Indias Primary Health Care Needs Quick Reform. Image Arko Datta Reuters. To what extent can the government absorb health care costs The answer lies in first addressing the basics. If the vast majority of patients are taken care of at the primary level, it will take the stress off insurance schemes, making them more viable. Early last year, Prime Minister Manmohan Singh announced the government would work towards providing Universal Health Coverage UHC for all. As intents go, it is as noble as it gets. This, because the operative word here is universal. Much like the Indian Constitution promises every citizen justice, liberty, equality and fraternity, the PM proposed health care be added, as a fundamental right, whether youre above the poverty line or below it. Soon after the announcement, at a high level ministerial meeting in Delhi almost every minister pledged to work together. Author, blogger, software engineer and serial entrepreneur. Contributor to some of the biggest media platforms including Forbes, Entrepreneur Magazine. Google Inc. is an American multinational technology company that specializes in Internetrelated services and products. These include online advertising technologies. In the months that followed, two ambitious programmes were announced National Urban Health Mission NUHM and Free Essential Medicines. When implemented, it would cost the country Rs 2. Rs 2. 8,5. 60 crore, respectively. But the agreement had irony written all over it. On December 2. 7 last year, representatives of various states fought fiercely over how the proposed food security bill ought to be financed. But when it came to the UHC, there seemed near consensus. For various reasons though, the idea didnt take off. Watch Parts Per Billion Online Forbes' title='Watch Parts Per Billion Online Forbes' />As things stand now, funding for the National Urban Health Mission and Free Essential Medicines have been deferred. Finance Minister P Chidambarams latest proposals mention one of them in passing. Its a bit of a disaster with two years of the Plan over, theres not much one can do towards the UHC in the remaining three years, says AK Shiva Kumar, a welfare economist from Harvard and convener of Kolkata Group, and advisor to the Sonia Gandhi led National Advisory Council NAC on universal health financing. BibMe Free Bibliography Citation Maker MLA, APA, Chicago, Harvard. Introduction The Indian textile industry is one of the largest industries in the world. The Ministry of Textiles in India has formulated numerous policies and schemes. Find the latest business news on Wall Street, jobs and the economy, the housing market, personal finance and money investments and much more on ABC News. Bureaucrats in Delhi are ambivalent too. While slow economic growth may come across as a plausible reason, truth is, nobody seems to be in charge. As for the states, while providing health care is their responsibility, by all indications, they arent prepared. Which state has projected its requirements for the medium term or has prepared any plan There may be many states that dont even know about the UHC, says M Govind Rao, director of the National Institute of Public Finance and Policy and a member of the 1. Finance Commission. Instead, he discovered, states are using money from the Centre to cut spending on health care, instead of using these funds to augment it. On its part, the Central government has always acted unilaterally and rarely consulted states on national health schemes, points out Priya Balasubramaniam, study director of the UHC. The Rural Health Mission, for instance, was delivered in a top down manner. Caught in this crossfire are initiatives that could drift so far apart that pulling all of them back into a single frameworkthe UHCwill be a challenge. R8E2m3Bg4/0.jpg' alt='Watch Parts Per Billion Online Forbes' title='Watch Parts Per Billion Online Forbes' />Making matters worse is that there is little evidence to indicate that political or administrative will exists to integrate essential primary, general secondary and specialised tertiary health care services under one umbrella. Who bells the catPrathap Reddy, chairman, Apollo Group of Hospitals, has a question. To what extent can the government absorb health care costs The answer, he says, lies in first addressing the basics, or primary health care PHC. Clean drinking water alone can help eliminate gastric ailments that afflict 2. See package Why We Need to Challenge Old Thinking on page 7. Pll Season 5 Streaming. The problem here isnt a lack of funds. In fact, nearly three fourths of the countrys health budget goes into addressing PHC through the National Rural Health Mission NRHM. The country spent close to Rs 2. Where it has been used wisely, things have worked. Take Bihar. Infant mortality rates there used to be among the highest in the country. Today, it is on par with the national average. This mission has shown what a little boost to public health spending can do, says Amarjeet Sinha, former health secretary, Bihar. But if you leave out states like Bihar, Assam and Rajasthan, most of the others are a black hole. In a first ever estimate on the quality of primary care in the country, World Bank economist Jishnu Das and his colleagues studied rural Madhya Pradesh and urban Delhi. In 6. 3 percent of the cases they looked at, treatment provided in public clinics was provided by insufficiently trained personnel. To drive the point home, Dr Naresh Trehan, chairman and managing director of Medanta, points to the Accredited Social Health Activists ASHA, or community health workers in the country. There are 8. 00,0. But theyre trained badly. We need to ask how can we upskill themHow can we make them our frontline workers who identify early signs of a diseaseImage Gireesh G V for Forbes India. THE MISSING Rural hospitals and primary health centres often have no doctors to man them or medicines to distribute. Similarly, theres a huge shortage of well trained community health workers in the country. To achieve that, PHC delivery needs to reinvent itself. There are creative solutions on offer. Gautam Sen, chairman of Healthspring, a general practice GP chain in Mumbai, has proven that in Radhanagari, Maharashtra. Kill For Me Full Movie. With financial assistance from Hindalco, Dr Sen runs a primary care centre that caters to 1. Rs 1. 2 lakh each year. He trains his own staff. As against this, the Central government spends on average Rs 3 crore to run a single centre in most states. In Radhanagari, Dr Sen says, the government has everything going Two rural hospitals and seven primary centres. But these centres have no doctors to man them or medicines to distribute. Unsurprisingly, villagers have given Dr Sen 1. Nachiket Mor, a former ICICI bank veteran and now a member of the expert group on health care, believes these are the kind of gate keepers every state needs. That, he believes, will ensure 9. In turn, this will take the stress off insurance schemes, make them viable, and offer them the latitude to focus on high cost tertiary care. Misplaced priorities. How many people know of the Rashtriya Swasthya Bima Yojana RSBY  The programme has enrolled 1. Many state governments have started their own insurance schemes named Arogyasri prefacing it with Rajiv or Vajpayee, depending upon their political party, Kalaingar, Cheeranjeevi and whatever else in their reckoning will go down well. These schemes are meant to pay for high end hospitalisation, easy to execute and cultivate vote banks. But heres the problem The insurance claim ratio is said to be rising at 3. But then, so are the costs. In the RSBY, average claims have moved up from Rs 7. Rs 1,1. 00 to Rs 1,2. Ironically again, the money isnt going into improving health care, but in purchasing it. In Andhra Pradesh, where Arogyasri originated and covers 8. Dr GN Rao, founder chairman of LV Prasad Eye Institute in Hyderabad. Infographic Sameer PawarMany government funded schemes are well intentioned in terms of providing secondary and tertiary care, says Dr Srinath Reddy, chairman of the expert group. However, these schemes do not provide continuity of care because they neglect primary care. If that happens, both Dr Reddy and Nachiket Mor fear schemes like these will induce demand for more expensive health care services, consume larger portions of the budget, and eventually drive health insurance premiums through the roof. This is the problem the US is grappling with. That is not to say insurance and a UHC plan are mutually exclusive. Before demitting office in February, Insurance Regulatory and Development Authority IRDA chairman Hari Narayan strongly advocated expanding RSBY across the country to include people above the poverty line as well. But if you do that, argues Mor, policy makers will have to integrate primary health care and secondary health care.