The health department of Rajasthan has taken a number of initiatives for improving the quality of healthcare delivery. According to a report , the Government of Rajasthan has been working very hard for the last four years to improve the health of common people.
Mission Parivar Vikas has been launched recently for improving the total fertility rate in Rajasthan, under which 14 districts have been targeted where total fertility rate is more than three. Similarly Mission Indradhanush and Intensified Mission Indradhanush (IMI) have been introduced in Rajasthan for encouraging vaccination and immunisation of children to ensure positive health outcomes in the State.
For improving maternal health and child health, many new initiatives, like the Chirayu programme, have been taken up. It has been executed in eight districts of Rajasthan where newborn mortality rate is very high. Moreover, initiatives like telemedicine, mobile dental van and many other initiatives have been introduced by the State Government.
The healthcare infrastructure in rural Rajasthan is also making a progress. Now people residing in rural areas are very satisfied with the healthcare infrastructure available there, the report points out.
Earlier, there used to be only a few centres with Auxiliary Nurse Midwives (ANMs) and doctors. But now every village in Rajasthan is connected to some sub centre or Primary Health Centre (PHC) or Community Health Centre (CHC). The state has also made available free of cost many drugs and diagnostic facilities to the public.
Under the Bhamashah Swasthya Bima Yojana, the entire treatment package is available to 67 per cent of the population free of cost if they hold a National Food Security Act (NFSA) card.
The children suffering from dental problems in rural schools in villages. To eradicate this issue, the government has introduced dental mobile vans which provide dental care services in all districts majorly to school children. Many new dentists have been deputed and dental chairs as well as dental treatments have been made available at CHC level. The state has also implemented an oral health programme. These measures will help improve the overall health status in the State.
Since Rajasthan is the largest state in the country having many unapproachable areas, to make health facilities accessible to all is a major challenge. Availability of sufficient number of doctors and super specialists is also an issue.
To overcome the shortage of doctors and paramedical staff, the state has started many courses in medical colleges. Likewise, it has initiated a 21-month course in medical colleges and tied up with the College of Physicians and Surgeons (CPS), Mumbai for starting similar kind of courses.
Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) cell is doing a wonderful job. The team has not only controlled female foeticide and sex determination in Rajasthan, but with the support of IPC and CrPc provisions and in collaboration with teams of neighbouring states, has acted against unregistered centres or registered centres involved in illegal act in six other states. States like Punjab, Haryana, Uttar Pradesh, Delhi, Gujarat, and MP have been also covered by PCPNDT team.
Female foeticide has become a subject of discussion these days. The rural areas people are changing their mindset and realising the importance of daughters. People have started educating their girl children, supporting them in their career and making them equal shareholders in property. These improvements in societal mindset will result in reduction of female foeticide and will improve child sex ratio.
Earlier, there used to be only a few centres with Auxiliary Nurse Midwives (ANMs) and doctors. But now every village in Rajasthan is connected to some sub centre or Primary Health Centre (PHC) or Community Health Centre (CHC). The state also made available free of cost many drugs and diagnostic facilities to the public.
Though Rajasthan has made significant improvement in healthcare sector, the state still has to make progress in many health indicators to deliver world-class quality health services, said Sheena Chhabra, Senior Health Specialist, Global Practice on Health, Nutrition and Population, World Bank, in her special address at the 3rd Healthcare Summit Rajasthan recently.
In terms of female literacy, Rajasthan is still comparatively lower than other states. But as Rajasthan is marching towards addressing issues relating to pregnancy, maternal and child directed causes, it also has an equal burden of non-communicable diseases, according to Chhabra.
“In terms of progress, I think that although Rajasthan started from a very low base what is exciting to see is that significant progress has been made over the last decade or so. If we see infant mortality rate, the rate of decline mirrors the rate of decline nationally. Infant mortality has declined by 36 per cent in Rajasthan. Similarly when we look at maternal mortality, it has reduced from 445 to 244 per 100,000 live births from 2001 to 2013 period. However, having achieved this Rajasthan is also the third largest contributor to mortality nationally.”
“In terms of total fertility rate, there has been much sharper decline in Rajasthan. In terms of life expectancy, it really mirrors the national average.”
Sex ratio at birth is another good story that is emerging, she added. “There has been an uplift in 2013-15. If you look at the period between 2005-14, the SRS data shows that Rajasthan has made impressive improvements in sex ratio at birth, through very innovative initiatives.”
Moving from health outcomes to looking at utilisation of services and intermediate indicators, one finds that across most of the indicators whether its institutional birth, post natal care, full immunisation of children or exclusive breast feeding utilisation of services has improved many folds. “The rate of utilisation of services has improved more substantially as compared to India,” Chhabra said.
“However, having said that, the agenda still remains unfinished and the issue of quality still remains a concern. One issue where Rajasthan has not made much progress is that of malnutrition. It is also an issue that most of the Indian states are grappling with. As much as 39 per cent of children have stunted growth and are too short for their age. Similarly, 37 per cent of children are underweight,” she pointed out.
Implementing information technology
Implementing information technology in health comes with its own set of challenges and replicating the success of one intervention in other conditions is one of the major one that we face today, said Naveen Jain, Secretary, Department of Medical, Health and Family Welfare, and Mission Director of National Health Mission in Rajasthan while speaking at the 3rd Healthcare Summit.
“Normally we talk about introducing information technology in health. But when we start implementing those IT interventions in health, many of us face a very strange problem, which is of replicating the same. We normally pilot IT interventions very well in health sector but when it comes to bigger states like Gujarat, Uttar Pradesh and Maharashtra and Rajasthan. It becomes very difficult to repeat the same success everywhere,” Jain said.
Rajasthan, which is geographically the largest state in India, has tried to do many IT interventions on a large scale. Take for instance, making online bank payments to Accredited Social Health Activists, or ASHAs, and giving Janani Suraksha Yojna incentives to all women who deliver in government facilities.
“We thought of making online bank payments to our front-line workers ASHAs even before anybody else talked about it in India. We were successful in doing it, and in the last 2.5 years all 50,000 ASHAs in Rajasthan are getting their monthly incentives directly into their bank accounts,” he said.
The success of this initiative encouraged the Government to plan other interventions on a much bigger scale. “That success inspired us to take many other interventions and doing it on a bigger level like giving JSY (Janani Suraksha Yojna) incentives to all women who deliver in government facilities. That number was huge, as in Rajasthan around 17 lakh births take place in a year, of which around 12-13 lakh births take place in government facilities,” the MD of NHM Rajasthan said.
Speaking of the challenges, Jain said: “It was a huge challenge as we needed to collect the details of bank account of every woman coming to a hospital for delivery. The Rajasthan Government introduced a new scheme that every girl child will be given extra money. So, now the software has to take care of two interventions at the same time — you have to give JSY money to every child and a particular amount of money to only girl child… But now the initiative has been running successfully.”
Telemedicine in Rajasthan
Telemedicine in Rajasthan started in 2006 through an initiative of the Government of Rajasthan and ISRO. First connectivity was made between Jhalawar and Sawai Man Singh Hospital in Jaipur to provide super medical tele-consultations to poor villagers while sitting at remote locations. This project was operated by ISRO through INSAT satellite network.
Under the c leadership of Dr ML Swarankar, in order to improve the health status of people by providing them primary and advanced healthcare, Mahatma Gandhi University of Medical Sciences & Technology (MGUMST) started telemedicine services in 2014 with four centres at Karol, Sikar, Rawatsat and Alwar to deliver specialty and super specialty medical services to rural areas through the State Telemedicine Department. MGUMST is the Rajasthan’s first private medical university to dispense telemedicine services in rural area.
The telemedicine centre at the Mahatma Gandhi Hospital (MGH) is the hub for all tele-consultations in Rajasthan. In 2014, the Mahatma Gandhi Hospital was designated as the nodal centre for all district hospitals by the Government of Rajasthan. With the passage of time, a number of telemedicine nodes connected to the Mahatma Gandhi Hospital Telemedicine Centre.
At present, MGH has made available their tele-consultation at 120 centres in various districts, satellite hospitals and community health centres CHC’s of the state. The tele-consultations were slow to come but now range from 150 to 200 consultations per day.
Telemedicine is becoming the cheapest and fastest way to bridge the gaps between urban and rural healthcare. Keeping in mind the vast progress of India in the field of information and communication technology, telemedicine can help the distant edges of the country access quality healthcare services.
As far as the objective of this project is concerned it is reaching the rural masses of Rajasthan. There has been significant progress in the telecommunication infrastructure in the country. Access to broadband internet connectivity in rural areas is increasing rapidly and there is a huge increase in understanding of internet and learning pattern.
The internet is playing an important role in providing cost-effective healthcare for the widespread populations of medical science and information and communication technology. Consistency in the availability of healthcare is being sustained by continuous efforts from both government and private sectors.
Government, NGOs and some private companies are trying to overcome the technology barrier and provide affordable and special healthcare through telemedicine.
Development Impact Bond
A new Development Impact Bond was announced by Mark Green, the USAID International Development Administrator, with an aim to reduce the number of mother and baby deaths in Rajasthan.
Developed by Merck for Mothers, USAID, the UBS Optimus Foundation and the Hindustan Latex Family Planning Promotion Trust (HLFPPT), it will be the world’s first health impact bond. Named after a Hindi expression meaning “excellence”, the Utkrisht Impact Bond will support implementing partners, the Population Services International (PSI) and HLFPPT to improve healthcare facilities and provide quality health services in the region. The impact bond is expected to save lives of up to 10,000 women and newborns over the next five years. Focused on outcomes, impact bonds are an innovative way to finance development using public-private partnerships.