Shortages in healthcare infrastructure and human resources plague India's primary healthcare system. This includes deficits of doctors, nurses, and other workers, as well as inadequate medicine supplies and health facility infrastructure especially in rural areas. To address these issues, the document proposes a solution that utilizes mobile networks, community health funds, and mobile medical units to improve access, while also increasing healthcare worker training, community involvement, and establishing strong monitoring systems to improve quality and ensure safety. This decentralized approach aims to achieve universal access to primary healthcare in a more effective manner than existing models.

1. Healing Touch: Universalizing access
to quality primary healthcare
Submitted By: Haresha Anand, Apoorva
Iyer, Kavya Narayanan, Neeraja
Pushpanathan & Archana Nair, Stella
Maris College, Tamil Nadu, Chennai.
MANTHAN: CITIZENS FOR
ACCOUNTABLE GOVERNANCE

2. Lack of Human Power
• Shortfall of Doctors: Deficit of 2866 (12%) MBBS Doctors; actual requirement-
23, 887. Implementation of 2 doctors to be present at PHCs not monitored.
• Shortfall of nurses and other health workers: 23% Shortfall. Fig 1: 37.% fall in
health assistants (female) and male- less by 41.6%. 1.% fall in health workers
(female) male: short by 64,6%.
PROBLEMS

3. • Medicine supply: Drug expenditure stands at 5,03,447 lakhs INR; being the largest
exporter of general medicines, spends only 0.1% on publicly funded medicine.
• Shortage of 9148 PHCs in 2012; Only 23, 109 for 6.5 lakh villages.
• Infrastructure spending not allocated appropriately; continues to be a lack of beds i.e, 9
to 1000 beds.
• Statewise analysis: Attendance in “established” schools decreasing by the year and stays
at 73% in rural India as a whole. Enrolment rates in private schools stands at 25.76%.
• Given the states that get high amount
of expenditure for HC, educationally
backward States like Uttar Pradesh,
Bihar, Madhya Pradesh and Jharkhand
have the lowest student attendance
rates (below 60 %).
• Failure in introducing apt
comprehensive policy to be used by
Centre and the State governments in
further developing public-private
partnerships.

4. • Inequitable distribution of facilities and/or infrastructure for
primary healthcare and maternal healthcare services, inadequate
referral services, lack of human resource and overburdened
healthcare facilities.
• Efforts of Reproductive and Child Health Programme (RCH)
services by rural community not met.
• Lack of community and support of local leaders.
• Lack of proper monitoring system, incentive for doctors in PHCs,
literate doctors and helpers, confidence of people in PHCs.
• " Right to Life" :every citizen has a right to proper means and standards
of living
• India ranks 134 in HDI; needs tremendous improvement and more
schemes to be successfully implemented.
• Educating people from grass-root level; children in rural, semi-urban
and urban areas; skill and knowledge development is key to increase
awareness.
• Development of inter-sectoral forums fail to occur at every level in
decision making.

5. OVERVIEW OF PROPOSED SOLUTION
Improving
Access
Improving
Quality
Ensuring
Safety
Advantage
over existing
model
• Using mobile
networks for
awareness and
continual
treatment.
• Creation of health
contingency funds
for provision of
health cover .
• Mobile medical
units and home
care to cater to
geriatric and other
excluded classes.
• Increasing supply
of doctors and
health workers in
the primary care
field .
• Training of locals
• Increasing
community
involvement.
• Improving
procurement,
storage and
availability of
free/subsidized
medicines.
• Providing
community based
health coverage.
• Creation of
database.
• Providing suitable
education to the
community.
• Providing benefits
to socially and
economically
challenged
entities.
• Strong monitoring
mechanism.
• More proactive
role of the
community.
• Technology driven
monitoring
mechanism.
• Increases scope
and availability of
heath services.
• More
decentralization
while ensuring
accountability.

6. PATH TOWARDS ACHIEVING UNIVERSAL ACCESS TO PRIMARY CARE
• 900 million people use
mobiles in India.
• Mobile networks are
used for awareness and
ensuring continual
treatment where
necessary.
Setting up a toll free helpline
using IVR.
The functions of this helpline:
• Call an ambulance
• Lodge complaints
• Address grievances
• Get information
regarding plans and
schemes
• Local civil bodies set up a
health contingency fund.
• The community ‘s
earning members
contribute nominal
amounts.
• Pooled money acts as a
cover for providing
primary care.
Creation of database in
PHC’s and SHC’s .
This will include basic data
like name, contact details
and also past medical history,
treatment prescribed and
medicines provided on
computers to ensure easy
retrieval.
• Mobile medical units will
be set up in Taluks.
• Basic amenities will be
provided.
• Aims at increasing
access and awareness .
• Will reach
disadvantaged classes
and remote areas.
• Compulsory internship in
public sector for state
medical college students
• Financial as well as
promotion incentives for
fully qualified medical
staff in rural areas.
• Training of other medical
staff
• Ensuring proper procurement, storage and availability of generic medicines .
• Promoting AYUSH.
• Setting up Fair price medicine shops.

7. WORKING OF THE SYSTEM
Civil body :Panchayat/
municipality/ corporation
People/community:
beneficiaries of
primary health care
Taluk
Hospital
PHC PHC PHC PHC
SHC SCH SHC
Mobile medical unit
Primary health
coverage by pooling
funds

8. THE PROPOSAL IN ACTION
• Central toll free helpline to be set up. This will be useful especially for pre-natal and post-natal care and also for
pregnant mothers ,who need continual and periodic treatment over a given span of time.
Also, any complaint or grievance has to be addressed within 72 hours.
• In India, tax revenue funds insurance. However, in-patient treatments are not covered. Since the expenditure is nominal
in the case of primary care, pooled funds are sufficient, aside from government subsidies which are already being
provided. This fund will be audited and accounted for (can also be brought into the purview of RTI). This will ensure
community involvement in medical care and also increase the accountability of the government as people pay a
nominal charge.
• Mobile medical units will enable access to geographically distant areas and will also cover geriatric care and cater to
differently abled people who face mobility issues.
• Urban –rural divide is solved by using incentives to doctors and health workers, promoting community involvement and
increasing expenditure on health in rural areas.
• Audit and monitoring of the scheme must not happen by govt authorities alone. The government should select eligible
people from private health sectors and other relevant sectors to go for a “site inspection” and file the report directly to
the government
• Migrant labourers who aren’t permanent residents of the state should be able to apply for a special card or a scheme
that will protect their interest. For example- people who migrate may not have a permanent address to proceed with
formalities to apply for a proper healthcare plan. These people should be identified and can be given “hospital
coupons”.
• Proper database of patients have to be created. This will include name, address,contact details of the ptient.name of
doctor,medicines given,time of visit ,medical history,etc.This again acts as a monitoring mechanism and also proper
record maintenance will be ensured so as to trace the leakages and flows of resources.

9. MONITORING MECHANISM
• Include health in the concurrent list.
• Set up a Health Inspection Committee in each
State that represents the Centre and oversees
the implementation in the state.
• The body should be independent of both state
and central governments.
• Body should include experts from the private
sector who can go for surprise on-field
inspections.
• Report filed directly to the Health Ministry.
• This should be done in addition to setting up a
Grievance Helpline.
• Increased accountability by State Government
for money which is allocated by centre.
• Unbiased reports filed .
• Chances of bribing Inspection Officers and other
malpractices reduces.

10. FINANCE
• To increase government spending to over 2% of
GDP, reduce private spending
• To introduce Insurance for out-patient
treatments and have investigators to avoid
fraudulent claim
• Promote Micro-Health Insurance schemes for
BPL families.
• To have every citizen of India enrolled in a
compulsory health insurance scheme, by paying
a very nominal amount , and this can be tracked
and implemented while registering for Aadhaar
scheme
• Government will pay premium for BPL families.
• For Migrant labourers introduce “Health
Coupons” that can be encashed in any hospital

11. References:
• Kurukshetra, A Journal on Rural Development, Vol 59, No. , May 2011
• Child Malnutrition in India, Sam Anderson & Dr. Samir Chaudhuri.
• India’s Malnutrition: A Mulit-Sectoral Solution, VeenaS Rao, 2010
• Annual Status of Education Report (Rural) 2012, Provisional, January 17, 2013
• Perceived Barriers to Utilization of Maternal Health and Child Health Services, Rural UP,
Neelanjan Pandey, IIPS, India.
• National Urban Health Mission( 2008-2013): Meeting the Challenges of Urban
Population:Focus on Urban Slums
• High level Expert Group Report on Universal Health Coverage for India, Instituted by
the Panning Commission of India.