2. The Primary Healthcare System(PHC):
“The important thing for government is not to do
things which individuals are doing already, and to do
them a little better or a little worse; but to do those
things which at present are not done at all”
- J. M. Keynes 1926
3. The idea of the BRIC(S)
Investment banker Jim O’Neill of Goldman Sachs first wrote in 2001 about the growth potential of four
countries that would overtake G7 in (PPP) size by 2027.
Countries with most economic potential for growth based on
Size
Demography
Recent growth rates
Embrace of globalisation
So China to become most important global exporter of manufactured goods; India exporter of services; Russia
and Brazil exporters of raw materials.
‘If it were possible to evaluate the loss, which this country annually suffers through
the avoidable waste of valuable human material and the lowering of human efficiency
through malnutrition and preventable morbidity, we feel that the result would be so
startling that the whole country would be aroused and would not rest until a radical
change had been brought about' (Bhore Committee Report 1946).
Primary Health Care – Indian vision, 1946
4. Slowdown in US and Europe has already
affected exports and GDP growth in BRICS
GDPgrowth
%
Industrial
production
Inflation
2012
Unemploy-
mentrate
Current
account
balance
2012
est.
Latest
quarter
Year-on-year
Latestdata %
Consumer
prices%
% (%ofGDP)
Brazil 1.5 1.6 -3.8 5.3 5.4 -2.8
Russia 3.7 2.9 1.9 5.1 5.2 +4.5
India 5.8 0.1 -0.4 9.4 9.8 -4.0
China 7.8 9.1 9.6 2.9 4.1 +2.6
South
Africa
2.5 3.2 -0.8 5.3 25.5 -6.3
5. What is primary health care?
• Primary health care is essential health care based on practical, scientifically sound
• socially acceptable methods and technology made universally accessible to
individuals and families in the community through their full participation and
• at a cost that the community and country can afford
PHC Status in India:
• ''In rural areas, there are no doctors. They (PHCs) are functioning only on paper.
There is no facility at PHCs. Hospitals function without any doctor,'‘
− a SC bench comprising Chief Justice K G Balakrishnan and Justices Ashok Bhan
and P Sathasivam *
8. Health Workforce in villages
Districts
1 doctor per
no. of villages
1 doctor per
rural
Population
Jalna 8 11346
Khammam 6 10340
Kozhikode 0.2 3180
Nadia 4 10820
Udaipur 4 4006
Ujjain 4 3612
Vaishali 6 10549
Varanasi 3 3979
Total 4 5963
10. PHC Economics – Current Scenario*
• RURAL (Primary/ Secondary)
per 1000
Beds 0.2
Doctors 0.6
PE 80,000
OoPs! 750,000
IMR 74/1000 LBs
U5MR 133/1000 LBs
Births Attended 33.5%
Imm. 37%
ANC median 2.5
• URBAN (Secondary/ Tertiary)
per 1000
Beds 3.0
Doctors 3.4
PE 560,000
OoPs!! 1,150,000
IMR 44/1000 LBs
U5MR 87/1000 LBs
Births Attended 73.3%
Imm. 61%
ANC median 4.2
11. NRHM - THE VISION
• Architectural correction in health care delivery
• Special focus on 18 states with weak indicators.
• Improve availability of quality health care in rural
• Synergy between health and determinants of good health
• Mainstream the Indian Systems of Medicine.
• Capacity Building.
• Involve the community in the planning process.
EXPECTED OUTCOMES:
2005 - 12
•Universal Quality Health care.
•IMR reduced to 30/1000 live births
•MMR reduced to 100/100,000 live births
•TFR reduced to 2.1
•Malaria Mortality Reduction Rate – 60%
•Kala Azar eliminated by 2010, Filaria reduced by 80 % by
2010
•Dengue Mortality reduced by 50% by 2012
•TB DOTS series – maintain 85% cure rate
•Responsive Health System
12. Indicator 2005-06 2006-
07
2007-
08
2008-
09
2009-
10
Institutional
Deliveries
54.1 56.6 59.1 61.6 64.1
Skilled birth
Attendants
58.8 61.8 65.8 69.8 74.3
Fully Immunized
Children
80.6 83.6 88.6 90.6 93.6
Couple
Protection Rates
59.7 61.7 64.7 66.7 69.7
Full ANC care
Received
50.8 55.8 62.8 69.8 78.8
Unmet Need for
Family Planning
4.2 3.2 2.7 1.7 1.0
Goal Indicators
14. Reproductive and Child Health (RCH)
programme
Major component of NRHM
• Child Health
• Immunization: BCG,OPV, DPT, TT, HepB
• Reproductive Health of Men and Women
• Family Planning
• OP, Tubectomy, CuT for women
• Condom, Non scalpel vasectomy for men
• Safe Abortion
• STD
• Adolescent RCH
15.
16. Why study different systems?
• First, many European countries have constructed programs that predate U.S.
programs by decades. (There is a wide variation in programs and experiences that is
worth discovering in and of itself.)
• Second, the U.S. system has some huge holes compared with the coverage in many
other systems.
• Understanding the approaches used by other countries may provide important clues to
assessing our own system. Many industrialized countries either provide:
1. health care directly through the government
2.publicly funded health insurance with comprehensive coverage.
17. Classifications of Health Care
Systems:
1. Traditional sickness insurance: fundamentally a private
insurance market approach with a state subsidy. (Example:
Germany)
2. National health insurance: a national-level health insurance
system. (Examples: Canada, Finland, Norway, Spain, and
Sweden.)
3. National health services: state provides the health care.
(Examples: Denmark, Greece, Italy, New Zealand, Portugal,
Turkey, and the United Kingdom.)
4. Mixed systems: contain elements of both traditional sickness
insurance and national health coverage. (Examples:
Switzerland, and the United States.)
18. THE UNITED KINGDOM-THE NATIONAL
HEALTH SERVICE
• National Health Service (NHS) was established in 1948 and provides
health care to all British residents.
• Services are not entirely free.
--private hospital rooms extra
--small surcharge for drug prescriptions filled outside the hospital.
--copayments: Dental care & eyeglasses
• approximately 35,000 GPs in 9,000 practices, servicing 90 % of all
patients
• Consultants are specialists, and patients must be referred to them by
GPs.
19. GERMANY: Sickness Funds
• The German health care system is
based on programs laid out by
Bismarck in 1883.
• Legislation required workers in
various occupations to enroll in
sickness insurance funds.
• The basic approach of mandatory
enrollment in autonomous
(independent) sickness funds,
financed by payroll taxes, lies at the
heart of the German social
insurance program.
• German health system has been
relatively successful at controlling
costs.
• Before the period of reforms, 1970
to 1977, spending increased at a
14.4 percent annual rate, but this
dropped to 6.5 percent from 1977
to 1983 and to 5.1 percent from
1983 to 1989.
Performance of German System
20. DIFFERENT KINDS OF POSSIBLE NATIONAL HEALTH
INSURANCE (NHI) PLANS:
A national health insurance scheme should possess several desirable
aspects. It should:
• provide a health "safety net" for all residents, irrespective of age or
employment status.
• provide choice for providers and patients.
• provide market incentives for cost containment.
• be relatively easy to administer.
• Policymakers faced a dilemma as to whether to fund national health
insurance coverage by individual mandate, employer/employee
mandate, or general revenues.
21. Conclusion
• The experience of the NHS in the area of cost containment is fairly
clear.
• Rationed care cuts money costs, and even with increased expenditures
from the healthcare reforms, total U.K. expenditures are expected to
be well below the European Union and the United States.
• 45 million uninsured is a limitation of the US system.
• A wait list of 1 million is a short coming of UK system.
22. Reference:
• World Bank Data Bank
• Census of India
• NRHM Health Statistics Information Portal
• World Health Organization India Data
