Health policy in Bihar

<–2/”>a >In the last few years, Bihar has shown improvement on some important family Health-indicators/”>Health Indicators, driven by cumulative efforts of the national and the State Government to strengthen the state public health system’s quality. The latest data released by the fourth National Family Health Survey (NFHS-4), 2015–2016, shows that the share of Women availing institutional births and receiving pre- and postnatal care has gone up substantially in the state. The fertility rate in Bihar has also come down from 4 children per woman in NHFS-3 to 3.4 in NHFS-4. However, Bihar still finds itself encumbered by daunting public health challenges on multiple fronts. The state continues to struggle on the nutritional status of children, with a huge share of underweight and stunted children. Further, over two-thirds of the children are anaemic.

Commitment to Improved Quality

The State Health Society, Bihar (SHSB) has been leading on second generation reform initiatives in the state in alignment with the Government of India (GoI) priorities and policies. In the past, focus was mostly on tertiary Services. However, in recent years, there has been a shift towards improving quality of care in relation to maternal and newborn child health and primary health. This commitment towards provision of quality health services to women and children is in line with the Government of India’s reproductive, maternal, newborn, child, and adolescent health (RMNCH+A) strategy.

Improved service quality is a crucial focus area for GoB. The state has been working with Sector Wide Approach to Strengthening Health (SWASTH) -a programme supported by the Department of International Development (DFID-UK) – to build quality at various health institutions by identifying and addressing gaps. The state government intends to institutionalise continuous quality improvements through a quality certification mechanism. This was previously done through the Family Friendly Hospital Initiative (FFHI) till 2014, and subsequently under the National Quality Assurance Standards (NQAS). In fact, Bihar is a pioneer in quality assurance, becoming the first state in the country to start the quality assurance process through the FFHI standards initiative in 2011-12. NQAS was launched in 2013 at the national level, and GoB started implementing the NQAS initiative in November 2014.

QUALITY ASSURANCE AND THE ROLE OF BTAST

The advent of the second generation reforms has seen significant Investment in public sector health systems and Infrastructure-2/”>INFRASTRUCTURE, especially in relation to quality improvement. In 2011-12, the SHSB adopted FFHI, which is a check list- based quality assurance certification programme. FFHI, which was developed to suit conditions in the state, provided the framework to carry out improvements in health facilities, mainly primary health centres and district and referral hospitals. To guide implementation of FFHI, the GoB asked its development partners to provide technical support to hospital administrators and service providers. The Bihar Technical Assistance and Support Team (BTAST), a consortium formed by Care UK, Care India, Options Consultancy Services and IPE Global, and supported by the Department for International Development (DFID-UK) has been providing technical assistance to selected health facilities identified by the state government to improve the quality of services. BTAST was allocated a bulk of the districts – 25 out of 38 districts.

However, in March 2014, GoI rolled out protocols and guidelines for NQAS with the intention of standardising quality assurance in the public sector health system in the country. As part of the quality assurance process, quality assurance committees or quality teams have been instituted at state level, district level, and at each facility level. The process entails a two-pronged approach: a) strengthening of systems and processes and b) ensuring IPHS standards. This approach is integrated into the public health system’s natural functioning, in conformity with the quality assurance cells at state, district, and regional level. State government departments were encouraged to include NQAS related quality assurance activities in annual Programme Implementation Plans (PIPs). The Government of Bihar has been an early adopter of NQAS, having stepped up its quality assurance objectives from FFHI to NQAS certification for which SHSB developed a quality assurance road map with support from BTAST.

Bihar initiated some innovations in the NQAS implementation process to meet local needs, while keeping the overall process in line with central government guidelines. For example, while the central guidelines do not have any provision for regional quality assurance committees, the state BTAST Intervention Districts Non-Intervention Districts health department has constituted regional quality assurance committees in nine regions following approval from the central government. The main rationale behind the constitution of regional committees is the ease of monitoring through regional channels. This provision, it is hoped, would enable the process to be better managed and the regional stakeholders to be more responsible.

BTAST has been helping SHSB at the field level as well as at the strategic level. It has been helping with building quality assurance teams at different levels, handholding quality assurance committee members at the facility level in understanding their roles and responsibilities in the quality assurance process, as well as creating a roadmap for NQAS and FFHI compliance. The Quality Assurance Roadmap, for 2014-16, has three focus areas: strengthening quality assurance mechanisms and structures across levels; upgrading facilities to fulfil quality related criteria as per the NQAS framework and certification; and training and capacity building of service providers. Whereas most states are strengthening facilities on their own, Bihar has employed Quality Consultants through BTAST at the facility and district level. BTAST’s technical experts supported SHSB at the state level. Some of the specific components of work have included:

Developing concept notes, road maps and work plans; drafting ToR, protocols and guidelines for quality improvement; carrying out assessments and studies on quality related issues; providing trainers for thematic workshops; supporting recruitment for quality assurance units; and, creating a pool of experts on quality assurance.
Addressing gaps in service provision that had been identified through assessments and verifications by supporting facility managers and district level managers to strengthen the infrastructure in labour rooms at various facilities (designated as ‘Delivery points’)
Helping selected facilities to improve the quality of care as per NQAS standards
Assisting service providers in the use of supportive supervision checklists and client survey checklists; and mentored district officials in monitoring and supportive supervision processes
Strengthening DQACs and RQACs to ensure regular meetings and members fulfil their responsibilities
Supporting district authorities in the preparation of District Health Action Plans and allocation of Resources
Supporting facility managers to systematically collect and analyse Key Performance Indicators (KPI) related data and develop quarterly KPI dashboards
Providing technical assistance to three government medical college hospitals on implementation of NQAS in their MCH units

Apart from the crucial issue of sustainability, other barriers to quality of care became apparent. Manpower shortage, especially of nursing staff and specialists; lack of training; persistent infrastructural issues; and shortage of emergency medicines and instruments and labour room essentials are the key gaps in some of the facilities. Along with addressing these longstanding issues, any sustainable solution for ensuring continued delivery of quality care must also address the critical need for regular monitoring and corrective action and securing the buy-in and motivation of healthcare staff.,

Health policy in Bihar is a complex and multifaceted issue. The state has a long history of poor health outcomes, and there are a number of factors that contribute to this. These include inadequate health infrastructure, poor health financing, a shortage of qualified health workers, and a lack of access to quality healthcare.

In recent years, the government of Bihar has made some progress in improving the state’s health system. However, there is still much work to be done. The following are some of the key challenges facing health policy in Bihar:

Health infrastructure: Bihar has a shortage of hospitals, clinics, and other health facilities. This makes it difficult for people to access quality healthcare.
Health financing: The government of Bihar spends a relatively low proportion of its budget on health. This means that there are limited resources available to invest in health infrastructure, health workforce, and other essential services.
Health workforce: Bihar has a shortage of qualified health workers. This is a major barrier to providing quality healthcare to the Population.
Access to quality healthcare: Many people in Bihar do not have access to quality healthcare. This is due to a number of factors, including the lack of health facilities, the shortage of health workers, and the high cost of healthcare.

The government of Bihar has taken some steps to address these challenges. In recent years, the government has invested in building new hospitals and clinics, training more health workers, and providing subsidies for healthcare. However, more needs to be done to improve the state’s health system.

The following are some of the key priorities for health policy in Bihar:

Investing in health infrastructure: The government of Bihar needs to invest in building new hospitals and clinics, and upgrading existing facilities. This will make it easier for people to access quality healthcare.
Improving health financing: The government of Bihar needs to increase the proportion of its budget that is spent on health. This will provide more resources to invest in health infrastructure, health workforce, and other essential services.
Strengthening the health workforce: The government of Bihar needs to train more health workers, and improve the working conditions of existing health workers. This will help to address the shortage of qualified health workers.
Expanding access to quality healthcare: The government of Bihar needs to expand access to quality healthcare, particularly for the poor and marginalized. This can be done by providing subsidies for healthcare, and by building more Health Facilities In Rural Areas.

Improving health outcomes in Bihar is a complex and challenging task. However, by addressing the key challenges facing health policy in the state, the government can make a significant difference to the health of the population.

In addition to the key priorities listed above, there are a number of other areas that need to be addressed in order to improve health outcomes in Bihar. These include:

Promoting health Education and awareness: The government of Bihar needs to promote health education and awareness among the population. This will help people to make healthier choices, and to take better care of their health.
Preventing and controlling diseases: The government of Bihar needs to invest in preventing and controlling diseases. This includes vaccinating children against preventable diseases, and providing treatment for people who are sick.
Promoting mental health: The government of Bihar needs to promote mental health. This includes providing treatment for people with mental health problems, and raising awareness of mental health issues.
Addressing the needs of vulnerable groups: The government of Bihar needs to address the needs of vulnerable groups, such as children, women, and the elderly. This includes providing them with access to quality healthcare, and protecting them from abuse and neglect.

Here are some frequently asked questions and short answers about health policy in general:

What is health policy?
Health policy is a set of strategies and interventions that are designed to improve the health of a population. It can include a wide range of activities, such as developing and implementing public health programs, regulating the healthcare Industry, and providing financial assistance for health care.
What are the goals of health policy?
The goals of health policy vary depending on the specific policy. However, some common goals include improving the health of the population, reducing health disparities, and controlling healthcare costs.
Who makes health policy?
Health policy is made by a variety of actors, including government officials, healthcare providers, insurers, and the public.
How is health policy implemented?
Health policy is implemented through a variety of mechanisms, such as laws, regulations, and programs.
What are some of the challenges of health policy?
Some of the challenges of health policy include the complexity of the healthcare system, the difficulty of measuring health outcomes, and the need to balance competing priorities.
What are some of the successes of health policy?
Some of the successes of health policy include the decline in smoking rates, the increase in immunization rates, and the development of new medical technologies.
What are some of the future trends in health policy?
Some of the future trends in health policy include the aging population, the increasing prevalence of chronic diseases, and the rising cost of healthcare.

The National Health Policy (NHP) 2020 aims to achieve universal health coverage (UHC) by 2030. Which of the following is not one of the key components of UHC?
(A) Access to essential health services
(B) Financial risk protection
(C) Quality and affordable healthcare
(D) Health promotion and disease prevention
The NHP 2020 also aims to reduce the out-of-pocket expenditure on healthcare to 15% of household income by 2030. Which of the following is not one of the strategies proposed to achieve this goal?
(A) Expanding the coverage of health insurance schemes
(B) Providing cashless treatment at public hospitals
(C) Regulating the prices of drugs and medical devices
(D) Promoting the use of generic drugs
The NHP 2020 also aims to improve the quality of healthcare in India. Which of the following is not one of the strategies proposed to achieve this goal?
(A) Increasing the number of doctors and nurses
(B) Improving the infrastructure of public hospitals
(C) Promoting the use of evidence-based medicine
(D) Regulating the medical profession
The NHP 2020 also aims to strengthen the public health system in India. Which of the following is not one of the strategies proposed to achieve this goal?
(A) Expanding the Network of primary health care centers
(B) Strengthening the surveillance system for communicable diseases
(C) Promoting the use of preventive health services
(D) Regulating the food and drug industry
The NHP 2020 is a comprehensive policy document that aims to improve the health of the people of India. It has been welcomed by many stakeholders, but it has also been criticized by some. Which of the following is not one of the criticisms of the NHP 2020?
(A) The NHP 2020 is not ambitious enough
(B) The NHP 2020 is not realistic
(C) The NHP 2020 is not adequately funded
(D) The NHP 2020 is not well-implemented
The NHP 2020 is a work in progress, and it will be implemented over the next decade. It is too early to say whether the NHP 2020 will be successful in achieving its goals. However, the NHP 2020 is a positive step towards improving the health of the people of India.
The NHP 2020 is a comprehensive policy document that aims to improve the health of the people of India. It has been welcomed by many stakeholders, but it has also been criticized by some. The criticisms of the NHP 2020 are valid, but they should not be used to dismiss the entire policy. The NHP 2020 is a work in progress, and it will be implemented over the next decade. It is too early to say whether the NHP 2020 will be successful in achieving its goals. However, the NHP 2020 is a positive step towards improving the health of the people of India.