SWOC ANALYSIS OF HEALTH CARE DELIVERY

SYSTEM INDIAPRESENTED BY : MRS ALKA MISHRA

M. SC. NURSING 1ST YEAR

INTRODUCTION• : “INDIA IS THE SECOND MOST POPULOUS COUNTRY IN THE

WORLD AND WITH A HEALTHCARE INFRASTRUCTURE THAT IS OVER-BURDENED WITH THIS EVER INCREASING POPULATION, A SET OF CHALLENGES THAT ARE UNIQUE TO INDIA ARISE.”. INDIA. HERE, THE HEALTHCARE INDUSTRY IS DOMINATED BY PRIVATE CAPITAL AND ITS GROWTH SPIRAL IS ALMOST UNREGULATED. ON THE OTHER HAND, 65 PER CENT OF OUR POPULATION DOES NOT HAVE ACCESS TO MODERN MEDICINE.

CONTED….• IT IS EVEN WORSE IF ONE LOOKS AT THE RURAL/URBAN DIVIDE :

ABOUT 80 PER CENT OF DOCTORS, 75 PER CENT OF DISPENSARIES AND 60 PER CENT OF HOSPITALS ARE LOCATED IN URBAN AREAS. SINCE THE PROCESS OF LIBERALISATION KICKED IN, THE HEALTH INFRASTRUCTURE PROVIDED BY

CONTED…• THE GOVERNMENT HAS ALMOST BROKEN DOWN. THE OVERALL

PRIVATE-PUBLIC SPENDING ON HEALTHCARE IS VERY LITTLE – IT ACCOUNTS FOR 4.8 PER CENT OF INDIA’S GDP. OF THIS, 3.6 PER CENT IS CONTRIBUTED BY THE PRIVATE SECTOR AND ONLY THE BALANCE 1.2 PER CENT BY THE GOVERNMENT.

OVERVIEW:• MILESTONES IN INDEPENDENT INDIA

• PRIMARY HEALTH CENTERS 1952

• FAMILY PLANNING 1952

• GREEN REVOLUTION 1967 - 1977

• NATIONAL HEALTH PROGRAMS – FROM 1957

• NATIONAL HEALTH POLICY – 1982 & 2002

• NRHM 2005

• PHFI -2008

• HEALTHCARE HAS EMERGED AS ONE OF THE LARGEST SERVICE SECTORS IN INDIA. RATHER DYNAMIC, IT IS CONSTANTLY DEVELOPING BUILDING FURTHER ON THE AREAS IT IS MOST COMPETENT AT.

CONTED…• HEALTHCARE DELIVERY IN INDIA

• PUBLIC HEALTH SECTOR• PRIMARY HEALTH CARE• SUB-CENTRES• PRIMARY HEALTH CENTRES• HOSPITALS / HEALTH CENTRES• COMMUNITY HEALTH CENTRES• RURAL HOSPITAL

CONTED…DISTRICT HOSPITALS/HEALTH CENTRES

• SPECIALIST HOSPITALS

• TEACHING HOSPITALS

• HEALTH INSURANCE SCHEMES

• EMPLOYEE STATE INSURANCE SCHEME

• CENTRAL GOVT. HEALTH SCHEME

• OTHER AGENCIES

• DEFENCE

• RAILWAYS

CONTED…• 2. PRIVATE SECTOR

• PRIVATE HOSPITALS, POLYCLINICS, NURSING HOMES, AND DISPENSARIES GENERAL PRACTITIONERS AND CLINICS

• 3. INDIGENOUS SYSTEMS OF MEDICINE

• AYURVEDA AND SIDDHA

• UNANI

• HOMEOPATH

• UN-REGISTERED PRACTITIONERS

• 4. VOLUNTARY HEALTH AGENCIES

• 5. NATIONAL HEALTH PROGRAMMES

STRENGTHS:• COMMITMENT TO ENHANCE THE BUDGET ON HEALTH

EXPENDITURE FROM 5.2% TO 6% OF GDP WITH THE GOVERNMENT CONTRIBUTION INCREASING FROM 0.9% TO 2% BY 2010/

• AVAILABILITY OF ADVANCE TECHNOLOGY AND PROVEN PUBLIC HEALTH STRATEGIES.

• FAVOURABLE ENVIRONMENT & SUPPORT OF INTERNATIONAL HEALTH AGENCIES, ECONOMIC AND POLITICAL REFORMS.

• INTEGRATION OF VERTICAL PROGRAM ACTIVITIES WITH GENERAL HEALTH SERVICES HAS ENSURED SUSTAINABILITY.

CONTED…• INTEGRATION OF AYUSH WITH GENERAL HEALTH CARE DELIVERY

SYSTEM.

• THIS PLANNED DEVELOPMENT OF ABOUT FIVE DECADES HAS RESULTED IN INCREASE IN THE HEALTH INFRASTRUCTURE TO MEET THE INCREASING DEMAND ON HEALTH SERVICES AT VARIOUS LEVEL.

• IPHS ARE THE SET OF STANDARDS ENVISAGED TO IMPROVE THE QUALITY OF HEALTH CARE DELIVERY IN THE COUNTRY.

• IT DECENTRALIZED ADMINISTRATION BY A HOSPITAL MANAGEMENT COMMITTEE AND PROVISION OF ADEQUATE FUNDS AND POWERS TO ENABLE THESE COMMITTEES TO REACH DESIRED LEVELS.

• THERE HAVE BEEN SIGNIFICANT ADVANCES IN THE HEALTHCARE SYSTEM IN INDIA OVER LAST FEW DECADES.

WEAKNESSES:• THREE WORRISOME TRENDS OF HEALTH CARE SYSTEM IN INDIA

–

• 1.HEALTH SYSTEM THAT DISPROPORTIONATELY FOCUS ON NARROW OFFER OF SPECIALIZED HEALTH CARE.

• 2.HEALTH SYSTEM WHERE A COMMAND AND CONTROL APPROACH FOCUSED ON SHORT-TERM RESULTS AND IS FRAGMENTING THE SERVICE DELIVERY.

• 3.HEALTH SYSTEMS WHERE GOVERNANCE HAS ALLOWED UNREGULATED COMMERCIALIZATION OF HEALTH TO FLOURISH.

CONTED….• OTHERS ARE -

• LACK OF MONITORING AND EVALUATION

• LACK OF GOVERNMENT EXPENDITURE ON PUBLIC HEALTH

• GAP IN SITUATION ANALYSIS AND POLICY PRESCRIPTION

• TOO MANY REGISTERS

• TOO MUCH REPEAT DATA COLLECTED

• DATA MISSING / SORTING NOT DONE

• DISTANCE FACTOR FOR COLLECTION OF DATA

CONTED….• GRASS ROOT HEALTH WORKERS ANM IS THE MAIN PERSON – TOO

MANY REGISTERS FOR HER

• HEALTH WORKERS ARE REQUIRED TO MAINTAIN LARGE NUMBER OF REGISTERS

• DATA GENERATED RARELY USED AS BASIS FOR MANAGEMENT DECISIONS.

• SEARCH SURVEYS / SRS/NHFS ALL CONDUCTED BUT NONE GIVE DETAILED COMPREHENSIVE COMPLETE DATA IN GIVEN TIME – ON TIME – DELAYED REPORTS

• SECRETARIAT SYSTEM OF GOVERNANCE

• PLANNING AND MONITORING AS CENTRAL ACTIVITY

CONTED….• H AND FW ADMINISTRATION CENTRALIZED

• NO OF PROGRAMS, SURVEYS WITH NO GROUND REALITIES USING THE SAME HFW STAFF

• MANY FAILURES IN ACHIEVING TARGETS IN THE PAST

• LACK OF COMMUNITY INVOLVEMENT

• LACK OF RESOURCES AND POOR BUDGETING

• LACK OF WELL PLANNED MONITORING AND EVALUATION

• DOCTORS ARE EXPORTED TO MANY OTHER COUNTRIES, AND ARE CONSIDERED AMONG THE BEST IN THE WORLD

CONTED….• THERE ARE MASSIVE INEQUITIES IN ACCESS TO HEALTHCARE –

WHILE THE RICH AVAIL OF MOST MODERN AND EXPENSIVE HEALTH SERVICES, THE POOR, ESPECIALLY IN RURAL AREAS DO NOT GET EVEN RUDIMENTARY HEALTHCARE.

• INCREDIBLY, HOSPITALISATION RATES AMONG THE WELL OFF ARE SIX TIMES HIGHER THAN RATES AMONG THE POOR.

OPPORTUNITIES:• BASED ON PAST EXPERIENCE OF NATIONAL HEALTH POLICY 1983

AND LONG HISTORY OF IMPLEMENTATION OF VARIOUS PROGRAMS, INDIA GET THIS OPPORTUNITY TO MOVE AHEAD IN HEALTH THROUGH HEALTH POLICY 2002

• SUPPORTIVE ENVIRONMENT AND ABSENCE OF OBVIOUS THREAT OF WAR, UNREST ETC.

• POLICY INITIATIVE WILL PROVIDE A NEW IMPETUS TO THE ‘DEVELOPMENT OF THE HEALTH SECTOR’.

• STAFF INVOLVED TO BE AWARE OF NEED FOR APPROPRIATE AND TIMELY INFORMATION TO UNDERSTAND HOW TO USE IT EFFECTIVELY

CONTED…..• PROVISION OF RESEARCH IN RCH AND CONTRACEPTIVE THAT

WILL HANDLE THE INCREASING DEMAND

• INTEGRATED APPROACH INVOLVING MOTHER, ADOLESCENT, AND CHILD IN THE AREA OF NUTRITION, HEALTH, EDUCATION, INVOLVING OTHER SYSTEMS OF MEDICINE ETC.

• DECENTRALIZATION AND MORE AUTONOMY FOR BETTER IMPLEMENTATION

• INDIA HAS THE LARGEST NUMBER OF MEDICAL COLLEGES IN THE WORLD

• INDIA PRODUCES AMONG LARGEST NUMBERS OF DOCTORS IN THE DEVELOPING WORLD

CONTED…..• COUNTRY IS THE FOURTH LARGEST PRODUCER OF DRUGS BY VOLUME

IN THE WORLD AND IS AMONG THE LARGEST EXPORTER OF DRUGS IN THE WORLD.

• “INNOVATION IN HEALTHCARE AND, PARTNERSHIP AMONGST PHARMACEUTICAL COMPANIES (GENERIC AND RESEARCH DRIVEN), GOVERNMENT OF INDIA, NGOS AND OTHER STAKEHOLDERS WILL BE KEY TO THIS CRITICAL ROLE TOWARDS ‘ACCESS TO HEALTHCARE’.

• INNOVATIVE BUSINESS MODELS NEED TO BE EXPLORED TO TACKLE ISSUES WHICH ARE VERY SPECIFIC TO INDIA. THESE COULD BE PPP, SOCIAL ENTREPRENEURSHIP OR PATIENT ASSISTANCE PROGRAMS, ETC. 

CONTED…• RAPIDLY AGEING POPULATION REQUIRES AFFORDABLE,

ACCESSIBLE AND QUALITY PUBLIC HEALTH SERVICES AND INNOVATION WILL KEY ROLE IN MEETING THESE NEEDS.”

CHALLENGES:• HEALTH TOURISM WILL DRAIN THE TRAINED MANPOWER TO PRIVATE

SECTOR AND WILL ENCOURAGE PRIVATIZATION IN ABSENCE OF REGULATION ON PRIVATE SECTOR FOR ENCOURAGEMENT COULD BE DANGEROUS FOR THE PUBLIC HEALTH.

• HOWEVER, POLICY PROPOSES REGULATION OF THE PRIVATE SECTOR BUT HOW AND WHEN IS NOT DESCRIBED IN DETAIL. PRIVATE EXPENDITURE IS ALREADY MORE IN INDIA AS COMPARE TO OTHER COUNTRIES IN THE WORLD.

• THERE IS A MARKED SHORTAGE OF TRAINED NURSES

• NEGATIVE INVOLVEMENT OF RELIGIOUS FUNDAMENTALISTS, FOR EXAMPLE POLIO STERILITY MYTH IMPENDING PULSE POLIO PROGRAM

CONTED….• CREATION OF A CADRE OF ‘HALF BACKED PARAMEDICAL DOCTORS’ IS

STRENGTHENING QUACKERY

• FINANCIAL AUTONOMY OF DISTRICT SOCIETIES MAY LEAD TO CORRUPTION AND NEED TO BE PUT UNDER STRICT OUTER REGULATION AND ACCOUNTABILITY

• CASH INCENTIVE AND HEAVY DEPENDENCY ON HEALTH CARE PROVIDERS IN GOVERNMENT SYSTEM WOULD COMPROMISE THE QUALITY AND INCREASE FINANCIAL BURDEN.

• OCCURRENCE OF UNEXPECTED NATURAL CALAMITIES AND CATASTROPHES

CONTED…..• MORE ENCOURAGEMENT TO PRIVATE SECTOR WILL MAKE THE INDIA THE

MOST PRIVATIZED HEALTH SYSTEM IN THE WORLD

• “INDIA FACES THE TWIN EPIDEMIC OF CONTINUING/EMERGING INFECTIOUS DISEASES AS WELL AS CHRONIC DEGENERATIVE DISEASES

• THE FORMER IS RELATED TO POOR IMPLEMENTATION OF THE PUBLIC HEALTH PROGRAMS, AND THE LATTER TO DEMOGRAPHIC TRANSITION WITH INCREASE IN LIFE EXPECTANCY.

CONTED…..• INDIA FACES HIGH BURDEN OF DISEASE BECAUSE OF LACK OF

ENVIRONMENTAL SANITATION AND SAFE DRINKING WATER, UNDER-NUTRITION, POOR LIVING CONDITIONS, AND LIMITED ACCESS TO PREVENTIVE AND CURATIVE HEALTH SERVICES

• LACK OF EDUCATION, GENDER INEQUALITY AND EXPLOSIVE GROWTH OF POPULATION CONTRIBUTE TO INCREASING BURDEN OF DISEASE.

• EXPENDITURE ON HEALTH BY THE GOVERNMENT CONTINUES TO BE LOW. IT IS NOT VIEWED AS AN INVESTMENT BUT RATHER AS A DEAD LOSS.

• STATES UNDER FINANCIAL CONSTRAINTS CUT EXPENDITURE ON HEALTH.