pradhanmantriswasthyayojana_sept2010

8/8/2019 PradhanMantriSwasthyaYojana_Sept2010

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Pradhan Mantri Swasthya

Yojana (PMSY) A case

studyAditya S Prakash, NMIMS MumbaiShraddha Kamat, NMIMS Mumbai

Dr. Surel Shah, NMIMS Mumbai

ConQuest Online

September 2010 Edition

www.iims-conquest.in


2/13


Pradhan Ma

(PMSY) A c

The Pradhan Mantri Swasthyahealthcare facilities available

however, the implementation o

the lackadaisical approach o

CMO of District Modnimb now

plan continues beyond the expe

to bring about change in an or

PMSY to private players, NGOs

Dr. Ashok, the Chief Medical O

the report he had just finished

of the Central Government sc

aimed at improving the healt

implemented on an experim

improvement in the health st

scheme. Dr. Ashok was aware

with a number of problems

performance. This explained t

January 2009. The report ha

conduct an in depth study of t

to improve its effectiveness.

The report which he had just

health situation in the Districtnowhere near the set targets.

ConQuest, IIM Shil

tri Swasthya Yojan

ase study

Aditya S Prakas

Shraddha Kama

Dr. Surel Sha

Yojana (PMSY) launched by the Central Governin rural areas is an ambitious plan which i

the plan is not so much to be spoken about,

the Government employees taking a toll on

aces the challenge of turning around the syste

rimental phase till 2012, and the strategic dec

anization which is resistant to change or to o

nd ex-servicemen.

ficer ofModnimb District, Manipur sat in his c

reading. Dr. Ashok was the District Head for

eme called Pradhan Mantri Swasthya Yojana.

hcare facilities available in the rural areas

ental basis till 2012. Only the achieveme

tistics of the rural population would see the

hat the implementation of the scheme in the

hich would need to be sorted out in orde

he presence of the three consultants in his r

been presented by the consultants, whom

e implementation of the scheme and to sugg

put down clearly indicated that PMSY had i

however after two years of its implementatiA number of loopholes in the system which

ong Consulting Club

a

, NMIMS Mumbai

, NMIMS Mumbai

, NMIMS Mumbai

ment to improve thevery well crafted;

ith corruption and

its effectiveness. The

to ensure that the

ision he now faces is

tsource functions of

air pondering over

he implementation

The Scheme which

of India was being

nt of a significant

continuance of the

District was riddled

r to achieve better

oom on the 25th of

he had called in to

st ways and means

proved the overall

n, the results weread crept up during


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implementation and constrai

eligible employees had dimin

well crafted plan to achieve am

The report lying on his table p

However, the first major choic

a sole Government initiative

resistant to change, and outs

servicemen.

The outsourcing model had b

results were highly varied; wcontrol of the system were c

with non-governmental provi

from the fact that a well fund

health care facility at all levels

the district level would be ide

the system was a challenge in i

It was little wonder then that

even as he weighed the pros a

Should PMSY be outsourc

functioning or should it ma

scheme?

Introduction to PMSY

The Government of India l

consultations and the incorp

experts, to improve the availa

rural areas. The Scheme ado

good health viz. segments of n

to improve on all these areas.

programme that promises to a

child mortality through sust

controlling communicable an

ConQuest, IIM Shil

ts like improper monitoring system, lack

ished the effectiveness of the scheme which h

bitious targets.

esented a number of recommendations to im

e that Dr. Ashok now faced was between reta

while brining about change in a Governme

ourcing some of its activities to private pla

en tried in a number of other States in the c

ile effectiveness did increase, mounting costuses for concern. While not ruling out mea

ers for meeting public health goals, there

ed, well functioning, effective and efficient p

- at the village, the sub centre, the Public Heal

l. However, bringing about such a massive ch

tself.

he CMO sat in his chair, with a frown etched

d cons of the two choices that lay before him:

d to include NGOs, public-private part

intain its complete control over the impl

unched the PMSY in April 2007, after

ration of many of the recommendations m

bility and access to quality health care for t

ts a synergistic approach by relating health

trition, sanitation, hygiene and safe drinking

The flagship programme of PMSY is the Moth

ddress crucial issues like maternal mortality,

ained interventions. Other objectives inclu

non-communicable diseases; stabilizing pop

ong Consulting Club

of motivated and

d started off with a

rove the system.

ning the scheme as

t system that was

ers, NGOs and ex-

untry, however the

s and a decrease iningful partnerships

as no getting away

ublic sector owned

h Centre (PHC) and

nge to turn around

cross his forehead,

nerships in their

ementation of the

large number of

de by civil society

ose residing in the

to determinants of

water and working

er and Child Health

amily planning and

de preventing and

ulation, gender and


4/13


demographic balance. It has a

(FHA) in each village.

The Plan of Action include

imbalance in health infrast

structures, optimization of h

health programmes, comm

management and financial

community health centers into

The progress in the first two

The major objectives of theperformance of the scheme we

1. Family planning2. Health During Pregnan3. Immunization

Progress Report

Family Planning

The main objective under t

sterilizations both NSV (for m

first two years indicates that

sterilization procedure is muc

There is no major improvem

reasons listed below:

1. The Family Planning in2. PMSY only gave the

expected to improve t

existence in 2007, due

Educators that was int

However, the support activitie

and hence there is very little i

of implementation.

ConQuest, IIM Shil

one of its key components provision of a Fe

increasing public expenditure on health,

ructure, pooling of resources, integration

ealth manpower, decentralization and distr

nity participation and ownership of as

personnel into district health system, a

functional hospitals.

years of implementation

cheme which would be tracked to get a pire those related to:

cy

he Family Planning initiative is to increa

en) and Laparoscopy (for women). The dat

a majority of sterilizations done is for wom

simpler for men.

ent after the implementation of the PMSY s

itiative was already in existence before the P

dvantage of integration of the various pr

he performance of the various stand alone

to the additional support activities like the F

oduced with the implementation of the sche

s/workers have not played their part to the fu

provement compared to what was possible i

ong Consulting Club

ale Health Activist

reducing regional

of organizational

ct management of

sets, induction of

d operationalizing

ture of the overall

se the number of

collected over the

n even though the

cheme for the two

SY scheme.

grammes and was

schemes already in

HA workers, Health

e.

lest extent possible

the first two years


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Health during Pregnancy

One of the major schemes of P

collected in the first two years

unwilling to approach the Hea

following causes:

1. Need for awareness apregnancy, periodic c

introduced under the

workers have not been

FHA workers are not

travelling needs to b

constraints due to thaverage varies from Rs

2. The older generationthrow their views and

3. As most of the populaexpenses incurred o

complications and eme

Immunization

PMSY hopes to fulfill the visio

Hepatitis - B and the like by pr

Even in the case of immuniza

the implementation of PMSY.

fact that the Immunization sc

support system planned under

In certain years, the decrease i

rather than parents not being

out situations and interrupti

scenarios:

1. Inadequate supply oresult of which they ar

Only in April 2009 did

ConQuest, IIM Shil

MSY is to improve the number of institutiona

of its implementationsuggests that the moth

lth institutions during pregnancy. This has be

ong young couples about the importance o

eck-ups and institutional delivery. For this,

MSY system. It is therefore a cause for conce

fully effective.

motivated to put in the effort, the reasons

done on foot owing to scattered populat

ir own family pressure and income per. 500 to Rs. 1000 is not attractive considering

still believes in the traditional system of de

nforce their decision on the younger couples.

tion is in the lower income class or BPL, the

being referred to bigger health instituti

rgencies.

of the Government to eradicate diseases lik

viding immunization and vaccination to infa

ion, there is negligible improvement in the f

s in the case of Family Planning, this could

eme was already in existence before PMSY, a

PMSY has not been as effective as it could ha

s also due to stock outs and disruptions in th

aware and willing to bring their children for i

ns in the supply of medicines occurs becau

medicine: Short supply of medicines at th

e unable to supply medicines to the sub level

he PHCs receive their first package of medici

ong Consulting Club

deliveries but data

rs are skeptical and

en attributed to the

f early detection of

FHA workers were

rn because the FHA

being that a lot of

on, they face time

onth which on anhe effort required.

ivery and tends to

y cannot afford the

ns in the case of

Polio, TB, Measles,

ts and children.

irst two years after

e attributed to the

d also because the

e been.

supply of medicine

mmunization. Stock

se of the following

district level as a

health institutions.

es.


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2. Improper distributioPHC is due to the impr

directly distributed fro

system is time consum

3. Distribution of medicsame amount of medi

average number of pa

surrounding areas like

The successful implementatio

the grass root level. The para

periodic basis and correctiveare met. However, a glance at

the District and Block levels.

becomes a daunting task to

corrective action. The inconsis

and monitoring system.

Elaboration on some of the

HR Issues

The Government faces serious

staff owing to a poorly design

The hiring of employees on a

compared to permanent emp

there are 30,000 MBBS Gradu

system up to the block level d

The employees are not moti

staffing issues can be summed

1) Improper performance app

2) Improper compensation str

3) Unattractive remote area p

4) Contractual jobs

5) Improper criteria for allocat

6) Unavailability of staff

ConQuest, IIM Shil

system of medicine: The delay in delivery

oper system of distribution wherein the allop

m the District Headquarters to the individual

ng and costly.

ne on wrong basis: An analysis of the syste

cines is distributed to different PHCs with

tients treated per month and the specific c

topography, living conditions and prevalent d

of any particular scheme is determined by

eters that measure the performance needs t

easures needs to be taken to ensure that thehe data indicates data inconsistency in a num

he incorrect data makes monitoring and ana

identify the actual gaps and loopholes in

tency can be attributed to errors in the data

ajor pain points of the System

challenges in attracting qualified doctors an

ed pay structure for the staff recruited unde

contractual basis creates a disparity in the

oyees employed under the Public Health S

tes passing out every year in our country, th

es not have more than 27,000 doctors at any

ated and committed to deliver the desire

up to be:

aisal system in place

cture in place

sting

ion of staff

ong Consulting Club

of medicines at the

athic medicines are

health centers. This

revealed that the

ut considering the

aracteristics of the

seases.

its effectiveness at

be monitored on a

bjectives and goalsber of areas at both

ysis difficult, and it

he system to take

ollection, reporting

other paramedical

the PMSY Scheme.

ay structure when

stem. Even though

entire rural health

given point of time.

results. The main


7/13


Absence of a proper monitori

The absence of a proper mo

corrective action and to t

implementation of the schem

existing system is not the mo

centers, however the system i

practices.

No structured plan for traini

There is no proper training sy

their skill set. Training is cond

in place to provide training pe

Less transparency in the flow

Very often, the employees at t

about the changes in the progr

of the roles, responsibilities a

system.

Improper data management

The system of data collection a

is time consuming and results

can easily modify the data befo

Improper utilization of Fund

The funds allocated to the di

mainly due to:

Corruption in the syste Lackadaisical approac Lack of the dynamism

Options/Scope for improve

The issues faced can be classifi

ConQuest, IIM Shil

ng system

itoring system and an official body to ide

ack progress has led to a lackadaisical

e. In certain cases, the higher authorities

st efficient e.g. distribution of medicines to

sluggish to change and no efforts are taken t

g of employees

tem in place to ensure that employees are co

ucted on an ad hoc basis as there is no depar

iodically after assessing the training needs of

of information

e lower end of the pyramid like the FHA wo

am. Hence there is an inconsistency between

d other features of the scheme and the actual

system

nd storage that are in place is a completely m

in manual error. It gives an opportunity for

re the reporting date.

ferent health centers are not utilized in the

m

of employees

o invest in new initiatives

ent

ed into two main classes:

ong Consulting Club

tify the gaps, take

approach to the

re aware that the

he different health

o revise the current

stantly updated on

ment or committee

the staff.

kers are not aware

heir understanding

expectations of the

nual process which

ata fudging as they

prescribed manner


8/13


1. Problems that hinder t

facilities

2. Problems faced by the aut

A number of issues that plagu

negligence in the implementa

improper monitoring system

process is slow. A host of oth

and inability to make use of th

There are two ways out of this

I. Improving the current systaware.

II. Through PPPs and involvem

I. Alternatives to improve the

Some of the viable solutions a

FHA Workers

In order to make the FHA w

strategy can be followed:

1. Provide adequate training

educate the public about the i

staff is often a constraint, vide

2. The FHA workers concentr

income. In order to spread aw

few such ailments could be

incentives over and above the

3. The day to day functioning

that the state has scattere

transportation allowance coul

their meager earnings.

ConQuest, IIM Shil

e rural masses from making use of th

orities in implementing an efficient healt

e PMSY are not because of any loopholes in

ion of the plan, sluggishness in the Govern

in place. The system is not receptive to cha

r issues is due to lack of awareness among t

facilities available.

dire situation:

m by creating a better monitoring system

ent of other local bodies and individuals.

current system

ailable to improve the existing system are as f

rkers more effective in increasing awarene

to the FHA workers in order to make them

portance and need for health care. Since av

s could be screened on the TV sets at PHCs.

te their efforts on pregnant women as this i

areness and keep a check on critical diseases

dentified by the district), the FHA worker

xisting scheme on bringing such patients.

of an FHA worker involves considerable tr

d population and inaccessible areas. Th

be provided so that they do not have to spe

ong Consulting Club

available health

care system

the plan but due to

ent system and an

ge and the change

he rural population

and making people

ollows:

s, a three pronged

fully competent to

ilability of training

the source of their

like TB, diarrhea (a

need to be given

velling considering

refore a monthly

d the amount from


9/13


Reporting system

1. Computerization of the enti

health centers would make th

faster.

2. A toll free number could be

call.

3. Complaint boxes could be in

Improving PHC performance

In order to resolve the issue

facility, following measures co

1. The PHCs can conduct medi2. A helpline could be institu

emergencies.

3. One of the major objectives

could be provided with a sma

can come and stay there for a f

Tackling shortages in medicin

1. The district could take the i

would require. The district co

supplied to each PHC. Decen

induced at the District level in

2. The amount of medicines s

patients treated by the PHC p

unique medical requirements

the Center. This would serve t

3. Rather than supplying medi

periodic basis so that the sub

the region. This would lessen

4. A bi-annual review meetin

and need to be procured, chan

II. PPPs as an option to impro

Some of the outsourcing optio

ConQuest, IIM Shil

re system and providing inter-connectivity b

process of data collection, reporting and mo

introduced at the district level on which th

stalled at each PHC and it could be checked on

faced by the rural population in reaching t

ld be taken:

al camps in the remote areas on a periodic bated at each PHC on which the locals could

of PMSY is to increase the number of instituti

ll ward where pregnant women could get ad

ew days prior to delivery.

supply

puts of the medical officers about the amou

ld then decide on the number of medicines

ralization of the system in this manner wo

erifying and repackaging the number of med

upplied to each PHC could be based on the

er month, amounts supplied during the prev

in the area, and the demand forecasted by th

reduce the degree of stock outs and expiry of

cines at the beginning of each year only, it co

equent supplies can be adjusted as per the p

xpiration of medicines.

could be held to discuss the latest medicin

es in demand and the like.

ve performance

s identified are as follows:

ong Consulting Club

tween the different

itoring simpler and

rural people could

a monthly basis.

he nearest medical

is.contact in times of

nal deliveries. PHC

mitted so that they

t of medicines they

hat can actually be

ld remove the lag

cines.

average number of

ious two years, the

e Medical Officer of

medicines.

ld be supplied at a

rsisting demand in

s that are available


10/13


Involving Non Governmental

The main cause for the non-ac

is the lack of a proper monit

improve the system. There is

beneficiaries are supposed to

PMSY. This way of monitorin

demanding. Hence there is gre

Partnerships in Medical and N

There is an option of trainin

Governmental organizations.

experts in the fieldon a regula

Partnerships with Private Prac

Government can hire local, p

partnerships can help govern

NGOs running PHCs

Many Non-Governmental orga

in many parts of the country.

remote regions or at public fa

is not able to provide those

services are needed.

Outsourcing basic services

There are many experiments

access to electricity provision,

The NGOs could keep track of

critically ill patients. A mobile

They could tie up with the loc

the patients to the hospital in c

Flexibility in human resource

The current health care syste

hired from local community b

ConQuest, IIM Shil

rganizations as Monitoring Body

ievement of the set targets after two years o

ring system to take corrective action as an

a plan for a community monitoring proces

undergo training to know what all benefits t

is not effective as the BPL people are uned

t scope for involving NGOs as monitoring bo

rsing Education

other employees like FHA workers, and n

Such a system would ensure that training

basis.

titioners

rivate practitioners to fill in the vacancies i

ent hospitals to engage professionals on per

nizations have come forward to take responsi

uch a window for partnerships with NGOs fo

ilities where for some reason the Governme

service guarantees, would be a useful way

in the country where nongovernmental pro

ambulance service, cleanliness, laundry, diet,

he pregnant women in their area and also ke

edical unit could be maintained by the NGOs

l transportation system such as matadors, m

ases of emergencies.

ngagement

demands government to hire nurses, param

ecause they will understand the local situati

ong Consulting Club

its implementation

when required to

s under which the

ey can expect from

cated and are less

ies.

rses, through Non-

is provided by the

n the system. Such

ase/per day basis.

bilities to run PHCs

service delivery, in

t delivery structure

o reach out where

ision improves the

iagnostics, etc.

ep a vigilant eye for

.

nivans to transport

edics, doctors to be

n more clearly and


11/13


will remain attached to the sy

residents as development wor

Development Opportunities fo

Building capacities and creati

retaining high quality and mo

the field must be important cr

can provide useful third party

assessment. There will be a fo

has to be linked with client s

Performance benchmarks wil

effective. The proposal is ncommunity owned and accoun

and need.

Medical Students and PMSY

Motivated students can devel

while they progress through t

network that includes opportu

200 medical colleges in India,

as electives during postings/In

Issues in PPPs

The hurdles which PMSY migh

1. There will be an increhuge pay for their se

create a conflict bet

differential pay structu

2. There should be a systis also the possibility o

and the PMSY body.

3. Cost will increase mdistribution system et

time because of increa

Non government bodie

ConQuest, IIM Shil

stem for the longer period of time. A system

ers needs to be encouraged at a larger scale.

r professionals NGOs in capacity building

ng opportunities for growth and developme

tivated manpower. Performance assessment

teria for progression in the system. The nong

platforms for continuing medical and nursi

cus on career progression and permanence

atisfaction, judged by Third Party Assessme

l have to be developed at each level for s

t informalization of the work force; it istable workforce that is compensated on the b

p leadership skills and address unmet com

e medical school. Students, staff, and physici

nities, encouragement, reflection, and proble

medical students could take up community

ternship.

face in implementing the above programs ar

ase in the cost involved as contract practitio

vices compared to permanent employees. I

een the existing employees and the gove

re.

em to keep a tab on the effectiveness of the N

f conflicts arising due to different styles of fun

anifold if PMSY opts for outsourcing the

c. to outer bodies. Also the process of fund

ed number of layers between the source and

s and fund releasing source i.e. government.

ong Consulting Club

of developing local

nt are essential for

and experience in

overnmental sector

g education and its

ut the permanence

ts of performance.

uch systems to be

much more for aasis of performance

unity health needs

ns provide a social

solving. With over

dministrative skills

as follows:

ners will demand a

fact this will also

nment because of

O run PHCs. There

ctioning of the NGO

jobs like training,

allocation will take

final destination i.e.


12/13


4. Creating infrastructur2007 to 2012. So ma

constraint.

5. The risks involved in aof such collaborations

whole project is up to

6. Sustaining the partner

Impact of outsourcing on dif

FHA and Nurses:The FHA wo

being provided, delayed pro

Outsourcing the administratiresolving some of these issues

District Administration: T

coordinating and monitoring

District Administration but thi

opinion. The DA might also be

been performing.

State Government: Creating

result in effective implementa

also act as a check on corrup

educated enough to raise a voi

Decision Point

Having been presented with t

decide if he wants to outsou

system already in place to me

in mind while making a decis

change as the scheme woul

constraints with respect to fu

monitoring the system. Irres

sound system in place to m

continuous improvement.

ConQuest, IIM Shil

and PPPs will take time whereas PMSY is

y of the options available can be negated

outsourcing venture are very high. There is

nd if this system fails then there will be no ti

012 only and the money lost will also be very

hip formed will be another major issue.

erent players

kers and nurses currently face problems like

cessing of salary, little support from the

n and monitoring of FHA workers and nuand would also aid in improving the effective

e District Administration has not been

he activities assigned. PPPs will act as a sup

s might also result in conflict on some issues

reluctant to relinquish control over the acti

PPs will increase the state expenditure. But

ion and better monitoring of the PMSY sche

t government officials because most of the

ce for the rights of the common man.

he pros and cons of the two courses of actio

ce some of the functions to external parties

t the targets set. Some critical factors that he

ion were the limited amount of time avail

be drawn to a close in 2012 if found to

ding and the challenges that would be faced

pective of the decision, he knew that there

onitor effectiveness, gather quantitative d

ong Consulting Club

5 year project i.e.

just based on time

o surety of success

e to recover as the

high.

insufficient training

ystem and so on.

ses would help iness of the workers.

very effective in

orting hand to the

ue to differences in

ities that they have

this will definitely

e. In fact PPPs will

PP officials will be

n, Dr. Ashok has to

or turnaround the

new he had to bear

able to bring about

be ineffective, the

in controlling and

ould have to be a

ta and to achieve


13/13


ConQuest, Consulting Club of IIM

Comments/feedback, please mail t

ConQuest, IIM Shil

Shillong

[email protected]

ong Consulting ClubThe Team

Conquest Online is the online

edition of ConQuest which is a

student driven Consulting club of

IIM Shillong. Team includes

Girish Krishnakumar |

[email protected]

Nitin Saxena |

[email protected]

Pradeep M.S. |

[email protected]

Sreethala G |

[email protected]

Sumit Kumar Rana |

[email protected]

Umamaheswaran B.S. |

[email protected]

pradhanmantriswasthyayojana_sept2010

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