PROBLEMS IN HEALTH SERVICE DELIVERY Non-availability of staff during duty

hours Lack of fundsCorruptionQuality of spendingLack of accountabilityLack of proper incentivesShortage of medicinesInadequate supervisionLack of proper infrastructure

INTRODUCTIONIndian Planning Commission opted for

Decentralisation to overcome the problems in public health care delivery.

To increase the accountability of health care providers.

To improve the health outcomes.

EXISTING DISASTER

MANAGEMENT STRUCTURE

Disaster Management Act,2005.National Institute of Disaster Management.National Disaster Response Force.National Disaster Mitigation Resource Center. (NDMRC).

National Disaster Management Authority.National Crisis Management Committee.National Exec. Committee.

State Disaster Management Authority (SDMA)District Disaster Response Force.(NDRF)

Calamity Relief Fund.Emergency Medical Relief Division of DGHS in MOHFW.

CONCLUSIONSNo Political decentralization.Positive and Negative effects of Aarogya shri on

Decentralization and Disaster Preparedness.Failure of State Government in conducting training

workshops and Periodic Drills of all stake holders in the preparation and implementation of Disaster Preparedness Plan.

No focus on Psycho-social Interventions.Delay in Payment by Central Government & State

government & Non-utilization of funds for appro-priate Decentralization of Health care & Disaster Preparedness.

CHALLENGES IN DISASTER PREPAREDNESS

Need for comprehensive Public Health Strategy to meet all expected needs through enhanced relationship and communication with private Health sectors for improving Psychological Preparedness help in event of disaster crisis.

Need interventions for Hospital staff Training on use of Multi-user System for Emergency Response. (MUSTER) at semi-urban and Rural Levels.

Need for development of Community Mental Health Services in rural areas.

Need for Gold Standards on Humanitarian Health Interventions.

CHALLENGES IN THE DECENTRALISATION OF HEALTH CARE AND DISASTER PREPAREDNESS IN ANDHRA PRADESH, INDIA

• Lack of proper commitment by state government towards decentralization.• Political Decentralization.( Control of Local Politicians on Non-Teaching

Hospitals).• Indian Medical Association Against Political Decentralization.

• Health administrators and bureaucrats are protected .

• State Protection of Regional Employees.

• Lack of accountability .• Improper implementation of

Decentralization as District Mayor not included in the committee. (against 74th Amendment Act)

• Corruption• Impact of Aarogya

shri on Decentralization.

• Delay in payments• Local Institutions

Depend on State government for funding

Non-utilization of funds and Budget by Local Government due to limited budget spending Facility.

• Deficiency in efficiency and Leadership of Chairmanship and composition of Hospital Development Society (HDS) In conducting regular Meetings to address issues Health care improvements.

• Limited transfer of power.• District Collector Chairman of

Selection Committee Instead of Zilla Parishad Chairman (Against 73rd Act)

PROBLEMS IN DECENTRALISATION OF HEALTH CARE

REFERENCES Mazzaferro C. & Zanardi A. (2008): Centralization versus Decentralization of public policies: Does the Heterogeneity of Individual Preferences Matter? Fiscal studies, 29(1), pp-35-73.  Mooji (2003): Smart Governance ? Politics in the policy process in Andhra Pradesh , India; Working Paper 228; Overseas Development Institute, London Mosca (2006): Is decentralization the real solution? A Three country study. Health Policy .vol.77, pp 113-120 Rondinelli D.A., Nelis J.R., & Cheema.G.S (1983): Decentralization in developing countries, Staff Working Paper 581. Washington, DC, World Bank. Singh, N (2008) Decentralization and Public Delivery of Health Care Services in India Munich Personal RePEc Archive. Available Online at http://mpra.ub.uni-muenchen.de/7869/ [Accessed on Nov 14 2009]http://www.searo.who.int/linkfiles/EHA_cp_India.pdf. (Accessed on Nov 14, 2009)

SHOEB AHMED ILYAS, EMSRHS, DEUSTO UNIVERSITY, BILBAO, SPAIN.

RECOMMENDATIONSIncrease in resources, Marked improvement of

Public Health infrastructure, medical and Para-medical staff availability, involvement of key stake holders & also community will help state government in proper implementation of Decentralization & Disaster Preparedness.

Training and orientation programs for Disaster Preparedness.

Quick approval of New Disaster Management policy & Training Module on Mass causality Management.My sincere thanks to J Agustín Ozamiz, Program Director of the EMSRHS and deep appreciation to my family,

friends & colleagues.

EXAMPLE OF MUMBAI TERROR ATTACKS ON 27 NOV, 2008.