Manthan Theme: Healing Touch

Towards guaranteeing a better living –Fixing India’s ailing health system

Team Name: AshaKiran

Yeshwanth Reddy

Vishranth Suresh

Keerthana Chilukuri

Chaitra Yarlagadda

Arun Sudarsan

India’s Health Status

Life Expectancy

65.48

MMR

200

CMR

61

AMR

247 – Male; 159 - Female

1:1953

Rural

1:5500

Urban

1:750

Doctor: Population Ratio

8.9

6.2

3.9

6.2

8.5

0

1

2

3

4

5

6

7

8

9

10

Brazil Russia India China South Africa

India spends less on health than

most developing countries

Health Expenditure as a % of GDP

(2011)?

Health, along with Education, is one of the

most important factors that contribute to

upward social mobility. More than 60% of

our population is in the rural

areas, inadequately served by the existing

infrastructure. India’s health is improving

slower than it ought to. We conceptualize

solutions for creating lasting impact.

23,887

PRIMARY HEALTH CENTRE

Radial Distance: 6.42 km

4,809

COMMUNITY HEALTH CENTRE

Radial Distance: 14.33 km

“Nearly 92% of deaths from communicable diseases occur among the poorest 20%”With the State funding only 3.9% of its GDP on

healthcare, the out-of-pocket expenditure has

skyrocketed in the country. As per World Bank

data, in 2011, the average OOP expenditure in

health was a staggering 86%. Brazilians, and

South Africans, for instance, spends only 57.8%

and 13.8% respectively. A significant illness

therefore, will drive Indians to poverty.

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There are only 45,629 MBBS and 22,625 PG

seats in the country. The total number of doctors

is roughly 6,14,439 across India. Rural India is

the least served, with a doctor: population ratio of

1:5500.R

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Access to affordable, quality primary healthcare is

a fundamental right of every citizen. The focus

therefore should be on building the necessary

infrastructure, and supporting it with the adequate

human capital.

GO

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RURAL MEDICAL PRACTICIONERS

CATCH THEM EARLY

• 50 students selected from each district after class

10 to undergo a 2+3 RMP Diploma Course.

• The Course is fully funded and supported by the

Government.

• The RMPs, once they finish the diploma are

required to work in sub-centres and PHCs for a

minimum period of 5 years

• RMPs are then given an option to continue

studies for further 3 years to earn MBBS degree

2PARADIGMATIC SHIFT – EQUIPPING

STUDENTS TO HEAL THEMSELVES

• Introduce a paradigmatic shift in healing

• Students from standard 8 onward are given basic

training on identifying symptoms, and

prescribing basic treatment procedures

• This is intended to serve the dual purpose of

creating awareness among students , and also to

motivate a few of them to take up RMP diploma

course (next part) after class 10

• Self-healing should be the new mantra

1

CONVERTING SCHOOLS:

RED CROSS ON SCHOOL GATES

• There are 1,48,424 sub-centres in India. The

average radial distance is 2.59 kilometers.

• With the RTE mandating the presence of a

school within 1 km.sq, it is possible to convert

1-2 rooms from selected schools to sub-centres

or PHCs.

• Some of the bigger schools’ classrooms will be

converted to PHCs, to reduce the number of

sub-centres affiliated to each PHC

3WHEREVER YOU ARE, THE HOSPITAL

COMES TO YOU

• A mobile ambulance cum sub-centre to be on the

wheels with RMPs and a few equipment like

ECG, X-ray, eye-testing, etc.

• This van will visit 2-3 villages a day, providing

services for free to BPL families, and for a

concessionary fee for APL families.

4

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JANUARY FEBRUARY MARCH

APRIL MAY JUNE

JULY AUGUST SEPTEMBER

OCTOBER NOVEMBER DECEMBER

(1) PREPARE CURRICULUM FOR SCHOOL AWARENESS TRAINING

(2) RMP CURRICULUM – PREPARATION & APPROVAL

(3) BUYING, MODIFYING, AND FINALIZING 1000 MOBILE VANS

(1) TRAINING FOR BIOLOGY TEACHERS FOR AWARENESS PROGRAM

(2) PUBLICITY CAMPAIGN TO ANNOUNCE START OF RMP IN 2015

(3) ROLL OUT OF 1000 MOBILE VANS IN NORTH-EAST & WEST OF INDIA

(2) RESOURCE UPGRADATION IN DISTRICT MEDICAL COLLEGES

(1) FINAL TRAINING FOR BIOLOGY TEACHERS FOR AWARENESS PROGRAM

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RMP PROGRAM

The first batch of RMPs will now enter the 3rd year of their course.

They will be put in the district medical college where they will be trained full time for the next 3 years by retired medical professionals

RED CROSS ON SCHOOLS

• Identify the areas where there are no sub-centres in the vicinity

• Modification/extension of the existing government buildings (schools/panchayatoffices) in such areas

• Development of this infrastructure will begin in South India where the man-power shortage is not as much as in North.

2017-18

Healing thyself

Roll out of school awareness programin 8th standard.

Once in a month practical labs inDistrict Colleges

RMP DIPLOMA

RMP program commences in all thedistricts (at class 11)

Weekly classes by retired professionalsin all districts

MOBILE VANS

Impact evaluation of first 1000 mobilehospitals

Scaling up to 2000

2015-17

Achieving universal coverage in health care : to ensure all people have access to

affordable, preventative, curative and rehabilitative health services

1) Full fledged awareness & self-healing programs

2) Rural Medical Practitioners

The first batch of RMPs, 32 thousand in number, will be ready to be deployed in

rural healthcare centres.

3) More hospitals

Enough number of hospitals would have be constructed by now such that there is

at least one sub-centre at a radial distance of 1.5km

These sub-centres will be manned with the RMPs.

4) Mobile hospitals

By now we will have 5000 mobile hospitals across India that take health care

services to the doorstep

2020 – 5 years after launch

The success of this plan would ensure two things– first, quality health care services to doorsteps of

the needy and second, healthcare awareness and contemporary health care services seeking

behaviour among the underprivileged.

Three phased course structure

Implementation:

1) Aimed to prepare medical assistants at the primary level, students can enrol in this 5 (2+3) year course on completion of the 10th standard.

2)First 2 years to be pursued at the school level, with weekly classes on health awareness and basic principles of diagnosis and the next 3 years to be pursued at the district medical colleges.

3)Students will be trained by retired doctors.

4)Upon completion, the RMPs will be salaried employees who can be promoted as per government norms and permitted to work in Public Health Centres.

Sustainability:

A modest fee can be collected from the middle and upper middle class students who can afford the RMP education to make the model self-sufficient or less loss incurring

Rural Medical Practitioners

(RMPs )

Specialized training to prevent basic health issues

Study of patient history and basic clinical examination

Diagnosis of common ailments ( Malaria / Anaemia / Hookworm /

Diarrhoea )

Primary Services

Concept and Implementation:

1) Mobile hospitals to address the present problems of mobility and accessibility to primary health care

2)Focus on access to villages which are cut off from regular health services

3)Extensive focus on children and women

4) Each mobile healthcare unit to visit 2-3 villages a day on a regular basis

To avail specialised services, a meagre fee can be charged only to the people who come under a high income bracket. However, people from slums and backward tribal areas should be provided absolute free of cost health care.

Mobile Hospitals

X-Ray/ ECG / First Aid

BP Examination

Minor Surgeries

Immunization

Ante-natal / Pre-natal services

Cost Estimates

Implementation risks:

• MBBS doctors might object to the introduction of a new RMP course

• Students might opt not to pursue

• RMP vis-a-vis the MBBS degree

• Funds for setup and maintenance of mobile hospital vans

• As a short-term challenge, infrastructure for the first few batches of RMPs might crop up

• Funds for setup and maintenance of mobile hospital vans

• The manpower required to run the mobile hospitals have to be be identified.

Mitigation factors:

• Differentiating RMPs from doctors by

giving them RMPs an “RMP” suffix

• Spreading awareness of the importance of

health care and the need for medical

assistants among the youth

• Implementing in Public Private Partnership

mode, mostly funded out of Corporate

Social Responsibility funds available with

India’s corporate houses

Monitoring criteria:

• Life expectancy

• Maternal mortality rate

• Infant mortality rate

• Decline in the advent and propagation of communicable diseases

• Diagnosis and recognition of diseases in an earlier stage

References

• NRHM health statistics information portal- https://nrhm-mis.nic.in/

• World Health Organization data

• http://www.censusindia.gov.in/2011-common/census_data_2001.html

• http://blogs.lse.ac.uk/indiaatlse/2012/11/26/maternal-healthcare-expenditure/

• http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

• Gearing up for health care, McKinsey report

• http://www.mobilehealthclinicsnetwork.org/vehicles_medical.html

• FOGSI.org-http://www.fogsi.org/index.php?option=com_content&view=article&id=278&Itemid=232

• http://www.wbhealth.gov.in/notice/let_to_aso.pdf

• http://articles.timesofindia.indiatimes.com/2010-09-01/india/28218508_1_mbbs-student-rural-areas-rural-health-care

• http://www.pwc.in/en_IN/in/assets/.../healthcare_financing_report_print.pdf