News from the Columbia Climate School

New working paper: Model Districts as a roadmap for scale-up

Read our team’s new working paper on ‘Model Districts as a Roadmap for Public Health Scale-up in India.’

In this paper we will briefly explain how India’s Ministry of Health and Family Welfare and The Earth Institute arrived at the need for the Model Districts initiative, the project’s proposed strategy for narrowing the policy-practice gaps and scaling-up required best practices and innovations, and the expected outcomes and impact of the project.  This working paper, and continued research work during the course of the project, seeks to contribute to the growing discussions around the health systems strengthening requirements for India’s rural public health services, for use by policy makers, programme managers, and health researchers.

As our earlier blog posts have described, India’s on-going struggle to provide high-quality public health services, particularly for the rural masses, is one of the country’s greatest challenges.  The National Rural Health Mission (NRHM) was launched in 2005 to improve access to quality health care for the rural population, and especially the poor, women, and children. Five years later, the Mission has some significant accomplishments, but coverage of high-priority interventions remains inadequate, programming quality is insufficient, efficient management and governance is lagging, and inequities further complicate delivery and uptake. Corrective action is required immediately to accelerate progress towards national and Millennium Development goals in health. The Ministry of Health and Family Welfare determined that required efforts in health systems strengthening would best be piloted and scaled-up as regional models, given India’s size and the wide variances in health system performance, disease burden, and sociocultural, political, economic contexts.

A Model District was designated in each geographical region: Assam (Northeast), Bihar (East), Uttar Pradesh (North), Rajasthan (West), and Andhra Pradesh (South).  These five Model Districts will serve as regional pilots for scaling up innovations and quality improvements in the six health system building blocks: financing, leadership and governance, supply chain management, human resources for health, infrastructure, and health information management systems.  By targeting active management and improved delivery processes within these six areas of the system, the project aims to enhance the quality of, and access to, health services delivery for the continuum of maternal and child health care, including antenatal care, safe delivery, immediate postnatal care, early childhood development and nutrition, and care for the well and sick child.  With this strategy, the Model Districts will seek to create ‘centres of excellence’ for the issues in designing, managing, and implementing scaled-up health systems, particularly in large rural areas and with a focus on maternal and child health and nutrition.

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