This document discusses improving primary healthcare in India through a public-private partnership (PPP) model called PCT. The PCT model involves PPP where private partners manage public primary health centers and provide free services. It also involves a community-based health insurance program where premiums are indexed to income to subsidize healthcare for the poor. The model leverages telemedicine to expand access to healthcare in rural and remote areas. While this approach could improve access, efficiency and quality of care, challenges like lack of policy strategy and oversight would need to be addressed through pilot testing and performance evaluations.

1. HEALING TOUCH:
Universalizing access to quality
primary healthcare
PRESENTED BY
TEAM: SANJEEVANI 2

2. PRIMARY HEALTH CARE
 Last year the Central government said
it would set aside Rs. 28,560 crore over
five years to provide essential
medicines free and cover 57% of the
population
 Latest budget barely finds any mention
for a provision of this kind, instead is a
nominal increase in outlay by Rs. 457
crore
 An advisor of the World Bank states:
“Rs. 100 crore worth of drugs were
procured. But the health secretary did
not know what to do with drugs worth
Rs. 35 crore. There was no demand.”
“Suction equipment worth Rs. 150
crore being dumped in toilets.”
 In some parts of country, people have
MALDISTRIBUTED PROMISED
PROGRAMMES
 UNIVERSAL HEALTH COVERAGE
 NATIONAL URBAN HEALTH
MISSION
 RURAL HEALTH MISSION
 FREE ESSENTIAL MEDICINES
 RASHTRIYA SWASTHIYA BIMA
YOJANA
UNDERDEVELOPED PRIMARY
HEALTHCARE
Like building up a bee comb for years together and
not oozing out even a drop of honey…!!!!

3. CURRENT SCENARIO

4. Only have some for of insurance
Have to borrow money or sell their assets to
meet their health care expenses
Indians slip below the poverty line because of
hospitalization due to a single bout of illness
Global diseases burden
Highest among countries with a high rate of HIV-
infected persons
10
%
40
%
25
%
21
%
3rd
 Maternal and Infant Mortality Rates in India’s poorest districts are worse than the sub-
Saharan Africa.
 Allopathic physicians are highly concentrated in urban areas compared to rural areas
(13.3 and 3.3 per 10,000 population, respectively).
 Out of the 660,856 doctors registered in India, only 12% are in the public sector.
Public spending on health
care in India is as low as
0.9% of the Gross
Domestic Product (GDP)
in contrast to a total
health expenditure of 5%
of GDP making public
health expenditure a mere
17%.
FACTS AND FIGURES

5. PCT MODEL
P
• Public Private
Partnership
C
• Community
Health Insurance
T
• Telemedicine:
Leveraging
Technology

6. PPP: Public Private Partnership
 RATIONALE TO COLLABORATE
 Given respective strengths and weaknesses, neither the public sector nor
private sector alone is in the best interest of the health system
 CONTRACTING MANAGEMENT OF PRIMARY HEALTH CENTRES:
Free services- diagnosis, consultation, treatment and drugs.
 CONTRACTING MANAGEMENT OF COMMUNITY HEALTH
CENTRE: Except select surgeries all services are free for poor patients
 CONTRACTING MANAGEMENT OF DIAGNOSTICS: Free for all poor
Patients; Subsidized rate for others

7.  In cross subsidization schemes, premiums are indexed to the member's income, and
access to health care for the poor is as good as (or better) than that for the wealthy. In
such schemes, wealthy members subsidize health care costs for poorer members.
Community Based Health Insurances
 The social security scheme's annual premium is Rs.72.5, Rs.30 of which is
earmarked for medical insurance, covered to a maximum of Rs.1200/year in case of
hospitalization.
 Women can also become lifetime members of the social security scheme by making
a fixed deposit of Rs.700 rupees — interest on this deposit is used to pay the annual
premium, and the deposit is returned to the woman when she turns 58.
Self Employed Women's Association's Integrated Social Security Scheme
Making aware to the whole community (below poverty line) and non-secured
women laborers can improve Health Care System. Educating them and
driving them to such participation can lessen down the problems.
Proposed Solution:

8.  Insurance coverage according to the members' income groups
 Protection to claimants from expenses arising from hospitalization (with
catastrophic costs i.e >10% consumption of person’s annual income)
 Reducing the lag time between discharge from hospital and reimbursement
Studies have been done on this subject and benefitted community
in the following ways:

9. Telemedicine in India
• ISRO has the following Telemedicine Program in India:
1) Remote/Rural Hospitals and Specialty Hospitals
2) Continuing Medical Education (CME)
3) Mobile Telemedicine Units
4) Disaster Management Support (DMS).
Telemedicine during Tsunami
The ISRO’s Telemedicine facilities at three hospitals -GB Pant Hospital, INHS Dhanvantari at Port Blair,
Andaman Island and Bishop Richardson Hospital at Car Nicobar along with ISRO Grama sat network at eight
islands was effectively used during post Tsunami disaster relief work for the benefit of the remote population of
Andaman and Nicobar Islands. More such Telemedicine centers are being planned at the primary health centers
of various islands of Andaman and Nicobar in India
TELEMEDICINE
“The delivery of healthcare services, where distance is a critical factor, by all healthcare
professionals using information and communication technologies for the exchange of valid
information for diagnosis, treatment and prevention of disease and injuries, research and
evaluation, and for continuing education of healthcare providers, all in the interests of advancing
the health of individuals and their communities” (WHO,2008).

10. imPaCT
Improve Access &
Reach
Improve Equity
(Reduce out of
pocket expenses)
Better Efficiency
Opportunity to
Regulate &
Accountability
Improve Quality/
Rational Practice
Imbibe Best
practices
Augment
Resources-
Funds,
Technology, HR

11. Challenges and Mitigation
•Mishandling or
Misuse of
technology
•Lack of penal
authority
•Concept risk
•May not attract
enough players
•Lack of Policy
Driven
Strategy- thus
lack continuity
Political Economic
TechnologicalSocial- Legal
Mitigation:
Well defined health
objectives/ Goals
 Prior Consultation
 Pilot Testing
Timely Payment
Performance
evaluation
Supervision &
Monitoring
Periodic review of
contract clauses

12. 1. Bull World Health Organ vol.80 n.8 Genebra Aug. 2002
2. Disaster Medicine, Telemedicine and Integrated Vector Control: United Nation’s Space Technology
Program for Disaster Management, Journal of Biology and Life Science
ISSN 2157-6076, 2011, Vol. 2, No. 1: E3
3. Forbes India Magazine - India's Primary Health Care Needs Quick Reform
4. Health and Population- Perspectives & Issues 8(3): 135-167, 1985
PRIMARY HEALTH CARE IN INDIA
5. FROM PHILANTHROPY TO HUMAN RIGHT: A Perspective for Activism in the Field of Health Care
Dr. Amar Jesani
6. Strengthening of Primary Health Care: Key to Deliver Inclusive Health Care
Rajiv Yeravdekar, Vidya Rajiv Yeravdekar, M. A. Tutakne, *Neeta P. Bhatia, Murlidhar Tambe
7. THE PHARMA INNOVATION - JOURNAL
Telemedicine- An Innovating Healthcare System In India
Vol. 2 No. 4 2013 www.thepharmajournal.com Page | 1
Debjit Bhowmik, S.Duraivel, Rajnish Kumar Singh, K.P.Sampath Kumar*
8. PUBLIC-PRIVATE PARTNERSHIP IN HEALTH CARE : CONTEXT, MODELS, AND LESSONS by
A.Venkat Raman, Faculty of Management Studies,University of Delhi, India
REFERENCES