- Universalizing Access To Primary Healthcare
Healing Touch
ANANNYA ROY, University of Calcutta, Kolkata
ARUNI MITRA, Indi...
Reasons for selecting the topic:
• India performs even worse in terms of health indicators than overall
human development....
PRESENT CHALLENGES
Posts Vacancies (in %)
PHC Doctors 10
CHC Specialists 63
PHC+CHC nurses 25
Pharmacist 27
Lab technician...
People believe
whatever is ‘free’ is
‘worthless’.
Direct cash transfer
better than subsidies,
but the latter may lead
to c...
Preventive Healthcare:
• Educate people about hygiene.
• Introduction of e-Toilets, Bio-toilets for the
same.
• Inculcate ...
How does the system work?
• Instead of an MBBS course, a shortened, subsidized
diploma course on basic medical training.
•...
•Flexible Hobson’s Choice - Make the medical students sign a bond mentioning
that everyone has to serve in the disadvantag...
(i) Health Subsidies may not move
the poor above a critical level of
steady income. Health Insurance
can deliver exactly t...
Monitoring Mechanism : Each and every expense should be accounted for. Apart
from separate CAG boards to oversee the movem...
Stakeholder’s Involved:
• The Government
• The Medical Practitioners and Auxiliary
Force (nurses, mid-wives and others).
•...
A GIANT LEAP FORWARD…
 Replacement of top-down approach by a holistic development model:
Our model of healthcare service ...
 Abhijit Vinayak Banerjee and Esther Duflo. Poor Economics (2012).
 Bulletin on Rural Health Statistics in India, 2009:
...
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  1. 1. - Universalizing Access To Primary Healthcare Healing Touch 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
  2. 2. Reasons for selecting the topic: • India performs even worse in terms of health indicators than overall human development. • 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 development. • 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”.
  3. 3. PRESENT CHALLENGES Posts Vacancies (in %) PHC Doctors 10 CHC Specialists 63 PHC+CHC nurses 25 Pharmacist 27 Lab technician 50 Short supply of trained doctors & health workers. 0.599 physicians / 1000 population Nurse to Physician ratio 2:1 Devoted time per patient is meagre Posts Density (per 10000 population) Rural Urban 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 Primary Healthcare 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.
  4. 4. People believe whatever is ‘free’ is ‘worthless’. Direct cash transfer better than subsidies, but the latter may lead to conspicuous consumption Medical “fair- price shops”, housing both generic and patented drugs ‘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 pharma companies People get access to medicines and other diagnostic services according to one’s need and financial ability Make it “cheap”, not “free” POLICY PRESCRIPTION 1. MEDICAL FAIR PRICE SHOPS
  5. 5. Preventive Healthcare: • Educate people about hygiene. • Introduction of e-Toilets, Bio-toilets for the same. • Inculcate family-planning ideas among the rural folk. • Imparting awareness of preventive measures for common prevalent diseases. POLICY PRESCRIPTION 2. ALTERNATIVE MEDICINE AYUSH Practitioners: • 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.
  6. 6. 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 equipment. Auxiliary Force • Increase in the number of nursing graduates and post-graduates who could be posted in rural areas. • Mandatory rural posting after MBBS internship. POLICY PRESCRIPTION 3. PARA DOCTORS
  7. 7. •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 options). •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 cities). • Incentives for rural health workers who can promote preventive healthcare. •Offering specialist training as incentive. 4. Incentive- Compatible Schemes
  8. 8. (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 private hospitals People believe whatever is ‘free’ is ‘worthless’. Basic medical costs seem very high to the rural poor A co-operative scheme of Health Insurance • People form a group and each person saves a small amount of money. • A co-operative insurance account is created. • If anyone of the group falls ill, he/she is insured through money from that account. Why is Health Insurance better than subsidies for a poor person? 5. REFORMED HEALTH INSURANCE
  9. 9. 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).
  10. 10. Stakeholder’s Involved: • The Government • The Medical Practitioners and Auxiliary Force (nurses, mid-wives and others). • The Pharmaceutical Companies. • Community. 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 of Snapdealnagar).
  11. 11. 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.
  12. 12.  Abhijit Vinayak Banerjee and Esther Duflo. Poor Economics (2012).  Bulletin on Rural Health Statistics in India, 2009: http://www.mohfw.nic.in/NRHM/BULLETIN%20ON.htm.  Government of India. Faster, sustainable and more inclusive growth: An approach to the 12th five year plan. New Delhi, 2011: http://planningcommission.nic.in/plans/planrel/12appdrft/appraoch_12plan.pdf  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.: http://www.measuredhs.com/pubs/pdf/FRIND3/FRIND3Vol1AndVol2.pdf  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. References

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