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  1. 1. Manthan Competition 2013 Group Members: Gaurav Sharma, Shailesh Mamgail, Manik Bansal, Piyush Gupta and Ariba Khan IIT ROORKEE Healing Touch : Universalizing Access to Quality Primary Healthcare Team SWASTHYA
  2. 2. At the turn of this century, Health outcomes in India and the quality of the underlying health system significantly lagged those of its own standards and as well as those of its’ peer nations. To state a few facts, For an Urban population of 37.7 Crore, The No. of Allopathic Hospitals & Hospitals under AYUSH systems in India are 11,613 & 3371 respectively and the No. of Hospital Beds is 540,000. On the other hand, For a whooping Rural population of 83.3 Crore, The No. of PHCs in India is 23391 and the No. of ASHAs in all states is 835,808 which means one ASHA for every 1000 rural population. Current Scenario 540000 835,808 11,613 3,371 23,391 No. of Hospital Beds In India No. of ASHAs in all states No. of Allopathic Hospitals No. of Hospitals under AYUSH Systems No. of PHCs in India Indian Healthcare System Facts
  3. 3. As highlighted by the aforementioned facts, the major problems plaguing the Indian Health Care System currently are discussed in detail as follows:  The Most important problem behind the inadequacies of the Indian Health System is due to the Poor Health Care Policies. Its root cause is the lack of adequate resources and improper implementation of already formulated policies.  Another massive issue is the Misallocation of financial resources and inadequate public expenditure on health which can corroborate the below par state of public health facilities. An average of 3.87% of the GDP is allocated to public health which is inadequate to meet the health requirements of the country.  Most of the Health Care Centers are aimed at benefiting the urban dwellers and the upper class. Health services in rural areas (especially those related to family planning and immunization) have inadequate facilities.  Also, Privatization of public health institutions have contributed to the increase in health costs. The accelerated phase of privatization and deregulation of the health sector in the recent years has resulted in a situation where 83 % of the aggregate expenditure on health in our country is private spending.  National Health Policy (NHP) being the backbone of the Health Care Policies, is riddled with confusions and contradictions as it only proposes numerous impressive principles and goals but does nothing to ensure that these are realized on the ground. On the other hand it can also be argued that this new NHP is an attempt towards legitimizing the ongoing privatization of the health care system of the country. Further, there is no analysis of what is happening to some of the major determinants of health-like food, water, and sanitation etc. and the important indicators (of health status) in the emerging scenario.  Another problem affecting the success of primary health centres is the Predominance of clinical and curative concerns over the intended emphasis on preventive work and the reluctance of staff to work in rural areas.
  4. 4. Our Implementation MODEL Our aim is to ensure the quality primary health for whole population of this country. We have tried to achieve this goal through a model, which involve existing schemes RSBY, NRHM, private insurance companies, private and government doctors, all working together to achieve this goal. We have also ensured that the investment involved in the execution of the model should be nominal and instead of introducing a completely new scheme, come up with better working model using existing schemes with use of better technology. MODEL:  Government provide funds, resources and create infrastructure providing good primary health to the people, major scheme in this respect is NRHM , now the officials involve of NRHM in our model are : ANM,ASHA,SHG  Make district health mission independent to allocate funds to Panchayats, at its own discretion received from Central and State government.  Any family member when need to get the treatment can either use Medical Helpline or in case of relatively major issues can go to the PHCs or can call the ambulance all these expenses incurred will be deducted from the RSBY credit amount i.e. Rs 30,000/- and the remaining balance will be send to the use through a message .  In case of patient wants to visit the PHCs , then the amount charged for the treatment will be send to the ASHA and to the patient, in case the amount is greater than Rs 5000/- then ASHA need to visit the PHCs due to check any discrepancy.  For organizing camps of mobile Hospital care, ANM can contact the PHCs.  Insurance companies are interested in people acquiring as many cards as possible instead of hiring executives should better create a Self Help Group in villages or localities which get the incentives on every RSBY card they formulate, this will provide employment to local people mainly women.
  5. 5. *Note: The Model has been further elaborated in detail in the subsequent slides.
  6. 6. Our Implementation MODEL Details of Medical Helpline for RSBY:  For common health problems like headache, common fever, diarrhea people generally prefer to go directly to nearby dispensary rather going far away PHCs of District hospital for that matter. To save these expenses we can put a patient- telecom – doctor- dispensary model. There will be an optional home delivery option as well.  Key components are: 1) Aggrieved Person: He can be a RSBY card holder or others. In case of RSBY card holder all charges of call center operative, doctor, medicine and delivery (if opted) will be automatically deducted from RSBY account and will be sent to respective person. In case of other classes, person would have to pay the entire fees to the dispensary. Fees of doctor and call center will be deducted from dispensary person’s account directly. 2) Call centers: To provide a toll free costumer service, manpower from PSU’s like BSNL or MTNL can be diverted to provide call centers. Or the manpower can be increased to provide 3) Doctor: Doctors will be asked to work for one hour a day for providing prescription on basis of symptoms forms provided by call centers. A fixed fees on per case basis will be given to person. 4) Registered Dispensaries: Dispensaries will be selected within a circles of atmost two or three villages. Owner of these dispensaries will be connected by AADHAR card. The cost of medicines (+ delivery charges in case of home delivery) will be sent directly to the medical shop. 5) Delivery man: Dispensary owner can hire people for delivering medicines. ASHA will ensure that the due payment is done by dispensary owner.
  7. 7. Our Implementation MODEL  It is explained as: 1) Patient calls a toll free number which connects him to a service center and will give his RSBY number. 2) Service center enquire basic symptoms and feeds them to a central database software that is programmed with additional questions for each basic query i.e. if basic problem is cough, then questions like i) Since how long. Ii) Any medication earlier iii) presence of blood in cough? May be pre fed in to the programs. The attendant fills the responses and thereby creates a form that he sends to the required doctor available at that slot. 3) The doctors looks at the forms and prescribes the medicines from a list of medicines defined in the software (updated monthly). He can also deny on grounds of insufficient information or he can ask to talk to patient directly. He can also refer the case to PHCs or other healthcare center. 4) The name of the dispensary and code will be sent to the user and prescription and code will be sent to dispensary person via SMS along with a verification code. 5) Now patient can go to any dispensary/medical clinic nearby and take medicine after confirmation using the verification code dispensary person. He can also ask for home delivery. He would be adequately charged for this. This is how our Model works and the patient would be ensured prompt primary health care effectively. And this is how Indian Population would be ensured its Right to Healthcare. To make this system even more efficient and reliable in future, we plan to implement direct interaction between patient and doctor through video conversation by establishing internet hubs in villages. This will ensure better diagnosis. Also it will be much easier, faster and cheaper to provide for such facility in remote areas.
  8. 8. Auxiliary Solutions:  The State parties to this Committee are supposed to submit periodic reports to the committee on Economic, Social and Cultural Rights as regards the implementation of the provision of the Committee. In turn the committee, after deliberating on the report with 6th representatives of the government concerned, is supposed to help State parties in improving the implementation of the rights enshrined in the Committee. There is no reason to believe that, with appropriate reorientations in fiscal policies of the central and the state governments, the task is beyond the economic capacity of the Indian nation. To put it bluntly, spending on schools, hospitals, poverty eradication etc. may be a desirable option for any society to enable it to spend less on police and prisons.  There is a need to set up an Independent and effective Health Regulatory and Development Authorities at both national and state levels that would supervise the quality of services delivered by both public and private sectors. Since the implication of this require huge capital thus this job can be handed over to ASHA under NRHM. The ASHA would oversee the contracts, accredit health care providers, develop ethical standards for delivery, enforce patient’s charter of rights and take steps to provide universal health care system support through legal and regulatory norms, standard treatment guidelines and management protocols for national health package. This can control entry, quality, quantity, and price. The ASHA ,through ANM, would also ensure grievance redressal mechanisms by linking up with measures to ensure citizen participation and accountability.
  9. 9.  Right to Healthcare: It is the need of the hour to ensure that all citizens must have health as a core entitlement, which is justiciable, and in whose provisioning the State must be held primarily accountable. With appropriate reorientations in fiscal policies of the central and the state governments, the task is achievable. The following graph represents health expenditure per capita (current US$), and as can be seen India performs poorly.  In another sign that India has much catching up to do, the Human Development Report 2013 released by the United Nations Development Programme (UNDP), ranked the country at a low 136 among 186 countries on its Human Development Index (HDI) — a composite measure of life expectancy, access to education and income levels. Auxiliary Solutions: 85 64 92 101 136 BRAZIL MALAYSIA SRILANKA CHINA INDIA World Human Development Index Ranking
  10. 10. References  Indian Healthcare: Inspiring possibilities, challenging journey, by McKinsey and Company (Dec, 2012)  Indian Census, 2011  Ministry of Women and Child Development (http://wcd.nic.in/)  Http://data.worldbank.org/  Ministry of Labour and Employment (http://labour.nic.in/content/)  Wikipedia (http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita)  Health Care in India - vision 2020, Issues and prospects by R. Srinivisan  Ministry of Health and Family Welfare (http://mohfw.nic.in/)