This document discusses solutions to improve India's primary healthcare system. It outlines problems such as inadequate immunization coverage, high maternal and infant mortality rates, and a lack of access to essential drugs and sanitation. The proposed solutions include capacity building through healthcare infrastructure development, expansion of insurance schemes, promoting generic drugs and public-private partnerships, and utilizing indigenous healthcare approaches. The team aims to develop an innovative model combining technology, insurance, and traditional medical practices to solve primary healthcare challenges in a sustainable manner.

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Manthan Topic: Healing Touch
Team Details
Ameya M. Talanki
Deepti Singh
Kapil Kanungo
NMR Sriharsha
Snigdha Singh
Indian Institute of Management Indore
Technology & Tradition - An Indigenous
Approach towards improving Primary Healthcare
An innovative model to solve India’s Primary Healthcare Problem

2. PROBLEM STATEMENT
WHO’s Primary Healthcare agenda includes,
• Education of the people about prevailing health
problems – People in rural areas and urban slums
have little knowledge about health matters. Socio-
economic backwardness, ignorance, traditions and
superstitions have been acting as blocks to
progressive thinking.
• Provision of essential drugs.
• Immunization - The coverage under Universal
Immunization is inadequate and a significant
proportion does not complete the multi-dose
schedules.
• Maternal and Child Healthcare –India currently has a
maternal mortality rate of 200 per 100,000 live births
& infant mortality rate of 49 per 1000 live births.
• Adequate supply of safe water and basic sanitation
The solution set suggests measures in the light of the aforesaid issues raised.
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50
100
150
200
250
300
350
India United
States
Russia Brazil South Africa World
Average
Maternal Mortality Rate/ 100,000 live births (2010)
Infant Mortality Rate/ 1000 live births (2010)
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3. Solutions proposed
• Rajasthan
Government
Case Study
• Novartis Case
• Development of
Indian Medicine
System
• Panchayats &
Anganwadis
• RSBY
• Yeshasvini
• Foreign Models
• Microinsurance
• Public Private
Partnerships
• Doctor- Patient
Ratio
• Infrastructure
Capability
Building
Insurance
Generic
Drugs
Indigenous
Measures
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4. Capacity Building
• Capacity building of physical and human infrastructure bridges gaps in the
existing capacity of the rural health infrastructure by establishing functional health
facilities through revitalization of the existing physical infrastructure, and fresh
construction or renovation wherever required.
• Release of funds for upgradation of CHCs to IPHS
– providing survey reports, details on CHCs upgraded, utilization certificates etc. after
the initial period of fund release.
• Planning for creation/strengthening of health infrastructure
The infusion of funds to create and upgrade infrastructure to the IPHS levels.
• Physical Infrastructure at health centers
• Hygiene and Sanitation at health centers
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5. Capacity Building
• Essential Services at Health Care Centers - Essential healthcare services to be
guaranteed at CHCs and PHCs. Operation theatre, blood storage facility and X-ray
facilities to be essential at CHCs and emergency services with 24x7 delivery.
• Appointment of Contractual Staff – Engagement of medical and support
manpower on contractual basis to provide additional manpower for the delivery of
healthcare services.
• Mobile Medical Staff - One Mobile Medical Unit (MMU) to be provided in each
district to serve outreach areas with the aim of taking the health care to the doorstep of
needy people.
• Health System Resource Centre - National Health System Resource Centre at the
Centre and a State Health System Resource Centre in each State to be established to
improve effectiveness of service delivery and efficiency of resources.
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6. INSURANCE
Only 26% of India’s population is covered under medical insurance. This presents a
very promising sector of growth in the near future.
• Government Schemes:
– Rashtriya Swasthya Bima Yojana provides health insurance to Below Poverty Line (BPL) families to
protect them from financial liabilities arising out of health shocks involving hospitalization.
- Yeshasvini is a Cooperative Health Care Scheme launched by Karnataka for farmers who are members
of the Cooperative Societies.
More such schemes need to be developed on a central level and the gambit of existing services needs
to be increased.
Incentive to
Hospitals:
• A hospital has the incentive to provide treatment to large number of beneficiaries as it is paid per
beneficiary treated.
Incentive to
Beneficiaries
• A beneficiary of RSBY gets cashless and paperless benefit in any of the empanelled hospitals. She
only needs to carry her smart card and provide verification through her finger print.
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7. INSURANCE
• Foreign Models:
– Universal Coverage Scheme in Thailand provides a comprehensive benefits package
for its beneficiaries and preventive care for all Thai citizens, focused on health
promotion and disease prevention e.g., immunizations, annual physical check ups
etc.
– Countries like Costa Rica, Morocco provide a mix of public and private insurance to
the residents and have been constantly ranked above the US in terms of Healthcare.
• Microinsurance:
– Insurance products that offer coverage to low-income households. A microinsurance
plan provides protection to individuals who have little savings and is tailored
specifically for lower valued assets and compensation for illness, injury or death.
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8. Implementation
In the light of the aforesaid facts, we propose the following:
• Universal Insurance: As insurance has inherent problems of Adverse selection and Moral
Hazard and we must avoid cross-subsidy in this sector by:
– Insurance to be provided by private parties.
– National scheme which focuses on rural areas. As this increases the load on infrastructure, this
cannot be made compulsory. So this should be taken up by cooperatives.
• Micro-insurance: in health sector can be introduced by establishing private hospitals in rural
areas and by providing special services to women of productive age.
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9. Public Private Partnership
Considering the investments and special skills needed to overcome infrastructure and
human resource hurdles, public-private partnerships and private initiatives are needed
to address the goal of building healthcare infrastructure.
Core
Hospitals run by private
sector but funded by
Government
Making it mandatory for
giants to invest a specified
portion in rural areas
Non-core
IT and
Technology Based
Absenteeism to
be kept in check
by the Private
sector itself
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10. Public Private Partnership
Non- Core vertical includes,
• IT and Technology based: Like ITC’s E-Chaupal facility utilizes technology
to directly link with rural farmers via Internet, similar measures can be
implemented in Healthcare sector also for effective information sharing.
• Broadband Healthcare Services: (by NGO’s and voluntary bodies)
– TELEMEDICINES: increasing importance for patients in rural remote
locations because of the scarcity of primary care physicians and
specialists. Requires broadband and access to the Internet
• For example, 108 Service is a free 24/7
emergency service for providing integrated
medical services. The service is provided
in Public Private Partnership between
State Government and Private EMS providers.
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11. Promoting Generic Drugs
• Generic Drugs are drugs which have come out of
the patent duration and now, any pharmaceutical
manufacturer can produce this salt.
• Doctors play a key role not only in prescribing
generic drugs but also in convincing the patients
that these drugs are 100% identical to commonly
used brands.
• For example, Rajasthan government is planning to
set up 105 drug stores that sell low-cost generic
medicines in the government hospitals.
• On April 1, the Supreme Court rejected the
attempt by Novartis to patent a new version of the
drug Glivec. Although this might discourage
Novartis to introduce its products in India in future,
it will be beneficial to those who cannot afford
expensive medicines.
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12. Indigenous Measures
• Developing Alternate Indian medical
systems like Ayurveda and
Homoepathy
• Role of Panchayats and Anganwadi:
in providing funds. These can be
regulated to avoid misuse.
• Establishment of a regulatory body:
We need a highly active regulatory
body in Healthcare sector like we
have TRAI for telecom, SEBI
Keeping in mind India’s scenario, we propose undertaking various indigenous
measures and not just adopting foreign policies,
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13. References:
• http://nihfw.org/Publications/material/J164.pdf
• http://www.health-policy-systems.com/content/11/1/25
• http://www.health-policy-systems.com/content/11/1/24
• http://forbesindia.com/article/universal-health-care/indias-primary-health-care-needs-quick-reform/34899/1
• http://www.gramvaani.org/?p=1629
• http://fampra.oxfordjournals.org/content/20/4/457.full
• http://www.unesco.org/education/tlsf/mods/theme_a/interact/www.worldgame.org/wwwproject/what02.shtml
• http://www.indiahealthprogress.in/reports-and-papers/primary-healthcare-needs-top-priority
• http://www.ijph.in/article.asp?issn=0019-557X;year=2013;volume=57;issue=2;spage=59;epage=64;aulast=Yeravdekar
• http://www.indiahealthprogress.in/releases/india-health-progress-free-generic-drug-program-positive-step-improving-access-health-care
• http://www.phcris.org.au/publications/researchroundup/issues/21.php
• http://www.who.int/countries/ind/en/
• http://www.iitk.ac.in/3inetwork/html/reports/IIR2007/11-Health.pdf
• http://lifesciences.ieee.org/publications/newsletter/january-2013/257-point-of-care-healthcaretechnology-in-india-challenges-and-journey-
ahead-a-clinician-s-perspective
• http://planningcommission.nic.in/plans/planrel/fiveyr/9th/vol2/v2c3-4.htm
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