Eleventh Five Year Plan

Health and Family Welfare and AYUSH 75Box 3.1.6Cultural AlignmentOften cultural alienation coupled with the apathy of doctors drives the tribals away from big hospitals and governmenthealth care facilities. The best way of delivering health care to the tribals is to do so in an environment that is familiar tothem. This is what has been done in Gadchiroli. The SEARCH hospital is a habitat of huts built between trees. The receptionarea resembles a Ghotul—the traditional place for social and cultural events in a Gond village. The patients don’t stayin wards but in individual huts with their families. Everything from bedsheets to towels is of khadi. The tribals oftenfeel isolated and scared in big buildings. Here, surrounded by their natural environment and loved ones, patients feelat home. The result: thousands of tribal patients from 10 blocks of Chandrapur and Gadchiroli flock to this hospital fortreatment.SEARCH has also demonstrated how tribal beliefs can be used to disseminate health education. Every year, a jatra isorganized in Shodhgram (SEARCH campus at Gadchiroli) in honour of Goddess Danteshwari, the deity revered by tribals.Representatives from as many as 40 tribal villages participate in this jatra. At the end of it, an Aarogya Sansad is held wherethe tribals are asked to enumerate their health concerns. After voting, one health problem is identified as the year’s priority.Representatives then go back to the villages and start working on the identified problem. This is regarded as a command fromthe Goddess herself which no one can oppose. For instance, one year, the tribals voted for eradication of malaria. They wereshocked to learn that malaria was caused by a mosquito bite and immediately wanted to know how to check the breeding ofmosquitoes. By communicating with the tribals in a language that they understand, SEARCH has been able to tackle manysuperstitions and unhealthy practices.3.1.66 Under the NRHM, emphasis has been given toallocate 70% of the total financial resources to belowdistrict level (block level and below), 20% at districtlevel, and 10% at State level. Efforts will be made toallocate funds under various schemes and programmesas per NRHM guidelines. Further, the requirementsof funds for a fully functional primary health care system(defined as all services at block level and below,including field-based implementation of disease controland preventive activities, but not administration)will also be worked out.SECONDARY AND TERTIARY HEALTH CARE3.1.67 Secondary and Tertiary health care will receiveattention. There is an urgent need to take a freshlook at how public and private sector can be betterutilized during the Eleventh Five Year Plan. The NRHMaddresses these issues through a few strategies. Prioritieswill be given to strategies involving PPPs, riskpoolingmechanisms, and cross subsidization.3.1.68 Administration of the secondary and tertiarycare hospitals will be professionalized and trainedprofessionals posted as Medical Superintendents. Hospitalswill be allowed to recruit various staff includingjunior doctors on ad hoc and contract basis. Drugspurchase should be made through centralized ratecontract and decentralized distribution with zerostock at headquarter level. Emergency and disasterstock should be located at each hospital. Drugs atall levels with minimum of one year shelf life shouldbe supplied.3.1.69 District hospitals, which play a key role in providinghealth services to the poor, need substantialimprovement in infrastructure and other facilities toperform their role more effectively. This would alsobe a key intermediate step in the health strategy, tillthe vision of health care through PHCs and communityhealth centres is fully realized. The Plan willalso complete setting up of 6 AIIMS-like institutions,upgrading 13 existing medical institutes under thePradhan Mantri Swasthya Suraksha Yojana (PMSSY)and strengthening the Central Government hospitals.Adoption of PPP mode will be explored for theseactivities.3.1.70 It is often observed that Government MedicalColleges and Hospitals are on the verge of derecognitionmainly because they fail to adhere to theinfrastructure, equipment, and staff norms, as laiddown by MCI. This is thought to be due to lackof funding. The Centre and States will have to makeprovisions for strengthening these institutions.