The Structured Learning Course On
Decentralised Health Management

This module based learning programme complements official processes of capacity building with a more informal, open ended participatory and immediate reaching out to all these individuals and organisations with essential information and tools as well as with a diversity of views and programme options. It provides both access to technical resources and the opportunity to be sensitised to ongoing debates. By actively engaging individuals and organisations within their existing spheres of work and by facilitating their participation in enhancing the quality of health services, this course would expand the number of sensitised persons - the potential missionaries needed to support the Mission.

CONTENTS: The programme is not a substitute for the formal training and certification of public health management professionals in public health training institutions. The content also does not necessarily reflect the official positions of the Mission- in either technical detail or programme strategy. It complements official processes of capacity building with a more informal, open ended participatory and immediate reaching out to all these individuals and organisations with essential information and tools as well as with a diversity of views and programme options. It provides both access to technical resources and the opportunity to be sensitised to ongoing debates. By actively engaging individuals and organisations within their existing spheres of work and by facilitating their participation in enhancing the quality of health services, this programme would expand the number of sensitised persons- the potential missionaries needed to support the Mission!

AIM: Strengthening technical assistance capacities at district and state levels to support processes that lead to achieving the NRHM’s goals of decentralisation through district, block and village health plans and thereby accelerate moves towards effective, equitable, accessible and affordable health care for all.

TRAINING MATERIALS: The training material follows the comprehensive primary health care approach. It is expected to enable the participants to develop the knowledge and skills needed for effective district health planning and for advocacy and support to decentralised health planning and management.

The materials is therefore organised as a set of modules that cover the following areas:

1. Introduction to Public Health System: A brief overview of the goals of the health sector and in the current context – the goals of the National Rural Health Mission. Also a brief introduction to the structure of the public health system- and some understanding of the constraints that it’s different components are facing.
2. Reduction of Maternal Mortality: An understanding of the socio –medical causes of maternal mortality, an assessment of constraints being faced by current schemes for provision of care in pregnancy are facing and a look at best practices that have successfully addressed these bottlenecks.
3. Accelerating Child Survival: An understanding of the common causes of child mortality and the bottlenecks that current strategies are facing. A look at the wealth of best practices from which evidence based strategies for improving child health could be drawn up.
4. Community Participation and Community Health Workers: Understanding these concepts and learning from large scale community health worker programmes to make a success of the ASHA scheme. This module is designed as a tool-kit of everything one needs to know about the ASHA programme!!!
5. Behaviour Change Communication and Training: How these two essential supportive elements of any public health system can be rendered more effective avoiding the errors and pitfalls of the past.
6. Mainstreaming Women’s Health Concerns: Women’s Health Issues (beyond care at pregnancy) are addressed in this module. Also there is an exploration of concepts like gender sensitive health services and gender mainstreaming and an effort to convert a number of desirable concepts into pragmatic steps.
7. Community Participation beyond Community Health Worker Programmes involves learning about tools of community diagnosis, understanding village level planning and the role of panchayats; finding the spaces where community may participate effectively in decision making. Also to understand and draw on the strengths of Non Governmental Organisations.
8. Disease Control Programmes need to be incorporated into a district plan for efficient use of resources and effective implementation and to adapt programmes to meet local specificities. This is discussed with reference to Malaria, Tuberculosis and HIV and the National Disease Surveillance programme.
9. Convergence: The district plan needs to incorporate a comprehensive understanding of the social determinants of health especially with reference to food and nutrition. The district needs to plan for a number of sectors to act together to address nutrition and food security issues, safe water and sanitation and school education in an integrated manner.
10. District Health Planning: The skills and tools for situation analysis and programme assessment, the conceptual clarity to frame objectives, choose evidence based strategies and frame appropriate indicators are covered in this module. With this module, reached in the sixth month – the minimum knowledge and skills for district level health planning would be in place.
11. District Health Management looks at the development of managerial capacity. It also includes areas like health infrastructure planning, systems for procurement and logistics, rational use of drugs, health management information systems and quality assurance mechanisms.
12. Engaging with the Private Sector to ensure its contribution towards public health goals, building public private partnerships, assessing health insurance options, and moving towards a stewardship role for the government in interacting with the private sector are addressed in this module.
13. Legal Obligations of District Health Systems within which the health system operates is explored in this module.
14. Key Issues of Governance and Health Sector Reform, the perspective frameworks within which different stakeholders operate, the approach to decentralisation, and the options available for promoting and managing change considering existing relationships of power are explored and discussed here.
15. Optional Areas that the course participant may further choose from include urban health planning, tribal health planning, addressing health issues of marginalised groups, introduction to hospital administration, the approach to non communicable disease including mental health etc.
16. Each module has six to ten lessons with project work at the end of most of the lessons. The modules, project work and contact programmes taken together act as a tool kit for the construction of a district health plan.

OPERATIONAL DETAILS

PROGRAMME STRUCTURE: The course has been designed as a module-based distance education programme, to be completed, optimally, within an 18-month period. This will be accompanied by at least one CONTACT PROGRAMME in each quarter and a number of informal contact opportunities. Interactive activities and projects to strengthen the quality of knowledge sharing would also be built in. These contact programmes, will be used as a platform to analyse the status of ongoing health planning in the district and assess the existing and future opportunities for participation in district health planning and in health programmes. For assisting the district level learning process and for promoting networking and mutual support, a core team of state level programme coordinators and a number of voluntary programme associates/experts will act as resource persons. The process of receiving certification by a nationally accredited body for the programme has been taken up. Participants who send in the monthly feedback forms, undertake and complete all course activities and/or attend the contact programmes regularly, will be deemed to have completed the programme successfully and this would be acknowledged by the course authorities. The assessment of participants will be an ongoing process aimed at aiding both the participants and the course coordinators to gauge their own progress and identify areas for further improvement.

FACULTY: Faculty for developing training materials and conducting contact programmes comprises of resource persons who have been actively involved in providing technical assistance to district level health programmes in the EAG states. The faculty has been largely be drawn from the senior experts of state level and regional health resource centers and technical agencies working in the EAG states- the State Health Resource Center Chhattisgarh, Population Foundation of India, Child In Need Institute, ICICI Centre for Child Health and Nutrition and agencies like UNICEF and from NGO networks. The course is being coordinated by Public Health Resource Centre based in Delhi.

We recommend the course as most useful for those already involved in health sector programme planning or implementation- either in the government or in the non-governmental sector, and to those who volunteer to undertake this course as an opportunity to develop their own knowledge and skills to enable them to contribute better to the creation of equitable health systems. Any NGO or state or district health society or any other health related organisation which wants to sponsor candidates for the course may also contact us for further details.

PHRN certificate will be provided to all trainees. Certification will be based on level of achievement; modules trained in and project assignments/ review questions submitted.
FORMAL (DIPLOMA) CERTIFICATION: Formal certification (diploma in District Health Management) may be available to interested trainees. This would depend upon a university undertaking to recognize and conduct the course and discussions with potential universities are on going. Those who opt for the course would have to pay a fee, attend contact programmes, submit periodic assignments and do project work/ dissertations as required over a one year period.  
 
PARTICIPATION AND MEMBERSHIP:

• E group- Communication and information sharing in the network is enabled by an e group (http://groups.yahoo.com/groups/phrn2006). Any concerned individual may join the PHRN e group by a simple process of application through an existing member.
• Annual membership- Annual membership to the general body of the network may be applied for through an existing member along with the annual fees of Rs 200/-
• Life time membership-A life time membership may be applied for and carries a fee of Rs 3000/-
• Associate membership- Associate membership can be applied for by any organisation actively involved with health related activities. Fees will be fixed by the governing board on a case by case basis and representation to the general body will be by representation.
• Student membership and affiliate membership- It may be applied for free of charge. These members will not be considered members of the general body.
• Course Participant- For the structured learning course Rs 1200 - to be paid in one installment, or in three installments payable quarterly. A minimum of 14 mandatory modules and two optional modules would be sent. In the first quarter 5 modules, in the second quarter 5 modules, in the third quarter 4 modules and in the last quarter 2 optional modules would be sent. There is one CONTACT PROGRAMME in each quarter and a number of informal contact opportunities. Concessions will be considered on a case-by-case basis. Organisations are welcome to sponsor participants. Please note that the fees only cover the cost of printing and posting of the modules. If universities are to certify the course this would involve additional costs. Supplementary course material would also be available on payments by post but could be downloaded free from the PHRN website.