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2012, PLOS One
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2000, SSRN Electronic Journal
A framework for designing and costing of Essential Primary Health Package for federal states. The document provide guideline and methodology for developing EHP for attaining Universal health Coverage in Federal States like India
Individuals should be entitled to a ‘fair innings’, and the primary role of health systems should be the prevention of premature mortality. In India, 66 percent of all deaths are premature. The bur-den of premature mortality has shifted from child (0-5 years) to adult (30-69 years) level over the years – there are three times more deaths happening at the latter vis-à-vis the former level. Never-theless, primary health systems continue to focus almost exclusively on child mortality. They need to make a health system transition and get engaged in the prevention of risk factors, mor-bidity and mortality related to chronic diseases – the biggest determinant of adult mortality – to-gether with their original focus on child mortality. This paper analyzes some of the major chal-lenges in terms of governance, manpower and financing that such a transition will be faced with, and offers a number of actionable policy recommendations. It does so based on desk and field research in four Indian states – Uttar Pradesh, Rajasthan, Kerala and Tamil Nadu (two health-backward and two health-advanced) – and four countries – Japan, Canada, United States and Sri Lanka (with varying probability of premature mortality due to non-communicable diseases) – in-volving semi-structured interviews with close to 200 stakeholders from policy, industry, interna-tional organizations, civil society and the academia. A reorientation of national and state health policies, systems and resources (financial, human and infrastructural) is urgently required to begin addressing the massive burden of premature mortality due to chronic diseases in India – the highest in the world – and prevent human and economic costs associated with them. State gov-ernments will have to embrace their legal responsibility of being the primary agents for the sur-vival and health of their population. Their role is also the most critical because prevention of chronic diseases requires a sustained, long-term engagement, which neither the Centre nor inter-national organizations could commit to. There will, however, be macro roles – visionary, regulato-ry, financial, technical, etc. – that the Centre will have to play towards this end.
Health for the millions
The achievement of global sustainable development goals (SDGs) depends largely on India’s progress, given the country’s massive size and its moderate historical success in key health and nutrition outcomes over the last several years. This further increases the relevance and need for effective monitoring of India’s performance, through timely and disaggregated data, which ensures systematic assessments and coursecorrection. As India will be depending mainly on surveys to supply targetrelated data in the medium run, this paper classifies existing health and nutrition indicators from the draft National Indicator Framework (NIF), in terms of data availability. By highlighting the gaps in available data, the authors make specific recommendations to streamline existing surveys to align them with the requirements of an NIF for the SDGs. The authors review the draft NIF released by the Ministry of Statistics and Programme Implementation (MoSPI), and propose a revised one as part of this exercise
2013, The Journal of Pediatrics
Introduction: Nearly 220000 patients are diagnosed with end-stage renal disease (ESRD) every year, which calls for an additional demand of 34 million dialysis sessions in India. The government of India has announced a National Dialysis Programme to provide for free dialysis in public hospitals. In this article we estimate the overall cost of performing hemodialysis (HD) in a tertiary care hospital. Second, we assess the catastrophic impact of out-of-pocket expenditures (OOPEs) for HD on households and its determinants.
2018, WHO
This paper describes the status, challenges and scope for strengthening surveillance of chronic disease risk factors, morbidities and mortality in India. We draw upon the surveillance experience of four selected States of India namely Uttar Pradesh, Rajasthan, Kerala and Tamil Nadu to understand key requirements in relation to financing, infrastructure, human resources and governance. The public health system is grappling with resource constraints but there is room for more efforts to undertake systematic population-based chronic disease surveillance in India. Although there are no immediate policy goals to ensure population-based screening, opportunistic screening of selected chronic diseases is an important strategy under the National Programme for Prevention and Control of Diabetes, Cardiovascular diseases and Stroke (NPCDCS). However, surveillance activities under this programme are performing sub-optimally due to issues related to funding constraints, operational guidelines and inadequate clinical, technical and managerial staff. It is apparent that public health system should devote additional resources towards active population-based surveillance. Besides financing, there is a need to develop institutional mechanisms for engagement of adequate human resources for surveillance and disease management. Engagement of AYUSH and community health workers (ASHAs or others) is identified as reasonable options but would require sound incentive mechanism to ensure good coverage and programme outreach. Furthermore, local support, both social and political, is critical to create a conducive environment to contact beneficiaries and for information recording. In this endeavour, private sector is identified as a potential partner that needs enabling environment to come up with services under PPP.
Background. Information on the use of major surgery in India is scarce. In this study we aimed to bridge this gap by auditing hospital claims from Rajiv Aarogyasri Community Health Insurance Scheme, which provides access to free hospital care through state-funded insurance to 68 million beneficiaries, an estimated 81% of population in the states of Telangana and Andhra Pradesh. Methods. Publicly available deidentified hospital claim data for all surgery procedures conducted between mid-2008 and mid-2012 were compiled across all 23 districts in Telangana and Andhra Pradesh. Results. A total of 677,332 operative admissions (80% at private hospitals) were recorded at an annual rate of 259 per 100,000 beneficiaries, with male subjects accounting for 56% of admissions. Injury was the most common cause for operative admission (27%) with operative correction of long bone fractures being the most common procedure (20%) identified in the audit. Diseases of the digestive (16%), genitourinary (12%), and musculoskeletal (10%) systems were other leading causes for operative admissions. Most hospital bed-days were used by admissions for injuries (31%) and diseases of the digestive (17%) and musculoskeletal system (11%) costing 19%, 13%, and 11% of reimbursement. Operations on the circulatory system (8%) accounted for 21% of reimbursements. Annual per capita cost of operative claims was US$1.48. Conclusion. The use of surgery by an insured population in India continued to be low despite access to financing comparable with greater spending countries, highlighting need for strategies, beyond traditional health financing, that prioritize improvement in access, delivery, and use of operative care.
2018, IJSR
BACKGROUND: India with 1.34 billion population is facing unique health care delivery problems particularly regarding the poor spending on health, access, quality, safety, lack of accountability, corruption, etc. Inequalities and health-related expenses resulting in impoverishment further marginalises the poor, underprivileged and outreach. The government of India has come up with a highly ambitious initiative Ayushman Bharat – National Health Protection Mission (AB-NHPM) as a shift from traditional health planning approaches towards a comprehensive healthcare vision. METHODS: Literature available, government publications, documents, press releases and other related material has been consulted to appraise the NHPM initiative. RESULTS: AB-NHPS was officially announced by Prime Minister Narendra Modi on 15 August 2018, in his Independence Day speech. This flagship project was launched on September 25, 2018. The objective of ambitious AB-NHPSis to provide coverage of INR 500,00 per family annually, benefiting more than 10 crore poor families. The scheme will target poor, deprived rural families and identified occupational category of urban workers' families, 8.03 crore in rural and 2.33 crore in urban areas, as per the latest Socio-economic Caste Census (SECC) data. The eligibility criteria include: 10 crore families belonging to poor and vulnerable population based on SECC database, will take care of almost all secondary care and most of tertiary care procedures, the entitlement will be decided on the basis of deprivation criteria in the SECC database, automatically included families in rural areas having any one of the following: households without shelter, destitute, living on alms, manual scavenger families, primitive tribal groups, legally released bonded labour, will also come under this scheme. For urban areas, 11 defined occupational categories will be entitled under the scheme, the treatment in case of hospitalization will be free of cost for the family, all pre-existing conditions will be covered from day one of the policy. The benefit cover will include pre and post hospitalization and the beneficiary will be able to go to public or empanelled private hospitals across the country and get free treatment. CONCLUSION: The NHPS enjoys a guaranteed potential to improve the lives of millions of Indians. The scheme is prominent against the backdrop that several Central Ministries and State/UT Governments have launched health insurance/ protection schemes for their own specific set of beneficiaries. To improve their efficiency, reach and coverage, a critical need has been recognized to converge these schemes, such as the Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS). This article presents the critical analysis of policy initiative, philosophy, key features, implications, impact, concerns, constraints and paving the way for future healthcare solutions.
2010
Abstract: This study attempted to evaluate the working of the Central Government Health Scheme (CGHS) and Ex-servicemen Contributory Health Scheme (ECHS) by assessing patient satisfaction as well as the issues and concerns of empaneled private healthcare providers.
2010, Microeconomics Working Papers
2012, The Southeast Asian Journal of Tropical Medicine and Public Health
Economic and political weekly
16 RAVI DUGGAL T he NHP 2001 begins with some of the recommendations of the NHP 1983 but all the four recommenda-tions listed in para 1.2, i through iv, in the 2001 policy document are unrealised nearly two decades later – the network of PHCs do not provide comprehensive primary health care but only family planning ser-vices, selected immunisation services and selected disease surveillance; health vol-unteers started in 1977 have now disap-peared in most states; there is no organised referral system for the hospitals because the decentralised care does not meet the health care needs of the masses; and evenly spread specialty and super specialty ser-vices do not exist, whether public or pri-vate they are located mostly in metro cities or other large cities. The NHP 1983 had other critical recom-mendations, which the NHP 2001 does not refer to: The establishment of a nationwide network of epidemiological stations that would facilitate the integration of various DRAFT NATIONAL HEALTH P...
2015, Cancer causes & control : CCC
Oral, breast, and cervical cancers are amenable to early detection and account for a third of India's cancer burden. We convened a symposium of diverse stakeholders to identify gaps in evidence, policy, and advocacy for the primary and secondary prevention of these cancers and recommendations to accelerate these efforts. Indian and global experts from government, academia, private sector (health care, media), donor organizations, and civil society (including cancer survivors and patient advocates) presented and discussed challenges and solutions related to strategic communication and implementation of prevention, early detection, and treatment linkages. Innovative approaches to implementing and scaling up primary and secondary prevention were discussed using examples from India and elsewhere in the world. Participants also reflected on existing global guidelines and national cancer prevention policies and experiences. Symposium participants proposed implementation-focused resear...
2018, Journal of the Academy of Hospital Administration
An estimated 29.5% population in India lives below poverty line. With meager 1.2% of Gross Domestic Product government spending on health and necessary evil of user charges to fund healthcare in developing countries, out of pocket catastrophic expenditures restrict access at point of tertiary care due to non-affordability despite government schemes. This study explored the system established by hospital administration for waiver of user charges for poor indigent patients. Methods A descriptive and ambi-spective study was done in an apex referral public hospital in India. Direct observations and interviews with key stakeholders were conducted to study exemption model. Disease profile of in-patients needing financial assistance and utilisation of surgical consumables provided free were prospectively studied for six months. Results On request from treating doctors, waiver of user charges were authorized by hospital administrators through socio-economic assessment by medical social officers (both available at all times). All requests were honored irrespective of documentary evidence of poverty. Waiver for surgical consumables was 27100 rupees (427 dollars) per patient and 837 rupees (13 dollars) per patient per day. Most prevalent were cancers (35.92%) and kidney diseases (24.65%). These poor patients had longer length of stay (22.3 days). Majority belonged to Bihar and Uttar Pradesh states. Conclusions The model, which can be adopted in similar settings, demonstrated increased access as all requests were honored. Financial expenditures revealed can help in budget projections. Disease profile and types of consumables revealed can be used as basis for strengthening healthcare delivery systems of referring states
The study focuses on two social protection intervention, i.e. Mahatma Gandhi National Rural Employment. Guarantee Scheme (MGNREGS) and the National Rural Health Mission (NRHM) linked to the economic and social aspects of the SDGs in India. The findings of the study show that these programmes are facing three major challenges, in terms of strategy, engagement and evaluation. Thus, the study proposes to strengthen the means of implementations through increased partnership among stakeholders in planning, convergence and coordination of different interventions, diversify resources and share knowledge on the SDGs in this regard.The study highlights the varation in access across social groups.
This paper focuses on health policy making and health financing strategies historically and shows how globalisation processes, specifically structural adjustment programs under World Bank oversight structurally altered health sector development in India taking it on a path of growing inequity. It concludes with reemphasising that healthcare is a public good and cannot be left to the vagaries of the market. To realise its social or public value it has to be organized and regulated using both public and private resources for social benefit. Such is the global experience where healthcare is universally accessible with equity. Why should it be different in India?
2018
Background: Prior experience and the persisting threat of influenza pandemic indicate the need for global and local preparedness and public health response capacity. The pandemic of 2009 highlighted the importance of such planning and the value of prior efforts at all levels. Our review of the public health response to this pandemic in Pune, India, considers the challenges of integrating global and national strategies in local programmes and lessons learned for influenza pandemic preparedness. Methods: Global, national and local pandemic preparedness and response plans have been reviewed. In-depth interviews were undertaken with district health policy-makers and administrators who coordinated the pandemic response in Pune. Results: In the absence of a comprehensive district-level pandemic preparedness plan, the response had to be improvised. Media reporting of the influenza pandemic and inaccurate information that was reported at times contributed to anxiety in the general public and to widespread fear and panic. Additional challenges included inadequate public health services and reluctance of private healthcare providers to treat people with flu-like symptoms. Policy-makers developed a response strategy that they referred to as the Pune plan, which relied on powers sanctioned by the Epidemic Act of 1897 and resources made available by the union health ministry, state health department and a government diagnostic laboratory in Pune. Conclusion: The World Health Organization's (WHO's) global strategy for pandemic control focuses on national planning, but state-level and local experience in a large nation like India shows how national planning may be adapted and implemented. The priority of local experience and requirements does not negate the need for higher level planning. It does, however, indicate the importance of local adaptability as an essential feature of the planning process. Experience and the implicit Pune plan that emerged are relevant for pandemic preparedness and other public health emergencies. Implications for policy makers • Evidence generated through the experience of the 2009 H1N1 influenza pandemic should be acknowledged. Analysis of the response and consideration of findings should strengthen planning for preparedness. • Findings from our review consider strategies for ongoing activities, including continued public health surveillance of influenza, guidelines for criteria-based diagnosis and the need to ensure effective communication among all concerned stakeholders. • Specific efforts are required to formulate national policies for influenza vaccination and to promote awareness of the status of primary healthcare providers as a high-risk group that should be vaccinated, and the priority for them to vaccinate their patients. • Colonial legislation played a major role in developing a pandemic response in Pune, but it is important to update such legislation to acknowledge experience and support pandemic management strategies. Implications for the public The threat of recurrence of an influenza pandemic indicates a need not only for vigilance and preparedness of policy-makers but also the priority of community awareness. A strategy to explain risks and recommendations to the public is a fundamental interest and responsibility of the health system for managing future outbreaks. Our analysis of experience of the 2009 pandemic in Pune and implications incorporated in the Pune plan are relevant to engage the public in pandemic response planning. Abstract In a recent article, Gorik Ooms has drawn attention to the normative underpinnings of the politics of global health. We claim that Ooms is indirectly submitting to a liberal conception of politics by framing the politics of global health as a question of individual morality. Drawing on the theoretical works of Chantal Mouffe, we introduce a conflictual concept of the political as an alternative to Ooms' conception. Using controversies surrounding medical treatment of AIDS patients in developing countries as a case we underline the opportunity for political changes, through political articulation of an issue, and collective mobilization based on such an articulation. Citation: Askheim C, Heggen K, Engebretsen E. Politics and power in global health: the constituting role of conflicts: Comment on " Navigating between stealth advocacy and unconscious dogmatism: the challenge of researching the norms, politics and power of global health.
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2018, IJSR
Ayushman Bharat-National Health Protection Scheme (AB-NHPS) is the largest government-sponsored healthcare scheme in the world aimed to provide healthcare facilities to over 10 crore families (8.03 crore families in rural and 2.33 crore in urban areas will be entitle), covering urban and rural poor families as per the socio-economic census of 2011. It will also benefit the lower middleclass, middle-class and upper-middle class by job opportunities in the medical sector as new hospitals will open in Tier-2 and Tier-3 cities. This scheme is targeted at poor, deprived rural families and identified occupational categories of urban workers' families. To ensure that nobody is left out (especially women, children and the elderly), there will be no cap on the family size and age under the ABNHPS. The scheme will be cashless and paperless at public hospitals and empanelled private hospitals. It will cost the exchequer around INR 5,000 crore this year because of the time taken to rollout the scheme. The scheme will cost INR 10,000 crore when it is rolled out across India next year. AB-NHPS is largely seen credit positive for insurance companies as it will aide in higher premium growth as it will help grow health premiums and provide insurers with cross-selling and servicing opportunities. At a time when cost of private health care is shooting up, a universal health insurance scheme is expected to be lapped up by the poor. The scheme can be a step in the right direction to reach out to the poorest of the poor just before the next elections. Will NHPS ensure healthcare for all and wellness for all is a matter of time to see.
2008, Journal of Health Management
Background: Over 80% of global deaths caused by cardiovascular disease (CVD) and diabetes (DM) occur in developing countries. The burden of non-communicable disease (NCDs) in South Asia is increasing rapidly. Objectives: To estimate the costs of CVD and the costs of DM to individuals and society in Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. Methods: We systematically searched six health and economic databases for studies identifying costs related to CVD or DM and their respective complications. Costs were extracted from included studies and converted to US$ for the price year 2015 to enable meaningful comparisons. Results: Of the 71 articles suitable for full text review, 29 studies met the inclusion criteria. The majority were cost of illness studies (n=27) and were from the patient perspective (n=23). Most collected data since 2000 (n=23) and included data from India (n=24). No studies included longitudinal costs at the patient level. Medical costs for routine management of CVD and DM were broadly similar. These costs escalate significantly once complications occur which require treatment, particularly for stroke, major coronary events and amputations. Costs are mainly borne by the individual and family. Some included studies modelled rapidly rising future costs. The majority of studies included had methodological weaknesses. Conclusions: Marked increases in costs have been identified when complications of these chronic diseases occur, underlining the importance of secondary prevention approaches in disease management in South Asia. Higher quality studies, especially those that include longitudinal costs, are required to establish more robust cost estimates.
This document reports the proceedings of a research-to-policy workshop that was organized as part of a multi-country cross-disciplinary research project on the private health care sector in urban poor neighbourhoods in India, Indonesia and Thailand, entitled "Health System Reform and Ethics: Private Practitioners in Poor Urban Neighbourhoods in India, Indonesia and Thailand". The project consisted of a combination of medical anthropological research among private (for-profit) practitioners and among people living in poor urban neighbourhoods; a health economics study among poor urban households and a desk study that assessed existing regulations and ethical guidelines in the three countries. The project period was April 2004 to December 2007. A number of other studies in the past have shown that the role of the private sector can be problematic, perhaps even more so in India than in the other participating countries. At the same time, there has been a push of public-private partnerships. The workshop intended to discuss the rationale, the benefits and limitations and risks of this strategy. Even if there are examples of successful partnerships that serve sound public health purposes, such partnerships may not address the structural problems that establish effective access barriers for the poor. Based on research that provided a critical assessment of the role of the private sector the workshop should develop relevant strategies to address public health problems related to the role of the private-for-profit health sector. The overall purpose of the project was to identify viable strategies for strengthening ethical practice in the private healthcare sector in poor neighbourhoods through feasible and locally acceptable control mechanisms and other possible means. It was believed that this is only possible through a combined understanding of patients’, private practitioners’ and drug vendors’ perspectives. Health ethics, in this connection, may be broadly understood as a consensus-based normative regulatory framework that primarily works to protect patients against iatrogenic adverse events when utilizing the health system. The existing scientific literature shows that a framework of this type is not in place, or is not working to the desired effect, in a number of countries in South- and Southeast Asia. The project consisted of four sub-studies that complemented each other in order to give a detailed and multi-faceted understanding of the local health systems under study: 1) Existing regulatory mechanisms, including ethical codes and legislation with direct implications for general private practitioners: desk study 2) Health systems ethics among private practitioners: ethnographic sub-study 3) Family-level treatment and health-related decision-making: interview sub-study 4) Household survey: health economics sub-study The project was funded by the Danida Council for Development Research (RUF, after 2006 renamed to FFU) with a budget of four million DKK covering a period of three years (2004-07). The workshop During 20-22 June 2007, a 3-day workshop was held at Naresuan University, Phitsanulok, Thailand, to disseminate findings of this and related research in the region and develop policy implications.