Alternative health system and public private partnership

ALTERNATIVE HEALTH
SYSTEM AND
PUBLIC
PRIVATE
PARTNERSHIP
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INTRODUCTION
Department of Indian Systems of Medicine and
Homoeopathy (ISM&H) was established. In 1995 and
renamed as Department of Ayurveda, Yoga &
Naturopathy, Siddha, Unani and Homoeopathy
(AYUSH) in November, 2003. There has been a three
fold increase in the Plan budget of the Department in the
10th as compared as 9th Plan, most of which was on
account of scaling up of the budget provision in the last
two years of the 10th Five Year Plan i.e. 2004 –2005 and
2005 – 2006 in line with the declared policy of the
Central Government to increase the budgetary provision
for AYUSH sector for mainstreaming it in the national
health care delivery network.
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INTEGRATION OF AYUSH
The integration of Ayush is to be carried out
at the State and district level:
Membership of the State and District Mission
and the Integrated State and District Health
Societies of a person from Ayush so that they are
part of all the decision making processes. The
infrastructure will be used for providing a
greater availability of services. All the National
Programmes will also be implemented by Ayush
with regular reporting. Trainings also will be
jointly carried out so that the skills of the Ayush
personnel can carry out the National
programmes effectively.

MONITORING AND EVALUATION
Management Information Systems under the
NRHM will be web enabled for citizen scrutiny.
Civil society organizations will collaborate with the
health system in preparing a People‟ Health Report at
the district level. . State and National reports anon
People‟s health to be tabled in assemblies and
parliament. Each health facility will report to their
respective Panchayats- sub centers to the Gram
Panchayat, Hospitals to the Rogi Kalyan Samiti, and
District Heath Mission to the Zila Parishad. External
evaluations of the NRHM will be conducted through
professional organizations with involvement of civil
society.

MAINSTREAMING AYUSH UNDER NRHM
Strategies:
 Integrate and mainstream ISM &H in health care
delivery system including National Programmes.
 Encourage and facilitate in setting up of specialty
centers.
 Facilitate and Strengthen Quality Control Laboratory.
 Strengthening the Drug Standardization and Research
Activities on AYUSH.
 Develop Advocacy for AYUSH.
 Establish Sectoral linkages for AYUSH activities
Broad Objectives
 Mainstreaming of AYUSH in the health care service
delivery system to strengthen the existing public health
system.

Activities:
 Improving the availability of AYUSH treatment faculties
and integrating it with the existing Health Care Service
Delivery System.
 Integration of AYUSH services in 314 CHC / Block PHC
with appointment of contractual AYUSH Doctors.
 Appointment of 200 paramedics where AYUSH Doctors
shall be posted.
 Appointment of a Data assistant to support the ISM&H
Directorate.
 Strengthening of AYUSH Dispensaries with provision of
storage equipments.
 Making provision for AYUSH Drugs at all levels.
 Establishment of specialized therapy centers in District
Head Quarter Hospitals & 3 Medical Colleges.
 AYUSH doctors to be involved in all National Health Care
programmes, especially in the priority areas like IMR,
MMR, Control of Malaria, Filaria, and other
communicable diseases etc.

INTEGRATION OF AYUSH WITH ASHA.
 Training module for ASHA and ANMs have to be
updated to incorporate information of AYUSH.
 Training & capacity building to be undertaken by the
Director, SIHFW, Bhubaneswar and necessary
training material for the purpose to be modified and
provided accordingly.
 Drug kit that will be provided to ASHA will contain
one AYUSH preparation in the form of iron
supplement. But other drugs which are used in the
treatment of common diseases, control of
communicable diseases as well as drugs promoting
the maternal and child health as well as improving
quality of life could be included subsequently.

DRUG MANAGEMENT:
Priority will be given to manufacture
drugs in Govt. Sector Pharmacies as per their
capacity. In case of any surplus funds, drugs will
be procured from the market observing all
financial formalities of the
 Government.
 Provision of Rs. 25,000/- to supply drugs per
AYUSH dispensary has been projected as per
NRHM norm.
 Provisions of medicines for District AYUSH
wings and Specialty Therapy Centers proposed
to be operated in the State.

SPECIAL INITIATIVES FOR MAINSTREAMING
AND STRENGTHENING OF AYUSH
Strengthening the Quality Control Laboratory:
 The quantum of Ayurvedic and Homoeopathic medicines
used / procured in both public and private health sectors is
huge. There has been wide ranging concern about spurious,
counterfeit and sub standard drugs. In order to prevent the
spread of sub standard drugs and to ensure that the drugs
manufactured or sold or distributed throughout the state are
of standard quality, drug regulation and enforcement unit has
to be established in the state.
 The drug regulatory mechanism to be strengthened at the
state level to improve the quality of drugs used in AYUSH
and ensure proper standardization. The existing State Drug
Testing and Research Laboratory (ISM) at Bhubaneswar shall
also be modernized and strengthened for the purpose.

STRENGTHENING THE DRUG
STANDARDIZATION AND RESEARCH ACTIVITIES ON
AYUSH
 It has been proposed to evaluate the chemical,
pharmacological and clinical efficacy of the plant drugs.
 The pharmacologically viable drugs will be screened clinically
under WHO guideline to establish the therapeutic activity.
 Clinical trial on different diseases like Psoriasis, Liver
disorders, Diabetics, Asthma will be conducted to establish the
effect of various drugs used for such diseases.
 It has also been proposed to conduct literary research like
translation of manuscripts and its publications.
 Re-vitalization of the local health traditions and the knowledge
of traditional drugs used by experienced local health
traditioners will be gathered and documented

STRENGTHENING OF THE STATE AND DISTRICT
MANAGEMENT SYSTEM OF AYUSH:
 It is proposed to create necessary Managerial post
in the State and District level for effective
supervision and implementation of different
activities.
 Necessary vehicles with supporting manpower
has also been proposed to strengthen the
supervisory
 Joint monitoring visits to health centers to be
undertaken by both AYUSH and Health Care
Officials at the District level‟s/State level.

CORE STRATEGIES OF NRHM INCLUDE:
 Decentralized village and district level health
planning and management
 Appointment of Accredited Social Health
Activist (ASHA) to facilitate access to health
services
 Strengthening the public health service delivery
infrastructure, particularly at village, primary
and secondary levels,
 Mainstreaming AYUSH,
 Improved management capacity to organize
health systems and services in public health

TYPES OF AYUSH-
AYURVEDA
Ayurveda - Concept and Principles
Life in Ayurveda is conceived as the union of
body, senses, mind and soul. The living man is a
conglomeration of three humours (Vata, Pitta &Kapha),
seven basic tissues (Rasa, Rakta, Mansa, Meda, Asthi,
Majja & Shukra) and the waste products of the body
such as faeces, urine and sweat. Thus the total body
matrix comprises of the humours, the tissues and the
waste products of the body.

DIAGNOSIS
In Ayuveda diagnosis is always done of the
patient as a whole.
 General physical examination
 Pulse examination
 Urine examination
 Examination of the faeces
 Examination of tongue and eyes.
 Examination of skin and ear including tactile and
auditory functions.

TYPES OF TREATMENT
The treatment of disease can broadly be
classified as
 Shodhana therapy (Purification Treatment)
 Shamana therapy (Palliative Treatment)
 Pathya Vyavastha (Prescription of diet and
activity)
 Nidan Parivarjan (Avoidance of disease causing
and aggravating factors)
 Satvavajaya(Psychotherapy)
 Rasayana therapy(use of immunomodulators and
rejuvenation medicines)

a) Shodhana treatment aims at removal of the causative factors of
somatic and psychosomatic diseases. The process involves
internal and external purification. The usual practices involved
are Panchkarma (medically induced Emesis, Purgation, Oil
Enema, Decoction enema and Nasal administration of
medicines), Pre-panchkarma procedures (external and internal
oleation and induced sweating). Panchkarma treatment focuses
on metabolic management.
(b) Shamana therapy involves suppression of vitiated humours
(doshas). The process by which disturbed humour subsides or
returns to normal without creating imbalance of other humours is
known as shamana. This treatment is achieved by use of
appetisers, digestives, exercise and exposure to sun, fresh air etc.
In this form of treatment, palliatives and sedatives are used.
(c) Pathya Vyavastha comprises indications and contraindications
in respect of diet, activity, habits and emotional status. This is
done with a view to enhance the effects of therapeutic measures
and to impede the pathogenetic processes. Emphasis on do‟s and
don‟ts of diet etc is laid with the aim to stimulate Agni and
optimize digestion and assimilation of food in order to ensure
strength of tissues.

(d) Nidan Parivarjan is to avoid the known disease
causing factors in diet and lifestyle of the patient.
(e) Satvavajaya concerns mainly with the area of mental
disturbances. This includes restraining the mind from
desires for unwholesome objects and cultivation of
courage, memory and concentration. The study of
psychology and psychiatry have been developed
extensively in Ayurveda and have wide range of
approaches in the treatment of mental disorders.
(f) Rasayana therapy deals with promotion of strength
and vitality. The integrity of body matrix, promotion of
memory, intelligence, immunity against the disease.

NATUROPATHY
Principles
 All disease, their cause and their treatment are one.
 The basic cause of disease is not bacteria.
 Acute diseases are our friends not he enemies. Chronic
diseases are the outcome of wrong treatment and
suppression of the acute diseases.
 Nature is the greatest healer. Body the capacity to prevent
itself from diseases and regain health if unhealthy.
 In Naturopathy patient is treated and not the disease.
 In Naturopathy diagnosis is easily possible. Long waiting
for diagnosis is not required for treatment.
 Patients suffering from chronic ailments are also treated
successfully in comparatively less time in Naturopathy.

The methods applied for cure in Naturopathy are the
following: -
 Water Therapy
 Air Therapy
 Fire Therapy: Existence of all the creatures and forms
depends upon “Agni” (Fire).
 Space Therapy: Congestion causes disease. Fasting is
the best therapy to relieve congestion of body and mind.
 Mud Therapy: Mud absorbs, dissolves and eliminates
the toxins and rejuvenates the body. It is employed in
treatment of various diseases like constipation, skin
diseases etc.

 Food Therapy
 Massage Therapy
 Acupressure
 Magneto Therapy: Magnets influence health. South
and North poles of different powers and shapes are
employed in treatment.
 Chromo Therapy: Sun rays have seven colours –
violet, indigo, blue, green, yellow, orange and
red. These colours are employed through irradiation or
body or by administering charged water, oil and pills for
treatment.

SIDDHA
Introduction and Origin
Siddha system is one of the oldest systems
of medicine in India . The term Siddha means
achievements and Siddhars were saintly persons
who achieved results in medicine. Eighteen
Siddhars were said to have contributed towards the
development of this medical system. Siddha
literature is in Tamil and it is practiced largely in
Tamil speaking part of India and abroad. The
Siddha System is largely therapeutic in nature.

DIAGNOSIS AND TREATMENT
The diagnosis of diseases involve identifying
it causes. Identification of causative factors is
through the examination of pulse, urine, eyes, study
of voice, color of body, tongue and the status of the
digestive system. The system has worked out details
procedure of urine examination which includes study
of it‟s color, smell, density, quantity and oil drop
spreading pattern. It holistic in approach and the
diagnosis involves the study of person as a whole as
well as his disease.

The Siddha System is effective in treating
chronic cases of liver, skin diseases especially
“Psoriasis”, rheumatic problems, anemia,
prostate enlargement, bleeding piles and peptic
ulcer. The Siddha Medicines which contains
mercury, silver, lead and sulphur have been
found to be effective in treating certain
infectious diseases including venereal diseases.

UNANI
 Introduction and Origin
Unani System of Medicines originated in Greece
and is based on the teachings of Hippocrates and
Gallen and it developed in to an elaborate Medical
System by Arabs, like Rhazes , Avicenna, Al-
Zahravi , Ibne-Nafis and others. Unani System has
Shown remarkable results in curing the diseases like
Arthritis, Leucoderma, Jaundice, Liver disorders,
Nervous system disorders, Bronchial Asthma, and
several other acute and chronic diseases where other
systems have not been able to give desired response.

 Unani treatment is based on its natural and remarkable diagnosis methods
and is affordable. It is mainly dependent on the Temperament (Mizaj) of
the patient, hereditary condition and effects, different complaints, signs
and symptoms of the body, external observation, examination of the
PULSE (Nubz), urine and stool etc. Unique and special treatment
methods like Dieto therapy (Ilaj-bil-Ghiza), Climatic therapy (Ilaj-bil-
Hawa), Regimental therapy (Ilaj-bit-Tadbir), make it a different and
remarkable and popular system.
 Regimental therapy includes venesection, cupping, diaphoresis, diuresis,
Turkish bath, massage, cauterization, purging, emesis, exercise, leeching,
etc.
 Dieto therapy (Ilaj-bil-Ghiza) aims at treating certain ailments by
administration of specific diets or by regulating the quantity and quality
of food.
 Pharmacotherapy (Ilaj-bid-Dawa) is mainly dependent upon local
available herbal drugs which make the system indigenous. Similarly,
surgery has also been in use in this system for quite long. In fact, the
ancient physicians of Unani Medicine were pioneers in this field and had
developed their own instruments and techniques. But at present only
minor surgery is in vogue in this system.

YOGA
The tradition of Yoga was born in India several
thousand years ago. Its founders were great Saints and
Sages. The great Yogis gave rational interpretation of their
experiences about Yoga and brought a practically sound and
scientifically prepared method within every one‟s reach.
Yoga philosophy is an Art and Science of living in tune with
Brahmand- The Universe. Yoga has its origins in the
Vedas, the oldest record of Indian culture. It was
systematized by the great Indian sage Patanjali in the Yoga
Sutra as a special Darshana. Although, this work was
followed by many other important texts on Yoga, but
Patanjali‟s Yoga Sutra is certainly the most significant
wherein no change is possible. It is the only book which has
touched almost all the aspects of human life.

STREAMS OF YOGA :
 There are a large numbers of methods of Yoga catering to the
needs of different persons in society. They are broadly
classified into four streams. Swami Vivekananda puts them as
Work, Worship, Philosophy and Psychic control.
 Karma Yoga, the path of work, involves doing action in a
skilful way. In other words, it can be said as a way of enjoying
work, doing it effortlessly. The success or failure should not be
allowed to cause ripples in the mind.
 „Bhakti Yoga‟ the path of worship is a systematic method of
engaging the mind in the practice of divine love. This attitutde
of love softens our emotions and tranquillises our mind.
 Jnana Yoga, the path of philosophy, is a systematic way of
tutoring the mind about the realities of life by contemplation.
This will strip off the garb of Avidya (ignorance) from our
mind and the mind goes to its natural state of rest.

Principles
 Yoga means a holistic approach towards the cause and treatment of
disease.
 According to Yoga, most of the diseases Mental, Psychosomatic and
Physical originate in mind through wrong way of thinking, living and
eating which is caused by attachment.
 The basic approach of Yoga is to correct the life style by cultivating a
rational positive and spiritual attitude towards all life situation.
 Yoga does not treat gross body alone, it takes into consideration all the
five Kosa‟s (Sheaths) i.e. Manomaya Kosa, Annamaya Kosa, (grass
Sheath) Pranamaya Kosa (Extral Body) (Psychic Body), Vijyanmaya Kosa
(intellect Sheath) and Anandamaya Kosa (Bliss sheath).
 Like Ayurveda and Naturopathy Yoga also takes up the cleansing of the
body as the first measure to fight disease. While Ayurveda performs its
pancha karma through the help of ametics purgative Yoga performs them
without the help of any drug i.e. by developing full efficiency and control
of eliminative systems of the body. Which no other system of health care
can do.
 All the systems of medicine at their best aim at curing the disease whereas
Yoga aims at preventing the disease and promoting health by
reconditioning the psycho-physiological mechanism of the individual.

PUBLIC PRIVATE PARTNERSHIP-
Vision
Facilitating and enhancing quality public service delivery by being
a catalyst for efficient, effective and value-for-money best practice
solutions
Mission
 To enable National Treasury and provincial treasuries to effectively
regulate PPPs
 To evolve as a dynamic and sustainable center of excellence for PPPs
 To drive PPP deal flow by identifying project opportunities that yield
value for all stakeholders
 To provide technical assistance to public institutions through project
feasibility, procurement and management; and
 To promote an enabling environment for PPPs by:
o facilitating certainty in the regulatory framework
o developing best practice guidelines
o providing training
o disseminating reliable information; and
o driving black economic empowerment in PPPs.

Values
 Fairness.
 Empowerment.
 Professionalism.
 Integrity.
 Passion.

DEFINITION-
PPP as a contract between a public sector
institution/municipality and a private party, in which
the private party assumes substantial financial,
technical and operational risk in the design,
financing, building and operation of a project.
Two types of PPPs are specifically defined:
 where the private party performs an
institutional/municipal function
 where the private party acquires the use of
state/municipal property for its own commercial
purposes PPP may also be a hybrid of these types.

CENTRALLY SPONSORED SCHEMES
DEVELOPMENT AND UPGRADATION OF AYUSH
INSTITUTES/COLLEGES-
(i) Development of UG colleges.
(ii) Assistance to P.G. Medical Education
(iii) Re-orientation Training Programme for AYUSH Personnel.
(iv) Renovation and strengthening of Hospital wards of Govt./
Govt. aided teaching
(v) Establishment of computer laboratory.
(vi)Up-gradation of academy institutes to the status model
Institutes of AYUSH.

HOSPITALS AND DISPENSARIES
 The scheme has been designed with a view to make
available the benefits of Ayurveda, Unani, Siddha, Yoga &
Naturopathy and Homoeopathy to the public at large.
 Through this scheme the Central Government intends to
encourage setting up of general and specialized treatment
centers of ISM&H in allopathic hospitals and support the
efforts of State Governments to improve the supply
position of essential drugs in dispensaries situated in rural
and backward areas, so that the faith of people in ISM&H
could be enhanced.

STATE OF PUBLIC HEALTH
1) Union Government contribution to public health
expenditure is 15% while States contribution about 85%
2) Vertical Health and Family Welfare Programmes have
limited to operational levels.
3) Lack of community ownership of public health
programmes impacts levels of efficiency, accountability
and effectiveness.
4) Lack of integration of sanitation, hygiene, nutrition and
drinking water issue.
5) Population Stabilization is still a challenge, especially in
States with weak demographic indicators.

NATIONAL RURAL HEALTH MISSION –
THE VISION
GOALS
1) Reduction in Infant Mortality Rate (IMR) and Maternal
Mortality Ratio (MMR)
2)Universal access to public health services such as Women‟s
health, child health, water, sanitation & hygiene, immunization,
and Nutrition.
3)Prevention and control of communicable and non-communicable
diseases, including locally endemic diseases
4)Access to integrated comprehensive primary healthcare
5)Population stabilization, gender and demographic balance.
6)Revitalize local health traditions and mainstream AYUSH
7)Promotion of healthy life styles

Supplementary Strategies:
• Regulation of Private Sector including the informal rural
practitioners to ensure availability of quality service to citizens
at reasonable cost.
• Promotion of Public Private Partnerships for achieving
public health goals.
• Mainstreaming AYUSH – revitalizing local health traditions.
• Reorienting medical education to support rural health issues
including regulation of Medical care and Medical Ethics.
• Effective and viable risk pooling and social health insurance
to provide health security to the poor by ensuring accessible,
affordable, accountable
and good quality hospital care.

PLAN OF ACTION COMPONENT (A): ACCREDITED
SOCIAL HEALTH ACTIVISTS
• Every village/large habitat will have a female Accredited
Social Health Activist (ASHA) - chosen by and accountable
to the panchayat- to act as the interface between the
community and the public health system. States to choose
State specific models.
• ASHA would act as a bridge between the ANM and the
village and be accountable to the Panchayat.
• She will be an honorary volunteer, receiving performance-
based compensation for promoting universal immunization,
referral and escort services for RCH, construction of
household toilets, and other healthcare delivery programmes.

• She will be trained on a pedagogy of public health developed
and mentored through a Standing Mentoring Group at
National level incorporating best practices and implemented
through active involvement of community health resource
organizations.
• She will facilitate preparation and implementation of the
Village Health Plan along with Anganwadi worker, ANM,
functionaries of other Departments, and Self Help Group
members, under the leadership of the Village Health
Committee of the Panchayat.

COMPONENT (B): STRENGTHENING SUB-CENTRES
• Each sub-centre will have an Untied Fund for local action @
Rs. 10,000 per annum. This Fund will be deposited in a joint
Bank Account of the ANM & Sarpanch and operated by the
ANM, in consultation with the Village Health Committee.
• Supply of essential drugs, both allopathic and AYUSH, to
the Sub-centers.
• In case of additional Outlays, Multipurpose Workers
(Male)/Additional ANMs wherever needed, sanction of new
Sub-centers as per 2001 population norm, and upgrading
existing Sub-centers, including buildings for Sub-centers
functioning in rented premises will be considered.

COMPONENT (C): STRENGTHENING PRIMARY HEALTH
CENTRES
Mission aims at Strengthening PHC for quality preventive,
promotive, curative, supervisory and Outreach services,
through:
• Adequate and regular supply of essential quality drugs and
equipment (including Supply of Auto Disabled Syringes for
immunization) to PHCs
• Provision of 24 hour service in 50% PHCs by addressing
shortage of doctors, especially in high focus States, through
mainstreaming AYUSH manpower.
• Observance of Standard treatment guidelines & protocols.
• In case of additional Outlays, intensification of ongoing
communicable disease control programmes, new programmes
for control of non communicable diseases, up gradation of
100% PHCs for 24 hours referral service, and provision of
2nd doctor at PHC level (1 male, 1 female) would be
undertaken on the basis of felt need.

 COMPONENT (D): STRENGTHENING CHCs FOR FIRST
REFERRAL CARE
A key strategy of the Mission is:
• Operationalizing 3222 existing Community Health Centers
(30-50 beds) as 24 Hour First Referral Units, including
posting of anaesthetists.
• Codification of new Indian Public Health Standards, setting
norms for infrastructure, staff, equipment, management etc.
for CHCs.
• Promotion of Stakeholder Committees (Rogi Kalyan
Samitis) for hospital management.
• Developing standards of services and costs in hospital care.
• Develop, display and ensure compliance to Citizen‟s at
CHC/PHC level.
• In case of additional Outlays, creation of new Community
Health Centers (30-50 beds) to meet the population norm as
per Census 2001, and bearing their recurring costs for the
Mission period could be considered.

COMPONENT (E): CONVERGING SANITATION AND
HYGIENE UNDER NRHM
• Total Sanitation Campaign (TSC) is presently implemented
in 350 districts, and is proposed to cover all districts in 10th
Plan.
• Components of TSC include rural sanitary marts, individual
household toilets, women sanitary complex, and School
Sanitation Programme.
• Similar to the TSC is also implemented through Panchayati
Raj Institutions (PRIs).
• The District Health Mission would therefore guide activities
of sanitation at district level, and promote joint for public
health, sanitation and hygiene, through Village Health &
Sanitation Committee, and promote household toilets and
School Sanitation Programme. ASHA would be incentivized
for promoting household toilets by the Mission.

COMPONENT (F): STRENGTHENING DISEASE
CONTROL PROGRAMMES
• National Disease Control Programmes for Malaria , TB,
Kala Azar, Filaria, Blindness & Iodine Deficiency and
Integrated Disease Surveillance Programme shall be
integrated under the Mission, for improved programme
delivery.
• New Initiatives would be launched for control of Non
Communicable Diseases.
• Disease surveillance system at village level would be
strengthened.
• Supply of generic drugs (both AYUSH & Allopathic) for
common ailments at village, SC, PHC/CHC level.
• Provision of a mobile medical unit at District level for
improved Outreach services.

COMPONENT (G): PUBLIC-PRIVATE PARTNERSHIP FOR
PUBLIC HEALTH GOALS, INCLUDING REGULATION
OF PRIVATE SECTOR
• Since almost 75% of health services are being currently
provided by the private sector, there is a need to refine
regulation
• Regulation to be transparent and accountable
• Reform of regulatory bodies/creation where necessary
• District Institutional Mechanism for Mission must have
representation of private sector
• Need to develop guidelines for Public-Private Partnership
(PPP) in health sector. Identifying areas of partnership, which
are need based, thematic and geographic.
• Public sector to play the lead role in defining the framework
and sustaining the partnership
• Management plan for PPP initiatives: at District/State and
National levels

INSTITUTIONAL MECHANISMS
• Village Health & Sanitation Samiti (at village level consisting of
Panchayat Representative/s, ANM/MPW, Anganwadi worker,
teacher, ASHA, community health volunteers
• Rogi Kalyan Samiti (or equivalent) for community management of
public hospitals
• District Health Mission, under the leadership of Zilla Parishad with
District Health Head as Convener and all relevant departments,
NGOs, private professionals etc represented on it
• State Health Mission, Chaired by Chief Minister and co-chaired by
Health Minister and with the State Health Secretary as Convener-
representation of related departments, NGOs, private professionals
etc
• Integration of Departments of Health and Family Welfare, at
National and State level
• National Mission Steering Group chaired by Union Minister for
Health & Family Welfare with Deputy Chairman Planning
Commission, Ministers of Panchayat Raj, Rural Development and
Human Resource Development and public health professionals as
members, to provide policy support and guidance to the Mission.
• Empowered Programme Committee chaired by Secretary HFW, to
be the Executive Body of the Mission.

TECHNICAL SUPPORT
• To be effective the Mission needs a strong component of
Technical Support
• This would include reorientation into public health
management
• Reposition existing health resource institutions, like
Population Research Centre (PRC), Regional Resource Centre
(RRC), State Institute of Health & Family Welfare (SIHFW)
• Involve NGOs as resource organizations
• Improved Health Information System
• Support required at all levels: National, State, District and
sub-district.
• Mission would require two distinct support mechanisms –
Program Management Support Centre and Health Trust of
India.

A) PROGRAM MANAGEMENT SUPPORT CENTRE
• For Strengthening Management Systems-basic program
management, financial systems, infrastructure maintenance,
procurement & logistics systems, Monitoring & Information
System (MIS), non-lapsable health pool etc.
• For Developing Manpower Systems – recruitment (induction
of MBAs/CAs /MCAs), training & curriculum development
(revitalization of existing
institutions & partnerships with NGO & private sector. Sector
institutions), motivation & performance appraisal etc.
• For Improved Governance – decentralization &
empowerment of communities, induction of IT based systems
like e-banking, social audit and right to information.

ROLE OF NGOs IN THE MISSION
· Included in institutional arrangement at National, State and
District levels, including Standing Mentoring Group for
ASHA
· Member of Task Groups
· Provision of Training, BCC and Technical Support for
ASHAs/DHM
· Health Resource Organizations
· Service delivery for identified population groups on select
themes
· For monitoring, evaluation and social audit

MAINSTREAMING AYUSH
· The Mission seeks to revitalize local health traditions and
mainstream AYUSH infrastructure, including manpower,
and drugs, to strengthen the public health system at all
levels.
· AYUSH medications shall be included in the Drug Kit
provided at village levels to ASHA.
· The additional supply of generic drugs for common
ailments at Sub center/PHC/CHC levels under the Mission
shall also include AYUSH formulations.
· At the CHC level, two rooms shall be provided for
AYUSH practitioner and pharmacist under the Indian
Public Health System (IPHS) model.
· Single doctor PHCs shall be upgraded to two doctor PHCs
by mainstreaming AYUSH practitioner at that level.

MONITORING AND EVALUATION
· Health MIS to be developed up to CHC level, and web-
enabled for citizen scrutiny
· Sub-centers to report on performance to Panchayats,
Hospitals to Rogi Kalyan Samitis and District Health
Mission to Zilla Parishad
· The District Health Mission to monitor compliance to
Citizen‟s at CHC level
· Annual District Reports on People‟s Health (to be prepared
by Govt./NGO collaboration)
· State and National Reports on People‟s Health to be tabled
in Assemblies, Parliament
· External evaluation/social audit through professional
bodies/NGOs.

BIBLIOGRAPHY-
1) K.Park,Park‟s textbook of preventive and social medicine/s
banarsides bhanot publishers,19th edition,2007;1,67-72.
2) Stanhop.M,Community health nursing,3rd edition,mosby
USA,27-28,112,115.
3) AYUSH, Medical journal, March 2006,4(14),41-57.
4) Public health ,Journal of india,April 2007,5(3),61-68.
5) WWW.Google.com Search-AYUSH
6) www.Wikipedia.com Search-AYUSH with PPP

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