Managing Health at District Level: A Framework for Enhancing Programme Implementation in India

COVID-19 pandemic has brought to the fore the need for a strong health system for the social protection of people and to improve health programme implementation in the coming years. India has made great progress in health over the past 50 years; however, despite the progress made, it is faced with several challenges. While infectious diseases remain an unfinished agenda, chronic non-communicable diseases (NCDs) are rising and are now the leading cause of mortality in the country. This is further compounded by the prevailing inequalities in access to quality health care among population groups including those living in remote rural areas. To achieve Universal Health Coverage and Sustainable Development Goals by 2030, India in 2017 revised its National Health Policy and committed itself to attain the highest possible level of good health and well-being, through preventive and promotive health interventions. While policies are enunciated and plans are formulated, the implementation at ground level is at best tardy and lack lustre As an administrative unit for programme implementation, a district has a key role to play in implementing national programmes and in delivery of basic health services to the people. They are strategically placed to plan, organise and lead efforts meant to deliver primary health care services through better management of existing resources and by fully engaging all relevant stakeholders in contributing towards achievement of national health goals and in responding to a public health emergency such as Covid-19. Planning and managing health problems need an improved and responsive health governance. Strategic planning, monitoring and evaluation require integration and coordination of various health programmes including dealing with health crises, fostering inter-sectoral involvement and engagement of the community as a key actor. Efforts are needed to ensure that services reach the most vulnerable and marginalised sections of the society. Adequate governance support at district level through a whole-of-society approach is essential to bridge the health inequities and ensure equitable access to health services.