TOPIC :Universalizing access to Primary healthcare

RESTRUCTURING THE HEALTH MESH : A PROPOSITION TO ALLEVIATE THE FLAWS IN THE PRESENT SYSTEM

TEAM : CHARAK PUNJ TEAM MEMBERS : DENNY SAINI KARTIK ANAND AAKRITI KUNTAL SAMIR ALI KHUSHBOO MITTAL

Present Scenario India’s healthcare expenditure forms only 3.87% of GDP

2 Major healthcare inititiatives in India.

1. National Rural Health Mission (NRHM)

2. Rashtriya Swasthya Bima Yojana (RSBY)

Indians reportedly pay 60% of health costs out-of-pocket, and of this, the

majority are on drugs.

India ranks 150 out of 214 countries in terms of infant mortality rates.

India ranks 136 out of 187 countries with an HDI of 0.554

GDP

India's economy grew at an annual rate of 5.3 % in the quarter ended March 2012, much lower than expectations of 6.1 %

The GDP numbers mean that the country’s growth slowed for eight successive quarters through the three months ended December 2012.

India’s vital clinical statistics(approx.)

Cancer : 3 Million

Diabetes : 34 Million

HIV : 8-10 million

Epilepsy : 8 million

Hypertension : 150 million

Schizophrenia : 1 Million

Asthma : 40 Million

Alzheimer’s : 1.5 million

Cardiac-Related

Deaths : 2 million

Infant mortality rate (IMR) is the number of new-borns dying under a year of age divided by the number of live births during the year times 1000. It is the number of deaths that occur in the first year of life for 1000 live births.

Infant Mortality Rate

Cause of problem Reason of the cause solution

1 Lack of trust in government/free facilities. More attention in private hospitals Improved services, honest workers

2 Superstious beliefs and customs Ingrained in the culture due to lineage Target to change the lifestyle

3 No treatment of the disease at initial stage.

Illusion of invincibility Facilitating easier access to medicines and creating Awareness

4 Allopathic treatment considered to be harmful for health in later stages.

A mindset that considers natural or ‘desi’ methods therapeutic in the long run.

Building trust in allopathic medicines by citing examples and creating more homeopathy centers

5 Doctor alienated from the society. They do not prefer to reside in villages.

A medium to relay knowledge between doctors and villages

6 Ayurveda has not yet established itself in villages.

Knowledge is scattered . Consolidation of such knowledge through concerted efforts and creation of more ayurvedic health centers

AN INSIGHT INTO THE RURAL MINDSET :FACTORS HAMPERING HEALTH PROMOTION

A DECENTRALIZED AUTONOMOUS BODY FOR MANAGEMENT AND VIGILANCE MAY PROVIDE THE KEY TO RESCUING A COLLAPSING VISION.

Creation of a health management centre at block level. Each to be assigned responsibility

of villages lying in its proximity. Enrollment of local residents with minimal qualifications and othe from medical background for job posts.

The HMC shall facilitate the purpose of a Helpline. For this it should maintain a dynamic database of all information regarding health ,hygiene, sanitation including the doctors available, optimum treatment plans, hospitals, healthcare schemes, preventive measures, first aid.

It shall conduct regular surveys ,maintain records of and deal with problems faced by nearby primary health centers, sub centers etc. It can provide other supporting services for instance continuous supply and provision of ‘ayush’ kits and products which are generally out of stock in PHCs etc

BLUEPRINT OF PROPOSED STRUCTURE

COURSE OF ACTION

The HMC shall have employees that undertake regular surveys and interact with the village community that is assigned to them. Preferably the employee should be a resident of the village. They would entertain various responsibilities as

Imparting knowledge regarding health schemes, immediate health concerns.

Take actions in resonance with a foresight to change the lifestyle.

Assist the ANMs in their work.

Ensure implementation of all NRHM schemes.

SALIENT FEATURES :

Ignorance about NRHM schemes still blooming, people at disadvantage due to lack of knowledge regarding their rights.

Integration of Upstream, downstream and midstream efforts. Midstream efforts crucial; increasing involvement of college students , job seeking rural youth ,panchayats, rural schools ,prominent local figures through suitable incentives.

Campaigns should invariably adopt behavioral change as a goal.

Goals should be clear about target population, objectives should be measurable.

Communication strategy : nukkad nataks,posters

Message content : Emphasis on information new to target group and essential for behavioral change, Lucid ,comprehensible and concise.

The HMC shall promote campaigning as a necessary measure to tackle abject ignorance prevalent.

Inspite of the various programmes, one of the reason behind failure is insufficient advertising mediums. TV advertisements are usually out of the reach for typical rural areas. Because most of the villages are deprived of the electricity, televisions, literacy and most importantly awareness. So there is a need to make our advertising methods more effective so that it reaches everyone. The best possible way is to come in direct contact with the general people .

HEALTH PROMOTION GUIDING PRINCIPLE

Health promotion is acceptance that health and social wellbeing are determined by many factors outside the health system which include socioeconomic conditions, patterns of consumption , demographic patterns, learning environments, family patterns, the cultural and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change.

Health promotion component needs to be strengthened with simple, cost-effective, innovative, culturally and geographically appropriate models, combining the issue-based and settings-based designs and ensuring community participation.

For effective implementation of health promotion we need to engage sectors beyond health and adopt an approach of health in all policies rather than just the health policy.

Ing

• Funds collected from panchayats. •From the funds under the ministries working for rural development.

•The existing govt. buildings which are redundant can be utilized or new buildings need to be constructed.

•The heads of such HMCs should be retired military persons or government officials . •The customer care personnel can be local residents with minimal qualifications and proficiency in local languages. •Certain Persons with medical education are mandatory for posts.

KEY FEATURES OF IMPLEMENTATION

PROPOSED SOURCES OF FUNDING INFRASTRUCTURE WORKFORCE

CHALLENGES

The autonomous body should work independently to avoid possible corruption which could arise from affiliation with NRHM’s or other concerned employees.

The Panchayat and the villagers may not easily accept an HMC employee as a part of administration which could result in various problems for the new comer.

Recruiting desired retired military persons ,Govt. officials in such a large number.

The new system shall tackle the claws of corruption etched in the present system through surveys and checks.

It will pave the way for reinforced efficacy as per original vision.

It will focus on the vices of ignorance and inefficient management that are key factors in the failure of present system.

MERITS

Impact of Solution

As the plan is related to management so the work done by the dept. can be directly evaluated by the state government without interrupting other departments.

The plan is bound to provide better job opportunities for the youth that consist of India’s 50% of the population

Sustainability of the solution

The plan provides a better and more reliable management system if executed as per the plan. It posses enough flexibility for the changes that can be applied any time whenever they are required.

Scalability of the plan

The plan aims at changing the lifestyle of the village and provide an opportunity to avail the services that have yet not reached the villages. To connect it with the rest of developing country and make it a part of development to create a healthier and disease free India.

Appendix

References

http://censusindia.gov.in/Census_Data_2001/Census_data_finder/A_Series/Number_of_Village.htm

http://www.ncbi.nlm.nih.gov/

http://people.oregonstate.edu

http://www.issuesinmedicalethics.org

Computerization of Panchayat Raj Institutions(PRIs) under the e-Panchayat Mission Mode Project in Andhra Pradesh under BTOM (Build, Transfer ,Operate & Maintain )Model July 2013

Preparation of Gram Panchayat Level Plan published by A.M.M. Zakir