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(GIST OF YOJANA) Kayakalp: Transforming Public Health Facilities [JANUARY-2020]

Kayakalp: Transforming Public Health Facilities

Introduction:

Kayakalp initiative of the Ministry of Health & Family Welfare began in 2015 with the aim of improving infrastructure upkeep, hygiene and sanitation, and infection control practices in Central Government institutions and public health facilities in all the States and UTs.

Major highlights of the scheme:

Health facilities are assessed and scored on a number of parameters, and every year the highest-scoring facilities at each level receive recognition though Kayakalp Awards that carry cash, apart from the citation.
The scheme has resulted in significant improvement in the level of the cleanliness, hygiene, and infection control practices at public healthcare facilities and has inculcated a culture of ongoing assessment and peer review to promote hygiene, cleanliness, and sanitation. For ensuring the objective assessment of “Swachhata” at the public health facilities, assessment is done under seven thematic areas.
Training is provided for not only undertaking the assessment but also for implementation of correct protocols and practices. Trained assessors undertake the final assessment and generate a score for short-listed health facilities. Kayakalp has not only been able to facelift the public health facilities but has made significant contributions towards moulding the behavioural practices of the public.
This paradigm shift is well reflected in the number of “satisfied" patients as reported through “Mera Aspataal '', an ICT-based patient feedback system. Kayakalp made a modest beginning in its first year with assessing only the District Hospitals (DH). Subsequently, within a span of three years, all the Sub District Hospitals, Community Health Centres, and Primary Health Centres (Rural and Urban) have also been brought under its ambit.
The number of facilities participating in Kayakalp has increased manifold. Starting with participation of 700 DHs, in the last financial year, approximately 26,000 health facilities have participated in Kayakalp. Not only the number of facilities participating under the initiative has multiplied, the number of facilities scoring 70% (passing criteria) or more has also increased manifold over the years.
Apart from the gargantuan participation of the primary and secondary-level healthcare facilities, tertiary-level healthcare facilities participate with the same vigour and enthusiasm. With participation of 10 facilities in year 2015-16, the number has risen to 24 Central Government institutions in the year 2018-19. Taking a step ahead, from FY 2019-20, Kayakalp has now been introduced to Ayushman Bharat Health and Wellness Centres (ABHWCs). Also, in order to ensure that “voice of patients, the health clients” is heard and their feedback is obtained for each of the facilities visited by them, the data of ‘Mera Aspataal’ household toilets have been Kayakalp scoring for DHs.
In the current year, for holistic and comprehensive improvement across the health sector, the Kayakalp scheme has been extended to the private sector health facilities. Quality Council of India (QCI) through its constituent National Accreditation Board for Hospital & Healthcare Providers (NABH) conducted Kayakalp assessment in the private hospitals. The assessments were conducted as per the Kayakalp guidelines established by MoHFW encompassing parameters viz. hospital/facility upkeep, sanitation and hygiene, waste management, infection control, hospital support services, and hygiene promotion. QCI conducted Kayakalp assessments in 653 private hospitals pan India within a duration of two months.
The hospitals were classified in three categories and out of the 653 facilities, 635 hospitals were found compliant with Kayakalp Guidelines.
MoHFW has also used the platforms of Village Health Sanitation and Nutrition Committees (VHSNCs) under the National Health Mission and Mahila Arogya Samitis (MAS) under the National Urban Health Mission (NUHM) to promote sanitation in the vulnerable urban communities.
Many States have adopted innovative practices in making VHSNCs and MAS effective. Accredited Social Health Activists (ASHs) also work with VHSNCs to mobilise the community for construction and use of toilets. MAS are recently established community groups of about 12 to 20 women from primarily poor and vulnerable populations in urban areas, and they are working for mobilizing communities on a range of issues, including sanitation.
Not only healthcare professionals or health departments, MoHFW has worked on inter-ministerial collaboration for hygiene and sanitation. Leveraging the momentum achieved under Kayakalp, MoHFW and Ministry of Jal Shakti started an integrated scheme, the “Swachh Swasth Sarvatra” in December 2016. Under this initiative, resources have been provided to CUCs located in Open Defecation Free (ODF) blocks which are yet to meet the Kayakalp criteria. In 2019, the country’s three best PHCs under Kayakalp from Andhra Pradesh, Gujarat, and Karnataka were also felicitated by Ministry of Jal Shakti.
Efforts made under Kayakalp and Swachh Bharat Abhiyan have been well recognised by the WHO as well, which mentions that nearly all (97%) DHs now have some or the other form of proper waste management.
Swachh Bharat Abhiyan along with Kayakalp has given thrust to the country’s efforts to achieve Sustainable Development Goal 3 (Good health and well-being) and Goal 6 (Clean water and sanitation) respectively.
As reported by the WHO, it is expected that Swachh Bharat Abhiyan will result in averting more than 3,00,000 deaths (diarrhoea and protein-energy malnutrition) between 2014 and October 2019. More than 14 million DALYs (Disability Adjusted Life Years) are estimated to be avoided (diarrhoea and protein energy malnutrition) between 2014 and October 2019.
The achievements under the Swachh Bharat Abhiyan are applaudable. As many as one crore household toilets have been built since its launch in October 2014, almost 6 lakhs villages have been declared ODF villages and 35 States/UTs too are now ODF.

Way forward:

The initiative has been able to create a ripple of improvement in the public health sector and has been possible because of the collaborative efforts of all States. This being said, the overall activities to maintain hygiene have now developed into a habit, sustaining a Kayakalp certification or an ODF certification has led to people practicing hygiene practices in their daily lives.
Not only have hygiene habits lead to overall positive health outcomes (reduction in hospital-acquired infection, reduction on antibiotic use etc.) the clean facilities have given a takeaway message to people to also keep their home and surroundings clean and that is an impact beyond the four walls and boundaries of a public health facility, indeed. The synergy and momentum achieved under Swachh Bharat Mission shall continue to expand and deliver a ‘Clean India, a Healthy India’.