Kerala Comprehensive Health Plan

Problem Statement

Following the decentralisation process in Kerala, the allocation to all departments, including Health, was decreased proportionally to allocate 25-30% of the State Plan Fund to Local Self Government Institutions as recommended by the Kerala Finance Commission. This resulted in a financial crunch in continuing the various programmes. Lethargy of the departments in liaisoning with Panchayati Raj Institutions resulted in miniscule allocations to the health sector from LSGD plan resources in the earlier three plan period.

Programme Description

The Comprehensive Health Plan (CHP) initiated by NRHM in the State as a massive Campaign in 2011-12 has succeeded in the first three years of the XIIth Five Year Plan in placing Public Health Care firmly on the agenda of Local Self Governments/Panchayati Raj Institutions (PRIs). Decentralized planning is not a new concept in the State, but such an initiative in the Health Sector as a joint initiative of NRHM, Health and other related departments and PRIs was a novel venture. In Kerala, PRIs in the State are sufficiently capacitated and empowered since the last two decades to own and manage all the developmental activities of departments brought under their control, which included the Public Health services. A Comprehensive Health Plan was prepared through a decentralised Plan Preparation process on a pilot basis in Alappuzha district. Considering the success and participatory approach, the process has been extended to all the districts of Kerala. The Comprehensive Health Plan was planned as a Decentralised Plan Campaign involving all the field staff of Health/Health-related departments and NGOs, as a joint initiative of PRIs and NRHM. Health Plans of all wards of Grama Panchayaths were prepared and all such Plans were consolidated at Grama/Block/ District Panchayathlevel as projects and duly vetted by the District Planning Committee (DPC), a Constitutional body with the District Panchayath President as Chairman and District Collector as Member Secretary. State and district level TOTs and workshops were conducted to roll out the campaign. State/districtlevel workshops were periodically conducted for Medical Officers (Implementation officers of LSGD Health Projects) and health staff to familiarise them with the procedures/techniques of taking up and implementing LSGD projects. To motivate and energise the PRIs to take up more health and health-related projects and also the Medical Officers in charge of PHC/CHC, District Panchayat, Corporation/Municipality Arogya Keralam Puraskaram was institutionalised. NRHM in association with Doordarshan, Kerala has produced a documentary on Health Initiatives of PRIs- covering the State-level “Arogyakeralam Puraskaram" award winners of 2012-13. This was widely acclaimed and noticed by the public at large, resulting in taking up of more health projects by PRIs from their Plan allocation.

Financial investment

Around 15,000 meetings/workshops were conducted in the State as part of the Campaign. Altogether projects worth Rs. 209 crores were included in the Health Sector from the allocation of LSGDs. However, the expense incurred—around Rs. 40 lakhs—is meagre considering the total amount (Rs. 209 crores) of health projects included in the PRI's Annual Action Plan of 2012-13.

Conclusions/Lessons Learnt

A review of the last three years compared to XIth Five Year Plan compared reveals that NRHM in association with Health Service Department has succeeded in diverting the resources from LSGD plan.

Source: National Health Systems Resource Centre