Details for Reform Option "Establishment of District Health Agencies to manage health services: various States"
Establishment of agencies to manage Health and Family Welfare (H&FW) services in the districts through a State Government Order (GO).
The agencies can take a variety of forms, eg. the Zilla Parishad itself; a committee set up by state executive order; a statutory body created by the state; corporation or company; society.
Most of the current agencies are extensions of existing societies chaired by the District Development Officer (DDO) with the District Health Officer (DHO) as secretary. It is not recommended that an additional society be created and in fact the creation of the agency can be an opportunity to amalgamate a range of existing societies with similar memberships.
Membership includes representatives from Panchayats, H&FW department, NGOs and private sector.
Powers may include, for example, recruitment and dismissal of staff; schemes to generate income for local use; construction and maintenance of health facilities; procurement of emergency drugs.
Each agency manages a Sector Reform Fund (SRF) as a channel for funds from government and development partners (donors) for the development of local services.
In Haryana, District Health and Family Welfare Societies have been functioning successfully since January 2002. The societies, which have a governing council and an executive body, also spend user fees and have been able to make significant improvements to both infrastructure and services.
Decentralisation: Decisions can be made quickly without waiting for State Government to respond.
Accountability: Responsibility for all H&FW services in a district clearly rests with one management body.
Streamlined: Brings a number of different societies under one management team so services are better coordinated.
Communication: Strengthens links between Panchayats, district H&FW services, NGOs and the private sector.
Cooperation of state government and existing community organisations/societies. State GO.
Who needs to be consulted
District Panchayat, District and State H&FW Authority, NGOs, private sector.
Fair to good: the agency may well require a small secretariat which could be funded from a variety of sources such as the District H&FW budget or the District Panchayat budget. Haryana reports the system to be functioning successfully.
Chances of Replication
Good: although the constitution, name, form and membership of district agencies will vary according to local circumstances.
This reform option, which gives a local management focus for effective decentralisation of H&FW services, will facilitate other reform options to take place.
ECTA PROD Team, New Delhi, July 2002. Updated October 2004.