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People-Focussed Governance of

UHC:
Issues, approaches
and
Possible Roles of Communities
Raman VR
PHFI / PHRN / PSM / PHM

JSA National Convention on UHC
Plenary on Governance and Community Action
28-29 November 2012, New Delhi

poor HR development and management  Inadequately generated.Public Health Governance in India: Key Issues  Weak state of institutions and capacities  Plight of Political will and legal/policy environments  Centralised powers. poorly used information & evidence  Poorly developed infrastructure/ service norms . decentralised responsibilities  District Health Systems a distant dream  Poor financing. finance management  Systems inefficiencies result in capture by powerful  Constrained space for Indian/ indigenous systems  Huge HRH gaps.

esp.2 Unclear roles / undeveloped capacities of local bodies Limited mechanisms / capacity for community participation Vulnerable procurement and distribution systems Uncontrolled vested interests in health technologies Withered regulatory systems. conflict situations STRONG institutional mechanisms FOR corruption Given these.        Public Health Governance in India: Key Issues. for private Inattention to social determinants and health impact Difficult geographies. is it doing that BADLY ?? .

and at which levels?  What resources are required?  Timeframe?  How to set them up? . not just programmes/packages!  Institutional frameworks for all levels and areas  Strengthening / dismantling existing frameworks  Using a comprehensive framework  Governance Toolkits for UHC (PHFI)  What institutions needed.Towards an Alternative Approach  Governance the KEY for people’s health systems!  Right to Health.

estimate needs.Pathways to Pro-People Governance  Active capacity building to develop Human Resources  Define levels. frame contents  Identify People and Build capacities for:  Community action  Systems strengthening  Plan and strategize course of action  Examples  District Capacity Building (PHRN).  People for Health (PHFI) .

.JSA Constituents’ Role?  Shift from current passive capacity building approach  Develop 10 member public health task force per block  Initially follow RTHC / CBM initiatives  Expand further. . ------------------------------------------------ Public Health Systems would essentially require people too  JSA affiliates can support in preparing a motivated workforce for different levels..

attention on social determinants. building integrated approaches  Unveiling the major avenues of corruption  Constitutional and Operational commitment to:  Health For All  Public Health Systems for all  Free and accessible health care for all  Central role of peoples and communities in Health Bridging between communities and health systems towards these . addressing inequities.Aiming At  Health system decentralisation  Development of pro-people health workforce  Fully equipped and functional District Health Systems  Optimum regulation of non-public care  Beyond health care.

integrated programmes Understanding community needs Service Guarantees Communities: Leadership and institutions Support health systems PRI Ownership .Bridging between communities and health systems to achieve People Focussed Health Governance Social and gender inclusion Health systems: Appropriate financing Adequate infrastructure Capacity building Optimized HR Monitoring Health/Supply Demand mobilisation Trained personnel New.

inequities Community mobilisation Negotiation with systems Support to systems Better Governance Persistence Health systems .Bridging between communities and health systems to achieve Pro-poor Health Governance Communities Bridging Process Committed leadership Capacity building Coordination with PRIs Focus on Social determinants.