The Transformation Tracker March 2024 I Volume 05

Eliminating diseases, one region at a time

Recently, The Hindu published an article titled "Eliminating Diseases, One Region at a Time," authored by Mr. Rajeev Sadanandan, Chief Executive Officer, Health Systems Transformation Platform. This article served as a wake-up call, highlighting the necessity of robust surveillance systems, investment in infrastructure, workforce training, and capable of identifying every occurrence of diseases. It emphasized the importance of continued vigilance even after elimination to prevent the re-emergence of diseases.

The article underscores the remarkable progress in disease elimination, notably the imminent eradication of guinea worm disease. It elaborates on the strides made towards disease elimination, particularly in combating guinea worm disease, stressing the necessity of a methodical approach, robust surveillance, and regional tactics to accomplish this objective. Emphasizing the distinction between elimination and eradication, it clarifies that elimination aims to halt transmission within specific regions, fostering public health improvements and engendering political and administrative commitment, whereas eradication signifies the permanent cessation of the disease with no possibility of resurgence.

However, disease elimination poses significant challenges, requiring rigorous surveillance, diagnostics, and healthcare infrastructure. It is resource-intensive and could potentially divert attention from other health priorities, particularly in weaker health systems. Therefore, careful analysis of costs and benefits, along with informed political support, is essential before embarking on elimination efforts.

While nationwide elimination may be challenging within the designated time frame, it is feasible for certain diseases in specific regions. The article highlights India’s efforts in disease elimination citing examples such as kala-azar and lymphatic filariasis. It emphasizes the importance of localized and phased strategies and suggests that elimination efforts can be more effectively managed at the regional level, encouraging multisectoral collaboration, innovation, and resource allocation, better management of the workload without compromising other essential tasks. However, it underscores the role of national and state governments in owning the process and coordinating regional efforts to culminate in national elimination.

In conclusion, the article underscores the importance of a systematic and regionally tailored approach, supported by careful planning, strong surveillance systems, multisectoral collaboration, political commitment, resource allocation, and regular monitoring to ensure sustainability while eliminating targeted diseases.

For further information, kindly click on the link provided below:

https://www.thehindu.com/opinion/op-ed/eliminating-diseases-one-region-at-a-time/article67973191.ece

Transforming Healthcare Leadership of Medical Officers of Odisha through HSTP facilitated Leadership Development Programme

?In the context of accelerated change in the Indian health system, Ayushman Bharat and the post-COVID-19 scenario emphasize that strong leadership and team management are essential for the successful implementation of health programs, particularly at the state level.

?Health Systems Transformation Platform (HSTP) recognized the need and proposed a groundbreaking Leadership Development program tailored to district-level managers in Odisha.?By equipping primary healthcare facility managers with management training and supportive supervision, the program seeks to enhance skills and decision-making autonomy, ultimately improving health outcomes. Leveraging the expertise of Athulya Performance CIP, renowned for implementing their leadership program 'Causing Incredible Performance' (CIP) across various non-government and government departments other than health, HSTP collaborated with Athulya to adapt CIP to the health context for implementation in Odisha.

The program focuses on nurturing management leadership skills among in-service public sector physicians and empowering managers to achieve unprecedented performance levels. The program underscores the crucial role of decentralized leadership in driving impactful change and efficiently attaining healthcare objectives. Developed collaboratively with Athulya Performance Facilitators and anchored at the State Institute for Health and Family Welfare, this Leadership Development program based on the 'Causing Incredible Performance' (CIP) Framework, signifies an important step forward in transforming healthcare management in Odisha.

The first cohort of the Leadership Development program in Odisha took place in 2022. The intervention aims to develop leadership competencies among the in-service medical officers holding management positions in Odisha.? The leadership development journey encompasses the following steps:

?1.????? Identifying potential participants and collaboratively developing Key Result Areas and other progress parameters within the purview of the CIP Framework.

2.????? ?Implementing the CIP framework for the selected participants through designated methods (workshops and individual coaching sessions).

3.????? Monitoring the progress of participants and providing necessary support throughout their learning journey.

4.????? Documenting the intervention to disseminate insights and learning to a wider audience.

Causing Incredible Performance Intervention is a results-based program that focuses on individual and organizational goals, indicating performance. Organizations categorize these goals/ performances into four types:

?1. Business-as-usual goals/ performance, 2. Stretch goals/performance 3. Impossible goals/performance and 4. Incredible goals/performance.

A business-as-usual (BAU) goal represents achievements participants are highly confident in attaining. ‘Incredible performance’ is indicative of any performance between “stretch performance” and ‘impossible performance’. ?Participants are instructed in the application of action principles to accomplish their self-set goals, facilitated through real-life coaching scenarios to yield organizationally significant outcomes. Participants establish a deeper connection with the framework by implementing these Action Principles beyond the classroom, producing unprecedented results.

The second cohort of this four-month intervention program was carried out between 7th November 2023 to March 2024.

Module 1: Spanning from 7th Nov to 10th Nov 2024, Module 1 entailed a four-day residential workshop. This session featured face-to-face training, encompassing the selection of topics and goal-setting activities.

Module 2: Following Module 1, Module 2 comprised a three-month online weekly individual coaching/ mentoring sessions. Assigned coaches conducted these sessions to monitor progress and assist participants in overcoming challenges faced while achieving their goals, applying the Action Principles of CIP.

Midterm review workshop: A three-day Mid-term review workshop was conducted in Shillong, Meghalaya in February—the workshop aimed to review the participants’?? progress and handhold the participants. Additionally, the workshop provided an opportunity for the visiting cohort from Odisha to gain insights into the healthcare systems of Meghalaya through an exposure visit to Tirot Singh Memorial Hospital in Mairang.

The participating physicians in the program tackled a broad spectrum of objectives, spanning the general management of hospital facilities such as the number of patients coming for OPD, number of telemedicine consultations, number of deliveries/surgeries performed, maintaining online records, and organizing the physical space within the health centers. Additionally, objectives related to addressing diseases and interventions/Government projects like Leprosy, Anaemia among pregnant women, HIV testing, facilitating blood donation, and providing care for hypertension patients were also pursued.

Remarkably, participants undertook incredible goals surpassing their usual performance benchmarks (BAU goals) by 1.2 to 7 times. This exemplifies the profound impact of the CIP program, which inspired them to take on goals of significant magnitude that may have seemed implausible and unattainable.

Among the twenty-two participants in the introductory workshop, eighteen declared their goals. Out of those who set their goals, fourteen participants achieved their incredible goals, with 78% of the participants successfully achieving their incredible goals.? Of the remaining four, two crossed their Stretch goals and the remaining two achieved their business-as-usual goals. Seven out of these fourteen participants also surpassed seemingly their impossible goals. One participant notably accomplished both of his incredible goals, one lasting for a month and the other for two months, demonstrating exceptional commitment and achievement.

On average, the Incredible Goals undertaken were 1.94 times higher than the Business-as-Usual Goals, indicating ambitious targets set by participants. Furthermore, when comparing the average results achieved to the Business-as-Usual Goals, the magnitude was 8.82 times higher, underscoring the substantial performance enhancements. Notably, the most significant leap in performance was observed at 12.7 times the BAU goal, showcasing remarkable achievements within the program.

To summarize, the Leadership Development Program for district and block-level Medical Officers and Program Managers of Odisha, initiated in 2022, aims to enhance leadership competencies among in-service medical officers. It acknowledges the vital role of strong leadership in driving health program implementation. Through workshops, coaching sessions, and a midterm review workshop, participants enhance their skills and achieve remarkable goals, often surpassing their usual benchmarks. The program's success is evident in the significant performance jump observed, highlighting its transformative impact on healthcare management in Odisha.

Advancing Universal Health Coverage through Comprehensive Primary Healthcare:? The Mysore Urban Healthcare Delivery Model Story

Comprehensive Primary Healthcare (CPHC) stands as a cornerstone in the global pursuit of Universal Health Coverage (UHC), ensuring access to a wide spectrum of health services without financial hardship. India's Ayushman Bharat initiative, launched in 2018, aims to bolster UHC through two main components: Health and Wellness Centers (HWCs) and Pradhan Mantri Jan Arogya Yojana (PMJAY). Despite these efforts, global progress towards UHC has stagnated since 2015, with financial hardship impacting billions worldwide. However, the benefits of UHC are undeniable, spanning from improved health outcomes to economic growth and equity in healthcare access.

To ensure equitable access to RMNCH+A services for vulnerable populations in urban settings, HSTP is spearheading a project to develop an urban healthcare delivery model to enhance RMNCH+A outcomes.? The project focuses on bolstering Comprehensive Primary Healthcare services specially tailored to cater to the needs of vulnerable populations in urban areas. The project will be implemented across four Urban Primary Health Centres (UPHCs) located in Mysuru, Karnataka. These UPHCs include Bannimantapa UPHC, Lashkar GandhinagaraMohalla UPHC, Kumbarkoppalu UPHC, and Vishweshwaranagar UPHC, strategically covering the 3 assembly constituencies and representing different areas of the city, with maximum vulnerable population Together, these UPHCs will encompass an average of 12 wards, constituting approximately 24% of the city's total of 65 wards, and serving a population of around 2.1 lakh.

?Through community engagement, health system strengthening, and convergence of stakeholders, the project seeks to create resilient community healthcare structures and increase coverage of quality-assured RMNCH+A services. Noteworthy successes of this framework in India include its utilization in High Priority Districts and innovative approaches like the Aspirational Districts Program, showcasing its adaptability and effectiveness in addressing public health challenges.

The project adopts a multi-layered strategy to foster active community participation and enhance the coverage and quality of RMNCH +A care for PW, CU5, adolescents, and eligible couples (aged 15-49). Through systematic household mapping of 863 households, vulnerable populations are identified for effective service planning and delivery. Community Facilitators, alongside Area and Zonal Coordinators, encourage beneficiaries to enroll in PMJAY schemes during house-to-house visits, mobilizing decision-makers (husbands and mother-in-laws) to avail of Jan Ausadhi Kendras services. Prioritizing marginalized groups in slum areas and remote regions, the project ensures equitable vaccine access and comprehensive coverage. Field staff's dedicated efforts maintain increased immunization coverage through regular NIDs and SNIDs for all CU5, regardless of economic status. Pregnant and lactating women are regularly counseled on ANC services, early registration, completion of 4 mandatory? ANC visits, family preparedness, danger signs of high-risk pregnancies, breastfeeding, nutrition, and early childhood care and Kangaroo mother care for premature with low birth weight infants Currently, the project operates in Bannimantapa UPHC with 4 ASHAs and 4 ANMs serving a population of 4315 (M-2429, F-1886). The project has made significant strides, benefiting over 17,000 individuals, including children, women, and the disabled. As we navigate the intricacies of healthcare delivery, our pursuit of Universal Health Coverage remains paramount. Through CPHC, strategic frameworks like RMNCH+A, and targeted interventions in urban areas, we inch closer to our goal of ensuring equitable access to quality healthcare for all, with minimum OOPE.

In conclusion, the Mysore Urban Healthcare Delivery Model stands as a beacon of innovation and progress in the realm of public health, particularly in the context of advancing UHC. By prioritizing CPHC and focusing on vulnerable populations in urban areas, the project has demonstrated its effectiveness in addressing critical health needs, especially in the realm of RMNCH+A services. Through its multi-layered approach, which encompasses community engagement, health system strengthening, leveraging the existing health platforms, and targeted interventions, the project has addressed the issue of ensuring equitable access to healthcare services. Leveraging schemes like Pradhan Mantri Jan Arogya Yojana PMJAY and platforms like Jan Ausadhi Kendras have further enhanced its impact, benefiting thousands of individuals in the region. As the project continues to make strides in immunization, ANC services, and family preparedness, it sets a precedent for effective healthcare delivery models nationwide, underscoring the importance of comprehensive approaches and strategic frameworks in achieving quality healthcare for all.

?About HSTP

Health Systems Transformation Platform (HSTP), a not-for-profit Indian organization, aims to generate evidence on health policy and systems and promote the use of that evidence in policymaking. HSTP's strategy is to analyze 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 the ‘Forum for Health Systems Design and Transformation’, a company licensed under section 8 of the Indian Companies Act 2013.