1. Equity in Health Care vs Inequity = Under Served Geographic Economic Social Road Access Poverty, Class Stigma

2. Geographic Under Served North Bengal Tea Gardens Char/ Islands Paschimanchal

4. Coverage Evaluation Survey West Bengal 2009 Economic Inequity/ Poverty affects Services

5. Strongest association with Female Literacy MAPEDIR Purulia Literacy status of Mothers who Died 47.2 48.33 40.2 34.9 31.67 37.4 7.5 12.1 13.2 12.5 10.3 4.7 0% 20% 40% 60% 80% 100% May 2005 – July 2006 July 2006-September 2007 May 2008 - March 2010 Illiterate Upto 8th Standard 9th Standard & above DNK

6. Map of maternal deaths MAPEDIR Purulia 2005 2006 2007 2008 2009 2010 (Jan-Jul) DECREASING NUMBER OF REPORTED MATERNAL DEATHS BLOCK-WISE PROGRESS

7. Social Factors affect Immunization Coverage Evaluation Survey West Bengal 2009

8. AWC Outreach Govt Hosp Coverage Evaluation Survey West Bengal 2009

9. Map Health Problems Infectious Acute Chronic ARI/ Pneumonia/ Otitis TB Malaria Leprosy Measles Filaria Diarrhoea Kala Azar HIV Detecting and preventing hypertension in remote areas Barun Mukhopadhyay http://www.issuesinmedicalethics.org/144oa124.html Non Infectious Acute Chronic Snakebite BP Injury Diabetes Drowning Asthma Blindness Deafness Mental Congenital Cancer RCH Maternal Neonatal Malnutrition

10. What Is To Be Done Community- Outreach- Clinic/ Facility-

11. What Is To Be Done Community ASHA/ 2nd ANM Zinc + ORS for Diarrhoea IMNCI Referral Transport Local Practitioners/ Tea Gardens CHCMI/ VHSC Sanitation/ ICDS/ Iodine/ Vitamin A/ Iron

12. What Is To Be Done Outreach -Need Based Plans -Flexibility Brick Kilns Bidi Workers -Additional Funds SHG/ NGO role

13. What Is To Be Done Clinic/ Facility - Government- Quality - NGO/ PPP- Access - Continuum of Care (MCH/ Neonatal)‏ - AMO - Certification of Private Providers (ISO)

14. What Is To Be Done Support and Monitoring - Drug Supply - Laboratory - IT (mobile/ internet/ tele- medicine) - Surveillance - Verbal Autopsy/ Death Review Primary Health Care- Indian Scenario WHO Country Office for India (HSD) August 2008

15. First-sustain rapid diagnostic kits, ACT and funds. Reach sufficient coverage (80%) of bed nets, particularly to BPL Second, orient MO in PHC -early referral of malaria with complications. Third, community awareness to seek prompt treatment. Fourth, spray teams must catch up DDT spraying Fifth, orient private practitioners -appropriate anti-malarials, management of severe malaria and early referral. PPP with tea gardens Risk factors for malaria deaths in Jalpaiguri district, West Bengal, India: evidence for further action J Sarkar et al Malar J. 2009; 8: 133. Published online 2009 June 16

16. The Way Forward Improving health in India will require building up the health system in the next ten to twenty years. Five core concerns emerge when facing the challenge of improving health in India: (i) promoting equity by reducing household expenditure on total health spending and experimenting with alternate models of health financing; (ii) restructuring the existing primary health care system to make it more accountable; (iii) reducing disease burden and the level of risk; (iv) establishing institutional frameworks for improved quality of governance of health; IV. ( Regulations and institutional infrastructure for coping with health markets) (v) investing in technology and human resources for a more professional and skilled workforce and better monitoring Report of National Commission for Macroeconomics and Health 2005

17. Reducing household expenditures of the poor: Options for financing comprehensive health care 1. a core package consisting of public goods and costing Rs 150 per capita, to be made universally accessible at public cost; 2. a basic package consisting, in addition to the above, surgery and medical treatment costing Rs 310 per capita; and 3. a secondary care package costing Rs 700 per capita and consisting of treatment for vascular diseases, cancer and mental illness, and referrals Innovative financing models must be tried to ensure that such packages are universally accessible Report of National Commission for Macroeconomics and Health 2005