HEALING TOUCH Universalizing access to quality primary

healthcare

Team Details: SAYON DUTTA

PRATEEK RAJ

MANISH CHAUDHARY

PRATEEK KEDIA

ANUPAM KUMAR

Health Problems in India At the turn of the century, India’s Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) lagged behind the average for the low and middle income countries (LMIC), as did its life expectancy. • The Indian healthcare sector faced shortages of workforce and infrastructure. India had 1.7

trained allopathic doctors and nurses per 1,000 population in the year 2000 compared to the WHO recommended guideline of 2.5 per 1,000 population. Bed density in the country was 0.67 per 1,000 population in the year 2002, well below the global average of 2.6 and WHO benchmark of 3.5.

• Total healthcare expenditure was 4.3 per cent of GDP in 2000, below the LMIC average of 5.3 percent. More importantly, out-of-pocket spend was 67 percent, much higher than the LMIC average of 44 percent. Health insurance covered only 5 per cent of Indians in 2004.

• IMR and life expectancy, continue to fall behind LMIC averages. It is likely that India will fall short of the 2015 targets for IMR and MMR set in the Millennium Development Goals. The non-communicable disease burden has grown to 53 per cent of the total disease burden by 2008, according to the WHO.

• Healthcare spend is not growing at the same pace as GDP. As per WHO National Health Accounts, India’s healthcare spending as a percentage of GDP has reduced from 4.4 per cent in 2000 to 4.0 per cent in 2010.

• Underutilization of existing resources further compounds the problem of meagre infrastructure. Private sector hospitals routinely face utilization issues. Utilization of public sector facilities remains low. Although the bed density has increased to 1.3 beds per thousand but it still remains underutilized.

Health Profile of India

Health Profile of India

Indian healthcare expenditure has grown slower than economy, unlike most peers

About 50% of existing medical workforce does not practice in the formal health system

Solution Proposed

Implementation Details

MNREGA Health Insurance

Assuming 5 Cr of families coming under MNREGA

Increasing the wage by 10 INR and 20 INR is taken from their income as health insurance.

As a result 4000 INR per year per family is generated ,i.e. , 20000 Cr INR of Annual

Expenditure

This expenditure obtained must be implemented in forming a health insurance

service for the MNREGA workers

For proper implementation of this program Health Card would be issued to MNREGA

workers

Doctors/ Beds/ Nurses Utilization

Up to 90 per cent of registered practitioners will need to practice. This would include

nurses also.

AYUSH and rural medical practitioner needs to be incorporated into mainstream

healthcare at national level

An Ad Campaign for improving the brand & image of Govt. Medical facilities.

In return these medical practitioners will be benefitted by timely promotion and rotation

policy system

Rotation policy system involves alternate posting in rural and urban areas

Pay hike and other incentives to be decided by pay commission in a stipulated time frame

Implementation Details

Consultations from private doctors regarding:

a) Treatment of patients especially during emergency cases

b) Acquiring , implementing and

maintenance of equipments

c) Better medicines

Proper training program for both

doctors and nurses. First target would be major government hospitals and then

they will target smaller hospitals in

their states.

Maintenance Management :

a) Attendants , nurses including both

governmental and private

b) proper managerial staff and maintenance staff for equipments

Public-private partnership

Implementation Details

Prevention

All important vaccines to be administered to infants free of cost for BPL families.

These vaccinations would include Hepatitis B , Diphtheria-Pertussis-Tetanus (DPT) , Rotavirus ,

Measles-Mumps-Rubella(MMR) , Varicella(chicken pox) , Haemophilus Influenza

B(HiB) , Hepatitiis A vaccines

Program Implementation:

1) Happening through series of camps that will be happening in all villages in period of 3 months. Also available at Govt. hospitals.

2) Every camp would be having 2 certified doctors,2 certified nurses,10 medical students.

States responsible for implementing it.

3)Camps would be for below poverty line families free

Ad campaign Imparting knowledge regarding the total implementation

of:

Integration of health insurance with MNREGA by providing good example of having health

insurance(wastage of resources if money not allocated for health ex. smoking , liquor , etc.)

Free vaccination drive

Image improvement drive for medical Governmental institutions

Finally, improving medical profession as whole for present as well as future budding Doctors.

Total expenditure = 200 Cr INR on AD Campaign

Impact

• Health Insurance Coverage : Around 25 Cr people coming under health insurance as a part of MNREGA. This section forms the lower strata of the population.

• Proper Utilization of Present Resources : This is the most cost effective way of tackling lots of issues. Thereby resulting in :

– Increase in beds from 1.3 beds to 2.1 beds per 1000 patients.

– Increase in doctors/nurses ratio to 2-2.2 per 1000 patients.

• Decrease in mortality rate, non communicable diseases and communicable diseases by a considerable amount.

• Development of Medical Infrastructure as well as human resources. It will surely help in attracting more people towards pursuing Medical as a profession.

• Most important of all is that the medical facilities would be available at affordable prices. The campaign would be driven with the motto of “Affordable Medication to Diagnose the Present and Support Humanity.”

• Implementation of all the above programs mentioned would require an increase of present health budget by 10-11% .

Risks and Mitigation

What about the families not enrolled in MNREGA ?

a) Non Below Poverty Line : These families need to put atleast 1000 INR/annum in order to avail health fund facilities . Government would provide 4.5% p.a. interest on that.

b) Below Poverty Line : They need to join MNREGA to access the benefits provided there. This will create more jobs as well as result in more people coming under the net of MNREGA.

How will people react on Rs. 10 cut off in MNREGA ??

(Since, increasing the wage from 120 INR to 130 INR and cutting off

20 INR from that 130 INR)

The proposed AD Campaign will educate the masses regarding health benefits being offered to them in return to that 10 INR cut off. For example, people spend that daily income of 120 INR in smoking , drinking liquor, etc. , so it will make them realize the importance of health. “10(rupees) now adds more than 10(years) to your life“.

How to find volunteers for vaccination programs ?

a) Internship Opportunities would be made available for the volunteers.

b) Moreover they would be provided with volunteer certificates along with minor stipends.

c) Above all this would add more to their networking and also train them for their future endeavours.

How to ensure smooth public-private partnership ?

a) For Consultation & Emergency Activities , a stipulated amount as a payment would be provided to the private organisation.

b) Government will act as primary payer and Private Organisation as primary provider.

c) It would also add to the fulfillment of Corporate Social Responsibility.

d) License & Grants would be provided to private organisation.

Appendix

References

• Executive Summary India Healthcare Inspiring Possibilities and

Challenging Journey by McKinsey & Company

• India’s Primary Healthcare needs Quick Reform by Forbes Magazine

• India : Health Profile by World Health Organisation

• Human Resources in Health Sector by Central Bureau of Health Intelligence

• Global Health Expenditure Database

• Health Care in India – VISION 2020 – of Planning Commission