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  1. 1. Manthan Topic - Healing Touch : Universalizing access to quality primary healthcare “ A Model To Expand and Improve Primary Health Care Services ” Team Details : Team Coordinator – Harshad Nimbore 9158505029 Team Member 1 – Sudarshan Lahane 9423777322 Team Member 2 – Akshay Shelke 8275319240 Team Member 3 – Sachin Thorbole 8600076692 Team Member 4 – Ajit Narwade 8087912351
  2. 2. 0 5 10 15 20 25 30 35 40 45 50 Inant Mortality Rate Maternal Mortality Rate Birth Rate India China USA ( Per 1000 people ) 0 10 20 30 40 50 60 70 80 90 Life Expectancy ( in years ) • India spends 3.9% of GDP on health • Conditions have improved but not upto expectations, when compared with developed nations Causes of poor state of Indian Primary Health Care • Inadequate Sanitation and Water Supply - Due to hazards of wastes through Physical, Biological or Microbiological - 31% Sanitation coverage and 88% access to water in India • Lack of Education - Lower educational level is shown to adversely affect the health - Literacy rate in Rural area 68.9% and Urban area 85% • Poor Availability and Accessibility of Primary Health Care Centre - There are 23109 PHC for population about 121 billion in India - Hence the availability is less than International Standards • Unavailability of Skilled workforce and Infrastructure - Only 30% of PHC’s have 24 hrs delivery facility - Unavailability of well equipped laboratories Higher Infant Mortality Rate, Maternal Mortality Rate and Lower Life Expectancy are the Indicators for Inadequacy of Primary Health Care Facilities
  3. 3. Our model Concerns at : 1.Develop a blue print for human resources in health, for India. 2.Rework the physical and financial norms needed to ensure quality, universal reach and access of health care services. 3.Suggest critical management reforms in order to improve efficiency, effectiveness and accountability of the health delivery system. 4.Identify pathways for constructive participation of communities and the private for-profit and not-for- profit sectors in the delivery of health care. 5.Develop systems which will ensure access to essential drugs, vaccines and medical technology by enhancing their availability and reducing cost to the Indian consumer. 6.Develop a frameworkfor health financing and financial protection that offers universal access to health services. Outcomes
  4. 4. Universalizing Primary Health Care Health Financing and Financial Protection Human Resources for Health Community Participation and Citizen Engagement Access to Medicines, Vaccines and Technology Managemen t and Institutional Reforms Social Determinants of Health Elements of Primary Health Care The Alma-Ata declaration has outlined 8 essential components of primary health care •Education about prevailing health problems & methods of preventing & controlling them. •Promotion of food supply & proper nutrition. •Adequate supply of safe water and basic sanitation. •Maternal & child health care, including family planning/welfare. •Immunization against major infectious diseases. •Prevention of locally endemic diseases. •Appropriate treatment of common diseases & injuries. •Provision of essential drugs.
  5. 5. Health Financing and Financial Protection 1. Government (Central government and states combined) should increase public expenditures on health from the current level of 1.2% of GDP to at least 2.5% by the end of the 12th plan, and to at least 3% of GDP by 2022. 2. Use general taxation as the principal source of health care financing – complemented by additional mandatory deductions for health care from salaried individuals and tax payers, either as a proportion of taxable income or as a proportion of salary. 3. Expenditures on primary health care, including general health information and promotion, curative services at the primary level, screening for risk factors at the population level and cost effective treatment, targeted towards specific risk factors, should account for at least 70% of all health care expenditures. 4. Purchases of all health care services under the UHC system should be undertaken either directly by the Central and state governments through their Departments of Health or by quasi - governmental autonomous agencies established for the purpose. 5. Ensure availability of free essential medicines by increasing public spending on drug procurement. TRANSITION IN HEALTH FINANCING AND INSURANCE TO UNIVERSAL COVERAGE PROJECTED SHARE OF PUBLIC AND PRIVATE SPENDING
  6. 6. Recommendations Expected Outcomes 1.Strengthening institutional mechanisms for community participation in governance of health at multiple levels . •Transparent and participatory health governance administration at all levels; • A health system that is responsive to people’s needs 2.Increasing the number of community health workers to two workers for a village and equivalent urban administrative unit • Improved coverage of national health programmes and optimum reduction in problems addressed by those programmes. • Improved maternal health status and reduction in maternal and infant mortality 3.Enhancing the role of Panchayati Raj Institutions and elected representatives in health governance and community oversight, and in facilitating convergence with other services • Better convergence and coordination between health and other initiatives that determine better health outcomes • Improved accountability of healthcare providers to local bodies 4.Instituting a formal grievance redressal mechanism • Improvement in quality and outreach of health services. • Improved user satisfaction levels for all health and related services. Community Participation and Citizen Engagement 1. Increased community participation in health care—its delivery, governance and accountability—represents the deepening of democracy. 2. Our recommendations seek to strengthen institutional mechanisms for community participation and citizen engagement in order to make health planning, review and implementation more responsive to the voices and needs of communities. 3. Transform existing Village Health Committees (or Health & Sanitation Committees) into participatory Health Councils. 4. Organize regular Health Assemblies. 5. Enhance the role of elected representatives as well as Panchayati Raj institutions (in rural areas) and local bodies (in urban areas)in health governance and in facilitating convergence with other services. 6. Institute a formal grievance redressal mechanism at the block level. 7. Strengthen the role of civil society and non-governmental organizations.
  7. 7. Human Resources for Health •Ensure adequate numbers of trained health care providers and technical health care workers at different levels by a) giving primacy to the provision of primary health care b) increasing HRH density to achieve WHO norms of at least 23 health workers per 10,000 population (doctors, nurses, and midwives) •Enhance the quality of HRH education and training by introducing competency-based, health system-connected curricula and continuous education •Invest in additional educational institutions to produce and train the requisite health workforce •Establish District Health Knowledge Institutes (DHKIs) •Establish a dedicated training system for Community Health Workers •Strengthen existing State and Regional Institutes of Family Welfare and selectively develop Regional Faculty Development Centres to enhance the availability of adequately trained faculty and faculty-sharing across institutions •Establish State Health Science Universities •Establish the National Council for Human Resources in Health (NCHRH) PROJECTED HRH DENSITY BASED ON IMPLEMENTATION OF RECOMMENDATIONS PLANNING FOR 1 DOCTOR PER 10,000 POPULATION - FEASIBILITY OPTIONS
  8. 8. Access to Medicine, Vaccine and Technology •Enforce price controls and price regulation especially on essential drugs •Revise and expand the Essential Drugs List •Strengthen the public sector to protect the capacity of domestic drug and vaccines industry to meet national needs •Ensure the rational use of drugs •Set up national and state drug supply logistics corporations •Protect the safeguards provided by the Indian patents law and the TRIPS Agreement against the country’s ability to produce essential drugs •Empower the Ministry of Health and Family Welfare to strengthen the drug regulatory system Drug Insecurity (Current Scenario) Partial Drug Security (Scenario 1) Complete Drug Security (Scenario 2) 1. Significant inter-state & inter district disparities of public expenditure on drugs with enormous burden on households. 1. Scaling up public spending on drugs with considerable reduction in household spending government. 1. Reversal of current ratio of government :household expenditure to 2:1, with financial burden moving to government. 2. Partial EDL, generic & rational use of drugs in public health facilities. 2.Government health facilities to substantially procure EDL drugs with focus on generic and rational drug use. 2. Centralised public procurement & public distribution system of medicines. 3. High drug price due to liberalisation of drug price Control. 3. All essential drugs under price control. 3. Price control for essential drugs while non-essential drugs are price monitored. Key Outcomes: a. High Impoverishment & catastrophic payments of households; b. Acute shortages & chronic stock outs of drugs in public health facilities. c. Wastage of resources to the tune of 0.4 to 0.6% of GDP. Expected Outcomes: a. Large decline in impoverishment & catastrophic payments to households b. Public facilities provide uninterrupted drug supply; c. Significant savings to the Exchequer. Potential Outcomes: a. Very low impoverishment & catastrophic spending of households; b. Drug shortages & stock- outs eliminated. c. Savings to the tune of 0.5 - 0.6% of GDP to the exchequer. Timeline: Current Scenario Timeline: 1-2 years Timeline: 5-7 years
  9. 9. Management and Institutional Reforms 1.Introduce All India and state level Public Health Service Cadres and a specialized state level Health Systems Management Cadre in order to give greater attention to public health and also strengthen the management of the UHC system. 2.Adopt better human resource practices to improve recruitment, retention motivation and performance; rationalize pay and incentives; and assure career tracks for competency-based professional advancement. 3.Develop a national health information technology network based on uniform standards to ensure inter- operability between all health care stakeholders. 4. Establish financing and budgeting systems to streamline fund flow. Health Service Norms: Reorienting Health Service Delivery for Universal Health Coverage • Develop a National Health Package that offers, as part of the entitlement of every citizen, essential health services at different levels of the health care delivery system. • Develop effective contracting-in guidelines with adequate checks and balances for the provision of health care by the formal private sector. • Reorient health care provision to focus significantly on primary health care. • Strengthen District Hospitals. • Ensure equitable access to functional beds for guaranteeing secondary and tertiary care. Ensure adherence to quality assurance standards in the provision of health care at all levels of service delivery • Ensure equitable access to health facilities in urban areas by rationalizing services and focusing particularly on the health needs of the urban poor.
  10. 10. Proposed Expenditure for Universalizing Primary Health Care
  11. 11. Major Challenges for Primary Health Care: 1.Insecurity of balanced diet. 2.Lack of Education. 3.Inadequate water supply and proper sanitation. 4.Awareness about health. 5.Inadequate medical facilities and drugs. • Reforms in the Public Distribution System (PDS), as enunciated in the NFSB, with an emphasis on local procurement, local storage, and local distribution. Local procurement will include nutritious food grains like millets which could improve nutrition and health. • Recognition of the integral role of healthcare, water and sanitation and agriculture, among other factors, for food and nutrition security in the NFSB, and call for action on these. • Reforms in the Integrated Child Development Scheme (ICDS) with a strong focus on pregnant and breast-feeding women, children under 2 years, early identification of malnourished children and mothers, and their treatment. Convergence with the health system is recommended. • Extension of Rashtriya Swasthya Bima Yojana (RSBY) and other social protection measures to mere occupation categories within the informal economy, thereby providing health insurance to the poorest of workers. • Recognition of land and forests as crucial assets of the poor on which their very livelihoods and very survival depend, and hence, enactment of laws to protect these assets. • The Right to Education for all children of our country. What is required to enable UHC is action on multiple, intersecting and overlapping social determinants. There are several initiatives of the government currently that have the potential to positively impact the mitigating factors like lack of education , proper sanitation and water supply , food security. These include: • The right to food under the proposed National Food Security Bill, (NFSB) wherein 90% of rural and 50% of urban poor families will be entitled to food.