre is also required to conduct workshops and
meetings on behalf of Government of India for effective operationalization of NRHM in the NE
Region.
The RRC-NE is organized as a ‘hub-and-spoke’ structure. The hub is headed by the Director (full time) with a Core Team of experts in Public Health,.Finance, Accounting and Audit, .Procurement and Logistics,Health Management and Information System,Community Mobilization and Civil Engineer-cum-Architect
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A BRIEF REPORT ON THE ACTIVITIES CARRIED OUT IN NE STATES DURING THE TENURE OF SHRI. K. RAMAMOORTHY, JS (NE), MOHFW, GOI
During my tenure (2005-2008) as Joint Secretary(NE) the northeastern states achieved many mile stones. One of the biggest challenges in any programme implementation the set up of institutional arrangements at the State level, District level and at Facility level.
It was mandated that for getting assistance under the National Rural Health Mission , the concerned state government should sign Memorandum of Understanding (MoU) with Government of India , followed by setting up of State and District Health Missions.The State NRHM has to be headed by a Mission Director. It was also mandated that all the existing vertical health programs are to be merged while forming the State Health Society. Periodical discussions and monthly video conferences led to the achievement of these basic goals.
· One major thrust under the NRHM was to form Rogi Kalyan Samiti( Hospital Management Society) at District Hospital, SDH, CHC, PHC etc. I still remember the days I used the chair the Hospital Development Society at the taluk level during my days as Assistant Collector/Sub Collector during 1980-82. It dawned on the Ministry of Health & FAmily welfare to have such set up in all the district,taluk and sub divisional levels. I also remember my step to give total financial autonomy to Hospital Development Societies meaning thereby that the income generated by the hospitals would be retained at the facility level and ploughed back into the system for repair of equipment, furniture,maintenance of building,water supply,electricity,telephone and purchase of medicines in case the stock gets exhausted. of course, I had a wage a war with the Finance Department of Kerala during 2006-07.
F The only addition here is that the Ministry of Heealth provided recurring financial support to the committee to carry out its own plan for the development of the hospital. In NE states also, the RKS was formed in different categories of hospitals, as mandated. Many of these committees have been doing many innovative works in NE states.
· A
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XXXXXXXX -Fig 1 Items procured by RKS using profit of the laboratory at Melagarh Sub-Divisional Hospital, South Tripura |
XXXXXXXX---Fig 2 Heat Radiant Warmer is procured by RKS and using profit of the laboratory at Melagarh Sub-Divisional Hospital, South Tripura |
Managing any show is always an art, which necessarily requires skills. Majority of the Medical Officers lack these skills. To support in this front, it was decided to engage staffs at State, District, Block with managerial background so that the programme can be managed efficiently and it can deliver goods. It was named as State Program Management Support Unit (SPMSU), District Program Management Support Unit (DPMSU) and Block Program Management Support Unit (BPMSU). Engagements were made as per the state’s requirements from State Program Manager, State MIS Manager, State IEC/BCC Expert, State Finance Manager etc. The same types of engagements were also made for the district. At Block level, Block Program Manager, Block Accounts Manager was engaged. In NE states also, for majority of the state the SPMSU, DPMSU, BPMSU staffs are in place.
· State Programme Management Support Unit and District Programme Management Support Unit were formed and all required personnel were placed.
The Government of India launched National Rural Health Mission (NRHM) to address the health needs of rural population, especially the vulnerable sections of society in April 2005. The Goal of the Mission is to improve the availability of and access to quality primary health care for the people, especially for the vulnerable groups focusing the women and children. To serve the rural community, the Sub-centre is the most peripheral level of contact with the community under the public health service delivery system. This caters to a population of around 5000, but is effectively serving much larger population. With less than 50% MPW (M) being available in the State, the ANM is heavily overworked, which compromise the quality of services & community aspects of services. The very nature of her job responsibilities makes it difficult for her to take up the responsibility of a ‘Change Agent’ on health in a village. Thus a new band of community based activists, named as Accredited Social Health Activist (ASHA) has been positioned to fill this void of community processes. 1 ASHA is engaged per 1000 population in plain areas, which was relaxed for hilly areas, like NE states.
.Because of the active persuasion of Sri Ramamoorthy, all the NE states could take initiatives for selection of ASHA and train them. A total of 49000 ASHAs were selected during 2007-08. Provision of drug kits for each of the trained ASHAs was made available.
The condition of the health infrastructure was in a very bad shape before NRHM, so it was mandated under NRHM to give major thrust to the infrastructure strengthening. 33% of the total fund is earmarked for the strengthening of infrastructure. To know the status of infrastructure of the different hospitals and to take up infrastructure strengthening on priority, massive drive was carried out for doing facility survey (as per IPHS) of District Hospitals and CHCs in NE states. The facility survey findings were also shared with the Ministry. Based on the facility survey findings, facilities were taken up for infrastructure improvement. Identified CHCs from NE states were given Rs. 20 lac for infrastructure strengthening. 56 District Hospitals (18 from Assam, 3 from Meghalaya, 14 from Arunachal Pradesh, 11 from Nagaland, 2 from Manipur, 2 from Sikkim, 6 from Mizoram) from NE states were given Rs. 1 crore each during March’07 for improving the existing status of the infrastructure. State like Assam has compiled a booklet on the findings of the facility survey. The District Program Management Support Unit staffs are taking lead role in getting the facility survey done of different health facilities. With the technical inputs given by the Engineer of the Department, work is executed with the support of Hospital Management Society.
Along with the infrastructure strengthening, it is equally important to put qualified Human Resources (both medical and paramedical) at the facility so that ultimately, people who come seeking services get the desired services from the facility. So, provisions were made under NRHM for appointment of health professionals at different categories of hospitals starting from SC to District Hospitals. Accordingly, 2nd ANM as per the mandate of NRHM was introduced at SCs of NE states. The provision of engaging 2nd ANM at SC has not only reduced the work load of the existing ANM but also it has increased the overall performances of the SC. Also, a number of Specialist, Medical Officer (Allopathic), MO (AYUSH), Staff Nurses, Lab Technician and MPW (Female) were made available at the health facilities. While giving engagement of staffs at different health facilities, it has also been ensured that the staffs stays at their place of posting and deliver services. Many states in NE states have come up with their own innovative plan to ensure that the staffs engaged stay at the place of posting.
Most of the NE villages lie in remote areas,where it would be impossible to make available health care. So we decided to press into service Mobile Medical Units. Going by the past experience of the Ministry in supplying unwieldy Mobile Medical Vans, my division specially designed MMUs( nos) with essential equipment,medicines,manpower etc. for the NE states bearing in mind the hilly terrain. I was also responsible for assisting the Ne states particularly Assam to go in for Boat Clinics to reach out to its riverine pockets I also suggested that Union Territories like Andaman & Nicobar and Lakshadweep should get support for Boat Clinics.We found that they were popular among the people living in reverine belts of Brahmaputra.
ii. TakInitially, I was required to operationalise the North East Indira Gandhi Regional Institute of Medical Sciences (NEIGRIMS),Shillong for which the late Prime Minister Rajiv Gandhi laid the foundation stone way back in 1986. The construction phase of the institute at a cost of Rs.469 crores was progressing at snails pace. with a missionary zeal I took up the task, convened fortnightly review meetings with the agency Hindustan Construction Company ( a PSU under the Ministry), the Director and the others and speeded up the process.Then came the question of recruiting manpower( both teaching and non teaching) and procurement of high end equipment required for the 500 bedded multi specialty teaching hospital and institution. It was a Herculean Task to get suitable candidates for the faculty positions.However, with faculty recruited 300 beds were operationalised. Departments like ------------------------------------------------------------- were started. I also got the Nursing College Building completed and admitted the first batch of B.Sc Nursing students during the academic year 2007-08.Now, the first batch of B.SC Nursing students are passing out of the college this year. we also admitted the first batch of M.B.B.S students, who are in the third year now.
During one of the visits to Manipur in early 2007, the Hon'ble Prime Minister promised that the Regional Institute of Medical Sciences,Iphal, Manipur would be taken over by the Ministry of Health & Family Welfare. Making use of this assurance, the North Eastern Council prevailed upon the PMO to instruct our Ministry to take two of their institutions such as - Regional Institute of Paramedical & Nursing, (RIPANS) - Mizoram, Lok Nath Priya Mental Hospital -Tezpur, Assam. Reluctantly, we agreed to take them over and started working on their upgradation.We released Rs 85 crore for setting up a Super Specialty Hospital at the Gawhati Medical College,Assam.
Photographs:
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Figure 1 K. Ramamoorthy, JS (NE) is seen while welcoming Dr. A. Ramadoss, Hon'ble H & FW Minister, GoI |
Figure 2 Dr. A. Ramadoss, Hon'ble H & FW Minister, GoI in seen while inaugurating RRC-NE. Ms. Jalega, AS cum MD, NRHM, India is also seen |
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Figure 3 Dr. A. Ramadoss, Hon'ble H & FW Minister, GoI, Mr. K. Ramamoorthy, JS (NE) and Dr. A.C. Baishya, Director, RRC-NE is seen |
Figure 4 K. Ramamoorthy, JS (NE) is seen while giving speech. Dr. A. Ramadoss, Hon'ble H & FW Minister, GoI. and Dr. B. Barman, H & FW Minister, Assam is also seen |
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Figure 5 Mr. K. Ramamoorthy JS (NE) is seen while presiding over the launching regional meeting of NRHM in Guwahati |
Figure 6 Mr. K. Ramamoorthy JS (NE) is seen in the dais during ASHA Sanmelan held at Assam on 8th July'08 |
