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The State Health
Resource Centre ,is a autonomous organization which plays the role as an
“Additional technical capacity to the department of health and family
welfare Chhattisgarh”. Its role in initiating
and sustaining the Mitanin program, its role in supporting the
health sector reform agenda and in launching innovative and technically
sound new program initiatives. Chhattisgarh
has been acknowledged widely its owes its effectiveness to its
institutional structure, its policies on its own human resource
development.
The SHRC is
developing a program and is being strengthened to respond to request
from other state to assist them in this effort
In March, 2002,
RCH Society, Chhattisgarh and the Regional Office (Raipur) of
ActionAid India Society (AAI) executed an MoU. The MoU was signed in the
context of European Commission assisted Sector Investment Programme
(SIP) and State Health Resource Centre, Chhattisgarh was
to function as “additional technical capacity to the Department of Health
& Family Welfare in designing the reform agenda
developing operational guidelines for implementation of reform
programme and arranging / providing on-going technical supporting to the
District Health Administration and other programme managers in
implementing this reform programme.”
With regard to
setting up the SHRC, the role of AAI
was defined in para 4.1 and 4.2 of the MoU as follows:
“4.1
The AAI will set up and manage a State Health Resource Centre (SHRC).
In this regard, the AAI will:
¨
set up the physical infrastructure for
the SHRC,
¨
recruit experts and support staff for the
SHRC, as provided for in the budget and agreed upon with the RCHS,
¨
arrange for the induction, training,
exposure and capacity building inputs of SHRC experts and staff,
¨
evolve systems for the effective
functioning of the SHRC. More
specifically, AAI will develop all systems/ manuals/ policies for smooth
functioning of the SHRC. In
the first six months, AAI will develop, amongst other systems, the
following:
¨ Accounting and Auditing
Standards Manual
¨ HR Policies and Procedures Manual
¨ Operations Manual
¨ Gender Policy Manual
¨ provide administration inputs to the SHRC
as required from time to time, and
¨ review periodically the functioning of
the SHRC.
4.2
In addition to managing the SHRC, the AAI has agreed to perform
the following other tasks:
¨
Facilitate, 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.
¨
Conduct independent reviews of the intensity and direction of
the reform process on behalf of the GOC.
¨
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.”
Defining the
SHRC’s roles
The SHRC, Chhattisgarh has been called
upon to play the following roles:
·
Assist the department in evolving projects and programmes and
in providing strategic analyses that would guide planning.
·
Develop guidelines, communication material, draft orders etc
for approved innovative projects and health sector reform strategies
that have to be rolled out.
·
Locate and contract in suitable technical expertise to
work with state teams to develop proposals, evaluate programmes or aid
implementation.
·
Undertake formative and operational research and rapid
programme appraisals so as to make planning evidence based and so as to
assess progress and institute correctional 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. This role may be described as that of an
internal “champion”( proactive supporter) of reform
·
Sustain civil society participation in reform process and
ensure that partnership programmes succeed. For example, the NRHM is
promoting a number of committees- state and district health societies,
hospital development committees etc- but there has to be a champion of
ensuring 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 turnkey 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
is in the Mitanin Programme where it built up an innovative and locally
adapted programme design, helped find and support people within the
government to play leadership roles, brought in and trained the best
elements within civil soceity, scientifically evaluated the programme
and based on feedback improved on design, trained the trainers and even
routed the funds to the district health societies and built up flexible
and rigorous accounting procedures that ensured that expenditure and
utilization certificates broadly came on time.
Another very different example of the
change management role is with regard to training for short term life
saving skill training in emergency obstetrics. The SHRC negotiated with
health facilities and professional bodies to initiate the training,
convinced key players in the districts and in the directorate of the
need for this approach, built up evaluation and support systems so that
the initial poor results of this approach were overcome even as
the programme had to be defended against internal cynicism and
provided personal support to the trainees till at least some of them
started providing emergency obstetric services.
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 the SHRC must be created to contribute to such a role.
SHRC as
institutional innovation:
Institutionally, therefore,
the SHRC is unique and has the following specific features:
·
It is an autonomous body with its own governing body and
executive committee and its rules and regulations. The government has
sufficient representation in it to ensure transparency of all its
operations and to intervene is there are problems that need such
assistance. But all recruitments, contracts etc for the SHRC team are
done autonomously and independent of 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 if the government is satisfied
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 authority over the government officers or
implementation authorities. It is purely facilitatory 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 champion 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 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.
SHRC as a process
As mentioned above, the SHRC was
established through a ‘host’ NGO which then had experienced
officers who had worked closely with the government. The partnership
with the NGO –ActionAid in our 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’
organization 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 without
(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
/ SIHFW / State Society on an on-going basis.
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