New Directions in Rural Healthcare
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New Directions in Rural Healthcare

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The presentation briefly outlines some of the research areas in rural primary healthcare that we focus on.

The presentation briefly outlines some of the research areas in rural primary healthcare that we focus on.

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New Directions in Rural Healthcare New Directions in Rural Healthcare Presentation Transcript

  • New Directions in Healthcare
    Nachiket Mor, Ph.D.
    Member, Board of Directors, ICTPH
    OECD Conference
    New Delhi, June 14th, 2011
  • About ICTPH
    • An action-research centre focussed on finding durable solutions to challenges of healthcare in Rural India
    • Set up by IKP Trust
    • Headquartered at IKP Knowledge Park, Hyderabad (200 acre R&D, Incubation Facility within the Genome Valley)
    • President: Dr. Zeena Johar
    • Chairman of the Board: Dr. Ramesh Mashelkar
  • Healthcare Challenges
    • Inadequate infrastructure
    • Low quality of care
    • Insufficient human resources
    • High out-of-pocket expenditure at point-of-care
    • Healthcare system not patient or wellness focussed
    • Need for policy level as well as field level innovations
  • ICTPH Research Focus
    • Infrastructure
    • Interventions
    • Human Resources
    • Financing
  • Desired Infrastructure
    • A well provisioned health-centre at 8,000 to 10,000 population level with ability to deal with a wide range of conditions
    • Technology to allow for:
    • Accurate diagnosis
    • Appropriate treatment
    • Quality control
    • Comprehensive enrolment and risk screening for landscape epidemiology and risk factor tracking
  • The ICTPH Approach
    • Clear identification of service area
    • GPS Enabled Android Mobile Phones
    • Rapid enrollment and risk screening
    • Geo-tagging
    • 10,000 individuals in 7-10 days
  • Geo-tagging and ID Card
    Chelampatti
    Pachur
    Uppundarpetti
    Thekku
    Ayyampatti
    Kotaitheru
    Adanakottai
    Karkaripatti
    Andipatti & Mudalipatti
  • Rural Micro Health Centre
    • One rural RMHC for 10,000 population
    • Vision, Dental, Cancer
    • Internet, Computers, HMIS
    • Blood collection
  • Drugs & Diagnostics
    • Haematology: Complete Blood Count(KX 21)
    • Biochemistry: Glucose, Lipid Profile, LFT, KFT (Chem 7)
    • Strip Tests:Malaria, Pregnancy, Urine
  • ICTPH Research Focus
    • Infrastructure
    • Interventions
    • Human Resources
    • Financing
  • Desired Interventions
    • Wide range of conditions
    • Standardised treatment
    • Rational prescriptions
    • Focus on risk factor management and early interventions
  • ICTPH Approach
    Patient removes footwear and enters RMHC
    Interventions
    Yes
    Is the patient a pregnant woman?
    Disease Management
    No
    Guide-Patient Protocol
    Diagnostics
    RMHC
    Physician-Patient Protocol
    Emergency Management
    Vision
    Diagnostic Tests
    Procedures:
    •   Nebulisation
    • Suture
    • Suture Removal
    • Dressing (Minor/major)
    • Injections
    • IV’s
    Consultation:
    1.Physical Examination
    2.SOAP Methodology
    • Subjective
    • Objective
    • Assessment
    • Planning
    Dental
    Screening
  • Physician-Patient Protocol
    Allows heightened diagnosis of disease:
    • Standardized format - signs & symptoms, diagnostic tests, treatment, and prevention (specific to a disease/condition).
    • Pictures to allow visual confirmation
    • Physical assessment protocol allowing targeted disease & condition specific physical examination
  • Otitis Media
  • Risk Factor Assessment
    Population
    PISP
  • Infant Nutrition Supplementation
    We recommend Sprinkles micronutrient powder
    Is your child between 6-24 months old?
    • Iron (12.5 mg)
    • Zinc (5 mg)
    • Folic Acid (160 µg)
    • Vitamin A (300 µg)
    • Vitamin C (30 mg)
    Unless you child has one of the following:
    Acute infection
    Severe Anaemia
    Severe Acute Malnutrition
  • ICTPH Research Focus
    • Infrastructure
    • Interventions
    • Human Resources
    • Financing
  • Human Resources Challenge
    • Unwillingness to serve in rural locations
    • Inadequate supply of MBBS doctors
    • High salary & support costs
    • Poor quality of care
  • Clinical processes (HMIS, PISP & pre – consultation protocols), Basic Procedures
    Physiology, Patho-physiology, Diagnosis & Standard Treatment Protocols
    Pharmacology, Medication and Diagnostics and Procedures
    ICTPH Approach
    • Recruit licensed Ayurveda and Siddha practitioners (BAMS, BSMS)
    • Offer bridging certificate course in modern medicine
    • Combine with a general inductionprogram &soft skills training
    Clinical Practice
    • Gastro-intestinal
    • Respiratory
    • Cardio-vascular diseases
    • Cancer
    • Diabetes
    • Dermatology
    • Musculo-skeletal
    • Ophthalmology
    • Dentistry
    • Diagnostics
  • Structured Environment
    • Certified Physician
    • Health Extension Worker
    • Real-time HMIS data entry
    • Real-time Centralised Audit
  • ICTPH Research Focus
    • Infrastructure
    • Interventions
    • Human Resources
    • Financing
  • Financing Challenge
    • Low levels of pre-payment
    • Entirely a fee-for-service model
    • Standalone insurance schemes such as RSBY are well run and therefore run the risk of:
    • Relative over-supply of higher levels of care
    • Not focussed on wellness
    • Expenditures could tend towards 100% utilisation
  • ICTPH Approach
    • HMO / ACO approach towards integrated primary, secondary and tertiary care
    • Strong focus on risk factor management and gate-keeping function at the primary care level
    • Move away from FFS and OOP to capitation and pre-payment models
    • Overall annual costs to remain below Rs. 1300 ($30) per capita per year (2.6% of GDP)
  • Thank You