2. Health Problems in India
At the turn of the century, India’s Infant Mortality Rate (IMR) and Maternal Mortality Ratio
(MMR) lagged behind the average for the low and middle income countries (LMIC), as did
its life expectancy.
• The Indian healthcare sector faced shortages of workforce and infrastructure. India had 1.7
trained allopathic doctors and nurses per 1,000 population in the year 2000 compared to
the WHO recommended guideline of 2.5 per 1,000 population. Bed density in the country
was 0.67 per 1,000 population in the year 2002, well below the global average of 2.6 and
WHO benchmark of 3.5.
• Total healthcare expenditure was 4.3 per cent of GDP in 2000, below the LMIC average of
5.3 percent. More importantly, out-of-pocket spend was 67 percent, much higher than the
LMIC average of 44 percent. Health insurance covered only 5 per cent of Indians in 2004.
• IMR and life expectancy, continue to fall behind LMIC averages. It is likely that India will fall
short of the 2015 targets for IMR and MMR set in the Millennium Development Goals. The
non-communicable disease burden has grown to 53 per cent of the total disease burden by
2008, according to the WHO.
• Healthcare spend is not growing at the same pace as GDP. As per WHO National Health
Accounts, India’s healthcare spending as a percentage of GDP has reduced from 4.4 per cent
in 2000 to 4.0 per cent in 2010.
• Underutilization of existing resources further compounds the problem of meagre
infrastructure. Private sector hospitals routinely face utilization issues. Utilization of public
sector facilities remains low. Although the bed density has increased to 1.3 beds per
thousand but it still remains underutilized.
5. Indian healthcare expenditure
has grown slower than economy,
unlike most peers
About 50% of existing medical
workforce does not practice in
the formal health system
7. Implementation Details
MNREGA Health Insurance
Assuming 5 Cr of families coming under
MNREGA
Increasing the wage by 10 INR and 20 INR is
taken from their income as health insurance.
As a result 4000 INR per year per family is
generated ,i.e. , 20000 Cr INR of Annual
Expenditure
This expenditure obtained must be
implemented in forming a health insurance
service for the MNREGA workers
For proper implementation of this program
Health Card would be issued to MNREGA
workers
Doctors/ Beds/ Nurses
Utilization
Up to 90 per cent of registered practitioners
will need to practice. This would include
nurses also.
AYUSH and rural medical practitioner needs
to be incorporated into mainstream
healthcare at national level
An Ad Campaign for improving the brand &
image of Govt. Medical facilities.
In return these medical practitioners will be
benefitted by timely promotion and rotation
policy system
Rotation policy system involves alternate
posting in rural and urban areas
Pay hike and other incentives to be decided
by pay commission in a stipulated time frame
8. Implementation Details
Consultations from private
doctors regarding:
a) Treatment of patients
especially during
emergency cases
b) Acquiring ,
implementing and
maintenance of
equipments
c) Better medicines
Proper training
program for both
doctors and nurses.
First target would be
major government
hospitals and then
they will target
smaller hospitals in
their states.
Maintenance
Management :
a) Attendants , nurses
including both
governmental and
private
b) proper managerial
staff and maintenance
staff for equipments
Public-private
partnership
9. Implementation Details
Prevention
All important vaccines to be administered to
infants free of cost for BPL families.
These vaccinations would include Hepatitis B ,
Diphtheria-Pertussis-Tetanus (DPT) , Rotavirus ,
Measles-Mumps-Rubella(MMR) ,
Varicella(chicken pox) , Haemophilus Influenza
B(HiB) , Hepatitiis A vaccines
Program Implementation:
1) Happening through series of camps that will
be happening in all villages in period of 3
months. Also available at Govt. hospitals.
2) Every camp would be having 2 certified
doctors,2 certified nurses,10 medical students.
States responsible for implementing it.
3)Camps would be for below poverty line
families free
Ad campaign
Imparting knowledge regarding the total implementation
of:
Integration of health insurance with MNREGA by
providing good example of having health
insurance(wastage of resources if money not
allocated for health ex. smoking , liquor , etc.)
Free vaccination drive
Image improvement drive for medical
Governmental institutions
Finally, improving medical profession as whole for
present as well as future budding Doctors.
Total expenditure = 200 Cr INR on AD Campaign
10. Impact
• Health Insurance Coverage : Around 25 Cr people coming under health insurance
as a part of MNREGA. This section forms the lower strata of the population.
• Proper Utilization of Present Resources : This is the most cost effective way of
tackling lots of issues. Thereby resulting in :
– Increase in beds from 1.3 beds to 2.1 beds per 1000 patients.
– Increase in doctors/nurses ratio to 2-2.2 per 1000 patients.
• Decrease in mortality rate, non communicable diseases and communicable
diseases by a considerable amount.
• Development of Medical Infrastructure as well as human resources. It will surely
help in attracting more people towards pursuing Medical as a profession.
• Most important of all is that the medical facilities would be available at affordable
prices. The campaign would be driven with the motto of “Affordable Medication
to Diagnose the Present and Support Humanity.”
• Implementation of all the above programs mentioned would require an increase
of present health budget by 10-11% .
11. Risks and Mitigation
What about the families not
enrolled in MNREGA ?
a) Non Below Poverty Line : These families need to put atleast
1000 INR/annum in order to avail health fund facilities .
Government would provide 4.5% p.a. interest on that.
b) Below Poverty Line : They need to join MNREGA to access
the benefits provided there. This will create more jobs as well
as result in more people coming under the net of MNREGA.
How will people react on Rs. 10 cut
off in MNREGA ??
(Since, increasing the wage from
120 INR to 130 INR and cutting off
20 INR from that 130 INR)
The proposed AD Campaign will educate the masses
regarding health benefits being offered to them in
return to that 10 INR cut off. For example, people
spend that daily income of 120 INR in smoking ,
drinking liquor, etc. , so it will make them realize the
importance of health. “10(rupees) now adds more
than 10(years) to your life“.
How to find volunteers for
vaccination programs ?
a) Internship Opportunities would be made available for
the volunteers.
b) Moreover they would be provided with volunteer
certificates along with minor stipends.
c) Above all this would add more to their networking and
also train them for their future endeavours.
How to ensure smooth public-
private partnership ?
a) For Consultation & Emergency Activities , a stipulated amount
as a payment would be provided to the private organisation.
b) Government will act as primary payer and Private
Organisation as primary provider.
c) It would also add to the fulfillment of Corporate Social
Responsibility.
d) License & Grants would be provided to private organisation.
12. Appendix
References
• Executive Summary India Healthcare Inspiring Possibilities and
Challenging Journey by McKinsey & Company
• India’s Primary Healthcare needs Quick Reform by Forbes Magazine
• India : Health Profile by World Health Organisation
• Human Resources in Health Sector by Central Bureau of Health
Intelligence
• Global Health Expenditure Database
• Health Care in India – VISION 2020 – of Planning Commission
