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P LANNING P ARADIGM
quality of care in the private sector as
well as create some accountability
Strengthen the health information
system and database to facilitate better
planning as well as audit and accountability.
Infact the NRHM clearly articulates the
need for architectural correction. Such
restructuring will be possible only if:
The healthcare system, both public and
private, is organized under a common
umbrella/framework as discussed
above
The fi nancing mechanism of healthcare
is pooled and coordinated by a
single-payer system
Access to healthcare is organized under
a common system which all persons
are able to access without any barriers
Public fi nance of healthcare is the predominant
source of fi nancing
The providers of healthcare services
have reasonable autonomy in managing
the provision of services
The decision-making and planning of
health services is decentralized within
a local governance framework
The healthcare system is subject to
continuous public/community monitoring
and social audit under a regulated
mechanism which leads to accountability
across all stakeholders
involved
The NRHM Framework
one way or another
116 THE IIPM THINK TANK
tries to address the above issues but has
failed to come up with a strategy which
could accomplish such an architectural
correction. The framework only facilitates
a smoother fl ow of resources to the lower
levels and calls for involvement of local
governance structures like panchayat raj
institutions in planning and decision making.
But the modalities of this interface
have not been worked out and hence the
local government involvement is only
peripheral. In order to accomplish the
restructuring that we are talking about
the following modalities among others
need to be in place:
All resources, fi nancial and human,
should be transferred to the local authority
of the Health District (say Block
panchayats)
The health district will work out a detailed
plan which is based on local
needs and aspirations and is evidence
based within the framework already
worked out under NRHM with appropriate
modifi cations
The private health sector of the district
will have to be brought on board as
they will form an integral part of restructuring
of the healthcare system
An appropriate regulatory and
accreditation mechanism which will
facilitate the inclusion of the private
health sector under the universal access
healthcare mechanism will have to
be worked out
Private health services, wherever
needed, both ambulatory (FMP) and
hospital, will have to be contracted in
and appropriate norms and modalities,
including payment mechanisms and
protocols for practice, will have to be
worked out
Undertaking detailed bottom-up planning
and budgeting and allocating resources
appropriately to different institutions/providers
(current budget levels
being inadequate new resources will also
have to be raised)
Training of all stakeholders to understand
and become part of the restructuring
process
Developing a monitoring and audit
mechanism and training key players to
do it
Further the most important challenge
would be reining in the completely as yet
unregulated private health sector. Where
the private health sector is concerned it
functions completely on supply-induced
demand which fuels unnecessary procedures,
prescriptions, surgeries, referrals
etc.. leading to its characterization as an
unethical and mal-practice oriented provisioning
of healthcare. This has huge fi -
nancial implications on households, infl
ating costs of healthcare, spiraling
indebtedness and pauperization and being
responsible for the largest OOPS anywhere
in the world.
The challenges across the
country differ due to different
levels of development of
the public and private health
sectors in the states. For in-