kssp19sep10

KSSP discussion paper

Biju Soman

Human resources challenges in Kerala

Thiruvananthapuram, 19 Sep 2010

Public health challenge

• Overall well-being of the society– public health is the art and

science of achieving this

• Healthcare delivery system– Is a means not the end…– Unparallel increase in costs

Healthcare spending grows much higher

19 Sep 2010 2KSSP HEALTH COMMISSION

Owe Reinhardt, Princeton University, 2009

healthcare cost

• Raising costs– Medical & hospitality services– Equity concerns (elderly)

• Technology adds– Costly diagnostics & treatments

• Multiple players– Lack of coordination (US model)

• No incentives – To reduce costs! Burden is more for the poor


*Bodenheimer T. New Engl J Med 358:10 2008; KSSP Study; 2005-06

SES % family income

4 31.7

3 18.1

2 13.0

1 10.4

Technology can bring down cost

• e-Health initiatives– EMR & EHR for better documentation– e-Reference– Digital X-rays (Narayana Hrudayalaya)– e-kiosks in rural areas (Aravind Eye hospital)– Universal Spectacles (VisionSpring)– Teamlet model– e-consultations– HIMS models

Easy to adjust refractory power


Bhattacharyya et al. Health Research Policy and Systems 8:24. 2010

Healthcare gets attention

• More inputs from GoI

• the saga of NRHM

• Uptake in Health Insurance

• RSBY (CHIS)

• Corporate and Private health establishments

• But…

PHC Punnayur


Becomes costlier

• Disruptive Financing – Quantity of contacts/procedures

• Crisis in health insurance – Overbilling, moral hazards– Payout Ratio more (70%)

• No incentives to bring down costs– Why should we?


future Managed care initiatives

An organization assumes responsibility for all necessary health care for an individual/family/community in

exchange for a fixed payment

• yearly premium for sufficiently long duration

• profit increases by avoiding catastrophic events

• strict monitoring by an independent agency


A paradigm change


The paradigm change

Smith, R. BMJ 1997;314:1495

future Managed care initiatives

• Consumer education• Standard protocols• Better HIMS• Optimal use of professionals• Newer technologies• Harness support from other sectors (education,

agriculture, transportation, social welfare, etc)

Client participation,

trans-disciplinary approaches,

equity

Primary Health Care


Smith R. BMJ 1997;324:1495


Four suggestions

Grass root level workers

Doctors and specialists

Supervision & surveillance

Medical(Health) Education

Junior Public Health Nurses

• Empower them

• Respect them and bring respect to them

• Have major role to play


HIMS initiatives of SCTIMST

• ASA initiative– Customized DHIS software (CHC Vizhinjam)– Runs in over 1000 health centers in Kerala)– Formats got revised at national level– Reporting through mobile SMS

• Coming up– Customized laptops for field staff (JPHNs)– Individual module (EHR)– Multi-touch screen computer kiosks– Preventive cardiology initiative



Geo-referenced maps of field areas


Geo-referenced maps of field areaClearly delineates coastal overcrowding


Uses Open Source SoftwaresCost ~ Rs 15000

Pilot testing of its use for JPHNs is planned

19 Sep 2010 KSSP Health Commission 16

One health worker per ward Pool up JPHNs, JHIs & junior-grade supervisory

officers, if necessary

5 days in the field and one day at PHC Let them work with ASAs, Anganwadi teachers, etc

Provide laptops with Geo-referenced field datasets to all HWs

Can help in Computer registration of patients at PHC

Doctors

• Better parity in salary (public & private)•Thailand experience

• Better incentives for working in rural areas•Tamil Nadu experience

• Zonal recruiting and posting

• Better working environment for specialists•Convert TLQ hosp into Single/Two Specialty centers•Comprehensive 24 hour services including emergency services•Rotation OP clinics by specialists in the nearby PHC/CHCs


Supervisory Cadre

Better MonitoringMulti-touch screen kiosks in district offices

Real time monitoring of epidemicsTechnical support from Medical Colleges

Research wing (Health System Research) within health services


Medical(Health) Education

National Council for Human Resources

National and state level accreditation

Multi-disciplinary approaches


Recap• Healthcare challenges

• Cost containment

• Technical solutions

• Managed care settings

• Let’s aim at overall wellbeing

Thank You19 Sep 2010 20KSSP HEALTH COMMISSION