HR for

1. People for Health: Advancing Human
Resources for Public Health
“Capacity Building”
3rd Feb. 2012
Bhubaneswar
Dr Saurabh Jain
MD, PGD-Health Econ, MPH
State Health Resource Centre, Raipur
Chhattisgarh 1

2. “capacity building refers to the creation,
expansion or upgrading of a stock of desired
qualities and features called capabilities that
could be continually drawn upon over time. . .
The focus of capacity building therefore tends
to be on improving the stock rather than on
managing whatever is available.”
- Paul (1995),
Capacity building for health sector reform, WHO
2

3. Capacity building
vs
Training
vs
Human resource development
3

4. Chhattisgarh, ninth largest state of India -25.5 *(census
2011) million population
4

5. 80% of people living in villages/hamlets
32% of Population are Tribal- 7 of India’s primitive tribal groups live here
(Abujhmaria, Baiga, Bharia Saharia, Hill Korwa, Kamar , Birhor)

6. Lush green Forests-44% of land area- is our asset and liability
with Mines –Tin,Coal,Iron

7. State Profile
• Population of the State = 2.5 Crore No of Districts =27
• No of Blocks = 146 No of villages = 20,126
Health Facilities Number of functioning Population covered per
facilities facility
Sub-centres 5,076 3,862
PHC 741 26,400
CHC level hospitals 148 CHC +17 CH=165 1.54 Lakh
District Hospitals 17 15.02 Lakh
Medical colleges 3 85.13 Lakh
7

8. Health systems framework
Interaction with context:
* with national policies, culture, values
Leadership & governance: * with international context
* policy – making * with other sectors and actors
* regulation
* coordination 3 10
Organisation of resources: 8
1
Organisation and delivery of Outcomes:
* universal access
human financing health care services:
* quality of care
resources * primary health care – specialised
4 5 * health problem specific – general
* prevention – curative care
6 7Monitoring & * public – private, for profit – not for profit,
Medical supplies
evaluation / formal - informat
& technologies
information
Goals: 1
* improved health
* responsiveness
Interaction with population: * social & financial
* demand generation protection
9
* participation of individuals and groups in community
* accountability
Guiding by values and principles:
* health care as a right
* autonomy <> security
* protection of public <> response to individual suffering
* effectiveness <> efficiency
* participation, accountability, trust 2
* social justice and equity
* global social responsibility
* sustainability: at which level?
Source: Josefien et al, Inst. Trop. Med., Antwerp

9. Training norms of GoI
Sn. Category Training programme Duration GoI Norm
Maternal Health
1 Medical LSAS (*) 18 weeks One anaesthetist per FRU
Officers EmOC/CEmOC(*) 16 weeks One Ob./Gy. per FRU
(doctors) Management. Of 15 days One doctor per 24x7 PHC and CHC
Common Obstetric
Complications
(SBA)(*)
Blood Storage (*) 3 days One Doctor per FRU
MTP (*) 15 days One doctor per 24x7 PHC and CHC
RTI/STI (*) 2 days One doctor per 24x7 PHC and CHC
2 ANM and SBA (**) 15 days All ANMs and Staff Nurses per 24x7
SNs PHC(all sanctioned post of ANM’s &
SN’s taken in account for calculation)
3 LTs Blood Storage(*) 3 days All LT's posted at FRU
9

10. Training norms of GoI (contd.)
Sn. Category Training Duration GoI Norm
programme
Child Health
4 Medical F- IMNCI (**) 11 days One trained doctor per PHC and CHC
Officers FBNC(*) 3 days One Trained doctor per dist hospital
(doctors) NSSK (**) 2 days All doctors at PHC
Immunisation (*) 2 days One trained doctor per PHC and CHC
5 ANM/ IMNCI (*) 8 days All ANMs, Staff Nurses, AWW(all sanctioned
LHV and post of ANM’s, SN & AWW taken in account
SNs for calculation)
FBNC (*) 3 days All staff nurses
NSSK (*) 2 days All ANM's, LHV & SN(all sanctioned post of
ANM’s, LHV & SN taken into account for
calculation)
Immunisation 2 days All ANM's
(***)
Family Planning, ARSH, IMEP, and Disease Control Programmes……………………so on and so forth
10

11. Capacity building pyramid
11
Source: Christopher Potter, Systemic capacity building, Health Pol and Planning

12. Systemic capacity building
12

13. 13

14. Issues & Challenges
• Training capacity/infrastructure- state/dist.
• Training need assessment
• Quality
– functional status
– faculty/resource pool
– training plan
– database
14

15. Issues & Challenges (contd.)
• Quality
– rationalization of trained HRH
– training material in local language
– fund flow
– tapping other resources (medical college..)
– monitoring tools
– evaluation
15

16. Policy decisions
• Efforts to strengthen SIHFW & RIHFW
• Focus pvt public (nursing training)
• Private sector allowed to use public health
facilities for training
• RMA MBBS bridge course
• Bridge course for AYUSH
16

17. Policy decisions (contd.)
• PHRN engaged for ‘fast-track’ training of MOs
and others
• Mapping under MCH plan
• EmOC and LSAS initiated for MOs
• RMAs being trained for BEmOC and others
• Mitanins promoted for ANM and B.Sc nursing
course
17

18. Policy decisions (contd.)
• ANMs promoted for B.SC nursing course
• MOs working in hardest areas given
preference in PG seats
18

19. Training institutions in the State
Facility 2007-08 Current Status
Govt. Pvt. Total Seats Govt. Pvt. Tota Seats
l
SIHFW 1 0 1 NA 1 0 1 NA
HFW-TC 1 0 1 NA 1 0 1 NA
Dist.TC 6 0 6 NA 14 0 14 NA
B.Sc. Nursing 1 10 11 450 6 41 47 2220
GNM-TC 4 2 6 161 4 25 29 981
ANM-TC 7 1 8 320 13 57 70 2404
MPW(Male) 3 0 3 180 3 41 44 2450
TC 19

20. Health Indicators: (as per *SRS and AHS 2011)
India Chhattisgarh
Indicators 2000 2008 2011
Changes
(2000- 2000 2008 2011
Changes
(2000-
2011) 2011)
IMR Total 68 55 50 88 59 51
-18 -37
IMR Rural 74 61 55 94 61 55
-19 -39
IMR Urban 43 37 34 54 49 40
-9 -14
Birth Rate Total 25.8 23.1 22.5
-3.3 31.2 26.5 23.9
-7.3
Birth Rate Rural 27.5 24.7 24.1
-3.4 33.2 28 24.8
-8.4
Birth Rate Urban 20.7 18.6 18.3
-2.4 23.5 19.9 20.6
-2.9
Death Rate Total 8.5 7.4 7.3
-1.2 10.2 8.5 7.6
-2.6
Death Rate 9.3 8 7.8 11 8.5 8
-1.5 -3
Rural
Death Rate 6.3 6 5.8 7.5 6.5 6.2
-0.5 -1.3
20
Urban

21. Thanks
21