- Universalizing Access To Primary Healthcare
ANANNYA ROY, University of Calcutta, Kolkata
ARUNI MITRA, Indian Statistical Institute, Kolkata
MANISIT DAS, Indian Institute of Technology, Kharagpur
RAKTIM KUMAR NAG, Jadavpur University, Kolkata
SOUMIK BANERJEE, University of Calcutta, Kolkata
Reasons for selecting the topic:
• India performs even worse in terms of health indicators than overall
• India ranks 136 in terms of HDI (2012). In terms of just Health Index,
India’s performance is even worse – it ranks a dismal 142.
• Even Sri Lanka (rank 62) and Bangladesh (rank 122), with much lower
income, performs better than India in terms of health indicators of Human
• Agriculture still forms the backbone of our economy. Adding to that,
nearly 70% of India’s population lives in rural areas. Hence, health of the
rural people is of utmost importance. And better health would diminish
India’s spending in the long run and the domino effect started by a
‘healthy rural India’ would certainly lead to higher GDP and HDI rank.
• Huge scope of making India “healthy”.
Posts Vacancies (in %)
PHC Doctors 10
CHC Specialists 63
PHC+CHC nurses 25
Lab technician 50
Short supply of trained doctors
& health workers.
Density (per 10000 population)
Allopathic Physicians 3.3 13.3
Nurses & Mid-wives 4.1 15.9
Average Rural Sub-Centre caters to 4 villages within a
service sub-centre of 2.61 km.
Limited reach of
Difficulty in recruiting and
retaining high quality doctors
in disadvantaged areas
Source: Strengthening of Primary Healthcare-Key to Deliver Inclusive Healthcare, Indian Journal of Public Health.
whatever is ‘free’ is
Direct cash transfer
better than subsidies,
but the latter may lead
‘Dadan’ system: Govt. enters
into an agreement with the
pharma companies such that it
will buy the drugs at a price
enough to compensate the latter,
but lower than the market price,
in lieu of wider market
Break the nexus
between doctors and
People get access to medicines
and other diagnostic services
according to one’s need and
Make it “cheap”, not “free”
1. MEDICAL FAIR PRICE SHOPS
• Educate people about hygiene.
• Introduction of e-Toilets, Bio-toilets for the
• Inculcate family-planning ideas among the
• Imparting awareness of preventive
measures for common prevalent diseases.
2. ALTERNATIVE MEDICINE
• Unconventional therapies like Unani (palliative medicine),
Homeopathy, Ayurveda (for non-epidemic cases scenario) -
cost effective, less or no side-effects, mostly natural medicines.
• Certified AYUSH practitioners should be allowed to prescribe
allopathic drugs during emergencies(after some integrated
training) – help in curbing quacks and ensure that rural people
get timely treatment.
• FACT: Several PHCs in remote areas are still run by AYUSH
practitioners, yielding better than anticipated results.
How does the system work?
• Instead of an MBBS course, a shortened, subsidized
diploma course on basic medical training.
• A 3-3.5 years course on rural health and healthcare
(on the lines of B.Sc. in rural healthcare practised in
Assam & Chhattisgarh).
• Basic training involves techniques that can handle
emergency situations and, help detect and cure
common prevalent ailments.
• Focus more on Preventive healthcare than curative.
• Preferential selection of rural students for training
will help retain the ‘para-doctors’ to rural areas.
• Para-Doctors need to travel and should always be
equipped with basic and emergency medicines and
• Increase in the number of nursing graduates
and post-graduates who could be posted in
• Mandatory rural posting after MBBS
3. PARA DOCTORS
•Flexible Hobson’s Choice - Make the medical students sign a bond mentioning
that everyone has to serve in the disadvantaged areas for at least 2 years. The
service can spread over 4 years, serving for at least 4 months in a stretch (suitable
•In case of violation of the above, medical students would need to pay the
enormous subsidies the government spent on them. Else, graduation certificates
won’t be issued.
•The introduction of differential salary system – higher salary and other
emoluments for doctors willing to work in remote areas.
•The provision of decent living quarters and family facilities(specially children’s
tuition allowance) for the doctors in rural areas.
•Faster rank promotion for rural medical practitioners. The Govt. can create newer
posts with little increase in salary but higher ranks – should instill confidence
and encourage the doctors.
•Provision of innovative benefit packages (for example- providing nurses or
junior doctors with car allowance, something that only senior staffs get in the
• Incentives for rural health workers who can promote preventive healthcare.
•Offering specialist training as incentive.
(i) Health Subsidies may not move
the poor above a critical level of
steady income. Health Insurance
can deliver exactly that by
absorbing the contingency risks.
(ii) Facilities can be availed even in
whatever is ‘free’ is
Basic medical costs
seem very high to
the rural poor
A co-operative scheme of
• People form a group and each person
saves a small amount of money.
• A co-operative insurance account is
• If anyone of the group falls ill, he/she
is insured through money from that
Why is Health Insurance better
than subsidies for a poor person?
Monitoring Mechanism : Each and every expense should be accounted for. Apart
from separate CAG boards to oversee the movements, a detailed account of expenses
should be uploaded on a government website(maintained by private company, so better
security) for the public to view and question any irregularity or suspicious expense(to be
compared against the official govt. sanctions/records). This step can help check the any
large or small scale embezzlements (like the UP NRHM scam).
• The Government
• The Medical Practitioners and Auxiliary
Force (nurses, mid-wives and others).
• The Pharmaceutical Companies.
Proposed Sources of Funding(apart from Government sanctions):
• The education subsidies that will be cut off from those students unwilling to be posted in rural
areas can be used to finance the diploma course and the necessary infrastructure.
• The Health Insurance Scheme is almost self-financed.
• Mandatory CSR initiatives on part of the MNCs.
• 2 way benefit project by implementing innovative marketing strategies. Example –a company
X takes the responsibility of building and operating health centres in a village and in return
ask them to rename the roads or the village to X or things related to X(something in the lines
A GIANT LEAP FORWARD…
Replacement of top-down approach by a holistic development model:
Our model of healthcare service calls for a change in workplace culture
from hierarchical to relational management, through better language-
compatibility and stronger mesh of human bonds.
From “Financing Subsidies” to “Subsidizing Finance”:
Instead of financing a huge subsidy-bill for healthcare facilities, we call for
subsidizing the health insurance premium rates so that the poor folk can
afford such financial instruments.
Abhijit Vinayak Banerjee and Esther Duflo. Poor Economics (2012).
Bulletin on Rural Health Statistics in India, 2009:
Government of India. Faster, sustainable and more inclusive growth: An approach to the
12th five year plan. New Delhi, 2011:
International Institute for Population Sciences and Macro International (September 2007).
"National Family Health Survey (NFHS-3), 2005-06". Ministry of Health and Family
Welfare, Government of India. p. 436-40.:
Yeravdekar R, Yeravdekar VR, Tutakne M A, Bhatia NP, Tambe M. “Strengthening of
Primary Healthcare-Key to Deliver Inclusive Healthcare”. Indian Journal of Public Health.