inter sectoral coordination

INTER SECTORAL

COORDINATIONBY-

PRAMOD KUMAR

INTRODUCTION Inter sectoral coordination for

achieving health goals has been accepted as one of the guiding principles of the health strategy that was adopted at the international conference on primary health care.

DEFINITIONS INTER:

Inter means with in or it self.  SECTOR:

Sector refers to the different – different areas or they may be different organizations.

  COORDINATION:

Coordination is an administrative process which seeks to bring about unity of purpose in order to achieve common objectives.

INTER SECTORAL COORDINATION:Intersectoral coordination refers to the promotion and co-ordination of the activities of different sectors of health care system to enhance and to provide a qualitative services to community.

NEED FOR INTERSECTORAL COORDINATION:

There are many governmental departments and agencies working for people whose activities are closely linked with health, as health itself is a multi-sectoral subject that needs-

Clean waterSanitationPollution free environmentEconomic conditionsFood production etc.

Earlier health care system focused more on ’curative’ rather than ‘preventive’ aspects.

COLLABORATION: Collaboration implies a cooperative

situation where two or more participants have a common goal and where each has sufficient information as to what others are going to do to enable him to make correct decision.

Collaboration is- More participative Implies commitment Economizes efforts Improves quality of work Avoid duplication Optimizes output

collaboration continue… Collaboration is a process--- that facilitates

different functionaries and community to work together for efficient service delivery.

COLLABORATION LEADS -THIRST T = TIME SAVINGH =HELPS IN BUILDING RAPPORT WITH

OTHERSI =INCREASES EFFICIENCYR =REDUCES WORKLOADS =SHARING OF IDEAST =TRUSTWORTHY

NEED FOR COORDINATION IN HEALTH CARE DELIVER SYSTEM:-

To improve vertical nature of programs.

To maintain focus on primary health care.

To provide directionality.

To promote team work.

TYPES OF COORDINATION

INTRA-SECTORAL.

INTER SECTORAL.

CONSTRAINTS IN INTER-SECTORAL COORDINATION:-

1. AT THE KNOWLEDGE LEVEL:- Lack of knowledge of other programmes and

goals of other sectors. Each programme is implemented in an isolated manner.

For example Health Deptt. may not know the goals of ICDS programme, which in turn may not be aware of the goals of RCH programme etc. This leads to misunderstanding, repetition and sometimes even contradictions, which affect the credibility.

constraints continue…2. AT THE ATTITUDINAL LEVEL:-

The feeling of ‘why should I go, the other person should come forward’.

The attitudes are often based on misconception—coordination means more work and assuming responsibility for others work.

constraints continue…3. AT THE PRACTICE LEVEL:-

Lack of knowledge about the mechanisms. People do not know how to go about it and how to formalize it. The formal mechanism such as constitution of Advisory Committees, Coordination Committees, Task-forces etc.

PRE-REQUISITES FOR EFFECTIVE INTER SECTORAL COORDINATION

leadership style and willingness.

Health policies and priorities.

Sharing of a common vision and perspective.

Defining role and responsibilities of participatory agencies.

Participatory decision making.

Developing informal contacts with involved groups.

Learning more about quality of services.

Spelling out strategies and procedures.

Conducting joint monitoring and evaluation.

Taking immediate remedial measures in solving problems related to coordination/resource mobilization.

AREAS OF INTER SECTORAL COORDINATION

Promotion of nutrition

Agriculture

EducationSocial Welfare/Women and

Child Developmen

t

Panchayats

Animal Husbandry

ACTIVITIES OF HEALTH DEPARTMENT PROVIDING SCOPE FOR INTER-SECTORAL COORDINATION

Supply of safe water, Excreta disposal and refuse disposal, Waste water disposal, Maternal and child health, Family welfare, immunization against

major infectious diseases, Prevention and control of locally

endemic diseases, and health education on prevailing health problems.

MECHANISM OF COORDINATION

LISTING out the programmes which need joint efforts.

IDENTIFYING the areas where coordination is required.

KNOWING the categories of health personnel whose activities should be integrated.

LOCATING the level of health systems where joint efforts are needed.

FORMING coordination committee of members of district health team which includes all the middle level supervisors and specialized functionaries.

FORMING of operation teams at field level.

STEPS IN PLANNING INTER-SECTORAL COORDINATION

LISTING THE PROGRAMMES

IDENTIFYING - THE AREAS/ ACTIVITIES 

DIFFERENT ORGANIZATIONS AND AGENCIES

GOOD LOCAL NGOS TO FACILITATE COMMUNITY’S INVOLVEMENT

DEVELOPING AN ACTION PLAN FOR:

Independent tasksJoint tasksSharing of resourcesField work teams

CREATE INFORMAL FORUM FOR MEETINGS, ACKNOWLEDGEMENT

AND APPRECIATION OF ALL PARTNERS EFFORTS IN ACHIEVING

THE TARGETS.

INVOLVING COMMUNITY FOR COMMUNITY PARTICIPATION

Community participation has been identified as an important means of overcoming sectoral barriers.

It is the community and its involvement that best motivates collaboration between sectors through the community, health goals can be linked to and reinforces other goals of well being.

It is a long arduous task but results are good and lasting.

continue… The ranges of activities of community

participation therefore include the following:Helping community to analyze their problems

and their causes.To identify the needs and prioritize them in a

logical manner. Sometimes felt needs of the community may be different from the perceived need of the health professional.

To plan activities to meet these needs/solve the problems and to find resources for them.

To monitor closely the implementation of programmes.

Last but not the least to own the programme by assuming full responsibility for its implementation.

ADVANTAGES OF COMMUNITY PARTICIPATION

MORE achievement at lower cost.

CATALYST for further development.

DEVELOPS a sense of ownership and subsequently responsibility in utilization and maintenance of health care services.

INCULCATES self-reliance by enhancing the use of local indigenous expertise.

INNOVATIVE PROJECTS IN COMMUNITY PARTICIPATION IN HEALTH Rangabela project, West Bengal

Comprehensive Rural Development Project, Jamkhed, Maharashtra

RUSHA Integrated Health and Community Development Project, Vallur, Tamil Nadu.

STRATEGIES FOR ENHANCING COMMUNITY PARTICIPATION

Recruitment of local frontline

health workers.Working with local groups.

Working with NGOs.

Development and use of simple indigenous

technologies.

Demand driven approach rather

than supply driven approach.

RESEARCH ARTICLE TITLE OF THE STUDY:-

Intersectoral coordination, community empowerment and dengue prevention: six years of controlled interventions in Playa Municipality, Havana, Cuba.

OBJECTIVE:To document the process, outcome and effectiveness of a community-based intervention for dengue control.

METHODS: The primary intervention, focused on

strengthening intersectoral coordination, was initiated by researchers in January 2000 in a pilot area in Playa municipality, Havana. In August 2002 health authorities extended the intervention to neighbouring areas, one of which was selected for evaluation. In August 2003 a complementary strategy, focused on community empowerment, was initiated in half of the pilot area. Longitudinal process assessment was carried out using document analysis, interviews and group discussions. Random population surveys in 1999, 2002 and 2005 assessed levels of participation and behavioural changes. Entomological surveillance data from 1999 to 2005 were used to determine effectiveness.

RESULTS: Mean scores for participation in the pilot area were

1.6, 3.4 and 4.4 at baseline, and 2 years after initiating intersectoral coordination and intersectoral coordination plus community empowerment interventions, respectively. While in the control area little behavioural change was observed over time, changes were considerable in the pilot and extension areas, with 80% of households involved in the community empowerment intervention showed adequate behavioural patterns. The pilot and extension areas attained comparable entomological effectiveness with significantly lower Breteau indices (BIs) than the control area. The pilot (sub-) area with the community empowerment intervention reached BIs below 0.1 that continued to be significantly lower than the one in the control area until the end of the study.

CONCLUSION:The study showed a trend in the levels and quality of participation, behavioural change and effectiveness of Aedes control from the routine activities only over an intervention with intersectoral coordination to one that combined intersectoral coordination and community empowerment approach.