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Chetna Maliye

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Equity in health is determined not only by health care but also by broader societal developments. Ensuring universal health care for all also raises the need for universalizing elementary education and promoting gender equity. Health will gain priority attention if people see health care as a legitimate right and an entitlement.

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THE ROLE OF THE HEALTH SECTOR Health sector has critical & multiple roles to play in reducing health inequities across key health outcomes & acts as a buffer on other social determinants of health inequities

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National Rural Health Mission A revolution in the health sector National Rural Health Mission was launched on 12th April, 2005 Objective: To provide effective health care to the rural population, the disadvantaged groups including women and children by Improving access Enhancing equity and accountability Promoting decentralization

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NRHM: Main Approaches 1. Community Ownership and Health Action by community 2. IPHS Standards: monitoring progress against standards 3. Strengthening of public health care delivery system 4. Improved program management 5. Flexible financing

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Community Ownership and Health Action by community At the village level : Involvement of PRI, village level committee (VHNSC) and SHGs ASHA At the facility level: hospital management committees (RKS) At the management level district health societies

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The National Urban Health Mission Indias flagship health program focused on city slums The program, aims to target 80 million urban poor who are estimated to be growing at 5-7% annually, Funded by the Centre in the first year but will require participation from state governments and local municipal bodies later The health ministry initiative also envisages urban health centres one for every 50,000 people.

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THE NATIONAL HEALTH BILL, 2009 Collective and Individual Rights in relation to health A Bill to provide for protection and fulfillment of rights in relation to health and wellbeing, health equity and justice, including those related to all the underlying determinants of health as well as health care; and for achieving the goal of health for all; and for matters connected therewith or incidental thereto. Right to health Right to access Right against discrimination Right to dignity Right of participation, information Right to justice Rights related to health care Duties of users Rights of health care providers

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Rights specifically related to health care (Users Rights): Right to seek health care and treatment Right to emergency treatment and care Right to quality of care Right to information Right to medical records and data Right to autonomy/ self determination and prior voluntary informed consent Right to confidentiality, information disclosure, privacy Health Rights Charter

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Vouchers Increase the Poors Access to FP/RH Services in India Case Study Under NRHM public private partnership approaches are piloted USAID funded project is pilot testing a voucher scheme in Uttaranchal & Uttar Pradesh - 2007 Under the scheme the NGOs distribute subsidized service vouchers to ASHAs. ASHAs identify & distribute to the BPL families.

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Vouchers reduce economic barriers to access target subsidies directly to the poor facilitate monitoring of program outputs, ensure the poor have access to high-quality services, and provide incentives for efficiency in service delivery. Achievements 4,000 poor women redeemed vouchers for antenatal care check-ups, 800 sought treatment for reproductive tract or sexually transmitted infections > 500 pregnant women delivered their babies in health facilities.

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Chiranjeevi Scheme - Gujarat Broad Issues Non - availability of Obstetricians & Gynecologists at the govt. health care facility Accessibility of services-Tribal and urban slums Poor utilization of services- Low felt need of health & medical services Lack of user friendly & quality public health services Costly private health and medical services No health insurance coverage

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Service Coverage Outsourcing- voucher system Emergency Obstetric Care & Neonatal Care Private Gynecologists in their facility Payment to Gynecologists for working in government hospital

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SERVICE PACKAGE Service No. of casesRate Per CaseCost Normal delivery8580068000 Complicated cases Eclampsia1000 Forceps/vacuum/breech310003000 Episiotomy800 Septicemia230006000 Blood transfusion310003000 Cesarean (7%)7500035000 Predelivery visit100 10000 Investigation100505000 Sonography301504500 Dai100505000 Transport10020020000 Grand total179500

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Institutional deliveries trend

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Rashtriya Swasthya Bima Yojna (RSBY) Central Government Insurance scheme for the Below Poverty Line (BPL) families in the unorganized sector. Objective: Provide insurance cover to below poverty line (BPL) households from major health shocks that involve hospitalization. State to take up 20% of the districts each year in the next five years.

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75 % financing by Government of India (GOI) & 25% by the state government. BPL families are entitled to more than 700 in-patient medical procedures with a cost of up to 30,000 rupees per annum for a nominal registration fee of 30 rupees. Pre-existing medical conditions are covered and there is no age limit. Coverage extends to the head of household, spouse and up to three dependents.

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Use of Smart Card has made the scheme truly cashless. First time, contribution of 30/ rupees is sought as registration fee, from the BPL beneficiary with a view to inculcate a sense of ownership. The smart card along with an information pamphlet describing the scheme and the list of hospitals is provided on the spot once the beneficiary has paid the 30 rupee fee. Transportation cost of Rs. 100/ per visit with an overall limit of Rs. 1,000/ per annum is also admissible under the scheme.

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INTERSECTORAL ACTION FOR HEALTH

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Total Sanitation Campaign (TSC) A comprehensive program to ensure sanitation facilities in rural areas with broader goal to eradicate the practice of open defecation. Principle: low to no subsidy where a nominal subsidy in the form of incentive is given to rural poor households for construction of toilets. Emphasis: IEC, Capacity Building and Hygiene Education with involvement of PRIs, CBOs, and NGOs etc. Key intervention areas: Individual household latrines, School Sanitation and Hygiene Education Community Sanitary Complex, Anganwadi toilets supported by Rural Sanitary Marts and Production Centers.

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Integrated Child Development Services (ICDS) Scheme Provides 0-6 yrs children with an integrated package of services supplementary nutrition health care pre-school education The Supreme Court has directed the Government of India to increase the number of anganwadis from 6 lakh to 14 lakh habitations.

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Rural communities and slum dwellers are entitled to an Anganwadi on demand (not later than three months) from the date of demand in cases where a settlement has at least 40 children under six but no Anganwadi.

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Government of Indias flagship program for Universalization of elementary education (free and compulsory education to the children of 6-14 years age group, a fundamental right). Open new schools in habitations with no schooling facilities and strengthen existing school infrastructure A special focus on lifes skills, girls education and children with special needs. Computer education to bridge the digital divide

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IMPROVING FOOD SECURITY & REDUCING POVERTY Key to reducing overall child malnutrition & inequities by income level

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Antyodaya Anna Yojana - 2000 Aim: To provide special food- based assistance to destitute households. Destitute households are given an Antyodaya card and are entitled to special grain quotas at highly subsidized prices. Beneficiary household is entitled to 35kg. of subsidized rice or wheat per month from the designated local ration shop. The subsidized price charged is Rs. 2/- per kg. for wheat and Rs. 3/- per kg. for rice.

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Indira Gandhi National Old Age Pension Scheme Available to poor persons aged 65 years or older. Central Government provides for Rs. 200/- per pensioner per month and the states contribute an equal amount.

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Thank you