Health Systems Strengthening

  • Adoption of the Indian Public Health Standards: This defined not only the service package that each facility must provide, but also specified the minimum inputs required to ensure quality of care, in terms of infrastructure, equipment, skilled human resources, and supplies. It was an assurance to the states of financing the gaps between available levels of these inputs and the levels needed to achieve the IPHS norms. A substantial increase in these inputs was driven by facility surveys to identify gaps and then planning and financing to close these gaps.
  • Quality standards have been defined with respect to clinical protocols, administrative and management processes and for support services. The Operational Guidelines for Maternal and Newborn care published by the Ministry of Health and Family Welfare comprehensively defined such quality standards for RCH care.
  • Skill gaps and Standard Treatment Protocols: Skill sets and standard treatment protocols required for provide quality RCH services and training packages that would provide these skill sets were designed. These include the Skilled Birth Attendance (SBA) training package for ANMs, the Navjat Shishu Suraksha Karyakram (NSSK) and the IMNCI packages for ANMs, the Home Based Newborn Care (HBNC) for ASHAs, and the Emergency Obstetric Care (EmOC) package for doctors. These training packages also introduced the standard treatment protocols in each of these areas.
  • Hospital Management Societies (RKS) and untied funds: The mandatory creation of a hospital management society (Rogi Kalyan Samiti) and empowering this body with untied funds has allowed public participation also contributed to improved quality of care. RKS members were trained and sensitized on quality of care issues. Before the onset of NRHM, many states generated funds from user fees, however the untied grants to all public health facilities were made available under NRHM which reduced financial barriers to access of health care. This is clearly evident from the increased utilization of indoor and outdoor services at health facilities
  • Quality Improvement Programmes: NRHM also supports initiatives for building quality management systems. These range from formation of quality assurance committees which use check lists and periodic monitoring visits to assess quality gaps, to more structured quality management systems leading to a third party audit and quality certification- either using ISO 9001: 2008 or NABH. Till date, 82 facilities have been certified by ISO, nine facilities have been certified by NABH and 446 facilities are under process of certification.