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  1. 1. HEALING TOUCH: UNIVERSALIZING ACCESS TO QUALITY PRIMARY HEALTHCARE Manthan Topic : Healthcare Team Lite-Knights Neeti Pokharna, Nishank Varshney, Ayush Agrawal, Ayushi Varshney, Mitul Salecha
  2. 2. Total healthcare expenditure was 4.3 % of GDP, below the LMIC average of 5.3%. More importantly, Health insurance covered only 5% of Indians Indian healthcare sector faces shortage of workforce and infrastructure. India has 1.7 trained allopathic doctors and nurses per 1,000 population compared to WHO recommended guideline of 2.5 per 1,000 population. India’s Infant Mortality Rate, Maternal Mortality Ratio and Life Expectancy lags behind average of low and middle income countries. Current Condition in India
  3. 3. Why do we need to improve Healthcare? “ Health is an input into EconomicDevelopment of a country” Over 25% of hospitalizedIndians fall below poverty line because of hospital expenses Over 40% of hospitalizedIndians borrowheavily or sell assets to cover expenses Hospitalized Indians spend 58% of their total annual expenditure on health care Only 10% Indians have some form of health insurance, mostlyinadequate
  4. 4. Health Indicators continue to lag. HealthCare spend is not growing at same pace as GDP. Out of pocket spending continues to be high. Infrastructure gaps remain substantial, and are exacerbated by underutilization of existing resources. Health workforce remains inadequate and underutilized. While regulatory systems have been partially defined, a holistic regulatory framework is required. Public-private collaboration has not yet achieved scale. MAJOR CHALLENGES BEFORE INDIA In last few years, India’s health system developed well in few areas. Public sector efforts gained momentum with adoption of MDGs, as Govt. had set targets to reduce the MMR by three quarters between 1990 and 2015; to halt the spread of HIV /AIDS, malaria and other major diseases; and to revise their spread by 2015.
  5. 5. 1. The focus needs to be on efficiency, especially through better utilization. Government should ideally choose between the payer or provider role. Large scale implementation needs strengthening. A decentralized federal system functions effectively when supported by a common policy framework. 4. Prevention and early stage management should be a core focus area. Creating universal access has to be a primary focus, with a secondary focus on efficiency or quality. 2. An all-encompassing vision of future demand for health services should guide this vision and roadmap for Indian health system. Transforming the health system is a long-term journey, championed and driven by political leadership over a sustained period. 3. A constructive and transparent dialogue will be needed between the public and private sectors at this early stage of the journey. To collaborate with the private sector, government would need an inclusive vision, dialogue and an effective regulatory framework. THE ROAD AHEAD Raising an Army of Community Health Volunteers Strengthening the Primary Health Care Delivery System National Mission for Sanitation Taluk / Block Level Referral Hospitals for Curative Care Risk-Poolingand Hospital Care Financing Public Private Partnerships
  6. 6. Raising an Army of Community Health Workers Honorarium of Rs.1000 / month Accountable to village Panchayat 3 months’ training (Union) + health kit + refresher courses Urban Health Worker (UHW) in areas inhabited by low income and poor populations. One VHW per 1000 population (a million gainfully employed) Women from the community Training: Rs. 200 Crore per year for training of VHWs/UHWs, spread over three years. Borne by the Union Honorarium: Rs. 1200 Crore per annum (shared equally by Union and states) Health kits: Rs. 100 Crore per annum for a few generic drugs etc. (shared equally by Union and states) Refresher workshop: Rs. 50 Crore per annum – 2 refresher workshops – 3 days each (shared equally by Union and states)User charges as prescribed by Panchayat Incentives for performance
  7. 7. Strengthening of Primary Healthcare Delivery System Up gradation of PHCs in order to provide 24 hour delivery services New programmes for the control of non-communicable diseases Urban health posts Intensification of ongoing communicable disease control programs Provisioning of 35 essential drugs in all PHCs Direct Union Financing of Male MPWs Addressing shortage of other paramedical staff Addressing shortage of doctors in 8 states Male MPWs - Rs. 828 Crore/year Intensification of on-going disease control programs - Rs. 500 Crore/year Supply of listed drugs - Rs. 500 Crore/year Urban health posts - Rs. 200 Crore/year Control of non-communicable Diseases - Rs. 260 Crore/year Up gradation of PHCs for 24-hour delivery – Rs. 480 Crore /year Supply of auto-destruct syringes – Rs. 60 Crore /year
  8. 8. National Mission for Sanitation 50 million units with private funds + 50 million with subsidies 100 million toilets in 5 years A toilet for every household Health, hygiene, dignity and aesthetics Great Sanitation Movement 50 million toilets - Rs. 12,000 Crore – (One-Time allocation) Union’s Share : Rs 8,000 crore, States Share : Rs. 4,000 Crore Spread over 5 years for 10 million toilets a year, i.e., Rs 1600 Crore per year for the Union and Rs. 800 crore per year for all states put together. Annual fund requirement for 5 years : Rs. 2400 Crore. In addition, a national public health education program and propagation of technology may cost Rs 100 Crore per year. The Union may take up this campaign. Total fund requirement for 5 years: Rs. 2500 Crore/ Year
  9. 9. Taluk/Block Level Referral Hospitals for curative care Capital cost of 7000 CHCs at Rs. 1 crore each: Rs. 7000 Crore Annual cost (spread over five years): Rs. 1400 Crore Recruitment, appointment, control and financial provision by Local Government, with full assistance from State and Union Governments in the form of grants To be controlled by the local government (District Panchayat or Town/City Government) One 30-50 bed referral hospital for every 100,000 population Staff – One Civil Surgeon, 3 or 4 Civil Assistant Surgeons, a dentist, 7 or 8 staff nurses and 2 paramedical personnel Encourage public-private partnerships Ensure choice to patients among multiple service providers Encourage competition among health care providers Create incentives and risk-reward system to promote quality health service delivery Ensure access and quality of service to those with no influence or voice Raise resources innovatively & make the program sustainable. Strengthen public health care Health Insurance: Objectives
  10. 10. Risk Pooling and Hospital Care Financing National health insurance will further strengthen private providers at the cost of public exchequer Public health system is in disarray Most of the disease burden is a consequence of failure of primary care Traditional health insurance is not an answer for health care requirements of poor Funding Requirements Risk-pooling: from Union and states : Rs. 6000 Crore / Annum Less current maintenance cost of public hospitals (estimated) : Rs. 3500 Crore / Annum Additional Requirement * : Rs. 2500 Crore / Annum Community Based Health Insurance : Rs. 100 Crore / Annum ------------------------------------ Total Rs. 2600 Crore / Annum ------------------------------------ * Rs. 3000 Crore will be raised separately as local taxes.
  11. 11. Risk Pooling and Hospital Care Financing Reimbursement will be based on standard costs and services Patients will have a choice to visit any public hospital. The public hospital care costs will be reimbursed by DHB / money follows the patient. Pooling of the money at the District level with a new authority – District Health Board (DHB) under the overall umbrella of elected local governments Citizens’ share to be collected by the local governments as cess/tax Financing by the Union, State and citizens (those above poverty), pooling Rs. 90-100 per capita This will be the precursor of a National Health Service which serves all people at low cost There will be regular health accounting to trace expenditure flows, analyze costs and benefits, and demand and supply Patients can go to tertiary hospitals only in emergencies or upon referral by secondary care hospitals A part of the fund (15% ) will be separately administered for tertiary care / teaching hospitals at the State level A phased program will be evolved for existing public hospitals to give time for transition.
  12. 12. 1. re_Inspiring_pssibilities_and_challenging_journey.pdf 2. 3. 4. References