Inter sector coordination is essential for sustainable development in India. Participation with the developmental agencies will gave more fruitful results. Moreover, it generate ownership among the common masses. At the same time all the stakeholders understand the sense of responsibility and accountability as well. On the other side the coordination agencies come to know about each other and the objectives of the agencies in general.

1. INTER-SECTORAL COORDINATIONINTER-SECTORAL COORDINATION
IN HEALTH CARE DELIVERYIN HEALTH CARE DELIVERY
Yade Lal TekhreYade Lal Tekhre
Former ProfessorFormer Professor
Department of Social SciencesDepartment of Social Sciences
National Institute of HealthNational Institute of Health
and Family Welfare,and Family Welfare,
New Delhi, IndiaNew Delhi, India
yadelal20@yahoo.cayadelal20@yahoo.ca

2. INTER-SECTORALINTER-SECTORAL
COORDINATIONCOORDINATION
IN HEALTH CARE DELIVERYIN HEALTH CARE DELIVERY
What to doWhat to do
• Discuss the concept of inter-Discuss the concept of inter-
sectoral coordinationsectoral coordination
• List out of the variousList out of the various
organizations for ISC at districtorganizations for ISC at district
levellevel
• Describe likely mechanism ofDescribe likely mechanism of
coordinationcoordination

3. WHY INTER-SECTORALWHY INTER-SECTORAL
COORDINATION IS NEEDEDCOORDINATION IS NEEDED
ISCISC for achieving healthfor achieving health
goals has been accepted asgoals has been accepted as
one of theone of the guiding principlesguiding principles
of the health strategyof the health strategy thatthat
was adopted at thewas adopted at the
international conference oninternational conference on
primary health care.primary health care.
(Alma-Ata, USSR, 1978)(Alma-Ata, USSR, 1978)
33

4. There are manyThere are many
governmentalgovernmental
departments anddepartments and
agencies working foragencies working for
people whosepeople whose activitiesactivities
are closely linkedare closely linked withwith
healthhealth, as health itself is, as health itself is
a multi-sectoral subjecta multi-sectoral subject 44

5. 1.1. Clean waterClean water
2.2. SanitationSanitation
3.3. Pollution free environmentPollution free environment
4.4. Economic conditionsEconomic conditions
5.5. Food production etc.Food production etc.
Health is an essential component ofHealth is an essential component of
all developmental activities.all developmental activities.
Multilateral linkages exist betweenMultilateral linkages exist between
health, socio-cultural, political andhealth, socio-cultural, political and
economic spheres.economic spheres. 55

6. Earlier health care systemEarlier health care system
focused more onfocused more on ’curative’curative’ rather’ rather
than ‘than ‘preventivepreventive’ aspects’ aspects
The coordinated health careThe coordinated health care
activities involvedactivities involved working withworking with
peoplepeople,, PRIPRI member, localmember, local
groups,groups, youthyouth clubs,clubs, MahilaMahila
MandalsMandals,, self-helps groupsself-helps groups, and, and
NGOsNGOs etc.etc.
66

7. COLLABORATION ISCOLLABORATION IS
–MoreMore participativeparticipative
–ImpliesImplies commitmentcommitment
–EconomizesEconomizes effortsefforts
–ImprovesImproves qualityquality of workof work
–AvoidAvoid duplicationduplication and wastageand wastage
–OptimizesOptimizes outputoutput
77

8. ‘‘Willing cooperation andWilling cooperation and
agreement toagreement to
collaborate leads tocollaborate leads to
effective coordinationeffective coordination’’
the ultimate aim ofthe ultimate aim of
coordination iscoordination is
convergenceconvergence of health careof health care
services in the communityservices in the community
88

9. MEANING:MEANING:
Coordination is anCoordination is an administrativeadministrative
processprocess which seeks to bring about unitywhich seeks to bring about unity
of purpose in order toof purpose in order to achieve commonachieve common
objectivesobjectives. Coordination implies a. Coordination implies a
cooperative situationcooperative situation where two or morewhere two or more
participants have a common goal andparticipants have a common goal and
wherewhere each has sufficient informationeach has sufficient information asas
to what others are going to do to enableto what others are going to do to enable
him to makehim to make correct decisioncorrect decision..
99

10. Convergence is a process--- thatConvergence is a process--- that
facilitatesfacilitates different functionariesdifferent functionaries andand
communitycommunity to work together forto work together for
efficient service delivery.efficient service delivery.
CONVERGENCE LEADSCONVERGENCE LEADS THIRSTTHIRST
TT == TIME SAVINGTIME SAVING
HH == HELPS IN BUILDING RAPPORT WITH OTHERSHELPS IN BUILDING RAPPORT WITH OTHERS
II == INCREASES EFFICIENCYINCREASES EFFICIENCY
RR == REDUCES WORKLOADREDUCES WORKLOAD
SS == SHARING OF IDEASSHARING OF IDEAS
TT == TRUSTWORTHYTRUSTWORTHY 1010

11. NEED FOR COORDINATION INNEED FOR COORDINATION IN
HEALTH CARE DELIVER SYSTEMHEALTH CARE DELIVER SYSTEM
MOST of the times these programmeMOST of the times these programme
pursue the achievement of theirpursue the achievement of their
specific objectives in aspecific objectives in a vertical mannervertical manner
loosing sight of the ultimate goal ofloosing sight of the ultimate goal of
primary health careprimary health care. It is to ensure. It is to ensure
unity of purpose and direction and tounity of purpose and direction and to
encourage team workencourage team work to deliver primaryto deliver primary
health care at various levelshealth care at various levels
1111

12. TYPES OF COORDINATIONTYPES OF COORDINATION
WITHIN the department –WITHIN the department – Intra-sectoralIntra-sectoral
BETWEEN the department –BETWEEN the department –
Inter-sectoral coordinationInter-sectoral coordination
Intra-sectoral coordinationIntra-sectoral coordination:: AT the districtAT the district
level- number of programme such aslevel- number of programme such as
malaria control, leprosy, blindnessmalaria control, leprosy, blindness
control, MCH, Immunization, NRHMcontrol, MCH, Immunization, NRHM
etc. is implementing. Many of theseetc. is implementing. Many of these
programmes are adopting similarprogrammes are adopting similar
strategies but they go on theirstrategies but they go on their
separate ways in the field.separate ways in the field. 1212

13. FREQUENTFREQUENT meetings, sharing ofmeetings, sharing of
experience and success stories etc.experience and success stories etc.
will be helpful in fosteringwill be helpful in fostering intra-intra-
sectoral coordinationsectoral coordination
INTER-SECTORAL COORDINATION:INTER-SECTORAL COORDINATION:
Alma-Ata declaration has alsoAlma-Ata declaration has also
suggestedsuggested multi sectoral approachmulti sectoral approach asas
one of the basic principles underlyingone of the basic principles underlying
primary health careprimary health care. The changes in. The changes in
other sectors affect health andother sectors affect health and
similarly health affects thesimilarly health affects the
development in other sectors alsodevelopment in other sectors also
1313

14. CONSTRAINTS IN INTER-CONSTRAINTS IN INTER-
SECTORAL COORDINATIONSECTORAL COORDINATION
THREETHREE LEVELLEVEL PROBLEMS:PROBLEMS:
1.1. At theAt the KNOWLEDGEKNOWLEDGE levellevel
2.2. At theAt the ATTITUDINALATTITUDINAL levellevel
3.3. At theAt the PRACTICEPRACTICE levellevel
1414

15. KNOWLEDGEKNOWLEDGE --
Lack ofLack of knowledge ofknowledge of otherother
programmes and goalsprogrammes and goals of otherof other
sectors. Each programme issectors. Each programme is
implemented in an isolated manner.implemented in an isolated manner.
For example Health Deptt. may notFor example Health Deptt. may not
know the goals ofknow the goals of ICDS programmeICDS programme,,
which in turn may not be aware ofwhich in turn may not be aware of
the goals of RCH programme etc.the goals of RCH programme etc.
This leads toThis leads to misunderstandingmisunderstanding,,
repetition and some times evenrepetition and some times even
contradictions, whichcontradictions, which affect theaffect the
credibility.credibility. 1515

16. ATTITUDEATTITUDE --
POWER conflict and egoist attitudesPOWER conflict and egoist attitudes
based on the dogmatic belief ofbased on the dogmatic belief of ‘my‘my
programmeprogramme’’, ‘, ‘why shouldwhy should II’’ andand
‘could not care less’ act as a barrier‘could not care less’ act as a barrier
in the way of mutual understandingin the way of mutual understanding
and team work. The feeling ofand team work. The feeling of ‘why‘why
should I go, the other person shouldshould I go, the other person should
come forward’come forward’.. The attitudes areThe attitudes are
often based on misconception—often based on misconception—
coordination means more work andcoordination means more work and
assuming responsibility for othersassuming responsibility for others
work.work.
1616

17. Clear understanding of the conceptClear understanding of the concept
of coordination is required to changeof coordination is required to change
thethe mind setmind set of functionaries. Theof functionaries. The
personality of the leader is also ofpersonality of the leader is also of
critical importance in this case.critical importance in this case.
Authoritarian leadership will not beAuthoritarian leadership will not be
useful. Democratic leadershipuseful. Democratic leadership
encouragingencouraging frequent participativefrequent participative
consultations and decision makingconsultations and decision making
will foster coordination.will foster coordination.
1717

18. PRACTICEPRACTICE --
Lack of knowledge about theLack of knowledge about the
mechanismsmechanisms. People do not know. People do not know
how to go about it and how tohow to go about it and how to
formalize it. The formal mechanismformalize it. The formal mechanism
such assuch as constitution of Advisoryconstitution of Advisory
Committees, CoordinationCommittees, Coordination
Committees, Task-forcesCommittees, Task-forces etc. fosteretc. foster
coordination. People feel thatcoordination. People feel that
coordination means ‘coordination means ‘additionaladditional
responsibilitiesresponsibilities’’
1818

19. ISCISC
leadershipleadership style and willingnessstyle and willingness
HealthHealth policies and prioritiespolicies and priorities
Sharing of aSharing of a common visioncommon vision andand
perspectiveperspective
DefiningDefining role and responsibilities ofrole and responsibilities of
participatory agenciesparticipatory agencies
ParticipatoryParticipatory decision makingdecision making
DevelopingDeveloping informal contacts with involvedinformal contacts with involved
groupsgroups
LearningLearning more about quality of servicesmore about quality of services
Spelling outSpelling out strategiesstrategies and proceduresand procedures
ConductingConducting joint monitoring and evaluationjoint monitoring and evaluation
TakingTaking immediateimmediate remedial measures in solvingremedial measures in solving
problems related to coordination/resourceproblems related to coordination/resource
mobilizationmobilization 1919

20. Areas of Inter SectoralAreas of Inter Sectoral
CoordinationCoordination
PROMOTION OF NUTRITIONPROMOTION OF NUTRITION
AgricultureAgriculture
EducationEducation
Social Welfare/Women andSocial Welfare/Women and
Child DevelopmentChild Development
PanchayatsPanchayats
Animal HusbandryAnimal Husbandry
CooperativeCooperative
BanksBanks 2020

21. Some of the activities of healthSome of the activities of health
department providing scope fordepartment providing scope for
inter-sectoral coordination are:inter-sectoral coordination are:
– Supply of safe water,Supply of safe water,
– Excreta disposal and refuse disposal,Excreta disposal and refuse disposal,
– Waste water disposal,Waste water disposal,
– Maternal and child health,Maternal and child health,
– Family welfare, immunization againstFamily welfare, immunization against
major infectious diseases,major infectious diseases,
– Prevention and control of locallyPrevention and control of locally
endemic diseases, and health educationendemic diseases, and health education
on prevailing health problems.on prevailing health problems. 2121

22. MECHANISM OF COORDINATIONMECHANISM OF COORDINATION
LISTINGLISTING out the programmes which need jointout the programmes which need joint
effortsefforts
IDENTIFYINGIDENTIFYING the areas where coordination isthe areas where coordination is
requiredrequired
KNOWINGKNOWING the categories of health personnelthe categories of health personnel
whose activities should be integratedwhose activities should be integrated
LOCATINGLOCATING the level of health systems wherethe level of health systems where
joint efforts are neededjoint efforts are needed
FORMINGFORMING coordination committee of memberscoordination committee of members
of district health team which includes all theof district health team which includes all the
middle level supervisors and specializedmiddle level supervisors and specialized
functionariesfunctionaries
FORMINGFORMING of operation teams at field levelof operation teams at field level
2222

23. Steps in Planning Inter-Steps in Planning Inter-
sectoral Coordinationsectoral Coordination
LISTINGLISTING THE PROGRAMMES,THE PROGRAMMES,
IDENTIFYINGIDENTIFYING - THE AREAS/- THE AREAS/
ACTIVITIES;ACTIVITIES;
DIFFERENTDIFFERENT ORGANIZATIONS ANDORGANIZATIONS AND
AGENCIES;AGENCIES;
GOODGOOD LOCAL NGOs to facilitateLOCAL NGOs to facilitate
community’s involvement;community’s involvement;
DEVELOPING AN ACTION PLAN FOR:DEVELOPING AN ACTION PLAN FOR:
2323

24. –Independent tasksIndependent tasks
–Joint tasksJoint tasks
–Sharing of resourcesSharing of resources
–Field work teamsField work teams
Create informal forum forCreate informal forum for
meetings; acknowledgement andmeetings; acknowledgement and
appreciation of all partners’appreciation of all partners’
efforts in achieving the targets.efforts in achieving the targets.
2424

25. INVOLVING THE COMMUNITY FORINVOLVING THE COMMUNITY FOR
COMMUNITY PARTICIPATIONCOMMUNITY PARTICIPATION
Community participation has beenCommunity participation has been
identified as an important means ofidentified as an important means of
overcoming sectoral barriersovercoming sectoral barriers. It is. It is
the community and its involvementthe community and its involvement
that best motivatesthat best motivates collaborationcollaboration
between sectors through thebetween sectors through the
communitycommunity, health goals can be, health goals can be
linked to and reinforces other goalslinked to and reinforces other goals
of well being.of well being.
2525

26. THE process of communityTHE process of community
participation is therefore byparticipation is therefore by
no means easyno means easy..
It is a long arduous taskIt is a long arduous task
butbut results are good andresults are good and
lastinglasting. The ranges of. The ranges of
activities of communityactivities of community
participation thereforeparticipation therefore
include the following:include the following:
2626

27. 1.1. HelpingHelping community to analyze their problemscommunity to analyze their problems
and their causes.and their causes.
2.2. ToTo identifyidentify the needs and prioritize them in athe needs and prioritize them in a
logical manner. Sometimes felt needs of thelogical manner. Sometimes felt needs of the
community may be different from thecommunity may be different from the
perceived need of the health professional.perceived need of the health professional.
3.3. ToTo planplan activities to meet these needs/solveactivities to meet these needs/solve
the problems and to find resources for them.the problems and to find resources for them.
4.4. ToTo monitormonitor closely the implementation ofclosely the implementation of
programmes.programmes.
5.5. Last but not the least to own the programme byLast but not the least to own the programme by
assumingassuming full responsibilityfull responsibility for itsfor its
implementation.implementation.
2727

28. Advantages of CommunityAdvantages of Community
ParticipationParticipation
MORE achievement atMORE achievement at lower costlower cost
CATALYSTCATALYST for further developmentfor further development
DEVELOPS aDEVELOPS a sense of ownershipsense of ownership andand
subsequently responsibility insubsequently responsibility in
utilization and maintenance of healthutilization and maintenance of health
care servicescare services
INCULCATESINCULCATES self-relianceself-reliance byby
enhancing the use of local indigenousenhancing the use of local indigenous
expertiseexpertise
2828

29. IMPEDIMENT/OBSTRUCTION/BARRIER/BLOCKAGE TOIMPEDIMENT/OBSTRUCTION/BARRIER/BLOCKAGE TO
COMMUNITY PARTICIPATION IN HEALTH CARECOMMUNITY PARTICIPATION IN HEALTH CARE
THE health care system in the country isTHE health care system in the country is not havingnot having
roots in the cultureroots in the culture and traditions of our people.and traditions of our people.
HEALTH need not be viewed in an isolated mannerHEALTH need not be viewed in an isolated manner
HEALTH personnel doHEALTH personnel do not have the requisite attitudesnot have the requisite attitudes
andand skills to work with the communityskills to work with the community. There is a gap. There is a gap
between ‘providers’ and ‘users’.between ‘providers’ and ‘users’.
PRE-OCCUPATION with targets and infra-structuralPRE-OCCUPATION with targets and infra-structural
issues,issues, bureaucratizationbureaucratization and compartmentalization ofand compartmentalization of
various departments and sectors, and lack ofvarious departments and sectors, and lack of
coordination among them.coordination among them.
2929

30. Innovative Projects In CommunityInnovative Projects In Community
Participation In HealthParticipation In Health
Rangabela project, West BengalRangabela project, West Bengal
Comprehensive Rural DevelopmentComprehensive Rural Development
Project, Jamkhed, MaharashtraProject, Jamkhed, Maharashtra
RUSHA Integrated Health andRUSHA Integrated Health and
Community Development Project,Community Development Project,
Vallur, Tamil Nadu.Vallur, Tamil Nadu.
3030

31. AN ANALYSIS of successfulAN ANALYSIS of successful
community based projects highlightscommunity based projects highlights
the following learning experiences:the following learning experiences:
An attempt toAn attempt to integrate health withintegrate health with
development activitiesdevelopment activities
Preventive and promotive orientationsPreventive and promotive orientations
Search for anSearch for an appropriate technologyappropriate technology
Promotion and utilization ofPromotion and utilization of locallocal
resourcesresources
Training ofTraining of locallocal health workershealth workers
InvolvingInvolving people’s groups andpeople’s groups and
organizationsorganizations
3131

32. Some Significant Strategies For EnhancingSome Significant Strategies For Enhancing
Community ParticipationCommunity Participation
Recruitment of local frontline healthRecruitment of local frontline health
workersworkers
Working with local groupsWorking with local groups
Working with NGOsWorking with NGOs
Use of PRA/PLA techniquesUse of PRA/PLA techniques
Development and use of simpleDevelopment and use of simple
indigenous technologiesindigenous technologies
Demand driven approach rather thanDemand driven approach rather than
supply driven approachsupply driven approach
3232

33. Role of Panchayati RajRole of Panchayati Raj
Institutions in Health and FWInstitutions in Health and FW
7373rdrd
Constitutional amendment givenConstitutional amendment given
adequateadequate powers to Gram Panchayatpowers to Gram Panchayat
for the development of its village andfor the development of its village and
health is one of the major componentshealth is one of the major components
The Village Health Plan is consideredThe Village Health Plan is considered
as the first step in enabling villageas the first step in enabling village
communities to take charge of theircommunities to take charge of their
own health needsown health needs

34. The 73rd constitutionalThe 73rd constitutional
amendment, which prescribesamendment, which prescribes
uniform structureuniform structure of localof local
governments throughout thegovernments throughout the
country, provides the basiscountry, provides the basis
for conceptualising the role offor conceptualising the role of
PRIs for localPRIs for local self-governanceself-governance
and developmentand development
3434

35. Within the PRIs Village HealthWithin the PRIs Village Health
CommitteeCommittee ((Swasthya SamitiSwasthya Samiti)) is anis an
important entity, it has to beimportant entity, it has to be
strengthened and links have to bestrengthened and links have to be
established with block and Districtestablished with block and District
level units with special reference tolevel units with special reference to
capacity building;capacity building;
Role and responsibility has to beRole and responsibility has to be
fixed at the other side towardsfixed at the other side towards
betterment of health of the villagersbetterment of health of the villagers
3535

36. Functions of Panchayati RajFunctions of Panchayati Raj
Institutions ( XIth Schedule)Institutions ( XIth Schedule)
(11) Drinking Water;(11) Drinking Water;
(16) Poverty Alleviation(16) Poverty Alleviation
Programmes;Programmes;
(17) Education;(17) Education;
(23) Health & Sanitation including(23) Health & Sanitation including
Hospitals; Primary HealthHospitals; Primary Health
Centers & Dispensaries;Centers & Dispensaries;
(24) Family Welfare;(24) Family Welfare;
(25) Women and Child Development;(25) Women and Child Development;
(28) Public Distribution System.(28) Public Distribution System.
3636

37. According to PRI Act, out ofAccording to PRI Act, out of 29 subjects29 subjects fivefive
subjects are directly associated with thesubjects are directly associated with the
health and family welfare, which are:health and family welfare, which are:
1.1.Safe drinking water,Safe drinking water,
2.2.Health and sanitationHealth and sanitation
(including health centers)(including health centers)
3.3.Family welfare,Family welfare,
4.4.Women and child development,Women and child development,
5.5.Social welfareSocial welfare (including Physically and(including Physically and
mentally challengedmentally challenged))
3737

38. "involvement of Panchayat Raj"involvement of Panchayat Raj
institutions for ensuring inter sectoralinstitutions for ensuring inter sectoral
coordination and communitycoordination and community
participation in planning, monitoringparticipation in planning, monitoring
and management", although medicaland management", although medical
practitioners in voluntary and jointpractitioners in voluntary and joint
sectors, industries in the organizedsectors, industries in the organized
and the unorganized sectors andand the unorganized sectors and
labour representatives have also beenlabour representatives have also been
bracketed with PRIs for suchbracketed with PRIs for such
involvement. Planning commissioninvolvement. Planning commission 3838

39. Health is a very critical sector inHealth is a very critical sector in
these arrangements. In the existingthese arrangements. In the existing
arrangement of allocation ofarrangement of allocation of
responsibilities,responsibilities, health system righthealth system right
from sub-centers to the districtfrom sub-centers to the district
hospitals including family welfarehospitals including family welfare
apparatus falls inapparatus falls in the domain ofthe domain of
PRIsPRIs. It is expected that PRIs would. It is expected that PRIs would
promote public participation in healthpromote public participation in health
and family welfare management andand family welfare management and
develop strong affinity anddevelop strong affinity and
ownership feeling towardsownership feeling towards
institutions and programmesinstitutions and programmes
associated with themassociated with them
3939

40. The PRIs, therefore, would beThe PRIs, therefore, would be
policy making bodiespolicy making bodies in theirin their
own jurisdiction. To dischargeown jurisdiction. To discharge
this role, they would have tothis role, they would have to
gather necessary information,gather necessary information,
interact with technical personnel,interact with technical personnel,
consult local people throughconsult local people through
various Institutionsvarious Institutions in which theyin which they
participate and associate expertsparticipate and associate experts
and non-experts outside theand non-experts outside the
GovernmentGovernment
4040

41. Basic characteristics of PRIs inBasic characteristics of PRIs in
Health and Family WelfareHealth and Family Welfare
PRIs are a set of democratically electedPRIs are a set of democratically elected
structures of self-governance at threestructures of self-governance at three
levelslevels
The National Population Policy (NPP)The National Population Policy (NPP)
2000 has put a great deal of emphasis2000 has put a great deal of emphasis
on the role of PRIs in formulating andon the role of PRIs in formulating and
implementing area specific policies andimplementing area specific policies and
programmers relevant for populationprogrammers relevant for population
stabilization and other programmesstabilization and other programmes
4141

42. Panchayats have been consideredPanchayats have been considered
useful for promotional and motivationaluseful for promotional and motivational
activities in respect ofactivities in respect of small andsmall and
healthier familieshealthier families
PRIs could be rewarded forPRIs could be rewarded for
universalizinguniversalizing small family normsmall family norm,,
achieving reductions in infant mortalityachieving reductions in infant mortality
and birth rates and promoting literacyand birth rates and promoting literacy
with completion of primary schoolingwith completion of primary schooling
Panchayat should appoint a competentPanchayat should appoint a competent
and mature midwife assisted byand mature midwife assisted by
volunteers to look aftervolunteers to look after villagevillage
maternity hutmaternity hut 4242

43. Thank youThank you