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  1. 1. VISION To make India capable of drafting and implementing the right to free and mandatory primary healthcare. A HEALTHIER AND PROSPEROUS INDIA
  2. 2. • India spends a considerable share of its GDP(4.2%) on the health sector, but the share per capita is very low at PPP $132. • The share of the public spending on the health sector is low at 1.2%. • High private spending leads to problems of inequality, inadequacy and often poverty as the economically weak end up in debts to pay for the medical expenses. • Around 75 percent spending is on outdoor patient services and medicines. • The expenditure on health varies widely through diff states with typically low income states having a lesser emphasis on health. • Though India has many world class hospitals more than 25% of population is left out of the loop.  Status Quo Indicators India China Brazil Sri- lanka IMR 52 17 17 13 Fully Immunized% 66 95 99 99 Birth by skilled attendants 47 96 98 97 Health expenditure % of GDP 4.2 4.3 8.4 4.1 Per capita spending $ 122 265 875 187  India and the World Right to education cant complete its purpose until supporting to it we have a Right to free and mandatory Primary health. Health being the major reason for poverty leads to a increased drop out rate for earning purpose and AN UNHEALTHY COMMUNITY CAN NEVER PROVIDE A GOOD EDUCATION.
  3. 3.  Infrastructure-Government Hospitals •Government hospitals are present in every settlement in India. They range from the district hospitals and government medical colleges of the cities to the rural hospitals and sub district hospitals in small towns to the primary health care centres in villages. •India had a total of 11993 allopathic government hospitals in 2011. •Existence of a distribution system for UHC in the form of Government Hospitals Government Hospitals as a distribution system for UHC •Despite presence of the UHC system through the country we never succeeded due to:- 1)The government assigns a very small portion of its spending to the health sector, the capital available for providing wages to the medical professionals and subsidized medicines is quite small. There is thus a scarcity of both medicines and qualified doctors. 2) Vey few doctors choose to work in the government hospitals. The problem is especially serious in the rural areas. 3) Due to a consequent lack of proper medical care at these hospitals, many patients prefer the private hospitals Shortcomings of the current system • 62% of PHCs are conducting less than 10 deliveries in a month. • 10% of CHCs do not provide 24x7 normal delivery services. • 34% of CHCs do not have operation theatre facilities. • Only 19% of CHCs offer caesarean section deliveries . • Only 9% of CHCs have blood storage facilities and of the 4,535 CHCs, only 754 are functional as per IPHS norms.
  4. 4. •We can now analyze ways to rid the government hospitals of their drawbacks so that they could work as focal points of UHC in the country •Government should increase public expenditure on health from 1.2% to at least 2.5% by the end of the 12th plan. Increase spending on UHC •Number of doctors in the government hospitals needs to increased. The doctors should be given incentives to work at government hospitals over private hospitals. Starting salary for an MD doctor at a government hospital is Rs. 2625(basic pay). Though this salary seems sufficient, it is actually quite low considering the number of years() required to get an MD and the comparative earnings of private medical professionals. •Many government doctors thus have their own private clinics to supplement the government salary. •Private doctors have another incentive to provide quality medical care to a higher number of patients- the amount of money that they earn is directly proportional to the number of patients as well as the quality of their service. Government doctors Vs Private doctors- a case of skewed incentives •Government doctors could be provided with similar incentives. A good measure would be to fix their basic salaries and provide higher floating salaries in proportion to the number of patients that they treat. •This will bring the government doctors in direct competition with the private medical professionals and will thus compel them to improve the quality of services that they provide in order to increase the number of patients they treat . Improved quality at the subsidized rates coupled with the subsidized medicines will attract a higher number of patients to the government hospitals and will facilitate a better distribution of the UHC schemes. Better incentives for doctors = Better service in government hospitals due to competition with the private sector and thus a better outreach of UHC  Changes needed to be undertaken:
  5. 5.  Proposed measures to be under taken: Increased spending Government should increase public expenditure on health from 1.2% to at least 2.5% by the end of the 12th plan. The money required for this should be raised through general taxation on the entire population and not through specific taxes Equitable spending Reduce the disparity in expenditure on health in various states by assisting the states . Also allow states higher flexibility in allocating the provided recourses Integrate all government funded insurance schemes like Rashtriya Swasthya Bima Yojna with the national UHC program. Areas of Emphasis 70 percent expenditure should be targeted on the primary and preventive health sectors. Essential medicines should be made available for free. Universal health coverage 1.Gender equality. Efficient accountable and transparent system Reduction of poverty Gender productiv ity Improved health outcomes
  6. 6. ACCESS TO MEDICINES AND VACCINES. India being large exporter of generic drugs is incapable of providing Essential Drugs to all. In 1984 33% medicines in comparison to 9% now was provided for free and the same for out patients from 18% to 5%. 25% people in India didn’t receive medicine just because they cant afford it after loosing all what they had India regulates 10% drugs as compared to 90% in 1990s. Drug prices varies in between 100%to 5000% of the original cost of the 90000 pharmacy companies . Widespread use of irrational medicines and no strict implementation of STANDARD TRAETMENT GUIDELINES(STG). All schemes focus LOW FREQUENCY HIGH COST TREATMENT and none of them focus on HIGH FREQUENCY LOW COST TREATMENT which is common to all. BIHAR TAMILNADU The proportion of stock-outs for Tamil Nadu stands around 17%, with an average duration of 50 days Average of 42% stock- outs of drugs with a mean duration of 105 days  OUTCOMES OF THE PREVAILING SYSTEM: An unreliable and inefficient procurement and distribution system. Best and the worst figures in terms of the medicine availability.
  7. 7. 1.Enforce price regulation and apply price control on all formulations in the Essential Drug List. 2.Schemes to be introduced which focus specially on high frequency low cost treatment. 1.Reduction in irrational medicine use and strictly weeding out unwanted medicines from market. 2.Laying out judicially enforceable STANDARD TREATMENT GUIDELINES. 1.Strengthening the public sector and opening PSU for EDL productions and ensure a compulsion of essential drug production on private companies at regulated cost. 1.At least one warehouse be built in each district to ensure ease of availability of drugs and vaccines to all. 2.Fee EDL and monitored price of non-EDL medicines. Increase Public Spending on Drug Procurement to 0.5% of the GDP from 0.2%. 0 1 2 3 4 5 2011 2017 2022 Public spending Private spending Introduction of All-Indian Health Services is one of the biggest need towards the administration in health sector. Right to free and mandatory PRIMARY health, as a fundamental right in analogy to education!! Should be the aim of any government. Sustainable rise according to our population. Transfer the DEPARTMENT OF PHARMACEUTICALS to the MINISTRY OF HEALTH for better regulation of the EDL and their production accordingly.  Proposed solutions
  8. 8. In urban areas, the decline in food insecurity between 2000 and 2006 has been by a margin of only 0.4%, out ofstep with the 6% growth rate in the same period A 2002 Planning Commission report expressed alarm over the ‘rather extensive presence’ of fluoride and arsenic in Indian drinking water, which is associated with a number of cancers A study of backward districts in 12 Indian states is found that 88% of adolescent girls were undernourished while almost 64.6% reported some form of sexual abuse. The odds of reporting poor health are 88% higher among ST/ SC and 73% higher among OBC women as compared to forward castes Civil conflict is also associated with poor health: political combatants and refugees in Chattisgarh face syndemics of malnutrition, malaria, and other communicable diseases Nutrition and Food security Water and Sanitation Social Exclusion Gender Bias Work (In)Security, Occupational Health and Disasters Provide not only the necessary means of curing disease when it occurs, but also for preventing it by bringing about an environment and conditions of living which would prevent the germs of disease taking hold…[through] an organised public service – SOKHEY REPORT Multiple studies have found that tribal children face the greatest incidence of malnutrition in India, particularly in the states of Jharkhand, Bihar, Madhya Pradesh, Chhattisgarh, Odisha, and West Bengal  Social Determinants of Health-Problems
  9. 9. Decentralisation Ability of locals to make decisions regarding water planning an management with adequate technical support from the Government. Example- Andhra Pradesh Farmer Managed Groundwater Systems project Ability of locals to invite private players into water managements through guidelines established by government through which they could gain a substantial knowledge and would be closer to self sustainability. Introduction of management devolution Index thereby decentralization can be scaled and appropriate measures can be taken as necessary. Behavioural change Behavioural change in the community through awareness programmes which should be an integral part of Health workers job and also with collaborating with various NGO’s present in this field. Method adopted in a village in Karnataka shows how community support makes a difference-People in the community blow a whistle when they see a person openly defecating, thus making him embarrassed and awkward. Awareness has to be brought into the people through active volunteers and health workers. General Convergence of water shed programme with flagship government like Mahatma Gandhi National Rural Employment Guarantee Act. Primacy for conjunctive use of water has to be given because of the growing needs of the population and depletion of ground water resources. Maintenance of the toilets built has to be given priority with regular cleaning of the facility. Feeling Socially awkward and embarrassed plays an important role in governing our behaviour-Milgram
  10. 10. Infant mortality rate in India is 52 per 1000 live births(higher than many sub-Saharan countries). Maternal mortality rate 212 per 1,00,000 child births(Higher than global average).  Skewed production of Human resources for health:  South states accounting for 31% population have 58% share of MBBS seats in contrary to empowered action group states which comprise 46% of India’s population but only 21% of share of MBBS seats.  26% of doctors reside in rural areas serving 72% of India’s population.  Urban density of nurses is 3 times that of rural and urban India has 4 times more health workers per 10,000 population than rural.  Education for health professionals is more clinically and technologically driven towards a treatment-oriented curative paradigm rather than population-focused primary and preventive health care.  Private sector accounts for 93% of hospitals and 85% of doctors in India.  National commission on population projects India’s population to reach 1353 million by 2022.  A joint learning initiative by WHO has established a threshold of 25 health workers(doctors , nurses and midwives)for a 10,000 population and India has 19.  Requirements of human resources(education and training)to achieve Universal health coverage will cost a staggering 37,000crores. Country Doctors per 1000 population Nurses and Midwives per doctor India 0.5 2.19 China 1.6 3.4 Thailand 0.3 5.07 USA 5.5 19.6 Source: WHO,UHC report, World bank data and other reports.  Current Human Resources For Health
  11. 11. Nobody can go back and start a new beginning but anyone can start today and make a new ending. M -Maria Robinson Measures to enhance primary health care Provide one additional village level health worker to the existing one and also one to low-income urban populations. Provide incentives based on their performance and also offer performance-based admission to Nursing schools, ANM schools. Health worker1 Trained in maternal and child health care, family planning, HBNC etc. Involved in health education of non- communicable diseases ( hypertension, diabetes, cancers etc.) Health worker2 Basic health promotion and prevention around malaria, leprosy , HIV and other infectious and communicable diseases. Importance of usage of safe drinking water and proper sanitation facilities. India has the largest number of medical colleges in the world this could be leveraged with little effort to increase the annual output without compromising on quality front. Employment • Potential to generate nearly 2 million jobs. • The estimated availability of roughly 19 lakh village level health workers by 2022 will pave the way for health care accessibility and thereby shift the focus of health care delivery from secondary and tertiary sectors to the primary sector over the next decades. Human resource empowerment •Bachelor of rural health care (BRHC)a three year course focused on primary and preventive health care can be provided and faculty could be drawn from India’s pool of retired teachers. Equitable distribution. •Additional educational institutions(medical colleges , nursing colleges, ANM schools)with a partnership ratio 80:20 between government and private sector in districts whose population exceeds 10 lakhs and further effectiveness could be attained by attaching these to existing district hospitals with reservation in the order 50:30:20 for local candidates in the district, other district candidates of the state and to other states respectively. Path for progress
  12. 12. REFERENCES: • • • WHO reports. • • High Level Expert Group Report on Universal health coverage for India(Instituted by the Planning Commission of India) • “Closing the gap in a generation”-WHO Report. On-going programmes for betterment of health care-major bottlenecks in them: • Movement towards Ensuring People’s Drinking Water Security in Rural India- Ministry of rural Development Report. • National Urban Sanitation Policy- Ministry of Urban Development report. • “Ensuring Drinking Water Security In Rural India” –Department of Drinking Water and sanitation Report • Ministry of Health & Family Welfare-Government of India