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Manthan Topic: Healing Touch

Team Details

Ameya M. TalankiDeepti Singh

Kapil KanungoNMR SriharshaSnigdha Singh

Indian Institute of Management Indore

Technology & Tradition - An Indigenous Approach towards improving Primary Healthcare

An innovative model to solve India’s Primary Healthcare Problem

PROBLEM STATEMENT

WHO’s Primary Healthcare agenda includes,

• Education of the people about prevailing healthproblems – People in rural areas and urban slumshave little knowledge about health matters. Socio-economic backwardness, ignorance, traditions andsuperstitions have been acting as blocks toprogressive thinking.

• Provision of essential drugs.

• Immunization - The coverage under UniversalImmunization is inadequate and a significantproportion does not complete the multi-doseschedules.

• Maternal and Child Healthcare –India currently has amaternal mortality rate of 200 per 100,000 live births& infant mortality rate of 49 per 1000 live births.

• Adequate supply of safe water and basic sanitation

The solution set suggests measures in the light of the aforesaid issues raised.

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India UnitedStates

Russia Brazil South Africa WorldAverage

Maternal Mortality Rate/ 100,000 live births (2010)

Infant Mortality Rate/ 1000 live births (2010)

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Solutions proposed

• Rajasthan Government Case Study

• Novartis Case

• Development of Indian Medicine System

• Panchayats & Anganwadis

• RSBY

• Yeshasvini

• Foreign Models

• Microinsurance

• Public Private Partnerships

• Doctor- Patient Ratio

• Infrastructure

Capability Building

Insurance

Generic Drugs

Indigenous Measures

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Capacity Building

• Capacity building of physical and human infrastructure bridges gaps in the existing capacity of the rural health infrastructure by establishing functional health facilities through revitalization of the existing physical infrastructure, and fresh construction or renovation wherever required.

• Release of funds for upgradation of CHCs to IPHS

– providing survey reports, details on CHCs upgraded, utilization certificates etc. after the initial period of fund release.

• Planning for creation/strengthening of health infrastructure

The infusion of funds to create and upgrade infrastructure to the IPHS levels.

• Physical Infrastructure at health centers

• Hygiene and Sanitation at health centers

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Capacity Building• Essential Services at Health Care Centers - Essential healthcare services to be

guaranteed at CHCs and PHCs. Operation theatre, blood storage facility and X-ray facilities to be essential at CHCs and emergency services with 24x7 delivery.

• Appointment of Contractual Staff – Engagement of medical and support manpower on contractual basis to provide additional manpower for the delivery of healthcare services.

• Mobile Medical Staff - One Mobile Medical Unit (MMU) to be provided in each district to serve outreach areas with the aim of taking the health care to the doorstep of needy people.

• Health System Resource Centre - National Health System Resource Centre at the Centre and a State Health System Resource Centre in each State to be established to improve effectiveness of service delivery and efficiency of resources.

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INSURANCEOnly 26% of India’s population is covered under medical insurance. This presents avery promising sector of growth in the near future.

• Government Schemes:– Rashtriya Swasthya Bima Yojana provides health insurance to Below Poverty Line (BPL) families to

protect them from financial liabilities arising out of health shocks involving hospitalization.

- Yeshasvini is a Cooperative Health Care Scheme launched by Karnataka for farmers who are membersof the Cooperative Societies.

More such schemes need to be developed on a central level and the gambit of existing services needsto be increased.

Incentive to Hospitals:

• A hospital has the incentive to provide treatment to large number of beneficiaries as it is paid per beneficiary treated.

Incentive to Beneficiaries

• A beneficiary of RSBY gets cashless and paperless benefit in any of the empanelled hospitals. Sheonly needs to carry her smart card and provide verification through her finger print.

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INSURANCE

• Foreign Models:

– Universal Coverage Scheme in Thailand provides a comprehensive benefits packagefor its beneficiaries and preventive care for all Thai citizens, focused on healthpromotion and disease prevention e.g., immunizations, annual physical check upsetc.

– Countries like Costa Rica, Morocco provide a mix of public and private insurance tothe residents and have been constantly ranked above the US in terms of Healthcare.

• Microinsurance:

– Insurance products that offer coverage to low-income households. A microinsuranceplan provides protection to individuals who have little savings and is tailoredspecifically for lower valued assets and compensation for illness, injury or death.

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ImplementationIn the light of the aforesaid facts, we propose the following:

• Universal Insurance: As insurance has inherent problems of Adverse selection and MoralHazard and we must avoid cross-subsidy in this sector by:

– Insurance to be provided by private parties.

– National scheme which focuses on rural areas. As this increases the load on infrastructure, thiscannot be made compulsory. So this should be taken up by cooperatives.

• Micro-insurance: in health sector can be introduced by establishing private hospitals in ruralareas and by providing special services to women of productive age.

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Public Private PartnershipConsidering the investments and special skills needed to overcome infrastructure andhuman resource hurdles, public-private partnerships and private initiatives are neededto address the goal of building healthcare infrastructure.

Core

Hospitals run by private sector but funded by

Government

Making it mandatory for giants to invest a specified

portion in rural areas

Non-core

IT and Technology Based

Absenteeism to be kept in check

by the Private sector itself

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Public Private PartnershipNon- Core vertical includes,• IT and Technology based: Like ITC’s E-Chaupal facility utilizes technology

to directly link with rural farmers via Internet, similar measures can beimplemented in Healthcare sector also for effective information sharing.

• Broadband Healthcare Services: (by NGO’s and voluntary bodies)– TELEMEDICINES: increasing importance for patients in rural remote

locations because of the scarcity of primary care physicians andspecialists. Requires broadband and access to the Internet

• For example, 108 Service is a free 24/7emergency service for providing integratedmedical services. The service is providedin Public Private Partnership betweenState Government and Private EMS providers.

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Promoting Generic Drugs

• Generic Drugs are drugs which have come out of the patent duration and now, any pharmaceutical manufacturer can produce this salt.

• Doctors play a key role not only in prescribing generic drugs but also in convincing the patients that these drugs are 100% identical to commonly used brands.

• For example, Rajasthan government is planning to set up 105 drug stores that sell low-cost generic medicines in the government hospitals.

• On April 1, the Supreme Court rejected the attempt by Novartis to patent a new version of the drug Glivec. Although this might discourage Novartis to introduce its products in India in future, it will be beneficial to those who cannot afford expensive medicines.

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Indigenous Measures

• Developing Alternate Indian medical systems like Ayurveda and Homoepathy

• Role of Panchayats and Anganwadi: in providing funds. These can be regulated to avoid misuse.

• Establishment of a regulatory body: We need a highly active regulatory body in Healthcare sector like we have TRAI for telecom, SEBI

Keeping in mind India’s scenario, we propose undertaking various indigenous measures and not just adopting foreign policies,

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References:• http://nihfw.org/Publications/material/J164.pdf

• http://www.health-policy-systems.com/content/11/1/25

• http://www.health-policy-systems.com/content/11/1/24

• http://forbesindia.com/article/universal-health-care/indias-primary-health-care-needs-quick-reform/34899/1

• http://www.gramvaani.org/?p=1629

• http://fampra.oxfordjournals.org/content/20/4/457.full

• http://www.unesco.org/education/tlsf/mods/theme_a/interact/www.worldgame.org/wwwproject/what02.shtml

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

• http://www.ijph.in/article.asp?issn=0019-557X;year=2013;volume=57;issue=2;spage=59;epage=64;aulast=Yeravdekar

• http://www.indiahealthprogress.in/releases/india-health-progress-free-generic-drug-program-positive-step-improving-access-health-care

• http://www.phcris.org.au/publications/researchroundup/issues/21.php

• http://www.who.int/countries/ind/en/

• http://www.iitk.ac.in/3inetwork/html/reports/IIR2007/11-Health.pdf

• http://lifesciences.ieee.org/publications/newsletter/january-2013/257-point-of-care-healthcaretechnology-in-india-challenges-and-journey-ahead-a-clinician-s-perspective

• http://planningcommission.nic.in/plans/planrel/fiveyr/9th/vol2/v2c3-4.htm

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