Download - New Directions in Rural Healthcare
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New Directions in Healthcare
Nachiket Mor, Ph.D.Member, Board of Directors, ICTPH
OECD ConferenceNew Delhi, June 14th, 2011
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About ICTPH
An action-research centre focussed on finding durable solutions to challenges of healthcare in Rural India
Set up by IKP Trust
Headquartered at IKP Knowledge Park, Hyderabad (200 acre R&D, Incubation Facility within the Genome Valley)
President: Dr. Zeena Johar
Chairman of the Board: Dr. Ramesh Mashelkar
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Healthcare Challenges
Inadequate infrastructure
Low quality of care
Insufficient human resources
High out-of-pocket expenditure at point-of-care
Healthcare system not patient or wellness focussed
Need for policy level as well as field level innovations
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ICTPH Research Focus
Infrastructure
Interventions
Human Resources
Financing
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Desired Infrastructure
A well provisioned health-centre at 8,000 to 10,000 population level with ability to deal with a wide range of conditions
Technology to allow for:
Accurate diagnosis
Appropriate treatment
Quality control
Comprehensive enrolment and risk screening for landscape epidemiology and risk factor tracking
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The ICTPH Approach
• Clear identification of service area
• GPS Enabled Android Mobile Phones
• Rapid enrollment and risk screening
• Geo-tagging
• 10,000 individuals in 7-10 days
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Chelampatti
KarkaripattiAndipatti & Mudalipatti
Ayyampatti
Pachur
Kotaitheru
UppundarpettiThekku
Adanakottai
Geo-tagging and ID Card
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Rural Micro Health Centre
One rural RMHC for 10,000 population
Vision, Dental, Cancer
Internet, Computers, HMIS
Blood collection
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Drugs & Diagnostics
Haematology: Complete Blood Count (KX 21)
Biochemistry: Glucose, Lipid Profile, LFT, KFT (Chem 7)
Strip Tests: Malaria, Pregnancy, Urine
THERAPEUTIC ACTIVITY CLASS NUCLEUS MOLECULE FORMULATION STRENGTH
ENDOCRINE SYSTEM
Anti Diabetic Biguanide Biguanide Metformin HCl Tablet (500 mg)
Anti Diabetic Sulfonyl Urea Sulfonyl Urea Glibenclamide Tablet (5 mg)
Anti Diabetic Sulfonyl Urea Sulfonyl Urea Glimepiride Tablet (1 mg; 2 mg)
CARDIO VASCULAR SYSTEM
Anti Anginal Isosorbide trinitrate Tablet (10 mg)
Anti Hypertensive Calcium Channel Blocker Dihydropyridine Amlodipine Tablet (5 mg; 2.5 mg)
Anti Hypertensive Angiotensin II Antagonist Losartan pottassium Tablet (50 mg)
Anti Hypertensive Beta 1 Receptor Blocker Napthalene Atenelol Tablet (50 mg)
Diuretic / Anti Hypertensive Loop Diuretic Anthranilic Acid FrusemideTablet (40 mg); Injection (10 mg / ml)
Diuretic / Anti Hypertensive Sodium Chloride Symporter Benzothiadiazine Hydrochlorthiazide
Hyperlipidemia HMG-CoA Reductase Statin Atorvastatin Tablet (10 mg)
ICTPH Protocol Linked Essential Drug List (67 Single Formulations)
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ICTPH Research Focus
Infrastructure
Interventions
Human Resources
Financing
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Desired Interventions
Wide range of conditions
Standardised treatment
Rational prescriptions
Focus on risk factor management and early interventions
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Patient removes footwear and enters RMHC
Guide-Patient Protocol
Is the patient a pregnant woman?
Physician-Patient Protocol
Yes
No
Diagnostic Tests
Procedures:• Nebulisation• Suture• Suture Removal• Dressing (Minor/major)• Injections• IV’s
Consultation:1.Physical Examination
2.SOAP Methodology• Subjective• Objective• Assessment• Planning
ICTPH ApproachR
MH
C
Disease Management
Diagnostics
Screening
Vision
Dental
Interventions
Emergency Management
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Physician-Patient Protocol
Allows heightened diagnosis of disease:
Standardized format - signs & symptoms, diagnostic tests, treatment, and prevention (specific to a disease/condition).
Pictures to allow visual confirmation
Physical assessment protocol allowing targeted disease & condition specific physical examination
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Otitis Media
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Risk Factor Assessment
Condition Management
Diseased
Risk Factor
s
Normal
Population
PISP
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Infant Nutrition Supplementation
Is your child between 6-24 months old?
We recommend Sprinkles micronutrient powder
Unless you child has one of the following:
Acute infection Severe Anaemia Severe Acute Malnutrition
Iron (12.5 mg) Zinc (5 mg) Folic Acid (160 µg) Vitamin A (300 µg) Vitamin C (30 mg)
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ICTPH Research Focus
Infrastructure
Interventions
Human Resources
Financing
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Human Resources Challenge
Unwillingness to serve in rural locations
Inadequate supply of MBBS doctors
High salary & support costs
Poor quality of care
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Recruit licensed Ayurveda and Siddha practitioners (BAMS, BSMS) Offer bridging certificate course in modern medicine Combine with a general induction program & soft skills training
ICTPH Approach
Clinical processes (HMIS, PISP & pre – consultation protocols), Basic Procedures
Physiology, Patho-physiology, Diagnosis & Standard Treatment Protocols
Pharmacology, Medication and Diagnostics and Procedures
Clinical Practice Gastro-intestinal Respiratory Cardio-vascular diseases Cancer Diabetes Dermatology Musculo-skeletal Ophthalmology Dentistry Diagnostics
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Structured Environment
Certified Physician
Health Extension Worker
Real-time HMIS data entry
Real-time Centralised Audit
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ICTPH Research Focus
Infrastructure
Interventions
Human Resources
Financing
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Financing Challenge
Low levels of pre-payment
Entirely a fee-for-service model
Standalone insurance schemes such as RSBY are well run and therefore run the risk of:
Relative over-supply of higher levels of care
Not focussed on wellness
Expenditures could tend towards 100% utilisation
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ICTPH Approach
HMO / ACO approach towards integrated primary, secondary and tertiary care
Strong focus on risk factor management and gate-keeping function at the primary care level
Move away from FFS and OOP to capitation and pre-payment models
Overall annual costs to remain below Rs. 1300 ($30) per capita per year (2.6% of GDP)
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Thank You