To secure universal access to and delivery of primary health care to
move beyond mere illness prevention
First-contact, person-focused healthcare
promotive, preventive, curative and rehabilitative
Community empowerment and stakeholder participation
Long term health
Inter-sectoral integration of sanitation education, nutrition
Reducing exclusion and social disparities in access
funded schemes are
well intentioned in
terms of providing
however they do not
of care because they
- Dr Srinath
of Expert Group
ENVISIONED PRIMARY HEALTH CARE
Active community engagement in an inclusive,
decentralised & incentive based model
Recurrent Health Plan: Based on an area
specific ‘focus’ issue
Area: Sub-district level (Block and
Municipality/ Municipal corporation)
Timeline: Two Years
Common Entrance Exam: To test health
policy awareness of supervising staff
Existing government policies on health:
Integrate and implement
Incentives: recognition, career growth and
monetary awards for policy oriented workforce.
Resource building: Multi sectoral
coordination between public - private
Building an effective network of stakeholders at the Sub-District level
Engaging people from below and expert personnel from above
*Swa-swastha implies that the onus of good health is on the self.
The policy will involve the community in improving its own overall quality of health, Swa-Swastha*.
One’s good health lies in the good health of others.
It is the site of policy implementation and sustenance.
MEDICAL SUPPORT STAFF
ADMINISTRATIVE SUPPORT STAFF
Formulate and conduct the health plan
Train Medical support staff
File and evaluate a report at the end of every
two year plan
Professional Staff: Doctors and AYUSH
practitioners for curative care
Policy oriented support staff: Nurses,
Midwives, ASHA workers, Arogya Sevikas,
Track and oversee policy goals
Generate and manage resources
Compile and digitise data for health
management information system
Basic Qualification: Matriculation; drawn
from the community
Policy Orientation: A three-month course in
Health Policy Implementation
TRAJECTORY OF MODEL
Medical Officer and Project Manager, with inputs from the community, will formulate and implement a
systematic two year health plan
Gather data on the endemic
problems of the area
Identify ‘the focus’ for the
2-year plan, with inputs from
the community. For example,
Recognise existing government
policies (if any), to tackle
Narrow down to relevant
and viable alternatives
In the absence of policy
precedents, strategize based on
existing economic and human
Formulate a comprehensive
model with strategic pit-stops
Example: ‘Focus’ - Malaria
Pit-stop – sanitation; followed
by insecticide spraying,
installation of mosquito nets
Execute the model arrived
at with inclusive multi-level
Review the policy
Submit the report to the
District medical officer
Publicise report in local
should become priority of the
Community Based Incentives
Access to primary health care
Focussed attention to urgent health requirements
Increase in overall health, awareness and participation
Increase in investment in health infrastructure. Corrective programmes for areas that
Medical/Administrative Support Staff
Permanent government job with fixed remuneration
Special perks for exceeding specified goals and targets
Monetary and Non Monetary incentives based on performance evaluated every 2 years
Example, Awards and recognition; Health insurance for their families
Medical Practitioners/Project Managers
Career Pathway moving upwards in the Health/Administrative wings of the Ministry
Conditional to fulfilment of a minimum of 3 two-year projects
(This will ensure an inflow and retention of staff in these areas, ordinarily undesired)
The model involves varied incentives for all stakeholders to ensure greater participation,
retention and efficacy in implementation of policy goals
RESOURCE BUILDING - FINANCE
Increase GDP allocation as
the role of the state is
The scheme provides every MP 5 crores per
annum for developmental projects in his/her
Allocate a minimum of 1 crore per annum per
MP for the policy. Total amount thus generated
would be atleast 790 crores which will act as a
Generate tax especially for health care like the
2% education cess
Redirect taxes on alcohol, tobacco and food
with little nutritional value to health care
NON – STATE ACTORS
Foster Public-Private Partnership
funding in a 60:40 ratio
Seek financing from regional
banks like the Asian
Development Bank for rural and
remote area projects
Grameen Banks can also act as
a source of funding
Invite private equity
investment in Health care. The
PWC Emerging Market Report
suggests this has improved
infrastructure in rural and urban
• Encourage adoption of
villages/slum clusters by hospitals
and medical colleges.
• Partner with existing NGOs in the
area which serve as centres of first
contact. Eg. Arpana Trust manages
a MCD health centre in Molarbund,
Coordinate with the existing NGOs
• Economically obtain generic drugs
through pharmacy linkages.
• The Tamil Nadu style passbook
mechanism can avoid wastage.
• Conduct Health camps
• Increase Mobile vans and Mobile Health Schemes
• Introduce Wireless technology and Tele-Medicine
• Digitise Health records (like in Thailand)
• Register people at the nearest health centre (PHC/CHC/ Govt.
• Registration Fee: Rs. 30/person per year.
• Benefit of the registration: free consultation; referral and
maintenance of medical history.
• Policy personnel will act as Point of Access.
• Improve reach of existing government health insurance
Example: RSBY, AABY, JBY, Varishtha Pension Yojana,
Universal Health Scheme
IMPACT OF POLICY
The Health Plan includes
certain mandatory programmes
for sustainable health,
implemented through inter
sectoral linkages, making the
system active instead of
are formulated to
become health enabling
Infant Mortality Rates
Pregnancy related short term
bridge courses for the medical
IMR and MMR reduced
& Health Camps
Integration of existing policies
like Chacha Nehru Sehat
Yojana & School Health
Regular health camps in schools
ascertaining early prognosis and
Induction of a massive
workforce in the health sector
accompanied by skillset
How does the model ensure accountability ?
Local Media will provide publicity to the inefficiencies of the
All reports and records will be uploaded online for scrutiny
State Directorates will investigate the misuse of funds (if any)
“It is hard to think of anything more
important than health for human well-
being and the quality of life.”
Health as a problem, however, doesn’t
occupy centre stage in Indian
The present proposal places a person in
a position of advantage, where he/she
can effectively deliberate and negotiate
about health concerns.
Well being is the collective common
good, therefore must be pursued until
made universal, and beyond.
Reports can be gathered from PHCs, government hospitals,
District Statistical officers
Local committees like Village Health and Sanitation Committee
will collect localised data
Whilst dealing with the ‘focus’ area problem, general health
infrastructure is expanded
Thus, instead of neglecting general health, the policy will
work towards it
How do you counter inefficient data collection ?
Is general health compromised by prioritising a
particular focus ?
High Level Expert Group Report on Universal Health Coverage for India - Instituted by Planning Commission of
India November 2011.
Twelfth Five Year Plan (2012 – 2017), Social Sectors, Planning Commission (Government of India), 2013, Sage
Publications India Pvt. Ltd.
World Health Organisation India Data
Urban Health Resource Centre Website
Partnerships with NGOs and Private Sectors for Improving Health of Urban Poor, Dr Siddharth Agarwal, UHRC,
Feb 9, 2009.
Annual Report, 2012 – 13, Ministry of Health and Family Welfare, Government of India.
Evaluation of Health Management Information System in India: Need for Computerized Databases, Ranganayakulu
Bodavala, HMIS, 2010.
Healthcare In India, Emerging Market Report 2007 , PriceWaterHouse Coopers Publications
Mobile Based Primary Healthcare for Rural India, M V Ramana Murthy.
An Uncertain Glory, Chapter 6, Jean Dreze and Amartya Sen, Allen Lane, Penguin Books, 2013.
Somnath Roy on Primary Health Care In India, Health and Population – Perspectives and Issues.
Replicating Tamil Nadu’s Drug Procurement Model, Prabal Vikram Singh, Anand Tatambhotla, Rohini Rao
Kalvakuntla, Maulik Chokshi, Economic and Political Weekly, September 29, 2012.
Hospitals and Primary Health Care , International Study by International Hospital Federation.
‘Good health at low cost’ 25 Years on, Dina Balabanova, Martin Mckee, Anne Mills, Rockefeller Foundation, 2011.