Quality Primary Healthcare
Problems of Primary Healthcare:-
Approachability for community Increase trust
Accessibility to Health delivery Increase number.of service providers
Acceptability for Community Involve Community
Affordability for Community Mitigate financial shock of health expenses
Accountability of Health Delivery Assured health delivery
Microfinance Health Insurance Scheme with a Nodal Center at
Reimburse Out- of- pocket spending on medication due to non-
Include private healthcare providers for assured service in case of
non- availability at CHC.
Profits from Insurance Scheme re-invested in local community via
Federation of Self Help Groups (SFG) or Co-operatives to increase
revenue generation and community development.
Microfinance Health Insurance
Microfinance Health Insurance
PHC, CHC and
Selected Private set ups
Re imbursement of
due to unavailability
Improved Demand for Healthcare Services.
Strengthening of Referral system.
Increased Utilization of existing set up.
Heathcare and Associated
Contingency Fund for
Improved health seeking behaviour
Sustainability at local level.
Boost to local economy
Overall Community Development
Health education at workplace.
Health Education and
Merits of Proposed Solution
Low utilization of existing
Increased Utilization of existing Infrastructure by
i) Increased trust in existing system due to assured service
ii) Improved Health-seeking behaviour
iii) Change in felt-need through community
Unavailability of Services and
Viable alternative services by including Private Sector
and re-imbursement of Out of Pocket Expenses for
Minimal emphasis on
Community Infrastructure development to improve access
to clean drinking water, proper sanitation and good
nutrition to promote overall health of community.
Low involvement of
Direct community involvement by incorporating
representatives in the Nodal Office at CHC level to guide
overall functioning and improve accountability.
Required Massive Budget
Allocation for upgradation
Budget generation at local level – Improvement in
services without additional budget requirement, So
Pre- existing infrastructure.
No specialized resource required,
can be locally sourced
Increase in Scale
-Running costs decreases
Running cost generated within the scheme
without reliance on outside monetary input.
Flexibility in service provision according to existing infrastructure.
Decreasing costs with increasing duration due to improvement in overall
As more number of clients
(insurees) join the scheme
i) Risk pool increases
ii) Revenue generated
iii) Average cost per
Community Level National Level
2 months 6 months 2 years 5 years
IMPLEMENTATION - Requirements
Training team (5 membered)
NGOs and Health Officers
5 lakhs p.a.
Nodal Officer (new post)
Representatives of villages
Health insurance cards
10 lakhs p.a.
(existing post NRHM)
Premium collection register 10,000 p.a.
Reps. of villages
(selected by Panchayat)
Community level workers
Health education material
Source of Funding
for Start Up Allocated under NRHM
Generated at Community level
within the Scheme
Bed Occupancy rates.
- Average time
- Maximum time
Maternal Mortality Rates.
Infant Mortality Rates.
expenditure as percentage
of annual spending.
Data from SRS and Census
Projected Impact – Improved health service delivery, Improved Health Seeking
Behaviour, Boost local economy and Overall community Developement
Boost Local Economy
Sudden increase in
Can be implemented
under NHM along
charges for services
Low trust in
Client attrition and
Mitigation of threat by Risk Pooling over time and over place( Interlink with other CHCs)
Availability and accessibility of health care is important for overall health status of
Both physical and financial accessibility is equally important.
28.8% of population ( in sample studies ) were having positive health seeking
behavior towards government health care facilities.Majority of the sample studied i.e.
71.2% were having negative health seeking behavior towards government health
Medicine accounted for 70% of treatment cost followed by investigation and
consultation cost. Out of pocket expenditure was the most common financing option
(93.6%) and in 5.6% cases they borrowed money or sale assets and in 0.8% cases
government health insurance were the financing option.
Micro- Insurance for health with involvement of Private healthcare providers solves
issue of physical and financial accessibilty.
Organization of community based health insurance or government insurance with
contribution from public is urgently needed to protect the poor from slipping into
poverty and indebtedness.
Raykumar P et al
Health care seeking and treatment cost in a rural community of West Bengal, India ,
[theHealth 2012; 3(3): 67-70]
Mandal S, Kanjilal B, Peters DH, Lucas H.
Catastrophic out-of-pocket pay-ment for health care and its impact on households:
Experience from West Bengal, India.
Ray TK, Pandav CS, Anand K, Kapoor SK, Dwivedi SN.
Out-of-pocket expenditure on healthcare in a north Indian village.
[Natl Med J India. 2002;15:257-60.]
Rose Ann Dominic et al
Health seeking behavior of rural adults.
[NUJHS Vol. 3, No.3, September 2013, ISSN 2249-7110]
Ghosh et al
Factors affecting the healthcare seeking behaviour of mothers regarding their children in
a rural community of Darjeeling district, West Bengal.
[International Journal of Medicine and Public Health,Jan-Mar 2013,Vol 3,Issue 1 ]
Programme Evaluation Organisation, Planning Commission,Government of India
Evaluation Study of National Rural Health Mission (NRHM) in 7 States