Skip to main content

'Retrograde move': Chhattisgarh govt winding up Health Resource Centres, a model for other states

By Dr Antony KR* 
In the history of Public Health in India, a significant mile stone was, the introduction of Target Free Approach in 1996 by the visionary Secretary of Health Shri J.C. Pant. A shift from centrally set targets to the felt and expressed needs of the community in Programming. This was a liberation from the age-old yoke of targets upon the Health Staff, from the lowest cadre ANM to District Medical Officer and State Health department Supervisors. Ever since the first two National Health Programmes of Family Planning and Malaria Control started, it was always a target driven monitoring and performance assessment. Targets and number games have no human face, consideration for patient rights, quality of services, or client satisfaction. This paradigm shift led to the local adaptation in need assessment, approach to community for their involvement and support in programme planning and implementation.
Almost a decade later National Rural Health Mission was launched in 2005 while Secretary of Health Shri P.K.Hota and Joint Secretary Shri Amarjeet Sinha were in command. It had a vision of Improving access of rural people, and marginalized communities, especially poor women and children, to equitable, affordable, accountable and effective primary healthcare. This was to be achieved through participatory bottom-up planning and decentralization to district level management. One of the five main approaches in NRHM was the Communitization agenda. The components of this community oriented and community involved process was the selection and capacity building training of ASHAs, formation of a grass root level team of ASHA, ANM, Anganwadi Worker triad, formation of Village level Health, Nutrition, Water and Sanitation committees, Rogi Kalyan Samitis for PHC/CHC and District Hospitals. Ensuring accountability and quality in health service delivery for best Client Satisfaction was the aim.
Those were not a prescription from the standard text books in public health, but an evolved process especially in the newly formed State of Chhattisgarh since 2000 through the stewardship of another pioneering model of technical capacity building for Public Health Service delivery called State Health Resource Centre.
SHRC Chhattisgarh was formed after a Civil society-government partnership consultation and it had quickly initiated the selection and training of Mitanins (friend of women) in every habitation of 1000 population, the prototype of ASHAs later under NRHM. Over 15-18 rounds of cascade model of training using very innovatively adapted modules, the not so educated Mitanins acquired an amazing level of knowledge and skills over two decades. Apart from house visits and gathering of data, they provided basic symptomatic medicines for temporary relief from their Dawa Peti, and gathered children and mothers for immunization, and medical check-ups. They diagnosed pregnancy using kits, also collected sputum for tuberculosis and blood smears for malaria diagnosis. Provision of directly observed treatment for TB and supply of blister packs for Leprosy treatment were undertaken by Mitanins.    
Their constant onsite mentoring and supportive supervision was provided by Mitanin Trainers, Block and District level Resource persons. Before NRHM was launched these 25000 Mitanins provided free service for nearly three years. Respect and recognition in their villages and hamlets were the only remuneration they got. After 2005 they started getting performance linked honorarium like ASHAs elsewhere in the country.
SHRC was providing technical support to the State Health Sector in annual Project planning and budgeting, identifying crucial human resource gaps and their recruitment, operationalizing First Referral Units for Emergency Obstetrics and Newborn Care, operationalizing 108 Ambulance system for Emergency transportation, etc. It organized policy workshops on Malaria and TB control, Leprosy eradication, Sickle Cell anaemia etc. It got a Corporation formed for Drugs and Equipment procurement and supply similar to that of Tamil Nadu model. Urban Health Mission piloting and recruitment of staff for NRHM and NACO were undertaken by SHRC.
 Seeing the vibrancy and innovations undertaken by SHRC Chhattisgarh for NHM, at the National level authorities decided to replicate similar SHRCs in other states. 12 States launched SHRCs emulating the Chhattisgarh model till 2019 and now it is 18 States. At national level an NHSRC was formed with similar objectives and functions for providing Technical Support to Government of India under the leadership of Dr Sundararaman who was the first Director of SHRC Chhattisgarh. In 2022 the NHM raised the budget allocation for running cost of major State SHRCs to Rs 2.5 Crores annually.
Union Health Ministry has come out with a Framework on SHRC operationalization in June 2024.It recognizes it as an apex body for providing technical assistance to States having so many diverse challenges and unique features, undertaking implementation research, monitoring and evaluation, health system development and act as a “think tank” to provide innovations, document good practices and launch pilot projects. SHRC Chhattisgarh has been pioneering all these ideas even before NRHM started and continued playing that role model for the last two decades.
The last MOU is now expired and fate of the employed professionals are undecided. Already the State Programme Unit of NHM has taken over the Mitanin program and ASHA Resource centre at SHRC.
While the Union Government is actively promoting more of States to follow the example of Chhattisgarh, the irony is that the current government is closing down its own well acclaimed model. Instead of encouraging “out of the box” thinking by a think-tank to resolve their problems, the State is pruning the autonomy of Public Health experts to purely confine to their regimented dictates. This is quite a retrograde move, not beneficial to the marginalized communities in Chhattisgarh. An urgent course correction is highly warranted.   
----
*Independent Monitor, National Health Mission, Govt of India; Former Director, State Health Resource Centre, Chhattisgarh; Former Health & Nutrition Specialist, UNICEF, India; Life Member of Indian Academy of Paediatrics, Indian  Public Health Association, Public Health Resource Network

Comments

TRENDING

Loktantra Bachao Abhiyan raises concerns over Jharkhand Adivasis' plight in Assam, BJP policies

By Our Representative  The Loktantra Bachao Abhiyan (Save Democracy Campaign) has issued a pressing call to protect Adivasi rights in Jharkhand, highlighting serious concerns over the treatment of Jharkhandi Adivasis in Assam. During a press conference in Ranchi on November 9, representatives from Assam, Chhattisgarh, and Madhya Pradesh criticized the current approach of BJP-led governments in these states, arguing it has exacerbated Adivasi struggles for rights, land, and cultural preservation.

Promoting love or instilling hate and fear: Why is RSS seeking a meeting with Rahul Gandhi?

By Ram Puniyani*  India's anti-colonial struggle was marked by a diverse range of social movements, one of the most significant being Hindu-Muslim unity and the emergence of a unified Indian identity among people of all religions. The nationalist, anti-colonial movement championed this unity, best embodied by Mahatma Gandhi, who ultimately gave his life for this cause. Gandhi once wrote, “The union that we want is not a patched-up thing but a union of hearts... Swaraj (self-rule) for India must be an impossible dream without an indissoluble union between the Hindus and Muslims of India. It must not be a mere truce... It must be a partnership between equals, each respecting the religion of the other.”

A Marxist intellectual who dwelt into complex areas of the Indian socio-political landscape

By Harsh Thakor*  Professor Manoranjan Mohanty has been a dedicated advocate for human rights over five decades. His work as a scholar and activist has supported revolutionary democratic movements, navigating complex areas of the Indian socio-political landscape. His balanced, non-partisan approach to human rights and social justice has made his books essential resources for advocates of democracy.

Four J&K MLAs visit Wular lake, pledge support to fisher community, environmental conservation

By Shamim Ahmed*   In a historic meeting that highlighted both environmental and social concerns, four Members of the Legislative Assembly (MLAs) visited Wular Lake to meet with the fisherfolk community, signaling a significant step in addressing their longstanding issues. This gathering, organized with the support of dedicated advocates, marks a strengthening of efforts to both safeguard the lake’s ecosystem and support the community’s welfare.

Supreme Court’s dismissal of PIL on Covid vaccine safety is counter to known science and mathematics

By Bhaskaran Raman*  On 14 Oct 2024, the Supreme Court of India dismissed a Public Interest Litigation (PIL) on the side-effects of the Covid vaccine. In 2021, the world saw the rollout of various Covid vaccine candidates. In India, Bharat Biotech’s Covaxin and Serum Institute of India’s Covishield were rolled out. Covishield was nothing but Oxford’s AstraZeneca relabelled in India. The importance of open-minded and scientific probe of Covid vaccine safety In 2020/2021, all Covid vaccines were authorized for emergency use, which meant that the necessary efficacy and safety follow-up was incomplete at that time. The originally approved trials – called randomised controlled trials (RCT) had a “vaccine” group and a “placebo” group for comparison. Such experimental comparison/control is the cornerstone of the scientific method – which even children learn in photosynthesis experiments in class-1. The vaccine trials were scheduled to conclude in late 2022/early 2023. For instance, Covax...

Swami Vivekananda's views on caste and sexuality were 'painfully' regressive

By Bhaskar Sur* Swami Vivekananda now belongs more to the modern Hindu mythology than reality. It makes a daunting job to discover the real human being who knew unemployment, humiliation of losing a teaching job for 'incompetence', longed in vain for the bliss of a happy conjugal life only to suffer the consequent frustration.

A Hindu alternative to Valentine's Day? 'Shiv-Parvati was first love marriage in Universe'

By Rajiv Shah  The other day, I was searching on Google a quote on Maha Shivratri which I wanted to send to someone, a confirmed Shiv Bhakt, quite close to me -- with an underlying message to act positively instead of being negative. On top of the search, I chanced upon an article in, imagine!, a Nashik Corporation site which offered me something very unusual. 

Buddhist shrines were 'massively destroyed' by Brahmanical rulers: Historian DN Jha

Nalanda mahavihara By Our Representative Prominent historian DN Jha, an expert in India's ancient and medieval past, in his new book , "Against the Grain: Notes on Identity, Intolerance and History", in a sharp critique of "Hindutva ideologues", who look at the ancient period of Indian history as "a golden age marked by social harmony, devoid of any religious violence", has said, "Demolition and desecration of rival religious establishments, and the appropriation of their idols, was not uncommon in India before the advent of Islam".

Right-arm fast bowler who helped West Indies shape arguably greatest Test team in cricket history

By Harsh Thakor*  Malcolm Marshall redefined what it meant to be a right-arm fast bowler, challenging the traditional laws of biomechanics with his unique skill. As we remember his 25th death anniversary on November 4th, we reflect on the legacy he left behind after his untimely death from colon cancer. For a significant part of his career, Marshall was considered one of the fastest and most formidable bowlers in the world, helping to shape the West Indies into arguably the greatest Test team in cricket history.

Will Left victory in Sri Lanka deliver economic sovereignty plan, go beyond 'tired' IMF agenda?

By Atul Chandra, Vijay Prashad*  On September 22, 2024, the Sri Lankan election authority announced that Anura Kumara Dissanayake of the Janatha Vimukthi Peramuna (JVP)-led National People’s Power (NPP) alliance won the presidential election. Dissanayake, who has been the leader of the left-wing JVP since 2014, defeated 37 other candidates, including the incumbent president Ranil Wickremesinghe of the United National Party (UNP) and his closest challenger Sajith Premadasa of the Samagi Jana Balawegaya.