Eleventh Five Year Plan

80 Eleventh Five Year Planto 4% in 1988 and then to 22% in 2001. It is now acknowledgedthat unless 100% coverage is achieved andproper solid waste management (SWM) carried out,health indicators will not show significant improvement.Toilets are essential also for ensuring the safetyand dignity of girls and women. Lack of adequate numberof toilets with privacy affects the school dropoutrate of girl child. The solution, therefore, is to provideclean drinking water and adequate sanitation coveragethroughout the country by adoption of a convergentapproach by VHSCs under the NRHM.3.1.83 During the Eleventh Five Year Plan, the Ministryof Health and Family Welfare (MoHFW) will takeup a Programme for Prevention and Control of WaterBorne Diseases as a part of Sarva Swasthya Abhiyan,which will establish a mechanism of collaborationwith other departments (for supplying safe water tocommunity and carry out water quality monitoring),with specific responsibilities. The targets are: (i) by2010, to reduce the burden of waterborne diseases to75% of the present level; and (ii) by 2015, to reducethe burden of waterborne diseases to 50% of thepresent level. In order to achieve 100% coverage ofclean water and sanitation, Eleventh Five Year Planstrategies include:• Convergence of health care, hygiene, sanitation, anddrinking water at the village level through VHSCsunder NRHM.• Renewed efforts under NUHM to cover primaryhealth care, safe drinking water, and sanitation inurban areas.• Participation of stake holders at all levels, from planning,design, and location to implementation andmanagement of the projects.• Institutionalization of water quality monitoring andsurveillance systems by involving PRIs, community,NGOs, and other CSO.• Increased attention to Behavioural Change Communication.• Linking treatment of sewage and industrial effluentsto development planning.Enhancing PPP3.1.84 During the last few years, the Centre as well asthe State Governments have initiated a wide variety ofPPP arrangements to meet peoples’ growing healthcare needs (few examples provided in Box 3.1.10).Besides these examples, services like cleaning andmaintenance of buildings, security, waste management,scavenging, laundry, diet have been contracted out tothe private sector by many States.3.1.85 The existing evidence for PPP does not alloweasy generalization. Contracting is the predominantmodel for PPP in India. Some partnerships are simplecontracts (like laundry, diet, cleaning, etc.), othersare more complex involving many stakeholders withtheir respective responsibilities. For example, theYeshaswini Health Insurance scheme for farmers inKarnataka includes the State Department of Cooperatives,the Yeshaswini Trust with its almost 200 privatehospitals, a corporate Third Party Administrator(TPA), and beneficiaries with the eligibility conditions.It is seen that in most partnerships, the State HealthDepartment is the principal partner with limited stakeholderconsultation. However, true partnerships thatmean equality among partners, mutual commitmentto goals, shared decision making, and risk taking arerarely seen.3.1.86 Findings of existing case studies also bringforth concerns such as absence of the beneficiary inthe entire process, lack of effective governance mechanismsfor ensuring accountability, non transparentmechanisms, lack of appropriate monitoring and governancesystems, and institutionalized managementstructures to handle the task. For example, while contractingout PHCs, the State Governments sometimeshand over the worst performing PHCs to NGOs. Notpaying the initial instalment to NGOs at the start ofthe project is another problem. The NGOs are neversure whether the money will eventually be releasedand if so, how much to expect. Management of healthfacilities should be handed over to NGOs only if theprocess is completely transparent and there is a stronglocal monitoring mechanism. This is the objectiveof Government–NGO partnership envisaged in theEleventh Five Year Plan.3.1.87 During the Eleventh Five Year Plan, the experienceof PPP initiatives in selected States will be studiedthoroughly. Based on evidence, efforts will be made