Health Sector Reforms

1
Health Sector Reforms

• Shiv Chandra Mathur
• Director
• State Institute of Health and Family Welfare,
  Rajasthan, Jaipur

2
Challenges to the Health System

• Stagnant public spending on health
• Between 75-90 spending by states. Largely tied
  up in salaries expenditures
• Curative public services favor the rich
• Hospitalization frequently means financial
  catastrophe.

3
WDR 1993 - Approaches

• Fostering environment enabling households to
  improve health
• Improving Government spending on Health
• Promoting diversity and competition.

4
Health Sector Reforms

• What do we mean by reforms?
• What are the essential components of reforms?
• How do reform differ from Normal evolutionary
  system changes?

5
Health Sector Reformsdefinitions

• Sustained, purposeful change to improve the
  efficiency, equity and effectiveness of the
  health sector.
• Berman,1995

• A process that seeks changes in health sector
  policies, financing, and organization of
  services, as well as the role of government, to
  reach national health objectives.
• Population Council,1998

6
HSR is concerned with

• Defining priorities
• Refining policies
• Reforming Institutions

7
HSR deals with

• Equity
• Efficiency
• Quality
• Financing

8
Principles of Health Sector Reforms

• Overseeing the needs of the entire population
  pro-poor gender sensitive and client friendly.
• Looking forward to the health transition
• Removing the blind spot to the private sector
• Focusing efforts by ensuring quality,
  efficiency and accountability of health services

9
Functions covered by HSR

• Governance
• Provisions
• Financing
• Resource Generation

10
Key elements of HSR

• Structural rather than incremental/evolutionary
  change
• Change in policy objectives followed by
  institutional change, rather than redefinition of
  objectives alone
• Purposive rather than haphazard change
• Sustained and long term rather than one off
  change
• Political top down process led by national,
  regional or local government.

11
Governance related HSR

• Evolving standard protocols for care at P/S/T
  care settings
• Quality assurance mechanism such as Consumer
  Protection Act and Citizens charter for
  hospitals
• Appropriate delegation of power to PRIs.

12
Classifying HSR- financing

• User Charges
• Insurance
• Private sector Growth
• Increasing resources to health sector

13
Classifying HSR- health system organization and
management

• Decentralization
• Contracting out of services
• Reviewing the public-private mix.

14
Classifying HSR - Public Sector Reforms

• Downsizing the public sector
• Productivity Improvement
• Improving geographic coverage
• Increasing role of local government.

15
Reforms attempted in Health and F.W.Sector in
Rajasthan

• Jan Mangal Project 1992
• Strengthening FRUs 1994-2001
• Decentralized District Planning since 1995-96
• Creation of RMRS-user charges since 1995-96
• Reorganizing the Training System 1995-96
• Concurrent Evaluation in F.W.Program 1996-97

16
Reforms attempted in Health and F.W.Sector in
Rajasthan - 2

• Draft Training Policy 1997-98
• Devolution of Powers to PRIs - 90s
• Population Policy 2000
• Job Responsibilities specifications 2000
• Preparation of EDL 2000
• Health Vision Document 2025