Improving Primary Healthcare in Rural India
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Challenges to Healthcare in India - The Five A's
Challenges to Healthcare in India - The Five A's
Challenges to Healthcare in India - The Five A's
The Indian healthcare scenario presents a spectrum of contrasting landscapes. At one end of the spectrum are the glitzy steel and glass structures delivering high tech medicare to the well-heeled, mostly urban Indian. At the other end are the ramshackle outposts in the remote reaches of the “other India” trying desperately to live up to
The Indian healthcare scenario presents a spectrum of contrasting landscapes. At one end of the spectrum are the glitzy steel and glass structures delivering high tech medicare to the well-heeled, mostly urban Indian. At the other end are the ramshackle outposts in the remote reaches of the “other India” trying desperately to live up to their identity as health subcenters, waiting to be transformed to shrines of health and wellness, a story which we will wait to see unfold. With the rapid pace of change currently being witnessed, this spectrum is likely to widen further, presenting even more complexity in the future.
Our country began with a glorious tradition of public health, as seen in the references to the descriptions of the Indus valley civilization (5500–1300 BCE) which mention “Arogya” as reflecting “holistic well-being."The Chinese traveler Fa-Hien (tr.AD 399–414) takes this further, commenting on the excellent facilities for curative care at the time. Today, we are a country of 1,296,667,068 people (estimated as of this writing) who present an enormous diversity, and therefore, an enormous challenge to the healthcare delivery system.
This brings into sharp focus the WHO theme of 2018, which calls for “Universal Health Coverage-Everyone, Everywhere.”What are the challenges in delivering healthcare to the “everyone” which must include the socially disadvantaged, the economically challenged, and the systemically marginalized? What keeps us from reaching the “everywhere,” which must include the remote areas in our Himalayan region for instance, where until recently, essentials were airlifted by air force helicopters?While there are many challenges,
I present five “A's” for our consideration:
⦁Awareness or the lack of it: How aware is the Indian population about important issues regarding their own health? Studies on awareness are many and diverse, but lacunae in awareness appear to cut across the lifespan in our country. Adequate knowledge regarding breastfeeding practice was found in only one-third of the antenatal mothers in two studies.Moving ahead in the lifecycle, a study in urban Haryana found that only 11.3% of the adolescent girls studied knew correctly about key reproductive health issues. A review article on geriatric morbidity found that 20.3% of participants were aware of common causes of prevalent illness and their prevention.Why is the level of health awareness low in the Indian population? The answers may lie in low educational status, poor functional literacy, low accent on education within the healthcare system, and low priority for health in the population, among others.What is encouraging is that efforts to enhance awareness levels have generally shown promising results. For instance, a study in Bihar and Jharkhand demonstrated improved levels of awareness and perceptions about abortion following a behavioral change intervention.
.⦁Access or the lack of it: Access (to healthcare) is defined by the Oxford dictionary as “The right or opportunity to use or benefit from (healthcare)” Again, when we look beyond the somewhat well-connected urban populations to the urban underprivileged, and to their rural counterparts, the question “What is the level of access of our population to healthcare of good quality?” is an extremely relevant one. A 2002 paper speaks of access being a complex concept and speaks of aspects of availability, supply, and utilization of healthcare services as being factors in determining access. Barriers to access in the financial, organizational, social, and cultural domains can limit the utilization of services, even in places where they are “available.”Physical reach is one of the basic determinants of access, defined as “ the ability to enter a healthcare facility within 5 km from the place of residence or work”Using this definition, a study in India in 2012 found that in rural areas, only 37% of people were able to access IP facilities within a 5 km distance, and 68% were able to access out-patient facilities. Krishna and Ananthapur, in their 2012 paper, postulate that in general, the more rustic (rural) one's existence – the further one lives from towns – the greater are the odds of disease, malnourishment, weakness, and premature death.Even if a healthcare facility is physically accessible, what is the quality of care that it offers? Is that care continuously available? While the National (Rural) Health Mission has done much to improve the infrastructure in the Indian Government healthcare system, a 2012 study of six states in India revealed that many of the primary health centers (PHCs) lacked basic infrastructural facilities such as beds, wards, toilets, drinking water facility, clean labor rooms for delivery, and regular electricity.As thinkers in the disciplines of community medicine and public health, we must encourage discussion on the determinants of access to healthcare. We should identify and analyze possible barriers to access in the financial, geographic, social, and system-related domains, and do our best to get our students and peers thinking about the problem of access to good quality healthcare.
⦁Absence or the human power crisis in healthcare: Any discussion on healthcare delivery should include arguably the most central of the characters involved – the human workforce. Do we have adequate numbers of personnel, are they appropriately trained, are they equitably deployed and is their morale in delivering the service reasonably high?A 2011 study estimated that India has roughly 20 health workers per 10,000 population, with allopathic doctors comprising 31% of the workforce, nurses and midwives 30%, pharmacists 11%, AYUSH practitioners 9%, and others 9%. This workforce is not distributed optimally, with most preferring to work in areas where infrastructure and facilities for family life and growth are higher. In general, the poorer areas of Northern and Central India have lower densities of health workers compared to the Southern states.While the private sector accounts for most of the health expenditures in the country, the state-run health sector still is the only option for much of the rural and peri-urban areas of the country. The lack of a qualified person at the point of delivery when a person has traveled a fair distance to reach is a big discouragement to the health-seeking behavior of the population. According to the rural health statistics of the Government of India (2015), about 10.4% of the sanctioned posts of auxiliary nurse midwives are vacant, which rises to 40.7% of the posts of male health workers. Twenty-seven percentage of doctor posts at PHCs were vacant, which is more than a quarter of the sanctioned posts.Considering that the private sector is the major player in healthcare service delivery, there have been many programs aiming to harness private expertise to provide public healthcare services.
⦁Affordability or the cost of healthcare: Quite simply, how costly is healthcare in India, and more importantly, how many can afford the cost of healthcare?It is common knowledge that the private sector is the dominant player in the healthcare arena in India. Almost 75% of healthcare expenditure comes from the pockets of households, and catastrophic healthcare cost is an important cause of impoverishment. Added to the problem is the lack of regulation in the private sector and the consequent variation in quality and costs of services.The public sector offers healthcare at low or no cost but is perceived as being unreliable, of indifferent quality and generally is not the first choice, unless one cannot afford private care.The solutions to the problem of affordability of healthcare lie in local and national initiatives. Nationally, the Government expenditure on health must urgently be scaled up, from <2% currently to at least 5%–6% of the gross domestic product in the short term.This will translate into the much-needed infrastructure boost in the rural and marginalized areas and hopefully to better availability of healthcare– services, infrastructure, and personnel. The much-awaited national health insurance program should be carefully rolled out, ensuring that the smallest member of the target population is enrolled and understands what exactly the scheme means to her.Locally, a consciousness of cost needs to be built into the healthcare sector, from the smallest to the highest level. Wasteful expenditure, options which demand high spending, unnecessary use of tests, and procedures should be avoided. The average medical student is not exposed to issues of cost of care during the course. Exposing young minds to issues of economics of healthcare will hopefully bring in a realization of the enormity of the situation, and the need to address it in whatever way possible.
⦁Accountability or the lack of it: Being accountable has been defined as the procedures and processes by which one party justifies and takes responsibility for its activities.In the healthcare profession, it may be argued that we are responsible for a variety of people and constituencies. We are responsible to our clients primarily in delivering the service that is their due. Our employers presume that the standard of service that is expected will be delivered. Our peers and colleagues expect a code of conduct from us that will enable the profession to grow in harmony. Our family and friends have their own expectations of us, while our government and country have an expectation of us that we will contribute to the general good. A spiritual or religious dimension may also be considered, where we are accountable to the principles of our faith.In the turbulent times that we live in, the relationships with all the constituents listed above have come under stress, with the client-provider axis being the most prominently affected. While unreasonable expectations may be at the bottom of much of the stress, it is time for the profession to recognize that the first step on the way forward is the recognition of the problem and its possible underlying causes. Ethics in healthcare should be a hotly discussed issue, within the profession, rather than outside it.Communication is a key skill to be inculcated among the young professionals who will be the leaders of the profession tomorrow. As leaders in community medicine and public health, we may be the best placed to put this high up in the list of skills to be imparted. A good communicator is better placed to deal with the pressures of the relationships with client, employer, peer, colleague, family, friend, and government.The five as presented above present challenges to the health of the public in our glorious country. As we get ready to face a future which is full of possibility and uncertainty in equal measure, let us recognize these and other challenges and prepare to meet them, remembering that the fight against ill health is the fight against all that is harmful to humanity.
The battle against Covid head-on -A Case Study
Challenges to Healthcare in India - The Five A's
Challenges to Healthcare in India - The Five A's
It’s been more than three months since the whole of India went on a strict lockdown to fight the pandemic. While the medical workers are at the forefront of the battle across the nation, gram panchayats were holding the fort in rural India. The panchayats have shown an extraordinary spirit and resilience, despite lacking in human and inst
It’s been more than three months since the whole of India went on a strict lockdown to fight the pandemic. While the medical workers are at the forefront of the battle across the nation, gram panchayats were holding the fort in rural India. The panchayats have shown an extraordinary spirit and resilience, despite lacking in human and institutional capacities, during this ongoing fight with the pandemic.
The entire nation, and particularly the mukhiyas and other members of the panchayats in Bihar, have learned about the sudden lockdown on television. The sudden announcement of lockdown gave little time to these grassroots institutional entities to prepare for the upcoming long battle. They knew that it would unleash mayhem unless the villages are protected.
The panchayats were quick to respond to the crisis as they wasted little time waiting for the formal instructions from the government. They knew that awareness among the people is a palliative to panic.
Case Study :Sri Shakil Ahmed, mukhiya of Sabaiya panchayat of Kotwa Block, East Champaran, said doctors and public health officials have come to the village to spread the awareness about the symptoms of Covid-19 among the people. He further said, his panchayat has distributed pamphlets, made public announcements in all the villages, sprinkled disinfectants, and monitored the situation continuously. All the mukhiyas contacted for the study said, they urged villagers to monitor for the symptoms, and practice social-distancing norms.
Support mobilised
The panchayats mobilised support, particularly from school teachers and health functionaries, in making extensive arrangements needed for containing the crisis. The repertoire of arrangements included, identifying buildings for quarantine centres; providing testing facilities and basic amenities in the quarantine centres; tracking of people in the quarantine centres and isolation; issuing job cards to workers returning from cities; distribution of sanitisers, soaps, and masks; distribution of ration to poor; ensuring direct benefit transfer to beneficiaries; timely harvesting and safeguarding of agricultural produce; and running community kitchens to support the poor and the members in the quarantine center.
It was a logistical nightmare for panchayats to oversee such arrangements on a large scale, given their limited financial and human resources. Srimati Priyanka, mukhiya of Larua panchayat of Morwa block, Samastipur district, said initially few people required support for food and the villagers themselves managed the community kitchens by contributing grains and vegetables grown in their kitchen gardens. The Chmavaliya panchayat in West Champaran has experienced over 4,000 reverse migrants during the crisis. The community kitchens have taken the help of mid-day meal kitchens to prepare food on a large scale for the people placed under quarantine.
The panchayats, as per the directive of the State government, have utilised the funds from Pancham Vitt Aayog to make all the necessary arrangements. The mukhiyas did not hesitate to bridge the shortage of funds with their own wherever necessary. According to them, they felt it is their duty and, more so, they did out of concern towards humanity.
The mukhiyas were able to manage the logistical nightmare successfully by leveraging on their social capital within the community and the determination to stand united against the invisible enemy. Our study found that frontal institutions could instil confidence among communities in fighting the crisis. There were seldom conflicts at the grassroots level as people viewed panchayats, primarily, as an insider working for the benefit of the community, unlike a block office.
DBT by State
The direct benefit transfer (DBT) of ₹500 per month for three months to all Jan Dhan account-holders and a one-time transfer of ₹1,000 by the Bihar government for all ration card holders provided much needed monetary support to the poor. Though there were instances of beneficiaries not receiving the amount in their accounts, the mukhiyas said that the transfers eased and comforted the minds of the poor.
Upendra Narayan Mandal, mukhiya of Katouna panchayat, Barhat Block, Jamui district said 80 per cent of the beneficiaries in his panchayat have received the transfers. The spokesperson, husband of mukhiya Srimati Lakshmi Devi of Chamvaliya panchayat, West Champaran district, said DBTs have reached less than 40 per cent of the people in her panchayat and they are working with the appropriate authorities to help DBT reach all the beneficiaries.
Further to DBT, husband of mukhiya Srimati Nutan Kumari of Sarbahdi panchayat, Biharshariff, Nalanda district, said that the panchayat has provided three kilos of rice, three kilos of wheat and one kilo of dal per person to all the households in their panchayat. The mukhiyas were all proud to say that unlike the poor in urban areas, the poor in rural areas do not face the acute pangs of hunger. They said village as a cohesive social unit ensured that none of the poor households had to go to sleep without a proper meal during the lockdown period.
Infrastructural challenges
The panchayats included in the study faced infrastructural challenges related to the availability of primary healthcare centres and treatment facilities. The mukhiyas, in most panchayats, anticipated problems arising out of infrastructural gaps, have arranged for a vehicle to transport sick and pregnant women to the nearest healthcare facility. A few of them have quoted instances of using their vehicles or hiring vehicles at their own expense to transport pregnant women to the nearest healthcare centre.
When asked about the personal expenses incurred in such arrangements, one of the mukhiyas responded, “The whole country is in crisis. All actors and people have contributed so much. So, what is the big deal if we are doing something?” The spirit of resilience and the determination to surmount the crisis by rising to the occasion in gram panchayats have, to a large extent, made up for the lack of infrastructural facilities.
Mukhiyas were all praise for their people for their cooperation during the crisis. Migrant workers returning from the cities were either put in quarantine centres or allowed to stay at home but with the condition to get regular check-ups for Covid-19. The number of reverse migrants in the study ranged from one to two hundred people, except for one where the number was close to a thousand.
The villages approached in the study have all operated multiple quarantine centres at panchayat and block levels to accommodate the numbers. Almost all mukhiyas said that there were instances of reverse migrants reaching home in the dark of the night to avoid quarantine. Anticipating resistance for quarantine, the leadership spoke to the families concerned to seek their cooperation and also explained with patience to the returning population about the importance of quarantine.
Quelling rumours
Panchayats had to fight rumours forwarded on WhatsApp on two issues. First, related to pandemic itself and, second, related to provisions made by the government for supporting the community during the lockdown. The panchayats responded to the first of these rumours by promoting awareness in the community about the pandemic, providing necessary support for medical services, and food wherever required. To assuage the fears of the spread of the virus, panchayats, with the help of health officials, have scheduled and conducted regular check-ups of people placed under quarantine. The panchayats have also distributed sanitisers, soaps, and masks to the households from the funds available with the panchayat.
The political conflict experienced by panchayats is about the rumour related to facilities made available by the government in the quarantine centres. The mukhiya of Sarbahdi panchayat said, there were disgruntling murmurs that the panchayats were not making all the necessary provisions as per the guidelines in the quarantine centres. The rumours were dispelled by engaging people in the quarantine centres in meaningful conversations. They set the records straight by detailing the benefits to be provided during quarantine and by co-opting people from an opposing rival party in managing the quarantine facilities to demonstrate transparency.
While panchayats were responding to the health challenges of Covid-19, there were challenges on the economic front as well. April being the harvesting season for wheat, lockdown restricted the movement of produce to the market. The farmers co-opted to help each other to harvest the crop and store the produce in the space available in panchayat buildings.
Panchayats have lowered the instances of distress selling and damage to harvest by facilitating their infrastructure, like the panchayat building, to keep the produce of farmers until they reach the market. However, as per mukhiyas, there was a felt need among the villagers for strengthening the Primary Agricultural Credit Societies (PACS) for better storage infrastructure. Chamvaliya panchayat mukhiya said PACS in her panchayat does not have storage facilities and that the lockdown has added another layer of storage concerns as farmers continue to worry about whether their produce will fetch the right prices if the lockdown continues for a longer time.
Job cards
The reverse migration of workers to the villages has created pressure on opportunities for work. Mukhiyas said panchayats are doing their best to provide job cards to people under the employment guarantee schemes. However, the lack of skill-related jobs under these schemes is a major impediment for people who do not want to do manual labour. The panchayats are unsure about addressing the issue of unemployment of skilled labour. They wished for skilled jobs to be provided under employment guarantee schemes. The mukhiya of Katauna panchayat expressed his concerns about skilled people doing manual labour under 20 or 22 ongoing schemes in the region for a meagre ₹202 per day.
The closure of schools and uncertainty about their reopening is another cause for serious concern. The mukhiyas are apprehensive about the technology-based solutions as most of the households cannot afford the technology. They wished that the crisis ends soon and that children resume their school.
The pandemic is a long drawn battle. The panchayats were able to hold the fort rock solid by mobilising the community to follow social-distancing norms and undergo testing during the lockdown period. Now that the reverse migration crisis is almost over as migrant labourers have reached their homes, the twist is that of new cases arising out of the ending of lockdown. The mukhiyas were unanimous in stating that the availability of basic healthcare is still a concern in this ongoing battle with Covid-19. The outcome of the country’s battle against Covid would depend upon empowering the panchayats to take decisions and enabling them with adequate resources to fight the virus.
State of Primary Healthcare in India
Challenges to Healthcare in India - The Five A's
Healthcare and the significance of Community Contribution
In the country in which hunger, poverty, environmental and health problem are too common we should demand from our government a good primary health care system. As India, being a democratic country provides us with the basic fundamental rights, especially the right to life enshrined in Article 21 which includes health, education, privacy
In the country in which hunger, poverty, environmental and health problem are too common we should demand from our government a good primary health care system. As India, being a democratic country provides us with the basic fundamental rights, especially the right to life enshrined in Article 21 which includes health, education, privacy etc. so it is the need of an hour to improve our primary health care system which would further help the people of the country to live healthy and enjoy their basic rights.
The primary health care system should be made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self reliance and self determination.
The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care (PHC), it expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people. It was the first international declaration underlining the importance of primary health care. The primary health care approach has since then been accepted by member countries of the World Health Organization (WHO) as the key to achieving the goal of “Health For All” but only in developing countries at first.
PRESENT SCENARIO OF PRIMARY HEALTH CARE
In this modern world, with ongoing increasing population the health sector is an important sector to show a greater concern as it is well said that a good health is above wealth. So, to deal with the primary health care system in India there is various agencies and organization working to improve the health issues in rural and urban areas. There are mainly two sector i.e. Public health sector and private sectors. These are working for improvement of health in our country.
The public health system in India comprises a set of state-owned health care facilities funded and controlled by the government of India. Some of these are controlled by agencies of the central government while some are controlled by the governments of the states of India. The governmental ministry which controls the central government interests in these institutions is the Ministry of Health & Family Welfare. Governmental spending on health care in India is exclusively this system, hence most of the treatments in these institutions are either fully or partially subsidized.
So, if we look towards our public sector in health the government should come up with new policies and measures to ensure better health to the people in India as the government action has a great impact on the public at large. Therefore, the polices should also have some positive effect. However at present there is a lot of burden chronic non-communicable diseases, demographic transition (increasing elderly population) and environmental changes, the tobacco-attributable deaths range from 800,000 to 900,000/year, leading to huge social and economic losses. The rising toll of road deaths and injuries (2—5 million hospitalizations, over 100,000 deaths). Insufficient financial resources for the health sector and inefficient utilization result in inequalities in health. The inequalities in health is somewhere due to the social, economic stratification in society according to income, education, occupation, gender and race or ethnicity.
The country’s healthcare system is characterized by inadequate infrastructure and limited resources. In fact, India’s healthcare infrastructure metrics is amongst the lowest in the world. According to the WHO World Health Statistics 2015, the public sector in India spent 1.16% on health as a percentage of the GDP, ranking 187th among 194 countries. The investment in healthcare is inadequate. Global evidence on health spending shows that unless a country spends at least 5-6% of its GDP on health, basic healthcare needs are seldom met.
Furthermore if we look at private sector in health care system, according to National Family Health Survey-3, the private medical sector remains the primary source of health care for 70% of households in urban areas and 63% of households in rural areas. Reliance on public and private health care sector varies significantly between states. The main reason at the national level is poor quality of care in the public sector, with more than 57% of households pointing to this as the reason for a preference for private health care. Most of the public healthcare caters to the rural areas; and the poor quality arises from the reluctance of experienced health care providers to visit the rural areas. Consequently, the majority of the public healthcare system catering to the rural and remote areas relies on inexperienced and unmotivated interns who are mandated to spend time in public healthcare clinics as part of their curricular requirement. Other major reasons are distance of the public sector facility, long wait times, and inconvenient hours of operation. The study conducted by IMS Institute for Healthcare Informatics in 2013, across 12 states in over 14,000 households indicated a steady increase in the usage of private healthcare facilities over the last 25 years for both Out Patient and In Patient services, across rural and urban areas.
TIERS OF PRIMARY HEALTH CARE SYSTEM:
(A)PUBLIC HEALTH CARE
PHC are established and maintained by govt.
Primary Health Centres
In developing countries the Primary Health Centre (PHC) is the basic structural and functional unit of the public health services. These is the parts of government funded public health system in India and are the most basic unit of this system.
As per the given data, 1, 00,000 of population is covered under every primary health centre and it covers all over about 100 villages. According to WHO report, in the developing countries health system is not responding accordingly as per the needs of society. India adopted primary health care system even before the declaration of Alma-ata on the principle that inability to pay should not prevent people from accessing health services.
Sub Centres
The first contact point between the primary health care system and the community is Sub-Centre(SC). All the sub centres are provided with the basic drugs as to easily accessible of drugs for all men, women and children. Sub centres are made so that it covers a population of 3000 in hilly or tribunal areas (difficult areas to access) and 5000 in plain areas.
Presently a sub centre is staffed by a male health worker and with one female health worker, prior one is known as Multipurpose worker and latter is known as Auxiliary nurse midwife. Sub centre must be at a place which could be easily accessible to general public as a whole, it should be in a central location.
Community Health Centre
The Community Health Centre (CHC), the third tier of the network of rural health care institutions, was required to act primarily as a referral centre (for the neighboring PHCs, usually 4 in number) for the patients requiring specialized health care services.
The main aim of having a CHC is in two fold, first one is to make modern health care which should be easily accessible to rural public and second is to ease the overcrowding in district areas. CCHCs were mainly designed to consist of four specialists in the field of medicine, surgery, paediatrics and gynaecology; 30 beds for indoor patients; operation theatre, labour room, X-ray machine, pathological laboratory, standby generator , etc., along with the complementary and Para medical staff. But dealing with present scenario only 30 percent of the total are working accordingly with their position and rest of the 70 percent are running with one specialist or even without any specialist. This shows the lack of facility system related to health care system in India.
Rural Hospitals
Health care system to be successful in rural areas is a big challenge for the health ministry of India to take care of, because most of the population about 70 percent of the total population is residing in rural areas where mortality rate due to diseases are on a high. Though there are several schemes run by government but there is lack of implementations as a cause which arises and results into non access of basic needs like availability of medicines. In rural India 8 percent of the centres do not have doctors or medical staff, 39 percent does not have lab technicians and 18 percent PHCs do not even have a pharmacist.
According to a report by IMS institute for health care and informatics, the current situation is the urban residents have access to 66 per cent of the total hospital beds available in India. In rural areas, to seek OPD treatment 32 per cent of rural respondents had to travel over 5 kms, while 68 per cent travelled less than 5 kms for the same.
Health Insurance Scheme
Health insurance scheme for Indian workers is a a self financing social security. This scheme is managed and headed by ESIC as Employees State Insurance Corporation in accordance with the rules and regulations stipulated by there in the ESI act 1948. It is an autonomous corporation by a statutory creation under ministry of labour and Employment government of India.
Central Govt. Health Scheme
The Central Government Health Scheme (CGHS) was started under the Indian Ministry of Health and Family Welfare in 1954. It was aim to provide comprehensive medical care facilities to the Central Governmental Employees including the pensioners and their dependents residing in CGHS covered cities. This scheme took place for the first time in Delhi in 1954, subsequently it spreaded to the following 17 cities: Allahabad, Ahmadabad, Bangalore, Mumbai, Kolkata, Hyderabad, Jaipur, Jabalpur, Lucknow, Chennai, West Bengal, Nagpur, Patna, Pune, Kanpur, Thiruvananthapuram and Guwahati.
(B) PRIVATE SECTOR
Private hospitals
Private hospitals are not funded by Government, they are run by one for personal benefit and to avail the service through direct payments from patients and insurance providers, and do not receive public money. Collaboration with the private sector to provide health services to the poor has generated many challenges. In our country people are choosing private hospitals because of lack of facilities available in the public hospitals even though to afford the price of private hospital is almost next to impossible for most of the people.
Indigenous system of medicine
This system includes Ayurveda, Siddi, Unani and Tibbi, Homeopathy. Most of the traditional systems of India including Ayurveda have their roots in folk medicine. Ayurveda is considered as most efficient system which originated in India about 3000-5000 years ago as an oldest health care system in the world. Similarly Siddi, Unani, Tibbi and Homeopathy are the various system for health care especially adopted by the Indians. India is a vast country with a variety of religions where people still belief in their cultural system rather scientific system.
(C) NATIONAL HEALTH PROGRAMMES
Since India became independent, several measures have been taken by the Indian Government under national health programmers in India. Some of the recent initiatives are: Rashtriya Bal SwasthiyaKaryakaram (RBSL), Rashtriya Kishore SwasthyaKriyakaram (RKSK), Weekly Iron Folic Acid Supplementation Programme(WIFS). The main object of these programmes are-
⦁ to control or eradication of communicable diseases
⦁ improvement of environmental sanitation
⦁ raising the standard of nutrition
⦁ control of population
⦁ improving rural health
PROBLEMS:
In India, communicable diseases, maternal, perinatal, and nutritional deficiencies continue to be important causes of deaths non communicable diseases like diabetes, cardiovascular diseases, respiratory disorders, cancers, and injuries are showing the rising trends. Delivering of qualitative health care services is considering a basic need irrespective of age, gender, and culture.
The key growth inhibitors are:
Neglect of rural population: In major urban areas, healthcare is of adequate quality, approaching and occasionally meeting Western standards. However, access to quality medical care is limited or unavailable in most rural areas. This has led to a deterioration of health in rural areas, which is also affecting the agricultural sector, with increased rate of malnutrition found in the backward areas of the state, high infant and maternal mortality rate, and increased risk of spread of diseases in rural areas and the nearby urban areas.20
Although, there are large no. of PHC’s and rural hospitals yet the urban bias is visible. According to health information 31.5% of hospitals and 16% hospital beds are situated in rural areas where 75% of total population resides. Moreover the doctors are unwilling to serve in rural areas.
Emphasis On Culture Method:
The health care system of our country depend upon the western model, and there is no use for culture method for health care but in actual practice mainly in rural areas we can say due to shortage of money or inconvenience they use their own traditional method to cure the disease known as desi dawai, ayurvedic medicines etc. even more in early days delivery of a woman were done at homes in villages by mid wives.
Inadequate Outlay for Health:
According to the National Health Policy 2002, the Govt. contribution to health sector constitutes only 0.9 percent of the GDP. This is quite insufficient. In India, public expenditure on health is 17.3% of the total health expenditure while in China, the same is 24.9% and in Sri Lanka and USA, the same is 45.4 and 44.1 respectively. This is the main cause of low health standards in the country. Due to insufficient doctors, the rural people have to suffer a lot in getting proper medical treatment. As per Hindustan Times India is Short of 5 lakhs doctors, India has just 1 for 1,674 people.
Social Inequality:
According to the National Family Health Survey-III (2005-06) clearly highlight the caste differentials in relation to health status. The survey documents low levels of contraceptive use among the Scheduled Castes and the Scheduled Tribes compared to forward castes. Stunting, wasting, underweight and anemia in children and anemia in adults are higher among the lower castes. Similarly, neonatal, postnatal, infant, child and under-five statistics clearly show a higher mortality among the SCs and the STs. Problems in accessing health care were higher among the lower castes.
Expensive Health Service:
A new government survey shows that in 2014 more than 70% of illnesses were treated in the private sector including clinics, hospitals and charitable institutions, a four percentage point increase over a 10-year period. Private Doctors were the most important single source of treatment in both rural and urban sectors,” said the National Sample Survey Office (NSSO) survey of over 3.3 lakhs households across India released this week. The survey also said the number of people visiting private institutions for healthcare was higher in urban areas at 79% than just 72% in rural India. Many people are turning to private health providers that have mushroomed across the country because of poor infrastructure at often overcrowded government-run hospitals. The NSSO data showed that people opted for private sector even though it cost almost four times as much as treatment in government institutions. The numbers are telling: In 2014, the average cost of hospital care by a public utility was Rs 6,120 while a private institution cost more than four times as much at Rs 25,850. A decade earlier, the difference between the two was less than three times. For higher cost treatments like cancer, the average cost in a government hospital was Rs 24,526 compared to Rs 78,050 in the private sector. The cost of treatment for skin infections, respiratory and accidents is between four to 10 time higher in private clinics, the survey showed.
SUGGUESTIONS:
Behind all this glitter there are some ominous signs of the ills that pervade the health care system. A coherent and sustainable plan that addresses the healthcare needs of the masses is strikingly absent. There are no national standards by which physicians, nurses, pharmacists and hospitals are trained.
According to public health foundation of India, Mr. Reddy has given few recommendation:
Increase health-care spending to 2.5% of GDP: At the moment, the Indian government spends about 1% of its gross domestic product on health care, according the Organization for Economic Cooperation and Development. But it is recommended to spend 2.5% of GDP by 2017.While public spending is high as a portion of GDP, low priority is accorded to health.” The report puts Indian public spending at 33% of the GDP, of which only 4% is spent on health care.
Spend more on primary care: Additional funds shouldn’t go only to maintaining the present health system, with its skewed spending choices. Much as in education, Indian health spending has often favored treatment at hospitals in large cities over more widely available basic and preventive care. Over time, 70% of public spending should be on primary care. Pre-natal check-ups and regular deliveries would be primary care, for example, while a cesarean-section delivery would be secondary care.
Develop an all-India public health service:
The committee suggested the country needs an all-India service of public health workers along the lines of the system that Tamil Nadu has, which some observers say is the best in India.
In general, to make a national health system that works, the report says that more medical and nursing schools will need to be set up and millions more basic health workers will be required, particularly in villages. We need doctors, we need nurses, we need community health workers. “We need a multilayered health work force.”
Buy more drugs in bulk:
Out-of-pocket spending on medicine has gone up in India, and now accounts for almost three-fourths of all private health-care spending, the Indian government could take a cue from Tamil Nadu, which purchases drugs in bulk and provides many medicines for free to patients. That would involve significantly increasing public spending on drugs from around $1 billion now.
The present system (and its escalating costs) is not sustainable due to its inefficiency and a lack of aligned incentives for improving performance. It will not be easy and it will not be inexpensive. But it has been done in other parts of the world before and it can be done here too. The potential to create the best healthcare system in the world exists. It is time to commence the debate, develop a plan and execute it.
Way forward
As now we are in globalization era in which we have to develop ourselves with a very high pace in order to compete with the other developed countries. India’s progress towards achieving the Millennium Development Goal is slow and it is well known that primary health care is important for achieving the goals. The only thing which can be done is that government should take effective step in order to resolve the health related issues and problem.
Moreover in rural areas, it should be ensured that doctors prove themselves to be more resourceful then paramedical personnel, as in rural areas people mostly believe in the latter case. As our health care system is dealing with main two sector i.e. public sector and private sector. In both these sector although far reaching results are achieved but still for our country population is not enough we have to still improve working of both the sectors but primarily we should improve our public sector so that a larger no. of public is benefited specially the rural areas at affordable prices and with easy accessibility. And then secondly, we should improve private sector by providing them subsides though government which will help the people to get high technologies and advanced medicine at cheap rates and disease can be cured in every nook and corner of the country.
Healthcare and the significance of Community Contribution
Healthcare and the significance of Community Contribution
Healthcare and the significance of Community Contribution
Healthcare is the right of every individual but lack of quality infrastructure, dearth of qualified medical functionaries, and non- access to basic medicines and medical facilities thwarts its reach to 60% of population in India. A majority of 700 million people lives in rural areas where the condition of medical facilities is deplorable.
Healthcare is the right of every individual but lack of quality infrastructure, dearth of qualified medical functionaries, and non- access to basic medicines and medical facilities thwarts its reach to 60% of population in India. A majority of 700 million people lives in rural areas where the condition of medical facilities is deplorable. Considering the picture of grim facts there is a dire need of new practices and procedures to ensure that quality and timely healthcare reaches the deprived corners of the Indian villages. Though a lot of policies and programs are being run by the Government but the success and effectiveness of these programs is questionable due to gaps in the implementation. In rural India, where the number of Primary health care centers (PHCs) is limited, 8% of the centers do not have doctors or medical staff, 39% do not have lab technicians and 18% PHCs do not even have a pharmacist.
India also accounts for the largest number of maternity deaths. A majority of these are in rural areas where maternal health care is poor. Even in private sector, health care is often confined to family planning and antenatal care and do not extend to more critical services like labor and delivery, where proper medical care can save life in the case of complications.
The Problems
Due to non accessibility to public health care and low quality of health care services, a majority of people in India turn to the local private health sector as their first choice of care. If we look at the health landscape of India 92 percent of health care visits are to private providers of which 70 percent is urban population. However, private health care is expensive, often unregulated and variable in quality. Besides being unreliable for the illiterate, it is also unaffordable by low income rural folks.
To control the spread of diseases and reduce the growing rates of mortality due to lack of adequate health facilities, special attention needs to be given to the health care in rural areas. The key challenges in the healthcare sector are low quality of care, poor accountability, lack of awareness, and limited access to facilities.
Various organizations are coming together for improvements in health care and technology plays a crucial role to facilitate this. Information and communications Technology provides hosts of solutions for successful implementation of these changes.
Technology for Rural Health Care
Several organizations are working alongside the government and NGOs to help relieve the burden on the public health system using mobile technology. India has over 900 million mobile phone users and this fact can be leveraged to employ better practices in even the remote areas. Leading global organizations of healthcare industry are using our mobile technology to enhance the quality of care and bridge the gaps in healthcare services.
Gram Vaani provides cutting- edge mobile and IVR solutions to automate processes and applies best practices in the field. Our services cater to health care sector, social sector, and corporate organizations for connecting with the difficult to reach markets at bottom of the pyramid.
We have built simple technologies on mobile to suit the needs of different sectors and verticals. By improving the systems and functions of our clients we have impacted thousands of lives in rural India. Through mobile and IVR services we have an extensive reach across the demography. Our initiative is focused on delivering best tools and solutions to our partners for reaching out to the rural markets and gives a platform to be directly connected to them. Leading global organizations of healthcare industry are using our technology to enhance the quality of care and bridge the gaps in healthcare services in rural India.
Improving Healthcare on the ground
We are employing mobile technology in several healthcare projects for leading global organizations. In partnership with the White Ribbon Alliance for Safe Motherhood, for a program of Merck for Mothers, we are working to upgrade the quality of maternity healthcare in India. There’s growing evidence from developing countries confirming that patient’s perception of quality of care and satisfaction with care are critical to utilization of health services. To this end, we are building a quality-of-care checklist for expectant mothers (and their families) to answer using mobile phones and rate on factors such as whether they were treated with respect during the delivery, whether they got entitlement for institutional delivery, whether the transportation provided was of good quality, etc.
This tool is constructive for:
⦁ Making women aware of their rights to demand good quality of care,
⦁ Bringing accountability by highlighting lapses in the health delivery process, and,
⦁ Increasing uptake of appropriate health services at the right venues
As a part of another healthcare program Ananya in Bihar, with NGO’s PATH and PCI, we are mobilizing communities using our voice technologies to demand greater accountability from the health delivery infrastructure. Through simple education and discussion programs on mobile we make the marginalized communities aware of best practices in healthcare and sanitation, and about their rights and entitlements from the health delivery system. The community members are encouraged to engage and share their stories with each other on our open mobile platform, and to demand grievance redressal and accountability from the health system.
Campaigns for Healthcare Accountability
In association with Grand Challenges Canada, we conducted a Health campaign to review health services for accountability in Jharkhand. In this campaign on Mobile Vaani we invited opinions, experiences, information and feedback from public on current Government health facilities in Jharkhand.
People from different districts of Jharkhand left messages on various issues in health care facilities, such as; health facilities available at PHCs, Laboratory testing and Delivery facilities at Government Health Centers, availability of clean toilet and drinking water at PHCs, and distance of the nearest health center from the Village.
Within the first 4 weeks of the campaign, more than 1600 callers from 12 districts of Jharkhand called in and participated. Lot of important facts were brought forward in the campaign. 50 percent of the people informed that there was no facility of Laboratory Investigation or Delivery available at their nearest Health Centers. While a total of 86 percent callers shared that the facility of drinking water and public toilet was not available in the Government Health centers.
The campaign enabled us to:
⦁ Understand the present scenario of health facilities in Jharkhand
⦁ Identify major issues that people are facing while seeking health services.
⦁ Review the state of PHC infrastructure and its connectivity to nearby villages
⦁ Build awareness about accountability in health care
To bring about a change in the existing healthcare system we took the voices of people to the Government authorities. We collated data from our campaign and communicated the real picture to the district collectors and state health department for action.
Other Campaigns on Mobile Vaani
Social campaigns conducted on Mobile Vaani platform are an initiative to identify, understand and get solutions for public problems and social issues. The campaigns are active discussions where the community members are engaged to contribute their views about various issues, and our team helps coordinate these discussions into manageable threads. We have done campaigns on various issues and received tremendous response on our voice based medium on mobile phone, much higher than simple broadcast of information on radio or television. The results for information dissemination and call-to-action through these campaigns have been phenomenal.
Gram Vaani Technologies for advanced Healthcare delivery
Gram Vaani has built innovative voice applications for organizations working in health care sector to automate and manage their processes efficiently. Our vAutomate suite of technologies provides host of services, including the following mobile technologies that can be used for better rural health care delivery in several ways:
⦁ Survey: Organizations can create a custom questionnaire containing multiple-choice-questions, quantitative input questions, and qualitative audio recordings, that can be broadcast to different contact groups. For example: a network of ASHA workers (community health workers) can be sent a survey to capture self-reported data on the number of visits they did; similarly, AWWs (Aanganwadi Workers) can be sent a survey to get data on the number of children that were fed, the menu that was served, and if they are running out of ration supply and need to alert the district authorities.
⦁ Inform: Organizations can build an audio pack with a series of tutorial messages, which can be played out over a phone call to a desired contact group. For example, ASHAs or AWWs, could be sent messages on best practices to follow during ante-natal care, danger signs to look out for, and ensure that they take expectant mothers for institutional delivery.
⦁ Answer: As an extension to vInform technology, the users can also ask questions, which can be answered by experts. Thus, if ASHAs or AWWs have any questions or concerns, they can record their message which can be answered by experts live or through recordings over the phone.
We customize these services and solutions as per our client’s needs and devise ways to reach ‘under-served’ communities and ‘out of reach’ markets.
Gram Vaani started in 2009 with the intent of reversing the flow of information, that is, to make it bottom-up instead of top-down. Using simple technologies and social context to design tools, we have been able to impact communities at large -more than 2 million users in over 7 Indian States, Afghanistan, Pakistan, Namibia and South Africa. More interesting than this are the outcomes of what we have done: Forty rural radio stations are able to manage and share content over mobiles and the web, corrupt ration shop officials in Jharkhand were arrested due to citizen complaints made on our platform, Women Sarpanches in Uttar Pradesh shared learning and opinions on their work with senior government officials, and citizens were able to monitor and report on waste management in 18 wards of Delhi to hold MCD officials accountable for their work. We work with organizations all across India and in other developing parts of the world.
Revival and modernization of sick PHCs and CHCs
Healthcare and the significance of Community Contribution
Revival and modernization of sick PHCs and CHCs
- Revival And Modernization Of Sick Primary Health Centre in medically most backward region of India and foster the purpose of the systematic operational frameworks , efficient manpower and medium for fulfilling the objective of the same.
Managing firm recognizes the importance of establishing a business to customer relationship that foster
- Revival And Modernization Of Sick Primary Health Centre in medically most backward region of India and foster the purpose of the systematic operational frameworks , efficient manpower and medium for fulfilling the objective of the same.
Managing firm recognizes the importance of establishing a business to customer relationship that fosters mutual understanding, shared responsibilities and a commitment to working together for the improvement of Healthcare Services through this Health Centre.
- To render India’s most backward areas with basic Healthcare facilities during first 5 years post Project Commencement by Redevelopment and Modernisation of existing sick Primary Health Centre (PHCs)/Community Health Centre (CHCs)
- To drive out inferior quality of medical Services from the Unserved or Underserved areas mainly rural and semi-urban areas
- To reduces patients load on Secondary and Tertiary Health Centre
- With this initiative ,we are able to generate employment opportunity on regional basis
MedicantCare is first Medical based Company that recognizes the importance of establishing a business to business and business to Public relationship that fosters mutual understanding, shared responsibilities and a commitment to working together for the improvement of Healthcare Services and also recognizes the importance of developing Basic Medical Services and other associated Services beneficial for all stakeholder in Healthcare Sector.
It also recognizes that improvements are needed in the Indian healthcare across India and with major focus on Rural-India and adjoining poor countries ,to strengthen and improve the quality of healthcare services that are inclusively dependent on medical machinery manufacturing ,their supplies chain through dealers ,machine’s service support and availability of parts support
Objective
A) With this initiative to provide healthcare facilities for the poorest of the poor
B) To transform worse healthcare based services into affordable and accessible healthcare facilities
C) To drive out inferior quality of unprofessional healthcare services into professional services
D) To provide high quality healthcare service support to far flung region of India’s Eastern and North Eastern Region and adjoining Countries Of Bhutan, Nepal and Bangladesh.
The firm allows us the opportunity to present to you any medical equipment specific to patient needs and within their cost restraints. Through personal attention to patient and a careful understanding of their goals of improving healthcare services, we are able to deliver the healthcare solutions that fit every possible healthcare related needs.
1) Post mutual consensus on the discussed terms and condition & operation framework ,Memorandum of Agreement shall be undersigned
2) Building revival as per clinic setup requirement
Note –Certification/approval/Renewal and building modification shall be taken into mission mode paralleling (1 Quarter)
3) Staff Selection, Marketing, Public Awareness for Healthcare Services and organizing Free medical Camp for Vulnerable Section of the Society including Tribal and other Backward Rural Region (1 Quarter)
Managing firm shall successfully adapted their business operations to the new professional environment and their service activities to the large and ambitious Programs. The technological scope of the restructured setup aims directly at services and so complements quality improvement of the services provided
We will place its focus primarily to provides adequate support for longer- term, pre-competitive support involving healthcare services.
We have encompass all aspects of productive healthcare services and must give special consideration to environmental sustainability, minimization of materials waste and efficient services with optimum rate of services by offering direct discount to the registered patients
This will further strengthen PHCs –
· Customer relation and will prosper our business further
· Long term strategy and planning has also needed to be taken more into account. We have developed business strategies which focus on the lower price facilities along with other competitive factors such as quality, relation and value-for-money. However, Strategic management of business is indispensable in order to identify and evaluate future opportunities which will reflect the objective of the project.
This Series Of Operation Requires -
-Productive management
-Efficient workforce of Technician , Administrative Staff Etc
-Capital
Recommendations for Action
•Work cooperatively to ensure appropriate, efficient communication in support of the objectives of accessible healthcare to far flung region of North-Eastern and Central India
• Regularlyshareinformationabouthospitalsetupsuccessesandbarriersto success with the intent to improve turnover
•Maintain capital in the accounts for day to day business related to production
, procurement, man force and other business requirements
• Schedule annually a joint meeting between parties to review the status of operation
• Regularly monitor progress on implementation of the mutually discussed objective
• Facilitateparticipationbyallstakeholderinsharingmarketperspectivesthat may be useful in enhancing the objective
Execution
India with over 1.40 billion demographic strength ,with around 70% are fully or partially dependent on Public or privately funded medical infrastructure
Since over 70 years of our independence, remaining 30% of the population i.e. over 30cr Population still don’t have access to basic medical facilities that is reason for –
- Higher Mortality rate
- Higher tuberculosis cases
- Higher Child Mortality rate
- Higher cases of Non-communicable cases like Diabetes/Obesity etc.
To Counter this challenging Situation , we have planned to start a prosperous move for Revival and Modernization of Sick Grass-root Medical Infrastructures (i.e. Primary Health Centre –PHCs / Community Health Centre-CHCs ) through
INCUBATION Phase -1(1 Quarter)
Statute Licensing, Hiring of Skilled OR Semi-Skilled Resources, Selection & renovation of Sample PHCs, Marketing and Public Awareness
GROWING Phase -2(2 Quarter)
Organizing Medical camps with the support of Health Professionals for Health awareness as part of extending serving Market
TAKE-OFF Phase-3
Post 3 quarter of Project Commencement (refer to Sales and Profit Estimation)
To serve the unserved section of the society with the cordial cooperation of medical/non-medical stakeholders to make India As-
HEALTHY &PROSPEROUS BHARAT
NOTE:
One Primary Health centre (PHCs) to render Primary Medical Services to 30000peoples
(As Per Indian Public Health Standards)
So, Number of Primary Health Centres required to served 30 Crores or 300 Million Unserved Indians is 30Cr or 300 millions/30000 = 10000 Primary Health Centre.
Benefits of projects
1. Accessible Health care Services–
As healthcare expenses still constitute over 70% out of packet expenses and this can provide accessible and affordable medical service to the unserved who are still required to travel miles for accessing basic medicalfacilities
2. As a Bridge-
To act as bridge between Patient and medical services and minimize the role of commission agent that would increases overall cost of medicalexpenses
3. Affordability–
Our affordable medical charges and quality-oriented Services would fill the gap left due to expensive medical facilities and incapability of vulnerable or unserved peoples to enjoy medical services at very affordable cost
4. People’s Movement–
We work with peoples who are denied basic right of basic health facilities for decades through MEMBERSHIP PROGRAMME at very affordable cost complemented with multiple healthcare facilities for the member and his/her Families.
Infusing life into primary health care in India
Healthcare and the significance of Community Contribution
Revival and modernization of sick PHCs and CHCs
The recently released new National Health Policy (NHP)-2017 is a welcome move that presents a clear vision of how India’s sluggish healthcare system can be stimulated to deliver health and well-being to all by 2030, in order to meet the Sustainable Development Goal (SGD) on health.
The policy acknowledges the need for increasing the lev
The recently released new National Health Policy (NHP)-2017 is a welcome move that presents a clear vision of how India’s sluggish healthcare system can be stimulated to deliver health and well-being to all by 2030, in order to meet the Sustainable Development Goal (SGD) on health.
The policy acknowledges the need for increasing the level of public financing for health, stating that the government must spend 2.5% of GDP by 2025. While this is sub-optimal and projects a further date than public health advocates had hoped for, the promise to double public financing over next eight years is still welcome, given that government funding was virtually stagnant for several decades.
However, Central budgets from now on must reflect a steady rise annually, to give credence to this promise. It also remains to be seen how States will conform to the recommendation that spending on health must rise above 8% of their budgets by 2020. Primary health care is rightly prioritised for two-thirds or more of all public funding. Free drugs, diagnostic and emergency services would be provided to all in public hospitals.
Challenges Ahead
Primary Health Care (PHC) as a concept came to existence in independent India on the recommendation of Bhore Committee Report in 1946. The PHC in India has been a great challenge because of its diversity and disparity. From North to South, East to West, rich to poor, urban to the rural population, disease prevalence varies significantly. Language, cultural beliefs, social stigmas, literacy rate, and general awareness are few challenges encountered.
The current status of PHC in India is very grim. Besides low rates of institutionalized delivery and immunization coverage, high maternal and infant mortality rate which is definitely a concern and priority, availability of formal primary care in urban and rural areas particularly is virtually non-existent.
Public health infrastructure is grossly inadequate to cater to health-care demands of 1.28 billion population of India. There are gross shortages of skilled health-care workers at primary care level. Whatever the resources are available, they are either overburden or underutilized. Review of the 11th plan performances shows that despite progress, goals were not achieved. Huge gaps in the field of training health-care professional at each level have been rightly pointed in the 12th Five Year Plan.
According to the 12th Five Year Plan (2012–2017) document, there has been substantial progress despite which health-care system suffers from few weaknesses such as the availability of health-care services from public and private sectors taken together. Qualities of health-care services are not uniform throughout the public and private sectors may be due to the lack of inadequately enforced regulatory standards.
The effectiveness of health care system is also affected by the ability of the community itself to participate in designing and implementing the delivery of services. The opportunity to design and manage such delivery provides empowerment to the community as well as better access, accountability, and transparency. Of late, the health care delivery must be made more consultative and inclusive. This can be achieved by employing methodologies based on community-based monitoring, which has proved successful in some parts of the country. It needs to be introduced in other parts. Health care provision by the organized private sector is virtually absent at the primary level, which highlights the need for providing adequate public resources to build a public sector health system.
Towards Strengthening Primary Health Care
Strengthening PHC would be a major step towards achieving the goal of mitigating the burden of diseases at advanced stage. It needs effective planning and future roadmap to reach the target. The PHC forms the anchor around which entire health-care delivery system is organised. This was evident from the recommendation by the High-Level Expert Group on Universal Healthcare appointed by the government of India to allocate 70% of the health-care budget for the PHC.
Although Primary care medical specialty ”family medicine” is a recognised post graduate qualification by the Medical Council of India (MCI), yet it has not been implemented in spirit despite the repeated emphasis in the national health policies. Family medicine or general practice departments do not exist at medical colleges in India because MCI regulations do not mandate so. Primary health care practitioners, therefore, have no formal postgraduate training, no specialist accreditation, and no system at par for career progression compared to their hospital specialists. They have lower pay and worse working conditions than their hospital colleagues. Lack of appropriate training or qualification and full career progression appears to be the major barrier to the availability of primary care doctors in the community.
There are a major difference in Millennium Development Goals (MDGs) health indicators between urban and rural areas and between states, with many states showing excellent progress towards the goals, and others, where the pace of change is much slower. The national target for infant mortality rate is less than 30/1000; the projected rate in 2015 is 31/1000 in urban areas but 43/1000 in rural areas.
Primary health care can be a very effective mechanism to control healthcare costs while improving health outcomes (by primary care doctors making referral decisions on the basis of accurate diagnoses and managing most patients in the community according to evidence-based guidelines using generic drugs).
Expanded institutional capacity, as well as new courses and cadres, are proposed to overcome the shortages of skilled human resources in the healthcare system. Public Health Management cadres are to be created in all States. The national health policy 2017 emphasizes popularizing of courses like MD (family medicine), policy further recommends for the creation of a large number of distance and continuing education options for general practitioners in the private as well as
the public sectors, which would upgrade their skills to manage the majority of cases at local level, thus avoiding unnecessary referrals. A variety of specialized nursing and paramedical courses are proposed, even as Accredited Social Health Activists (ASHAs) can career-track to become auxiliary nurse midwives. In India, there is a shortage of high caliber senior staff in primary health care to act as trainers and role models. Developing the required cadre of primary health care doctors, nurses, and other staff will strengthen the support of hospital clinicians.
Hope, the recommendations of NHP 2017 towards the strengthening of primary health care will meet implementation on the ground. There is no “one-size-fits-all” for delivering primary care, but effective teamwork and local ownership are common features to ensure successful delivery. And this can be achieved by multi-disciplinary clinical teams led by family physicians. Enabling them to take the rein of primary care similar to other countries such as Brazil, will certainly be a big leap towards strengthening primary health care in India.
Analysing the opportunities and challenges ASHA Health Workers
Community Health Programmes: Genesis and Impact on Rural Health
Community Health Programmes: Genesis and Impact on Rural Health
Globally, there is increasing interest in community health worker’s (CHW) performance; however, there are gaps in the evidence with respect to CHWs’ role in community participation and empowerment. Accredited Social Health Activists (ASHAs), whose roles include social activism, are the key cadre in India’s CHW programme which is designed
Globally, there is increasing interest in community health worker’s (CHW) performance; however, there are gaps in the evidence with respect to CHWs’ role in community participation and empowerment. Accredited Social Health Activists (ASHAs), whose roles include social activism, are the key cadre in India’s CHW programme which is designed to improve maternal and child health. In a diverse country like India, there is a need to understand how the ASHA programme operates in different underserved Indian contexts, such as rural Manipur.
Methods
We undertook qualitative research to explore stakeholders’ perceptions and experiences of the ASHA scheme in strengthening maternal health and uncover the opportunities and challenges ASHAs face in realising their multiple roles in rural Manipur, India. Data was collected through in-depth interviews (n = 18) and focus group discussions (n = 3 FGDs, 18 participants). Participants included ASHAs, key stakeholders and community members. They were purposively sampled based on remoteness of villages and primary health centres to capture diverse and relevant constituencies, as we believed experiences of ASHAs can be shaped by remoteness. Data were analysed using the thematic framework approach.
Results
Findings suggested that ASHAs are mostly understood as link workers. ASHA’s ability to address the immediate needs of rural and marginalised communities meant that they were valued as service providers. The programme is perceived to be beneficial as it improves awareness and behaviour change towards maternal care. However, there are a number of challenges; the selection of ASHAs is influenced by power structures and poor community sensitisation of the ASHA programme presents a major risk to success and sustainability. The primary health centres which ASHAs link to are ill-equipped. Thus, ASHAs experience adverse consequences in their ability to inspire trust and credibility in the community. Small and irregular monetary incentives demotivate ASHAs. Finally, ASHAs had limited knowledge about their role as an ‘activist’ and how to realise this.
Conclusions
ASHAs are valued for their contribution towards maternal health education and for their ability to provide basic biomedical care, but their role as social activists is much less visible as envisioned in the ASHA operational guideline. Access by ASHAs to fair monetary incentives commensurate with effort coupled with the poor functionality of the health system are critical elements limiting the role of ASHAs both within the health system and within communities in rural Manipur.
Background
Community health workers (CHWs) became prominent with the Alma Ata Declaration in 1978 that recognised primary health care as the key element for improving community health. The World Health Organization characterises CHWs as members of the community, selected by and answerable to the community they work for, and supported by the health system but with shorter training than professional health workers . Although these characteristics outline the fundamental relationships informing a CHW’s position, depending on the programme goal, they differ both within and across countries in terms of their roles and responsibilities, recruitment, training and incentives .
Several factors have shaped the experiences of community-based health workers, including the type and quality of supervision, level of linkages with health system structures, availability of drugs, clarity of the responsibilities, funding patterns and quality of programme management. Studies have shown that CHWs who come from the communities they serve have higher levels of acceptance from within these communities . Personality traits and skills like communication, motivation, leadership and ability to reach out to community members are also important factors shaping the effectiveness of CHWs . Adequate and appropriate compensation of CHWs has emerged as an important motivating factor for their continued participation in the programme. In a performance-based remuneration system, CHWs have to promote the use of health facilities in order to receive incentives. But negative experiences of the community with primary health care may discourage use of health services; it could limit CHWs to earn their incentives. There is a growing body of literature that focuses on technical aspects of CHW programme management such as selection, capacity building, supportive supervision and performance-based incentives. However, there are evidence gaps with respect to the extent to which CHWs can be health activists or agents of change, supporting community participation and empowerment which are crucial aspects of health improvement and sustainability.
Accredited Social Health Activist in India
The Accredited Social Health Activist (ASHA) was introduced by the National Rural Health Mission (NRHM) in 2005. They are female cadres of India’s community health worker programme. The primary goal of the ASHA programme is to promote uptake of skilled birth attendance in collaboration with facility-based auxiliary nurse midwives (ANMs) and the Anganwadi worker . Each ASHA is meant to cover a population of 1000 and receive performance- and service-based compensation for facilitating immunisation, referral and escort services for institutional deliveries. Promoting institutional delivery under the national scheme Janani Suraksha Yojana (JSY) is the most common ASHA task which comes with an incentive. JSY is a demand-side financing programme incentivising institutional delivery. ASHAs are paid Rs. 600 (£6.1 approx.) for every woman who is successfully referred for institutional delivery, and the post-partum mother is also entitled to Rs. 700 (£7.1 approx).
The ASHA programme guidelines envisage three different roles for ASHAs. First, ASHAs are to function as a ‘link worker’ , a bridge between the rural and vulnerable population within the health service centres. Second, ASHAs are to function as a ‘service extension worker’, whereby they are trained and provided with a kit that includes commodities such as condoms, oral contraceptive pills, delivery kits and simple life saving drugs including cotrimoxazole and chloroquine . Third, they are conceptualised as ‘health activists in the community who will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services’
The national guidelines stipulate that ASHAs are selected from the community they serve and receive 23 days of training in the first year and 12 days of training every subsequent year thereafter. The training curriculum aims to impart the knowledge, skills and attitudes required of an ASHA to effectively perform their roles and responsibilities. Since its implementation in 2005, there have been numerous studies evaluating the ASHA programme . Stakeholders have different interpretations and understandings of the ASHA programme, which has resulted in a state-level variation in programme implementation . As these studies are mainly cross-sectional, they provide limited information on the experiences of ASHAs themselves in realising their different roles as well as the communities they serve. India has huge socio-economic and political diversity, and there is a need to better understand ASHAs’ multiple roles within the many diverse Indian contexts they operate.. This study focuses on the state of Manipur which has been relatively under-researched compared to other regions in India.
Manipur Case Study-
Manipur is a small landlocked state located in the North-East Region of India with an area of 22 327 km2 and has a population of 2 570 390 . Manipur, though small in size, is unique in respect of its ethnic composition. The Manipur valley comprises of four administrative areas and is mostly inhabited by the dominant Meitei community, whereas the hilly region is administratively divided into five districts and has 33 ethnic communities. In the hills, the two major tribes by current nomenclature are the Nagas and the Kukis.
Most of the 33 tribes are characterised as either as Naga or Kuki. Since the 1960s, Manipur has witnessed a series of ethnic and armed conflicts due to separatist movements and demand for homeland and control over resources . This situation has adversely affected socio-economic development, human security and the health situation, including access to and delivery of health services. The population living below the poverty line is 36.89 %, and nearly 52 % of the working population are engaged in agriculture .
In rural Manipur, delivery without skilled birth attendance was 52 % in the year 2012–13 .
Given these poor indicators of service utilisation, it is important to better understand the role of ASHAs in maternal health promotion. Though national surveys and health management information system data provide quantitative explanation, there is a paucity of literature and evidence that captures the experiences of ASHAs in fulfilling their multiple roles in a context like Manipur which is characterised by geographic, politico-military and cultural uniqueness. Therefore, this qualitative study was undertaken in rural Manipur to explore the perceptions of stakeholders on the ASHA programme and to understand the opportunities and challenges faced by ASHAs in achieving their multiple roles within this particular context and to discuss the implications of this within and beyond India.
Methods
A descriptive, exploratory qualitative design was deployed in order to gain insight into stakeholders’ perceptions and opinions of the ASHA programme. A qualitative study design was chosen as it is flexible and iterative; qualitative methods are useful in providing explanations and meanings related to the perceptions, experiences and attitudes of the researched within their own context .
The study was conducted in two administrative blocks (Purul block and Mao-Maram block) of Senapati district in the state of Manipur . Senapati district was pragmatically selected as the lead researcher (LS) had familiarity with the local dialect and cultural norms and has prior experience of working with the NRHM project in the district. Senapati district is characterised by hilly terrain, and most village settlements are located on the hill top. The villages are widely dispersed with poor roads and communication. It is inhabited by Naga tribes of Mao, Maram and Poumai sharing similar socio-economic and cultural practices.
We purposively sampled villages on the basis of their remoteness because we believed that the factors affecting service provision of ASHAs might be affected by remoteness. We sampled seven ASHAs, three post-partum mothers and one Anganwadi worker (AWW) from three remote villages; seven ASHAs, three post-partum mothers and one AWW from three less remote villages; and seven ASHAs from the district headquarter.
These villages were selected in consultation with the senior medical officer, and the criteria for remoteness of the village are dependent on the availability of all-weather roads and distance from the highway. We also sampled three doctors and one ANM from three primary health centres (PHCs) that provide service to the sampled villages because they represent a health system that could provide meaningful insights regarding ASHA programmes in the local setting. Three management staff (programme manager, ASHA trainer and ASHA coordinator) were selected from the district programme management unit located at the district headquarter, as they are responsible for the implementation of the ASHA programme.
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Community Health Programmes: Genesis and Impact on Rural Health
Community Health Programmes: Genesis and Impact on Rural Health
Community Health Programmes: Genesis and Impact on Rural Health
Health practitioners have come to realise that the top-down approach has not yielded desired results in the development paradigm. They are now restructuring social and development practices to create a sense of ownership in the target community to the programme. This has meant significant involvement of the community for design and delive
Health practitioners have come to realise that the top-down approach has not yielded desired results in the development paradigm. They are now restructuring social and development practices to create a sense of ownership in the target community to the programme. This has meant significant involvement of the community for design and delivery. Special care has been taken by programme designers to include more vulnerable sections of the society.
In case of healthcare delivery interventions, the focus on involving the community has been even more evident. This is partly because the success of a health programmes depends largely on its acceptance by the people.
New insights in healthcare
Preventive health programmes like immunisations are aimed at the entire population and are focused on otherwise healthy people. Thus, the onus of making these programmes a success shifts from people to provider, as healthy people have no immediate need for seeking out health services. Compulsory measures have often backfired, causing a shift to communication and education to increase reception of the programme. Volunteers drawn from the community for awareness and outreach have been vital for the process.
The thrust can be traced back to the declaration of Alma Ata in 1978 that was signed at the International Conference on Primary Health Care. It took cognizance of social and economic causes of ill health and focussed on issues of accessibility and affordability thereby linking health to development.
Primary Health Care (PHC) was recognised as an integral part of every country’s health system and central to social and economic development. Comprehensive health care was the proposed solution. It stressed on community participation and a spirit of self-reliance, on the principles of equity, use of appropriate technology, affordability and sustainability of health systems. However, global and top driven interventions found little or no place in the idea of PHC.
This has also led to change in the understanding of health, which is now being recognised as a function of social, economic and cultural forces. Concerns of health are not solely confined to the Ministry of Health. Effective convergence between various departments has become imperative.
Involving the community
People’s access to healthcare, education, conditions of work and leisure determine their chances of living fulfilling lives. Addressing rural health concerns through the National Rural Health Mission (NRHM) (now National Health Mission) is based on the principle of convergence with other determinants like water, sanitation and nutrition.
NRHM has also adopted the model of ASHAs (Accredited Social Health Activists) and ANMs (Auxiliary Nursing Midwives) who function as community health workers. It seeks convergence with Ministry of Women and Child Development’s ICDS (Integrated Child Development Services) that also utilises the services of aanganwadi (child day care centres) workers to increase their outreach.
These community health workers, drawn primarily from the same village, have had a tremendous impact on nutrition, reproductive health and contraception, immunization, and safer deliveries. They have also accelerated behaviour change - hand washing, use of ORS, benefits of breastfeeding, safe sex and calorific norms. Polio Eradication Programme also successfully utilised the outreach and networks of community volunteers to achieve the status of polio free India.
The success of this model on a national scale has also been replicated to some extent by independent non-profits, albeit at a micro scale. Perhaps the first such experiment was by adopted by the Society for Education, Action and Research in Community Health (SEARCH) located in Gadchiroli, Maharashtra. It got the leaders of the community to sign participation agreements and trained local women as Village Health Workers (VHWs). Initiating a dialogue with the community to listen to their problems, conduct studies with them, inform them of evidence and then engage with them is a priority for the non-profit.
Rajiv Gandhi Mahila Vikas Pariyojana is another good example of the model of community ownership and participation by women. In fact, the entire design of the programme is to help poor, rural women through community institutions in the form of self help groups (SHGs).
Within this programme, community based health care is provided through the Swasthya Sakhi Programme. Volunteers are identified from within the community to train as Swasthya Sakhi (friends for health) and undergo regular training and meetings to facilitate awareness and ensure women’s access to healthcare institutions. Studies by the organisation have noted improvements in the number of women seeking ante-natal care, consuming iron pills for anaemia, and being trained in good behavioural practices.
Overcoming constraints
While these programmes have effective outcomes, they can be fraught with several problems. Communities are never homogenous - they include differences in status, access to resources and power imbalance. This may result in a scenario where the powerful may dominate the programme and lead to shift in its priorities.
To combat this, it’s essential that programmes let locals function as investigators and researchers. Participatory mapping and modelling can be used to make social, health or demographic maps. This can be useful tool for ‘silent’ people in the community to express their views.
Similarly, institutional or Venn diagramming can be used for identifying individuals and institutions important in and for a community, and their relationships for understanding power structures. Even role play and theatre can be used to explore realities.
These recommendations can run into problems - ranging from lack of money and resources, to simplistic ideas about community. However if these constraints are successfully overcome then community based health programmes can go a long way in addressing rural health issues and outcomes.
Increasing cost of Primary Healthcare across India
Community Health Programmes: Genesis and Impact on Rural Health
Increasing unit cost of Healthcare at Grassroot Health Centre
India with over 1.40 billion demographic strength ,with around 70% are fully or partially dependent on Public or privately funded medical infrastructure.
Since over 70 years of our independence, remaining 30% of the population i.e. over 30cr Population still don’t have access to basic medical facilities that is reason for –
- Higher Mortali
India with over 1.40 billion demographic strength ,with around 70% are fully or partially dependent on Public or privately funded medical infrastructure.
Since over 70 years of our independence, remaining 30% of the population i.e. over 30cr Population still don’t have access to basic medical facilities that is reason for –
- Higher Mortality rate
- Higher tuberculosis cases
- Higher Child Mortality rate
- Higher cases of Non-communicable cases like Diabetes/Obesity etc
To Counter this challenging Situation , we have planned to start a prosperous move for Revival and Modernisation of Sick Grass-root Medical Infrastructures (i.e. Primary Health Centre –PHCs / Community Health Centre-CHCs ) through
INCUBATION Phase -1(1 Quarter)
Statute Licensing, Hiring of Skilled OR Semi-Skilled Resources, Selection & renovation of Sample PHCs, Marketing and Public Awareness.
GROWING Phase -2(1 Quarter)
Organising Medical camps with the support of Health Professionals for Health awareness as part of extending serving Market
TAKE-OFF Phase-3
Post 3 quarter of Project Commencement (refer to Sales and Profit Estimation)
To serve the unserved section of the society with the cordial cooperation of medical/non-medical stakeholders to make India As-
HEALTHY &PROSPEROUS BHARAT
NOTE:
One Primary Health centre (PHCs) to render Primary Medical Services to 30000peoples
(As Per Indian Public Health Standards)
So, Number of Primary Health Centres required to served 30 Croresor 300 Million Unserved Indians is 30Cr or 300 millions/30000 = 10000 Primary Health Centres
Increasing unit cost of Healthcare at Grassroot Health Centre
Annual cost of Delivering Healthcare at primary Health centres
Increasing unit cost of Healthcare at Grassroot Health Centre
It is equally interesting to observe that the reimbursement packages under government-funded health insurance schemes are based on expert opinion that rely on existing prices or reimbursement rates with little empirically assessed evidence on cost of care . Estimates involving the unit cost of health services, especially at the level of
It is equally interesting to observe that the reimbursement packages under government-funded health insurance schemes are based on expert opinion that rely on existing prices or reimbursement rates with little empirically assessed evidence on cost of care . Estimates involving the unit cost of health services, especially at the level of secondary care, can be used to empirically derive the package rates for various disease conditions.
Further, if the government were to scale up healthcare services substantially, estimates of total cost and its input-wise distribution can provide vital information for allocating additional resources. Finally, while the debate on whether to choose demand-side or supply-side financing for the health system of India continues to grow, estimates of health system costs across various levels of healthcare delivery can provide evidence in terms of which model is more efficient and what the level of additional investment should be
Regardless of the seeming need for information on the cost of provision of healthcare from a health system perspective, the available evidence is insufficient in terms of being either outdated or not comprehensive in terms of covering the range of services or a significantly wide geographical area in the selection of facilities.
Estimates generated by the World Health Organization (WHO; 2005) and National Commission on Macroeconomics and Health (NCMH; 2005) are outdated .
Secondly, estimates of healthcare expenditure generated by the National Health Accounts (NHA) are based on financial costs rather than a more complete economic costing .Thirdly, although there are a few primary studies on the cost of secondary healthcare, these are specifically focused on north Indian states . It is difficult to generalise the cost estimates from these studies to a pan-Indian context due to variability across states in terms of availability of infrastructure and utilisation patterns.
Considering this critical gap, the present study was designed to estimate the total and unit costs of delivering healthcare services at the level of CHCs and DHs. In addition, distribution of cost in terms of the input, level and type of services was also assessed. The latter was relevant to any decision regarding programmes to improve the efficiency of healthcare services.
Materials and Methods
Study Area
The present study was carried out in the four diverse states of Himachal Pradesh (HP), Tamil Nadu (TN), Kerala and Odisha. These states were selected based on health system performance, availability of health system infrastructure/human resources and service utilisation in addition to geographic location. The states of Kerala and TN represented the southern region as well as the states with the best health indicators and well-developed health infrastructure . In comparison to these states, Odisha represented a state with poor health infrastructure and below average health indicators. HP represented a hilly state in North India with population coverage norms, government spending, availability of healthcare infrastructure and utilisation rates different from those in the rest of India .
HP is the state with the highest government health spending per capita in India and has one of the highest utilisation levels of public healthcare facilities for inpatient care compared with the rest of India . A normal CHC caters to a population of 0.12 million, whereas in hilly areas a CHC caters to a population of 80,000 . Furthermore, HP is one of the states with surplus availability of human resources, i.e. medical and paramedical staff, at the DH level .
A multistage stratified random sampling was followed for the selection of the health facilities across the four states. In the first stage, districts within each of the states were divided into three strata based on a ranking matrix, considering various socioeconomic and demographic indicators, developed by International Institute of Population Sciences (IIPS) in Mumbai in 2006.
A district was then selected for the present study based on simple random sampling from each strata . In case of TN and Odisha, however, the overall districts were divided into 2 strata, from which the districts were randomly selected. In the second stage, as each district consisted of one DH, that DH was selected for the study. In addition, 15% of the CHCs in each of the selected districts were selected randomly. Finally, a total of 19 CHCs (HP = 3, Odisha = 7, TN = 3 and Kerala = 6) and ten DHs (three each in HP and Kerala and two each in Odisha and TN) were selected across the four states.
Facility Definition
As per Indian Public Health Standards (IPHS), CHCs cater to a population of 80,000–120,000 (depending on the region and terrain), have 30 beds and have at least four medical specialists in medicine, surgery, paediatrics and gynaecology, along with other medical and paramedical staff. CHCs have an operating theatre, an X-ray, a labour room and laboratory facilities and serve as a referral centre for primary health centres (PHCs) within the block and also provide healthcare facilities for obstetric care and specialist consultations .
DHs have a bed capacity of 75–500 beds, and serve as a main hub for the provision of secondary care for a district of a defined geographical area containing a defined population. Specialists from the fields of medicine, surgery, orthopaedics, paediatrics, ear nose throat (ENT), ophthalmology, gynaecology and obstetrics, pulmonary medicine, dentistry, dermatology, etc. provide outdoor patient department (OPD), indoor patient department (IPD) and emergency care. A DH also provides specialist services for specific areas such as accident and trauma care, dialysis, antiretroviral therapy, newborn intensive care and psychiatry. It is also supported by diagnostic, laboratory and radiological testing facilities .
Data Collection
A bottom-up costing method was used to assess the economic cost of health services, The first step for the cost assessment was identification of cost centres and their classification into primary/patient and secondary/supportive cost centres After this, data on both the capital and recurrent resource use incurred when delivering health services for each of the cost centres were collected for the financial year of 2014–2015.
A facility survey along with a review of facility maps and stock registers was undertaken to assess the space and the quantity of various items of capital equipment (and furniture items) present in the facility. Data on the quantity of drugs and consumables were assessed by reviewing the respective stock registers, vouchers and pharmacy records. Further, data on incentives paid to the beneficiaries (conditional cash transfers) under the various health schemes, untied funds, annual maintenance grants, etc. were obtained from the district health administration office (Civil Surgeon Office) of each district. Monthly expenditures relating to electricity, water, telephone, internet, petrol/diesel, etc. were obtained from the accounts office of each facility. Similarly, expenses related to the maintenance of equipment, laundry and dietetics were obtained from the routine account reports for the reference year. After identification of all inputs, data on service utilisation in the form of the number of outpatient consultations, hospitalisations, operations, etc. were captured by reviewing the routine records of the facility (such as outpatient registers, inpatient registers and other monthly reports). The data were collected by postgraduate-level qualified field investigators who were specifically trained for the cost data collection.
Annual cost of Delivering Healthcare at primary Health centres
Annual cost of Delivering Healthcare at primary Health centres
Annual cost of Delivering Healthcare at primary Health centres
The concept of Primary Health Centre (PHC) is not new to India. The Bhore Committee in 1946 gave the concept of a PHC as a basic health unit to provide as close to the people as possible, an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care.
The health p
The concept of Primary Health Centre (PHC) is not new to India. The Bhore Committee in 1946 gave the concept of a PHC as a basic health unit to provide as close to the people as possible, an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care.
The health planners in India have visualized the PHC and its Sub-Centres (SCs) as the proper infrastructure to provide health services to the rural population. The Central Council of Health at its first meeting held in January 1953 had recommended the establishment of PHCs in community development blocks to provide comprehensive health care to the rural population. These centres were functioning as peripheral health service institutions with little or no community involvement.
Increasingly, these centres came under criticism, as they were not able to provide adequate health coverage, partly, because they were poorly staffed and equipped and lacked basic amenities. The 6th Five year Plan (1983-88) proposed reorganization of PHCs on the basis of one PHC for every 30,000 rural populations in the plains and one PHC for every 20,000 population in hilly, tribal and desert areas for more effective coverage.
However, as the population density in the country is not uniform, the number of PHCs would depend upon the case load.
PHCs should become functional for round the clock with provision of 24 × 7 nursing facilities. Select PHCs, especially in large blocks where the CHC is over one hour of journey time away, may be upgraded to provide 24 hour emergency hospital care for a number of conditions by increasing the number of Medical Officers; preferably such PHCs should have the same IPHS norms as for a CHC. There are 23673 PHCs functioning in the country as on March 2010 as per Rural Health Statistics Bulletin, 2010.
The number of PHCs functioning on 24x7 basis are 9107and number of PHCs where three staff Nurses have been posted are 7629 (as on 31-3-2011). PHCs are the cornerstone of rural health services- a first port of call to a qualified doctor of the public sector in rural areas for the sick and those who directly report or referred from Sub-Centres for curative, preventive and promotive health care.
It acts as a referral unit for 6 Sub-Centres and refer out cases to Community Health Centres (CHCs-30 bedded hospital) and higher order public hospitals at sub-district and district hospitals. It has 4-6 indoor beds for patients.
PHCs are not spared from issues such as the inability to perform up to the expectation due to
(i) non-availability of doctors at PHCs;
(ii) even if posted, doctors do not stay at the PHC HQ;
(iii) inadequate physical infrastructure and facilities;
(iv) insufficient quantities of drugs;
(v) lack of accountability to the public and lack of community participation;
(vi) lack of set standards for monitoring quality care etc.
Standards are a means of describing the level of quality that health care organizations are expected to meet or aspire to. Key aim of these standards is to underpin the delivery of quality services which are fair and responsive to client’s needs, provided equitably and deliver improvements in the health and wellbeing of the population.
Primary Healthcare-PHCs and the Community at Grassroot Level
Annual cost of Delivering Healthcare at primary Health centres
Annual cost of Delivering Healthcare at primary Health centres
Primary health care is a whole-of-society approach to health and well-being centred on the needs and preferences of individuals, families and communities. It addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing.
It provides whole-person
Primary health care is a whole-of-society approach to health and well-being centred on the needs and preferences of individuals, families and communities. It addresses the broader determinants of health and focuses on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing.
It provides whole-person care for health needs throughout the lifespan, not just for a set of specific diseases. Primary health care ensures people receive comprehensive care - ranging from promotion and prevention to treatment, rehabilitation and palliative care - as close as feasible to people’s everyday environment.
Stronger primary health care is essential to achieving the health-related Sustainable Development Goals (SDGs) and universal health coverage.
It contributes to the attainment of other goals beyond the health goal (SDG3), including those on poverty, hunger, education, gender equality, clean water and sanitation, work and economic growth, reducing inequality and climate action.
WHO recognizes the central role of primary health care for achieving health and well-being for all, at all ages.
India’s 2017 National Health Policy commits the government to investing a major proportion (>2/3rds) of resources to PHC. The main mechanism to achieve this are the 150000 Health and Wellness Centres (HWCs), which are intended to become the main points of contact for communities within the public health system. These centres will provide comprehensive health care, covering around 70% of out-patient care, including noncommunicable diseases and maternal and child health services. These centres will also provide free essential drugs and diagnostic services as well as referral access to secondary
This is part of the government’s effort to achieve universal health coverage through is flagship initiative, the Ayushman Bharat programme. Launched in 2018, the programme includes the health insurance component, the Pradhan Mantri Jan Aarogya Yojna (PM-JAY)
Principle of the Primary Healthcare Services
Equitable distribution: The majority of the hospitals and healthcare institution are concentrated in towns and cities. Whereas the rural area which needs health services more, hardly have any hospitals. Primary Healthcare helps to redress this imbalance more by focusing on the rural areas and bringing these services as close to the people’s home.
Community participation: The participation of the local people for discharging healthcare needs is not possible. That’s the reason the government of India is taking help from the communities for the participation of people.
With the help of communities, the government can overcome the language, cultural and communication barriers.
Intersectoral Coordination: The government of India has realised that primary Healthcare cannot be provided by the Health sector alone. The difference department of government must come forward and work in an integrated pattern.
And our public Healthcare institution does not have the money for doing costly diagnostic test and treatment. So Primary Healthcare in India is currently relaying on low budget technologies.
One such technology used in India is ORS, low-cost treatment for diarrhoea and dehydration. It can be stored anywhere and hardly have any side effects.
Levels of the Primary Healthcare
Primary Level: Primary healthcare is the first level of contact between the healthcare institution and the patient. It includes Sub-centres and Primary Health centre.
Sub Centre – It is the most peripheral and the first contact point between the patient and the healthcare facility. It has three employees
1. The Health worker male
2. The Health worker female and
3. A Voluntary worker.
The Government of India’s Ministry of Health and Family welfare, is responsible in providing the 100% fund for the Sub-centres.
Primary Health Centres – It is the first point of contact between the village community and the Doctor. It has a strength of at least 15 people, including a Medical officer, a medical health assistant. The Medical officer is considered as the leader of the team or Primary Health centre.
Each Primary Health Centre acts as a referral point for 6 Sub-centres. And they have a bed strength of four to six beds.
Secondary Level: The secondary level is the first referral level where the patient is referred, depending upon the seriousness of the issue. It includes the Community health centre.
Community Health Centre – Here, the staff strength is 30, including 4 specialist doctors, there should be a Physician, a Surgeon, a Gynaecologist and a Paediatrician. Three new posts have been created under the NRHM program. They are Ophthalmic Surgeon, Anaesthetist and Public Health Program Manager.
Each Community Health Centre acts as a referral point for 4 Primary Health Centre.
Tertiary Level: The tertiary level is the second referral level, and it includes the Hospitals and Medical Colleges. The tertiary Health centre doesn’t come under the Primary Healthcare, so we are skipping its explanation.
Population Norms for doctors in India
The government of India recommends that there should be one doctor per 3500 population. One nurse per 5000 population, one health worker per 5000 people and health assistant per 20000 people. And also 1 Anganwadi worker per 400-800 people in open areas and 300-800 in Hills.
Condition of Primary Health care in India
The penurious condition of the local Healthcare system in the India is not a secret, especially in India’s villages where the infrastructure is at a critical stage. Government hospitals are surviving in very poor conditions, they often crash to provide necessary health services to the sick people. And private hospital staying out of the reach of most peoples.
As we all know India is the most densely populated country in the world, and soon it will surpass China in terms of population. And that will need a high demand for health services in India.
- India ranks high in the list of most ill nations.
- · Over 32% of total deaths in India occur due to health-related diseases.
- · According to global burn up diseases studies, India’s ranking in the Healthcare Index is 154 out of 190 countries.
Despite such poor statistics, the budget allotment in healthcare services is meagre. India spends around only 2% of its GDP on Healthcare.
We can say that the significant challenges in front of Primary Health care system in India are
- · Poor patient to doctor ratio
- · Lack of Infrastructure
- · Low public spending
- · Low health cover for the rural population
- · High out of the pocket expenditure
- · Unequal distribution of Human Resources.
Importance to Primary Healthcare
They provide basic healthcare facilities and work toward improve prevention of disease rather than happening of disease at the first instance.
Primary Health care is the only practical course of action to address the problems of malnutrition, child death and another illness-causing disease in India.
It not only provides good health to individuals or family but the community as a whole, especially to the tribal communities of rural and remote areas.
Primary Healthcare is the basics of the Health Infrastructure of the country. And a suitable infrastructure can help a country to achieve health-related Sustainable Development goals.
Most of the patient directly goes to the secondary health centre for the cure of simple disease, which is usually present at a longer distance. This is due to the absence of the Primary Healthcare.
It helps to create awareness of viral diseases, sanitation practices and family planning as well. Ultimately it can help to control the population of the nation.
Improving basic health services will reduce out of pocket expenditure of patient.
Good necessary health infrastructure can reduce the burden of the government as most of the disease will be prevented and cured at the first level itself.
Government steps to improve Primary Health care in India
Apart from the health services provided by the government, the private is flourishing in India. In just the last decade the hospitalisation cost has have increased by a massive 300%, indicating a large amount of household saving goes to availing health services.
In 2008 the Government of India brought the National health insurance scheme for the rural population of India. This scheme provided medical coverage of worth 3 Lakh rupees to a family working in the unorganised sector. A similar scheme was also introduced at the state level, but none of these schemes followed a particular standard.
Why Revival of PHCs is needed
Across the World, Developing and Underdeveloped Countries like India with over 135 cr demographic strength ,with around 70% are fully or partially dependent on Public or privately funded medical infrastructure Since over 70 years of our independence, remaining 30% of the population i.e. over 30cr Population still don’t have access to basic medical facilities that is reason for –
❑Higher Mortality rate
❑Higher tuberculosis cases
❑Higher Child Mortality rate
❑Higher cases of Non-communicable cases like Diabetes/Obesity etc.
To Counter this challenging Situation , we have planned to start a prosperous move for Revival and Modernisation of Sick Grassroot Medical Infrastructures (i.e. Primary Health Centre –PHCs / Community Health Centre-CHCs ) at make healthcare facilities accessible and affordable at grassroot covering Rural and Semi-urban area that constitute over 70% of the country's Population .
We are medicant care
Our Health Mission
MedicantCare is first Medical based Company that recognizes the importance of establishing a business to business and business to Public relationship that fosters mutual understanding, shared responsibilities and a commitment to working together for the improvement of Healthcare Services and also recognizes the importance of developing Basic Medical Services and other associated Services beneficial for all stakeholder in Healthcare Sector It also recognizes that improvements are needed in the Indian healthcare across India and with major focus on Rural India and adjoining poor countries ,to strengthen and improve the quality of healthcare services that are inclusively dependent on medical machinery manufacturing ,their supplies chain through dealers ,machine’s service support and availability of parts support
Objective
❑To render India’s most backward areas with basic Healthcare facilities during first 5 years post Project Commencement by Redevelopment and Modernisation of existing sick Primary Health Centres (PHCs)/Community Health Centre (CHCs)
❑To drive out inferior quality of medical Services from the Unserved or Underserved areas mainly rural and semi-urban areas
❑To reduces patients load on Secondary and Tertiary Health Centres
❑With this initiative ,we are able to generate employment opportunity on regional basisIndia with over 140 cr demographic strength ,with around 70% are fully or partially dependent on Public or privately funded medical infrastructure Since over 70 years of our independence, remaining 30% of the population i.e. over 30cr Population still don’t have access to basic medical facilities that is reason for –
❑Higher Mortality rate
❑Higher Child Mortality rate s cases
❑Higher Child Mortality rate
❑Higher cases of Non-communicable cases like Diabetes/Obesity etc.
Challenges & Solution
To Counter this challenging Situation , we have planned to start a prosperous move for Revival and Modernisation of Sick Grassroot Medical Infrastructures (i.e. Primary Health Centre –PHCs / Community Health Centre-CHCs ) through
Phase -1 Development of 5 Sample PHCs in different location across India in first Two (2) Quarters
Phase -2 Revival,development and Modernization of over 200+ Sick PHCs in medically underserved and unserved regions across India in next 1 year To serve the unserved section of the society with the cordial cooperation of medical /non-medical stakeholders to make India As
HEALTHY & PROSPEROUS SOCIETY