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
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