Universalizing Access to Quality Primary Healthcare
In India
Team Details:
Jaya Tibrewal
Nishant Goel
Rohit Gupta
Shagun C...
A) The Infant Mortality Rate and Maternal Mortality Rate in India is still very high even after 66 years of independence
•...
Solutions Implementation Impact
Performance-based pay
for Anganwadi workers
• The salary will have a fixed portion of 1500...
Solutions Implementation Impact
• Building up a corpus fund
• The Fund might be used
to finance 24 hour
ambulance service ...
Solutions
Provide them with
incentive to work
in rural and tribal
areas
Mainstreaming AYUSH • Formal recognition
of Family...
PHC
GP GP GP GP GP
Workers
Integrated with
Village Panchayat
Committee/
Primary School
Teachers
Training
Phase II
• ASHA &...
Govt.
Supplier
District
Warehouse
2
District
Warehouse
1
PHC
PHC
PHC
AW
AW
AW
1
3
2
5
4 Order = PHC(Requirement) +
30-40 A...
Implementation Underlying Principal
Replacement of AYUSH gram methodology with Phased
Approach
As shown above.
Medicinal P...
Solution Implementation Impact
Telemedicines
• Provide specialized training to doctors
• Spread awareness in people taking...
Genre of Challenge Challenges Mitigation Measures
Social Challenges • Rigidity and reluctance on the part of
the villagers...
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Sanjeevni

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Sanjeevni

  1. 1. Universalizing Access to Quality Primary Healthcare In India Team Details: Jaya Tibrewal Nishant Goel Rohit Gupta Shagun Chaudhry Sonal Chaudhary
  2. 2. A) The Infant Mortality Rate and Maternal Mortality Rate in India is still very high even after 66 years of independence • Infant mortality rate is 51/1000 in rural India • Contagious and poverty related diseases are not contained at primary level • 72% infants & 52% married women in India have anaemia,44% under the age of 5 are underweight • Maternal mortality rate:200 deaths/100000 live births Inference: Anganwadi is obsolete in India with respect to the current scenario, isn’t performing as it was envisioned to B) The major reason for deaths in rural India is due to lack of healthcare services in life and death situations • 46000 people die annually due to snake bites as they don’t get timely treatment • 110000 people die annually due to non availability of ambulance in emergency Inference: In times of emergency healthcare infrastructure of India is handicapped/inadequate C) There is a paucity of medical practitioners in rural India due to which people don’t get medical attention • Doctors available per 1000 of urban population=2.97 • Doctors available per 1000 of rural population=0.7 • The potential of more than a million pharmacists remains untapped in India Inference: Though India churns out many doctors every year, there is a serious shortfall of trained personnel in rural areas D) India pharmacy Industry losing 500 Cr. every year on account of expired medicines • 66% of rural Indians do not have access to critical medicine Inference: High monetary loss to country by expiry of medicines and vaccinations arising out of mismanagement E) Amongst developing countries India’s spending on IT healthcare is one of the lowest • Access to specialized care is limited in rural India • No database maintenance of people, their medical history • No centralized system to keep records of medicines and their supply chain Inference: Potential of IT remains untapped in India Problem Statement
  3. 3. Solutions Implementation Impact Performance-based pay for Anganwadi workers • The salary will have a fixed portion of 1500 and a variable portion of 0-3000 per month • The evaluation will be done by the Panchayat in the same way ASHA is evaluated • Increase in motivation to do work Increasing the No. of Active Anganwadi workers per village • The preference to be given to ladies with less household responsibility. • Ensuring that people involved in anganwadi system are not involved in any other panchayat activity • Distribution of work will lead to completion on goals Providing On-Job training to Anganwadi workers • Minimum of 3-4 Workshops to be organised each year • The responsibility of workshops will be of Panchayats • Will help in preparation of Anganwadi for newer diseases and trends Increasing Community Participation • Involvement of beneficiaries of the Anganwadi services to be made a part of the plan designing (bottom up approach) • Making Panchayat more accountable for the activities and progress of Anganwadi units • Making Anganwadi , a central place for community meetings • Will ultimately lead to success of entire initiative of universalising primary healthcare Strengthening the Anganwadi Infrastructure • Providing Washroom facilities • Increasing the children activity space • Provision of integrating 2-3 small Anganwadi in a community into a single Anganwadi • Change in habits and practices of villagers • Change in perspective of villagers towards healthcare Proposed Solutions  Strengthening the Anganwadi
  4. 4. Solutions Implementation Impact • Building up a corpus fund • The Fund might be used to finance 24 hour ambulance service –with basic life support system • Regulatory authority responsible for carrying out regular audits • Extra grants from Govt. in case of epidemics • Presence of Ambulance help in providing access to primary healthcare by old-age and physically disabled people (in case of emergency) • Catering to emergency medical expenses of villagers  Establishment of Rashtriya Swasthya Durbhash Kendra • Establishment of 24x7 call centre network to provide emergency healthcare services to people • Anyone who needs to see a General Practitioner(GP) at night or on the weekend, when their usual practice is closed, will be able to contact local GP practice and have their call automatically put through to the National Health Call Centre Network • Staffed by qualified health professionals. A nurse in the first instance, and then a GP, if required,will assess the patient’s needs and provide appropriate advice and options. If needed, the GP will arrange for the patient to be seen by a local GP • Cost Effective • Healthcare a phone call away Corpus Fund State Government grants Central Government Grants Contribution by Village Community (Meagre Amount)  Corpus Fund for village emergencies Flow of cash in Corpus Fund
  5. 5. Solutions Provide them with incentive to work in rural and tribal areas Mainstreaming AYUSH • Formal recognition of Family Medicine as a special discipline in medicine. Proper Training and incentive to be provided for higher retention. Involving them for personalised medication Implementation • Providing lucrative career path. • Seats reserved for Post Graduation if they serve for 3 years in rural area. • Awareness through Campaigns-one stop approach(discussed later) • Availability of Ayush beyond PHC level(phased approach-discussed later) • Fellowships, centralized training programmes and CMEs for talents in AYUSH • Provide appropriate care for various diseases. • Introducing a family medicine course in every medical college. • Career Path: Junior Dr-->Personal Physician -->Clinic Head • Increase Salaries. • Provide good career trajectory. • Proper Security to be provided - Vicarious liability of the PHCs/Hospitals to provide social security to nurses Inclusion of practical course relating to prescription of medicine. Impact Retention of Physicians in Rural India • Cost effective healthcare solution • No side effects of AYUSH • Ensure a better average level of public health. • Abridge the gap between need and availability of doctors(MBBS). Strengthening of capacity and better public health care. • Turnaround Time will decrease. • Saves resources. Human Resources MBBS Doctors AYUSH Doctors Family Medicine Nurses Pharmacists  Tapping the potential of Human Resource.
  6. 6. PHC GP GP GP GP GP Workers Integrated with Village Panchayat Committee/ Primary School Teachers Training Phase II • ASHA & Anganwadi • PHC Phase I • Diagnostics • Awareness , AYUSH and disease related • Greater ownership at the community ensuring people translate this awareness into appropriate action. • Awareness -peoples’ knowledge of the disease, its causes and related precautions. common myths and misconceptions, • Interdepartmental(ID) and Inter-Sectoral (IS) coordination • 4 per village( 2 women+ one youth +one teacher) are part of the Campaign team for one village • In phase 1 ,conducted each month ,team conducts various diagnostic tests and awareness related to AYUSH. • In phase 2 , the data collected was shared with other stakeholders for further action. • Municipal bodies (MB) to take initiative and ensure that awareness activities are undertaken in all wards in their operational area during the campaign month • A core group comprising of the Municipal Commissioner , NGOs and social worker, would conduct the awareness programme in one slum area every day during evening • As colleges are on vacation during the month of May special summer camps would be conducted by urban youth groups like YMCA focusing on health, HIV/AIDS and other social issues. • Awareness campaign should be made compulsory in every industry facilitated by CII MB Create Teams For Campaign on the Slums under that particular MB  One Stop Approach Focus: Preventive Care Training • Diagnostics • Awareness Database of villagers Database Awareness campaigns in talk –shows , seminars conducted by CII 1 2 4 3 5 6 1 2 3a 3b 4 IS /ID GP-Gram Panchayat 1 Month In Rural India In Slums
  7. 7. Govt. Supplier District Warehouse 2 District Warehouse 1 PHC PHC PHC AW AW AW 1 3 2 5 4 Order = PHC(Requirement) + 30-40 Anganwadi that comes under that PHC Order =Inventory Assessed through data from Phase 1 of One-Stop Approach CD Traditional Model Proposed Model Implementation Warehouses were overused in the beginning & Underused towards the end of the year Warehouse inventory maintained with economic order quantity Centralised Server to maintain records of medicine at district warehouse to facilitate cross- warehouse medicine in times of emergency anganwadi(AW) and PHC have a huge stock of expired medicine No Expired medicines at anganwadi and PHC Central Database (CD) will look for the nearest district warehouse with readily available stock and place an order to ensure quick delivery.(Interoperability)  Revamping the Supply Chain Management System
  8. 8. Implementation Underlying Principal Replacement of AYUSH gram methodology with Phased Approach As shown above. Medicinal Plants(Self- Healing) grown in the backyards: Natural remedies based on ancient Indian medicinal system heals many basic diseases. Therapeutic Packages Provision of specialized packages for special health conditions which modern medicines do not cover. For e.g. Intractable diseases, nutritional disorders like anemia etc. Intensive R and D Development of R and D based AYUSH for prioritized diseases. Strengthen and upgrade the National AYUSH Institutes Performance based budgeting : Allocation criterion should reflect the current status of each hospital: size, complexity of cases handled, the number of service patients served etc. Achieve national health outcome goals Assigning territorial responsibility to AYUSH colleges to achieve the national health outcome goals. Independent evaluations of major schemes Develop a robust system of independent mentoring and evaluation for all major schemes. Phase 1 Co-location of AYUSH facilities for every 15 villages. Phase 2 Co-location of AYUSH facilities for every 10 villages. Phase 3 Co-location of AYUSH facilities for every 5 villages. One Stop Approach Promote culture of Self- Healing Provide evidence based support on the efficacy of AYUSH Organize free Medical Camps  Phased Approach of establishment of AYUSH as a healthcare system 1 year 1 year
  9. 9. Solution Implementation Impact Telemedicines • Provide specialized training to doctors • Spread awareness in people taking Panchayat’s support. • Unify satellite networks of Private players like APOLLO and provide ISROs services. • Usage of mobile vans with fully equipped network and other facilities. • Create a seamless network of medical treatment across the country, irrespective of infrastructure constraints. • Sharing of satellite service will lead to cost savings for all the service providers. UID • Aadhar card includes Electronic Health Record of patient, insurance details, diagnostic reports. • Swiped at hospitals/PHCs across the country • Data to be maintained by private companies • Transmission of data about patient irrespective of his current geography. • Epidemic forecasting doing analysis of geographic patient record. Management Information system • Database maintenance of beneficiaries. • Includes Finance module, personnel module, grievance redressal module, Target setting module. • Can be used in disease forecasting, drug procurement. • Automation of transactions, digitization of data. • Complaints lodged can be traced. • Spreading of information using omnipresent cyberspace. • Helps medical practitioner take critical decisions. E-health • Use existing IT infrastructure of e-panchayat. • Hire one medical practitioner and field worker per village. • Build and maintain database of village. • Using Aakash tablet to access data on the cloud server • GPS-enabled ambulances and mobile technology to send follow-ups to families. • IT enabled villages without spending much on infrastructure. • Survey results of field worker helps govt. design new schemes tailor made for that area. • Anywhere, anytime access to health data on the cloud. UID for storing patient health records, disease forecasting and supply chain planning of medicines Aakash tablet distribution to health workers in each village to access data on the cloud Merging e-panchayat infrastructure with e medicine making health care reach the last mile. Technician keeps record of data and Promotes awareness among villagers about sanitation, hygiene ad first aid, animal bites. Unify satellite networks of service providers of telemedicines Use of MIS-management information system to identify beneficiaries, disease forecast, drug procurement, grievance redressal module  Integrating Healthcare with IT
  10. 10. Genre of Challenge Challenges Mitigation Measures Social Challenges • Rigidity and reluctance on the part of the villagers • Adaptability to new system • Inclusion of community • Creating awareness using Media , Nukkad Naatak Economic • Misuse of Funds • Fund might prove insufficient to cater the needs of many people at one time. • Tracking of fund through MIS • Levying health cess Political Bottlenecks to enforcement of policy Increase in pubic expenditure Technical • Cost and privacy constraints of data maintenance on the cloud • Maintenance cost incurred due to private sector’s role • Giving access to limited authority • Strong Security system to be placed Human Resource Existence of quackery in the current system Removal of quackery from system by strengthening human resource as discussed earlier Challenges and Mitigation Measures

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