Looking Back at 2023

At the Health Systems Transformation Platform (HSTP), 2023 has been a year of overcoming roadblocks, reaching milestones, strengthening our partnerships with the states of Odisha and Meghalaya, foraying into the state of Chhattisgarh, and continuing our work in the cities of Mysuru and Bhopal. Here’s looking back at the year that was.

Strengthening Public Health Systems in Odisha

In strengthening the public health system in the state, HSTP worked closely with the Government of Odisha on various strategic initiatives in 2023. One of the pivotal contributions was the development of the Biju Swasthya Kalyan Yojana (BSKY) Claim Adjudication Manual, in collaboration with the State Health Assurance Society and the Department of Health and Family Welfare. This manual is aimed at facilitating an efficient and transparent claim adjudication process, crucial for the effective allocation of resources, reducing the risk of inappropriate payments, and ensuring the financial stability of the healthcare system. It will play a fundamental role in building trust among beneficiaries and providers, thereby facilitating access to quality care and advancing the goals of Universal Health Coverage (UHC).

Additionally, efforts were directed towards enhancing the competencies of primary healthcare providers such as Pharmacists, Technologists, Medical Officers, and Community Health Officers. Training manuals specifically designed for In-Service Pharmacists and Medical Laboratory Technologists in Primary Healthcare Settings were published and disseminated extensively, bridging a significant gap in the healthcare workforce, and paving the way for a model for future scaling of interventions. In collaboration with the Directorate of Nursing, HSTP has contextualised the Competency Assessment Framework to the state of Odisha.

The implementation of "Creating Incredible Performances," a leadership development program, facilitated the enhancement of mid-level health officials' performance within the public sector. Furthermore, a collaboration with the Asian Institute of Public Health (AIPH) University aimed at improving access to medicines in public health facilities through a comprehensive study. This study, conducted across four selected districts, employed a mixed-method approach to identify factors contributing to higher out-of-pocket expenses for patients. It also looked at best practices from the medical corporations in other states. The analysis involved gathering data from diverse stakeholders, enabling a comprehensive assessment of essential medicine availability and prescription practices within the state. Subsequent recommendations were formulated and implemented by Odisha State Medical Corporation Limited and the Department of Health to enhance access to essential medicines in the state.

At the State Level Brainstorming Workshop on 'One Health' in Odisha, HSTP’s insights on the strategy for the state action plan on 'One Health' covering strengthening surveillance systems through real-time data sharing to addressing the silent epidemic of antimicrobial resistance, demonstrating HSTP’s commitment to innovative, comprehensive solutions to health systems strengthening, were much appreciated. As the technical partner to the Department of Health Odisha, HSTP will be supporting the state’s efforts to create actionable plans for ‘One Health’ at the state and district levels.

Strengthening Health Policies and Resource Planning in Meghalaya

In Meghalaya, HSTP's support spanned critical areas including health financing, resource planning for?health, Human Resources for Health (HRH), and digital health. The team conducted a comprehensive analysis of the state's health budget to begin with, which highlighted resource allocation gaps and existing expenditure patterns. Based on these insights, HSTP collaborated with the state in formulating a long-term health sector plan aligned with state health objectives and international health frameworks.

A significant milestone involved providing technical assistance to develop a state-specific Policy for the Creation of Specialist, Public Health, and Teaching Sub-Cadres. The release of the draft policy document for public feedback marked a crucial step towards a more robust and responsive healthcare system in Meghalaya. Further endeavours were directed at implementing Internal Performance Agreements (IPAs) within the state's health department. This initiative aimed to strategically plan, allocate, and utilize resources based on identified needs, thereby improving service delivery in the state. The IPAs have also been rolled out in the state in November this year, marking yet another step forward towards a healthier future.

Comprehensive Health Systems Strengthening in Chhattisgarh

In Chhattisgarh, HSTP supports holistic health systems strengthening the state in decision-making for policy and program implementation, building capacities, and designing and validating multifaceted interventions.?

Working on strengthening the state’s secondary care services, HSTP has conducted a comprehensive gap assessment of health facilities, identifying specific needs in line with IPHS 2022 norms, using a two-pronged approach: planning based on identified gaps and strengthening the facilities. This initiative aims to increase the number of secondary healthcare facilities (District Hospitals) offering a specific number of speciality services, ensure that secondary care facilities are aligned to IPHS norms, and also that there is an increase in utilisation of services at the health facilities in the state. Our team supports the state in gap analysis, planning, training, and implementation.?

HSPT’s work towards fortifying the Emergency Care System (ECS) in the state began with assessing hospitals and colleges, conducting a comprehensive gap analysis followed by resource planning and facility strengthening, building capacities of select personnel through the initiative of Champions of Change, and policy support for developing a road accident victim treatment policy. HSTP is currently supporting the state in developing a comprehensive trauma plan for the state. Other areas of focussed efforts include digital health integration, extending coverage models, reviewing state employee scheme packages, and strengthening supply chain systems.?

The Think Tank in Action

HSTP's commitment to impactful research was demonstrated through various publications, addressing critical aspects of healthcare delivery. The team’s research focused on areas such as a health systems assessment framework, procurement and supply chain management, home healthcare, medical laboratory services, and ambulance services. These studies highlighted key challenges and proposed recommendations for improving healthcare delivery across diverse domains. They will also guide the team in their further work in the respective areas.?

Leading the public health discourse in the country, HSTP conducted collaborative studies on decentralization in health, disseminated the Lancet Global Health Commission Reports, and continued to contribute to publications in reputable journals. Topics focused on crucial aspects of health financing, fairness in health financing for Universal Health Coverage (UHC) and policymaking perspectives, fostering discourse and providing valuable insights for shaping healthcare policies and practices.

In a recent development, the joint proposal submitted by the Regional Medical Research Centre (RMRC), Bhubaneswar, and HSTP was shortlisted for a Multisite Implementation Research on strengthening HWCs in India by ICMR.

Digital Health Integration with State Health Departments

HSTP has been involved in strengthening the digital health landscape in the states of Odisha, Meghalaya, and Chhattisgarh through various endeavours. These endeavours have included providing assistance to states in implementing Hospital Information Systems and supply chain management systems, as well as showcasing the idea of unified systems to integrate healthcare services at the primary level. The organization has also initiated collaborations with the Ministry of Health and Family Welfare (MoHFW) and CDAC to enhance the DVDMS application, incorporate RCH into the NCD application, and establish a unified health system at the primary level to support AB-HWCs. These efforts are aimed at streamlining the exchange of health data and enhancing overall healthcare delivery using digital public goods.

Vital Capacity Building

The vital capacity-building initiatives undertaken by HSTP showcased its commitment to enhancing the skills and capabilities of professionals who work in public health.?

Towards the end of the year, HSTP organised an orientation and training programme for young development professionals working with the organisation, ‘Professional Assistance for Development Action’ (PRADAN). The objective of the programme was to empower young development professionals with a comprehensive understanding of India's health systems and enhance the participants’ ability to collaborate with health department officials to improve public access to services. 12 participants working in rural tribal regions of six states - Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, and West Bengal attended the training facilitated by the HSTP team. The training focussed on developing an overall understanding of the structure and operations of India’s health systems at the central, and state, with an emphasis on the district, and block levels. The participants acquired insights into health services provided at various levels of healthcare facilities, along with a comprehensive grasp of key government health programmes, policies, and schemes. The discussions centred around the challenges confronting people’s access to health services and how to overcome those. The programme was enriched by learning from real-life examples of facilitators’ own experiences as community health practitioners. Hands-on exercises on analysing a health system and facilitating care-seeking offered the participants an opportunity to put learning into practice. Going forward, the participants will translate the learning from the programme to field practice in the respective geographies where they work. To support their continued engagement on health issues and with the health department, HSTP will organise need-based online sessions.?

The India HPSR Fellowship program, launched in 2021, has seen significant success, with the third cohort inaugurated in 2023. This cohort comprises participants from diverse states and disciplines. Through the mentoring process, the fellows undergo five comprehensive modules covering topics like Introduction to Health Systems, Health Policy & Policy Process, Introduction to HPSR, Framing HPSR Questions, Transitioning from Research Question to Research Design, and drafting a Health Policy and Systems Research Proposal. They are also guided to develop an HPSR proposal showcasing the integration of foundational concepts, core values, and critical thinking. However, the biggest takeaway for the fellows has always been a change from gap-finding to looking at health challenges from a holistic perspective. As with other cohorts, we have observed this cohort start applying HPSR methods to their regular course of work. A direct impact is seen when they go on to win accolades for their work in different forums, publishing books, and especially when they start rethinking their process of conducting research.?

Our journalism fellow, from the inaugural cohort of the Health Journalism Fellowship, was also awarded this year, thus recognising the impactful reporting done by journalists on vulnerable community issues related to health systems.?

It has been a great year for new beginnings and strengthening existing partnerships for HSTP, and we are looking forward to a bigger, better, healthier 2024.?

From all of us at HSTP, we hope it turns out the same for you, as well.?

About HSTP

Health Systems Transformation Platform (HSTP), a not-for-profit Indian organisation, aims to generate evidence on health policy and systems and promote the use of that evidence in policymaking. HSTP's strategy is to analyse the state of the healthcare system, identify opportunities for improvement, propose solutions to the state government, support them in the implementation of the accepted ones, and validate them through implementation research. We then turn our analysis, implementation research and findings into knowledge products, that are available for use in alternative situations so that our research can achieve a scale large enough to make a difference at the national level.

HSTP is a not-for-profit organization registered in the name of 'Forum for Health Systems Design and Transformation', a company licensed under section 8 of the Indian Companies Act 2013.

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