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Arogyabanks 2012

Arogyabanks 2012

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This is an idea I tested in 2010 in some vilages with help of NGOs. It is workable, but we need a more serious trial and analysis. I am proposing that village & community based health centers is a key to many of our health system problems. This will provide a wide network of services at the base of the health care pyramid, generate local employment and spread health information in the last mile. I am appealing for help. Pl call me on 09422271544 or email on shyamashtekar@yahoo.com

This is an idea I tested in 2010 in some vilages with help of NGOs. It is workable, but we need a more serious trial and analysis. I am proposing that village & community based health centers is a key to many of our health system problems. This will provide a wide network of services at the base of the health care pyramid, generate local employment and spread health information in the last mile. I am appealing for help. Pl call me on 09422271544 or email on shyamashtekar@yahoo.com

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Arogyabanks 2012

  1. 1. • An initiative for village/community based self-reliant health facilities • Will provide primary Info, disease detection, care and linkages
  2. 2. Arogya Banks A business or CSR plan PROPOSED BY Dr Shyam Ashtekar, MD (PSM) Consultant Community Health Nashik 422013
  3. 3. Need and feasibility
  4. 4. In 1940!
  5. 5. Need • 70% villages have no local health facility • Villages have to purchase inferior health care, travel a distance, pay stiff costs (Rs 50- per episode) and access costs • Loss of daily income for two (sick+attendant) • Major drain on rural family incomes, 2nd important cause of indebtedness
  6. 6. 16% villages and docs: 2000 study in Nasik villages w ithout doctors villages w ith docs 84%
  7. 7. A health system pyramid without much foundation!! No docs for villages, not even good health workers
  8. 8. Many efforts on rural health: A draw? O X X X O O O O X
  9. 9. Concept-Arogyabank • We want to provide a comprehensive and winning formula • A health facility for serving comprehensive first level care-curative, preventive, health-promotive, information needs and referral • A PPP model at grassroots
  10. 10. We take our Mandate from • Health for all by 2000 • National Health Policy 2002 • National Rural Health Mission • 72-73rd constitutional amendments • Policy on PPP (public-private partnerships)
  11. 11. Integrated model-PPP • Several old and new experiments/schemes are integrated in this • Provides a broad-frame for innovation and experiments • We will technically support the network
  12. 12. Ownership- model • Shared between village panchayats, public health dept, people, private sector and provider (health worker) • Corporate ownership possible • Each AB Unit–ownership with local bodies/SHGs
  13. 13. Objectives-to provide • Primary medical aid for 50+ health problems • Health information through print and e- medium • Preventive care for important health problems • Referral to proper institutions and follow up • Save some health expenditure and some access costs
  14. 14. Feasibility • Crying public need felt-expressed felt need! • Many villages are deprived of health care • 73rd amendment to constitution empowers villages • People already spend resources • Govt schemes exist-PHW/ASHA etc-but defunct • We need to explain the options and tie up loose ends
  15. 15. Location and Hardware
  16. 16. Locating • 1000-2000 pop cluster and within 2 km • Rural location (can be urban also) • based on expressed need by Panchayat/a valid village body or group • Generally we will omit village with health sub/center • Selection on basis of participation by village panchayat/ SHGs and fulfilling conditions
  17. 17. Space and shelter • The facility should have a visible shelter-room • Standard color code • A small room/dome can do
  18. 18. Hardware • Furniture-cupboard. table, chairs/seats • Clinical set-wt machine, BP, thermometer etc • Computer for health demos, with 2 hr back up. • Connectivity welcome –will start E health • Mobile phone mandatory
  19. 19. Legalities
  20. 20. Legal support • Mandate from 73rd amendment to constitution • Use of MMP act section2/iv- exempting health volunteers from MMP (no sales, no profits) • Use of FDA schedule K, 13-use of medicines by CHWs etc • Use of FDA schedule 23-village shop remedies
  21. 21. Human Resources
  22. 22. Better trained HealthWorker • A trained professional health care worker (we will train) • Man or woman, or both for a bigger population • Retired soldier, disabled persons can also participate • Part time work and compensation to start with.
  23. 23. Use of ASHA-PHW • Both ASHA & Pada Health Worker are existing health workers with some financial and system support • PHW (Pada Health Worker) gets 400 Rs per month, little work, looking for worthwhile work and role inn the health system
  24. 24. ANM or MPW? • Both Auxiliary Nurse and Male health worker are existing health workers with good financial and system support • MPW/ANM can fit the bill if Govt system wants an experiment with Arogyabank.
  25. 25. Eligibility and Entry Test • Eligibility: 10th is fine • We may conduct an entry test, hence village panchayat can recommend 3-4 candidates
  26. 26. Training and accreditation
  27. 27. Training • Level 1-Arogyamitra course -spread on 5 months, ODL, total 5 wks • Level 2-palliative care, clinic assistant, emergency aid, • Level 3 additional modules: select diseases, scientific massage, data-management, • Level 4: child care, geriatric care, care for disable, even Skilled Birth Attendant
  28. 28. Accreditation • Health worker: We will conduct examinations for every level annually, This will be an ODL programme with continuous assessment and credits • Procedures: SOPs are ready • Center: standard norms
  29. 29. Tasks & activities
  30. 30. Free/public paid Tasks 1. First aid for emergency (free) 2. Nutrition education 3. Detection of important illnesses-anemia, HBP,DM,TB,cancers 4. Water test, water-disinfection 5. School Health 6. Assisting in RCH & NHPs (VBD, Nirmalgram) 7. AYUSH promotion 8. Referral and follow up 9. Health data
  31. 31. User paid Tasks • Part-time primary care • Detection of important illnesses- anemia, HBP,DM,TB,cancers • Home care • Simple lab tests, water test • Assisting in RCH & NHPs (VBD, Nirmalgram)
  32. 32. Time-sharing • 1 hour in morning and evening -for medical care to start with. • The health worker will do his/her livelihood activities in the daytime • Public interest activities to be timed as per inputs/supports
  33. 33. Drug kit and supplies
  34. 34. Consumables • 20 primary care medicines each from allopathy, Ayurveda, Homeo • National Health program supplies like DOTS, malaria remedies, condoms, pills etc • Herbal remedies • Wound care material
  35. 35. Fever Aspirin/Pamol Tribhuavnkirti, Guduchighanvati Belladona Tulsi kadha, w arm w ater, tepid sponging old injury pain/muka mar Aspirin/Pamol Arnica 30 Toothpain Aspirin RS Common cold paracetomol* tribhuvankirti allium sepa ST3/ST3/LI19/LI4 Lemon grass tea URTI Aspirin/Pamol Sitophaladi, tribhuvan***, Ginger+honey or jaggery URTI-productive Cozal+pamol Sitophaladi, Milk+haldi, Jeshthimadh, adulsa childhood LRTI Cozal+pamol Milk+garlic LRTI adults Cozal+pamol Steam inhalalation Tonsillitis Cozal+aspirin/pamol Mirc IR Asthma attack# Salbutomol-inhale/tab Sitophaladi Rein17/LU7 Breathing exercises, GIS Acidity Gellucil** Sootshekhar*** Hiccoughs Jaggery child dirrhea ORS Jaiphal (balghuti) Diarrhea-adult Furazolid+ORS Kutajghanvati Arsenic alba Cof ee, Constipation triphala churna, Arogyavardhini LI4/ST36/ST6 Aamla, Rajgira bhaji, Constipation-child Gheee/oil by mouth at night w orms albendazole dysentery-amebic metronidazole Kutajghanvati Merc Cor Cof ee, dysentery-w ith blood Cozal+dicylomine Kutajghanvati Ghee Nausea/motion sickness Ipicac Moravala vomiting/ motion sickness domperidone sootshekhar Arsenic alba Pain-abdomen-adult Dicyclomine#& para Mag phos Indigestion, gases Hinguastak churna ST36/P6 for appetite Pain-abd-baby (criyng)# Hing appl/murudsheng skin Boil Arogyavardhini Hepar sulf Inf w ounds Cozal+dressing triphala w ash+neem oil calendula papaya, aloe Itch/alleregy/insect bite CPM Fungal inf ection w hitfield /miconazole Scabies-dry Gammsacb Urinary Burning urine sodamint dhaniya paani, kulatha kadha Hem opoietic Anemia Fersolate Other infect dis Malaria chloroquin China 30 chirait-kadha Jaundice & fever Pamol Arogyavardhini Bhi-amalki kalk conjunctivitis Tetra eye drops ear inf ection Cozal+Para+CPM Wax in ear Hydrogen peroxide Fem Repr sys Vaginitis GV+Metro pessary# Triphala w ash Crushed garlic petal dysmenorrhea Paracetomol Lactation(to boost lactation) Shatavari kalp Em ergencies dog-bite soap w ash snake bite Elastic bandage Chest pain (acute)# IsobarbideT+aspirin Ushnatavikar Burning, piles, nosebleed Chandrakala Barf f or nosebleed
  36. 36. Supplies • Standard purchase from listed store for allopathy and Ayurveda & Homeopathy • Home /local remedies • NHP (programs) supplies from primary health center /subcenter • Explore periodic Network supply
  37. 37. Panchayat links • Mandated by 73rd amendment • Contractual worker for specified period and tasks • Panchayat shares owenership • Space is owned by panchayat
  38. 38. Info bank and software
  39. 39. Software • Common clinical protocols • CDs for health information-e book • E-learning modules for HW and people • Slideshows and Videos on health • Info on health facilities with contacts
  40. 40. Mobile connectivity • Use of mobile mandatory • For information exchange and network • Broadband connectivity will offer extra advantage. • Back up by experts • Referral links
  41. 41. Continuous health education through • Arogyavidya: CD • Print-outs, printed pamphlets • Meetings • Refresher training • Posters • SMS /voice narratives on cellphone. • House-journal
  42. 42. Academic • The flexi-learning model (ODL) with accreditation, • use of IT based learning • low-cost adult learning –lifelong learning • Deconstruct and ring type model with increasing complexity level • Epidemiologically fitted for needs
  43. 43. Economics of Arogyabanks
  44. 44. A) Development funds- • Human Resource development/ unit costs Selection Training & accredit 5000 Level2 training 5000 10000
  45. 45. B) Capital-funds furniture Netw ork 5000 equipment Netw ork 5000 starting kit Netw ork 1000 Computer Netw ork 30000 cellphone& cdNetw ork 4000 Corpus Netw ork 5000 60000
  46. 46. C) Operational Costs Operationl exp annualised Honorarium PHW/ASHA payment 24000 Drug refills revolving fund 1000 HEd material 1000 maintenance 1000 travel 1000 28000
  47. 47. Costs and returns: Some Guestimates •10 illness services daily- at Rs average 10s, brings 2500 per month. (drug costs are extra) •Tests and other services: 1000 per month •Out of 3500, 2000 will go to paramedic •1500 will go to overheads and network profit per month. Rs 500 for monitoring •Rs 12000 annual profit, on a capital of 60000. •We plan to start 100 centers, hence about 12 lakh proceed per cluster of 100 (say half a district)
  48. 48. Additional Pay for the health worker (3h/day/6day per week) • Village retainership through panchayat funds/untied funds (300 pm) for 1 hr daily • Task payment from Public Health dept for national programs (about 300 pm) for 1 hr daily • User fees for other personal health needs (about 1400 pm) for 1 hr daily
  49. 49. Overheads • This factor will depend upon the network size and spread • A 100 unit network should require two full timers to look after and coordinate
  50. 50. Outcome and cost- efficiency • Primary care for 70% needs at 30% costs (less than access costs), • Will reduce irrational care by unqualified persons • Preventive care of enormous value to people and nation • Will reduce hospital loads, hence improve efficiency • Early care will reduce morbidity • Follow up tasks will improve outcome • Public health system gets a foothold in community
  51. 51. Monitoring and quality • Code of conduct for care providers • Technical work monitoring by network agency • Social and cost monitoring with village body
  52. 52. Network and management
  53. 53. Network • A close network of 100 centers will maximize use, impact, visibility and viability • Professional and info-management, supplies
  54. 54. Management- Various models • Stand-alone units • Small area networks • Large are networks
  55. 55. Corporate Social Responsibility • CSR can add value and management inputs • CSR can create this unique contribution to health system
  56. 56. Linkages with Public health system • Links with MPW, ANM, Health visitor and PHC doctors • Links with Anganwadi • Village sanitation and water supply committee
  57. 57. Stakeholder priorities
  58. 58. Peoples’ priorities • People need to get good quality care • At low cost • Timely • Humanitarian • Accountable services • Referral and follow up support
  59. 59. Health Worker priorities • Should get quality training, some life saving skills • Reasonable earning for part time work-about 1000-2000 at least • Respectable role, popular utility • Hold interest of community • Safety from hassles
  60. 60. Public health system should • Appreciate the complimentary role of this network • Be ready to contract out work and provide support and supplies • Deliver timely payments for program tasks
  61. 61. Steps and phases GramP passes resolution for the AB & gives undertaking Village has ASHA/PHW & enroles in AM-YCMOU 6m prog OR or the ASHA/PHW passes in Entry test equal to L1 Preparation Selects-prepares one room/shelter/hut Logo painting Team visits and Okays Undertaking of the HCProvider Computer system donated-trial run Network provides basic kit and equipment (15000) Candidate gets mobile if connectivity is available Phase1 (1yr) AB starts working, mentors visit fortnightly Weekly tele review of services/stocks/funds/problems Monthly meeting at block for help Phase2 Upgraded week long training programmes (L2) Enhancement of work/stocks/logistics Review and feedback
  62. 62. Remember • Network ownership and branding is crucial • Quality, reliability, connectivity important • PPP model can be a win-win • Urban program will add value
  63. 63. This Arogya Bank is a true story At village Pofala, ta Fulambri, Dt Aurngabad, Dr Ambedkar Vaidyakiya Pratsithan & Hedgewar hospital has started an Arogyabank . The trained paramedic is smt Chaya Krushna Gade, 22yrs, at her own home some 9 month back
  64. 64. Thanks Dr Shyam Ashtekar Nashik email: shyamashtekar@yahoo.com 9422271544

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