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  1. 1. To secure universal access to and delivery of primary health care to move beyond mere illness prevention POLICY STATEMENT First-contact, person-focused healthcare promotive, preventive, curative and rehabilitative Responsible health Community empowerment and stakeholder participation Long term health Inter-sectoral integration of sanitation education, nutrition Ensuring equity Reducing exclusion and social disparities in access “Many government funded schemes are well intentioned in terms of providing secondary and tertiary care, however they do not provide continuity of care because they neglect Primary care.” - Dr Srinath Reddy, Chairman of Expert Group on UHC ENVISIONED PRIMARY HEALTH CARE
  2. 2. 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 stakeholders POLICY OVERVIEW
  3. 3. PERSONNEL INVOLVED 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 OFFICERS MEDICAL SUPPORT STAFF PROJECT MANAGERS ADMINISTRATIVE SUPPORT STAFF RESPONSIBILITY 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, Technicians RESPONSIBILTY 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 COMMUNITY PARTICIPATION
  4. 4. TRAJECTORY OF MODEL Medical Officer and Project Manager, with inputs from the community, will formulate and implement a systematic two year health plan Problem Recognition Gather data on the endemic problems of the area Identify ‘the focus’ for the 2-year plan, with inputs from the community. For example, Malaria-elimination Alternative Generation Recognise existing government policies (if any), to tackle diagnosed ‘focus’ Choice Making Narrow down to relevant and viable alternatives In the absence of policy precedents, strategize based on existing economic and human resources Model Development Formulate a comprehensive model with strategic pit-stops Example: ‘Focus’ - Malaria elimination Pit-stop – sanitation; followed by insecticide spraying, installation of mosquito nets etc. Implementation Execute the model arrived at with inclusive multi-level stakeholder participation Assessment Review the policy Submit the report to the District medical officer Publicise report in local media Unaccomplished goals should become priority of the subsequent plans
  5. 5. 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 lagged behind 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) INCENTIVES INVOLVED The model involves varied incentives for all stakeholders to ensure greater participation, retention and efficacy in implementation of policy goals
  6. 6. RESOURCE BUILDING - FINANCE STATE + Increase GDP allocation as the role of the state is fundamental The scheme provides every MP 5 crores per annum for developmental projects in his/her constituency 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 supplementary fund 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 GDP MPLAD TAXATION 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 REGIONAL BANKS Invite private equity investment in Health care. The PWC Emerging Market Report suggests this has improved infrastructure in rural and urban areas. PRIVATE EQUITY PPP
  7. 7. • 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, Delhi. Coordinate with the existing NGOs and hospitals. ENSURING ACCESSIBILITY • 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) Improving Access Drugs • Register people at the nearest health centre (PHC/CHC/ Govt. Hospital). • Registration Fee: Rs. 30/person per year. • Benefit of the registration: free consultation; referral and maintenance of medical history. Registration • Policy personnel will act as Point of Access. • Improve reach of existing government health insurance schemes Example: RSBY, AABY, JBY, Varishtha Pension Yojana, Universal Health Scheme Financial Support
  8. 8. IMPACT OF POLICY The Health Plan includes certain mandatory programmes for sustainable health, implemented through inter sectoral linkages, making the system active instead of reactive. Inter-sectoral linkages are formulated to improve sanitation Community spaces become health enabling environments Sanitation Combating Maternal & Infant Mortality Rates Pregnancy related short term bridge courses for the medical support staff IMR and MMR reduced Health Education & Health Camps Integration of existing policies like Chacha Nehru Sehat Yojana & School Health Scheme (Delhi) Regular health camps in schools ascertaining early prognosis and immediate referrals Employment Generation Induction of a massive workforce in the health sector accompanied by skillset development
  9. 9. SURMOUNTING CHALLENGES How does the model ensure accountability ? Local Media will provide publicity to the inefficiencies of the project All reports and records will be uploaded online for scrutiny State Directorates will investigate the misuse of funds (if any) CONCLUSION “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 democratic politics. 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 ?
  10. 10. APPENDIX REFERENCES 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.
  11. 11. 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. APPENDIX REFERENCES