Chapter 11 Education, Health, Environment and Housing Education




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Health

11.93 The mission of the Government of West Bengal is to improve the health status of all, especially, the people in greatest need. In view of this, Health Sector Reform Programme has been initiated by the Department of Health and Family Welfare, comprising of the following interventions :



  • Upgradation of physical infrastructure in the primary, secondary and tertiary sector,

  • Manpower planning and rationalization,

  • Involvement of PRIs in health matter,

  • Partnership with profit and non-profit organizations,

  • Administrative and financial decentralization to the District and Block
    Health and Family Welfare Samities ,

  • Grant of functional autonomy to hospitals through formation of Rogi Kalyan Samiti ( Patient Welfare Committees ).

11.94 The state is also implementing the National Rural Health Mission launched by the Government of India on 12th April ,2005, for providing integrated primary health care services, specially to the poor and vulnerable sections of the society.


11.95 Apart from the support from the State Budget and National Programmes, the Government of West Bengal has received financial and technical support from External Development Partners, viz., DFID, EC, KFW-GTZ for this purpose.
11.96 The following Table 11.3 shows the health facilities in West Bengal.

Table 11.3



Health Facilities in West Bengal (2005-06)


Sl. No.

Hospitals/Health Centres

No. of Institution

Total No. of beds (Sanctioned)

A.

Hospitals/Health Centres under Department of Health & Family Welfare

11760

51582

1.

Medical College Hospital

9

11130

2.

District Hospital

15

7010

3.

Sub-Divisional Hospital

45

8506

4.

State General Hospital

35

4019

5.

Other Hospitals

32

7553

6.

Rural Hospitals

95

3418

7.

Block Primary Health Centres

251

4699

8.

Primary Health Centres

922

5247

9.

Sub Centres

10356

0

B.

Hospitals under other Departments of State Government(including Undertaking Government organizations)

67

6042

C.

Hospitals under Local Body

30

940

D.

Hospitals under Government of India(including Undertaking Government organizations)

57

6208

E.

Hospital under NGO/Private

1726

27543




Total

13640

92315

Source : Department of Health and Family Welfare, Government of West Bengal.


Primary Health Care


    1. In the rural areas, through the network of Primary health Care system consisting of 10,356 Sub-Centres, 922 Primary Health Centres(PHC), 251 Block Primary Health Centres (BPHC). In addition to Nursing Homes and Non-Government Organisations, the main thrust has been given on the improvement of primary health care service.

11.98 The following important activities have been initiated during the year, 2006-07:


  • Upgradation of one PHC in each Block (342 PHC) in all the districts with 10-beded 24- hours round the clock facilities,




  • Upgradation of 184 BPHCs in different districts to 30-beded 24-hours round the clock facilities providing higher level services. Out of 184 BPHCs, 82 BPHCs have been upgraded into 30-beded Rural Hospitals,




  • E-Governance activities,




  • Repair, renovation and rehabilitation works at different health Institutions.



  • In the first phase of implementation of KfW funded Basic Health project, civil works for rehabilitation of 38 BPHCs & 92 PHCs and construction of 95 Sub-Centres have been completed. Steps have also been taken to fully equip these rehabilitated facilities with General and Medical epuipment including Furniture & Office Equipment so as to operationalize these upgraded facilities. In the second phase of the Project, starting during2006-07, Rehabilitation / Renovation of further 29 BPHCs with enhanced outlay of about 2 crore per BPHC has been taken up.




  • Under the management of NGO/CBO/Trust etc. under Public Private Partnership (PPP), an innovative Scheme of providing Ambulance Services at the basic health care level, has been iintroduced. The Government has now decided to expand and replicate the Scheme throughout the state. In addition to 133 ambulances already procured and handed over to NGOs for running at BPHC level, 194 ambulances are being procured during the current year under a different project for handing over to NGOs for running in the remaining BPHCs of the state.




  • During the current year, GTZ is providing technical support to design a Health Insurance Scheme for Landless Agricultural Labourers .The design process will be completed by the end of the current financial year. The Scheme is expected to be launched on pilot basis in Burdwan District in 2007-08. In Quality Management , GTZ is helping to develop quality standards, such as Standard Treatment Protocols for primary health care and a Bio-Medical Waste Management System for primary health care institutions. They are also engage in developing quality management systems in public facilities and plan for an accreditation system for quality improvement in the private hospitals . In Public Private Partnership , GTZ is helping to design partnership programmes with NGOs. They will also help us to design a programme for involving private practitioners of the districts in National Public Health Programmes, so that the access of the people to these programmes is increased. They would also provide their assistance in various technical issues of Public Private Partnerships as and when necessary.

  • The State , West Bengal, owing to better health indicators, has been categorized as a low-focus state under the National Rural Health Mission (NRHM) ,2005-2012, launched by the Govt. of India along with other states like Kerala, Tamil Nadu, Andra Pradesh, Karnataka, Maharashtra, Punjab, Haryana and Gujarat and hence all the interventions under NRHM are not applicable to the state. During 2006-07, the following activities were undertaken in the state under the NRHM:




  • Up gradation of the 32 Block Primary Health Centres to Indian Public Health Standards (IPHS)




  • Formaion of Rogi Kalyan Samities (Hospital Management Committees) up to the level of Primary Health Centres and allocation of flexible funds to the Rogi Kalyan Samities up to the level of Block Primary Health Centres/Rural Hospitals.




  • Retention of User Charges at the facilities .




  • Grant of United Fund to all the Sub-Centres of the State @ Rs. 10,000/- per Sub-Centre.




  • Operationalization of 100 PHCs in the State into 10-bedded 24-hours round-the clock facility.




  • Engagement of Second ANMs on contractual basis for all the Sub-Centres of the state.




  • Enhancement of Training Capacities of the existing Government Nursing Training Schools and establishment of 10 Nursing Training Schools in Government Sector.




  • Engagement of 9,645 Accredited Social Health Activists (ASHA) in 60 identified difficult blocks of the state as honorary health worker in each village .




  • Preparation of District Health Plan for the year 2007-08 with bottom-up approach.




  • Establishment of Block Management Unit and engagement of Block Accounts Managers for all the blocks of the state.




  • Procurement of Drugs for First Referral Units as 1PH standards.




  • Procurement of 170 Ambulances for ensuring quick referral services from PHC to higher level health facilities through local NGOs/CBOs/ Trusts on PPP basis.




  • United fund for all the PHCs of the state @ Rs. 25,000/- per PHC.

  • Annual Maintenance Grant to all the PHCs of the state @ Rs. 50,000/- per PHC.




  • Operationalization of 82 BPHCs in the state with at least three specialist doctors and required paramedical staff.




  • Annual Maintenance Grant for all the BPHC / Rural Hospitals of the State @ Rs. 1.00 per lakh per BPHC / RH.




  • An innovative scheme named “Ayushmati” under Public Private Partnership for providing Basic and Emergency Obstetric Care launched this year.

  • These activities will be continued during the year 2007-08 also.




  • Under the Reproductive and Child Health (RCH II) programme, a major flagship programme under National Rural Health Mission (NRHM), thrust has been given on schemes related to Institutional Deliveries, Safe Motherhood, Operationalization of First Referral Units, Basic and Comprehensive Emergency Obstetric Care, strengthening of Referral System, strengthening of Routine immunization and related Cold Chain system, Referral Transport for delivery, etc. Exemption of User Charges has been extended to all pregnant women and children below one year age accessing State Government hospital for institutional delivery and curative treatment irrespective of BPL/APL status. In order to operationalise the First Referral Units, training for the Anaesthetists is going on. 21 FRUs are expected to be functional 2006-07. Two New Sick Born Care units have already been functioning in Purulia and Birbhum ( at Suri) to save critical neo-natal cases. 2 more units at Islampur and Cooch Behar are in process of opening by the end of this period




  • In order to supplement and strengthen the on-going Routine Immunization of the mother and children against six preventable diseases, special immunization weeks are being followed since December,06 and will continue till March,07. These, along with the outreach programme, are being implemented, as an important component of R.C.H. with a view to streamlining the existing Universal immunization Programme(UIP).




  • Reduction of infant mortality as well as maternal mortality continues to be one of the important objectives of the family welfare activities in the health sector strategy. Increasing and promoting institutional deliveries through schemes like Janani Suraksha Yojana is a vital means for reducing IMR and MMR. As a result of concerted efforts, IMR has come down to 38 per 1000 live births in this year from 40 of the previous year. MMR has also remarkably declined from 266 in 2004 to 194 for every 1,00,000 live births in 2005 (as per NSSO data, 2006).




  • Preventive Measures have been taken to control birth rate. Total birth rate has also shown some encouraging improvement. It has fallen to 18.8 from the last year’s 19.3. Reduction of birth rate is a significant indicator towards population stabilization.




  • Polio Eradication Programme has been intensively continuing in our state, with only one case being reported in the year.




  • So far as Mainstreaming of AYUSH ( Ayurvedic/ Unani/ Siddha/ and Homeopathy) is concerned , stresses have been laid down towards total decentralization of the units up to Gram Panchayat level. 200 such new Ayurvedic and 300 new Homeopathic clinics have been sanctioned. These clinics will be run by the Gram Panchayats with the support from the Government.

11.99 During early 80’s, there was no definite structure for delivery of Urban Primary Health Care Services, particularly to the urban poor. The then existing tertiary health care facilities were supposed to address the ailing patients only. Hence, preventive & promotive health care including primary health care services were practically non-existing. As a result , the women and children , the major vulnerable group, were affected.

11.100 In view of the above situation, the State Government launched CUDP III Health Programme assisted by the World Bank for the urban poor of selected ULBs in the jurisdiction of Kolkata Metropolitan Area for a period of seven years. The resultant effect in terms of output in the health scenario was remarkable. With this experience , the several other primary health care programmes for the urban poor, have been launched in phases covering all the 126 Urban Local Bodies of the State, West Bengal. The main thrust of the urban health care programme is mother & child care through reduction of fertility, morbidity and mortality. In fact, holistic health care is envisaged by providing quality health care services at door-steps, accessible health facilities, referral and satellite services.
11.101 Above all, the inner core idea of the programmes is to implement Life Cycle Approach i.e. care of the individual from womb to tomb. Keeping this in perspective,the care package starts as soon as the women become pregnant. In addition,the adolescents are being taken care of as they are the future parents of the Nation.
11.102 Community participation at different tiers is the essence of these programmes which indicate a paradigm shift from ‘Top Down’ to ‘Bottom Up’ approach.

11.103 The objectives are overall improvement of urban health scenario with reference to



  • reduction in Crude Birth Rate (CBR),




  • provide primary health care service delivery to the requirements of the urban population with focus to BPL population,







  • ensure maximum utilization of Govt. Institutions for referral services with regard to Maternity, Child Health, Diagnostic and Curative services.

11.104 The strategy of these programmes are:




  • Health & Family Welfare Committee has been formed for each ULB to oversee health issues and its addressal,




  • The existing Ward Committee is responsible for monitoring & supervision and co-ordinating the implementation of Primary Health, Public Health and National Health programmes at ward level,




  • Co-ordination and linkage with Department of Health & Family Welfare at state, District and Sub-Division level,




  • Decentralisation of services in three tier systems i.e.grass-root level (door-step) , urban sub-health center and referral for effective permeation of RCH, Public Health Services to the community,




  • Providing package of primary health care services by the female Honorary Health Workers (HHWs) at grass-root level,




  • The HHW, drafted from the community itself , looks after about 1000 population i.e.200 BPL families approximately and maintains link between the health facilities and the community,




  • A Sub-Centre is to cover 5000 BPL population, the accommodation of which is provided by the ULBs/ NGOs/ CBOs ,




  • Referral services has been linked with the nearest Govt.facilities like Distrct Hospital,Sub- Divisional Hospital, State General Hospital, Block Primary Health Centre (BPHC), Rural Hospital, Municipal run referral center as applicable,




  • Strong Information, Education & Communication (IEC) base is developed for enhancing motivation and health awareness generation,




  • Computerisation of Health Management Information System(HMIS) is done for monitoring & evalution of the programmes.

11.105 Expected Outcome at a glance :




  • For Mother: Enhanced pregnancy care; Uncomplicated / Clean & Safe delivery; Increased Institutional delivery; Increased T.T, goverage; Reduction of Maternal Morbidity & Mortality; Reduction of Low Birth Weight Babies (LBWs).




  • For Children : Reduction of Infant Mortality; Promotion of Breast Feeding; Proper Weaning & feeding practices; Immunisation coverage of infants i.e. BCG, DPT, OPV & Measles; Reduction of incidence of Anaemia; Reduction of Morbidity from Diarrhoeal dehydration, ARI & Vaccine Preventable Diseases.




  • For Eligible Couples : Reduction in unsafe Medical Termination of Pregnancy (MTP) case; Increased awareness level of the reference community in Reproductive & child Health, Family Welfare & Nutrition; Enhanced Couple Protection Rate.




  • For Adolescents : Enhanced adolescents health care; Increased awareness on health issues including RTIs, HIV/AIDS.




  • Others : Reduction in communicable diseases of under-5 children; Community participation in management of public health; Improved sanitation; Enhanced access to safe water.

11.106 The Table 11.4 shows the different Urban Health Programmes running in West Bengal.


Table 11.4

Different Urban Health Programme in West Bengal


Sl. No.

Project

Project Assisted

Duration of Project

Population covered

No. of ULBs covered

1

CUDP-III

World Bank

1985-86 to 1991-92

16.00 lakh in KMA

41


2

CSIP

DFID

1992-93 to 1997-98

2.85 lakh in KMA

3

IPP-VIII

World Bank

1993-94 to June 2002

38.00 Lakh in KMA

4

IPP-VII-(Extn.)

World Bank

2000 to June 2002

8.30

lakh in Non-KMA



10

5

R.C.H. Sub-Project

World Bank

1998 to March, 2004

2.53 Lakh in Non-KMA

1

6

HHW Scheme

DFID

Feb.,2004 Continuing

2.86 lakh in Non-KMA ULB

11

7

Community Based Primary Health Care Services

Dept. of Healthy & Family Welfare

Feb., 2006 Continuing

11.23 Lakh in Non-KMA ULBs

63

Source : Department of Municipal Affairs, Government of West Bengal.


It is to be noted here that all the above mentioned Programmes are continued and maintained by the State Government after cessation of external funding support.
11.107 In the light of the Urban Primary Health Care services, the main target group, the poor and marginalized people have been benefited to a great extent so far their health needs are concerned. The urban areas have shown remarkable progress in reduction of birth rate, infant mortality and maternal mortality rate with enhancement of couple protection rate as well.


    1. This model of Community Based Health Programme launched by the State Govt. has not only been appreciated by other States of India but also has been applauded by WHO and different Foreign Donor Agencies. The State Govt. is very much concerned about the urban health matters and is committed to continue such primary health care services, preventive & promotive in nature, in all the Urban Local Bodies covering total population with focus on poor and marginalized ones.



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