A post-event report of the International Conference on Health Systems Strengthening hosted by the Government of Tamil Nadu during May 7 10, 2010 in Chennai
L-R: Dr. Girdhar Gyani, Secretary General, QCI & CEO, NABH; Mukesh Chawla, Sector Manager, Health Systems Strengthening, The World Bank; Erin Soto, Hon’ble Minister & Counselor for International Development, USAID – India; Shri MRK Panneerselvam, Minister for Health, Government of Tamil Nadu; Prof. K Anbazhagan, Hon’ble Minister of Finance, Government of Tamil Nadu; Dr. Syeda Saiyidain Hameed, Member, Planning Commission of India; Ms. Sujatha Rao, Secretary, Union Ministry of Health & Family Welfare; Mr. VK Subburaj, Principal Secretary, Health & Family Welfare Department, Tamil Nadu; and Dr. S Vijayakumar, Project Director, TNHSP.
Aimed at facilitating the understanding of health systems strengthening, sharing international and national experiences of good practices on health systems strengthening and facilitating national and state policies for improving health systems, ICONHSS witnessed three days of active conferencing and deliberations over the need and ways of strengthening health systems and turned out to be an excellent learning experience for all.
The conference was organised in effective collaboration with various stakeholders across verticals and laterals including the Government of India, The World Bank, National AIDS Control Organisation (NACO), United States Agency for International Development (USAID) India, World Health Organisation (WHO), Tamil Nadu State AIDS Control Society (TANSACS), Indian Council of Medical Research (ICMR), AIDS Prevention and Control Project Voluntary Health Services (APAC-VHS), Solidarity and Action Against the HIV Infection in India (SAATHII), National Rural Health Mission (NRHM), the Tamil Nadu Dr. MGR Medical University, Public Health Management Institute (PHMI), and the Chettinad Health City, among others. The conference was presided by Mr. VK Subburaj, Principal Secretary to Government, Health and Family Welfare Department, Tamil Nadu.
PRE-CONFERENCE WORKSHOP: LEARNINGS FROM THE HEALTH SYSTEMS INITIATIVES IN INDIA
The oganisers held a pre-conference workshop on May 6, 2010, the objective of which was to provide an overview of the Tamil Nadu Health Systems Project, its various initiatives and the current status. During the Presidential Address at the inaugural session of the pre-conference workshop, Mr. VK Subburaj, Principal Secretary to Government, Health and Family Welfare Department, Tamil Nadu, talked about the strengths of the TNHSP and the improvements it has brought about in the health sector in Tamil Nadu. The inaugural address by Prof. Dr. Mayil Vahanan Natarajan, Vice Chancellor, The TN Dr. MGR Medical University, focussed on the need of reviving the medical curriculum in India to include strengthening of healthcare systems as a subject.
The role of the World Bank in supporting healthcare systems strengthening projects in various states including Tamil Nadu was outlined by Dr. Preeti Kudesia, Senior Public Health Specialist at the World Bank. The second session at the pre-conference workshop focussed on providing an overview of the health systems. Dr. Nandraj provided statistics on the current status of health systems in India with respect to all key elements. Dr. Preeti Kudesia’s presentation focussed on the support provided by the World Bank in strengthening health systems in India. The World Bank has supported several state health systems projects in the country in Andhra Pradesh, Karnataka, Punjab, West Bengal, Orissa, Maharashta, Uttar Pradesh, Uttarakhand, Rajasthan and Tamil Nadu. Focussing specifically on Tamil Nadu, she said that the state had done extremely well in addressing all these issues. The next session of the day focussed on sharing good practices from the World Bank funded health systems projects in India. Chaired by Dr. Preeti Kudesia and Dr. V Kumaraswami, Officer-in-Charge, National Institute of Epidemiology, Chennai, the session brought together representatives of various states’ health systems project to share best practices.
The theme of the last session of the pre-conference workshop was on integration of chronic disease prevention and management in public health. The session was chaired by Dr. K Srinath Reddy, President, Public Health Foundation of India (PHFI) and Dr. Thanikachalam, Chairman & Director (Cardiac Care Centre), Professor Emeritus of Cardiology, Sri Ramachandra Medical College & Research Institute.
INAUGURAL SESSION
A grand inauguration ceremony was hosted on the first day of the conference, which was attended by Prof. K Anbazhagan, the Hon’ble Minister of Finance, Government of Tamil Nadu; Sri MRK Panneerselvam, Minister for Health, Government of Tamil Nadu; Ms. Sujatha Rao, Secretary, Union Ministry of Health & Family Welfare; Dr. Syeda Saiyidain Hameed, Member, Planning Commission of India; Mr. Mukesh Chawla, Sector Manager, Health Systems Strengthening, The World Bank; Ms. Erin Soto, Hon’ble Minister and Counselor for International Development, USAID India; Dr. Girdhar J Gyani, Secretary General, Quality Council of India & CEO, National Accreditation Board for Hospitals & Healthcare Providers; Mr. VK Subburaj, Principal Secretary to Government, Health and Family Welfare Department, Tamil Nadu; and Dr S Vijayakumar, Special Secretary (Health & Family Welfare) and Project Director, TNHSP and Kalaignar Insurance Scheme for Life Saving Treatment.
At the onset, Mr. VK Subburaj informed that because of the success of the project in the first phase, the World Bank has provided an additional budget of INR 627 crore for the extension of the project for three more years. Further, Dr. Girdhar Gyani said that, under the TNHSP, Tamil Nadu has taken a lead in opting for accreditation for its government hospitals and was pleased to inform that two government hospitals in the state have already received the prestigious NABH accreditation. Ms. Erin Soto said that USAID is moving towards the health systems strengthening approach to improve the quality of life of the fellow global citizens.
The Special Address at the inaugural session was given by Ms. Sujatha Rao, who congratulated the Government of Tamil Nadu for strengthening its health systems. She laid stress on the emergence of health insurance as one of the solutions to making healthcare accessible as almost eight percent people get pushed below poverty line every year because of huge out-of-pocket healthcare spending. Delivering the keynote address, Dr. Syeda Saiyidain Hameed said that the Planning Commission supports TNHSP in all its endeavours as the former considers health systems strengthening as a very important building block for the nation. The Hon’ble Minister of Health, Government of Tamil Nadu, Sri MRK Panneerselvam delivered the Presidential Address, in which he informed that the Government of Tamil Nadu has doubled its health budget from INR 1951 crore in 2006-07 to INR 3888 crore in the current financial year 2010-11. The Inaugural Address was delivered by Prof. K Anbazhagan, the Hon’ble Minister of Finance, Government of Tamil Nadu. He said that the strategies of the Tamil Nadu government in the health sector are impact making and the government is keen on improving health of pregnant women, children and poor. The inaugural session ended with a vote of thanks, delivered by Dr Vijayakumar.
DAY I
Following the inaugural session, the conference proceeded with a session on health systems strengthening in India coupled with financing for universal access. Chaired by Ms. Sujatha Rao and Dr. Mukesh Chawla, the session saw eminent speakers deliberating on strengthening of health systems and the role of financing in the health sector. Renowned Cardiologist, Dr. Devi P Shetty, Chairman, Narayana Hrudayalaya Group of Hospitals, made the first presentation in which he talked about the role of private sector investments in improving access to healthcare in India. Following his presentation, Mr. VK Subburaj shared Tamil Nadu’s experiences on health systems strengthening and talked about how TNHSP’s efforts had brought about a significant improvement in the health of the citizens of Tamil Nadu. Elaborating further on the topic, Dr. Mukesh Chawla laid stress on innovations in strengthening health systems.
Dr. Ganga Murthy, Additional Chief Economic Advisor, Government of India, described National Health Accounts and its role in tracking the flow of resources, thereby providing evidence base for financing healthcare. Dr. Ravi Duggal, Senior Trainer and Health Analyst, International Budget Partnership said that the key issues in India are high out-of-pocket expenses and low public health spending. The last session on day I focussed on service delivery and was chaired by Ms. Girija Vaidyanathan, Mission Director, NRHM and Project Director, RCH, Tamil Nadu and Dr. K Srinath Reddy. Ms. Kerry Pelzman, Director, Office of Population, Health & Nutrition, USAID India, shared the global experiences of health services delivery, listing the challenges that are faced throughout the globe. Dr. Preeti Kudesia stressed on the importance of quality in healthcare and listed the key quality ingredients. Dr. Prakash, Medical Director, Star Health & Allied Insurance said that insurance can play a key role in enhancing access to quality healthcare. Star Health Insurance runs key health insurance schemes in partnership with the government in the states of Andhra Pradesh and Tamil Nadu. Dr. K Srikanth Reddy talked about the challenges in delivery of services for prevention and control of non-communicable diseases.
DAY II
Day II of the conference began with a session on human resources, chaired by Dr. Michael Friedman, US Public Health Service Medical Officer (UPHMSO), CDC, Atlanta and Dr. Mala Rao, Director, Indian Institute of Public Health, Hyderabad. Dr. Michael Friedman, at the beginning of the session, talked about the development of public health workforce and its relevance in India. Ms. Pamela Rao, Senior Advisor Health Systems Strengthening, USAID also shared her views on the key factors that attract healthcare workers to rural areas. Dr. Kara Hanson, Reader, Health Systems Economics, London School of Hygiene and Tropical Medicine talked about the importance of financial and non-financial incentives to attract health workers to rural areas. Dr. Padmanabhan, Advisor, Public Health Administration, NHSRC discussed the topic “Health & Human Resources Priorities in India”. Linking maternal deaths with the healthcare manpower in a country, he stated that countries with most number of maternal deaths have been noticed to have the least number of healthcare workers. Dr. Krishna Rao, Head of Health Economics, Public Health Foundation of India made an assessment of task shifting in primary healthcare.
“Ms. Sujatha Rao talked about the role of NRHM for enhancing healthcare services in the country and how ASHAs, the face of NRHM, have proved to be a good model in delivering healthcare in rural areas.”
Following the first session, two parallel sessions were held on human resources and service delivery. The session on human resources was chaired by Dr. KS Jacob, Professor and Head, Department of Psychiatry, CMC, Vellore and Dr. Kara Hanson. Certain key presentations in this session include: innovative methods in medical education by Dr. Vinod Shah, Co-ordinator, Department of Distance Education, CMC, Vellore; availability, motivation and capacity building of nurses: experiences from the private sector by Dr. Lata Venkatesan, Principal Apollo College of Nursing; innovative human resource practices for effective health service delivery: experiences from Aravind Eye Care System by Ms. Preeti John, Senior Faculty, LAICO, Aravind Eye Care System; rationalisation of human resources: Tamil Nadu experience by Dr. (Capt.) M Kamatchi, Expert Advisor, TNHSP; development of emergency medical technicians cadre by Dr. GV Ramana Rao, utive Partner, GVK EMRI; and more. The parallel session on service delivery, chaired by Dr. DCS Reddy, NPO-HIV-AIDS Surveillance, WHO and Dr. ES Krishnamoorthy, Secretary, VHS, Chennai, saw eminent speakers deliberating on the various aspects of service delivery and how it can be improved in India.
The key presentations made during this session included: access to healthcare for vulnerable populations: experience from Andhra Pradesh by Ms. Lipika Nanda, Director, Family Health International, Andhra Pradesh; care at time of critical emergencies by Dr. Gurusamy, CEO, TNHSP; under-reported deaths and inflated deliveries: making sense of health management information systems in India by Dr. Upendra Bhojani, Faculty, Institute of Public Health, Bangalore; self-help groups for filarial morbidity management by Dr. Sairu Philip, Associate Professor, Department of Community Medicine, TD Medical College, Alappuzha; citizens help desk at hospitals: empowering the public with information and guidance by Mr. S Selvakumar, Project Director, Karnataka Health Systems Development and Reforms Project, and many more.Chaired by Dr. Mukesh Chawla and Dr. Sunil Nandraj, the final session on day II focussed on the various aspects of healthcare financing. At the beginning of the session, Dr. Chawla gave an overview of the global perspective of healthcare financing and the relevance it has in India. Following Dr. Chawla’s presentation, Dr. Gerard La Forgia, Lead Health Specialist, the World Bank, India highlighted the various aspects of performance based funding. Dr. Muraleedharan, Professor, Department of Humanities and Social Sciences, IIT, Madras brought in a benefit incidence analysis of public spending in healthcare in the states of Orissa and Tamil Nadu. Highlighting case studies from these two states, Dr. Muraleedharan stated that there is a need for deeper analysis of the extent to which public policies have been efficiently designed to make them pro-poor and the emergence and role of private providers needs further study.
The second half of this session saw a panel discussion with Dr. Devadasan, Technical Advisor, Institute of Public Health, Bangalore; Dr. Indrani Gupta, Professor, Institute of Economic Growth, New Delhi; Dr. Sakthivel Selvaraj, Health Economist, PHFI; and Mr. Babu A, Chief utive Officer, Aarogyasri Healthcare Trust came together and deliberated on the various options for health financing. The key pointers discussed included public, private, community and public-private financing options.DAY III
The third day of the conference began with a session on Governance, chaired by Dr. CAK Yesudian, Dean, School of Health Systems, TISS and Ms. Meena Gupta, Former Health Secretary, Orissa. During the introductory remarks, Dr. Yesudian talked about healthcare governance in India; its evolution and determinants. Sharing global perspectives on health governance, Ms. Pamela Rao defined health governance as ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, the provision of appropriate regulations and incentives, attention to system design and accountability. The next presentation by Mr. PWC Davidar, Secretary, Information Technology, Tamil Nadu Government revolved around the role of information technology in health governance. Taking Tamil Nadu’s example, Mr. Davidar discussed the IT current infrastructure of Tamil Nadu, its implementation and the various stakeholders that have been a part of all these projects. Mr. Abhay Shukla, Coordinator, SAATHI CEHAT, India talked about community based monitoring of health services: an evolving model of people cenetred health systems governance. He said that community based monitoring is a process for changing the power balance. The second part of the session comprised a panel discussion on planning, human resource policies, management, corruption, regulations and monitoring.
“Talking about Global Funds in India, Dr. Addai said that Global Funds was set up to fight against HIV, TB, Malaria with an investment of USD 19.3 billion in 144 countries. In India, the Global Funds have been active since 2002.”
Positive synergies between health systems and global health development initiatives was the focus of the second session of the day. Chaired by Mr. Chandra Mouli, Secretary, Department of AIDS Control and DG, NACO and Mr. Prasada Rao, Director, UNAIDS Support Team for Asia and the Pacific, UNAIDS; the key speakers at this session included Dr. Edward Addai, Director, Monitoring and uation, GFATM; Dr. Badara Samb, Coordinator, WHO, France; and Dr. Preet Dhillon, Senior Scientific Officer, SANCD, India. The session also comprised a panel discussion on translating recommendations of positive synergies into action. Discussing recommendations from the positive synergies initiatives, Dr. Badara Samb said that the financial allocations for diseases can be effectively used to strengthen the entire health system. While, Dr. Preet Dhillon concentrated on a framework for integration of chronic diseases as part of public health services, she said that the main challenge was that chronic disease prevention and management do not form a central part of the existing health systems.
Health systems research was the focus of the last session of the day that also comprised of a panel discussion on priorities for health systems research in India. Chairing the session, Dr. Vishwa Mohan Katoch, Secretary to Government of India and Director General, ICMR and Dr. S Venkatesh, DDG, NACO focussed on generating interesting discussions revolving health systems research, priorities and the role of data in decision making. Dr. Kara Hanson provided an overview of the methods and approaches for health systems research. She said that the purpose of health systems research is to understand the current state of knowledge systematic literature review, access current performance of health system/policy/intervention and uate health systems interventions. Dr. TP Ahluwalia, DDG, Division of Health Systems Research, ICMR said that the Government of India has recently recognised the crucial role of health research by providing a departmental status to research in the Health Ministry.
Dr. Venkatesh gave the example of the effective and timely use of data at all levels is a key necessity for controlling the HIV epidemic, thereby stressing on the role of data in decision making.VALEDICTORY SESSION The International Conference on Health Systems Strengthening ended with a valedictory function on May 9, 2010, which witnessed the release of the Chennai Declaration, urging the government to take some crucial steps towards strengthening health systems in the state of Tamil Nadu. Present at the ceremony were Mr. KS Sripathi, Chief Secretary, Government of Tamil Nadu along with Mr. VM Katoch, Mr. Chandra Mouli, Mr. VK Subburaj and Dr. S Vijayakumar. Mr. Sripathy said that while Tamil Nadu had done fairly well in uplifting its healthcare sector, the state still needs to focus on key areas such as controlling water and air pollution to enhance the health of its citizens. Mr. Katoch mentioned that to achieve the millennium development goals, India needs to control the spread of epidemics with a greater focus on generating adequate manpower. Mr. Chandra Mouli also shared his views on how healthcare in the country can be made better by better implementation of available resources. 
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