Manthan Topic - Healing Touch : Universalizing access to quality
“ A Model To Expand and Improve Primary Health Care Services ”
Team Details :
Team Coordinator – Harshad Nimbore firstname.lastname@example.org 9158505029
Team Member 1 – Sudarshan Lahane email@example.com 9423777322
Team Member 2 – Akshay Shelke firstname.lastname@example.org 8275319240
Team Member 3 – Sachin Thorbole email@example.com 8600076692
Team Member 4 – Ajit Narwade firstname.lastname@example.org 8087912351
( Per 1000 people )
( 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
- 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
Our model Concerns at :
1.Develop a blue print for human resources in health, for
2.Rework the physical and financial norms needed to
ensure quality, universal reach and access of health
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
6.Develop a frameworkfor health financing and financial
protection that offers universal access to 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
•Maternal & child health care, including family
•Immunization against major infectious diseases.
•Prevention of locally endemic diseases.
•Appropriate treatment of common diseases &
•Provision of essential drugs.
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
Recommendations Expected Outcomes
mechanisms for community
participation in governance of
health at multiple levels .
•Transparent and participatory
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
• Improved coverage of national
health programmes and optimum
reduction in problems addressed
by those programmes.
• Improved maternal health status
and reduction in maternal and
3.Enhancing the role of Panchayati
Raj Institutions and elected
representatives in health
governance and community
oversight, and in
facilitating convergence with other
• Better convergence and
coordination between health and
other initiatives that determine
better health outcomes
• Improved accountability of
healthcare providers to local
4.Instituting a formal grievance
• Improvement in quality and
outreach of health services.
• Improved user satisfaction levels
for all health and related services.
Community Participation and Citizen
1. Increased community participation in health care—its delivery,
governance and accountability—represents the deepening of
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
7. Strengthen the role of civil society and non-governmental
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
•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
•Establish State Health Science Universities
•Establish the National Council for Human Resources in
PROJECTED HRH DENSITY BASED ON IMPLEMENTATION OF RECOMMENDATIONS
PLANNING FOR 1 DOCTOR PER 10,000 POPULATION - FEASIBILITY OPTIONS
Access to Medicine, Vaccine and
•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
•Ensure the rational use of drugs
•Set up national and state drug supply logistics
•Protect the safeguards provided by the Indian
and the TRIPS Agreement against the country’s
ability to produce
•Empower the Ministry of Health and Family
Welfare to strengthen the
drug regulatory system
Drug Insecurity (Current
Partial Drug Security
Complete Drug Security
1. Significant inter-state &
inter district disparities of
public expenditure on drugs
with enormous burden on
1. Scaling up public spending
on drugs with considerable
reduction in household
1. Reversal of current ratio of
expenditure to 2:1, with
financial burden moving to
2. Partial EDL, generic &
rational use of drugs in public
facilities to substantially
procure EDL drugs with focus
on generic and rational drug
2. Centralised public
procurement & public
distribution system of
3. High drug price due to
liberalisation of drug price
3. All essential drugs under
3. Price control for essential
drugs while non-essential
drugs are price monitored.
a. High Impoverishment &
catastrophic payments of
b. Acute shortages & chronic
stock outs of drugs in public
c. Wastage of resources to
the tune of 0.4 to 0.6% of
a. Large decline in
catastrophic payments to
b. Public facilities provide
uninterrupted drug supply;
c. Significant savings to the
a. Very low impoverishment
& catastrophic spending of
b. Drug shortages & stock-
c. Savings to the tune of 0.5 -
0.6% of GDP to the
Timeline: Current Scenario Timeline: 1-2 years Timeline: 5-7 years
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
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
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
• 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.
Proposed Expenditure for Universalizing Primary Health Care
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
• 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
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.