Soon after taking the charge of the Health Ministry, the Uttarakhand Health Minister Dr. Ramesh Pokhriyal ‘Nishank’, in his mission to improve the health services in the state, did not loose time to check and inspect the state of affairs in the hospitals and health centers. While the general public did appreciate his enthusiasm and action to improve the health services in the state, the public health professionals knew that such actions and ‘danda approach’ are short lived and not a sustainable to improve health services in the long run.
To improve the health services in the state, reforms in Health Sector are imperative. Many health sector reforms have been mentioned in various academic and policy papers and many countries and governments have initiated reforms to improve their health services.
One major suggestion has been through the public-private partnership mechanism. The state should encourage and facilitate private hospitals, companies, NGOs and trust to invest and operate some of the existing health institutions and also to open new health institutions.
In Uttarakhand, we need to invite proposals from Private parties, NGOs, trusts to be partners in managing our health system. To begin with, the Bhowali TB sanatorium and Hospital, Ramsey Hospital, Nainital, Coronation Hospital, Dehradun, Government Hospital, Haldwani, can be taken up for joint ventures.
All types Medical Colleges, including those in private sector can be given one Primary Health Centre (PHC) in their area to operate and Manage the services.
The process of decentralization can be initiated by placing the Health Services under local self government, in accordance with the Panchyati Raj Act.-73 & & 74. A beginning with District Hospitals and other Urban Health Institutions can be placed under Nagar Nigam and Nagar Pallikas. Government doctors and staff can be posted on deputation till Nigams/Pallikas appoints its doctors and other staff. A beginning with district Dehradun can be made.
The state has already seen the opposition from within when the village level health functionaries were placed under the Gram Panchayats. The process could be started with first placing the funds under the panchyati raj institutions.
The process of decentralization needs strong political will as a strong opposition from within to change the status quo is expected and is natural.
To ensure good quality of drugs, medicines and their logistics, the procurement of drug, medical equipments and consumables needs to be de-linked from the health directorate and can be given to Garhwal and Kumaon Mandal Vikas Nigams or any other specialized agency. Not only the Procurement, but also the storage and transportation of this right up the Primary Health Centre level can be done and given to GMVN/KMVN. This will ensure that the health directorate will always point fingers, if there is any comprise on the quality of drugs and on the logistics support.
There is the need for administrative reforms in health bureaucracy. A large number of doctors in the state are doing administrative work, which can be taken up by non-medical managerial staff. In a state were the doctors in Health institutions are in acute shortage, there is need to abolish some of the posts/offices.
To begin with we need to abolish the post of Deputy CMO. Many specialist doctors in the district are being made Dy.CMO due to promotion reasons. They can be given the same salary grade and suitable designation at the district Hospitals.
Time to abolish regional office, at Pauri and at Nainital, which are present since Uttar Pradesh days. Now the present state can do without these offices.
The dearth of human resources, particularly doctors in the Health sector is known. The Nursing and Para-Medical staff also assists, substantially in providing the health services. By opening Nursing and Para Medical schools in the government Hospitals, we can have more Para medics in the coming years. With the kind of infrastructure available, most of the district and base hospitals can start B.Sc- Nursing and B.Sc in various Para Medical courses. The state government can provide, the necessary technical and financial support, to open many Para medical schools. Public Private Partnership is this area can also be explored.
There is a need Health Regulatory Authority in the state. The state has no knowledge and legal framework to control, monitor and regulate Health Providers and Institutions giving health services in the state. The state needs to have a Health services regulatory authority.
The above are some of the areas, where the state can initiate the process of Health Sector reforms.