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Kishanganj District Public Private Partnership Project
Prasannakumar PN
Director Programme Operations
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Bihar- Fact Sheet
Population about 104 million; 90% rural & 54% BPL (Source: Bihar Fact Sheet, UNDP)
State HDI Rank(out of 23) - 21 ( 2007-8) (Source: Bihar Fact Sheet, UNDP)
Health Care: Government 20% Non-Government 80%
(Source: Ananya Programme, June 2013)
Highest Out-of-Pocket exp. on private health services
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The Transition in Bihar
Eye health projects with NGOs till 2008
Revised programme strategy in 2009 – moving away from service delivery to system
strengthening
Working with and within the government system
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Rationale of PPP approach
• 14 District hospitals out of 37 districts did not have eye
surgeon
• 69 out of 70 Referral hospitals did not have eye surgeon
• 17 out of 37 District hospitals had no Para Medical
Ophthalmic Assistant
• 434 out of 533 Primary Health Centres did not have Para
Medical Ophthalmic Assistant
Why Kishanganj? • Poorest of the 7 identified Districts • Farthest from Patna, State capital of Bihar • Priority of Govt. of Bihar for intervention • People going to Nepal for eye surgeries; poor outcomes
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The Kishanganj journey
2009:
Pilot project initiated in PPP
model in Kishanganj
2010:
Growth in surgical output in Kishanganj
district
2011:
Review of Kishanganj
performance by NPCB
2012:
Vision Centers set up in
Bhagalpur & Munger; OT refurbished
2013:
Cataract surgeries
started; ASHAs trained in Bhagalpur
2014:
GoB orders full-time
Ophthalmologist in
Kishanganj
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Kishanganj – then and now Systems & Services 2009 2014
No. of regular PMOAs in OPD in
District Hospital
0(visiting twice a
week)
2
OPD/Month 80(avg) 1100(avg.)
OPD Equipment in Dist. Hospital Torch & Trial Set All equipment as per VISION 2020
protocols
Eye Department Non-existent OPD & IPD (in sync)
Operation Theatre Non-existent Eye OT as per VISION 2020
protocols
Eye IPD Non-existent 25 bedded Eye IPD
Vision Centre Non-existent VCs in 7 PHCs functional at least
twice a week
Disease Specific
Intervention(cataract)
None since year
2000
1000/year
District Coverage Kishanganj Kishanganj, Katihar, Purnea,
Araria, Khagaria, Begusarai, W.
Dinajpur(WB) (Kishanganj DM’s
testimonial)
Post-Operative Follow-up Not Applicable Follow-up in Hospital and VC by
PMOAs of Govt.
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The impact
Increase in OPD from 80/month in 2009 to 1100/month(avg) in 2014
Increase in surgeries from zero in 2009 to 1000/year in 2014
Trained manpower in place: No PMOA in 2009 to 2 PMOAs in 2014
Lessing of out of pocket expenditure for the common man- Cataract Surgery @ Rs.2 from Rs. 3000/ in 2009 at Nepal
Government order on posting of ophthalmologist
Sustainable system in place
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Learnings
• Strong political will & government ownership critical
for initiation
• Involvement & ownership of government critical for
success
• Considerable time required for advocacy
• Short-term review for monitoring progress
- allow room for mid-course corrections
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Challenges
• Coordination between State-level and District-level.
• Acceptance and understanding of concept of
Systems Strengthening- concerned only with
service delivery to meet govt. targets
• Varying involvement of District-level government
leadership- changes with leadership change.
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Challenges
• Lack of interest of Govt. to sustain the initiative-
e.g. deputation of Ophthalmologist.
• Even after 5 years the Govt. takes this as a NGO
supported programme- not a collaborative effort.
• Lack of interest of the Government in scaling up
such initiative
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Way forward
Withdrawal from Kishanganj
Strengthening systems in
Bhagalpur, Munger, Begusarai and
Samastipur
State-level health systems
development initiatives focussing on systems change
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Thank
You!