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

Public Health Governance in India: Key

Issues
Weak state of institutions and capacities
Plight of Political will and legal/policy environments
Centralised powers, 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, poor HR development and

management
Inadequately generated, poorly used information &

evidence
Poorly developed infrastructure/ service norms

Public Health Governance in India: Key

Issues- 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, esp. for private
Inattention to social determinants and health
impact
Difficult geographies, conflict situations
STRONG institutional mechanisms FOR corruption
Given these, is it doing that BADLY ??

Towards an Alternative Approach

Governance the KEY for peoples health

systems!
Right to Health; 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, and at which levels?
What resources are required?
Timeframe?
How to set them up?

Pathways to Pro-People
Governance

Active capacity building to develop Human

Resources
Define levels, estimate needs, 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..

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- attention on social determinants,

addressing inequities, 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

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, integrated programmes
Understanding community needs
Service Guarantees

Communities:
Leadership and institutions

Support health systems

PRI Ownership

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,
inequities
Community mobilisation
Negotiation with systems
Support to systems
Better Governance
Persistence

Health
systems