The document summarizes a team's proposal on universal access to primary health care. The team details their coordinator, members, and contact information. It then discusses definitions of primary health care, principles of PHC, services offered at health centers, strategies to improve quality PHC according to WHO, requirements for universal access, and proposed solutions focusing on patient-provider relationships and comprehensive, equitable care.

1. Manthan Topic: “HEALING TOUCH: UNIvErsAL ACCEss TO
PrImAry HEALTH CArE”
TEAM DETAILS:
TEAM COORDINATOR-YASHONIL GANGWAL
TEAM MEMBERS:
TUSHAR PAL
MAHESHYADAV
SOHIL JAIN
RAHUL BAJAJ
Email Id: yashonilgangwal@gmail.com
College Name:Acropolis Institute OfTechnology & Research, Indore.
Contact Number:9584755524

2. HEALINGTOUCH
Universalizing access to quality primary
healthcare
Definition
PHC is an essential health care that is a socially
appropriate, universally accessible, scientifically
sound first level care provided by a suitably trained
workforce supported by integrated referral systems
and in a way that gives priority to those most in
need, maximises community and individual self-
reliance and participation and involves collaboration
with other sectors.
Primary Health Care
Preventive services
Curative services
General services Care of vulnerable groups
Outpatient clinic (referral)
Laboratory services
Dispensary
First aid and emergency
services
Health education
Monitoring of environment
Prev.&control of endemic diseases
Health office services
Maternal & child health
School health services
Geriatric health services
Occupational health services
Principles for PHC
PHC based on the following principles :
– Social equity
– Nation-wide coverage
– Self-reliance
– Inter-sectoral coordination
– People’s involvement in the planning and implementation of health
programs

3. Services Offered by Health Centers
 Primary Medical Care
 Preventive Health Care
 Prenatal, Perinantal, & Newborn Care
 Gynecological Care
 HIV Care
 Hearing/Vision Screening
• Oral Health
• Mental Health
• Substance Abuse
• Pharmacy
• X-Rays and Lab
• Specialty Medical Care
• Enabling Services
Health Center Patients By Insurance Status, 2010
Health Center Patients by Payer Source, 2015 Health Center Revenue, 2010
Medicaid
39%
Other
Public
Insurance
3%
Private
7%
Uninsured/
Self-Pay
6%
Other
Grants and
Contracts
23%

4. WHO Strategies of Quality PHC
1. Reducing excess mortality of poor marginalized populations:
PHC must ensure access to health services for the most disadvantaged populations, and focus on interventions which will
directly impact on the major causes of mortality, morbidity and disability for those populations.
2. Reducing the leading risk factors to human health:
PHC, through its preventative and health promotion roles, must address those known risk factors, which are the major
determinants of health outcomes for local populations.
3. Developing Sustainable Health Systems:
PHC as a component of health systems must develop in ways, which are financially sustainable, supported by political leaders,
and supported by the populations served.
4. Developing an enabling policy and institutional environment:
PHC policy must be integrated with other policy domains, and play its part in the pursuit of wider social, economic,
environmental and development policy.
The Basic Requirements for Universal access to PHC (the 8 A’s and the 3 C’s)
• Appropriateness
• Availability
• Adequacy
• Accessibility
• Acceptability
• Affordability
• Assessability
• Accountability
• Completeness
• Comprehensiveness
• Continuity

5. Proposed Solution (The 7
commitments):
1. Fostering the Patient-Provider relationship
2. Comprehensive care
3. Improved access and health equity
4. Quality
5. Support team members to work at
their maximum scope
6. Effective collaboration and healthy
team dynamics
7. Primary Care Leadership
2. Comprehensive Care
• paying attention to all aspects of a
patients life
• understanding the barriers and
risks of low SES, discrimination
and migration
• proactive, relevant referrals
• includes mental health support

6. 3. Improving Access and Health Equity
Access to primary care can reduce
and eliminate health inequity
What is access anyway?
4. Quality
•Patient safety
•Constant thoughtful
evaluation of service
•Full use of EHR
everybody talks
about it
5. Supporting professionals to work
at their full competency
Empower nurse practitioners to be independent
primary care providers
Enable family physicians to manage complex patients and
act as a medical consultant to nursing staff
Define the RN and RPN roles as an integral part of the
clinical team and patient experience
Collaborate with Allied Health
Streamline administrative processes
6. Effective collaboration and healthy team dynamics 7. Primary Care Leadership
Creating
leadership
opportunities
and options for
primary care
practitioners
• Broadening scope
and strengthening
• Experience wearing
both hats
• Creates mutual
understanding of
each others worlds
• The more people
who have this
bridging goal the
more full the
understanding

7. Primary Health Care Strategy – Implementation Plan
The health system is experiencing a number of
pressures, which will intensify
Current pressures
 Workforce shortages at all levels
 Service failures
 Cost growth
 Safety and quality
 Health Targets
 Inequity of access
 Decisions in the national interest
• Pressures will intensify in the future:
 Population growth, redistribution and ageing;
 Increasing risk and prevalence of long term conditions;
 Risk of a second wave of health inequalities associated with obesity;
 Managing within an affordable funding path;
 Effective utilisation of the available workforce;
 Effective application of technological advances; and
 Rising consumer expectations
• Not a system: evaluation of the health reforms
• System leadership and strategic planning: Ministry review
• Lack of collaboration across DHB boundaries: Health & Disability Commissioner reports
Likely service configuration changes have been
identified
 Acute secondary and tertiary inpatient services will
consolidate into a smaller number of centres
 Smaller district hospitals will use clustering, regional
services and networks to expand their critical mass
 Services will shift between professional groups and
to lower levels of care
 Primary health care will have a greater role in
prevention, delivery of traditionally secondary based
services, and improved access to specialist diagnostic
testing
 Information technology will enable an increase in
integration and self management
Unmet need for GP services (any reason), adults by
gender
11.6 14.311.0 14.35.7 7.6
0
5
10
15
20
25
30
Men Women
Gender
Percent
1996/97
2002/03
2006/07
NZ Health Survey, 1996/97, 2002/03, 2006/07
Reducing iatrogenic error
• individual responsibility for patient safety
through tracking and reconciliation systems
• clear communications methods between
providers
• imbedded decision support tools
• creating a calm atmosphere through
thoughtful patient and information flow

8. Challenges
• Sustainability – funding, clinical, workforce,
demand/supply
• Workforce capability/capacity
• Trust and relationships – professional, PHO,
DHB, MOH
• Clinical leadership, governance
• Performance improvement – variability,
incentives/levers, measures, public info
• National leadership versus local autonomy.
?centralised policy
• Coordinated responses – information,
service equity. ?sector oversight
• Change in a commercial environment –
environment that encourages progress and
development
• Reduced rate of funding growth
• Collaboration in a devolved environment –
consensus difficult, variable
• Collective good vs lowest common
denominator responses. ?Decision making
processes needed
High Functioning teams
Essential
elements
Challenges
Shared vision, values and
philosophy
Long term Commitment by all levels
within an organization
Trust and Mutual support Building clients awareness and
understanding of interdisciplinary
approaches
Shared Decision making Redefining roles
Effective Communication Recognizing and addressing structural and
organizational barriers
Related Professional
development
Common understanding structures and
processes within an organization
Clear roles and
responsibilities of team
members
Understanding resistance to change
Enough Flexibility Ongoing evaluation and adjustment of
team approach
Accountability Developing clear, concise
communication systems
Adequate Resources Building and nurturing relationships

9. Possible direction
• Earned autonomy for capable
PHOs
• Stronger clinical governance –
balanced organisational
governance
• Clinical networks to drive
performance/quality
• Flexibility on funding use
• Outcomes based contracting
models – improved
accountability measures
• Partnership models with DHBs
• Strong locality focus,
geographic?
• Delegated funding
• Extended range of services
• Minimum population
• Multiple contract models
• Incentives for capital investment
for larger practices to develop
integrated service delivery
models
What platform do we build on?
• 80 PHOs established since 2002
• 4.0m people enrolled – and patient satisfaction
remains high, by international comparisons
• Access
– 50% reduction in schedule fees
– Very low cost access – 1.16m New Zealanders
– Children < 6 years – 77% free
– Cheaper pharmaceuticals for all
– Greater use of services
• Services
– More focus on chronic conditions
– Innovative new approaches, and greater use of nurses
• Improving performance
– Practice accreditation – Cornerstone/TeWana
– PHO Performance Programme – overall improvement, but
significant variation
– Quality Improvement Committee
HealthTargets

10. Where to start? Government Priority Major Areas
• Reduce Endless Waiting
• Towards Better, Sooner and
More Convenient Primary
Care
• Improving Performance and
Quality
• Strengthening the Health
Workforce
$-
$100,000
$200,000
$300,000
$400,000
Qtr. 1, 2010 Qtr. 2, 2010 Qtr. 3, 2010 Qtr. 4, 2010 Qtr. 1, 2011
Qtr. 2, 2011
Qtr. 3, 2011
Qtr. 4, 2011
$253,679
$72,404
$362,399
$103,434
Reimbursement Loss Total Cost
71% Cost Avoidance
Reduction in Emergency Department
Costs (excluding ancillaries):-

11. Optimum universal access of PHC is
achieved through:
• Adequate maternal care
• Periodic follow up of the “healthy
people”
• Breast feeding and proper nutrition
• Immunization
• Early detection and proper
management
• A sanitary and safe environment
• Health education of parents.
• Forms the basis for other levels
of health systems
• Addresses most important
problems in the community by
providing preventive, curative,
and rehabilitative services
• Organizes deployment of
resources aiming at promoting
and maintaining health.
• Constantly evolving process
• Constant nurturing
• Organizational commitment
• Encouraging and allowing clinicians to
have expanded roles that involve
leadership
• There will be mistakes along the way.
Learn from them
• Don’t forget about the patient
Primary care is an approach that:
• Focuses on the person not the
disease, considers all
determinants of health
• Integrates care when there is
more than one problem
• Uses resources to narrow
differences

12. Appendix
References
 NRHM Health Statistics Information Portal
 World Health Organization India Data
 Economic and Political Weekly (EPW)
 Access Alliance:Multicultural Health and Community
Services
 MINISTRY OF HEALTH: Manatu Hauora.
Never doubt that a small group of thoughtful people can change the
world. Indeed, it's the only thing that ever has.—Margaret Mead

13. Team Details:-
TEAM COORDINATOR:YASHONIL GANGWAL
TEAM MEMBERS:
TUSHAR PAL
MAHESH YADAV
SOHIL JAIN
RAHUL BAJAJ