HEALTHCARE IN THE NEW HEALTHCARE IN THE NEW MILLENNEUMMILLENNEUM

SYED AMIN TABISHSYED AMIN TABISH

2020thth Century Century 2020thth Century Century

Ecstasy: unprecedented progress by Ecstasy: unprecedented progress by medical sciences during last 4 decadesmedical sciences during last 4 decades

Tragedy: EID like AIDS (a global crises)Tragedy: EID like AIDS (a global crises)

Trauma: Political unrest, human rights Trauma: Political unrest, human rights issues, disasters, inequalities, etc.issues, disasters, inequalities, etc.

Romance: eradication of smallpox & Romance: eradication of smallpox & polio, information superhighway, polio, information superhighway, mapping of human genome, mapping of human genome, breakthroughs in nuclear & molecular breakthroughs in nuclear & molecular sciences including reproductive sciences including reproductive biology.biology.

HEALTH: MOST VALUABLE PUBLIC HEALTH: MOST VALUABLE PUBLIC SERVICESERVICE

Health is fundamental to quality of Health is fundamental to quality of lifelife

Health Services: a personal answer Health Services: a personal answer to personal needsto personal needs

Government should guarantee the Government should guarantee the existence of HC system providing existence of HC system providing equal, accessible, comprehensive equal, accessible, comprehensive & high quality care to all.& high quality care to all.

HEALTH: MOST VALUABLE PUBLIC SERVICEHEALTH: MOST VALUABLE PUBLIC SERVICE

HC : largest industry & its sheer HC : largest industry & its sheer size & complexity makes change size & complexity makes change an evolution of mammoth an evolution of mammoth proportionsproportions

No other sector reaches as many No other sector reaches as many people, as the HS, its market people, as the HS, its market being assured, whatever the being assured, whatever the odds.odds.

HEALTHCARE TRANSFORMATIONHEALTHCARE TRANSFORMATION Epidemiological & demographic Epidemiological & demographic

transitions transitions Improved Life Expectancy (aging)Improved Life Expectancy (aging) A better-informed & more demanding A better-informed & more demanding

populacepopulace New technologies & expansion of New technologies & expansion of

scientific knowledgescientific knowledge Universal trend towards greater Universal trend towards greater

decentralization pro-market economic decentralization pro-market economic policies, purchaser-provider split, rapid policies, purchaser-provider split, rapid expansion of Pvt. Sector, introduction of expansion of Pvt. Sector, introduction of user charges.user charges.

GRADUAL DECAYGRADUAL DECAYWe have observed with We have observed with considerableconsiderable consternation consternation the gradual but sure decay in the gradual but sure decay in Health services Health services The outbreak of Malaria in The outbreak of Malaria in virulent form, return of virulent form, return of Dengue (Delhi-1996) & Dengue (Delhi-1996) & Plague (Surat-1994), EID Plague (Surat-1994), EID (Tuberculosis) are some clear (Tuberculosis) are some clear signs of this decay.signs of this decay.

DOUBLE BURDEN OF DISEASEDOUBLE BURDEN OF DISEASE

We are also living under two We are also living under two shadows – one of infectious shadows – one of infectious diseases and the new and diseases and the new and growing shadow of growing shadow of

non-communicable non-communicable chronic Diseaseschronic Diseases

DOUBLE BURDEN OF DISEASE IIDOUBLE BURDEN OF DISEASE II

The health transition is due The health transition is due to combination of to combination of demographic & life style demographic & life style changes, industrialization & changes, industrialization & urbanizationurbanization

A thorough review of NHP & A thorough review of NHP & a total revamping & a total revamping & restructuring of the health restructuring of the health infrastructureinfrastructure

DICHOTOMYDICHOTOMY The large widespread health The large widespread health

infrastructure seems to be infrastructure seems to be nonfunctional & unresponsive in many nonfunctional & unresponsive in many parts. Instead of moving forward to parts. Instead of moving forward to meet the health challenges, it is sliding meet the health challenges, it is sliding backward. backward.

Extremely uneven health & Extremely uneven health & development process in various parts development process in various parts of the countryof the country

One can hardly believe that they are One can hardly believe that they are part of same nation. Even with in the part of same nation. Even with in the states which are doing reasonably well states which are doing reasonably well there remain regions of darkness where there remain regions of darkness where little has changed since independence.little has changed since independence.

LIVING ON THE EDGELIVING ON THE EDGEAN AGE OF DARKNESS & LIGHTAN AGE OF DARKNESS & LIGHT World has 450 billionaires: with the World has 450 billionaires: with the

value of their combined assets now value of their combined assets now exceeding combined income of poorest exceeding combined income of poorest 50% of world’s people50% of world’s people

These are obscenities of excess in a These are obscenities of excess in a world where 160 m children are world where 160 m children are malnourished, 840 m live without secure malnourished, 840 m live without secure sources of food & 1.2 b lack access to sources of food & 1.2 b lack access to safe drinking watersafe drinking water

A KNOELEDGE-BASED SOCIETYA KNOELEDGE-BASED SOCIETY Basic immunization saves lives of > 3 m Basic immunization saves lives of > 3 m

every year in developing countries every year in developing countries

WE LIVE IN A WORLD OF DISTURBING CONTRASTSWE LIVE IN A WORLD OF DISTURBING CONTRASTS

3/4ths of the world’s people live in 3/4ths of the world’s people live in developing count. enjoy only 16% of the developing count. enjoy only 16% of the world’s income world’s income

More than 1B people lack the opportunity More than 1B people lack the opportunity to consume in ways that would allow to consume in ways that would allow them to meet their most basic needs them to meet their most basic needs

More than 17 M people die every year More than 17 M people die every year from infectious & parasitic from infectious & parasitic diseases(D,M,TB) diseases(D,M,TB)

Challenges: reducing pop. growth, Challenges: reducing pop. growth, providing basic social servicesproviding basic social services

WE LIVE IN A WORLD OF DISTURBING CONTRASTS IIWE LIVE IN A WORLD OF DISTURBING CONTRASTS II

More than 90% of HIV infected cases More than 90% of HIV infected cases live in developing countrylive in developing countryDeveloping countries witnessed Developing countries witnessed unprecedented human develop. in unprecedented human develop. in past 30 years, it has covered as much past 30 years, it has covered as much distance during those 30 years as distance during those 30 years as industrial world did in a century.industrial world did in a century.But human deprivation remainsBut human deprivation remainsResources to be generated by cutting Resources to be generated by cutting excessive military spending & excessive military spending & privatizing inefficient pub. enterprisesprivatizing inefficient pub. enterprises

CURRENT HEALTH STATUS IN INDIACURRENT HEALTH STATUS IN INDIA

India’s public sector health expenditure India’s public sector health expenditure today is Rs.10,000 crore per year (which is today is Rs.10,000 crore per year (which is being spent on 4800 hospitals, 450000 beds, being spent on 4800 hospitals, 450000 beds, 11100 dispensaries, 21802 Primary Health 11100 dispensaries, 21802 Primary Health Centers, 132285 Sub – centers & various Centers, 132285 Sub – centers & various preventive & promotive programs, including preventive & promotive programs, including family planning)family planning)In India, life expect. has doubled from 32 yrs In India, life expect. has doubled from 32 yrs (1947) to 63 yrs. in 2000 & IMR declined from (1947) to 63 yrs. in 2000 & IMR declined from 146 to 70146 to 70Many disparities & distortions remain.Many disparities & distortions remain.Progress has been unevenProgress has been unevenConsequences: neglected areas, forgotten Consequences: neglected areas, forgotten populations & overlooked issues.populations & overlooked issues.

Healthcare ExpenditureHealthcare Expenditure HC system absorb 8% of the total world HC system absorb 8% of the total world

productproduct Industrial countries spend 90% of this Industrial countries spend 90% of this

amount, with average per capita exp. of amount, with average per capita exp. of $1500 on HC as compared to $41 in $1500 on HC as compared to $41 in developing countriesdeveloping countries

India spends 1.6% of GDP (even lower prop. India spends 1.6% of GDP (even lower prop. spent on PHspent on PH

The institutional base is weak, NGO’s are The institutional base is weak, NGO’s are underutilized, & finally pvt. sector is gigantic, underutilized, & finally pvt. sector is gigantic, virtually completely unregulated & offers virtually completely unregulated & offers some of the best & worst care seen anywhere.some of the best & worst care seen anywhere.

THE DRIVERS OF CHANGETHE DRIVERS OF CHANGE

Drivers of change in Drivers of change in developed world are developed world are reaching limits of welfare reaching limits of welfare state exhausting traditional state exhausting traditional methods of containing cost methods of containing cost & expecting increasing & expecting increasing consumer sophisticationconsumer sophistication

THE DRIVERS OF CHANGE IITHE DRIVERS OF CHANGE II

No HC system in the world is No HC system in the world is stablestable

Growth of Middle Class, Growth of Middle Class, greater demands from the greater demands from the middle class, & globalization middle class, & globalization of economies are driving of economies are driving change in developing world.change in developing world.

EPIDEMIOLOGICAL PERSPECTIVE FOR HC EPIDEMIOLOGICAL PERSPECTIVE FOR HC MANAGEMENTMANAGEMENT

Population’s ability to benefit Population’s ability to benefit from from HCHC

An understanding of the An understanding of the characteristics of pop. (tends characteristics of pop. (tends in size, demographic & social in size, demographic & social characteristics/distribution of characteristics/distribution of exposures that could exposures that could influence healthinfluence health

EPIDEMIOLOGICAL PERSPECTIVE FOR EPIDEMIOLOGICAL PERSPECTIVE FOR HC MANAGEMENT IIHC MANAGEMENT II

Assess how & when HN are Assess how & when HN are distributed throughout a pop. & distributed throughout a pop. & evaluate the use & efficiency of evaluate the use & efficiency of interventionsinterventions

Assessment based on incidence & Assessment based on incidence & prevalence on one hand & prevalence on one hand & effectiveness of HC on the other effectiveness of HC on the other forms the Epidemiological forms the Epidemiological approach to Needs Assessment.approach to Needs Assessment.

MEDICAL EDUCATIONMEDICAL EDUCATIONMedical education is at Medical education is at the cross roads today.the cross roads today.

Society wants to respond to Society wants to respond to people’s HN with people’s HN with interventions that are interventions that are relevant, efficient, affordable relevant, efficient, affordable & equitably accessible to all & equitably accessible to all its members.its members.

MEDICAL EDUCATION IIMEDICAL EDUCATION IIDoctor of the future:Doctor of the future: A caregiverA caregiver CommunicatorCommunicator Decision makerDecision maker Community leaderCommunity leader A good managerA good manager Med. Uni. should introduce Med. Uni. should introduce

accountability, creative autonomy, accountability, creative autonomy, quality & new methodologies, for quality & new methodologies, for preparing future doctors to function preparing future doctors to function properly in society.properly in society.

MEDICAL EDUCATION - IIIMEDICAL EDUCATION - IIIAgenda for action:Agenda for action: Setting up of a National HR Dev. Setting up of a National HR Dev.

Comm.Comm. A comprehensive ban on Med. A comprehensive ban on Med.

College expansionCollege expansion Strengthening MCI to control fall in Strengthening MCI to control fall in

standardsstandards Examination reformExamination reform Establishment of Uni. Of Health Establishment of Uni. Of Health

sciencessciences

MEDICAL EDUCATION - IVMEDICAL EDUCATION - IV

Developments in ME include:Developments in ME include: Curriculum planning (PBL, TBL, Curriculum planning (PBL, TBL,

Community orientation)Community orientation) Assessment Assessment

(performance-related/objective (performance-related/objective structured Clinical Exam./assessment of structured Clinical Exam./assessment of critical thinking)critical thinking)

Teaching & learning (simulation, Teaching & learning (simulation, computer- assisted, multimedia)computer- assisted, multimedia)

Instructional materials developmentInstructional materials development Research & evaluation.Research & evaluation.

EMERGING INFECTIOUS DISEASESEMERGING INFECTIOUS DISEASES Leading cause of death worldwideLeading cause of death worldwide/17 /17

m die/yearm die/year Malaria, TB, Dengue, Hem. Fever, Malaria, TB, Dengue, Hem. Fever,

Hepatitis, JE, Ebola Virus, Hanta virus, Hepatitis, JE, Ebola Virus, Hanta virus, yellow fever, E. Coli 0157, Kala-azar, yellow fever, E. Coli 0157, Kala-azar, plague, BSEplague, BSE threaten lives of millions threaten lives of millions of peopleof people

An outbreak of Cholera in Mexico-An outbreak of Cholera in Mexico-300 300 deaths, plague in India: loss of deaths, plague in India: loss of $1.7m/Zaire & entire world dodged a $1.7m/Zaire & entire world dodged a bullet in bullet in 19951995 - outbreak of Ebola - outbreak of Ebola occurred/effective surveillance saved occurred/effective surveillance saved millions.millions.

EMERGING INFECTIOUS DISEASES IIEMERGING INFECTIOUS DISEASES II

Tackling EID:Tackling EID: Pro-active & planned approach should Pro-active & planned approach should

includeinclude 1. Preparatory state1. Preparatory state 2. Alert phase2. Alert phase 3. Response phase3. Response phase 4. Follow-up phase4. Follow-up phase Information system be developed.Information system be developed. Comprehensive communication Comprehensive communication

strategystrategy Infrastructure & capacity buildingInfrastructure & capacity building Improve surveillance/improve responseImprove surveillance/improve response

Health Services in Rural Health Services in Rural AreasAreas

80 % rural population utilize 20% resources & 80 % rural population utilize 20% resources & 20% urban population gets 80% resources20% urban population gets 80% resources

Basic goal of decentralized planning is to Basic goal of decentralized planning is to eliminate poverty, ignorance & ill-health, eliminate poverty, ignorance & ill-health, improve the QOL of people & raise their improve the QOL of people & raise their standard of livingstandard of living

HS provided should be:HS provided should be:

- - accessible, available on a continuing accessible, available on a continuing basis, acceptable culturally & socially, basis, acceptable culturally & socially, affordableaffordable

Emphasis on disease prevention & health Emphasis on disease prevention & health promotion.promotion.

HEALTH OF WOMEN/CHILDREN & ELDERLYHEALTH OF WOMEN/CHILDREN & ELDERLY Social, health & nutritional status of the Social, health & nutritional status of the

most vulnerable sections of society reflect most vulnerable sections of society reflect the real index of development. India ranks the real index of development. India ranks 135135thth in the list in the list

Marginalisation of women Marginalisation of women Children are the future of a societyChildren are the future of a society India has the dubious distinction of having India has the dubious distinction of having

highest no. of infant deaths in the world.highest no. of infant deaths in the world. Elderly persons: 7.6% population is likely to Elderly persons: 7.6% population is likely to

increaseincrease Ensure their welfare, prevent disease & Ensure their welfare, prevent disease &

disability.disability.

CONTROL OF COMMUNICABLE DISEASESCONTROL OF COMMUNICABLE DISEASES Good environmental sanitation Good environmental sanitation Prompting Healthy life styles Prompting Healthy life styles Undertaking control or Eradicating ProgramsUndertaking control or Eradicating Programs Proper Organizational Set-up with Effective Proper Organizational Set-up with Effective

LeadershipLeadership Strengthening General Health Services Strengthening General Health Services Comprehensive & vibrant Epidemiological Comprehensive & vibrant Epidemiological

servicesservices Disease specific measures for control of high Disease specific measures for control of high

priority infection (TB, Malaria, AIDS, RTI, priority infection (TB, Malaria, AIDS, RTI, Hepatitis)Hepatitis)

Information exchange Comprehensive & Information exchange Comprehensive & vibrant Epidemiological servicesvibrant Epidemiological services

POPULATION STABPOPULATION STAB: : A DILEMMAA DILEMMA

India has crossed the billion markIndia has crossed the billion mark Unchecked pop. growth negates all Unchecked pop. growth negates all

progress madeprogress made Tremendous pressure on resourcesTremendous pressure on resources With present growth, India will have With present growth, India will have

1600 m faces in 2025 that will be 1600 m faces in 2025 that will be deprived of constitutional guarantee deprived of constitutional guarantee of health/ education/nutrition/ of health/ education/nutrition/ shelter/employment.shelter/employment.

POPULATION STAB: A DILEMMA POPULATION STAB: A DILEMMA IIII Nearly 1/3Nearly 1/3rdrd of children >16 are forced of children >16 are forced

to lead an impoverished life/150 m to lead an impoverished life/150 m were denied basic HC/226m drink were denied basic HC/226m drink contaminated water/640m do not have contaminated water/640m do not have access to basic san. & 50% of world’s access to basic san. & 50% of world’s illiteratesilliterates

Eradicate illiteracy & Communicate Eradicate illiteracy & Communicate effectivelyeffectively

Eliminate corruption Eliminate corruption Small family norm must reflect Small family norm must reflect

responsible parenthoodresponsible parenthood

THE PRIVATE HEALTH THE PRIVATE HEALTH SECTORSECTOR

Today, HC has become fully commodifiedToday, HC has become fully commodified A fairly large investment by Pub. Sector A fairly large investment by Pub. Sector

(that is otherwise inadequate) is being (that is otherwise inadequate) is being wastedwasted

Pvt. Sector responsible for 3/4Pvt. Sector responsible for 3/4thth of HC of HC Given current ethical standards Pvt. Sec. Given current ethical standards Pvt. Sec.

doesn’t provide quality at reasonable costdoesn’t provide quality at reasonable cost Before it becomes a public menace, Before it becomes a public menace,

introduce regulatory participatory normsintroduce regulatory participatory norms

CHANGING HEALTH & HC CHANGING HEALTH & HC PARADIGMPARADIGM

We have to look beyond so called We have to look beyond so called predominantly reductionist predominantly reductionist biomedical model of HC to a holistic biomedical model of HC to a holistic model that puts human being in the model that puts human being in the centercenter

The total participation of its citizensThe total participation of its citizens Progress is easiest made if we r Progress is easiest made if we r

tuned in with national geniustuned in with national genius New ideas are being discussed:New ideas are being discussed: (Birth with a future/dying with (Birth with a future/dying with

dignity/rationing of care/total body systems dignity/rationing of care/total body systems conditioning)conditioning)

CHANGING HEALTH & HC PARADIGMCHANGING HEALTH & HC PARADIGM QUALITY MANAGEMENTQUALITY MANAGEMENT

In medicine poor quality is In medicine poor quality is expensiveexpensive

Patient safety can not be Patient safety can not be compromisedcompromised

We can no longer afford high We can no longer afford high cost of low qualitycost of low quality

Quality management is scientific Quality management is scientific search for most effective waysearch for most effective way

EMERGENCY HEALTH CAREEMERGENCY HEALTH CARE

Emergency Situations requiring Emergency Situations requiring immediate attention occur frequentlyimmediate attention occur frequently

Bhopal Gas tragedy/Earthquake in Bhopal Gas tragedy/Earthquake in Latur & Gujrat/Cyclone in Orrisa/Rail Latur & Gujrat/Cyclone in Orrisa/Rail Accidents Accidents

When managed appropriately, good When managed appropriately, good chance of survival chance of survival

Preserving life, disability limitation Preserving life, disability limitation Emergency preparedness/EMS/CATSEmergency preparedness/EMS/CATS Apply zoning conceptApply zoning concept

MENTAL HEALTHMENTAL HEALTH• Mental illness is not a personal failure. Rare is the

family that will be free from an encounter with mental disorder.

• Neuropsychiatric conditions accounted for 10% of burden out of an estimated 39% of all DALYs

• Wide gap between availability & implementation of effective interventions

• Theme of WHD 2001: “Stop exclusion, Dare to care”• New understanding, new hope: combining science &

sensibility to bring down barriers to care & cure• Mental health care needs less costly technology

Mental health - IIMental health - II• Provide treatment in primary care

• Make psychotropic drugs available

• Give care in the community

• Educate the public

• Involve communities/families/individuals

• Establish national policies, programs

• Develop human resources

• Link with other sectors

• Support more research

DEVELOPMENT & THE DEVELOPMENT & THE ENVIRONMENTENVIRONMENT

The achievement of sustained & equitable dev. The achievement of sustained & equitable dev. remains the greatest challenge facing human remains the greatest challenge facing human racerace>1 B people still live in acute poverty & suffer >1 B people still live in acute poverty & suffer Inadequate access to resourcesInadequate access to resourcesEssential task of dev. Is to provide opportunitiesEssential task of dev. Is to provide opportunitiesIn developing countries 30% of pop. Lack access to In developing countries 30% of pop. Lack access to safe water & 60% to basic sanitationsafe water & 60% to basic sanitation>90% of waste water discharged into >90% of waste water discharged into streams/rivers resulting in water borne dis.streams/rivers resulting in water borne dis.Air pollution from industrial emissions, car exhaust Air pollution from industrial emissions, car exhaust etc. kills >2.7m people/yr.etc. kills >2.7m people/yr.Domestic solid waste – 50% remains uncollectedDomestic solid waste – 50% remains uncollectedCost of environmental degradation in India: 6% of Cost of environmental degradation in India: 6% of GDPGDP

DEVELOPMENT & THE ENVIRONMENT-IIDEVELOPMENT & THE ENVIRONMENT-IIExcess CO2, Methane etc. trap heat are Excess CO2, Methane etc. trap heat are accumulating in troposphere. Global Warmingaccumulating in troposphere. Global Warming

Priority should be given to:Priority should be given to:1/31/3rdrd of world’s pop. that has inadequate san. of world’s pop. that has inadequate san. & 1 B without safe water& 1 B without safe water1.3 B people who are exposed to unsafe 1.3 B people who are exposed to unsafe conditions caused by soot & smokeconditions caused by soot & smoke700m women/children who suffer from indoor 700m women/children who suffer from indoor air poll.air poll.Hundreds of millions of farmers livelihoods Hundreds of millions of farmers livelihoods depend on good environmental stewardshipdepend on good environmental stewardshipMillions of deaths each year from dirty water Millions of deaths each year from dirty water & indoor air poll. Cry out for immediate & indoor air poll. Cry out for immediate action.action.

HUMAN DEVOLOPMENT & GENDER HUMAN DEVOLOPMENT & GENDER EQUALITYEQUALITY

History is likely to judge the progress in the History is likely to judge the progress in the 2121stst century by 1 major yardstick:is there a century by 1 major yardstick:is there a growing equality of opportunity between growing equality of opportunity between people & among nations people & among nations

The most persistent disparity has been The most persistent disparity has been Gender DisparityGender Disparity

Women still continue 72% of world’s poor & Women still continue 72% of world’s poor & 2/32/3rdrd of worlds illiterates of worlds illiterates

Human development if not engendered, is Human development if not engendered, is endangeredendangered

Investing in Women’s capabilities & Investing in Women’s capabilities & empowering them. empowering them.

ERADICATING POVERTYERADICATING POVERTYPoverty has many facts. It is much more Poverty has many facts. It is much more than low income. It also reflects poor health than low income. It also reflects poor health & education, deprivation in knowledge, etc& education, deprivation in knowledge, etcThe world has the resources & know how to The world has the resources & know how to create a poverty-free world in less than a create a poverty-free world in less than a generationgenerationOver the past 3 decades more than a dozen Over the past 3 decades more than a dozen developing countries have shown that it is developing countries have shown that it is possible to eliminate absolute poverty possible to eliminate absolute poverty Poverty is not to be suffered in silence by Poverty is not to be suffered in silence by the poor. the poor. A people- centered strategy for eradicating A people- centered strategy for eradicating poverty should start by building the assets poverty should start by building the assets of the poor.of the poor.

INVESTING IN HUMAN DEVELOPMENTINVESTING IN HUMAN DEVELOPMENT •Countries must invest liberally in human development so that they are ready to face the challenge of Globalization • Globalization is integrating consuming markets around the world. But it is also creating new inequalities• The time has come to create a new world that is more humane, more stable, more justComponents of Human Development paradigm:Productivity, Equity, Sustainability, Empowerment

TOWARDS DEVELOPING A TOWARDS DEVELOPING A CIVIL SOCIETYCIVIL SOCIETY

Consumption levels of more than a Consumption levels of more than a billion poor people must be raised billion poor people must be raised

Strong civil society alliances should Strong civil society alliances should be built to protect consumer rights be built to protect consumer rights

What is the meaning of growth if it What is the meaning of growth if it is translated into the lives of the is translated into the lives of the peoplepeople

Empowering people – perticullarly Empowering people – perticullarly women – is a sure way to link women – is a sure way to link growth & human developmentgrowth & human development

RESPONDING TO THE CHALLENGERESPONDING TO THE CHALLENGE

Need for better resource allocation Need for better resource allocation & need for improved utilization of & need for improved utilization of fundsfunds

Employment & income generationEmployment & income generation Secondary & tertiary medical care Secondary & tertiary medical care

(subsidy for poor)(subsidy for poor) PHC for AllPHC for All Fiscal incentives for backward areas Fiscal incentives for backward areas

(to encourage pvt. Practitioners to (to encourage pvt. Practitioners to open clinics in remote areasopen clinics in remote areas

Improving quality of PHCImproving quality of PHC

RESPONDING TO THE CHALLENGERESPONDING TO THE CHALLENGE

Reaching the Out reachReaching the Out reach Panchayat rajPanchayat raj User costs (China exp.),Use of pub. User costs (China exp.),Use of pub.

facilities by vulnerable sections can facilities by vulnerable sections can increase despite increase in user charges, increase despite increase in user charges, if quality is improved as if quality is improved as (e.g. Pakistan)(e.g. Pakistan)

Contracting outContracting out Fiscal incentives for backward areas Fiscal incentives for backward areas

(responsibility of Govt.), increased pvt. (responsibility of Govt.), increased pvt. Supply of services will provide with a Supply of services will provide with a choice, competition for pub. Sec.choice, competition for pub. Sec.

ACCREDITATION / REGULATING MEDICINEACCREDITATION / REGULATING MEDICINE Mushroom growth of Nursing Homes: a source Mushroom growth of Nursing Homes: a source

of concern because of substandard Pt. Care & of concern because of substandard Pt. Care & unethical practicesunethical practices

1 or 2 room shops with a scant regard for 1 or 2 room shops with a scant regard for standards can not be accepted as HC standards can not be accepted as HC institutions.institutions.

Assure consumers that no practitioner without Assure consumers that no practitioner without appropriate registration is treating a patientappropriate registration is treating a patient

Establish credibility of service – develop Establish credibility of service – develop comp. comp. standards standards

Aims: Vol. pursuit of Q/team building, Aims: Vol. pursuit of Q/team building, educationeducation

To bring in an entirely new range of To bring in an entirely new range of comprehensive regulations-Universal HCcomprehensive regulations-Universal HC

ACCREDITATION / REGULATING MEDICINEACCREDITATION / REGULATING MEDICINE

Regulation of MC & practice Regulation of MC & practice should include:should include:

Institutionally delivered HCInstitutionally delivered HC

Clinical Audit/TQM/CQIClinical Audit/TQM/CQI MCI must be strengthened to MCI must be strengthened to

improve self-regulationimprove self-regulation Enhancing levels of medical Enhancing levels of medical

AccountabilityAccountability Doctor’s Forum for fair med. CareDoctor’s Forum for fair med. Care

Future Health Goals/Core values of Med ProfFuture Health Goals/Core values of Med Prof Refocus recourses on those who need Refocus recourses on those who need

the mostthe most Poverty reduction by investment in Poverty reduction by investment in

most basic needs ( food, safe water, most basic needs ( food, safe water, sanitation & access to social service sanitation & access to social service

Universal HC for allUniversal HC for all Sustainable development Sustainable development Equity promotingEquity promoting Safe Safe && healthy environments healthy environments & & living living

conditionsconditions To enable all people to adopt To enable all people to adopt & &

maintain healthy l lifestyles & healthy maintain healthy l lifestyles & healthy behaviorbehavior

Future Health Goals/Core values of Med ProfFuture Health Goals/Core values of Med Prof

CORE VALUES:CORE VALUES: CaringCaring Commitment Commitment CompassionCompassion Integrity Integrity CompetenceCompetence Spirit of enquirySpirit of enquiry ConfidentialityConfidentiality ResponsibilityResponsibility AdvocacyAdvocacy

MANAGED CAREMANAGED CAREDeveloped in response to ever increasing HC costsDeveloped in response to ever increasing HC costsImportant Tools of MC:Important Tools of MC: For managed demandFor managed demand1.1. CapitationCapitation2.2. GatekeeperGatekeeper3.3. Advice line to patientsAdvice line to patients4.4. User feesUser fees5.5. Consumer educationConsumer education For medical managementFor medical management1.1. Utilization reviewUtilization review2.2. Preadmission certificationPreadmission certification3.3. Greater use of cl. PathwaysGreater use of cl. Pathways For care delivery:For care delivery:1.1. TelemedicineTelemedicine2.2. Alternative approaches to medAlternative approaches to med

MANAGED CARE IIMANAGED CARE IIHC system can be grouped intoHC system can be grouped into4 archetypes:4 archetypes: Socialized medicine (UK)Socialized medicine (UK) Socialized insurance (Canada)Socialized insurance (Canada) Mandatory Insurance (Japan)Mandatory Insurance (Japan) Voluntary Insurance (USA)Voluntary Insurance (USA) An integrated & virtual system An integrated & virtual system

(brought about by Disney & (brought about by Disney & Microsoft). With this system service Microsoft). With this system service can be provided any where, anytime can be provided any where, anytime by HC provider.by HC provider.

Informed ConsumerInformed Consumer

HOSPITAL- A Center of ExcellenceHOSPITAL- A Center of Excellence In India, out of total of 13692 hospitals: In India, out of total of 13692 hospitals:

4310(32%) are in rural areas & 9382 4310(32%) are in rural areas & 9382 (68%) are in urban areas. The (68%) are in urban areas. The Government owns 4235 (31%) of total Government owns 4235 (31%) of total hospital beds; local bodies control 2.5% of hospital beds; local bodies control 2.5% of hospitalshospitals

At present India has 1 hospital bed per At present India has 1 hospital bed per 1412 pop. Which is hardly sufficient to 1412 pop. Which is hardly sufficient to meet the challenges posed by meet the challenges posed by demographic & epidemiological shifts. demographic & epidemiological shifts. The overcrowding & overstretching of The overcrowding & overstretching of service results in poor patient outcomeservice results in poor patient outcome

Vision: The Scientific Vision: The Scientific MindsetMindset

Synergy between Science, Technology, Synergy between Science, Technology, Organization & public Policy: has Organization & public Policy: has helped bring about sea change in food, helped bring about sea change in food, environment. & agriculture.environment. & agriculture.The future will undoubtedly witness The future will undoubtedly witness revolutionary changes & new horizons revolutionary changes & new horizons opened up by cutting-edge scienceopened up by cutting-edge scienceA vibrant, responsive & globally A vibrant, responsive & globally competitive science system is crucial.competitive science system is crucial.This calls for strong social support & This calls for strong social support & commitment to Sciencecommitment to ScienceKnowledge is critical for development.Knowledge is critical for development.

ChallengesChallenges Hospital & Primary Health careHospital & Primary Health care Technological revolution Technological revolution Quality of care- CQI, ISO 9000 certific.Quality of care- CQI, ISO 9000 certific. Rising costs of HCRising costs of HC Privatization of HC Privatization of HC Consumer protection & medical prof.Consumer protection & medical prof. Market approach to health: there has to be an Market approach to health: there has to be an

paradigm shift from being “product oriented” to be paradigm shift from being “product oriented” to be “client oriented” “client oriented”

Restructuring Health care/Holistic Restructuring Health care/Holistic approachapproach

HOLISTIC APPROACHHOLISTIC APPROACH Radical institutional reforms: HC extended to those who Radical institutional reforms: HC extended to those who

need it most.need it most. Investment in decentralized pop.-based systems / HSR / Investment in decentralized pop.-based systems / HSR /

develop Evidence-based HC. develop Evidence-based HC. HS: responsive to needs of all,cost-effective & affordable, HS: responsive to needs of all,cost-effective & affordable,

of high Q, humane, caring, culturally acceptable, innovative of high Q, humane, caring, culturally acceptable, innovative in provision of services, sensitive.in provision of services, sensitive.

Holistic concept covers human biology, personal behavior Holistic concept covers human biology, personal behavior (lifestyle), Culture, medical care system, psychological & (lifestyle), Culture, medical care system, psychological & physical environment. physical environment.

Disease prevention & Health promotion Disease prevention & Health promotion

Health PolicyHealth Policy 20022002Objectives:• To achieve an acceptable standard of good

health amongst the general population• To increase access to decentralized Public

Health System by establishing new infrastructure in deficient areas & by upgrading the existing institutions

• Ensuring a more equitable access to health services across social & geographical expanse of country

• Increasing aggregate PH investment through a substantially increased Centl. Govt. Contribut.

Alternative StrategiesAlternative Strategies11. . Hospital: from center of excellence to community Hospital: from center of excellence to community

supportsupport2. Hospital without walls2. Hospital without walls3. Hospice3. Hospice4. Home care (Self care)4. Home care (Self care)5. Palliative care5. Palliative care6.6. Geriatric centersGeriatric centers Investing in health should be considered as an Investing in health should be considered as an

investment in HRD to enhance productivity.investment in HRD to enhance productivity. Create new intellectual capability, resource Create new intellectual capability, resource

capability, social justice & equitycapability, social justice & equity A new mindset to speed up reforms, reaching out A new mindset to speed up reforms, reaching out

hard-to-reach & helping hard-to helphard-to-reach & helping hard-to help By improving the prospects of the least of us, we By improving the prospects of the least of us, we

can assure a more productive, just & civil nation can assure a more productive, just & civil nation for all of usfor all of us

INVESTING IN HEALTHINVESTING IN HEALTH

Future Action:Future Action: Ensuring value for moneyEnsuring value for money Poverty reductionPoverty reduction Public health policyPublic health policy Strengthening national capabilities for Strengthening national capabilities for

emergency reliefemergency relief Emphasis of long-term & comprehensive Emphasis of long-term & comprehensive

strategiesstrategies

IMPROVING HEALTH OF THE NATIONIMPROVING HEALTH OF THE NATION

• Address the Burden of the ill-health among very poor populations with emphasis on RCH, Communicable Diseases, Nutrition, Mental Ill-health, Injury, Non-communicable Diseases

• Track & assess risks to health, & help societies to take action to reduce them.

• Improve the performance of health systems.• Encourage national policies which promote

health with contribution from economic, political & societal domains.

HEALTH: EVERYBODY’S HEALTH: EVERYBODY’S RIGHT,EVERYBODY’S RESPONSIBILITYRIGHT,EVERYBODY’S RESPONSIBILITY

LET US RISE TO THE LET US RISE TO THE RESPONSIBILITIES OF NEW RESPONSIBILITIES OF NEW WORLD – A BRAVE NEW WORLD WORLD – A BRAVE NEW WORLD THAT IS UNITED AGAINST THE THAT IS UNITED AGAINST THE COMMON ENEMIES OF COMMON ENEMIES OF HUMANKIND: POVERTY, HUMANKIND: POVERTY, IGNORANCE & DISEASE. A IGNORANCE & DISEASE. A WORLD WHICH WE CAN PASS WORLD WHICH WE CAN PASS ON TO OUR CHILDREN & THEIR ON TO OUR CHILDREN & THEIR CHILDREN WITH THE CHILDREN WITH THE KNOWLEDGE THAT WE ROSE KNOWLEDGE THAT WE ROSE TO THE RESPONSIBILITIES OF TO THE RESPONSIBILITIES OF THE NEW AGE.THE NEW AGE.

LOOKING AHEADLOOKING AHEAD