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DR J E PARK MEMORIAL ORATION

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Source: India RGI, Govt. of India (Latest Figures); Others ... Goa. 72.69. 61.83. Delhi. 82.16. 89.14. Bihar. 68.49. 70.65. Assam. 71.36. 72.42. Andhra Pradesh ... – PowerPoint PPT presentation

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Title: DR J E PARK MEMORIAL ORATION


1
DR J E PARK MEMORIAL ORATION
  • Prof N K Sethi
  • Senior Adviser (Health)
  • Planning Commission
  • Government of India

2
  • HEALTH CARE IN INDIA
  • CONCERNS CHALLENGES
  • AND
  • ROAD MAP

3
BACKGROUND
  • Health of a Nation
  • Development
  • Economic Growth
  • Strides since Independence
  • Infrastructure
  • Human Resources for Health
  • Institutions
  • Health Indices
  • Problems exist
  • Health status Malnutrition Cost of Health
    Care Equity Quality of care

4
CURRENT SCENARIO
  • INTERNATIONAL COMPARISON

Projected (2001-06) Source IndiaRGI, Govt. of
India (Latest Figures) OthersState of World
Population, 2006
5
CURRENT SCENARIO
  • TENTH PLAN GOALS WHERE ARE WE?

Source 1. Technical Group on Population
Projections set up by National Commission on
Population (Dec 2006), RGI, GOI 2. SRS 2006 3.
200103 Special Survey of Deaths using RHIME
(routine, re-sampled, household interview of
mortality with medical evaluation), RGI (2006)
GOI
6
Time Bound Goals for the Eleventh Five Year Plan
  • Reducing Total Fertility Rate to 2.1
  • Reducing Infant Mortality Rate (IMR) to 28 per
    1000 live births
  • Reducing Maternal Mortality Ratio (MMR) to 1 per
    1000 live births

7
TOTAL FERTILITY RATE
Projected
Projected
8
MATERNAL MORTALITY RATIO
MMR IN INDIA TRENDS BASED ON LOG LINEAR MODEL
1996-2013
9
INFANT MORTALITY RATE
IMR IN INDIA
10
WHAT AILS OUR HEALTH SYSTEM?
  • Low Public Health Expenditure
  • Planning and Approach
  • Infrastructure and Human Resources
  • Monitoring and Evaluation
  • Lack of Convergence
  • Lack of Integration
  • Preventive and Community health
  • Geographical Imbalances
  • Emerging Threats
  • Lack of emphasis on Equity and Inclusiveness

11
DISPARITIES DIVIDES
URBAN --- RURAL
Source Ministry of Health Family Welfare
(GOI), 2006 and NHFS 3, IIPS (200506).
URBAN SLUM ---------- NON - SLUM
12
DISPARITIES DIVIDES
13
DISEASE BURDEN
Source NCMH, 2005
14
HEALTH CARE INFRASTRUCTURE GAPS
Note All India shortfall is derived by adding
state-wise figures of shortfall ignoring the
existing surplus in some of the states Source
Bulletin of Rural Health Statistics in India,
Special Revised Edition, MOHFW (GOI), 2006
15
HUMAN RESOURCES FOR HEALTH GAPS
16
HUMAN RESOURCES FOR HEALTH GAPS
NUMBER OF PERSONS PER SPECIALIST AT CHCs (2006)
Source Bulletin of Rural Health Statistics in
India, Special Revised Edition, MOHFW (GOI), 2006
17
HEALTH CARE UTILIZATION
PERCENTAGE OF CASES OF HOSPITALIZED TREATMENT BY
TYPE OF HOSPITAL IN RURAL AREAS, INDIA
18
HEALTH CARE UTILIZATION
PERCENTAGE OF CASES OF HOSPITALIZED TREATMENT BY
TYPE OF HOSPITAL IN URBAN AREAS, INDIA
19
HEALTH CARE UTILIZATION
PERCENTAGE OF TREATED AILMENTS RECEIVING
NON-HOSPITALIZED TREATMENT FROM GOVT. SOURCES
20
COST OF TREATMENT
AVERAGE MEDICAL EXPENDITURE (Rs.) PER
HOSPITALIZATION CASE
21
EXPENDITURE ON HEALTH
22
EXPENDITURE ON DRUGS
23
WAY FORWARDGOALS
  • To strive towards health as a right for all
    citizens.
  • To facilitate convergence and development of
    public health systems and services responsive to
    health needs and aspirations of the people for an
    accountable, accessible and affordable system of
    quality services.
  • To restructure policies to achieve a faster,
    broad-based and inclusive growth and to achieve
    good health for people, especially the poor and
    the underprivileged.
  • To provide cash less health care to the poor and
    needy.

24
CONCERNS TO ADDRESS
  • Making Public Health Care system functional
  • Reducing disease burden and level of risk
  • Investing in human resources
  • Promoting equity by reducing household
    expenditure
  • Governance, Regulation Accreditation

25
APPROACHES NEEDED
  • Increased public spending on health (Centre and
    States)
  • At least 2 of GDP
  • Large share of allocation for primary health
    care
  • Adopt system centric approach rather than disease
    centric
  • Organic integration of funds, functions and
    functionaries under NRHM
  • Do not allow vertical structures below district
    level under different programmes

26
APPROACHES NEEDED
  • Comprehensive approach by convergence Encompass
    health care, sanitation, clean drinking water
    and nutrition through integrated district action
    plans for health based on village health plans
  • Address State/area specific health problems
  • Covered through funds provided under NRHM
    flexi-pool

27
APPROACHES NEEDED
  • Implement flexible norms for health care
    facilities and personnel
  • Based on distance, terrain, travel time and
    socio-cultural scenario instead of population
    norms alone
  • Up grade health infrastructure and set up new
    medical, dental, nursing and paramedical
    institutions in deficient areas through public
    private partnership

28
APPROACHES NEEDED
  • Tackle the problem of human resources for health
  • Meet the health needs of the urban poor
  • Prevent indebtedness due to expenditure on health
  • Create mechanisms for health insurance and
  • community risk-pooling
  • Reduce fertility
  • Meeting the unmet need, enhanced male
    participation,
  • reducing child mortality and other factors
    affecting fertility

29
APPROACHES NEEDED
  • Reduce infant mortality
  • Home based neonatal care provided by trained
    community health workers
  • Reduce maternal mortality
  • Skilled attendance at birth
  • Application oriented health system and
    bio-medical research for
  • Improved health
  • Propagation of low cost indigenous technology

30
APPROACHES NEEDED
  • Improve governance, transparency and
    accountability in the delivery of health services
  • Involve PRIs, Community and Civil Society
    Groups
  • Monitor outlays vs outputs and outcomes based on
  • Numerical achievements
  • PLUS
  • Improved functioning through adoption of
    Indian Public Health Service Standards at all
    levels

31
PROGRAMMES ACTIVITIES REQUIRED
  • National Rural Health Mission (NRHM) for rural
    India
  • National Urban Health Mission (NUHM) based on
    health insurance and public-private partnership
    (PPP) to meet the unmet needs of the urban
    population
  • Aligned with NRHM and existing urban schemes
  • Initially, focus on urban slums
  • Sarva Swasthya Abhiyan aims for inclusive growth
    by finding solutions for strengthening health
    services and focusing on neglected areas and
    groups

32
ACTIVITIES REQUIRED
  • Strengthening Health Systems
  • Primary Health Care
  • Secondary Tertiary Health Care
  • Access to Essential Drugs
  • Decentralized Governance Affecting Convergence
  • Role of PRIs and Civil Society
  • Enhancing Public-Private Partnership
  • Service delivery
  • Operation and Maintenance
  • Asset Creation

33
ACTIVITIES REQUIRED
  • Health Insurance
  • Community Risk Pooling
  • Community Based Health Insurance
  • Insurance for Unorganized Sector
  • Regulation and Accreditation
  • Appropriate Technology
  • Low Cost and Innovative Technology
  • eHealth

34
IMPROVEMENT REQUIRED
  • Gender Responsive Health Care
  • Sex ratio particularly child sex ratio
  • ANC
  • Safe deliveries
  • Emergency Obstetric Care - 2 hrs travel time
  • Post Partum Care
  • Safe Abortion Services
  • RTI/STI

35
IMPROVEMENT REQUIRED
  • Child Health
  • Home Based Neonatal Care (HBNC)
  • IMNCI
  • Skilled Care at Birth
  • Breast Feeding
  • Immunization
  • Care of Common Illnesses

36
OTHER ACTIVITIES REQUIRED
  • Non-Communicable Diseases Prevention and
    Control
  • School Health
  • Adolescent Health
  • Public Health Education
  • Research For Finding Solutions
  • Health Care for Older Persons

37
  • Transform Public Health Care into an accountable,
    accessible and affordable system of quality
    services
  • Role of Public Health all facets
  • (Indian Public Health Cadre?)

38
  • Plan ahead it was not raining when Noah built
    the ark
  • As quoted in Parks Textbook of Preventive and
    Social Medicine

39
  • THANK YOU

40
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41
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42
HEALTH FINANCING
SOURCE OF HEALTH CARE FINANCING IN INDIA (2001-02)
HEALTH SPENDING 4.5-6 OF GDP
43
HEALTH FINANCING
GROWTH OF PER CAPITA HEALTH EXPENDITURE BY
CENTRE AND STATES NOMINAL AND REAL TERMS
(1993-2004)
44
HEALTH FINANCING
  • To meet the target expenditure level
  • Total Plan expenditure needs to grow annually
  • Total health expenditure by 2011-12
  • Centre 0.40 to 0.87 of GDP
  • States 0.76 to 1.13 of GDP
  • States should assign at least 7-8 of expenditure
    towards health
  • Monitoring Outcomes vs Outlays Block Budgeting

45
HUMAN RESOURCES FOR HEALTH
ISSUES
  • Shortage of key cadres in rural areas
  • Absenteeism and irregular staff attendance
  • Lack of motivation or will to serve in rural
    areas
  • Weak or non-existent accountability framework
  • Non-transparent transfer and posting policy
  • Inadequate systems of incentive for all cadres
    especially in difficult area postings
  • Lack of career progress
  • Lack of standard protocols
  • Non-availability of drugs and diagnostic tests at
    health facilities

46
HUMAN RESOURCES FOR HEALTH
  • Possible Solutions
  • State-specific human resource management policy
  • Incentives for difficult areas
  • System for career progression
  • Devolution of power and functions to local health
    care institutions, local communities and
    Panchayats
  • Improved drugs, diagnostics and tele-linkages
  • Training and utilization of locally available
    paramedics, RMPs, VHWs and overall capacity
    building

47
Capacity Building for Health
  • As per requirement of States
  • ASHA
  • State Mission Officers State PMU Officials
  • District Mission Officers District PMU
    Officials
  • Medical Colleges PSM, OG, Pediatrics Faculty
  • Faculty of Nursing Schools
  • Public Health Specialists
  • MOs 24 hrs PHC/FRU, EOC
  • MTP, Mini Lap, NSV, EC
  • Newer Aspects
  • Lab Technicians
  • ANM Reorientation EOC, JSY, ASHA etc.
  • Traditional Birth Attendants

NRHM
H. System
Outside H. System
  • Related Depts, Media NGOs
  • District Collectors/PRIs/Civil Society
  • IAS SCS Probationers
  • State Health Department
  • Professional Development Course for CMOs
  • CME for MOs, Para-medicals and RMPs
  • Professional Bodies other Organizations
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