The document discusses universalizing access to primary healthcare in India. It outlines the current healthcare structure and reasons for poor access, including insufficient funding, lack of availability and affordability. It proposes a roadmap to improve the system through measures like increasing infrastructure and availability of resources, improving human resource management, strengthening regulations, and public-private partnerships. The goal is to ensure equitable, affordable and quality healthcare access for all Indians.

1. Universalizing Access To Primary Healthcare
Team Details
• Yogesh Dukare
• Shweta Bharti
• Shilpa Gaur
• Himani Jain
• Chinar Sharma

2. Medical
college
SDH/District
hospital
1/100000
population
Community health
center 80,000-12,000
population
Primary Health Care Center
20000-30000 population
Sub-health center
3000-5000 population
Sub centre covers a population of 5000 in plain
areas and 3000 in Hilly and difficult terrains
Health Care delivery Architecture
Tertiary
level
Primarylevel
Secondary
level
Ensuring equitable access for all
Indian citizens residents, any part of
the country, regardless of income
level, social status, gender, caste or
religion, to affordable, accountable,
appropriate health services of
assured quality (promotive,
preventive, curative and
rehabilitative) as well as public health
services addressing the wider
determinants of health delivered to
individuals and populations, with the
government being the guarantor and
enabler, although not necessary the
only provider of health & related
services.
- HLEG , Planning Commision of India
What is Universal Health Coverage
The “first” level of contact between the individual and the health system. It
is provided by Subcenters , Primary healthcare centers & Community
Health care Centers .
Primary
Health Care :

3. Reasons for poor healthcare structure in India
Insufficient funding of public facilities
Physical reach of any healthcare facility is a challenge in rural areas,
particularly for patients with chronic ailments
Lack of availability of medical services
Inefficient management of available financial & human resources
The provision of healthcare services in India is skewed toward urban centers
and the private sector
Improper planning & allocation of resources
Financial inability to pay (Around 70% of total health spending is out of
pocket, and around 70% of that is on drugs.
Non availability of doctors in public health facilities is a key reason
for selecting private facility outpatient treatments
Even if only one of these components is missing, a patient
is unlikely to receive appropriate healthcare service.
Physical
accessibility
of required
healthcare
facilities for
a patient
Availability
of the
resources
required for
patient
treatment
Quality/
functionality
of the
resources
providing
care
Affordability
of the
complete
treatment to
the patient.
Complete
primary
healthcare

4. Roadmap to improvement in health care delivery status
Roadmap to
improve primary
healthcare
system
“The healthcare system in India is not delivering affordable, acceptable and accessible
healthcare to all Indians – which must be the test of its quality. Fixes to only parts of the
system cannot produce the systemic changes required.
- Arun Maira, member, Planning Commission of India.
Qucik
attention
25%
Lack of
specialists
6%
Can afford
6%
Less waiting
time
27%
Doctor
availability
23%
No free
medicies in
govt.
13%
Why people prefer
private hospitals

5. Infrastructure: Current status and road ahead
0
100000
200000
300000
400000
SHC PHC CHC SDH & DH
Current availibility Expected by 2020
• Currently around 0.9/1000 people,
excluding PHC
• Faulty planning led to under/over
utilized hospitals from rural to urban as
well as North India to South India
• Need-based allocation of beds, medical
equipment
• Increasing tax to GDP ratio over 15%
through non-linear taxation to generate
more funds
• Focusing on ease of access, within a 5km
distance
• Strategic partnership/ outsourcing with
key private players
• Standards for man-hours and skill set
required at each center, other
infrastructure like ambulance
• Implementation of a robust HMIS system
across all centers to share real time
information and analyze and track growth
Availability of beds Infrastructure Planning

6. Infrastructure Current status & roadahead
Health Care Delivery Medical Colleges Nursing Colleges
Dearth of Quality & Trained
HC Professionals.
Faculty recruitment Retention Attracting quality students
Poor Infrastructure & reach to
Tier 2/3 cities.
Maintaining bed occupancy
rates in Teaching hospitals
Limited ability to provide
clinical training
Insufficient Clinical Exposure
for Professionals
Strict regulatory norms Limited financial assistance for
students
Limited Opportunity for
continuous learning
Non Standard content Low quality curriculum
Brain Drain Limited research funding/High
equipment cost
Limited experienced Faculty &
absenteeism

7. Human resource management
0
8
16
24
WHO India
23
19
Heath HRM/10000 Population
India ranked 52 of the 57 countries
facing an HRH crisis.
•34% for MHW are not in position, while 38% of radiographer posts, 16% of lab Tech
posts, 31% of specialist posts, 20% of pharmacist posts, 17% of ANM posts, and
10% of doctor posts are vacant..
Shortage
•A.P, Karnataka, Kerala, Maharashtra, Pondicherry and TN represent 31% of the
population, but have a high share of MBBS seats (58%) and nursing colleges (63%)
•Bihar, Chhattisgarh, Jharkhand, M.P, Orissa, Rajasthan, Uttaranchal and U.P which
comprise 46% of population, have 21% MBBS seats and 20% Nursing colleges .
Skewed
Distribution
HRH shortfalls range from 63% for specialists to 10%
for doctors, and 9% for ANMs, respectively

8. Measures to Overcome the HRH Shortage in Rural Areas
ANM
•Increase of ANM/ sub centre from 1 to
2- can go to field on alternate days and
can ensure 6 days/week working
•Get ANM and MPW pre service
training centre functional.
•In areas where it is difficult to find
workers, especially in tribal areas,
introduce
vocational training for students in class
12th that leads to ANM’s and MPW’s.
•Ensure regular annual refresher
training for ANM’s and MPW’s
•Provision of short term courses on
multi skilling.
Doctor
•Improve the facilities and annual intake.
Annual output/ medical college in China
900+ and in India 100+.
•Incentivisation of doctors by paying
higher salaries for doctors working in
rural and tribal areas. Also include
performance based incentives as a
component of salary.
•Compulsory rural postings for MBBS
Students and a requirement to apply for
Post Graduate programs.
•Regular upgradation through CME’s and
short term courses on emergency and life
saving skills.
•Policies to avoid brain drain

9. Measures to Overcome the HRH Shortage in Rural Areas
Allied Practitioners
•Nurse Practitioners: Pick ANM or
pharmacist and provide curative training
but short term. Attend MBBS course but
allowed to skip firs one and a half year of
course.
•Provision of video conferencing to deal
with absence of qualified doctors.
•Internet facility availability in rural area and
training of the staff.
•AYUSH Practitioners: Recognition of the
Intensive skill up gradation programmes,
•Paramedical staff training to perform
primary wound care, labs services and
community rehabilitation.
PPP
•NGO’s should be aligned with the program to
seek help from corporate houses to initiate
health related programs as CSR initiatives.
Corporate houses can adopt village and
provide basic health and sanitation facilities.
Set up health camps to aid in detection,
treatment and prevention.
•Setting up of hospitals and colleges by
charitable organizations on St. Johns medical
college, Bangalore pattern where students
are charged less fees but they have to serve
in rural areas on completion.
•Involvement of Panchayat’s to provide
assistance workforce and services.

10. Planning & Integration
Insurance
Referral
Diagnostic
Medicines
Medicine
Referal System
Community participation
• Stock of 30-50 essential medicines at all time based on the frequency of
requirement
• Stock filling every week from District Hospitals with all essential medicines
• Prescription of generic drugs for cost effectiveness
• Strict control of FDA on quality & manufacturing of drugs
• Use of IT system to maintain database of referral centers/doctors for
each disease category & clinical speciality - Telemedicine
•Expert consultation & advice through Telemedicine Monitoring of referred
Patient and feedback along with integration
Diagnostic
Govt Subsidy on Diagnostic tests
Performance based incentives to doctors
Formulation of Village Community Insurance Scheme
Banking Contribution From Priority Sector Lending

11. Public –Private Partnership
Public- Private Partnership
Internet
&
Database
Internet
&
Database
DoctorDoctorPHC
ParamedicParamedic
PatientPatient
Mobile cab- 1 cab per 2500 sq KM area
Infrastructure( land, concessional equipment, laboratory, drugs, staff, IT ,
Tax Break)
Access to credit(interest rates)
Monitoring – Daily reporting and testing samples
Incentive System to ensure accountability- Indirect performance based (
Funding of incentives in later stage after seeing the performance in
quantitative and qualitative terms)
Public- Private Partnership

12. Regulations & strict implementation
Current
Scenario
•Unmanned
PHC’s
existing in
rural areas
depriving
patients of
immediate
attention in
case of
medical
emergencies
Gap to be
plugged
•Dearth of
trained
medicare
personnel
•High
absenteeism
rates of the
practitioners
Roadmap
•Compulsory
posting of
medical
practitioners
& interns as
per the
specifications
defined by
the GOI
•Availability of
diagnostic
facilities at
PHC’s
Availability
Out of he 2% CSR
obligation for
private players, 25-
30% to be invested
in raising more
PHC’ s and CHC’s
Physical
Accessibility/
Reach
Increased Insurance
penetration by special
incentives, subsidies to
private players
Affordability

13. Healthcare Access
Affordabili
ty
Availability
Physical
accessibility
Qu
alit
y
Innovative ideas relying less on capital expenditure and more on human capital
1. ASHA worker feedback mechanism routed through Panchayats and on the job training
programmes by ASHA workers recognized through village Panchayat feedbacks
2. Identification of people with entrepreneurial instinct, the right amount of knowledge and
commitment towards social work to educate and train people in rural areas on how to handle
emergencies and first aid treatment
Regulations & strict implementation
Current Scenario
• Most cases of
notifiable
diseases go
unreported as
only a few are
taken up and
followed up by
the concerned
authorities
Gap to be plugged
• Lack of
stringent
implementation
and action
against the
perpetrators
Roadmap
• Every single
case of any of
the notifiable
diseases to be
closely
monitored to
avoid
absenteeism
and availability
of doses
Quality

14. References
(McKinsey, 2012)Engaging consumers to manage Health care
demands medical_soultions_september2009_essay_series_india-
00068239 (IMS Health)
http://southasia.oneworld.net/peoplespeak/2018india-is-moving-
towards-a-system-of-universal-healthcare2019#.UijDiDbnflV
http://forbesindia.com/article/universal-health-care/indias-
primary-health-care-needs-quick-reform/34899/1
http://social.yourstory.in/2013/03/a-cure-to-indias-ailing-primary-
healthcare/
http://rmsc.nic.in/Drug_Procurement.html
http://modernmedicare.co.in/articles/diagnostics-in-india-the-
beginning-of-a-new-im-%E2%80%9Cage%E2%80%9D/
http://uhc-india.org/reports/hleg_report.pdf