DEPARTMENT OF HEALTH & FAMILY WELFARE
	HIMACHAL PRADESH (Health Vision - 2008)

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Mission of State Government is to provide the effective, efficient and value for money health services to the population of Himachal Pradesh  

Executive Summary

Majority of population in Himachal Pradesh is rural, and improvement of health status is the prime focus area of the state government. Though Himachal Pradesh has far better health indicators than the country averages, state’s commitment to health improvement makes the basis of roadmap document. The roadmap 2008 envisages the vision of the state, the targets to be attained and a guiding agenda to frame the strategy and tactical tools for attainment of targets.

 The roadmap 2008 broadly encapsulates the following points:  

·        Increased utilization of public health services.

·        Strengthening of primary health sector

·        Improving the quality of secondary health care

·        Public Health administrative capacity building

·        Extending public health services

·        Increased community participation and decentralization.

To crate dynamic, responsive and public-centric health administration.  

The primary goal of vision 2008 is to achieve the status –Health for All. It is striving for clearing the path, removing the hurdles, for better status of the health of the people leading towards improvement in quality of their lives, with main emphasis on equity and access.  

State has set the quantifiable targets for itself, to be achieved by year 2008.  

 Despite the dramatic achievements in the sphere of health in the state, the state now needs to focus on the second generation of achievements, where the quality of services and efficiency are of vital importance. The roadmap document summarizes the government’s efforts to look ahead and plan for the future.

With focus on surveillance of disease, the state is all set to launch the Integrated Disease Surveillance program to combat the communicable diseases. RCH-II program is all ready to take off with focus on health of mother and child, and to support all the efforts, state is continuously engaged in increasing the public health administrative capacity and extending the services to the masses.

 In order to achieve the above sets of indicators by the year 2008, the road map has been chalked out, aiming at availability of health facilities close to the residences of people, availability of trained manpower in all health institutions, improved quality of health care services, use of modern technology in health administration and management, and active participation of the community, voluntary and private sector, better coordination between different sectors and decentralization of powers.

THE ROADMAP AHEAD

The roadmap 2008 document envisages the equality & access and aims to do a situational analysis, to correct the imbalances, efforts to reduce shortcomings, increase the efficiency and effectiveness and create a foundation to build a society which is healthy in all the aspects; body, mind and soul.

Defining goal is to improve the health of the people of Himachal Pradesh and stresses upon the efforts to reduce the premature mortality at all stages of life cycle and reduction of non-fatal health outcomes as key components. Two intrinsic goals namely: Responsiveness of health system to legitimate expectations of the people of Himachal Pradesh & Fairness in financing and protection of poor from financial risk are the underlying goals for the state.

Roadmap 2008 aims to provide the people of Himachal Pradesh:

• Equal and increased distribution of primary health care services.
• Rationalize the distribution of manpower to increase the utilization and access of services.
• Increase the number of specialists in the state to take care of complicated cases and provide specialized services.
• Continuous training of health personnel to meet the new emerging challenges and increased patient satisfaction.
• To synergise efforts with indigenous system of medicine to increase the outreach and extension of services.
• To increase involvement of community and NGO participation.

With the aim of:

• Respect for the dignity of the person
• Prompt attention to health needs
• Basic amenities
• Respect for confidentiality

Besides Roadmap 2008 document on account of good governance practices shall initiate and strengthen existing system to address environmental health issues in the state:

·        Liquid Waste Disposal

·        Hospital Bio-Medical Waste Management

·        Solid Waste Management

·        Excreta Disposal

State has commitment for improved diagnostic services, availability of essential drugs, to increase the demand for services and hence increased utilization. In this regard, state will focus on strengthening of infrastructure and service delivery to provide the basic care at village level, improve facilities and services in CHCs and regional hospitals and providing the best available specialized care through medical colleges.

Strengthening of Primary Healthcare

The state government recognises the need to extend the health services to the areas which are underserved and providing the care to each and every member of the state.

• All the areas, where there exist no health institution will be given priority and every Gram Panchayat shall have the health institution within the easy reach of population with location of health institutions decided so that they are easily accessible to women and older people.

• For this, Government will identify the Gram Panchayats without any health institutions, and Government will strive for opening at least one sub-centre in each Gram Panchayat without any institution by the year 2008.

·          Urban health care is equal priority with the state government; government will take all the appropriate measures to strengthen the Urban Health Institutions located in the towns.  

• All health Institutions will be maintained in proper conditions, and administration shall place special emphasis on proper construction of buildings, maintenance and upkeep.

• As per the national health policy 2001, to serve the under served areas more effectively, state government shall utilize practitioners of Indian system of medicine and Homeopathy to expand the pool of service providers to provide the basic primary health services.

• A manual on job description of staff providing primary Health Care to bring in the efficiency and effective discharge of duties, one is entrusted with, shall be provided to all the health institutions to bring in more accountability.

• Adolescent Health with emphasis on awareness, percolation and sensitization of adolescents to the health in a manner that is sensitive to their needs with the help of Adolescent health program and related measures will be taken up by the state government. In addition, the state government, shall focus on aneamia and problem of malnutrition with special focus on women and children along with adolescents.

• Identification of person suffering from psychiatric and mental disorders on the pattern of proposed national programme for Mental Health will get boost in the state with already operational mental health hospital, for referrals, in the state.

• State is in the epidemiological transitional phase, shall focus on emerging life style diseases and identification of high risk groups for the same.

• With states commitment to improve the reproductive and child health services, Operation theatres and Labour Rooms shall be constructed in all Community Health Centres. First referral Units will be made functional in all the districts.

•  Priority to senior citizens shall be accorded in OPDs.

•  Special Programs will be initiated to tackle high risk behavioral tendency. Special emphasis will be placed on adolescent health.

• Detection of pre-cancerous conditions e.g. Cancer cervix, Cancer Breast and oral cancer shall be piloted initially in three districts namely Bilaspur, Mandi & Hamirpur and shall be replicated in all the districts in later stage.

Strengthening of Secondary Health Care:

With well established network of Civil Hospitals and District Hospitals , Himachal Pradesh exceeds the norms established by Government of India for provision and access of curative aspect of health care. Nevertheless increased awareness about the health which has resulted in increased demand for health services, state has taken measures to match the supply. To further strengthen the secondary health care and increase the supply side following initiatives will be undertaken:

• Gaps between sanctioned and existing bed strength in all Civil Hospitals will be made up by providing more bed space.

• New Civil Hospitals will be opened in the sub-divisions, where no civil hospital exists.

• Blood Banks shall be started in Regional Hospital Keylong & Rekong Peo and in Civil Hospitals at Jogindernagar, Kamla Nehru Hospital , Rampur and Rohru.

• Quality Circles shall be set up in all civil hospitals to improve the service delivery and patient satisfaction.

• More powers shall be given to Aspatal Kalyan Samitis to generate more resources. Peoples’ representatives shall be included in Aspatal Kalyan Samitis as members.

• HIV Testing and counseling facilities shall be set up in Regional Hospital Chamba and Keylong.

• Tele counseling services shall be set up in Civil Hospitals of tribal and remote areas and shall be linked with Medical Colleges in the state.

·        Diagnostic centres having facilities equal to Zonal Hospitals shall be set up in three District Hospitals at Solan, Bilaspur and Hamirpur. These shall have facilities like CAT scan, Ultrasound machine, TMT, Colposcope, color Doppler  etc. so that patients are not referred to Zonal Hospitals or outside the state.

·        Facilities at Regional Hospitals at Nahan and Hamirpur shall be upgraded by providing better curative and diagnostic services.  

·        All Civil Hospitals at sub-divisional level shall be provided with Semi-automatic Blood Analyzers to improve the laboratory services. 

·        All the laboratories up to block level will be upgraded under ISDP program for the surveillance of communicable diseases.  

• 100-bedded Civil Hospitals shall provide specialized services in medicine, surgery, Obstetrics and Gynecology and Pediatrics (Child diseases).

• All Regional Hospitals shall provide minimum 13 specialized services namely Medicine, Surgery, OBG, Eye, ENT, Orthopedics, Anesthesia, Radiology, Blood Transfusion, Pathology, Pediatrics, and Skin diseases.

• Preventive care and screening efforts will be strengthened in the state.All Regional and 100-bedded hospitals shall have special clinics the objective to provide primary prevention i.e. screening for early Detection and IEC facilities to provide people with relevant information.

• All Hospital shall be computerized up to block level.

• All hospitals shall have Hospital Manual and Citizens Charter and shall place emphasis on provision of quality services.

• One TB Training and Demonstration Centre is being established at TB Sanatorium Dharampur.

• A programme for rehabilitation of leprosy patients shall be started in the state  

• Management of hospital waste, and its safe disposal is the priority. All hospitals shall be provided with equipment like incinerators, autoclaves and chemicals to dispose off biomedical hospital waste as per the provisions of the Hospital Biomedical Waste Rules 1995.  

Specialized Medical Care & Strengthening of Medical Colleges:

With the objective of increased access to super specialty services so that people don’t have to go out of the state, state shall strengthen the medical colleges in the state to provide specialist medical care. This shall save time, money and resources to the people. Following initiatives will be undertaken:  

• Super specialties, hi-tech diagnostic facilities and trained manpower will be made available with in the state.           

• Facilities in Medical Colleges will be upgraded to provide advanced care to patients suffering from Heart diseases, neurological disorders, trauma, cancer and emerging diseases.

• MRI shall be set up in Indira Gandhi Medical College at Shimla.

• Mental Health Institute in Shimla has been made functional.

• An Eye Bank shall be started in one of the Medical Colleges.

• Blood Component Separation Unit shall be set up in RPMC Tanda.

• A Counseling Centre for HIV / AIDS shall be set up in KNH, Shimla.

• A DOTS centre for providing treatment to TB patients is being set up in IGMC Shimla.

• One Behaviour Change Surveillance unit and one CD4 / CD 8 count facility shall be set up in Tanda under HIV control programme

Conclusions:  

To meet the challenges, to grow and adapt, Health Department shall take steps to develop the human resources. So that state can deliver and is able to provide the maximum care to the people with dignity, empathy, care & respect each individual has right to. Government has approved a new training policy for Health and Family Welfare Department, where in Pre-service trainings for Female Health Workers, Male Health Workers, Staff Nurses, Radiographers, Lab Technicians, Operation Theatre Assistants, Pharmacists, Paramedical Ophthalmic Assistants & other Para-medical categories shall be started on continuous bases.  In service training for both medical officers and paramedics shall be provided to equip the personnel to take up the assignments and adapt to the changing requirements of the patients with sole aim of providing patient-centric services.  

State is committed to give priority to IEC with an objective to disseminate the information to the population groups that need special targeting besides mass media campaign. State government through public private partnerships with PRIs, NGOs and other channels will target the more vulnerable groups.  

Finally roadmap 2008 is promise of state government to improve the health status of people of Himachal Pradesh. It is reflection of seriousness of government to implement the programs, devise the strategies to implement them for the maximum effect for the betterment of people of Himachal Pradesh who are the real assets to take the state to the greater heights, socially and economically. It recognizes that health needs are dynamic and keep changing over time. Hence health department needs continuous adaptation and prioritization.  An improved standard of governance, with more empathetic and committed attitude to serve the people, is all the Roadmap 2008 document is all about.