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  1. 1. Manthan Topic: “HEALING TOUCH: UNIvErsAL ACCEss TO PrImAry HEALTH CArE” TEAM DETAILS: TEAM COORDINATOR-YASHONIL GANGWAL TEAM MEMBERS: TUSHAR PAL MAHESHYADAV SOHIL JAIN RAHUL BAJAJ Email Id: College Name:Acropolis Institute OfTechnology & Research, Indore. Contact Number:9584755524
  2. 2. HEALINGTOUCH Universalizing access to quality primary healthcare Definition PHC is an essential health care that is a socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems and in a way that gives priority to those most in need, maximises community and individual self- reliance and participation and involves collaboration with other sectors. Primary Health Care Preventive services Curative services General services Care of vulnerable groups Outpatient clinic (referral) Laboratory services Dispensary First aid and emergency services Health education Monitoring of environment Prev.&control of endemic diseases Health office services Maternal & child health School health services Geriatric health services Occupational health services Principles for PHC PHC based on the following principles : – Social equity – Nation-wide coverage – Self-reliance – Inter-sectoral coordination – People’s involvement in the planning and implementation of health programs
  3. 3. Services Offered by Health Centers  Primary Medical Care  Preventive Health Care  Prenatal, Perinantal, & Newborn Care  Gynecological Care  HIV Care  Hearing/Vision Screening • Oral Health • Mental Health • Substance Abuse • Pharmacy • X-Rays and Lab • Specialty Medical Care • Enabling Services Health Center Patients By Insurance Status, 2010 Health Center Patients by Payer Source, 2015 Health Center Revenue, 2010 Medicaid 39% Other Public Insurance 3% Private 7% Uninsured/ Self-Pay 6% Other Grants and Contracts 23%
  4. 4. WHO Strategies of Quality PHC 1. Reducing excess mortality of poor marginalized populations: PHC must ensure access to health services for the most disadvantaged populations, and focus on interventions which will directly impact on the major causes of mortality, morbidity and disability for those populations. 2. Reducing the leading risk factors to human health: PHC, through its preventative and health promotion roles, must address those known risk factors, which are the major determinants of health outcomes for local populations. 3. Developing Sustainable Health Systems: PHC as a component of health systems must develop in ways, which are financially sustainable, supported by political leaders, and supported by the populations served. 4. Developing an enabling policy and institutional environment: PHC policy must be integrated with other policy domains, and play its part in the pursuit of wider social, economic, environmental and development policy. The Basic Requirements for Universal access to PHC (the 8 A’s and the 3 C’s) • Appropriateness • Availability • Adequacy • Accessibility • Acceptability • Affordability • Assessability • Accountability • Completeness • Comprehensiveness • Continuity
  5. 5. Proposed Solution (The 7 commitments): 1. Fostering the Patient-Provider relationship 2. Comprehensive care 3. Improved access and health equity 4. Quality 5. Support team members to work at their maximum scope 6. Effective collaboration and healthy team dynamics 7. Primary Care Leadership 2. Comprehensive Care • paying attention to all aspects of a patients life • understanding the barriers and risks of low SES, discrimination and migration • proactive, relevant referrals • includes mental health support
  6. 6. 3. Improving Access and Health Equity Access to primary care can reduce and eliminate health inequity What is access anyway? 4. Quality •Patient safety •Constant thoughtful evaluation of service •Full use of EHR everybody talks about it 5. Supporting professionals to work at their full competency Empower nurse practitioners to be independent primary care providers Enable family physicians to manage complex patients and act as a medical consultant to nursing staff Define the RN and RPN roles as an integral part of the clinical team and patient experience Collaborate with Allied Health Streamline administrative processes 6. Effective collaboration and healthy team dynamics 7. Primary Care Leadership Creating leadership opportunities and options for primary care practitioners • Broadening scope and strengthening • Experience wearing both hats • Creates mutual understanding of each others worlds • The more people who have this bridging goal the more full the understanding
  7. 7. Primary Health Care Strategy – Implementation Plan The health system is experiencing a number of pressures, which will intensify Current pressures  Workforce shortages at all levels  Service failures  Cost growth  Safety and quality  Health Targets  Inequity of access  Decisions in the national interest • Pressures will intensify in the future:  Population growth, redistribution and ageing;  Increasing risk and prevalence of long term conditions;  Risk of a second wave of health inequalities associated with obesity;  Managing within an affordable funding path;  Effective utilisation of the available workforce;  Effective application of technological advances; and  Rising consumer expectations • Not a system: evaluation of the health reforms • System leadership and strategic planning: Ministry review • Lack of collaboration across DHB boundaries: Health & Disability Commissioner reports Likely service configuration changes have been identified  Acute secondary and tertiary inpatient services will consolidate into a smaller number of centres  Smaller district hospitals will use clustering, regional services and networks to expand their critical mass  Services will shift between professional groups and to lower levels of care  Primary health care will have a greater role in prevention, delivery of traditionally secondary based services, and improved access to specialist diagnostic testing  Information technology will enable an increase in integration and self management Unmet need for GP services (any reason), adults by gender 11.6 14.311.0 14.35.7 7.6 0 5 10 15 20 25 30 Men Women Gender Percent 1996/97 2002/03 2006/07 NZ Health Survey, 1996/97, 2002/03, 2006/07 Reducing iatrogenic error • individual responsibility for patient safety through tracking and reconciliation systems • clear communications methods between providers • imbedded decision support tools • creating a calm atmosphere through thoughtful patient and information flow
  8. 8. Challenges • Sustainability – funding, clinical, workforce, demand/supply • Workforce capability/capacity • Trust and relationships – professional, PHO, DHB, MOH • Clinical leadership, governance • Performance improvement – variability, incentives/levers, measures, public info • National leadership versus local autonomy. ?centralised policy • Coordinated responses – information, service equity. ?sector oversight • Change in a commercial environment – environment that encourages progress and development • Reduced rate of funding growth • Collaboration in a devolved environment – consensus difficult, variable • Collective good vs lowest common denominator responses. ?Decision making processes needed High Functioning teams Essential elements Challenges Shared vision, values and philosophy Long term Commitment by all levels within an organization Trust and Mutual support Building clients awareness and understanding of interdisciplinary approaches Shared Decision making Redefining roles Effective Communication Recognizing and addressing structural and organizational barriers Related Professional development Common understanding structures and processes within an organization Clear roles and responsibilities of team members Understanding resistance to change Enough Flexibility Ongoing evaluation and adjustment of team approach Accountability Developing clear, concise communication systems Adequate Resources Building and nurturing relationships
  9. 9. Possible direction • Earned autonomy for capable PHOs • Stronger clinical governance – balanced organisational governance • Clinical networks to drive performance/quality • Flexibility on funding use • Outcomes based contracting models – improved accountability measures • Partnership models with DHBs • Strong locality focus, geographic? • Delegated funding • Extended range of services • Minimum population • Multiple contract models • Incentives for capital investment for larger practices to develop integrated service delivery models What platform do we build on? • 80 PHOs established since 2002 • 4.0m people enrolled – and patient satisfaction remains high, by international comparisons • Access – 50% reduction in schedule fees – Very low cost access – 1.16m New Zealanders – Children < 6 years – 77% free – Cheaper pharmaceuticals for all – Greater use of services • Services – More focus on chronic conditions – Innovative new approaches, and greater use of nurses • Improving performance – Practice accreditation – Cornerstone/TeWana – PHO Performance Programme – overall improvement, but significant variation – Quality Improvement Committee HealthTargets
  10. 10. Where to start? Government Priority Major Areas • Reduce Endless Waiting • Towards Better, Sooner and More Convenient Primary Care • Improving Performance and Quality • Strengthening the Health Workforce $- $100,000 $200,000 $300,000 $400,000 Qtr. 1, 2010 Qtr. 2, 2010 Qtr. 3, 2010 Qtr. 4, 2010 Qtr. 1, 2011 Qtr. 2, 2011 Qtr. 3, 2011 Qtr. 4, 2011 $253,679 $72,404 $362,399 $103,434 Reimbursement Loss Total Cost 71% Cost Avoidance Reduction in Emergency Department Costs (excluding ancillaries):-
  11. 11. Optimum universal access of PHC is achieved through: • Adequate maternal care • Periodic follow up of the “healthy people” • Breast feeding and proper nutrition • Immunization • Early detection and proper management • A sanitary and safe environment • Health education of parents. • Forms the basis for other levels of health systems • Addresses most important problems in the community by providing preventive, curative, and rehabilitative services • Organizes deployment of resources aiming at promoting and maintaining health. • Constantly evolving process • Constant nurturing • Organizational commitment • Encouraging and allowing clinicians to have expanded roles that involve leadership • There will be mistakes along the way. Learn from them • Don’t forget about the patient Primary care is an approach that: • Focuses on the person not the disease, considers all determinants of health • Integrates care when there is more than one problem • Uses resources to narrow differences
  12. 12. Appendix References  NRHM Health Statistics Information Portal  World Health Organization India Data  Economic and Political Weekly (EPW)  Access Alliance:Multicultural Health and Community Services  MINISTRY OF HEALTH: Manatu Hauora. Never doubt that a small group of thoughtful people can change the world. Indeed, it's the only thing that ever has.—Margaret Mead