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PRESENTATION TO THE
HONOURABLE MINISTER
FOR
HEALTH & FAMILY WELFARE GOVERNMENT OF INDIA
WORLD
50 66
17 19
17 21
13 16
12 13
66
47
95
96
99
98
99
97
98
99
LOW PRIORITY TO PUBLIC SPENDING ON HEALTH INDIA AND COMPARATOR COUNTRIES 2009
Total public spending as % GDP (fiscal capacity) Public spending on health as % of total public spending Public spending on health as % of GDP
Thailand
23.3
14.0
3.3
Source: WHO database (2009)
Change in poverty (USD 1.08 per day) head count ratio by out of pocket payments in 11 countries in Asia
2030
(in Millions)
Diabetes
Hypertension Tobacco Deaths PPYLL Due to CVD Deaths (35-64 Yrs)
61
130 1+ 9.2
101
240 2+ 17.9
Kerala
: 13/1000
Over 35% of hospitalised persons fall below the poverty line because of hospital expenses
Over 2.2% of the population may be impoverished because of hospital expenses The majority of the citizens who did not access the health system were from the lowest income quintiles
NSSO (2006)
HEALTH SERVICES : URBAN RURAL DISPARITY 80% of Doctors 75% of Dispensaries 60% of Hospitals Qualified Physicians:
Ensure equitable access for all Indian citizens resident in any part of
the country, regardless of income level, social status, gender, caste or religion, to health services (promotive, preventive, curative, and rehabilitative) that are affordable, appropriate and of assured quality.
Definition
Ensuring equitable access for all Indian citizens resident in any part of the country, regardless of income level, social status, gender, caste or religion, to affordable, accountable and appropriate, assured quality health services (promotive, preventive, curative and rehabilitative) as well as public health services addressing wider determinants of health delivered to individuals and populations, with the government being the guarantor and enabler, although not necessarily the only provider, of health and related services.
Guiding Principles
Universality; Equity; Non-exclusion and non-discrimination; Comprehensive care that is rational & of good quality; Financial protection; Protection of patients rights that guarantees appropriateness of care, patient choice, portability & continuity of care; Consolidated & strengthened public health provisioning; Accountability & transparency; and Community participation
Our Vision
Universal Health Entitlement for every citizen - to a National Health Package (NHP) of essential primary, secondary & tertiary health care services that will funded by the government.
Package to be defined periodically by an Expert Group; can have state specific variations
Even on assuming total spending on health remains at the current level of around 4.5% of GDP, there will be a sharp decline in the proportion of private out-of-pocket spending on health - from 67% today to 33% by 2022
User Fees for health care were put forward as a way to recover costs and discourage the excessive use of health services and the over-consumption of care. This did not happen. Instead, user fees punished the poor.
-Dr. Margaret Chan, Director-General, WHO (2009)
Among the quick win strategies recommended by the Millennium Project was the removal of user fees for primary education and essential healthcare by the end of 2006.
- Dr. Jeffrey Sachs (2005)
NO USER FEE
NON-NHP SERVICES
NO USER FEE
NON-NHP SERVICES
ADDITIONAL SERVICES FOR THE
POOR
BREADTH
DEPTH
QUALITY
ACCOUNTABILITY
EQUITY
Regulate and Monitor Contract Private Providers For Quality, (As Per Need And Availability) Cost And With Defined Deliverables Health 0, 20, 30 Care Integrate 1 Through Networks of Providers Outcomes
(Public; Private; Public-Private)
Prompt payments
Registry
Transform existing Village Health Committees (or Health and Sanitation Committees) into participatory Health Councils; Organize regular Health Assemblies; Enhance the role of elected representatives as well as Panchayati Raj institutions (in rural areas) and local bodies (in urban areas); Strengthen the role of civil society and nongovernmental organizations. Institute a formal grievance redressal mechanism at the block level.
POLICY APPROACHES
WIDER SOCIETY
Media
Community Interventions
Settings Based
HEALTH COMMUNICATION
Systems Infrastructure
Access to Care
Quality of Care
INDIVIDUAL
DETERMINANTS
HLEG Recommends.
Creation of National Health Promotion and Protection Trust To Enable : - Effective Health Communication, Dissemination and Information Sharing - UHC Related Education to People , Patients, Providers - Health Impact Assessment of Policies and Programs in Other Sectors (to facilitate convergent action on the Social Determinants of Health)
- Collaboration with International Partners to draw upon Best Practices, Policies, and Lessons from the Global Context