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

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

• 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.

• 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.

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.

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.

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

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.

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.

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

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.