Universalizing Access

to

Quality Primary Healthcare

Healing Hands

Problem Statement

Problems of Primary Healthcare:-

Approachability for community Increase trust

Accessibility to Health delivery Increase number.of service providers

Acceptability for Community Involve Community

Affordability for Community Mitigate financial shock of health expenses

Accountability of Health Delivery Assured health delivery

Way

Forward

PROPOSED

SOLUTION

P

R

O

P

O

S

E

D

S

O

L

U

T

I

O

N

Microfinance Health Insurance Scheme with a Nodal Center at

CHC

Minimal premiums

Cashless benefits

Reimburse Out- of- pocket spending on medication due to non-

availability.

Include private healthcare providers for assured service in case of

non- availability at CHC.

Profits from Insurance Scheme re-invested in local community via

Federation of Self Help Groups (SFG) or Co-operatives to increase

revenue generation and community development.

Microfinance Health Insurance

Microfinance Health Insurance

Minimum Premiums

Cashless Services

PHC, CHC and

Selected Private set ups

Re imbursement of

Out-of-pocket expenditure

on medication

due to unavailability

Improved Demand for Healthcare Services.

Strengthening of Referral system.

Increased Utilization of existing set up.

Empowering community.

Investment in

Local Co-operative

Heathcare and Associated

Infrastructure Development

Contingency Fund for

Medical emergencies

Improved health seeking behaviour

Sustainability at local level.

Boost to local economy

Overall Community Development

Health education at workplace.

Health Education and

Behaviour Change

Communication

P

R

O

P

O

S

E

D

S

O

L

U

T

I

O

N

P

R

O

P

O

S

E

D

S

O

L

U

T

I

O

N

Flaws in Existing System

Merits of Proposed Solution

Low utilization of existing Healthcare Services

Increased Utilization of existing Infrastructure by i) Increased trust in existing system due to assured service delivery. ii) Improved Health-seeking behaviour iii) Change in felt-need through community involvement.

Unavailability of Services and Medication

Viable alternative services by including Private Sector and re-imbursement of Out of Pocket Expenses for unavailable drugs.

Minimal emphasis on Prevention

Community Infrastructure development to improve access to clean drinking water, proper sanitation and good nutrition to promote overall health of community.

Low involvement of community

Direct community involvement by incorporating representatives in the Nodal Office at CHC level to guide overall functioning and improve accountability.

Required Massive Budget Allocation for upgradation

Budget generation at local level – Improvement in services without additional budget requirement, So Sustainable!

P

R

O

P

O

S

E

D

S

O

L

U

T

I

O

N

Pre- existing infrastructure.

No specialized resource required,

can be locally sourced

Increase in Scale

-Running costs decreases

-Revenue generation

increases.

Running cost generated within the scheme

without reliance on outside monetary input.

Flexibility in service provision according to existing infrastructure.

Decreasing costs with increasing duration due to improvement in overall

health.

SCALABILITY

As more number of clients

(insurees) join the scheme

i) Risk pool increases

ii) Revenue generated

increases

iii) Average cost per

insuree decreases.

Community Level National Level

SUSTAINABILITY

IMPLEMENTATION

Marketing

and

response

evaluation

Launch

Insurance

Scheme

Start

Investment

in

Co-operatives

Monitoring-

Change in

health seeking

behaviour

Evaluation – Change in

Health Indices

&

Start

Investment

In

Community

Infrastructure

Developement

2 months 6 months 2 years 5 years

IMPLEMENTATION TIMELINE

IMPLEMENTATION - Requirements

LEVEL HUMAN

RESOURCE MATERIALS FUNDS

STATE

CHC

PHC

VILLAGE

Training team (5 membered)

NGOs and Health Officers

Education and

Marketing Media 5 lakhs p.a.

Nodal Office

Nodal Officer (new post)

MO-PHC

BDO

Representatives of villages

Health insurance cards

Guidebooks

Insuree registers

Claims register

Stationeries

10 lakhs p.a.

Accounts Manager

(existing post NRHM) Premium collection register 10,000 p.a.

Reps. of villages

(selected by Panchayat)

Marketing Team

MO-PHC

Community level workers

Health education material

Insuree register

Marketing material

10,000 p.a.

IMPLEMENTATION

Source of Funding

Initial Funds

for Start Up Allocated under NRHM

Maintenance

Fund

Generated at Community level

within the Scheme

IMPACT

Monitoring and Evaluation

IMPACT

OPD footfalls.

ANC registration.

Bed Occupancy rates.

Claims received.

Grievance Redressal

- Average time

- Maximum time

Maternal Mortality Rates.

Infant Mortality Rates.

Immunization Coverage.

Household medical.

expenditure as percentage

of annual spending.

Data from SRS and Census

Monitoring Evaluation

Projected Impact – Improved health service delivery, Improved Health Seeking

Behaviour, Boost local economy and Overall community Developement

Strength Weakness

Opportunity Threats

Existing Infrastructure

Strengthen Referral

Empower People

Reduce Out-of-Pocket

expenditure

Boost Local Economy

Improve village

infrastructure

Sudden increase in

Claims during

Epidemics

And Diasters

Can be implemented

under NHM along

with proposed

charges for services

at CHCs.

Low trust in

Govt. services

Requires mass

participation for

profit

Client attrition and

non-payments.

Strengths

Threats Opportunities

Weakness

Mitigation of threat by Risk Pooling over time and over place( Interlink with other CHCs)

Thank You

Annexure

Problem Analysis

Availability and accessibility of health care is important for overall health status of any community. Both physical and financial accessibility is equally important. Physical Accessibilty 28.8% of population ( in sample studies ) were having positive health seeking behavior towards government health care facilities.Majority of the sample studied i.e. 71.2% were having negative health seeking behavior towards government health care facilities. Financial Accessibility Medicine accounted for 70% of treatment cost followed by investigation and consultation cost. Out of pocket expenditure was the most common financing option (93.6%) and in 5.6% cases they borrowed money or sale assets and in 0.8% cases government health insurance were the financing option.

Problem Analysis

Micro- Insurance for health with involvement of Private healthcare providers solves issue of physical and financial accessibilty. Organization of community based health insurance or government insurance with contribution from public is urgently needed to protect the poor from slipping into poverty and indebtedness.

References

Raykumar P et al

Health care seeking and treatment cost in a rural community of West Bengal, India ,

[theHealth 2012; 3(3): 67-70]

Mandal S, Kanjilal B, Peters DH, Lucas H.

Catastrophic out-of-pocket pay-ment for health care and its impact on households:

Experience from West Bengal, India.

Ray TK, Pandav CS, Anand K, Kapoor SK, Dwivedi SN.

Out-of-pocket expenditure on healthcare in a north Indian village.

[Natl Med J India. 2002;15:257-60.]

Rose Ann Dominic et al

Health seeking behavior of rural adults.

[NUJHS Vol. 3, No.3, September 2013, ISSN 2249-7110]

References

Ghosh et al

Factors affecting the healthcare seeking behaviour of mothers regarding their children in

a rural community of Darjeeling district, West Bengal.

[International Journal of Medicine and Public Health,Jan-Mar 2013,Vol 3,Issue 1 ]

Programme Evaluation Organisation, Planning Commission,Government of India

Evaluation Study of National Rural Health Mission (NRHM) in 7 States [2011]