MFCM192: State Institutes of Health & Family Welfare and Growth of Public Health in India.pdf

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extracted text: State Institutes of Health & Family Welfare and Growth of
Public Health in India
Shiv Chandra Mathur
Public Health Specialist

Medicine to the study and application of biology in a matrix that is at once historical,
social, political, economic and cultural. The practice of Medicine is a part of sociology
and a product ofsociological factors.
Henry Siegerist
1.0
INTRODUCTION
This write-up is an attempt to draw the attention of public health activists towards the
process of institution building ofstate level institutions in our federal polity. There are a
dozen State Institutes of Health and Family Welfare in India. Almost all large states have
an apex level health training (and research!) institute at the State level! All these
institutes were started as a project activity with World Bank support under the banner of
‘India Population Project’. These projects were popularly designated as IPP. They had a
--------lifc-span-of-five-to-severryears4rreadrSiaterG?he"se_projecis were essentially to provide
strengthening support to Family Welfare Program in collaboration with Government of
India. Eventually during the life time of IPP’s in the respective states, SIHFWs were
brought up energetically. This entailed not only large scale civil works often in sprawling
campus, but recruiting the faculty and inducing a culture of streamlining the in-service
trainings for large health systems. Since the World Bank projects have a mechanism of
continuous dialogue between the three parties during the implementation phase - GOI,
respective State Government and World Bank Review Mission - continuous
improvements in the training process occurred as long as the projects were in vogue. But
once the IPP was winded up from a given State, the process of institution building of
SIHFW in that State has gone haywire.
Following text is a brief account of extent of ownership of SIHFW by the States, their
impact on the growth of public health in India, context of health sector reform in this
process, brief on couple of cases of SIHFW and possibilities of their revival in the light
of Public Health Foundation of India and lately a proposal to start State Health System
Resource Centre Under National Rural Health Mission in all the (erstwhile!) States
clubbed under Empowered Action Group.

2.0

HEALTH AND FAMILY WELFARE TRAINING CENTRES

Training Institutions to take care of in-service training in health sector were initially
started as Regional Health and Family Welfare Training Centers (RFPTC). This
momentum started in late fifties, reached to its pinnacle by 1978 when the number of
RFPTC’s in India rose to 47. The staff provided in these training centers was based on

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the recommendations of Mukherjee Committee Report. Since multi-disciplinary
professionals were expected to organize training activities in these centers in coordinated
and cooperative manner, varieties of disciplines such as Bio-medics, Social Science,
Health Education, Public Health Nursing and Statistics were converged in these training
centers. The main functions of RFPTCs identified were:
•

•

To plan, conduct, evaluate and follow up training programs including
refresher courses, seminars, workshops, conferences for health professionals in the
training centre and in the attached districts as a technical resource for a given
region;
To develop urban/ rural field practice and demonstration areas;.

•

To develop guides and manuals for training and to provide consultative
services on family planning and training to other voluntary and allied agencies;

•

To promote and coordinate teaching and training in family planning in the
training curricula and programs of other organizations.

These training centers were established with a norm of one for 10 rhillion populations.
They were exclusively FP training centers to begin with, subsequently widening their
horizon to health. RFPTC,s contributed substantially in developing the capacities of
health systems in seventies and eighties. Their ubiquitous presence was proved during
reorientation of health professionals to multipurpose scheme. Shift in management
approach from program to project mode might have led to weakening of their potency.
RFPTCs under the new jargon of HFWTC’s around the country are now surviving with
funds made available under centrally sponsored schemes of FP program. HFWTC’s have
huge buildings, large manpower and sufficient training hardware, most of which remains
underutilized. Latest addition to the network of these regional institutes was HFWTC,
Jodhpur. It was established specially for ten desert districts of western Rajasthan under
IPP-IX project. Way back in 1996-97, it entailed civil work of Rs. 2.5 crore, to construct
this huge training institute with a large hostel and staff quarters. Staff was collected and
institute functioned for five years. As soon as IPP-IX terminated, this beautifully created
HFWTC was dissolved and the assets so created were handed over to another department
of the State!

3.1

SIHFW Andhra Pradesh:

Established in 1992 under IPP-VI, it functions as an autonomous body. Governance is
through a board chaired by the chief secretary of the state. It has a faculty of 3 Professors,
3 Readers and two lecturers.
They cover the disciplines of Epidemiology.
Communication, Management and RCH. During 2003-04, all faculty members were sent
to different European Institutes under a Institution Development Program of Health
sector reforms supported by European Commission. While services for Mess, Hostel,
garden etc are hired on contract; ancillary support of 17 persons is there. Beside a 155
seat auditorium and a lecture theatre, institute has four training halls which more often
are given on rent to other agencies to conduct training program, thus bringing revenue to

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the institute. It has a hostel with 44 rooms and four VIP suites, seven computers and a
fairly .large library. State government is regularly giving them a grant-in-aids to the order
of Rs. 80 lakh per annum. Institute has been able to undertake several projects and earn a
substantial savings. This led to the creation of a corpus which gave confidence and
sustainability. Thus it boasted by re-designating itself as Indian Institute of Health and
Family Welfare! It can be said with certainty that SIHFW, Hyderabad could create a
niche as an autonomous institute in health sector. . Although led by a full time technical
director for seven continuous years, this is third occasion of fairly long duration when
SIHFW is under additional charge of Commissioner FW, Govt, of A.P..

Address: Vengel Rao Nagar, Hyderabad- 500038

Tele

3.2

: 040-2381-0691; website:www.iihfw.org

SIHFW, Rajasthan:

World Bank could persuade the Government of Rajasthan to follow the example of A.P.
Thus another SIHFW as an autonomous body was established in yet another large state
i.e. Rajasthan. Governing Board of the institute is chaired by Health Minister. It has a full
■time technical director selected through open competition. Between 1995 and 2001,
STHFVV'7'Rajasthmf fuhcfioned welFbut came to a grinding halt in January, 2002 when
IPP-IX was terminated. World Bank project could leave behind a legacy of huge building
in a sprawling campus and disillusionment for the State as to how to carry it on?
Virtually for earlier half of 2002, it was kept gasping.

Fortunately efforts to revive it were started soon. Bringing back a full time technical
director and exploiting the opportunity of clubbing the HRD component of erstwhile
projects in the State i.e. IPD, EC-SIP, RCH-1, RHSDP etc could infuse life into it.
Physical asset of a large unfurnished building could soon be changed into a throbbing
institute by the component of “Strengthening SIHFW” under European Commission
supported sector reforms program. Equipping the 24 double occupancy rooms in the
hostel, a library with more than 3000 books, four training halls and an auditorium with
100 seats brought life to the campus.. There are six faculty positions covering the area of
Community Health, Communication and Management. Additionally, support staff of ten
persons and subsequently, a contingent of Consultants as CTI in RCH-2 were also made
available.
Thus SIHFW restarted working on its mission to help the Medical and Health
Department of Government of Rajasthan in continuously improving the quality of
services provided through variety of public facilities. Thus institute’s involvement in
organizational development through concurrent conduct of in-service trainings and
operational research started creating a dent. Managing more than a dozen trainings in
RCH-2 Project throughout the state now seems to be it’s routine. Beside holding flagship
for a network of HFWTC’s and ANMTC’s and guiding them in implementing the
training strategy of RCH-1 and 2, it has oriented all the Project Management Units
created in 32 districts of the State under NRHM. It has also set the ball rolling for
orienting ASHA through a cascade approach. Short term research projects undertaken by

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the SIHFW provided consultancy for mid-course corrections in national health program
and projects on one hand and provided a feel on training needs of the department on the
other hand. Of course, this phenomena set ball rolling for Institute to earn consultancy.
Institute has hardly received any financial support from State Government over last four
years. But it has demonstrated that a self sufficient autonomy can be created even within
public system!

Address: SIHFW, Rajasthan, Jhalana Institutional Area, Jaipur-302004

Telefax : 0141-2706534
3.3

SIHFW, Uttar Pradesh

World Bank has supported three IPP’s in Uttar Pradesh between 1973 and 1996, viz. IPP1, IPP-2 and IPP-6. Establishment of SIHFW, U.P is part of implementation of these
projects. It’s current shape was finalized in IPP-VI. It is an integral part of department of
health and family welfare of the state government. It is led by a full time technical
director who is selected through open competition. There are 2 positions of Professors, 3
Associate Professors and ten Assistant Professors in the faculty. Disciplines covered
include Education and Training, Communication, Statistics and Demography, Social
Science, Organization Behaviour, Community Health and Epidemiology. Research staff
is being additionally provided which includes 1 Joint Director, 1 Assistant Director. 4 .
Research Officers and 15 Research Assistants. Paraphernalia includes strength .of.57
persons. This SIHFW has two hostels with 35 rooms and one guest house with four
suites, 100 seat auditorium and four training halls. It maintains a convoy of five vehicles
and eight Pentium Computers. Its annual budget for 2004-05 was Rs. 1.37 crores.
SIHFW, UP conducts foundation courses, RCH-ToT, Nurses training and HIV
counseling program. Institute is collaborative training institute for RCH-2 Project for
Uttar Pradesh. It has published couple of research studies in last three years which
remained restricted between SIHFW, Lucknow and Government of U.P.

3.4

Address:

SIHFW, Indira Nagar, Lucknow

Telephone:

0522-2382201

SRC, Chattisgarh:

With carving out of Chattisgarh from Madhya Pradesh, two major projects i.e. cultivating
Mitanins as a community Health Worker and attempts to begin a consolidated course to
create a band of paramedical professionals led to the creation of State Health Resource
Center. Basically this is a research support to the health system of the State. The
experience of Chattisgarh Health System Resource Center is said to be very positive in
the opinion of Government of India in pushing reforms and building capacity for
improving health systems delivery at all levels. Government of India has directed all the
states under NRHM to establish similar health system resource centers albeit the SHRC,
Raipur is now being upgraded as SIHFW by the government of Chattisgarh.

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4.0 Health Sector Reforms and Professional Development Courses:

"That for the general promotion of the means necessary to prevent disease it would be
good economy to appoint a district medical officer, independent ofprivate practice, and
with the security of special qualifications with responsibility to initiate sanitary measures
and reclaim the execution of law - their task, was to be essentially with prevention. ”
Edwin Chadwick
Another major component of health sector reforms at country level is beginning of
Professional Development Courses (PDC) for district level Medical Officers. It was
around the beginning of new millennium that MOHFW in collaboration with NIHFW
evolved a 12 week long professional development course (PDC). It was primarily
addressed to Doctors who are already District Medical Officers, and secondarily to the
potential candidates who are soon expected to take charge of districts. NIHFW piloted
this^program for two years. Subsequently at the behest of European Commission,
MOHFW delegated the responsibility of conducting PDC to SIHFWs around the country.
This has been an appreciative beginning on the way to revitalize the SIHFWs where state
institutes in Punjab, Gujarat, Andhra and Orissa have proved their worth.
. In Madhya Pradesh, during the implementation of IPP-VI, state level institute was created
under the banner of State Institute of Health Management and Communication at
Gwalior. For almost a decade, this unconventionally jargoned state level health institute
has remained under the charge of Divisional Commissioner of Gwalior! Naturally, its
resources were exploited more often for activities not related to development of health
services. Substantial evidence of this fact is reflected in the decision to delegate PDC by
Gol to HFWTC, Indore for the State of Madhya Pradesh. Epilogue of this episode is that
HFWTCs if supported can deliver the goods!
After all every
black cloud has a
silver lining.

In Rajasthan, PDC was assigned to IIHMR, Jaipur in place of SIHFW with the pretext
that at two places these prestigious training programs were assigned to private
institutions. Other private institute identified was in Kerala where PDC never took off,
while in IIHMR, over a period of two years only two programs with 16 participants at
each time could be conducted. Had it been SIHFW of the State in implementing PDC, the
identification of participants could have been of the order where worthy utilization of
trainee after training could be possible! After all a private institutes do not feel as much
concerned on the profile of a participant as a institute of state having allegiance to the
health system of the respective state.

Overview of initiating PDC in India seems to be a good beginning in terms of making
provision for well oriented district level Medical Officers, since the later in our country
manage the health services for as large a population as two million. Nominating right
candidates has remained a challenge with the Health Directorates of respective states in
view of duration of ten continuous weeks. Officers who are already in service for 20-25
years charged with responsible portfolio have many stakes when they are supposed to be
away for two and half months.

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5.0

SHSRC and NRHM:

Framework for implementation of National Rural Health Mission (NRHM) has proposed
the setting up of State Health System Resource Centre (SHSRC) in EAG States to begin
with. It is expected that the SHSRC will work very closely with existing SIHFWs. PRCs
and HFWTCs. At this juncture, there is again a need to take stock of SIHFWs and
HFWTCs in various states. Exploiting the opportunity created within the frame of
NRHM may further pave the way to enhance the capacity of state’s own institutes. It
would further link up the research and in-service training. In fact, quality training can be
delivered only when trainers are consistently fed with on-going strengths and weaknesses
of the system. This has been a firm experience of SIFIFW of AP and Rajasthan. While in
Raipu, SHRC is remolding itself as SIFIFW- Chattisgarh, SIHFW- Rajasthan has initiated
the steps to demonstrate that as an already established autonomous body, it can play
effectively as SHSRC.

6.0

PHFI and SIHFWs:

Public Health Foundation of India launched in March 2006 plans to set up a chain of
Indian Institutes of Public Health (I1PH). Government of India has requested all the State
Governments at the time of launch of PHFI to come forward with the proposals for the
-foimdation-to -establish IIPH in their states. Incidentally the States having SIHFWs 'with
sufficient physical and manpower resources have expressed the interest from a new.end.
Thus they have overlooked the presence of Institutes which their own Government
created within last decade or at the most 15 years. Since the basic premise of Public
Health is optimization of resources, MOHFW and state governments owe a responsibility
to converge the movement of building up new institutions with strengthening the one’s
which are government’s own creation. Alternately a huge investments in HFWTCs and
select SIHFWs through central sponsored scheme funds needs a thorough review.

7.0

Conclusion:

Thus, we are passing through a dilemma. We observe the sustaining of HFWTC’s at
regional level and indifference for State level institutes created in recent past! We see
unproductive HFWTC’s larger than the much criticized SIHFW of their respective states!
SIHFW’s to begin with babies of central and respective state governments were
marginalized by the same creators. Ministries themselves could not ungrip themselves
from the overwhelming presence of IIHMR here, ASCI there and IIM boasting of their
Health Schools elsewhere! Eventually the bowel of nourishment from States which could
go to their own creations (SIHFW), also reached to the well established institutes (a
natural corollary of privatization). And State health burecracies are now nurturing the
ambition to establish yet another set of health training institutions under the garb of
public-private partnership! What is required is to advocate and persuade the decision
makers to carry on the growth of health systems on proper track. When Public Health
has many patrons around, Governance owes the onerous responsibility to regulate the
sponsor’s support effectively.
Further Reading:

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1.

Shiv Chandra: Manpower Development in Reproductive and Child Health Care in
Rajasthan : Innovations and Implications; Manpower Journal, 35:41-50(1999).

2.

Shiv Chandra: Health Manpower Development in an Indian State; Regional Health
Forum (WHO-SEAR), 2:35-40(1997).
Shiv Chandra: Health Manpower at Grassroots in Evaluating HRD (Ed.:Udai
Pareek),HRJD Network,Jaipur,1997.

4.

Satpathy S.K. and Venkatesh S.: Human Resources for Health India’s National
Rural Health Mission: Dimension and Challenges; Regional Health Forum (WHOSEAR), 10:29-37(2006).

5.

Ramchandran . P: Human Resources for Health; Ind.Jour.Med.Res, 123:485488(2006):

6.

IIHMR: State Program Implementation Plan for Reproductive and Child Health II
in Rajasthan,FY 2005-10;Health and F.W.Department, GoR,Jaipur,2005.

7.

National Rural Health Mission
MOHFW,GOI, New Delhi.
'

8.

State Program Implementation Pl'an-RCH-2, Medical and Health Department,
Government of Rajasthan, Jaipur-2004

(Framework for Implementation.2005-12)
------- --------------------------------- ------

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Table 1: SIHFW in India
Name & Address

Phone No.

Indian Institute of Health and Family Welfare,
Govt, of A.P. Vengalrao Nagar, Hyderabad-500038______________________
State Institute of Health & Family Welfare,
Khanapara, P/O Assam Sachivalaya, Guwahati- 781006__________________
State Institute of Health and Family Welfare Sheikhpura,
Patna-80014______________________________________________________
State Institute of Health and Family Welfare,
Near Sola Civil Hospital, Sarkhej- Gandhinagar Highway. Ahmedabad-380060
State Institute of Health and Family Welfare
Behind Tapori Park, Sect-6, Panchkula-145109, Haryana_________________
State Institute of Health and FW, Karnataka
----- -----Is' Cross Magadi Road, Bangalore-560023________'____________ ‘'
SIHFW, Thycaud, Thiruvananthapuram, Kerala- 695014_________________
State Institute of Health Management and Communication
City' Centre, Gwalior-474002, M.P.
______ ,________ \_____________
State Institute of Health & Family Welfare
;
■
Nayapali, Bhubaneswar-7510'12, Orissa________________ ._______________
SIHFW, Punjab
New Civil Hospital, Sector 34, Mohali, Chandigarh, Punjab_______________
SIHFW, Rajasthan
Jhalana Institutional Area, Jaipur-302004______________________________
SIHFW, UP
C-Block, Indira Nagar, Lucknow-226001, UP__________________________
State Institute of Health & Family Welfare,
29-G.N. Block, Sector-V, Bidhan Nagar, Kolkata- 700091

040-23810400

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0612-2286148

Leader as of
Oct. - Dec. 2006
Commissioner, FW
Govt, of A.P._____
Commissioner &
Seer. ofHlth&FW
Acting Director

079-27462811

Fulltime Technical

0361-2261605

Director

0172-2584549
680-23206425

Director! hcharge'

■0471-2336743
0751-2340229

0674-2402032

0172-2624353
0141-2706534
0522-2340597
033-23578870
033-23574531

-Eu LI Lime—Tech nkrai----Director____________
Commissioner Health ■
System Corporation
Fulltime Technical
Director____________
Director I/c

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