India faces significant challenges in primary healthcare including inadequate resources, lack of access in rural areas, and poor health outcomes. The presentation analyzes problems such as understaffing, lack of funding, and uneven quality of care. It identifies strategic opportunities to strengthen primary care through public-private partnerships, expanding insurance coverage, increasing healthcare spending, improving workforce and infrastructure development, and decentralizing healthcare administration. The goal is to transform India's primary healthcare system by 2025 to achieve universal access to affordable and high-quality primary care services.
As the burden of NCDs increases, various countries have introduced new and innovative modes of managing them in primary healthcare setting. APO, in conjunction with Duke Kunshan University, China, conducted a 4-country study (Bangladesh, China, Nepal and Viet Nam) to understand the different approaches used in involving CHWs in preventing and managing NCDs. Access full publication here http://bit.ly/2XnWwcd
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
Nick Goodwin: making a success of care co-ordinationThe King's Fund
Nick Goodwin, Chief Executive at the International Foundation for Integrated Care, looks at how care could be better co-ordinated around people with complex needs, and the challenges around delivering joined-up care.
World Alzheimer Report 2016: Improving healthcare for people living with deme...Adelina Comas-Herrera
Keynote paper at the 2016 Alzheimers NZ Biennial Conference and 19th Asia Pacific Regional Conference of Alzheimer’s Disease International, Wellington, New Zealand, November 2016
Localization of Universal Health Coverage for Equitable Health Outcomes in NepalDeepak Karki
Presentation entitled "Localization of Universal Health Coverage for Equitable Health Outcomes in Nepal" by Dr Shiva Raj Adhikari on the 18th Anniversary of Nepalt Health Economics Association.
This second edition of the health system review of Philippines shows the major changes that have occurred over the 7 years since the last review. Channelling of funds from sin tax to Health has shown unprecedented levels of finances are now available for UHC. PhilHealth has dramatically increased coverage of people as well as service providers that it works with from both government and non-government sectors. However major challenges remain; regional and socioeconomic disparities in the availability and accessibility of resources are prominent and there is a need to improve regulation of service providers. Philippines HiT reports on the current health system reforms undertaken including challenges of incorporating primary health care as in the overall health architecture of the country.
Thailand was the first country outside of China that reported COVID-19 infection in January 2020. At the peak of transmission during March-April 2020, it was reporting close to 200 new cases per day and yet it has been able to control the outbreak with no laboratory confirmed local transmission reported for over 100 days as of 2 September 2020.
This publication attempts to identify in a systematic way, various policies and steps that were put in place from the beginning of the outbreak to control COVID-19 transmission in the country.
The November 2020 update builds on the previous document by focusing on the challenges of balancing opening up the country and protecting the population from COVID-19 as well as preparing for the potential second wave.
While progress has been made in India over the past decade from both public and private sector initiatives, significant challenges persist in providing quality healthcare on an equitable, accessible and affordable basis across all regions and communities, according to a new IMS Institute for Healthcare Informatics study. A 40-45 percent reduction in out-of-pocket expenditures for both outpatient and inpatient treatments can be attained through a holistic approach addressing four critical, interrelated dimensions of healthcare access. Those components are: physical accessibility and the location of healthcare facilities; availability and capacity of needed resources; quality and functionality of service required for patient treatment; and affordability of treatment relative to a patient’s income.
The study – Understanding Healthcare Access in India: What is the Current State? – is the most comprehensive assessment of healthcare access undertaken since 2004 and is based on an extensive survey of nearly 15,000 households covering all socio-economic groups in rural and urban areas across 12 states. Information was gathered on more than 30,000 healthcare system interactions, supplemented by interviews with over 1,000 doctors and experts.
The full report is available at http://www.theimsinstitute.org for downloading.
Elena Reyes, PhD, Associate Professor & Director of Behavioral Medicine, Florida State University College of Medicine, Regional Director Southwest Florida
Latino Health Forum 2014
This describes the background problem, concept of health insurance, enrollment procedure, benefits,and implementation status of health insurance in Nepal, issues/concerns (discussion), take home message
As the burden of NCDs increases, various countries have introduced new and innovative modes of managing them in primary healthcare setting. APO, in conjunction with Duke Kunshan University, China, conducted a 4-country study (Bangladesh, China, Nepal and Viet Nam) to understand the different approaches used in involving CHWs in preventing and managing NCDs. Access full publication here http://bit.ly/2XnWwcd
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
Nick Goodwin: making a success of care co-ordinationThe King's Fund
Nick Goodwin, Chief Executive at the International Foundation for Integrated Care, looks at how care could be better co-ordinated around people with complex needs, and the challenges around delivering joined-up care.
World Alzheimer Report 2016: Improving healthcare for people living with deme...Adelina Comas-Herrera
Keynote paper at the 2016 Alzheimers NZ Biennial Conference and 19th Asia Pacific Regional Conference of Alzheimer’s Disease International, Wellington, New Zealand, November 2016
Localization of Universal Health Coverage for Equitable Health Outcomes in NepalDeepak Karki
Presentation entitled "Localization of Universal Health Coverage for Equitable Health Outcomes in Nepal" by Dr Shiva Raj Adhikari on the 18th Anniversary of Nepalt Health Economics Association.
This second edition of the health system review of Philippines shows the major changes that have occurred over the 7 years since the last review. Channelling of funds from sin tax to Health has shown unprecedented levels of finances are now available for UHC. PhilHealth has dramatically increased coverage of people as well as service providers that it works with from both government and non-government sectors. However major challenges remain; regional and socioeconomic disparities in the availability and accessibility of resources are prominent and there is a need to improve regulation of service providers. Philippines HiT reports on the current health system reforms undertaken including challenges of incorporating primary health care as in the overall health architecture of the country.
Thailand was the first country outside of China that reported COVID-19 infection in January 2020. At the peak of transmission during March-April 2020, it was reporting close to 200 new cases per day and yet it has been able to control the outbreak with no laboratory confirmed local transmission reported for over 100 days as of 2 September 2020.
This publication attempts to identify in a systematic way, various policies and steps that were put in place from the beginning of the outbreak to control COVID-19 transmission in the country.
The November 2020 update builds on the previous document by focusing on the challenges of balancing opening up the country and protecting the population from COVID-19 as well as preparing for the potential second wave.
While progress has been made in India over the past decade from both public and private sector initiatives, significant challenges persist in providing quality healthcare on an equitable, accessible and affordable basis across all regions and communities, according to a new IMS Institute for Healthcare Informatics study. A 40-45 percent reduction in out-of-pocket expenditures for both outpatient and inpatient treatments can be attained through a holistic approach addressing four critical, interrelated dimensions of healthcare access. Those components are: physical accessibility and the location of healthcare facilities; availability and capacity of needed resources; quality and functionality of service required for patient treatment; and affordability of treatment relative to a patient’s income.
The study – Understanding Healthcare Access in India: What is the Current State? – is the most comprehensive assessment of healthcare access undertaken since 2004 and is based on an extensive survey of nearly 15,000 households covering all socio-economic groups in rural and urban areas across 12 states. Information was gathered on more than 30,000 healthcare system interactions, supplemented by interviews with over 1,000 doctors and experts.
The full report is available at http://www.theimsinstitute.org for downloading.
Elena Reyes, PhD, Associate Professor & Director of Behavioral Medicine, Florida State University College of Medicine, Regional Director Southwest Florida
Latino Health Forum 2014
This describes the background problem, concept of health insurance, enrollment procedure, benefits,and implementation status of health insurance in Nepal, issues/concerns (discussion), take home message
Primary Health Care, Objectives, Principles and Policy DirectionsHealth and Labour
Presentation by Dr.Hans Kluge e.a., director of Health Systems, WHO-Euro at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012
The Indonesia HiT reports the significant improvement in the health status of the population over the last 25 years through transitional period in all fields. However, the country faces remaining and foreseeing challenges in communicable diseases and emerging NCDs. The HiT concludes with the future challenges of expanding coverage of National health insurance scheme (JKN), reducing regional disparities in health-care services, managing resources and engaging private sector.
Moving toward universal health coverage of Indonesia: where is the position?Ahmad Fuady
My final thesis about the Indonesian movement towards universal health coverage and its achievement in providing the right to health for Indonesian people.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. Executive Summary
2
Facts related
to health care
Problems
faced by India
Approach
taken
Key highlights
and solutions
Vision 2025
Flow of the presentation
India has some of the best tertiary care in the world and is gradually acquiring a name for itself even in the field of 'medical
tourism'. Secondary care is still a significant challenge, but even in several smaller towns and district headquarters, there is a
growing supply of maternity homes and multi-speciality secondary care facilities. In all of these systems, primary care forms
the anchor around which the entire system is built and there is a high level of integration between various levels of care with
strong gate-keeping and patient management functions being performed by the primary healthcare providers. The actual
situation in this regard on the ground in India is very grim. In most parts of the country, formal primary care is virtually non-
existent. Within the urban context, there is a some amount of formal primary care available in the form of general
practitioners, ophthalmologists, dentists, etc. We have identified operational issues in the system and provided a solution that
how partnerships can improve the face of primary system in India.
3. Where does India stand ?
3
21% Global disease burden and largest
communicable disease burden with India
3rd Highest among countries with
high rate of HIV-infected persons
33% Lack access to proper sanitation
3.3 per 10,000
Doctors in rural areas as compared
to 13.3 per 10,000 in urban areas
• Grossly underfunded, under staffed, and poorly equipped
• Allopathic physicians highly concentrated in urban areas
• Similar trends in concentration of nurses and midwives
Public Health Infrastructure
• Both urban and rural Indian households tend to use private medical sector
more frequently than public sector
• Due to poor level of quality care in public sector
• Long wait lines, inconvenient hours of operation and distance of public sector
facility
Private Health Care
• Public spending on health care in India as low as 0.9% of GDP in contrast to
total health expenditure of 5% of GDP
• Decreasing public health expenditure has adversely affected the health
outcomes
Health Care Costs
• Only 25% of rural population has availability to piped water as compared to
75% in urban areas
• Only 20% of total hospital beds in rural areas which have 68% of India’s
population
• Infant mortality rate in poorest 20% 2.5 times higher than the richest 20%
Urban Rural Disparities
4. Communicable diseases have a major impact on
the decrease in lives of people. Majorly due to
unawareness, carelessness and not taking
enough precautions.
The nurses ratio to population which stands at
current 0.1% is very less and needs
improvements.
Major reason for maximum infant death is
non availability of medicines at the right
time.
We need to work on improving current
levels of sanitation and water cleanliness in
order to establish intrusive development
Private Infrastructure has improved but we are
delivering half of what is a global average and
not even close to WHO guidelines
WHO survey ranks India 171 out of 175, in
terms of total GDP spent on healthcare. Nepal,
Bangladesh are better than India. Also the
utilization percentage of the budget is not 100%
Key Issues and Ground Realities
5. Inadequate human resources to
staff primary care, evidenced by
limited ability to recruit and
retain high quality staff,
particularly in disadvantaged
areas
Failure to deliver universally the
key primary care services
necessary to reach MDG targets
(vaccination, nutrition and
hygiene support, safe maternity
services, effective first contact
acute care for serious disease)
Failure to deliver effectively the
primary care services which
reduce health system costs
(prevention and care of chronic
diseases, effective diagnosis and
prioritization for hospital referral)
Lack of public and clinical
governance of performance
Poor leadership, public regard,
and professional status
Problems Identified
Overall generic problems
5
Underlying operational problems
Funding Models1
• Funding models that are unresponsive to the value of high quality acute,
preventive, and chronic care outside hospital
Distribution and Financing Schemes2
• Distribution and financing mechanisms for medicines that do not take advantage of
the availability of effective generic medicines
Information Systems3
• Lack of effective information systems, including failure to exploit the opportunities
for patient involvement in self care inherent in modern information technology
Human Resources4
• Multiskilling i.e. training individuals to perform tasks within their capacity but
beyond their traditional professional roles which will allow the available workforce
in the team to be deployed most efficiently
6. Problem Summary
• Primary care is an extremely unattractive
career for allopathic doctors
• Virtually no community based postgraduate
training and poor career prospects
• 10% of posts for doctors at the PHCs and
63% of the specialist posts at the CHCs, and
25% of the nursing posts at PHCs and CHCs
combined remained unfilled
• 27% of pharmacist and 50% of laboratory
technician posts also vacant
Human Resources
Platforms to build on
•Training and professional support for
nurses and other staff in primary care
teams
•Develop enhanced specialist roles by
partnership between professional
bodies, Universities, and private
educational providers
•Specific areas of reported need which
could be met include emergency
medicine, child health, orthopedics
•Tie up with countries of special repute
in Health Care in training and
implementation development
•Disciplines that need support in
delivering enhanced skills training
include physiotherapists, dieticians,
paramedics and therapists
Strategic Points
• Introduce incentive schemes—monetary
and non-monetary—and compulsory service
bonds to enhance recruitment of good
doctors to rural areas
• Establish partnership with international
colleges of repute for nurse training
• Establish new nurse institutes on the lines of
ITI across India. Award special economic and
infrastructure status to these institutes
• Preference for admission to education and
training courses for doctors and to local
students from rural and underserved areas
• Preference to clinical workers of local areas
for postgraduate training, financial
incentives, communication facilities, and
opportunities for education of their children
• Reintroduce compulsory service in
underserved areas by all medical graduates
7. Problem Summary
• Major difference in MDG health indicators
between urban and rural areas and between
states
• India is also off- track to meeting its declared
national and MDG targets for child mortality
• Projected infant mortality rate between
states varies 12-fold, from 5/1000 in Goa to
58/1000 in Madhya Pradesh and Meghalaya
• Failure to vaccinate and treat the common
childhood infections effectively
• Poor supply and distribution of vaccines,
including cold chain failures, are reported to
be common despite India being a major
vaccine producer
Universal Services
Platforms to build on
• Technical advisory teams (TASTs) for
provision of expert support from
multi nation and Indian expertise
• Development of local capacity and
sustainability
• Use of modern technology for early
recognition of the acutely ill child in
community settings both in
measuring vital signs and by parent
involvement
• Can be at a system (help line
numbers) or an individual level
(using mobile) as a means of
communication with the parent or
for distance monitoring system
• Strong potential for R&D partnership
with the IT and health technology
sector in India to develop innovative
affordable technologies with very
wide scale application
Strategic Points
• Build on innovative and effective
community development activities
• Employ social health activists and auxiliary
midwives, establishing local sanitation
committees, and organize emergency
transport systems
• Innovative approaches to obstetric care that
have reduced maternal mortality by building
effective local teams integrating primary
and hospital care
• Ensure that women have access to high
quality antenatal care as well as increasing
the number of births taking place in a safe
environment
8. Problem Summary
• Chronic diseases (such as heart disease, diabetes)are
the leading cause of death and disability in India.
• Care currently provided by the private sector and
is expensive.
• A substantial proportion of the population receive
no treatment (47% of diabetics and 91% of those
with angina)
• Restricted availability of preventive care, particularly
in poor and rural populations, increasing the burden
of disease.
• Detection of chronic at later stage due to lack of
systematic screening
• The lack of a strong primary care function also
means that diagnostic triage for both acute and
chronic disease is usually conducted by hospital
based doctors.
•high levels of investigation
• use of more expensive non-generic medicines
•potential for inappropriate management by
someone working outside their area of specialist
expertise.
• Unavailability of cost effective generic in primary
care; nor are they routinely used when they are
available.
Strengthening capacity to deliver services which reduce system cost
Strategic Points
• India has a major advantage in dealing with its
epidemic of chronic disease because its generic
pharmaceutical companies produce high quality
medicines at cheapest prices in the world.
• Effectiveness of Health workers at managing chronic
mental health problems (both anxiety & depression)
• Effectiveness of the diagnostic triage function with
access to standard diagnostic facilities like blood
tests, ultrasound, and imaging.
• Effectiveness of technology assisted self care (self-
monitoring of blood pressure, blood glucose) in
reducing morbidity and mortality.
•Self-management of chronic illness also reduces
healthcare workload and costs essential diagnostic
and monitoring technologies
•Affordable cost
• Allow real time monitoring or screening for a range
of other chronic diseases like diabetes
Platforms to build on
•Primary care doctors making referral
decisions on the basis of accurate
diagnoses and managing most patients
in the community according to evidence
based guidelines using generic drugs
•Creating PPP initiatives and developing
innovative care pathways for chronic
care and achieving a level of staff
motivation
•Facilitating the use of computerized
medical records and patient
management systems for chronic
disease prevention and management
•Developing a cadre of primary care
based advanced nurses specializing in
chronic diseases as well as nurses and
healthcare workers working at less
specialized levels
•Benefit : Provides a career framework
for health workers to become
advanced nurse specialists
•Starting at the level of the ASHA
worker and ending with an advanced
nurse practitioner.
9. Problem Summary
• Major variations between states in the
efficacy of governance.
• Limited knowledge in local governance
• Outcome of care not being monitored
effectively.
• Poor quality services, wastage, corruption.
weak management characterise primary
healthcare institutions.
• Problem of ‘ghost workers’ with up to a
50% absentee rate
• Huge unexplained variation in both within
and between states.
• public and private sectors
• differently qualified practitioners in drug
prescribing and frequency of surgical
interventions
• Inadequacy of training and attitudes to
deliver care of a consistently good standard.
Strengthening public and clinical governance
Platforms to build on
•Building effective internal investigation
and inquiry to track poor governance in
the health services and documenting
them.
•Karnataka, have already instituted
strong governance programmes based
on community involvement and
decentralised planning leading to
improvements in health outcomes.
•Andhra Pradesh has established health
financing schemes (to improve the
access of below poverty line families to
secondary and tertiary care) which are
built on IT platforms aimed at ensuring
clinical, financial, and administrative
governance. Such systems could
potentially be extended into primary
care.
• Taking a cue from the corporates and
starting an appraisal system on
performance basis for each primary
care clinician based on quality outcome
standards and patient feedback
Strategic Points
•Remuneration for primary care to be based on
assessment of performance against evidence
based on nationally agreed quality standards.
Adherence to these standards is assessed by
central electronic interrogation of computerised
patient records.
•All clinical activity undertaken in primary care
facilities, including prescribing and recording of
medical records, should be electronic & linked
with financial management system.
•At district level all financial and clinical
performance of all primary care centres to be
overseen by NRHM
•Creating a network of primary care providers to
develop a demand led situation—giving
patients choice to register with the right
primary care provider
•Conducting a nationally annual survey to
evaluate consumer satisfaction with primary
recording patient views about service quality
and ease of access.
•Creating IT support for clinical decisions by
doctors and self-care by patients to improve
care quality and clinical governance.
10. Problem Summary
• Primary care is not yet recognized by the
Medical Council of India (MCI) as a
specialty
• Primary care practitioners therefore have
no formal postgraduate training, no
specialist accreditation, and no system for
career progression
• They have lower pay and worse working
conditions than their hospital colleagues
• Lack of appropriate training or
qualification does not at present appear
to be a barrier to employment as a
primary care doctor
• The current primary care structure
requires recruitment of doctors to posts in
rural areas where basic housing and
education along with facilities for
personal healthcare may be poor
• Failure to recruit quality practitioners to
primary care over many years means that
there is no pool of well trained and
motivated primary care practitioners to
act as leaders and university faculty and
train the next generation
Primary Care Leadership
Platforms to build on
• The professional regulatory councils
in India can do much to support the
development of primary care.
• Great potential to share knowledge
and expertise with international
counterparts on how to promote the
training and recognition of primary
care practitioners.
• Links between nursing faculties are
limited. There is an opportunity to
remedy this and provide greater
support for the efforts of Indian
medical and nursing colleges to
establish academic departments of
primary care
• Partnership in establishing
national/state conferences on
primary care as a regular tradition
• Provide leadership training for
primary care clinicians in India by
partnering with international
Primary Health Care organizations
Strategic Points
• The high quality diagnostic and curative
primary care offered by doctors working in
major hospital outpatients and polyclinics
is limited in scope and function
• But possible starting point with greater
capacity to develop effective clinical
services working to international quality
standards
• Recently established family practice models
may evolve into a cohort of high quality
community based primary care centers
that could support training
• Harness public support to strengthen
health literacy among the public and refine
people’s expectations so that they begin to
understand the risks of overmedication and
over investigation
11. Primary Healthcare : India vs.
Brazil
Key takers from Brazil
(2010 vs. 1965)
• Health Insurance reach –
100%
• Doctor density: 1.7 per
1000– 425% rise
• Public expenditure: 4.2% -
200% rise
• Infant Mortality – 15 per
1000 births (Global : 38)
TransformingHealth System : Political leadership -> Major
Role
Creating universal access: Primary Focus, Secondary
focuson efficiency or quality
High allocation from Primary Healthcarein Union
Budget
Governmentshould choosebetween payer or provider
role
Decentralized Federal System supported by common policy
framework
Key learnings from Brazil
Envisioning India 2025
Improved Financial Access
•Extensive Insurance cover which should move up from current 25% to 75%
•Those who cannot pay for healthcare would receive it for free under public provision
•Authentication and record setup done through the UID card
HealthCare resource Gaps
•Healthcare must be include under infrastructure industry
•Overall Bed density should reach 2.5 per 1000 (current: 1.3/1000)
•1.5 beds per rural areas and 3.8 beds in urban areas(current 0.3/1000 & 3.4/1000)
Workforce Improvement
•Upto 90% registered practioners must be working effectively
•AYUSH & Rural Medical Practioners need to be incorporated into mainstream healthcare at national level
•Doctor density should increase to 0.9/1000 with doctor to nurse ration maintained at 1:2
More Budgetary Allocation
• At least 5.5% of Annual Budgetary expenditure must be allocated to
Primary Healthcare with focus on sanitation and clean drinking water
Integration of health facilities
• Public-private partnership and tracking of patient treatments
Generic Medicines
• Decrease on export of generic medicines and more effective utilization in
the current Indian Setup
• Increase in awareness among rural and urban areas regarding generics
• Improvement in Generics Distribution across the nation
Vision 2025
12. • Glossary
• ASHA :(Accredited Social Health Activist)
• WHO – World Health Organisation
• References
• Central Bureau of Health Intelligence in health sector, 2005&2010
• World Bank database
• WDI
• WHO
• Global Health Expenditure Database
• 12th 5year plan
• http://indiabudget.nic.in
• Kumar AK, Chen LC, Choudhury M, Ganju S, Mahajan V, Sinha A, et al. Financing healthcare for all: challenges
and opportunities. Lancet 2011;377:668-79.
• Patel V, Kumar AK, Paul VK, Rao KD, Reddy KS. Universal health care in India: the time is right. Lancet
2011;377:448-9
• Rao M, Rao KD, Kumar AK, Sundararaman T. Human resources for health in India. Lancet 2011;377:587-98.
• Sudarshan H, Prashanth NS. Good governance in health care: the Karnataka experience. Lancet 2011;377:790-2.
• Vision 2015. Medical Council of India. March 2011. www.mciindia.org/tools/announcement/MCI_booklet.pdf.
• Sundararaman T, Gupta G. Indian approaches to retaining skilled health workers in rural areas. Bull World Health
Organ 2011;89:73-7
Appendix and References
Thank You