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  • @Shashank- Thank You for taking the time out to go through our presentation. You are absolutely correct where the shortage of Trained HRH is concerned, but the studies ( including Govt. and NGO evaluations of NRHM ) show a gross under utilization of the Govt. services even when they are available, and the most common reason for which was stated by the study subjects as lack of trust in the quality and continued availability of services and drugs. For this reason, people go to private set ups where the costs of healthcare are extremely high, which leads to incomplete treatment, delays in treatment till money is arranged and delayed referral to higher centers when needed. By setting up a micro-insurance with cashless benefits, the delay due to arranging funds is taken care of. Further more, involvement of private sector within the scheme to provide services in case of non availability at PHCs and CHCs will take care of shortages in HRH. Since the scheme shall be operated at a CHC level, the local community shall be directly involved in the monitoring and feedback. Our primary aim is to change the health seeking behaviour of the population so that their first point-of -contact is with a Registered Medical Practitioner within a referral system of the Govt. Health set up while providing an economically sustainable solution to mitigate the financial burden of diseases at the individual level without much added burden on the Government.
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  • For 'universalizing quality healthcare', the immediate focus should be on PHC and CHC. And at these levels, human health resource (HRH) is the limiting factor and not expenditure (am making an assumption based on common sense and hence can be wrong). There is a shortage of HRH by18% at PHC and 34% at CHC level. Innovative solution like training nurses, pharamacist, ASHA etc to deal with basic and most primary ailments and be the first point of contact at PHC level can improve the doctor-to-patient ratio in rural areas.

    Then there is an issue of regular and reliable supply of medicines. MIS based inventory management can help tracking stock of essential medicines.
    There should be proper linkages (communication) and connectivity (transport services) between PHC, CHC and district hospitals so that referral of a person to higher level is smooth, paperless and less time consuming.

    And of course, community participation for monitoring, evaluation and feedback should form the skeleton of the health system, esp in rural areas.
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  • 1. Universalizing Access to Quality Primary Healthcare Healing Hands
  • 2. Problem Statement Problems of Primary Healthcare:- Approachability for community Increase trust Accessibility to Health delivery Increase number.of service providers Acceptability for Community Involve Community Affordability for Community Mitigate financial shock of health expenses Accountability of Health Delivery Assured health delivery Way Forward
  • 3. PROPOSED SOLUTION
  • 4. P R O P O S E D S O L U T I O N Microfinance Health Insurance Scheme with a Nodal Center at CHC  Minimal premiums  Cashless benefits  Reimburse Out- of- pocket spending on medication due to non- availability.  Include private healthcare providers for assured service in case of non- availability at CHC. Profits from Insurance Scheme re-invested in local community via Federation of Self Help Groups (SFG) or Co-operatives to increase revenue generation and community development. Microfinance Health Insurance
  • 5. Microfinance Health Insurance Minimum Premiums Cashless Services PHC, CHC and Selected Private set ups Re imbursement of Out-of-pocket expenditure on medication due to unavailability  Improved Demand for Healthcare Services.  Strengthening of Referral system.  Increased Utilization of existing set up.  Empowering community. Investment in Local Co-operative Heathcare and Associated Infrastructure Development Contingency Fund for Medical emergencies  Improved health seeking behaviour  Sustainability at local level.  Boost to local economy  Overall Community Development  Health education at workplace. Health Education and Behaviour Change Communication P R O P O S E D S O L U T I O N
  • 6. P R O P O S E D S O L U T I O N Flaws in Existing System Merits of Proposed Solution Low utilization of existing Healthcare Services Increased Utilization of existing Infrastructure by i) Increased trust in existing system due to assured service delivery. ii) Improved Health-seeking behaviour iii) Change in felt-need through community involvement. Unavailability of Services and Medication Viable alternative services by including Private Sector and re-imbursement of Out of Pocket Expenses for unavailable drugs. Minimal emphasis on Prevention Community Infrastructure development to improve access to clean drinking water, proper sanitation and good nutrition to promote overall health of community. Low involvement of community Direct community involvement by incorporating representatives in the Nodal Office at CHC level to guide overall functioning and improve accountability. Required Massive Budget Allocation for upgradation Budget generation at local level – Improvement in services without additional budget requirement, So Sustainable!
  • 7. P R O P O S E D S O L U T I O N Pre- existing infrastructure.  No specialized resource required, can be locally sourced  Increase in Scale -Running costs decreases -Revenue generation increases.  Running cost generated within the scheme without reliance on outside monetary input.  Flexibility in service provision according to existing infrastructure.  Decreasing costs with increasing duration due to improvement in overall health. SCALABILITY As more number of clients (insurees) join the scheme i) Risk pool increases ii) Revenue generated increases iii) Average cost per insuree decreases. Community Level National Level SUSTAINABILITY
  • 8. IMPLEMENTATION
  • 9. Marketing and response evaluation Launch Insurance Scheme Start Investment in Co-operatives Monitoring- Change in health seeking behaviour Evaluation – Change in Health Indices & Start Investment In Community Infrastructure Developement 2 months 6 months 2 years 5 years IMPLEMENTATION TIMELINE
  • 10. IMPLEMENTATION - Requirements LEVEL HUMAN RESOURCE MATERIALS FUNDS STATE CHC PHC VILLAGE Training team (5 membered) NGOs and Health Officers Education and Marketing Media 5 lakhs p.a. Nodal Office Nodal Officer (new post) MO-PHC BDO Representatives of villages Health insurance cards Guidebooks Insuree registers Claims register Stationeries 10 lakhs p.a. Accounts Manager (existing post NRHM) Premium collection register 10,000 p.a. Reps. of villages (selected by Panchayat) Marketing Team MO-PHC Community level workers Health education material Insuree register Marketing material 10,000 p.a.
  • 11. IMPLEMENTATION Source of Funding Initial Funds for Start Up Allocated under NRHM Maintenance Fund Generated at Community level within the Scheme
  • 12. IMPACT Monitoring and Evaluation
  • 13. IMPACT  OPD footfalls.  ANC registration.  Bed Occupancy rates.  Claims received.  Grievance Redressal - Average time - Maximum time  Maternal Mortality Rates.  Infant Mortality Rates.  Immunization Coverage.  Household medical. expenditure as percentage of annual spending. Data from SRS and Census Monitoring Evaluation Projected Impact – Improved health service delivery, Improved Health Seeking Behaviour, Boost local economy and Overall community Developement
  • 14. Strength Weakness Opportunity Threats
  • 15. Existing Infrastructure Strengthen Referral Empower People Reduce Out-of-Pocket expenditure Boost Local Economy Improve village infrastructure Sudden increase in Claims during Epidemics And Diasters Can be implemented under NHM along with proposed charges for services at CHCs. Low trust in Govt. services Requires mass participation for profit  Client attrition and non-payments. Strengths ThreatsOpportunities Weakness Mitigation of threat by Risk Pooling over time and over place( Interlink with other CHCs)
  • 16. Thank You
  • 17. Annexure
  • 18. Problem Analysis Availability and accessibility of health care is important for overall health status of any community. Both physical and financial accessibility is equally important. Physical Accessibilty 28.8% of population ( in sample studies ) were having positive health seeking behavior towards government health care facilities.Majority of the sample studied i.e. 71.2% were having negative health seeking behavior towards government health care facilities. Financial Accessibility Medicine accounted for 70% of treatment cost followed by investigation and consultation cost. Out of pocket expenditure was the most common financing option (93.6%) and in 5.6% cases they borrowed money or sale assets and in 0.8% cases government health insurance were the financing option.
  • 19. Problem Analysis Micro- Insurance for health with involvement of Private healthcare providers solves issue of physical and financial accessibilty. Organization of community based health insurance or government insurance with contribution from public is urgently needed to protect the poor from slipping into poverty and indebtedness.
  • 20. References Raykumar P et al Health care seeking and treatment cost in a rural community of West Bengal, India , [theHealth 2012; 3(3): 67-70] Mandal S, Kanjilal B, Peters DH, Lucas H. Catastrophic out-of-pocket pay-ment for health care and its impact on households: Experience from West Bengal, India.  Ray TK, Pandav CS, Anand K, Kapoor SK, Dwivedi SN. Out-of-pocket expenditure on healthcare in a north Indian village. [Natl Med J India. 2002;15:257-60.] Rose Ann Dominic et al Health seeking behavior of rural adults. [NUJHS Vol. 3, No.3, September 2013, ISSN 2249-7110]
  • 21. References  Ghosh et al Factors affecting the healthcare seeking behaviour of mothers regarding their children in a rural community of Darjeeling district, West Bengal. [International Journal of Medicine and Public Health,Jan-Mar 2013,Vol 3,Issue 1 ]  Programme Evaluation Organisation, Planning Commission,Government of India Evaluation Study of National Rural Health Mission (NRHM) in 7 States [2011]