New Directions in Healthcare      Nachiket Mor, Ph.D. Member, Board of Directors, ICTPH       OECD Conference   New Delhi,...
About ICTPH An action-research centre focussed on finding durable solutions  to challenges of healthcare in Rural India ...
Healthcare Challenges Inadequate infrastructure Low quality of care Insufficient human resources High out-of-pocket ex...
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 ...
The ICTPH Approach• Clear identification of service area• GPS Enabled Android Mobile Phones• Rapid enrollment and risk scr...
Geo-tagging and ID Card                                       Chelampatti      Pachur                       Uppundarpetti ...
Rural Micro Health Centre One rural RMHC for 10,000 population    Internet, Computers, HMIS Vision, Dental, Cancer     ...
Drugs & Diagnostics                                                Haematology: Complete Blood Count (KX 21)             ...
ICTPH Research Focus Infrastructure Interventions Human Resources Financing
Desired Interventions Wide range of conditions Standardised treatment Rational prescriptions Focus on risk factor mana...
ICTPH Approach                                             Patient removes footwear       Interventions                   ...
Physician-Patient ProtocolAllows heightened diagnosis of disease: Standardized format - signs & symptoms, diagnostic test...
Otitis Media
Risk Factor Assessment             Population                     PISP                         Normal            Risk     ...
Infant Nutrition Supplementation                         Is your child between 6-             We recommend Sprinkles      ...
ICTPH Research Focus Infrastructure Interventions Human Resources Financing
Human Resources Challenge Unwillingness to serve in rural locations Inadequate supply of MBBS doctors High salary & sup...
ICTPH Approach Recruit licensed Ayurveda and Siddha practitioners (BAMS, BSMS) Offer bridging certificate course in mode...
Structured Environment    Certified Physician    Health Extension Worker    Real-time HMIS data entry    Real-time Cen...
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 RSB...
ICTPH Approach HMO / ACO approach towards integrated primary, secondary  and tertiary care Strong focus on risk factor m...
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Dr Nachiket Mor's presentation at the OECD-NIPFP India Symposium, New Delhi, India

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OECD-NIPFP India Symposium which was held in New Delhi, 14 June 2011

Link: www.oecd.org/globalrelations/IndiaSymposium

Published in: Health & Medicine, Business
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Dr Nachiket Mor's presentation at the OECD-NIPFP India Symposium, New Delhi, India

  1. 1. New Directions in Healthcare Nachiket Mor, Ph.D. Member, Board of Directors, ICTPH OECD Conference New Delhi, June 14th, 2011
  2. 2. 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
  3. 3. 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
  4. 4. ICTPH Research Focus Infrastructure Interventions Human Resources Financing
  5. 5. 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
  6. 6. 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
  7. 7. Geo-tagging and ID Card Chelampatti Pachur Uppundarpetti ThekkuAyyampatti Kotaitheru Adanakottai Karkaripatti Andipatti & Mudalipatti
  8. 8. Rural Micro Health Centre One rural RMHC for 10,000 population  Internet, Computers, HMIS Vision, Dental, Cancer  Blood collection
  9. 9. Drugs & Diagnostics  Haematology: Complete Blood Count (KX 21)  Biochemistry: Glucose, Lipid Profile, LFT, KFT (Chem 7)  Strip Tests: Malaria, Pregnancy, Urine ICTPH Protocol Linked Essential Drug List (67 Single Formulations)THERAPEUTIC ACTIVITY CLASS NUCLEUS MOLECULE FORMULATION STRENGTHENDOCRINE SYSTEMAnti Diabetic Biguanide Biguanide Metformin HCl Tablet (500 mg)Anti Diabetic Sulfonyl Urea Sulfonyl Urea Glibenclamide Tablet (5 mg)Anti Diabetic Sulfonyl Urea Sulfonyl Urea Glimepiride Tablet (1 mg; 2 mg)CARDIO VASCULAR SYSTEMAnti Anginal Isosorbide trinitrate Tablet (10 mg)Anti Hypertensive Calcium Channel Blocker Dihydropyridine Amlodipine Tablet (5 mg; 2.5 mg)Anti Hypertensive Angiotensin II Antagonist Losartan pottassium Tablet (50 mg)Anti Hypertensive Beta 1 Receptor Blocker Napthalene Atenelol Tablet (50 mg) Tablet (40 mg); InjectionDiuretic / Anti Hypertensive Loop Diuretic Anthranilic Acid Frusemide (10 mg / ml)Diuretic / Anti Hypertensive Sodium Chloride Symporter Benzothiadiazine HydrochlorthiazideHyperlipidemia HMG-CoA Reductase Statin Atorvastatin Tablet (10 mg)
  10. 10. ICTPH Research Focus Infrastructure Interventions Human Resources Financing
  11. 11. Desired Interventions Wide range of conditions Standardised treatment Rational prescriptions Focus on risk factor management and early interventions
  12. 12. ICTPH Approach Patient removes footwear Interventions and enters RMHC Yes Is the patient a pregnant woman? Disease Management NoRMHC Guide-Patient Protocol Diagnostics Physician-Patient Protocol Emergency Management Vision Consultation: Procedures: 1.Physical Examination • Nebulisation • Suture 2.SOAP Methodology Diagnostic Tests • Suture Removal Dental •Subjective • Dressing (Minor/major) •Objective • Injections •Assessment • IV’s •Planning Screening
  13. 13. Physician-Patient ProtocolAllows 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
  14. 14. Otitis Media
  15. 15. Risk Factor Assessment Population PISP Normal Risk Factors Diseased Condition Management
  16. 16. Infant Nutrition Supplementation Is your child between 6- We recommend Sprinkles 24 months old? micronutrient powder Iron (12.5 mg) Zinc (5 mg) Unless you child has one of the following: Folic Acid (160 µg) Vitamin A (300 µg) Vitamin C (30 mg) Acute infection Severe Anaemia Severe Acute Malnutrition
  17. 17. ICTPH Research Focus Infrastructure Interventions Human Resources Financing
  18. 18. Human Resources Challenge Unwillingness to serve in rural locations Inadequate supply of MBBS doctors High salary & support costs Poor quality of care
  19. 19. ICTPH Approach Recruit licensed Ayurveda and Siddha practitioners (BAMS, BSMS) Offer bridging certificate course in modern medicine Combine with a general induction program & soft skills training Clinical Practice  Gastro-intestinal  Respiratory Clinical processes (HMIS, PISP &  Cardio-vascular diseases pre – consultation protocols), Basic Procedures  Cancer  Diabetes Physiology, Patho-physiology,  Dermatology Diagnosis & Standard Treatment Protocols  Musculo-skeletal  Ophthalmology Pharmacology, Medication and  Dentistry Diagnostics and Procedures  Diagnostics
  20. 20. Structured Environment  Certified Physician  Health Extension Worker  Real-time HMIS data entry  Real-time Centralised Audit
  21. 21. ICTPH Research Focus Infrastructure Interventions Human Resources Financing
  22. 22. 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
  23. 23. 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)
  24. 24. Thank You

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