The State Health Resource Centre,
Chattisgarh is an autonomous organization which was
designed as an “additional technical capacity to the
Department of
Health & Family Welfare Chhattisgarh”. Its main role is to
provide support in the process of health sector reforms.
This includes support in:
Policy Planning
and Strategic Thinking
Capacity
Development
Development of
Innovative and Adaptive Programme Desings
Community Based
Health Programmes
Conducting
Health System Research
Assisting the
Department of Health & Family Welfare, Chhattisgarh to
implement innovative strategies
To facilitate
this, the SHRC has an innovative work
charter, a special organisational structure and an appropriate
positioning.
Formation of the SHRC:
In March, 2002, RCH Society, Chhattisgarh and the Regional
Office (Raipur) of ActionAid India Society (AAI) executed a
Memorandum of Understanding. The MoU was signed in the context
of European Commission and Sector Investment Programme (SIP).
The State Health Resource Centre, Chhattisgarh was founded as
additional technical capacity to the
Department of Health & Family Welfare, Chhattisgarh and
as a state-civil-society body whereas the ActionAid's role was
to coordinate civil society organisations in setting up such a
body. During the following two years the initial team was put
together and the institution was made able to stand on its
own. Since 2004 the SHRC has been functioning as a fully
autonomous institution.
In addition to managing the SHRC, it was agreed in the MoU
(paragraph 4.2.) to perform the following other tasks:
evolve systems for the effective functioning of the SHRC.
More specifically, it will develop all Facilitates, on
behalf of the GOC, the development of operational framework
for forging partnerships with NGOs, CBOs and people’s
movements for effective implementation of the reforms
process.
evolve systems for the effective functioning of the SHRC.
More specifically, it will develop all Conduct independent
reviews of the intensity and direction of the reform process
on behalf of the GOC.
evolve systems for the effective functioning of the SHRC.
More specifically, it will develop and co-ordinate with the
State Resource Group - which is an advisory body comprising
health activists -, community health practitioners, NGOs,
CBOs and human rights organisations based in Chhattisgarh.
Vision: We as a State Civil Society Partnership
Organization of Public health Professionals are an enabler in
Chhattisgarh attaining for its every citizen highest
attainable level of physical mental, social and spiritual
health and quality health care that is equitable universally
accessible, affordable and gender sensitive through
empowerment of communities and development of an accountable
and responsive health system.
Mission: To aspire for
achievement of the highest level of efficiency & quality in
delivery System both Government & Non government to provide
the most professional technical support to Government, to act
as a catalyst and innovator in public health, to inspire and
sustain motivation of committed staff and civil society groups
in community health.
Strategies:
1. Generating evidence for policy formulation & strategic
planning of interventions in health.
2. Conceptualizing and designing Programmes addressing
prioritized health Problems.
3. Piloting innovations for feasibility of up scaling.
4. Community mobilization, organization and capacity building
leading to empowerment.
5. Training & skill up-gradation of health functionaries,
Stakeholders and partners and their networking.
6. Monitoring and evaluation of Programmes, services for
quality, client satisfaction, impact and outcomes.
Core Values:
1. Upholding human dignity, universal brother hood and
harmony.
2. Equity & Justice.
3. Intolerance to corruption & exploitation of the weak.
4. Preferential option for the poor and giving chance to the
marginalized.
5. Excellence and quality in everything we do.
6. Convergence and networking rather than doing alone.
7. Empowerment & system building for sustainability.
8. Putting people and communities first above our own
interest.
The SHRC, Chhattisgarh has been called upon to play the
following roles:
Assist the department in evolving projects and programmes
and in providing strategic analysis that would guide the
process of planning.
Develop guidelines, communication material, and draft orders
etc. for approved innovative projects and health sector
reform strategies that have to be implemented.
Locate and contract in suitable technical expertise to work
with state teams to develop proposals, evaluate programmes
or assist implementation.
Undertake formative as well as operational research, and
hold rapid programme appraisals to make planning based on
evidences and to assess progress towards initiating
corrective measures.
Support the directorate and implementation authorities in
monitoring reform measures, troubleshooting problems and
building consensus and providing internal advocacy for
reform measures at various stages of implementation.
Sustain civil society participation in reform process and
ensure all support measures for the partnership programmes'
success. For example, the NRHM is promoting a number of
committees - state and district health societies, hospital
development committees, village health and sanitarian
commitees etc. - but there has to be a model organisation to
ensure that the public does participate and that such
participation has sufficient quality and that the usual
hesitations to letting the public into public health are
overcome.
Undertake financial planning and management support for new
and innovative programmes of a sort that the department is
unused to running. Such management functions - may be on a
turn key mode - with the directorate enabled to take up the
activity soon once they the systems of management are
established.
One major example of SHRC role has been in the Mitanin Programme
where it built up an innovative and locally adapted
programme design, helping to find and to support people
within the government to play leadership roles and to
bring in and to train the best within civil society. The
SHRC scientifically took up the programme and based on
feedback, improved the design, trained the
trainers and even routed the funds through the district
health societies. Moreover it built up flexible but
rigorous accounting procedure that ensured an
expenditure and utilization in the desired manners.
Another example of the role of the SHRC is the life
saving skill Training
in emergency obstetrics. The SHRC negotiated with
professional health faculties to initiate the training,
convinced key players in the districts and in the
directorate of the need for this approach, it built up
evaluation and support systems so that the initial poor
results of this approach were overcome. It provided
personal support to the trainees till at least some of
them have
started
providing emergency obstetric services in remotest areas
of Chhattisgarh.
There are many more
examples - big and small - of the diverse catalyst roles that
are needed and today it is inconceivable to think of health
sector reform without such drivers for change. Whether it is
changing prescription practices of doctors or procurement
practices of the administration, whether it is introducing new
training programmes or ensuring that BCC programmes conform to
a scientific implementation framework, change does not happen
only on the basis of right thinking and capacity building.
Change requires having to contend with existing knowledge and
mindsets and institutional structures and that is where the
SHRC contributes.
Institutionally,
therefore, the SHRC is unique and has the following specific
features:
It is an
autonomous, with its own governing body and executive
committee with its own rules and regulations. The government
has sufficient representation in it to ensure transparency
of all its operations. But all recruitments, contracts etc.
for the SHRC team are done autonomously by SHRC itself, and
independent on the government.
The SHRC is
assigned tasks which it has to deliver in a time bound
manner. There are a set of long term tasks (like the Mitanin
Programme) and many immediate tasks that the government
assigns to it from time to time. The MoU is renewed as a
token of the government's satisfaction with the SHRC’s
performance on these tasks. The SHRC is not bound to accept
all tasks and can potentially refuse tasks that it feels is
beyond it, or that it does not agree with – though in
practice such a clause has never had to be exercised.
The SHRC has no
formal power over the government officers or implementation
authorities. It is purely facilitating and advisory in
nature. This prevents it from becoming a parallel authority
and prevents contestations of power that are the bane of
other institutional arrangements. Its effectiveness is
derived from the quality of inputs it provides and its
ability to internally leverage processes of change.
The SHRC, however,
has a ‘note-sheet’ level relationship with the directorate
and department and the state health society so that its
advice is available in a routine manner, on a wide number of
issues and forms part of the official records. The SHRC
faculty may be assigned specific monitoring or coordination
tasks by the directorates as nodal officers where such need
arises.
In view of the
unique nature of demands made on the organization and also
due to the considerable capacities needed in house, the SHRC
has had to evolve an innovative and appropriate set of HR
policies that brings in, builds and retain talents.
Typically, SHRC faculty turnover is low, and the work
culture and collective decision making and opportunity to
learn provides an alternative to the high salaries that
other comparable institutes offer and which SHRC itself can
ill afford.
As mentioned
above, the SHRC was established through a ‘host’
organisation which then had experienced officers who had
worked closely with the government. The partnership with
the NGO – ActionAid in SHRC's case – was formalized
through a MoU which mandated the NGO to set up and
manage the SHRC for and on behalf of the State, till it
could be a truly autonomous institution.
The decision to
engage a ‘host’ organisation guaranteed the freedom of
being able to find the right initial persons and build
the team for the SHRC. There was also considerable
flexibility to head-hunt for suitable persons to
constitute the initial team.
To ensure that
the SHRC had a character of an organization working for
change, and for reaching health care to the poor, the
governing body was evolved out of a number of
individuals and organizations known to be committed to
such values and who had a good track record of
supporting institutional development. The NGOs who were
interested and who participated in the formulation of a
health sector reform strategy were constituted into a
state advisory committee for health sector reform and
with their support the governing body was constituted.
The executive committee was made of those who were part
of the full time team.
Knowing the
lack of skilled persons who would be available to work
in the EAG states at the pay scales that we could offer
(comparable or marginally higher than government scales
– but not certainly at international agency pay scales)
- the SHRC followed a policy of recruiting persons with
the right mix of background and motivation and building
up their capacities in house. This required a certain
type of leadership and great emphasis on mentoring
arrangements.
Knowing that
this work requires experience and expertise on a wide
number of areas, and it would not be possible to hire
persons with such experience, the SHRC followed a policy
of ‘contracting-in’ experts to work with its team and
recorded this experience of working together in its
institutional memory so that the expertise available
locally increased cumulatively.
“Managing
change” requires patience and persistence, the ability
to withstand criticism and sometimes hostility both from
within (the government) as well as from outside (e.g.
civil society organisations’ initial refrain that the
Mitanin initiative represented government’s intention to
‘withdraw’ from its public health responsibility). The
change agents, at the same time, need to understand and
negotiate with different points of view, take various
initiatives and risks when no one else is ready to do so
and yet understand that “success” requires ownership of
the idea and the work by others - sometimes to the
exclusion of the main movers. The SHRC, therefore needed
to build-in a strong element of networking with similar
minded individuals and organizations both in the state
and national level, so that there was mutual solidarity
and a specially created peer support for supporting the
change process.
The bottom-line
of SHRC experience, in other words, is not just about
‘establishing’ yet another structure but finding a
suitable NGO and formalizing a partnership with it which
allows the NGO partner sufficient flexibility in finding
the right individuals who would become a team in
supporting the State Directorate / State Institute for
Health and Family Welfare / State Society on an on-going
basis.
State Health
Resource Centre, Chhattisgarh
First Floor, Health Training Centre Building
Bijli Chowk, Kalibadi, Raipur, Chhattisgarh, India
