The Government of India (GoI) initiated a policy reform process, commissioned research and policy studies and, together with donors, developed a reform agenda. This policy reform process involved a paradigm shift of India’s national Family Welfare Programme. The programme provided for system development for delivery of services with emphasis on quality and client satisfaction. This resulted in new policies for the 9th 5-year plan (1997-2002) to be supported by a Sector Investment Programme through a grant assistance of 240 million Euro funded by the European Union. In the implementation of this Programme, EPOS Health Consultants (Germany) provided the Technical Assistance (TA) as the lead firm in a consortium which included Options Consultancy Services Limited (UK) and a local partner, Vimarsh Consultancy Group.
The overall objective was to improve the quality and accessibility of health services with particular focus on the health status of women and children. The objective of the EC contribution was system support to enhance central, state, and district capacities to implement the Family Welfare system policy reform and the target-free approach, aiming at increasing quality and impact of services as well as ensuring a cost effective coverage of the population in Family Welfare Services and Reproductive and Child Health Services.
The responsibilities of the European Commission technical assistance (ECTA) included a Programme Preparation Phase (PPP) which encompassed the development of a workplan; support to the Reproductive and Child Health Project and contribution to the implementation of the new health and family welfare policies; and support to experimental pilot activities.
The Sector Investment Programme (SIP) which followed the PPP included the development of technical skills and relevant inputs for implementing the financial and managerial decentralisation process; reinforcing the decentralisation process at district level and below; and promoting attitude changes, programming abilities, and managerial skills of decision makers at central and state levels.
Specific activities included inter alia reform of logistics and purchases; social marketing strategies and programmes; urban and tribal health issues, first referral services; IEC strategies; financial reforms and management training. During the duration of the Programme, a Health Policy Reform Options Database (PROD-www.prod-india.com) was developed as a collaborative initiative between the Government of India and the European Union. PROD remains to be a state-of-the-art website which publicises Indian good practice and innovation in health reform, and provides instant access to source documents.
A major component of the SIP was to develop 'Sector Policy Support Programmes' (SPSP) at state level. These programmes were co-financed by the GoI through 'budget support', based on a Memorandum of Understanding or at least a State Action Plan agreed on between the Government and a participating state, and using EC grant money. Annual release of tranches was performance-based, with clearly defined milestones agreed among the states and the GoI. The ECTA provided substantial input to the development of these state-level sectors strategies and accurately monitored technical and financial progress for all milestones for the 24 states involved.