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Informed Decision for Planning the Public Health Infrastructure in Madhya Pradesh – Multiple Criteria Decision Analysis

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Informed Decision for Planning the Public Health Infrastructure in Madhya Pradesh – Multiple Criteria Decision Analysis Project Report Informed Decision for Planning the Public Health Infrastructure in Madhya Pradesh – Multiple Criteria Decision Analysis November 2020 State Health Resource Centre (SHRC) Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis Informed Decision forPlanningthePublic HealthInfrastructure in Madhya Pradesh– Multiple Criteria Decision Analysis November 2020 State Health Resource Center (SHRC) Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis Bhopal 1 About the Report Over the years, demand for new public health facilities and need for up-gradation has been realized by the state government for improving the access to health care services. Field observations and request from health officials has been a major criterionfor decision making. Department of Health and Family Welfare decided to use a data-driven scientific approach to formulate a systematic infrastructure upliftment plan which takes into account IPHS norms and service performance of the health facilities. Based on the request, SHRC-AIGGPA has conducted two studies using the multiple criteria decision analysis technique to suggest potential locations for establishing the new Sub Health Centres in Madhya Pradesh and, has also provided priority classification for up-gradation of selected public health facilities. The results of these studies are the amalgamation of two scientific approaches, (1) GIS-based location- allocation model and (2) priority setting decision using the Evidential Reasoning -ER model. Acknowledgement We are greatful to the Department of Health and Family Welfare, Madhya Pradesh and National Health Mission MP for providing the necessary data and technical inputs. Thank ful to the GIS and Image processing division, Madhya Pradesh Council of Science and Technology, Bhopal for providing the necessary infrastructure and technical support. Thank ful to the Madhya Pradesh Agency for Promotion of Information Technology, Bhopal for providing the technical inputs. Greatful to Mr. R Parushram, Formal Director General, Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis, Bhopal for overall guidance and support to carry out this study. Study Team Mr. Madan Mohan Upadhyay, Principal Advisor SHRC AIGGPA Ms. Preeti Upadhyay, Senior Advisor SHRC AIGGPA Dr. Alok Choudhary, Senior Principal Scientist MPCST Mr. Abhishek Kumar, Research Associate MPCST Mr. Kiran Mane, Consultant - Technology Management SeMT Institute welcomed comments and suggestions which may kindly be addressed to the Senior Advisor at [email protected] 2 Abbreviation CHC Community Health Center GoMP Government of Madhya Pradesh GIS Geographic Information System GPS Global Positioning System HMIS Health Management Information System IPHS Indian Public Health Standards LAM Location-allocation Analysis Model MAPIT Madhya Pradesh Agency for Promotion of Information Technology MPCST Madhya Pradesh Council of Science and Technology PHC Primary Health Center PMGSY Pradhan Mantri Gram Sadak Yojana ER Evidential Reasoning RGI Registrar General of India SHRC State Health Resource Center SHC Sub Health center SeMT State e-Governance Mission Team 3 Contents Summary .......................................................................................................................... 5 1. Introduction ................................................................................................................. 6 1.1 Background ................................................................................................... 6 1.2 Methodology ................................................................................................ 8 2. Results ........................................................................................................................ 15 2.1 Study 1 – Potential locations for new SHCs ....................................................... 15 2.2 Study 2 – Validation and priority setting of public health facilities ......................... 16 2.3Map – Sample .............................................................................................. 18 3. Discussion .................................................................................................................. 19 3.1 Strength and limitation ................................................................................. 19 3.2 Policy options and implications ...................................................................... 20 4. Conclusion ................................................................................................................. 21 References ...................................................................................................................... 22 Annexure 1-Table A ......................................................................................................... 23 Annexure 2- Table B ........................................................................................................ 24 Annexure 3- Table C ........................................................................................................ 32 Annexure 4-Block wise Map ......................................................................................... 63 4 Summary Background Considering the trends in growth and redistribution of population, it is not only necessary to upgrade the existing public health infrastructure to improve access and functionality, but also to plan for locations of new public health facilities to improve access. In order to identify the appropriate locations for new sub health centers and setting priorities for up-gradation of public health facilities that improves access, the Government of Madhya Pradesh (GoMP) requested State Health Resource Centre at Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis (SHRC-AIGGPA) to conduct a study based on data driven approach. The first study was titled “Identification of locations for establishing the new Sub Health Centers in Madhya Pradesh” while the second study titled “Feasibility of Public health facilities selected for up-gradation in Madhya Pradesh”. Objectives of Study 1: • To suggest locations for establishing new Sub Health Centers based on data driven scientific approach. • Designing block wise map to show the existing public health facilities and proposed location of new Sub Health Centers. Objectives of Study 2: • To validate public health facilities identified for up-gradation. • To suggest the priority category of 23 maternity wings, 278 Sub Health Centers, 291 Primary Health Centers and 73 Community Health Centers using data driven scientific method. Results The results based on GIS - Location Allocation (LA) Model and Evidential Reasoning (ER) Model provides recommendations to systematically plan the strengthening of health Infrastructure particularly physical establishments. The block wise map shows the current status of public health facilities in terms of geographical distribution in Madhya Pradesh. Results of study 1: • Prospective locations of 1,628 new sub health centers have been identified in 49 districts in Madhya Pradesh. • Block wise Geographical map generated for the same. Results of study 2: • The priority list of 665 public health facilities selected for up-gradation has been generated. • A map for each block presenting the locations of existing, new proposed sub health centers and, facility required for upgradation has been developed. 5 1. Introduction 1.1 Background Madhya Pradesh has a population of 7.2 crores as per census 2011. The population of Madhya Pradesh has grown from 6 crores in 2001 to 7.2 crore in 2011, an increase of almost 20 percent in a decade. According to population projections for India and the States 2001-2026 (Office of RGI), the population of Madhya Pradesh is expected to reach 8.8 crores by the year 2026. The changing population and societal behavior are intensifying the pressures on health systems and demanding more healthcare service centers. The National Health Policy 2017 highlights issues related to Infrastructure and Human Resources/Skill Gaps. According to the government of Madhya Pradesh official records, there are 10,204 Sub Health Centers, 1,205 Primary Health Centers, 330 Community Health Centers, 86 Civil Hospitals and 51 Districts Hospitals providing health care in the state. An attempt has been made by the Department of Health and Family Welfare, Madhya Pradesh to determine the prevailing gaps in Sub Health Centers in the state. At the same time, various public health facilities require up-gradation from the current facility type. The Department of Health has requested SHRC-AIGGPA to support in identification and validation of public health facilities through a scientific data-driven approach. Figure 1: Ad hoc priority setting and rational priority setting Note: adopted from Rob Baltussen, 2006 6 The infrastructure site decision influences and shapes the overall healthcare network within anarea. It is also a delicate decision for the local population whoare traditionally consulted via a mailed questionnaire. However, this method is not the most rational or transparent way for optimization of our research objectives and thus other methods are needed to improve the site location decision-making process (Dehe, Bamford, Bamford, & Moxham, 2011; Feldmann & Olhager, 2013). Healthcare organizations are becoming increasingly accountable to the local population (DoH, 2010) and modeling techniques such as location-allocation models and Geographic Information
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