1. Universalizing Access To Primary Healthcare
• Dr. Yogesh Dukare
• Shweta Bharti
• Shilpa Gaur
• Himani Jain
• Chinar Sharma
Team members

2. Medical
college
SDH/District
hospital
1/100000
population
Community health
center 80,000-12,000
population
Primary Health Care Center
20000-30000 population
Sub-health center
3000-5000 population
Sub centre covers a population of 5000 in plain
areas and 3000 in Hilly and difficult terrains
Indian Health Care Delivery Structure
Tertiary
level
Primarylevel
Secondary
level
Ensuring equitable access for all
Indian citizens residents, any part of
the country, regardless of income
level, social status, gender, caste or
religion, to affordable, accountable,
appropriate health services of
assured quality (promotive,
preventive, curative and
rehabilitative) as well as public health
services addressing the wider
determinants of health delivered to
individuals and populations, with the
government being the guarantor and
enabler, although not necessary the
only provider of health & related
services.
- HLEG , Planning Commision of India
What is Universal Health Coverage
The “first” level of contact between the individual and the health system. It
is provided by Subcenters , Primary healthcare centers & Community
Health care Centers .
Primary
Health Care : 2

3. Reasons for poor healthcare structure in India
Insufficient funding of public facilities
Physical reach of any healthcare facility is a challenge in rural areas,
particularly for patients with chronic ailments
Lack of availability of medical services
Inefficient management of available financial & human resources
The provision of healthcare services in India is skewed toward urban centers
and the private sector
Improper planning & allocation of resources
Financial inability to pay (Around 70% of total health spending is out of
pocket, and around 70% of that is on drugs.
Non availability of doctors in public health facilities is a key reason
for selecting private facility outpatient treatments
Even if only one of these components is missing, a patient
is unlikely to receive appropriate healthcare service.
Physical
accessibility
of required
healthcare
facilities for
a patient
Availability
of the
resources
required for
patient
treatment
Quality/
functionality
of the
resources
providing
care
Affordability
of the
complete
treatment to
the patient.
Complete
primary
healthcare
3

4. Roadmap to improvement in health care delivery status
Roadmap to
improve primary
healthcare
system
“The healthcare system in India is not delivering affordable, acceptable and accessible
healthcare to all Indians – which must be the test of its quality. Fixes to only parts of the
system cannot produce the systemic changes required.
- Arun Maira, member, Planning Commission of India.
25%
6%
6%
27%
23%
13%
Qucik attention
Lack of
specialists
Can afford
Less waiting time
Doctor
availability
No free medicies
in govt.
4
Why Indian people prefer Pvt.
healthcare services

5. Infrastructure: Current status and road ahead
• Currently overall bed
availability – 9/10,000
people
• Skewed proportion
within rural & urban
area as well as from
North India to South
India
Availability of beds
5
Rural Urban
Population of India 893874211 347617749
Number of Beds 454580 882420
Hospital Beds/10000 5 25
Supply Gap w.r.t Global average 2227043 160433
Total Gap 2387476
SHC PHC CHC SDH & DH
Current availibility 147069 23673 4535 1579
Expected by 2020 314547 50591 12648 5203
0
50000
100000
150000
200000
250000
300000
350000
Current availibility Expected by 2020
SHC: Sub-Health Center
PHC: Primary Health
Center
CHC: Community Health
Center
DH: District Hospitals
Number of Primary
Healthcare facility:
Current & proposed

6. Proposal for Infrastructure improvement
6
• Focusing on ease of access, within a 5km distance
• Strategic partnership/ outsourcing with key private players
• Standards for man-hours and skill set required at each center, other infrastructure like
ambulance services
• Implementation of a robust Hospital Management Information System across all centers
to share real time information about patients & treatment modalities
Infrastructure Planning
Some successful Public
–private partnerships
in Government
healthcare
infrastructure

7. Human Resource Management
0
8
16
24
WHO India
23
19
Heath HRM/10000 Population
India ranked 52 of the 57 countries
facing an HRH crisis.
• 34% for MHW are not in position, while 38% of radiographer posts, 16% of lab Tech
posts, 31% of specialist posts, 20% of pharmacist posts, 17% of ANM posts, and 10%
of doctor posts are vacant..
Shortage
• A.P, Karnataka, Kerala, Maharashtra, Pondicherry and TN represent 31% of the
population, but have a high share of MBBS seats (58%) and nursing colleges (63%)
• Bihar, Chhattisgarh, Jharkhand, M.P, Orissa, Rajasthan, Uttaranchal and U.P which
comprise 46% of population, have 21% MBBS seats and 20% Nursing colleges .
Skewed
Distribution
HRH shortfalls range from 63% for specialists to
10% for doctors, and 9% for ANMs, respectively
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8. 8
Human Resource Management- Scope for improvement
8
Incentivisation
Substantial monetary incentives which is
performance based and varies according to the
difficulty of the area
11
Compulsory Rural Service
Making two years of rural service
compulsory in public hospitals to a post
graduate medical student
22
Decentralization Related Options
Decentralization of decision-making on
recruitment and financing to district or block
Panchayat or hospital development committees for
medically underserved remote areas
Doctor alternatives & Training of
paramedical
All PHCs support staff should have an
induction training of 1 month imparting basic
clinical multi-skills them and then a refresher
of 15 days once in 2 or 3 years.
33
Professional Motivation for doctors in
PHC
CME scheme for Skill upgradation
programmes, ensuring access to drugs &
equipments related to their field of
specialization,
44
Training AYUSH practitioners
If AYUSH doctors are playing medical
officer roles then they should be provided
intensive skill upgradation programmes
55
77
88
66
Active Referral Systems
Active referral system with
feedback from referral institution to the
doctor referring enabling the patient to
be primarily managed at the lower center
clear understanding of who should be
referred avoiding high degree of
unnecessary referrals
Regular Monitor, Progress Against
Standards
Setting IPHS Standards ,Facility Surveys
to gain performance data of PHCs,
Independent Monitoring Committees at
block, district and state levels

9. ANM
• Increase of ANM/ sub center from 1
to 2- can go to field on alternate
days and can ensure 6 days/week
working
• Get ANM and MPW pre service
training centre functional.
• In areas where it is difficult to find
workers, especially in tribal areas,
introduce
vocational training for students in
class 12th that leads to ANM’s and
MPW’s.
• Ensure regular annual refresher
training for ANM’s and MPW’s
• Provision of short term courses on
multi skilling.
Doctor
• Improve the facilities and annual
intake. Annual output/ medical
college in China 900+ and in India
100+.
• Incentivisation of doctors by paying
higher salaries for doctors working in
rural and tribal areas. Also include
performance based incentives as a
component of salary.
• Compulsory rural postings for MBBS
Students and a requirement to apply
for Post Graduate programs.
• Regular upgradation through CME’s
and short term courses on emergency
and life saving skills.
• Policies to avoid brain drain
9
Human Resource Management- Scope for improvement

10. Planning & Integration
Medicines
Referral System
Diagnostic Services
Community participation
• Stock of 30-50 essential medicines at all time based on the frequency of requirement
• Stock filling every week from District Hospitals with all essential medicines
• Mandatory prescription of generic drugs for cost effectiveness
• Strict control of FDA on quality & manufacturing of drugs
• Use of IT system to maintain database of referral centers/doctors for each
disease category & clinical specialty
• Expert consultation & advice through Telemedicine Monitoring of referred
Patient and feedback along with integration
• Govt Subsidy on essential Diagnostic tests
• Performance based incentives to doctors
• Standardization of laboratory equipments on regular basis by regulatory
body
• Formulation of Village Community Insurance Scheme
• Banking Contribution From Priority Sector Lending
10

11. Regulations & strict implementation
Current
Scenario
• Unmanned
PHC’s
existing in
rural areas
depriving
patients of
immediate
attention in
case of
medical
emergencies
Gap to be
plugged
• Dearth of
trained
medicare
personnel
• High
absenteeism
rates of the
practitioners
Roadmap
• Compulsory
posting of
medical
practitioners
& interns as
per the
specifications
defined by
the GOI
• Availability of
minimum
essential
ddiagnostic
facilities at
PHC’s
Availability
Out of he 2% CSR
obligation for
private players,
25-30% to be
invested in raising
more PHC’ s and
CHC’s
CSR Policy
Change
Increased Insurance
penetration by special
incentives, subsidies
to private players
Affordability
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12. Innovative ideas relying less on capital expenditure and more on human capital
1. ASHA worker feedback mechanism routed through Panchayats and on the job training
programmes by ASHA workers recognized through village Panchayat feedbacks
2. Identification of people with entrepreneurial instinct, the right amount of knowledge
and commitment towards social work to educate and train people in rural areas on how to
handle emergencies and first aid treatment
Regulations & strict implementation
Current Scenario
• Most cases of
notifiable
diseases go
unreported as
only a few are
taken up and
followed up by
the concerned
authorities
Gap to be plugged
• Lack of stringent
implementation
and action
against the
perpetrators
Roadmap
• Every single case
of any of the
notifiable
diseases to be
closely
monitored to
avoid
absenteeism and
availability of
doses
Quality
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13. References
(McKinsey, 2012)Engaging consumers to manage Health care
demands medical_soultions_september2009_essay_series_india-
00068239 (IMS Health)
http://southasia.oneworld.net/peoplespeak/2018india-is-moving-
towards-a-system-of-universal-healthcare2019#.UijDiDbnflV
http://forbesindia.com/article/universal-health-care/indias-
primary-health-care-needs-quick-reform/34899/1
http://social.yourstory.in/2013/03/a-cure-to-indias-ailing-primary-
healthcare/
http://rmsc.nic.in/Drug_Procurement.html
http://modernmedicare.co.in/articles/diagnostics-in-india-the-
beginning-of-a-new-im-%E2%80%9Cage%E2%80%9D/
http://uhc-india.org/reports/hleg_report.pdf
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