Human Faces UAHC MFC 2011t

257 views

Published on

Background Paper by Dhruv Mankad

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
257
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Human Faces UAHC MFC 2011t

  1. 1. Human Faces of Universal Health Care - Dhruv Mankad1Tips about what is to be done and what is not to be done for Human Resources for UHC i 1. Five Facets of a Universal Health Care (as per MFC’s Concept Paper) • Whole population of a country can access same range of quality services. • Access should be according to needs and preferences. • Access should be regardless of income level, social status, gender, caste, religion, urban/rural or geographic residency, social or personal background. • It offers a comprehensive range of curative/symptomatic, preventive. promotive and rehabilitative health services. • It offers it at primary, secondary and tertiary levels, including common acute life saving interventions. 2. Five Tenets Regarding Human Resources for UHC • Whole population should have access to the same range of health care providers with ability to provide same quality of services – here the qualifications and competency level of the providers has to be same. • Access to them should be according to the health care seekers’ needs and preferences – a plural approach for providers qualified in all ‘pathies’ is essential. • Health Care Providers should be able to provide the services to patients regardless of income level, social status, gender, caste, religion, urban/rural or geographic residency, social or personal background. • The comprehensive range of health care providers for curative/symptomatic, preventive-promotive and rehabilitative health services should be available, accessible and affordable to the health care seekers. • Human resources should be available and able to provide primary, secondary and tertiary level of health care, including common acute life saving interventions. 3. Five Needs of Human Resources for UHC • Whole population of Human Resources should have the availability, accessibility and affordability of same range of education and trainings, responsibilities, quality of services and quality of life1 Email:<dhrvmankad@gmail.com> 1
  2. 2. • Access to them should be according to the needs and preferences of their families and they themselves • Health Care Providers should be enabled to provide the services to patients regardless of their own income needs, social status, gender, caste, religion, urban/rural or geographic residency, social or personal background. • A comprehensive plan for opportunities to provide curative/symptomatic, preventive-promotive and rehabilitative services should be available, accessible and affordable to the health care providers as per their needs, expertise and experiences. • Human resources should be enabled to provide primary, secondary and tertiary level of health care, including common acute life saving interventions.4. Five Do’s to Ensure the Five Tenets about and Five Needs of the Human Resources for UHC (suggested doers are in brackets) • Prepare a blue print for number of providers, locations where they are needed for primary, secondary and tertiary care, for the variety of expertise including in public- private health sector [SHSRC with a HR repository] • Restructure admission processes in Government medical colleges to students from rural background (HSC from a tehsil or selected district junior colleges, vernacular language proficiency as added credit) [State Ministry overviewing medical education in tandem with state medical and paramedical councils] • Compulsory placement in public health services [State Ministry overviewing medical education in tandem with state medical and paramedical councils] • Initiate an Indian Universal Health Services (I.U.H.S.) cadre: [POLITICAL WILL in tandem with MCI in consultation with Army Medical Corps] o A short service 3 to 5 years convertible to Permanent service if desirable by staff or required by public health. Both should have attractive monetary and non monetary rewards – o a comprehensive career plan for UHS cadre including family/ non family placements e.g. remote PHCs can be considered as non family placements with residential, school, transport facilities for families at ‘family base stations’ (In Maharashtra, PHCs in several districts would fall under such categories.) o a mandatory optimum level of quality of life, of quality of services, quality of placements and remunerations etc. o their career development – quality continuing education, supervision and training using new technologies, in new subjects e.g. after 3 years of working at PHC/Rural Hospital, on job DNB courses be allowed in selective RHs. (Add academic allowance to the faculty) 2
  3. 3. o Plan and implement induction processes including management and communication skills from PHC to above level • Encourage a parallel cadre of health care providers to fill in the pyramid of primary care – multipurpose workers, pharmacists, licensed family doctors etc. [State Ministry overviewing medical education in tandem with state medical and paramedical councils in consultation with Army Medical Corps]5. Five Don’ts to ensure the Five Tenets about and Five needs of the Human Resources for UHC (the suggested regulators are in brackets) • Do not allow cross-practices under the shadow of ‘plurality’. An allopathic doctor not trained with Ayurvedic Ras-Shastra prescribing a bhasma is as much a bogus ‘ayurvedic’ doctor as an ayurvedic doctor not trained with clinical pharmacology using an antibiotic as a bogus ‘allopathic’ doctor. [State Ministry overviewing medical education and public health services in tandem with state medical and paramedical councils, respective medical associations]. This also requires to regulate cross practices between different levels of professional protocols, e.g., a neurosurgeon should stick to tertiary level intervention only of neurosurgery. [Respective medical and paramedical councils, accreditation authorities, medical and paramedic associations.] • Do not allow any unprofessional practices – “yes, I have a medical shop also and I am having a beauty parlor, too! Yes, I am also working in a government hospital and having my personal clinic.” These practices are not only illegal and unethical but thoroughly unprofessional. [Respective medical and paramedical councils, accreditation authorities, medical and paramedic associations] • Do not encourage ‘contract-labor’-ness of medical and paramedical staff, ‘contracting’ professionals is different from employing them on ‘contract’. [State level Ministry overviewing public health services, Ministry of Labour, respective medical associations] • Do not place technical experts as financial administrators – the required professional expertise and perspective are quite different sometime opposite (unless they are trained as financial forensics during their career) [State level Ministry overviewing public health services, CAG, respective financial profession associations, IRDA etc.] • Do not protect the ‘non’-protectable lapses - breach of rules, ethics, management norms and procedures [State Ministry overviewing public health services, respective medical and paramedical councils, accreditation authorities, medical and paramedic associations] 3
  4. 4. Some Caveats 1. For the Five Do’s - Some of them seem to be Old Wines in New Bottles but actually they are Old Wines in Old Bottles; not opened earlier correctly so spilt over. They are some of course, New Wines in New Bottles. 2. For the Five Don’ts - Enforcement requires a political will, impartiality and objectivity. Are we prepared to universalize it?i Almost all Do’s and Don’ts are based on evidences in Human Resources at Brazil, Thailand, China and selectivehealth services in India – the Army Medical Corps. . Five of the selective literature are listed here. I. Thoresen SH, Fielding A. Inequitable distribution of human resources for health: perceptions among Thai healthcare professionals, Qual Prim Care. 2010; 18(1):49-56. II. Wibulpolprasert, Suwit and Pengpaibon, Paichit: Integrated strategies to tackle the inequitable distribution of doctors in Thailand: Four decades of experience, Human Resources for Health 2003, 1:12. III. Fabio Ferri-de-Barros, Andrew W. Howard, Douglas K. Martin: Inequitable Distribution of Health Resources in Brazil: An Analysis of National Priority Setting, Acta Bioethica 2009; 15 (2): 179-183 IV. Prof. Sudhir Anand DPhil, Victoria Y Fan SM, Junhua Zhang PhD , Lingling Zhang SM, Prof Yang Ke MD, Prof Zhe Dong PhD , Lincoln C Chen MD Chinas human resources for health: quantity, quality, and distribution: The Lancet, Volume 372, Issue 9651, Pages 1774 - 1781, 15 November 2008 V. Policy Guidelines Army Medical Officers. January 2004 (http://www.scribd.com/doc/14124223/Posting- Policy) 4

×