Equity in Health Care vs Inequity = Under Served

Geographic Economic Social

Road Access

Poverty, Class

Stigma

Hugli

Barddhaman

Murshidabad

Haora

Nadia

Kolkata

Darjiling

Maldah

Uttar Dinajpur

Dakshin Dinajpur

Jalpaiguri

Koch Bihar

BankuraPuruliya

Birbhum

Medinipur

North Twenty Four Parganas

South Twenty Four Parganas

Geographic Under Served

North Bengal

Tea Gardens

Char/ Islands

Paschimanchal

NPSP UDJ 2009-10

Prioritize Block2. Ismapur

3. Goalpokher-I4. Goalpokher-II

5. Karandighi6. Raiganj

Measles Outbreak Map

Coverage Evaluation Survey West Bengal 2009

Economic Inequity/ Poverty affects Services

Literacy status of Mothers who Died

47.2 48.3340.2

34.9 31.6737.4

7.5 12.1

13.2 12.5 10.3

4 . 7

0%20

%40

%60

%80

%10

0%

May 2005 – July 2006 July 2006-September 2007 May 2008 - March 2010

Illiterate Upto 8th Standard 9th Standard & above DNK

Strongest association with Female Literacy

MAPEDIR Purulia

2005 2006 2007

2008 2009

2010 (Jan-Jul)

DECREASING NUMBER OF REPORTED MATERNAL DEATHSBLOCK-WISE PROGRESS

Map of maternal deaths MAPEDIR Purulia

Social Factors affect Immunization

Coverage Evaluation Survey West Bengal 2009

AWCOutreach

Govt Hosp

Coverage Evaluation Survey West Bengal 2009

Map Health Problems Infectious

Acute Chronic ARI/ Pneumonia/ Otitis TBMalaria LeprosyMeasles FilariaDiarrhoea Kala Azar

HIV

Detecting and preventing hypertension in remote areasBarun Mukhopadhyay http://www.issuesinmedicalethics.org/144oa124.html

Non Infectious Acute ChronicSnakebite BPInjury DiabetesDrowning Asthma

BlindnessDeafness

Mental Congenital

Cancer

RCHMaternal NeonatalMalnutrition

What Is To Be Done

Community-

Outreach-

Clinic/ Facility-

What Is To Be DoneCommunity

ASHA/ 2nd ANM

Zinc + ORS for Diarrhoea

IMNCI

Referral Transport

Local Practitioners/ Tea Gardens

CHCMI/ VHSC

Sanitation/ ICDS/ Iodine/ Vitamin A/ Iron

What Is To Be Done

Outreach

-Need Based Plans

-Flexibility Brick Kilns Bidi Workers

-Additional FundsSHG/ NGO role

What Is To Be Done

Clinic/ Facility

- Government- Quality

- NGO/ PPP- Access

- Continuum of Care (MCH/ Neonatal)

- AMO

- Certification of Private Providers (ISO)

What Is To Be Done

Support and Monitoring

- Drug Supply

- Laboratory

- IT (mobile/ internet/ tele- medicine)

- Surveillance

- Verbal Autopsy/ Death ReviewPrimary Health Care- Indian Scenario WHO Country Office for India (HSD) August 2008

First-sustain rapid diagnostic kits, ACT and funds.

Reach sufficient coverage (80%) of bed nets, particularly to BPL

Second, orient MO in PHC -early referral of malaria with complications.

Third, community awareness to seek prompt treatment.

Fourth, spray teams must catch up DDT spraying

Fifth, orient private practitioners -appropriate anti-malarials, management of severe malaria and early referral.

PPP with tea gardens

Risk factors for malaria deaths in Jalpaiguri district, West Bengal, India: evidence for further actionJ Sarkar et alMalar J. 2009; 8: 133. Published online 2009 June 16

The Way ForwardImproving health in India will require building up the health system in the next ten to twenty years.

Five core concerns emerge when facing the challenge of improving health in India:

(i) promoting equity by reducing household expenditure on total health spending and experimenting with alternate models of health financing;

(ii) restructuring the existing primary health care system to make it more accountable;

(iii) reducing disease burden and the level of risk;

(iv) establishing institutional frameworks for improved quality of governance of health; IV. (Regulations and institutional infrastructurefor coping with health markets)

(v) investing in technology and human resources for a more professional and skilled workforce and better monitoring

Report of National Commission for Macroeconomics and Health 2005

Reducing household expenditures of the poor: Optionsfor financing comprehensive health care1. a core package consisting of public goods and costing Rs 150per capita, to be made universally accessible at public cost;

2. a basic package consisting, in addition to the above, surgeryand medical treatment costing Rs 310 per capita; and

3. a secondary care package costing Rs 700 per capita andconsisting of treatment for vascular diseases, cancerand mental illness, and referrals

Innovative financing models must be tried to ensure thatsuch packages are universally accessible

Report of National Commission for Macroeconomics and Health 2005