Not-for-profit sector in primary healthcare: can effective policy help improve health outcomes in these partnerships?

Abstract

The Indian government first started actively relying on partnerships with NGOs in health care in the field of Reproductive and Child Health. The roles played by NGOs ranged from advocacy to awareness creation and from preventive and promotive aspects of healthcare to implementation of national level programmes and schemes. Despite being touted to significantly augment government s effort to providing universal and comprehensive, free of charge primary health care to the needy, the picture of NGO involvement in health care has been hazy with limited data to assess the direct impact on health outcomes. Even though thousands of NGOs of different sizes and scales are operating in primary health, major health indicators in these communities have not shown a significant positive jump. As on December 2014, only 61 per cent of children between 12 -23 months have been immunized, only 41 per cent women have had the mandatory three ante-natal health check-ups before delivery and only 31 per cent pregnant women had received and consumed folic acid tablets. 1In the absence of a national policy that can dictate t he guidelines for NGO-Govt partnerships in primary healthcare to states, the monitoring and evaluation of such partnerships have remained weak. As a result, it has been difficult to establish whether involvement of NGOs has had a significant impact of the various health outcomes that are measured at a primary health centre. These include increase in coverage of RCH services, reduction in infant mortality rates and maternal mortality rates, emergency response mechanisms etc. Evaluation of the services of NGOs currently involved in primary health care is neither completely formalized nor is it enforced. It is realized that a guiding policy at the national level, given by an appropriately constituted board under the Ministry of Health and Family Welfare (MoHFW) and robust State NGO Cells at the state level can enable better monitoring and evaluation of NGO-Govt partnerships. These systems have a potential to make the process of selecting NGOs more transparent than it currently is and based on performance outcome measures make appropriate policy revisions at the state level tobetter harness the services of the voluntary sector in improving the delivery of primary health care services.