Jharkhand vis-à-vis the other
Although several Indian states have done remarkably well in population stabilization and pro States vision of reproductive and child health services, what makes the Indian performance look mediocre ininternational reckoning is the extremely slow progress made in a few large, northern states. The Government of India has recently begun to focus attention on eight states where the programme performance is particularly poor. The performance is particularly poor in five Empowered Action Group (FAG) states of Bihar, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh falling in a geographically contiguous territory, that includes now three newly formed states, Chattisgarh, Jharkhand and Uttaranchal.
The population of EAG states grew by 25 percent during 1991-2001 compared with the all-India average of 21 percent. Total fertility rate is 4.2, which is a whole one birth higher than the all-India average. Infant mortality rate is 82 as against 68 at the All-India level. In EAG states, only 44% of women are having antenatal check up during pregnancy, one fourth of the deliveries are attended by health professionals, one fifth of the children are fully immunized, and only one third of married women of reproductive ages are using contraception.
The reason for this striking regional contrast is complex and deep-rooted. On the one hand, high rates of poverty, illiteracy and low autonomy of women lead to poor knowledge and low demand of reproductive and child heath services. On the other hand poor infrastructure and bad governance compound the problem, Bridging the gap would require raising public awareness and changing behaviours. Sensitising administrators and encouraging the involvement of private sector in the delivery services
The Jharkhand Government vision
The Jharkhand government will pay special attention to RCH issues of the disadvantaged population living in remote areas.
- 1. It will give greater priority to women's health issues by following a life-cycle approach, providing quality services, and implementing safe motherhood and emergency obstetric care strategies.
- 2. It will place significant emphasis on child health issues by improving healthcare systems, protecting child health rights, and paying attention to nutrition issues.
- 3. It will address gender and human rights issues related to the reproductive health of the population in general and of women in particular.
- 4. It will achieve population stabilization by promoting informed choice and involving men in family planning.
- 5. It will increase the use of modern family planning methods by creating demand through behaviour change communication strategies and by improving the quality of services provided.
- 6. It will enhance technical, managerial and communication skills and competencies of healthcare providers and health managers.
- 7. It will strive to achieve a convergence of services at the grass-roots level, to establish inter-departmental linkages, and to involve elected representatives in programme planning and implementation at various levels.
- 8. It will build partnerships with various stakeholders such as NGOs, the organized sector, and other agencies to achieve synergy and develop institutional capacities.
The Government of Jharkhand think tank vision
- 1. Identification of Mission in September 2003.
- 2. Demand factors, private partnerships, documentation of good practices, Urban Health, Capacity strengthening, financial management and sharpening the tools of performance based management have been identified as some of the key issues to be processed to refine and complete the design process.
- 3. State Ownership critical.
- 4. Flexibility based on state needs and capacities.
- 5. Adequate institutional arrangements need to be in place.
- 6. Process and output indicators to be agreed upfront.
- 7. Insist on monitoring systems regularity and quality.
- 8. Management Capacity to be strengthened in the areas of planning, supervision, budgeting & fund flow.
- 9. Program management capacity at district levels to be strengthened. Weakness caused by frequent turn over, inadequate delegation, low motivation and lack of integration.
- 10. Absence of forecast of requirements of human resources (HR planning), training, posting and promotional policies.
11.Clearly developed state specific BCC Strategies.
- 12.The public heath activities client responsiveness to be improved.
- 13.Improve outreach services particularly regarding routine care and in retaining clients for completing the cycle of care.
- 14.Involvement of communities and local elected bodies in planning, management and monitoring of program performance.
- 15.Include and provide emphasis on neonatal health & adolescent health. Building bridges with other critical sectors such as rural development, sanitation, public health, nutrition(WCD) etc.
- 16.Dedicated structural arrangements to improve Programme management.
- 17.Improved ownership.
- 20.Effective structural arrangements at all levels.
- 21.Strengthened planning, monitoring and supervision.
- 22.Bring about a comprehensive integration of FP into safe motherhood and child health.