health for all an utopian dream or reality

HEALTH FOR ALL,An Utopian Dream or Possible Reality –The Indian Context

Dr Deodatt M Suryawanshi

Assistant Professor

Community Medicine

Outline of Presentation

• What is Health For All?

• Global Commitments :UN Declaration 1978 and MDGs 2000.

• Is investing in health beneficial.

• Is health a Priority?

• What's ailing India's Health care.

• Light at the Horizon: Universal health coverage (2012 -2022)

NHmFAU -National Health & Medical Facilities accrediation unit

What is Health for All ?

• Universally recognised as means to achieve Economic

development

• Commitment to promote the advancement of all citizens to achieve a

higher quality of life


HEALTH FOR ALL -HOLISTIC CONCEPT

Agriculture Industry

EducationMedicine & Public

Health

Health For All


Health for all : Universal Agreed Goal

UN Declaration in Alma Alta,

Kazakhstan 1978,the goal to achieve

Health for all by 2000 through

essential Primary Health care.


Millennium Development goals (2000 -2015)

• Reiteration of Commitment Of

Health for all through time bound

goals.

• 3 out of 8 Goals directly related to Health


Why investment in health is

beneficial


Feedbacks loops for the Development of nation


Education

Health

Human Capital

Human Development


Seizing the Demographic dividend


Seizing the demographic dividend…..

• India will have largest amount of workforce in the working age group by

2026.

• The challenge is to how to harness the vast potential of this human resource

and use in development of nation.

• Formation of human capital is essential for the development of the nation as

skillful and healthy workforce is an asset.


Healthy & Skilled work Force

Contributing more to the GDP of the nation

Economic Development


Why health is not the priority in India?

Maslow's hierarchy :Theory of Motivation of Needs


• If Physiological needs of people are not satisfied

they will seldom consider other needs as a priority

• People in India today are still facing the following

Problems:

Poverty

Lack of Food security

Affordable housing

Access to safe water and Sanitation.


Estimates of Poverty in India


Monthly Per capita expenditure (MPCE)


Half of income is spent on Food


Lack of Food Security : Unsatisfied basic need

• Food Security : India ranks 63 out of 79 nations on

the Global Hunger Index (GHI) Equal with Rwanda.

• Following facts presents a sorry picture of hungry India.

• 820 million chronically hungry people in the world.

• 1/3rd of the world’s hungry live in India.

• Over 20 crore Indians will sleep hungry tonight.

• 10 million people die every year of chronic hunger and hunger-

related diseases.


Access to Safe water & Sanitation

• About half of Indian

households still lack access to

sanitation facilities


• > 67 yrs of Independence still we are the same starting point where we started

poor ,Hungry ,malnourished vulnerable to the Triple burden of diseases.


Decreasing order of Priorities


What's Ailing India's Health care


AVAILABILITY OF HEALTH CARE

• Availability of health care services:

Public and private sectors taken together is quantitatively inadequate.

Rural urban divide : 25 % 75% divide for Resources and infrastructure.

Lack of Skilled human resources :


Quality of healthcare services

• Lack of Technical qualified Persons in Rural areas.

• Mercy of Quacks

• Regulatory standards for public and private hospitals are not adequately

defined and, in any case, are ineffectively enforced.

• Poorly enforced


Affordability of health care

• Problem for the vast majority of the population, especially in tertiary care.

• Lack of extensive and adequately funded public health services.

• Out of pocket expenditures arise even in public sector hospitals, since lack of medicines

means that patients have to buy them.

• Lack of Universal Health insurance.


Prone to Diseases

Out of Pocket

spending

Selling of income earning assets

Poverty

Lack of accessible and affordable

Health care


Pattern of health financing

• The health care system in India pre–dominantly is catered to by the private sector

• Expenditure in the private sector contributes to 78.05% of total health expenditure,

• Public sector accounts for 19.67% and

• External flows 2.28%.

• In totality, Health expenditure formed 4.25% of Gross Domestic Product (GDP)


Sources of financing health care in India. Sources of fund Distribution (%)

A) Public Funds

Central Government 6.78

State government 11.97

Local bodies 0.92

Total A 19.67

B) Private Funds

Household 71.13

Social insurance funds 1.13

Firms 5.73

NGOs 0.07

Total B 78.05

c) External flows (CG & SG% NGOS) 2.28

Total 100NHmFAU -National Health & Medical Facilities accrediation unit

Per capita Health expenditure

Per capita

expenditure

Rs %

Public share 242 20.18

Private share 959 79.82

Total 1201 100

• The per capita health

expenditure for India in 2004–05

was Rs. 1201 of which the share

of public was Rs. 242 (20.18%)

and that of private was Rs. 959

(79.82%).


Per capita Share of Health expenditure (2005 to expected 2022)

959

(79%)1825

(74%)

1725

(34%)

242

(21%)675

(26%)

3450

(66%)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2004 to 2005 2011 to 2012 target 2022

YEARS

Public share2

Private share


International Comparison of Health Expenditure


• 12 th Plan envisages to seize the

demographic dividend by investing in

Health of the people through the

concept of Universal health access or

Universal health coverage(UHC) for all

by 2022.


The Planning commission in Oct

2010 instituted a HLEG on

Universal Health coverage to give

inputs on universal health coverage

Under the Leadership of Dr K

Srinath Reddy .


What is Universal access to health ?

Ensuring equitable access for all Indian citizens(irrespective of various distinctions)

To provide affordable, accountable, appropriate health services of assured quality

(promotive, preventive, curative and rehabilitative)

Addressing the wider determinants of health delivered to individuals and

populations.

The government being the guarantor and enabler, although not necessarily the only

provider, of health and related services.


Why the need for Universal health Coverage

Increase Life expectancy

Population Vulnerable to non communicable diseases

Rising Cost of Health expenditure

Health Awareness

Increase demand

Triple Burden Of Diseases

Communicable diseases

Non Communicable

Mental illness


Vision of the HLEG on UHC


Recommendations of the HLEG

Health Financing and Financial Protection

Human resource for health

Access to Medicines, Vaccines and Technology

Management and Institutional Reforms:

Community Participation and Citizen Engagement.

Gender and Health


Health Financing and Financial Protection

Increase public expenditure on health

from the current level of 1.2 per cent of

GDP to at least 2.5 per cent by the end of

the Twelfth Plan, and to at least 3 per cent

of GDP by 2022.

Ensure availability of free essential

medicines by increasing public spending

on drug procurement.(0.1 to 0.5% of GDP)


Financing Health care For Universal Access

General taxation Comprehensive Health insurance

RSBY


A National Health Package

should be developed that offers,

as part of the entitlement of

every citizen, essential health

services at different levels of the

healthcare delivery system.


Human Resources for Health:

• Institutes of Family Welfare should be strengthened

• Regional Faculty Development Centres should be selectively developed to enhance

the availability of adequately trained faculty and faculty-sharing across institutions.

• District Health Knowledge Institutes, a dedicated training system for Community

Health Workers.

• Establishment of National Council for Human Resources in Health (NCHRH)

should be established.


• Norms For Health Staff

2011 2017 2022

Allopathic doctors, nurses and midwives per

1000 population

1.29 1.93 2.53

Population served per allopathic doctor 1953 1731 1451

Ratio of nurses and midwives to an

allopathic doctor

1.53 2.33 2.94

Ratio of nurses to an allopathic doctor 1 1.81 2.22


Access to Medicines, Vaccines and Technology:

Price controls and price regulation, especially on essential drugs, should be enforced.

The Essential Drugs List should be revised and expanded, and rational use of drugs

ensured.

Public sector should be strengthened to protect the capacity of domestic drug and

vaccines industry to meet national needs.

Safeguards provided by Indian patents law and the TRIPS Agreement against the

country’s ability to produce essential drugs should be protected.

MoHFW should be empowered to strengthen the drug regulatory systemNHmFAU -National Health & Medical Facilities accrediation unit

Management and Institutional Reforms:

Creation of All India and State level Public Health Service Cadres and a specialised

State level Health Systems Management Cadre.

The establishment of a National Health Regulatory and Development Authority

(NHRDA) a, National Drug Regulatory and Development Authority (NDRDA) and

a, National Health Promotion and Protection Trust (NHPPT) is also recommended.


Community Participation and Citizen Engagement:

Existing Village Health Committees should be

transformed into participatory Health Councils.

Organise regular Health Assemblies

Institute a formal grievance redressal mechanism at the

block level.


Gender and Health:

Improve access to health services for women, girls and other

vulnerable genders (going beyond maternal and child health)


Expected outcomes of UHC


Conclusion Health can only be made a priority when Government satisfies physiological needs of people,

which will lead to more awareness and health seeking behavior among people.

Health is a medium of Economic development and investing in Health is Beneficial for the

growth of a nation.

Universal Health coverage envisaged by the Planning Commision is a welcome step in the

direction


Thank you


References

• National health accounts 2004-2005 report

• 12th plan outlay document

• India human development report 2011

• Report of high level expert group on Universal Health coverage in India.


Organogram of National Health Regulatory and Development authority(NHRDA)

NHRDA

System support

Unit (SSU)NHMFAU HSEU

NHMFAU -National Health & Medical Facilities accreditation unit

HSEU – HEALTH SERVICE EVALUATION UNIT.

health for all an utopian dream or reality

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