Community Psychiatry in India

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Monthly Archives: April 2014

Emerging intersectoral health/social programs in Kerala.

See below a collated list of emerging intersectoral health (physical+ mental) and social care programs in Kerala. This list is complied based on newspaper reports of last three months.


Name of program/ Initiative


 


Collaborating Stakeholders


 


Target­­­­­­ area/population


 

Lifestyle Education and Awareness Programme (LEAP)


 

National Rural Health Mission (NRHM), The State Health Department, and the Education Dept.


 

Children (? School going)


 

District Early Intervention Centres (DEICs)


 

RBSK (Rashtriya Bal Swasthya Karyakram),Departments of Health and Social Justice, ‘State-wide Initiative on Disabilities’


 

All Children with disabilities 0-18 yrs


 

­­­­Dial A doctor (1056)


 

DISHA (Direct Intervention System for  Health Awareness), NRHM,The State Health Dept.


 

Health care and counseling over telephone


 

State-wide joint survey to prepare a database on disabilities


 

Departments of Health, Education, and Social Welfare, State social security mission,‘State-wide Initiative on Disabilities’


 

All age group, Prevention of disabilities, early detection and intervention, education, and rehabilitation.


 

NUHM (National Urban health mission)


 

The Health Dept, Depts of Urban Affairs, Social Justice, and Local Self Government with expanded District Health Societies.


 

Health care in urban areas.


 

NCD (Centrally sponsored Scheme)


 

NMHP, Cancer control, Diabetes, CVD, Stroke,Elderly care and Trauma


 

All non communicable diseases.


 

Clean campus/ Save campus.
(This list is not exhaustive)
 Home Dept+ Edu Dept.

Substance use in schools.

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NRHM: Expectation Vs Reality

This post is based on this report in TheHindu which is based on analysis of data from the India Human Development Survey (IHDS) of 2004-05 and 2011-12. It is a comparative analysis of the The Right to Education Act (RTE) , the National Rural Health Mission (NRHM), and the Janani Suraksha Yojana (JSY) across the said time frame. An excerpt on the NRHM is below

The NRHM is supposed to strengthen preventive and curative care, particularly in rural areas and in States with poor health infrastructure such as Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh. However, a very small proportion of the Indian population relies on public facilities. About 70 per cent of patients visit private providers — either as their first choice or once they are frustrated with public services.

Between 2005 and 2012, years when the NRHM was implemented, instead of increased usage of government services, we see a modest growth in the use of private services for minor illnesses such as cough, cold and fever (from 69 per cent to 73 per cent) as well as for treatment of major illnesses like diabetes, cancer and heart problems (from 67 per cent to 72 per cent). Ironically the greatest increase in the use of private services is in high-focus large States like U.P., Bihar, Rajasthan, M.P. and Orissa. Here the proportion of patients going to private providers increased by nearly 5 percentage points.

The disenchantment of parents and patients with government services is widespread. When asked in 2012 about their confidence in government and private schools and medical facilities, 53 per cent of the respondents expressed confidence in government schools compared to 72 per cent for private schools. Similar differences are observed for confidence in government doctors vis-à-vis private doctors. What explains this? There is no reason to believe that private doctors and teachers are more qualified than government doctors and teachers. Typically government recruitment standards are more stringent about training and qualifications while there is little control over the private sector. It is hard to imagine that anyone would prefer a self-styled private “doctor” in a distant village to an MBBS doctor in a Primary Health Centre (PHC). Yet, this is exactly what we see around us.

The reasons for these preferences are myriad. Parents and patients feel disrespected by government service providers and may find they get better service if they pay. For example, about 6 per cent of the patients see a government doctor or nurse in their private practice rather than in the government dispensary where the same services could be practically free. Government facilities are often irregular in their opening times and teacher and doctor absenteeism adds to the disenchantment.

My current vocation is as Filed Psychiatrist under the community Mental Health Program (CMHP), Kottayam District Kerala. The funds for the program are channelized through the NRHM. This mechanism made it possible for the DMHP/CMHP to establish in districts were the district hospitals are understaffed to to take up the program.

The CMHP is a hybrid venture of the regional medical college, and staff and vehicle provided by the NRHM. The potentials/pitfalls of this arrangement needs to be explored in due course. Early indications is that the program will suffer in terms of quality as all people involved in this arrangement have no long term stakes in the program. The program can at best drift along as it is nobody’s child.

One positive that I have noted is that infrastructure in all Commnity Health Centres (CHC) have improved thanks to NRHM funding. I also meet a lot of primary care doctors who have been appointed by NRHM. Other programs like the palliative care program and many other social care programs have nurses and counsellors appointed under NRHM.

Staff in the program which includes me are in contract employment. Salary and perks are less compared to those in permanent employment. Phenomenon called “service break” is built into the arrangement i.e every first day of the academic year (April 1) all staff contracts expire and we are reappointed on April 2. The staff  has been resisting this for a while, see below.

https://twitter.com/ram3481/status/451374245273018369

NRHM staff in Allahabad has also been demanding regularisation of tenure. See here. This post ends here.

https://twitter.com/ram3481/status/451374525624483840

Other recent connected news:

1. http://www.thehindu.com/news/national/kerala/national-health-mission-gasping-for-funds/article6063842.ece

2. http://www.newindianexpress.com/states/kerala/State-Health-Mission-Yet-to-be-Revamped/2014/06/02/article2258420.ece

3. http://www.thehindu.com/todays-paper/tp-national/tp-kerala/funds-crunch-nhm-fails-to-deliver/article6076996.ece

4. Lack of capacity at state level to absord nrhm funds

5. State gov reprioritising projects.”From 2014-15 onwards, Government of India has decided to route Central assistance through the Consolidated Fund of the State (CFS) instead of transferring directly to the implementing departments/agencies. While proposing CSS and other Centrally-assisted schemes for the next financial year, this point should also be taken into account.”

6. http://www.thehindu.com/todays-paper/tp-national/tp-kerala/nrhm-no-short-cut-to-universal-health-care/article3612505.ece “He said that with the NRHM focussing more on maternal health and child care, the idea of UHC somehow seemed to have been lost. But the NRHM could only be seen as an interim arrangement to fill out critical gaps in service delivery. It was up to the States to build on the basic infrastructure, Dr. Ramankutty, said.”