Universalizing access to quality primary healthcare

BY SAVERA

SHRADHA RAWAT DEEPAK PARIHAR HIMANSHU JOSHI SAALIM ZAIDI AYUSH AGARWAL

While India can competitively deliver world-class

health care (witness the success of medical tourism) the country is seriously underperforming when it

comes to taking care of its own.

CURRENT HEALTH STATUS OF INDIA

Total expenditure on health is 4.2% of GDP. Of this, current public expenditure is only 1.1% of GDP.

A serious problem is the improper allocation of public health care budget i.e. large and increasing proportion of expenditure on salaries (60 % to90%) and a markedly reduced (29% to 5%) proportion on non-salary components like medicines, equipment, fuel, etc. which has led to a waste of resources because the health personnel in place cannot work effectively without other supportive expenditure

The WHO in its Alma Ata Declaration had recommended that public health care expenditures should be at least 5 per cent of GDP if equity and universal coverage are to be realized. Most socialist countries spend 3.5 percent

FINANCIAL ASPECTS OF CURRENT PROBLEM

INDIA is the leading producer of Generic Drugs but it’s supply has fallen from 31% in 1987 to 9% in

2004

Use of Generic Drugs in SPAIN help them save 2.4 billion per

annum

India is losing more than 6% of its GDP annually due to premature deaths and preventable illnesses,

Diseases Estimated deaths in South East Asia (2008 WHO data)

Est. deaths in India* (2008)

Tuberculosis 405974 357257

Malaria 43200 38016

Diarrhea 1141586 1004596

Dengue 7064 6216

Nutritional deficiencies 84,123 74028

Maternal conditions 80620 70946

Total 1762567 1551059

*Assuming 88% of these deaths were in India, since it accounts for 88% of the population in this region. However, official records show the numbers to be far lesser. For example, India had only around 1000 reported malaria deaths in 2008. However, when the entire SE Asian region is taken the number of estimated malaria deaths is 43,200. Now this region has a total population of 1.3 billion and India had an estimated population of 1.15 billion in 2008. So it’s clearly implausible that despite having 88% of the population it only accounted for 2 percent of malaria deaths. So we’re assuming that 88% of all deaths caused by these diseases are in India. It’s extremely sad that so many Indians are losing their lives to diseases and conditions that could’ve been easily avoided with the most basic of healthcare services

NEED FOR DOCTOR OF BASIC DISEASES???

Acc. to WHO South East Asian Countries are Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives,

Myanmar, Nepal, Sri-Lanka, Thailand & Timor-Leste

MBBS - Bachelors of medicine and bachelor Of Surgery.

o The curriculum includes preclinical, para-clinical, clinical subjects comprising of social & preventive medicine, general medicine and general surgery.

5 year course

Total expenditure=12.5 lakh( in private institutions).

o After graduation, many students opt for higher studies in US or other countries.

BPHC - Bachelor Of Primary Health Care.

The Curriculum will only be limited to Diagnosis, treatment & Prevention of common diseases.

Curriculum should also include disaster management courses & logistics

3 years course

Total expenditure will be much less.

BPHC will be full time government employee

BPHC graduates will work for a period of 5 yrs in their native villages.

MBBS BPHC

WHAT WE NEED???

In the last two years AICTE received 500 applications from colleges seeking permission to shut down most of these colleges are in rural areas or Tier III cities ,utilizing these colleges to train BPHC students will be very cost effective as major infrastructure like classrooms are already present.

We propose a 50-30-20 sharing of fees between central govt, state govt and student, where central & state government will bear 50%-30% of tuition fees respectively and student will pay 20 % and will sign an agreement to work in villages for minimum 05 years

The performance of BPHC doctors will be analyzed annually by their Medical Officer preferably MD (Community Health Care).

BPHC

Gram Panchayat will also analyze the performance of BPHC

independently.

THE PLAN

SELECTION PROCEDURE A national entrance exam to be

conducted by Medical Council of India.

Eligibility: Students who completed their intermediate

with Biology as a subject

• Increase in the existing expenditure on public health care to 3% of GDP.

Major hospitals and pharmaceutical companies should set up medical cells in villages where BPHC will work.

At least 0.5% of the 2%(as set by the companies act 2013) to be spent on Health Care.

Why only Tata Memorial Hospital when we have 72 companies with billion dollar net worth?

• The BPHC doctors will wear logos of any company for 2 years which finances 25% of their education expenses

STAKEHOLDER

HEALTH CARE PROVIDERS

GOVERNMENT

CORPORATE

SPONSORS

57.80

%

87.60

%

86%

78.80

%

13.80

%

Out of Pocket Expenditure

BrazilRussiaIndiaChinaSouth Africa

PROGRAMME SPONSOR

They will be the regional sponsors

Will provide air ambulances, ambulances

and medical supplies.

COMMUNICATION SPONSOR

They will sponsor communication

equipments like cell phones and Aakash

tablets

For effective functioning it will be vital that

BPHC have access to communication facilities

HELPING HANDS

TRAINING COST For a 3 year course of PHC with study focused solely on basic diseases estimated cost will be around 3lakh for entire course. • Central Govt will pay only 50% i.e. 1.50 lakhs Total expenditure= 1.5 lakhs *593731 inhabited villages of India= Rs 9000 crore(approx) • State Govt will pay 30% i.e. 90,000 Total expenditure=90,000*of the 593731 villages = 5500 crore 91552 villages have population less than 200 So total expenditure will be much less

5% spending of profit on health care means 53,000crores Tax collection from corporations also increases every year sometimes as high as around 20%

ESTIMATED COST OF IMPLEMENTATION

India has enough for everyone’s NEED but not enough for anyone’s

GREED.

-Mahatma Gandhi

ORGANISATION COST •Pay band 9300-34800 with 3% annual increment •Grade pay:4200 •Total expenditure = 3 lakhs * 593731 villages = Rs 10,000 crore

3%of India's 2012 GDP is 36,91,68,30,00,000 i.e. 3lakh crores Even in the worst economic conditions G.D.P. grows by 4% each year Apart from the training and salary of BPHC no additional

investment would be required. We propose utilization of NRHM resources for equipments and other services.

Principal Secretary(H & FW)

Mission Director-NRHM Commissioner Rank Officer

Directorate Of Family Welfare

Directorate Of Medical & Health

State Programme Management Unit(SPMU)

District PMU

Block PMU headed by Medical Officer In-charge

ASHA

ORGANIZATIONAL SETUP

BPHC

BPHC & ASHA will co-ordinate each other

Central government should devise policy for providing better housing and education facility for children of Doctors to make rural posting more attractive

To avoid bankrupting the country with healthcare costs we must emphasize prevention, specifically teaching prevention.

There is a large no of engineering and management colleges which fail to attract students, encourage them to start nursing, pathology and other medical support courses by giving tax breaks and other incentives.

Large chunk of health care budget is spent on building infrastructure that ultimately goes to waste due to lack of maintenance. Private health care has a major presence in India, a PPP model can be implemented where private providers must provide health care to poor, for which the government will pay by utilizing Aadhar Cards .

Practitioners of Indigenous System of Medicines could extensively compensate for deficits in primary health care services.

Only 193 out of total 640 districts

have a medical college.

There are approximately 0.81 nurses per allopathic physician in India, this is not cost effective at

all.

India's ratio of nine hospital beds per 10,000 people is far from

adequate

SUPPORTING MEASURES

GRIEVANCE REDRESSAL MECHANISM

Complaints and suggestions can be directed to Gram Pradhans, Medical Officers, DM's, against all the BPHCs who ask for bribe or display negligence.

Suggestion Boxes for BPHC to be placed in all CHC&PHC

24 hours help line to report absentee doctors or any negligance.

Only training the BPHC will not be enough, we have to ensure the people graduating from the course are competent enough to take care of their duties.

This idea requires a substantial spending on health care, it may be tough in the current economic scenario.

LIMITATIONS

• 286,119,689 Indians are living in villages

• 50% of all villagers have no access to healthcare providers (Indiafacts.in and India Development gateway)

• 1551059 lives in 2008 could have been saved

IMPACT

IMAGINE WHAT WE CAN

ACHIEVE NOW!!!

During the recent calamity in Uttarakhand most of the affected

victims were senior citizens already suffering from chronic conditions like Hypertension Arthritis, Bronchal Asthama,

Diabetes .There was an immediate need of primary

health care for them and people with minor injuries

India knowledge @wharton

WHO country cooperative strategy

http://censusindia.gov.in

http://databank.worldbank.org

“Do the Poor Benefit from Public Spending on Healthcare in India?” A research paper by Consortium for Research on Equitable Health Systems (CREHS).The authors are based at Indian Institute of Technology (Madras), India.

“Strengthening of primary health care” A research paper by Mr.Rajiv Yeravdekar, Director Symbiosis Institute of Health Sciences

“HEALTH FINANCING IN INDIA” A research paper by R.D. Bansal Ex-Deputy Director General (Medical Education, Hospitals and Planning) D.G.H.S., Ministry of Health and Family Welfare, New Delhi.

Reuters India

NRHM information portal

REFERENCES