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UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRA
Sub-Centers &
Primary
Health Centre
Community
Health Centre
District
Hospital
Medical
College
Private
Clinics /
Hospital
Homeopathic
System of Medicine
Ayurveda System and
other indigenous system
Quacks
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRA
UNIVERSAL HEALTH COVERAGE
•
ESSENTIAL QUALITY HEALTH CARE PROTECTS
COUNTRIES FROM
EPIDEMICS
REDUCES POVERTY
REDUCES RISK OF HUNGER
CREATE JOBS
ENHANCE ECONOMIC GROWTH
GENDER EQUALITY
•
DEATH
FINANCIAL
HARDSHIPS
BUYING
FOOD
BUYING
MEDICINE
NO ONE
HAS TO
CHOOSE
NO ONE
HAS TO
CHOOSE
•
If we are to meet SDG
target 3.8 on achieving
universal health
coverage by 2030.
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRA
DOCTORS AT PHC SPECIALIST
DOCTORS
NURSES AT PHC /
CHC
25354
22040
78530
18900
4192
69022
PRESENT HEALTH SITUATION IN RURAL INDIA
REQUIRED IN POSITION
Rural health Statistics, 2015
TRENDS IN ACCESS TO MEDICINES IN INDIA – 1986 – 87 to 2004
Period Free Medicines
(%)
Partly Free
(%)
On payment
(%)
Not received
(%)
In Patient
1986 – 87 31.20 15.00 40.95 12.85
1995 - 96 12.29 13.15 67.75 6.80
2004 8.99 16.38 71.79 2.84
Out patient
1986 17.98 4.36 65.55 12.11
1995 – 96 7.21 2.71 79.32 10.76
2004 5.34 3.38 65.27 26.01
National Sample Survey, Round 60
Country Doctors per 10000
population
Beds per 10000
population
Nurses and
Midwives per
10,000
populations
India 7.0 (10) 9.0 (20) 17.1
Bangladesh 3.6 3.0 2.2
Sri Lanka 6.8 29.0 16.4
Thailand 3.9 18.0 20.8
Myanmar 6.1 6.0 10.0
World Health Statistics, WHO 2007 - 13
73.90% 26.10%
Doctors Distribution
Urban Rural
National Health Mission
Present Status
Doctors per 10,000
population
(Practicing Doctors)
Total doctors in
India (for
130,000,00,00
Population)
Total
demand
(1/1000
population)
Deficiency Present
Growth Rate
04 / 10,000
population
5,20,000 130,00,00 7,80,000 1.2
Way to 2030 Present Status Total doctors by
2030
Deficiency
estimated by
2030
Expected
Population in
2030
Doctors
needed by
2030
150,000,00,00 150,00,00 30,000
(out of 60,000 students
produced every year 50%
will be Practicing)
8,80,000
(5,20,000 + 3,60,000)
6,20,000
To achieve Universal Health Coverage there is
need to produce more (6,20,000) doctors
0
5000
10000
15000
20000
25000
RURAL URBAN OVERALL
14935
24436
18268
MEDICAL EXPENDITURE (IN Rs)
RURAL URBAN OVERALL NSSO 2014
OUT OF POCKET
EXPENDITURE
• 17.3 % Indians spend more than 10% of their
income for treatment and
• 3.9 % spend more than 25 % of their annual
income on treatment TRACKING UHC GLOBAL
MONITORING REPORT,2017
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
PRESENT SCENARIO TARGET FOR 2025 (NHP) WHO
RECOMMENDATIONS
1.15%
2.50%
5.00%
GDP EXPENDITURE ON HEALTH IN INDIA
PRESENT SCENARIO TARGET FOR 2025 (NHP) WHO RECOMMENDATIONS
SUPER SPECIALITY DOCTORS PRODUCED
EVERY YEAR
NEW CARDIAC CASES
EVERY YEAR
DM CARDIOLOGY 334 4.75 LAKH ANGIOPLASTY
/ YEAR
2.0 LAKH
CABG/YEARMCh CARDIO THORACIC
SURGERY
108
NATIONAL INTERVENTIONAL COUNCIL, 2015
10% – 25 %
ANNUAL INCREASE
COMPONENTS
OF
PRIMARY
HEALTH CARE
AVAILABILITY
ACCEPTIBILITY
AFFORDIBILITY
ACCOUNTABILITY
QUALITY
MOTIVATION
MISSING
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRA
PRIORITIZE
•
•
EXPAND COVERAGE FOR EVERY ONE
•
•
INCLUDING POOREST OF THE
POOR
•
•
POLITICAL
WILL
RESOURCES
FUTURISTIC
PLANNING &
EFFECTIVE
IMPLEMENTATION
HEALTH CESS
AYUSHMAN BHARAT
SWASTHA NAGRIK ABHIYAN
• Introduction of 1% Health
Cess in income tax from 2018
- 19
AYUSHMAN BHARAT
• In the union health budget 2018 – 19,
• Finance Minister of India launched “Ayushman Bharat” which include:
• Rs 5 lakh insurance cover to 10 Crore poor families
• 1 government medical college in three parliamentary constituencies
• 1200 crore for Ayushman Bharat program
• 1.5 lakh health wellness centers to be allocated in India
•
10 crore poor vulnerable families
approximately 50 crore beneficiaries
Rs 5 lakh per
family per year
The Swachh Bharat Abhiyan
Balanced, healthy diets and regular
exercises.
Addressing tobacco, alcohol and substance
abuse
SWASTHYA NAGRIK ABHIYAAN
Yatri Suraksha – preventing deaths due to rail and
road traffic accidents
Nirbhaya Nari –action against gender violence
Reduced stress and improved safety in the work
place
Reducing indoor and outdoor air pollution
SWASTHYA NAGRIK ABHIYAAN
Bhartiya Jan Aushadhi Pariyojna
Make in India
A price cap on stents
PMSSY
Union budget 2018
•
3348 stores in
India
•
The price of drug eluting stents revised downwards to just under Rs 28,000
The cap on bare metal stents raised from Rs 7,400 to Rs 7,660
The trade margin allowed on stents maintained at 8%
Revised price caps will remain in effect till March 31, 2019.
6 institutions like AIIMS
All existing AIIMS have functional
Medical & Nursing Colleges
Upgradation of 39 Medical Colleges /
Institutions
• Health
and Wellness Centres
• comprehensive care
1 new government medical
college for every 3
parliamentary districts
•
Rs 500 per month all TB
patients
The disease mainly affects
the poor and malnourished
PROVISION OF TERTIARY CARE SERVICES
POWER HOUSE OF MEDICAL PROFESSIONALS (MBBS AND MD
DOCTORS)
CAPACITY BUILDING OF PARA MEDICAL STAFF
MEDICAL RESEARCH
IMPLEMENTATION, MONITORING AND EVALUATION OF
NATIONAL HEALTH PROGRAMMES
POLICY ADVOCACY FOR CHANGES IN THE PROGRAM
STANDARD OPERATING PROCEDURE (SOP’S)
QUALITY ASSURANCE
A WAY TO FUTURE ESSENTIAL INNOVATIONS…
INCREASE NUMBER OF SPECIALIST AND SUPER
SPECIALIST COURSES
BIANNUAL ADMISSION TO PG SEATS
MBBS SEATS TO BE DIRECTLY CONVERTED TO
SPECIALIST SEATS
A WAY TO FUTURE ESSENTIAL INNOVATIONS…
Double shift of existing medical colleges
Public private partnerships
Telemedicine
Virtual medical university
I wish that I would become a medical student
and learn again with this technology. This is
my dream. Ultimately this is going to benefit
the people at large, because with this, you
will be able to produce good doctors and
good doctors ultimately will do a good job
for the people.
VIRTUAL MEDICAL UNIVERSITY:
MEDRC
VIRTUAL MEDICAL UNIVERSITY:
MEDRC
The idea is so great that it can break the
boundaries of one medical college, it
can break the boundaries of a state as
well as of a region and the medical
students all across the nation can see
the best faculty.
•
•
“If we don’t create the future, the
present extends itself”
- Toni Morrison (Song of Solomon)
Dhara bech denge, gagan bech denge…
Nadi naale parvat chaman bech denge…
Seva ke masiha agar tum na samjhe…
To satta ke masiha vatan bech denge…
UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRA

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UNIVERSAL HEALTH COVERAGE IN INDIA-PATH AHEAD -DR HARIVANSH CHOPRA

  • 2. Sub-Centers & Primary Health Centre Community Health Centre District Hospital Medical College Private Clinics / Hospital Homeopathic System of Medicine Ayurveda System and other indigenous system Quacks
  • 5. ESSENTIAL QUALITY HEALTH CARE PROTECTS COUNTRIES FROM EPIDEMICS REDUCES POVERTY REDUCES RISK OF HUNGER
  • 6. CREATE JOBS ENHANCE ECONOMIC GROWTH GENDER EQUALITY
  • 8. • If we are to meet SDG target 3.8 on achieving universal health coverage by 2030.
  • 10. DOCTORS AT PHC SPECIALIST DOCTORS NURSES AT PHC / CHC 25354 22040 78530 18900 4192 69022 PRESENT HEALTH SITUATION IN RURAL INDIA REQUIRED IN POSITION Rural health Statistics, 2015
  • 11. TRENDS IN ACCESS TO MEDICINES IN INDIA – 1986 – 87 to 2004 Period Free Medicines (%) Partly Free (%) On payment (%) Not received (%) In Patient 1986 – 87 31.20 15.00 40.95 12.85 1995 - 96 12.29 13.15 67.75 6.80 2004 8.99 16.38 71.79 2.84 Out patient 1986 17.98 4.36 65.55 12.11 1995 – 96 7.21 2.71 79.32 10.76 2004 5.34 3.38 65.27 26.01 National Sample Survey, Round 60
  • 12. Country Doctors per 10000 population Beds per 10000 population Nurses and Midwives per 10,000 populations India 7.0 (10) 9.0 (20) 17.1 Bangladesh 3.6 3.0 2.2 Sri Lanka 6.8 29.0 16.4 Thailand 3.9 18.0 20.8 Myanmar 6.1 6.0 10.0 World Health Statistics, WHO 2007 - 13
  • 13. 73.90% 26.10% Doctors Distribution Urban Rural National Health Mission
  • 14. Present Status Doctors per 10,000 population (Practicing Doctors) Total doctors in India (for 130,000,00,00 Population) Total demand (1/1000 population) Deficiency Present Growth Rate 04 / 10,000 population 5,20,000 130,00,00 7,80,000 1.2
  • 15. Way to 2030 Present Status Total doctors by 2030 Deficiency estimated by 2030 Expected Population in 2030 Doctors needed by 2030 150,000,00,00 150,00,00 30,000 (out of 60,000 students produced every year 50% will be Practicing) 8,80,000 (5,20,000 + 3,60,000) 6,20,000 To achieve Universal Health Coverage there is need to produce more (6,20,000) doctors
  • 16. 0 5000 10000 15000 20000 25000 RURAL URBAN OVERALL 14935 24436 18268 MEDICAL EXPENDITURE (IN Rs) RURAL URBAN OVERALL NSSO 2014
  • 17. OUT OF POCKET EXPENDITURE • 17.3 % Indians spend more than 10% of their income for treatment and • 3.9 % spend more than 25 % of their annual income on treatment TRACKING UHC GLOBAL MONITORING REPORT,2017
  • 18. 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% PRESENT SCENARIO TARGET FOR 2025 (NHP) WHO RECOMMENDATIONS 1.15% 2.50% 5.00% GDP EXPENDITURE ON HEALTH IN INDIA PRESENT SCENARIO TARGET FOR 2025 (NHP) WHO RECOMMENDATIONS
  • 19. SUPER SPECIALITY DOCTORS PRODUCED EVERY YEAR NEW CARDIAC CASES EVERY YEAR DM CARDIOLOGY 334 4.75 LAKH ANGIOPLASTY / YEAR 2.0 LAKH CABG/YEARMCh CARDIO THORACIC SURGERY 108 NATIONAL INTERVENTIONAL COUNCIL, 2015 10% – 25 % ANNUAL INCREASE
  • 23. EXPAND COVERAGE FOR EVERY ONE • •
  • 24. INCLUDING POOREST OF THE POOR • •
  • 27. • Introduction of 1% Health Cess in income tax from 2018 - 19
  • 28. AYUSHMAN BHARAT • In the union health budget 2018 – 19, • Finance Minister of India launched “Ayushman Bharat” which include: • Rs 5 lakh insurance cover to 10 Crore poor families • 1 government medical college in three parliamentary constituencies • 1200 crore for Ayushman Bharat program • 1.5 lakh health wellness centers to be allocated in India
  • 29. • 10 crore poor vulnerable families approximately 50 crore beneficiaries Rs 5 lakh per family per year
  • 30. The Swachh Bharat Abhiyan Balanced, healthy diets and regular exercises. Addressing tobacco, alcohol and substance abuse SWASTHYA NAGRIK ABHIYAAN
  • 31. Yatri Suraksha – preventing deaths due to rail and road traffic accidents Nirbhaya Nari –action against gender violence Reduced stress and improved safety in the work place Reducing indoor and outdoor air pollution SWASTHYA NAGRIK ABHIYAAN
  • 32. Bhartiya Jan Aushadhi Pariyojna Make in India A price cap on stents PMSSY Union budget 2018
  • 34.
  • 35. The price of drug eluting stents revised downwards to just under Rs 28,000 The cap on bare metal stents raised from Rs 7,400 to Rs 7,660 The trade margin allowed on stents maintained at 8% Revised price caps will remain in effect till March 31, 2019.
  • 36. 6 institutions like AIIMS All existing AIIMS have functional Medical & Nursing Colleges Upgradation of 39 Medical Colleges / Institutions
  • 37. • Health and Wellness Centres • comprehensive care
  • 38. 1 new government medical college for every 3 parliamentary districts
  • 39. • Rs 500 per month all TB patients The disease mainly affects the poor and malnourished
  • 40. PROVISION OF TERTIARY CARE SERVICES POWER HOUSE OF MEDICAL PROFESSIONALS (MBBS AND MD DOCTORS) CAPACITY BUILDING OF PARA MEDICAL STAFF MEDICAL RESEARCH
  • 41. IMPLEMENTATION, MONITORING AND EVALUATION OF NATIONAL HEALTH PROGRAMMES POLICY ADVOCACY FOR CHANGES IN THE PROGRAM STANDARD OPERATING PROCEDURE (SOP’S) QUALITY ASSURANCE
  • 42. A WAY TO FUTURE ESSENTIAL INNOVATIONS… INCREASE NUMBER OF SPECIALIST AND SUPER SPECIALIST COURSES BIANNUAL ADMISSION TO PG SEATS MBBS SEATS TO BE DIRECTLY CONVERTED TO SPECIALIST SEATS
  • 43. A WAY TO FUTURE ESSENTIAL INNOVATIONS… Double shift of existing medical colleges Public private partnerships Telemedicine Virtual medical university
  • 44. I wish that I would become a medical student and learn again with this technology. This is my dream. Ultimately this is going to benefit the people at large, because with this, you will be able to produce good doctors and good doctors ultimately will do a good job for the people. VIRTUAL MEDICAL UNIVERSITY: MEDRC
  • 45. VIRTUAL MEDICAL UNIVERSITY: MEDRC The idea is so great that it can break the boundaries of one medical college, it can break the boundaries of a state as well as of a region and the medical students all across the nation can see the best faculty.
  • 46.
  • 47.
  • 48. “If we don’t create the future, the present extends itself” - Toni Morrison (Song of Solomon)
  • 49. Dhara bech denge, gagan bech denge… Nadi naale parvat chaman bech denge… Seva ke masiha agar tum na samjhe… To satta ke masiha vatan bech denge…