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Inclusive Health Care

Inclusive Health Care. Situation Analysis-India. Exhibit above shows India’s ranking on five parameters among 193 countries. 1 being the best and 193 being the worst. Challenges at Public Hospitals:. Share of public health spending - very low

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Inclusive Health Care

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  1. Inclusive Health Care

  2. Situation Analysis-India Exhibit above shows India’s ranking on five parameters among 193 countries. 1 being the best and 193 being the worst Source- Language in India www.languageinindia.com ISSN 1930-2940 Vol. 13:4 April 2013

  3. Challenges at Public Hospitals: • Share of public health spending - very low • Quality of health care facilities- not very impressive. • Infrastructural facilities- very low. • Shortage of staffs including doctors, nurses and other health care professionals at Public Hospitals. • Facility-based and outreach services without being doctor dependent. Exhibit shows countries per capita Government spending on healthcare (in USD) on the left side and per capita private ‘OPE’ expenditure on healthcare on the right side. Source-Inclusive Healthcare Management for Sustainable Development Conference -August 2011 www.deloitte.com/in

  4. Inclusive health care to Inclusive Growth Inclusive health means bringing poor, women, children, tribal, mentally and physically challenged people and other social vulnerable groups under the umbrella of health care OrEquitable allocation of health care resources with benefits accruing to every section of the society. In India: Offering healthcare services to entire 1.2 billion (approx.) population i.e. including those that are currently excluded from healthcare services. Through providing availability, affordability, and quality in long-term and sustainable Manner. Source- Language in India www.languageinindia.com ISSN 1930-2940 Vol. 13:4 April 2013

  5. Availability • Increased public expenditures on health from 3.02% (2007-08) to 4.85% (2013-14) of the State Budget. • Establishment of GMSCL to provide free essential medicines;- increased drug procurement from 50.98 Cr. (2009-10) to 85.54 Cr. (2011-12) i.e. a rise of 35%. • Utilizing GIS Technology in identifying the need of PHC’s/CHC’s

  6. Availability • Expenditures on PHC’s has been increased through NRHM with an stress for general health information & promotion, curative services, screening for risk factors, and cost effective treatment targeted toward specific risk factors. • To have sufficient availability of trained health work force additional educational institutions have been established; • 36 new Medical Education Colleges (U.G, P.G of Medical, Dental and Physiotherapy)from previous 50 to a total 86 - increasing seats from 3933 (2007-08) to 7269 (2012-13) • 104 new Nursing Colleges from previous 35 to a total 139 Nursing Colleges- increasing seats from 1257 (2007-08) to 5748 (2012-13)

  7. Availability • To have better human resource practice and to improve recruitment, retention, motivation, performance, and a rational deployment of manpower is under Governments consideration. • Through MA Yojana, Chiranjivi Yojana, Balsakah Yojana, government is directly providing services without using insurance companies or any other independent agents to purchase health care services on be half of State government. • Chiranjivi Yojana for BPL population to lower maternal mortality and infant mortality rate and to increase institutional deliveries.

  8. Availability • Bal Sakaha Yojana for BPL and tribal population to take care of Sick new born and to reduce IMR; • Package of Rs 2,09,000 (from birth) and Rs 2,60,000 (from Home) for 100 newborns managed, • Income limit for beneficiaries is Rs 2 lac per annum • 194 pediatricians attended 54116 neonates (year 2012-13) • Chief Minister SETU to provide secondary level of services to all through PPP mode; • 137 specialist are giving services at various CHC/SDH/DH. • ASHA (Accredited Social Health Activist); • A total 31849 ASHAs in position

  9. Availability • 108 Services-Transporting all patients in emergencies to nearest hospital; • On an average attending 9000 calls per day • Attending an average 2250 emergencies with a total 41.43 lacs till date • Sickle Cell Anemia Control Program-Screening of tribal population in 12 districts for congenital disorder; • 50 lacs out of 89 lacs Tribal have been screened till date. • Mukhyamantri Amrutum ‘MA’ Yojana-To provide tertiary care services against 544 surgeries.

  10. Affordability • By contributing Rs.30 under RSBY scheme unorganized families can now avail smart card based cashless health insurance cover of Rs. 30,000 per family per annum. • 1354 hospitals are empanelled • Services beyond the reach of needy people has been made available through strengthening civil society, NGO’s, Rogi Kalyan Samiti (RKS) and through PPP; • Rs. 10000 per Village Health Sanitation and Nutrition Committee- ‘GSS’ to each PHC • Rs. 1.0 Lacs per RKS to each CHC & SDH • Rs. 5.0 Lacs per RKS to each DH

  11. Affordability • Khilkhilahat- A drop back facility to post partum BPL mothers from hospital to home. • Mamta Ghar- To provide safe & secure environment to BPL pregnant mothers before delivery. • Mission Balam Sukham- preventive & curative aspects desirable for: Adolescence, 9 months of pregnancy to first two years of age (Critical 1000 days ), Children up to 6 years of age group • Total No. of Village Child Nutrition Center (VCNC) Started-1702 • No. of Children Admitted- 34156 (Average 26 per VCNC) • Average Weight Gain- 601 gms

  12. Affordability • Low Income Group- 50% discount on Tertiary care surgeries at identified hospitals to families with an annual income of Rs.2 Lacs or less. • School Health- Health screening of all school going & out of school children’s and to identify primary, secondary and tertiary care ailments and providing curative services; • A total 96.5% (1,50,67,709) children's examined during 2012-13, out of which 7,072 children's identified for tertiary care.

  13. Quality • Gujarat is the first state in India to have NABH & NABL accreditation process and has 28 accredited institutes and more than 100 institutions under process. • To promote Quality services under Mukhyamantri Amrutum ‘MA’ Yojana an additional 2.5% over and above the Package rates are given as ‘quality incentive’ to Hospitals accredited by NABH, JCI or any other International Society for quality.

  14. Quality Initiative Program • Trained persons for Quality -3568

  15. MA Yojana • Mukhyamantri Amrutum “MA” Yojana is 100% State funded scheme. • A total 41.82 lacs BPL families have been covered under the scheme. • MA beneficiaries can avail quality medical and surgical care for catastrophic illnesses related to: Cardiovascular Surgeries, Renal (Kidney), Neurosurgeries, Burns, Poly-Trauma, Cancer (Malignancies), Neo-natal (newborn) diseases. • The scheme provides cashless treatment up to Rs.2,00,000/- per BPL family per annum on a family floater basis. • A unit of five members of the BPL family (Head of family, spouse, and three dependents) are covered

  16. Scheme Description • Newborn is also covered from day one as 6th member of the family. • Enrolled BPL family is provided a QR coded card (Quick Response Coded Card) containing photograph of the head of the family/ spouse with a unique registration number (URN). • The biometric thumb impressions of all the enrolled family members are capture. • 544 packages of catastrophic & critical care are pre defined • Rs.70 Cr. for MA Yojana in the year 2013-14.

  17. Scheme Description QR coded MA card: • The Arogya Mitras are appointed to facilitate the patient in availing diagnostic services, transportation cost, food, follow-ups and medicines after the discharge from the hospital.

  18. Scheme Description • Hospital Help Desk:

  19. Impact of the Scheme • “MA” Yojana provides quality medical and surgical care for the catastrophic illnesses to the BPL families involving hospitalization, surgeries and therapies through an empanelled super specialty hospitals • 63 hospitals (44 private -19 grant in aid/government hospitals) are empanelled so far. • 15,895 BPL beneficiaries were treated and amount of Rs.34.73 Cr. Was utilised. • Through ‘MA’, 1.83 Cr. people now have choice to select hospitals for their treatment.

  20. Agenda for action • Earmarking adequate financing for the public system that should aim to reach 5% of GDP in the medium term • Streamlining structures and human resources in facilities to improve efficiency, as well as rationalizing costs of care in public facilities based on actual needs.-HRMS Policy • Focus should be on Primary Care, availability at CHC/DH level. Public sector must lead the health sector rather than the Private sector. • Providing more equitable access across rural and urban areas- Through Urban Health Mission

  21. High Priority Talukas • Mapping of Talukas on the basis of following parameter-

  22. Categorization of Talukas • Based on above parameter and feedback received from District all 248, talukas of the State are divided into 3 Categories; • Category I:High Priority Talukas (77 Talukas) • Category II: Priority Talukas (118 Talukas) • Category III: Normal Talukas (53 Talukas) • PPP in Tertiary health services through innovation and expansion of existing schemes. • Establishing mechanisms to empower communities to participate in Healthcare programs. • Setting standard treatment protocols to ensure quality of care

  23. Summary • Inclusive health care can only be ensured if poor and underprevelidge class gets better careand this can be ensured only by government health care institutions through spending on infrastructure development, training of existing & new health care professionals to use modern equipments & facilities, and to ensure quality services etc.

  24. Thank You

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