Healing Touch:Universalizing access

to quality primary healthcare

EzazGopika JhunjhunwalaKartik DhimanSamkit RampuriaUtkarsh KumarBIRLA INSTITUTE OF TECHNOLOGY, RANCHI

Problem Statement India has a cumulative short fall of almost 17,000 Public Healthcare Centers (PHCs)

A concomitant shortage of 8500 Doctors across these centers

41% of existing PHCs lack healthcare personnel

Shortage of 2.6 million health workers

Inadequate funding for primary healthcare. The Union government has allocated only 1.04% of GDP towards improving health in their 12th plan. This is among the lowest budgetary allocations in the world

Lack of modern facilities and awareness

Inefficient implementation of government policies

SOLUTIONSDevelopment of

efficient healthcare workforce

Making sure that the people know what is

available, how to access it, and how different parts of the system work together

Procurement of modern facilities

Development of a hierarchical system

starting from the grass root level

1.

2. 3.

4.

Development of a hierarchical system starting from the grass root level

Sub Centers PHCs CHCs

• Establish a single sub centers for every two villages consisting of one male and one female health worker.

• Recognize eligible individuals from the village itself and provide them with incentives.

• Proper communication and transportation channel among the sub centers, PHCs and CHCs.

•A referral unit for 6 sub centers.

•Monitoring of the functioning and coordination with sub centers.

•4-6 bedded, with basic facilities.

•One medical officer In charge and 15 paramedical staff.

•A referral unit for 4 PHCs.

•Monitoring of the functioning and coordinating with PHCs.

•30 bedded hospital.

•Specialized in modern services.

•Equipped with Life support system.

Development of efficient healthcare workforce

• Assuming the worst case scenario that only 25% of the Indian Rural population has access to health facilities.75% of 6,38,000 villages = 4,78,500 villages.

•For every two village we intend to setup one sub centre. So for these 4,78,500 villages we need 2,39,250 sub centers.

•For every 6 sub centers we intend to setup one Public Healthcare Centre (PHC). So the number of PHCs required = 39,875.

•For every 4 PHCs we intend to setup one Community Healthcare Centre (CHC). So the number of CHCs required = 10,000 approx.

•Spread awareness and raise incentives to attract people for their own welfare.

•Develop barefoot doctors and paramedic teams.

•Make internships compulsory for MBBS graduates for at least 1 year in underserved areas and providing them with job and social security.

•Postgraduate courses should be sponsored by the government to improve the quality of workforce.

Development of efficient healthcare workforce

•Collaboration of Public and Private Sector for intensive training of paramedics, nurses and barefoot doctors.

•Appointment of Central Monitoring Team at district and state level.

•Monitoring Teams shall comprise of local representatives as well as government officials so that they have indigenous as wellas technical expertise.

•Monitoring Teams shall be rotated every one year and its members must be chosen in agreement with the beneficiaries of the plan.

•Regular survey for satisfactory functioning of the plans suggested.

•Immediate and strict action against malpractice. Stringent rules to govern the working of the workforce.

Procurement of Modern Facilities

•Linking of the health records of all individuals with AADHAR cards so that data can be accessed remotely.

•Issuing of school health cards for children to keep track of medical history.

•Installation of modern communication services with internet facilities at all sub levels.

•Proper transport system shall be placed for each sub center, PHC, and CHC for improved efficiency in traversal of the patients from peripheral centers to tertiary hospitals.

Making sure that the people know what is available, how to access it, and how different parts of the system work together

•It can be particularly difficult for patients moving from one part of the health system to another. For example, when theyare discharged from hospital, or when they need a range of health providers, such as a psychologist, dietician orphysiotherapist.

•Currently, no one is responsible for ensuring that each local community has the right mix of services to meet its healthneeds and it is difficult for patients to know whether things are working and, if not, who should fix them.

Funding- Successful Models• The Australian Government introduced the Medicare

system in 1984. All Australian Government funding for health services comes from taxation through its general revenue. A Medicare Levy is set at 1.5% of taxable earnings (for all but low income earners). A surcharge of an additional 1% is levied on high income earners who do not have private health insurance

• The UK health system, the National Health Service (NHS) is funded through taxation to provide free primary health care services to all UK permanent residents.

Expenses

2,39,250 sub

centers

39,875 PHCs

10,000 CHCs

239.25 crores

4000 crores

500 crores

1820 crores

6559.25 crores

Mass Coverage and Manpower RequirementTraining cost

of 1.82 million

paramedics

•62.436 billion people will be covered by workforce of 1.82 million paramedics, nurses and doctors.

Risks Involved

•Amount of time taken to implement any plan in India has been seen to be devastating.

•Conflicts between the governments at the state and central level.

•Inefficient Management of Manpower.

•The current situation of the economy does not permit the allocation of more resource considering the CAD and fiscal deficit.

•The AADHAR card system has not been implemented nationwide.

•Corruption.

•People in rural areas still stick to superstitious practices instead of availing the resources present.

References

•http://www.indiahealthprogress.in/reports-and-papers/primary-healthcare-needs-top-priority

•http://www.oifc.in/investing-in-india/investment-info/in-focus/booming-indian-healthcare-industry

•http://www.indiahealthprogress.in/reports-and-papers/healthcare-unwired-health-insurance-and-healthcare-access

•http://nrhm.gov.in/

•http://www.healthissuescentre.org.au/documents/items/2011/02/363952-upload-00001.pdf

•http://www.phcris.org.au/guides/phc_international.php

•http://www.google.com/