1. Universalizing Access to Quality Primary Healthcare
In India
Team Details:
Jaya Tibrewal
Nishant Goel
Rohit Gupta
Shagun Chaudhry
Sonal Chaudhary

2. A) The Infant Mortality Rate and Maternal Mortality Rate in India is still very high even after 66 years of independence
• Infant mortality rate is 51/1000 in rural India
• Contagious and poverty related diseases are not contained at primary level
• 72% infants & 52% married women in India have anaemia,44% under the age of 5 are underweight
• Maternal mortality rate:200 deaths/100000 live births
Inference: Anganwadi is obsolete in India with respect to the current scenario, isn’t performing as it was envisioned to
B) The major reason for deaths in rural India is due to lack of healthcare services in life and death situations
• 46000 people die annually due to snake bites as they don’t get timely treatment
• 110000 people die annually due to non availability of ambulance in emergency
Inference: In times of emergency healthcare infrastructure of India is handicapped/inadequate
C) There is a paucity of medical practitioners in rural India due to which people don’t get medical attention
• Doctors available per 1000 of urban population=2.97
• Doctors available per 1000 of rural population=0.7
• The potential of more than a million pharmacists remains untapped in India
Inference: Though India churns out many doctors every year, there is a serious shortfall of trained personnel in rural areas
D) India pharmacy Industry losing 500 Cr. every year on account of expired medicines
• 66% of rural Indians do not have access to critical medicine
Inference: High monetary loss to country by expiry of medicines and vaccinations arising out of mismanagement
E) Amongst developing countries India’s spending on IT healthcare is one of the lowest
• Access to specialized care is limited in rural India
• No database maintenance of people, their medical history
• No centralized system to keep records of medicines and their supply chain
Inference: Potential of IT remains untapped in India
Problem Statement

3. Solutions Implementation Impact
Performance-based pay
for Anganwadi workers
• The salary will have a fixed portion of 1500 and a variable portion of
0-3000 per month
• The evaluation will be done by the Panchayat in the same way ASHA is
evaluated
• Increase in motivation to do
work
Increasing the No. of
Active Anganwadi
workers per village
• The preference to be given to ladies with less household responsibility.
• Ensuring that people involved in anganwadi system are not involved in
any other panchayat activity
• Distribution of work will lead to
completion on goals
Providing On-Job training
to Anganwadi workers
• Minimum of 3-4 Workshops to be organised each year
• The responsibility of workshops will be of Panchayats
• Will help in preparation of
Anganwadi for newer diseases
and trends
Increasing Community
Participation
• Involvement of beneficiaries of the Anganwadi services to be made a
part of the plan designing (bottom up approach)
• Making Panchayat more accountable for the activities and progress of
Anganwadi units
• Making Anganwadi , a central place for community meetings
• Will ultimately lead to success of
entire initiative of universalising
primary healthcare
Strengthening the
Anganwadi
Infrastructure
• Providing Washroom facilities
• Increasing the children activity space
• Provision of integrating 2-3 small Anganwadi in a community into a
single Anganwadi
• Change in habits and practices of
villagers
• Change in perspective of villagers
towards healthcare
Proposed Solutions
 Strengthening the Anganwadi

4. Solutions Implementation Impact
• Building up a corpus fund
• The Fund might be used
to finance 24 hour
ambulance service –with
basic life support system
• Regulatory authority
responsible for carrying
out regular audits
• Extra grants from Govt. in
case of epidemics
• Presence of Ambulance help in
providing access to primary
healthcare by old-age and physically
disabled people (in case of
emergency)
• Catering to emergency medical
expenses of villagers
 Establishment of Rashtriya Swasthya Durbhash Kendra
• Establishment of 24x7
call centre network to
provide emergency
healthcare services to
people
• Anyone who needs to see a General Practitioner(GP) at night
or on the weekend, when their usual practice is closed, will be
able to contact local GP practice and have their call
automatically put through to the National Health Call Centre
Network
• Staffed by qualified health professionals. A nurse in the first
instance, and then a GP, if required,will assess the patient’s
needs and provide appropriate advice and options. If needed,
the GP will arrange for the patient to be seen by a local GP
• Cost Effective
• Healthcare a phone call away
Corpus
Fund
State Government
grants
Central Government
Grants
Contribution by Village
Community (Meagre
Amount)
 Corpus Fund for village emergencies
Flow of cash in Corpus Fund

5. Solutions
Provide them with
incentive to work
in rural and tribal
areas
Mainstreaming AYUSH • Formal recognition
of Family Medicine
as a special
discipline in
medicine.
Proper Training and
incentive to be
provided for higher
retention.
Involving them for
personalised
medication
Implementation
• Providing
lucrative career
path.
• Seats reserved
for Post
Graduation if
they serve for 3
years in rural
area.
• Awareness through
Campaigns-one stop
approach(discussed
later)
• Availability of Ayush
beyond PHC
level(phased
approach-discussed
later)
• Fellowships,
centralized training
programmes and
CMEs for talents in
AYUSH
• Provide
appropriate care
for various
diseases.
• Introducing a
family medicine
course in every
medical college.
• Career Path: Junior
Dr-->Personal
Physician -->Clinic
Head
• Increase Salaries.
• Provide good
career trajectory.
• Proper Security to
be provided -
Vicarious liability
of the
PHCs/Hospitals to
provide social
security to nurses
Inclusion of
practical course
relating to
prescription of
medicine.
Impact
Retention of
Physicians in Rural
India
• Cost effective
healthcare solution
• No side effects of
AYUSH
• Ensure a better
average level of
public health.
• Abridge the gap
between need and
availability of
doctors(MBBS).
Strengthening of
capacity and better
public health care.
• Turnaround Time
will decrease.
• Saves resources.
Human
Resources
MBBS
Doctors
AYUSH
Doctors
Family
Medicine
Nurses Pharmacists
 Tapping the potential of Human Resource.

6. PHC
GP GP GP GP GP
Workers
Integrated with
Village Panchayat
Committee/
Primary School
Teachers
Training
Phase II
• ASHA & Anganwadi
• PHC
Phase I
• Diagnostics
• Awareness , AYUSH
and disease related
• Greater ownership at the community ensuring people
translate this awareness into appropriate action.
• Awareness -peoples’ knowledge of the disease, its causes
and related precautions. common myths and
misconceptions,
• Interdepartmental(ID) and Inter-Sectoral (IS) coordination
• 4 per village( 2 women+ one youth +one teacher) are
part of the Campaign team for one village
• In phase 1 ,conducted each month ,team conducts
various diagnostic tests and awareness related to AYUSH.
• In phase 2 , the data collected was shared with other
stakeholders for further action.
• Municipal bodies (MB) to take initiative and ensure that
awareness activities are undertaken in all wards in their
operational area during the campaign month
• A core group comprising of the Municipal Commissioner ,
NGOs and social worker, would conduct the awareness
programme in one slum area every day during evening
• As colleges are on vacation during the month of May special
summer camps would be conducted by urban youth groups like
YMCA focusing on health, HIV/AIDS and other social issues.
• Awareness campaign should be made compulsory in every
industry facilitated by CII
MB
Create Teams For Campaign
on the Slums under that
particular MB
 One Stop Approach Focus: Preventive Care
Training
• Diagnostics
• Awareness
Database of
villagers
Database
Awareness
campaigns in talk
–shows , seminars
conducted by CII
1
2
4
3
5
6
1
2
3a
3b
4
IS /ID
GP-Gram Panchayat
1 Month
In Rural India
In Slums

7. Govt.
Supplier
District
Warehouse
2
District
Warehouse
1
PHC
PHC
PHC
AW
AW
AW
1
3
2
5
4 Order = PHC(Requirement) +
30-40 Anganwadi that
comes under that PHC
Order =Inventory Assessed
through data from
Phase 1 of One-Stop
Approach
CD
Traditional Model Proposed Model Implementation
Warehouses were overused in
the beginning & Underused
towards the end of the year
Warehouse inventory
maintained with economic order
quantity
Centralised Server to maintain records of medicine at district
warehouse to facilitate cross- warehouse medicine in times of
emergency
anganwadi(AW) and PHC have
a huge stock of expired
medicine
No Expired medicines at
anganwadi and PHC
Central Database (CD) will look for the nearest district warehouse with
readily available stock and place an order to ensure quick
delivery.(Interoperability)
 Revamping the Supply Chain Management System

8. Implementation Underlying Principal
Replacement of AYUSH gram methodology with Phased
Approach
As shown above.
Medicinal Plants(Self- Healing) grown in the backyards: Natural remedies based on ancient Indian medicinal system heals many basic
diseases.
Therapeutic Packages Provision of specialized packages for special health conditions which modern
medicines do not cover. For e.g. Intractable diseases, nutritional disorders like
anemia etc.
Intensive R and D Development of R and D based AYUSH for prioritized diseases.
Strengthen and upgrade the National AYUSH Institutes Performance based budgeting : Allocation criterion should reflect the current
status of each hospital: size, complexity of cases handled, the number of
service patients served etc.
Achieve national health outcome goals Assigning territorial responsibility to AYUSH colleges to achieve the national
health outcome goals.
Independent evaluations of major schemes Develop a robust system of independent mentoring and evaluation for all
major schemes.
Phase 1
Co-location of
AYUSH facilities
for every 15
villages.
Phase 2
Co-location of
AYUSH facilities
for every 10
villages.
Phase 3
Co-location of
AYUSH facilities
for every 5
villages.
One Stop
Approach
Promote
culture of Self-
Healing
Provide
evidence based
support on the
efficacy of
AYUSH
Organize free
Medical
Camps
 Phased Approach of establishment of AYUSH as a healthcare system
1 year 1 year

9. Solution Implementation Impact
Telemedicines
• Provide specialized training to doctors
• Spread awareness in people taking Panchayat’s support.
• Unify satellite networks of Private players like APOLLO and
provide ISROs services.
• Usage of mobile vans with fully equipped network and
other facilities.
• Create a seamless network of medical treatment
across the country, irrespective of infrastructure
constraints.
• Sharing of satellite service will lead to cost savings
for all the service providers.
UID
• Aadhar card includes Electronic Health Record of patient,
insurance details, diagnostic reports.
• Swiped at hospitals/PHCs across the country
• Data to be maintained by private companies
• Transmission of data about patient irrespective of
his current geography.
• Epidemic forecasting doing analysis of geographic
patient record.
Management
Information
system
• Database maintenance of beneficiaries.
• Includes Finance module, personnel module, grievance
redressal module, Target setting module.
• Can be used in disease forecasting, drug procurement.
• Automation of transactions, digitization of data.
• Complaints lodged can be traced.
• Spreading of information using omnipresent
cyberspace.
• Helps medical practitioner take critical decisions.
E-health
• Use existing IT infrastructure of e-panchayat.
• Hire one medical practitioner and field worker per village.
• Build and maintain database of village.
• Using Aakash tablet to access data on the cloud server
• GPS-enabled ambulances and mobile technology to send
follow-ups to families.
• IT enabled villages without spending much on
infrastructure.
• Survey results of field worker helps govt. design
new schemes tailor made for that area.
• Anywhere, anytime access to health data on the
cloud.
UID for storing patient health records,
disease forecasting and supply chain planning of medicines
Aakash tablet
distribution to health
workers in each village to
access data on the cloud
Merging e-panchayat
infrastructure with e
medicine making health
care reach the last mile.
Technician keeps record of data
and Promotes awareness among
villagers about sanitation,
hygiene ad first aid, animal bites.
Unify satellite
networks of
service providers
of telemedicines
Use of MIS-management information system to
identify beneficiaries, disease forecast, drug
procurement, grievance redressal module
 Integrating Healthcare with IT

10. Genre of Challenge Challenges Mitigation Measures
Social Challenges • Rigidity and reluctance on the part of
the villagers
• Adaptability to new system
• Inclusion of community
• Creating awareness using Media ,
Nukkad Naatak
Economic • Misuse of Funds
• Fund might prove insufficient to cater
the needs of many people at one
time.
• Tracking of fund through MIS
• Levying health cess
Political Bottlenecks to enforcement of policy Increase in pubic expenditure
Technical • Cost and privacy constraints of data
maintenance on the cloud
• Maintenance cost incurred due to
private sector’s role
• Giving access to limited authority
• Strong Security system to be placed
Human Resource Existence of quackery in the current
system
Removal of quackery from system by
strengthening human resource as
discussed earlier
Challenges and Mitigation Measures