The document proposes a policy to establish universal primary healthcare in India through a decentralized community-based model. Key aspects include: 1) Developing area-specific 2-year health plans at the sub-district level to address priority health issues like malaria, with involvement from medical officers, staff, and community stakeholders. 2) Establishing incentives for community participation in health as well as career growth for medical professionals involved in implementing plans. 3) Mobilizing resources from various sources including government budgets, private partnerships, and financing institutions to strengthen infrastructure and ensure accessibility of healthcare for all. The model aims to improve health outcomes through inter-sectoral coordination and making primary healthcare systems proactive and sustainable.

3. To secure universal access to and delivery of primary health care to
move beyond mere illness prevention
POLICY STATEMENT
First-contact, person-focused healthcare
promotive, preventive, curative and rehabilitative
Responsible health
Community empowerment and stakeholder participation
Long term health
Inter-sectoral integration of sanitation education, nutrition
Ensuring equity
Reducing exclusion and social disparities in access
“Many government
funded schemes are
well intentioned in
terms of providing
secondary and
tertiary care,
however they do not
provide continuity
of care because they
neglect Primary
care.”
- Dr Srinath
Reddy, Chairman
of Expert Group
on UHC
ENVISIONED PRIMARY HEALTH CARE

4. Active community engagement in an inclusive,
decentralised & incentive based model
 Recurrent Health Plan: Based on an area
specific ‘focus’ issue
 Area: Sub-district level (Block and
Municipality/ Municipal corporation)
 Timeline: Two Years
 Common Entrance Exam: To test health
policy awareness of supervising staff
 Existing government policies on health:
Integrate and implement
 Incentives: recognition, career growth and
monetary awards for policy oriented workforce.
 Resource building: Multi sectoral
coordination between public - private
stakeholders
POLICY OVERVIEW

5. PERSONNEL INVOLVED
Building an effective network of stakeholders at the Sub-District level
Engaging people from below and expert personnel from above
*Swa-swastha implies that the onus of good health is on the self.
The policy will involve the community in improving its own overall quality of health, Swa-Swastha*.
One’s good health lies in the good health of others.
It is the site of policy implementation and sustenance.
MEDICAL OFFICERS
MEDICAL SUPPORT STAFF
PROJECT MANAGERS
ADMINISTRATIVE SUPPORT STAFF
RESPONSIBILITY
Formulate and conduct the health plan
Train Medical support staff
File and evaluate a report at the end of every
two year plan
Professional Staff: Doctors and AYUSH
practitioners for curative care
Policy oriented support staff: Nurses,
Midwives, ASHA workers, Arogya Sevikas,
Technicians
RESPONSIBILTY
Track and oversee policy goals
Generate and manage resources
Compile and digitise data for health
management information system
Basic Qualification: Matriculation; drawn
from the community
Policy Orientation: A three-month course in
Health Policy Implementation
COMMUNITY PARTICIPATION

6. TRAJECTORY OF MODEL
Medical Officer and Project Manager, with inputs from the community, will formulate and implement a
systematic two year health plan
Problem Recognition
Gather data on the endemic
problems of the area
Identify ‘the focus’ for the
2-year plan, with inputs from
the community. For example,
Malaria-elimination
Alternative Generation
Recognise existing government
policies (if any), to tackle
diagnosed ‘focus’
Choice Making
Narrow down to relevant
and viable alternatives
In the absence of policy
precedents, strategize based on
existing economic and human
resources
Model Development
Formulate a comprehensive
model with strategic pit-stops
Example: ‘Focus’ - Malaria
elimination
Pit-stop – sanitation; followed
by insecticide spraying,
installation of mosquito nets
etc.
Implementation
Execute the model arrived
at with inclusive multi-level
stakeholder participation
Assessment
Review the policy
Submit the report to the
District medical officer
Publicise report in local
media
Unaccomplished goals
should become priority of the
subsequent plans

7. Community Based Incentives
Access to primary health care
Focussed attention to urgent health requirements
Increase in overall health, awareness and participation
Increase in investment in health infrastructure. Corrective programmes for areas that
lagged behind
Medical/Administrative Support Staff
Permanent government job with fixed remuneration
Special perks for exceeding specified goals and targets
Monetary and Non Monetary incentives based on performance evaluated every 2 years
Example, Awards and recognition; Health insurance for their families
Medical Practitioners/Project Managers
Career Pathway moving upwards in the Health/Administrative wings of the Ministry
Conditional to fulfilment of a minimum of 3 two-year projects
(This will ensure an inflow and retention of staff in these areas, ordinarily undesired)
INCENTIVES INVOLVED
The model involves varied incentives for all stakeholders to ensure greater participation,
retention and efficacy in implementation of policy goals

8. RESOURCE BUILDING - FINANCE
STATE
+
Increase GDP allocation as
the role of the state is
fundamental
The scheme provides every MP 5 crores per
annum for developmental projects in his/her
constituency
Allocate a minimum of 1 crore per annum per
MP for the policy. Total amount thus generated
would be atleast 790 crores which will act as a
supplementary fund
Generate tax especially for health care like the
2% education cess
Redirect taxes on alcohol, tobacco and food
with little nutritional value to health care
NON – STATE ACTORS
Foster Public-Private Partnership
funding in a 60:40 ratio
GDP
MPLAD
TAXATION
Seek financing from regional
banks like the Asian
Development Bank for rural and
remote area projects
Grameen Banks can also act as
a source of funding
REGIONAL BANKS
Invite private equity
investment in Health care. The
PWC Emerging Market Report
suggests this has improved
infrastructure in rural and urban
areas.
PRIVATE EQUITY
PPP

9. • Encourage adoption of
villages/slum clusters by hospitals
and medical colleges.
• Partner with existing NGOs in the
area which serve as centres of first
contact. Eg. Arpana Trust manages
a MCD health centre in Molarbund,
Delhi.
Coordinate with the existing NGOs
and hospitals.
ENSURING ACCESSIBILITY
• Economically obtain generic drugs
through pharmacy linkages.
• The Tamil Nadu style passbook
mechanism can avoid wastage.
• Conduct Health camps
• Increase Mobile vans and Mobile Health Schemes
• Introduce Wireless technology and Tele-Medicine
• Digitise Health records (like in Thailand)
Improving Access
Drugs
• Register people at the nearest health centre (PHC/CHC/ Govt.
Hospital).
• Registration Fee: Rs. 30/person per year.
• Benefit of the registration: free consultation; referral and
maintenance of medical history.
Registration
• Policy personnel will act as Point of Access.
• Improve reach of existing government health insurance
schemes
Example: RSBY, AABY, JBY, Varishtha Pension Yojana,
Universal Health Scheme
Financial Support

10. IMPACT OF POLICY
The Health Plan includes
certain mandatory programmes
for sustainable health,
implemented through inter
sectoral linkages, making the
system active instead of
reactive.
Inter-sectoral linkages
are formulated to
improve sanitation
Community spaces
become health enabling
environments
Sanitation
Combating Maternal
&
Infant Mortality Rates
Pregnancy related short term
bridge courses for the medical
support staff
IMR and MMR reduced
Health Education
& Health Camps
Integration of existing policies
like Chacha Nehru Sehat
Yojana & School Health
Scheme (Delhi)
Regular health camps in schools
ascertaining early prognosis and
immediate referrals
Employment Generation
Induction of a massive
workforce in the health sector
accompanied by skillset
development

11. SURMOUNTING CHALLENGES
How does the model ensure accountability ?
Local Media will provide publicity to the inefficiencies of the
project
All reports and records will be uploaded online for scrutiny
State Directorates will investigate the misuse of funds (if any)
CONCLUSION
“It is hard to think of anything more
important than health for human well-
being and the quality of life.”
Health as a problem, however, doesn’t
occupy centre stage in Indian
democratic politics.
The present proposal places a person in
a position of advantage, where he/she
can effectively deliberate and negotiate
about health concerns.
Well being is the collective common
good, therefore must be pursued until
made universal, and beyond.
Reports can be gathered from PHCs, government hospitals,
District Statistical officers
Local committees like Village Health and Sanitation Committee
will collect localised data
Whilst dealing with the ‘focus’ area problem, general health
infrastructure is expanded
Thus, instead of neglecting general health, the policy will
work towards it
How do you counter inefficient data collection ?
Is general health compromised by prioritising a
particular focus ?

12. APPENDIX
REFERENCES
High Level Expert Group Report on Universal Health Coverage for India - Instituted by Planning Commission of
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Twelfth Five Year Plan (2012 – 2017), Social Sectors, Planning Commission (Government of India), 2013, Sage
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World Health Organisation India Data
http://www.who.int/countries/ind/en/
Urban Health Resource Centre Website
http://www.uhrc.in/
Partnerships with NGOs and Private Sectors for Improving Health of Urban Poor, Dr Siddharth Agarwal, UHRC,
Feb 9, 2009.
Annual Report, 2012 – 13, Ministry of Health and Family Welfare, Government of India.
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Bodavala, HMIS, 2010.
Healthcare In India, Emerging Market Report 2007 , PriceWaterHouse Coopers Publications
Mobile Based Primary Healthcare for Rural India, M V Ramana Murthy.
An Uncertain Glory, Chapter 6, Jean Dreze and Amartya Sen, Allen Lane, Penguin Books, 2013.

13. Somnath Roy on Primary Health Care In India, Health and Population – Perspectives and Issues.
Replicating Tamil Nadu’s Drug Procurement Model, Prabal Vikram Singh, Anand Tatambhotla, Rohini Rao
Kalvakuntla, Maulik Chokshi, Economic and Political Weekly, September 29, 2012.
Hospitals and Primary Health Care , International Study by International Hospital Federation.
‘Good health at low cost’ 25 Years on, Dina Balabanova, Martin Mckee, Anne Mills, Rockefeller Foundation, 2011.
APPENDIX
REFERENCES