HEALING TOUCH – UNIVERSALIZING

ACCESS TO PRIMARY HEALTH CARE

- THE ‘MAC’ WAY

TEAM:

VISION2014 TEAM CO-ORDINATOR: VIPPARTHI SUTHEJ BHARGAV

KUMAR

TEAM MEMBERS:

SHAHANA

P.V.K.MOUNICA

N.ARUN KUMAR

G.VIJAY SOMI REDDY

COLLEGE: ANITS

VISAKHAPATNAM

ANDHRA PRADESH

INTRODUCTION Primary Health Care (PHC) – A system which provides the basic needs of medical care to prevent

further affect of diseases.

(or)

An approach to health beyond the traditional health care system that focuses on equity-producing social policy.

PHC is very essential to build the health of a country. Hence, it should be universalized to make INDIA a healthy nation.

PROBLEM STATEMENT:

The inability of the PHC system in reaching the public can be quoted as the major problem due to which INDIA is lagging far behind other countries in this issue.

The total population of India is 1.27 billion.

The number of villages in India is 6.5 lakh.

The number of PHC centers in India is 23,109.

These figures clearly show that 50% of villages in India don’t have the access to PHC centers.

The ratio of hospital beds to people is 9:10,000.

The main causes for this are:

The money allocated for PHC in the 5 year plans is not being properly utilized.

The plans for PHC launched by the government are not being implemented properly.

As health comes before anything in life and many people in our country don’t have this basic need, the grievances of the public made our ‘VISION2014’ team to select this problem so that we could voice our opinion on behalf of INDIA.

PUBLIC GRIEVANCES A survey conducted by our “VISION2014” team brings out the voice of the public about their need for

PHC as follows:

COMPLAINT: No presence of doctor in the hospital whenever required.

Only one doctor is available for any kind of treatment.

No availability of sanitation and water facility.

COMPLAINT: No sufficient beds in the hospital for patients.

No presence of specialized doctor in cases of emergency.

COMPLAINT: No medicines available in the PHC centers.

Doctor prescribes the same basic medicine for every small

problem.

G.SATYANARAYANA

EX-SARPANCH

LINGAMDORAPALEM

VISAKHAPATTNAM DT.

ANDHRA PRADESH

D.APPA RAO

EX-SARPANCH

GINJARTHI

VISAKHAPATNAM DT.

ANDHRA PRADESH

G.L.V.SATYANARAYANA

CHEDIKADA

VISAKHAPATNAM DT.

ANDHRA PRADESH

PROPOSED SOLUTION The following steps are to be taken to universalize PHC in India:

STEP (1): The problem of PHC can be solved by establishing a ‘MONITORING AND ACTION

CELL (MAC) FOR PHC’ at the central level to uplift the existing PHC centers. This functions in the

following way:

The head for ‘MONITORING AND ACTION CELL FOR PHC’ (MAC) who can be an IAS

officer, is appointed by the Prime Minister.

MONITORING AND

ACTION CELL HEAD

STATE HEALTH

SECRETARY

ADDITIONAL JOINT

COLLECTOR (AJC)

DIVISION

CO-ORDINATOR

PHC WORKERS

C0NTD.... PCs and biometric systems are established at each PHC by the ‘PHC development fund’.

The Monitoring and Action Cell is used to establish net facility to all the PHCs.

Using a well designed software, all the PHCs are connected to the Division level coordinator

AJC state health secretary MAC head.

The patient’s details are entered into the OP form designed in the software. They include

a) photograph of the patient

b) personal details

c) medical problem

d) doctor attended

All the patients coming to the PHCs each day can be noted through web cameras.

Thus, all the work done by the PHCs is regularly monitored by the division level coordinator

from time to time.

The duties of each of the officers appointed at each level are as follows:

PHC WORKERS: Supervise the work of each of the PHC centers which include

a) updating the details of the patient

b) proper maintenance of the PHC center

c) availability of drinking water and other basic facilities

DIVISION CO-ORDINATOR: The duties to be done are

a)supervising the work of PHC centers

b)developmental activities of PHC centers

c)checking the regular presence of doctors

d)conducting medical camps in remote areas where there is no PHC

CONTD…. ADDITIONAL JOINT COLLECTOR: The duties are:

a) monitoring the work at district level

b) proper allocation of funds to PHCs received from the government.

c) proper checking of the web camera videos to avoid malpractices in OP list

STATE HEALTH SECRETARY: The duties are:

a) coordinating the work of all the districts

b) proper running of the PHC state fund

c) division of fund allocated to each district equally

d) development of PHC centers

MONITORING AND ACTION CELL HEAD : The duties are:

a) coordinating the work of the PHCs of each state

b) proper usage of the fund allocated for PHC

c) uplifting the under developed states in case of PHC

d) supply of quality medicines to the state PHC centers

When all the above mentioned functions are properly implemented, then the existing PHCs will

develop to a stage where public requirements will be satisfied.

STEP (2):

To ensure the presence of the doctor in the hospital, the biometric attendance method can be

used, in which the doctors need to mark their presence at least for every 2 hours, which will be

automatically uploaded in the PHC website.

Medical camps should be conducted at least once in a month. Doctors should visit the villages

once in two weeks to bridge the gap between public and the government PHC centers. This helps

in reducing the private sector intervention which must be limited only to a certain extent.

CONTD….. Specialized doctors should be in a rotation process from one PHC to another, so that all the

people get benefited.

A help line number should be established, which gives about the information about the

availability of the high level surgeries and treatments, as most of the public don’t know about it.

A water plant which can serve the public for every 15,000 capacity.

STEP (3): Passing of the HEALTH BILL which will include the following points in major view:

Increase in the number of PHC centers in the country.

Rural and remote areas to be mainly concentrated.

Establishment of water plants in every village to provide safe drinking water facility.

Vaccinations against dangerous diseases and availability of all basic medicines.

To prevent the spread of contagious diseases at the basic level.

All drug companies should provide medicines to the PHCs at a subsidized rate of 10%.

Organization of the Monitoring and Action Cell (MAC) for PHC.

MERITS OF THE PROPOSED SOLUTION:

The proposed plan of 3 steps is better than the existing system because:

The cc camera facility in PHC centers will help in keeping every point crystal clear in view of

the government.

Online updating of the details of the patients helps to keep an eye on the functioning of the PHC.

Organizing of medical camps and other programs creates belief in the people on the government

plan and hence private intervention for profit issue can be reduced.

Rotation process of doctors helps the public to get accurate treatment for their problems.

Passing of the HEALTH BILL will lead to many positive results which include the safe drinking

water facility, vaccinations, subsidized medicines etc.

BUDGET DETAILS

BUDGET FOR STEP1: It includes appointment of officers at various levels, maintenance costs and

provision of internet facilities. The only newly appointed officer is division level officer.

Total number of districts in India = 671

Assume 3 divisions for 1 district, then total no. of divisions = 671*3=2013

Salary for each division level officer = Rs.1,80,000 per annum (Rs.15,000 per month)

Amount spent for salaries of all division level officers = 2013*Rs.1,80,000=Rs.36,23,40,000

Maintenance of each division level office =Rs.12,000 per annum.

Maintenance of all division level offices = 12,000*2013= Rs.2,41,56,000

Internet cost = Rs.2400 per annum (Rs.200 per month)

Internet cost for all PHCs and district level offices= (23,109+671)*2400 = Rs.6,02,92,800

Step 1

Salary for division level

officers= Rs.36,23,40,000

Maintenance of all offices

= Rs.2,41,56,000 Internet cost =

Rs.6,02,92,800

Total amount spent for

step1 = Rs.44,67,88,800

CONTD….

BUDGET FOR STEP 2: It includes rotation of doctors b/w PHCs, help line center, establishment of

drinking water facility, biometric availability, medical camps etc.

PCs and biometric devices through PHC development fund(being issued) = Rs.18,000

Medical camps cost also taken from PHC development fund(being issued by govt. to every PHC)

Rotation of doctors charge for 1 visit = Rs.260 (Rs.200 for travel on avg. + Rs.60 for food)

If 2 visits occur in week, then 104 visits per annum cost = Rs.260*104*23,109= Rs.62,48,67,360

Maintenance of 1 help line center for 1 state = Rs.1,80,000 per annum (Rs.15,000 per month)

Maintenance of 28 help line centers = 28*1,80,000= Rs.50,40,000

Water plant cost:

Total Indian population = 139 crore

1 plant for a population of 15,000 requires 92,667 plants on average each costing Rs.5lakh

By providing loans to educated unemployed in India for Rs.5 lakh at an interest of Rs.0.25 per

month, the interest per month would be Rs.1250.

In a span of 20 years, by paying an amount of Rs.2187.5 per month, the loan can be cleared.

Selling water at a cost of Rs.7 per 25lt. (maintenance Rs.2+ bank Rs.2 +owner Rs.2+travelling Re.1)

Needs 1094 bottles (approx.) to be sold in one month, which is no big deal in a population of 15,000.

In this way, unemployment and water problem both can be eliminated.

CONTD….

Total amount spent = step1 total + step 2 total = Rs.44,67,88,800 + Rs.62,99,07,360

= Rs.107,66,96,160 + Rs.10,00,00,000(other expense)

TOTAL BUDJET = Rs.117,66,96,160

This amount can be obtained by taking 50% of the money used for advertising the policies launched by the government.

Step 2

Rotation of doctors=

Rs.62,48,67,360

Help line center cost=

Rs.50,40,000

Total amount =

Rs.62,99,07,360

CHALLENGES AND MITIGATION

FACTORS

The MAC solution proposed may face the following challenges:

ECONOMIC: The cost of the plan is a be a high due to use of PCs , web cameras etc. The travel cost incurred due to rotation of doctors, conducting medical camps is also high.

This can be overcome by reducing the cost spent on advertising the inappropriately implemented policies of the government, which is around Rs.250 crores. If 50% of this amount is allotted to MAC plan, the problem will be solved.

TECHNOLOGICAL: Use of biometric devices will need more attention during usage as the device may damage due to improper handling.

This can be overcome by training all the PHC center workers about the proper usage of the devices. Regular verification of the device functioning will also help to overcome this problem.

POLITICAL: The money allocated for the MAC plan may be misused.

In order to end this corruption an IAS officer should be appointed to check the proper allocation of money.

SOCIAL: The doctors feel it difficult for the rotation process in PHC centers and they get stressed due to movement from one village to another.

This can be avoided by granting a holiday once in a week for each doctor. Due to rotation process, no PHC center will be left without a doctor.

By overcoming these challenges in an appropriate way, if the MAC solution is implemented strictly, then we can achieve universal primary health care in India very soon.

IMPACT OF THE SOLUTION

The MAC solution implemented will have the following positive results:

Provision of safe drinking water facility.

Remote areas will get proper medical attention through medical camps and welfare programs.

Diseases can be eliminated at the basic level.

Specialized doctors will be available to the public once in a while through rotation process.

Medicines will be available to the public at a subsidized cost through Health bill.

The assessment of the impact of MAC plan can be done and observed from the OP list designed on

the web. The reduction in the repetition of the patients and mortality rates will ensure the proper

functioning of the MAC. This will help in building a ‘HEALTHY INDIA’.

APPENDIX

1 National Sample Survey Organisation, Ministry of Statistics and Programme Implementation

(Government of India). 2006. Morbidity, health care and the condition of the aged. Report No.

507, NSS 60th round(January-June 2004). New Delhi: NSSO.

http://mospi.nic.in/rept%20_%20pubn/507_final.pdf (accessed April18, 2013).

Planning Commission (Government of India). 2013. Twelfth Five Year Plan (2012–2017): Social

Sectors, Vol.3. New Delhi: Planning Commission, p. 3.

http://planningcommission.gov.in/plans/planrel/12thplan/pdf/vol_3.pdf (accessed April 18,

2013).

4 National Sample Survey Organisation 2006, op.cit. For example, a recent study on one of the

first insurance schemes initiated in the state of Andhra Pradesh indicates that it consumed 25% of

the state’s health budget, but addressed only an estimated 2% of the burden of disease. See:

Purnendra Prasad, N. and Raghavendra, P. 2012. Healthcare models in the era of medical neo-

liberalism: A study of Aarogyasri in Andhra Pradesh, Economic and Political Weekly XLVII

Survey conducted by our team “VISION2014” in the district of Visakhapatnam.