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Equity in Health Care vs Inequity = Under Served Geographic Economic Social Road Access Poverty, Class Stigma
Geographic Under Served North Bengal Tea Gardens Char/ Islands Paschimanchal
NPSP UDJ 2009-10 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Measles Outbreak Map
Coverage Evaluation Survey West Bengal 2009 Economic Inequity/ Poverty affects Services
Strongest association with Female Literacy MAPEDIR Purulia Literacy status of Mothers who Died  47.2 48.33 40.2 34.9 31.67 37.4 7.5 12.1 13.2 12.5 10.3 4.7 0% 20% 40% 60% 80% 100% May 2005 – July 2006 July 2006-September 2007 May 2008 - March 2010 Illiterate Upto 8th Standard 9th Standard & above DNK
Map of maternal deaths MAPEDIR Purulia 2005 2006 2007 2008 2009 2010 (Jan-Jul) DECREASING NUMBER OF REPORTED MATERNAL DEATHS BLOCK-WISE PROGRESS
Social Factors affect Immunization Coverage Evaluation Survey West Bengal 2009
AWC Outreach Govt Hosp Coverage Evaluation Survey West Bengal 2009
Map Health Problems Infectious  Acute   Chronic     ARI/ Pneumonia/ Otitis TB Malaria Leprosy Measles Filaria Diarrhoea  Kala  Azar HIV Detecting and preventing hypertension in remote areas Barun Mukhopadhyay  http://www.issuesinmedicalethics.org/144oa124.html   Non Infectious    Acute  Chronic Snakebite BP Injury   Diabetes Drowning Asthma   Blindness Deafness Mental   Congenital      Cancer    RCH Maternal  Neonatal Malnutrition
What Is To Be Done Community- Outreach- Clinic/ Facility-
What Is To Be Done Community ASHA/ 2nd ANM Zinc + ORS for Diarrhoea IMNCI Referral Transport Local Practitioners/ Tea Gardens CHCMI/ VHSC Sanitation/ ICDS/  Iodine/ Vitamin A/ Iron
What Is To Be Done Outreach -Need Based Plans -Flexibility Brick Kilns Bidi Workers -Additional Funds SHG/ NGO role
What Is To Be Done Clinic/ Facility - Government- Quality - NGO/ PPP- Access - Continuum of Care (MCH/ Neonatal)‏ - AMO - Certification of Private Providers (ISO)
What Is To Be Done Support and Monitoring - Drug Supply - Laboratory - IT (mobile/ internet/ tele- medicine) - Surveillance - Verbal Autopsy/ Death Review Primary Health Care- Indian Scenario  WHO Country Office for India (HSD) August 2008
First-sustain rapid diagnostic kits, ACT and funds.  Reach sufficient coverage (80%) of bed nets, particularly to BPL Second, orient MO in PHC -early referral of malaria with complications.  Third, community awareness to seek prompt treatment. Fourth, spray teams must catch up DDT spraying Fifth, orient private practitioners -appropriate anti-malarials, management of severe malaria and early referral.  PPP with tea gardens Risk factors for malaria deaths in Jalpaiguri district, West Bengal, India: evidence for further action J Sarkar et al Malar J. 2009; 8: 133. Published online 2009 June 16
The Way Forward Improving health in India will require building up the health system in the next ten to twenty years.  Five core concerns emerge when facing the challenge of improving health in India: (i) promoting equity by reducing household expenditure on total health spending and experimenting with alternate models of health financing; (ii) restructuring the existing primary health care system to make it more accountable; (iii) reducing disease burden and the level of risk; (iv) establishing institutional frameworks for improved quality of governance of health;  IV. ( Regulations and institutional infrastructure for coping with health markets) (v) investing in technology and human resources for a more professional and skilled workforce and better monitoring Report of National Commission for Macroeconomics and Health 2005
Reducing household expenditures of the poor: Options for financing comprehensive health care 1. a core package consisting of public goods and costing Rs 150 per capita, to be made universally accessible at public cost; 2. a basic package consisting, in addition to the above, surgery and medical treatment costing Rs 310 per capita; and 3. a secondary care package costing Rs 700 per capita and consisting of treatment for vascular diseases, cancer and mental illness, and referrals Innovative financing models must be tried to ensure that such packages are universally accessible Report of National Commission for Macroeconomics and Health 2005

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Under served in west bengal health rev

  • 1. Equity in Health Care vs Inequity = Under Served Geographic Economic Social Road Access Poverty, Class Stigma
  • 2. Geographic Under Served North Bengal Tea Gardens Char/ Islands Paschimanchal
  • 3.
  • 4. Coverage Evaluation Survey West Bengal 2009 Economic Inequity/ Poverty affects Services
  • 5. Strongest association with Female Literacy MAPEDIR Purulia Literacy status of Mothers who Died 47.2 48.33 40.2 34.9 31.67 37.4 7.5 12.1 13.2 12.5 10.3 4.7 0% 20% 40% 60% 80% 100% May 2005 – July 2006 July 2006-September 2007 May 2008 - March 2010 Illiterate Upto 8th Standard 9th Standard & above DNK
  • 6. Map of maternal deaths MAPEDIR Purulia 2005 2006 2007 2008 2009 2010 (Jan-Jul) DECREASING NUMBER OF REPORTED MATERNAL DEATHS BLOCK-WISE PROGRESS
  • 7. Social Factors affect Immunization Coverage Evaluation Survey West Bengal 2009
  • 8. AWC Outreach Govt Hosp Coverage Evaluation Survey West Bengal 2009
  • 9. Map Health Problems Infectious Acute Chronic ARI/ Pneumonia/ Otitis TB Malaria Leprosy Measles Filaria Diarrhoea Kala Azar HIV Detecting and preventing hypertension in remote areas Barun Mukhopadhyay http://www.issuesinmedicalethics.org/144oa124.html Non Infectious Acute Chronic Snakebite BP Injury Diabetes Drowning Asthma Blindness Deafness Mental Congenital Cancer RCH Maternal Neonatal Malnutrition
  • 10. What Is To Be Done Community- Outreach- Clinic/ Facility-
  • 11. What Is To Be Done Community ASHA/ 2nd ANM Zinc + ORS for Diarrhoea IMNCI Referral Transport Local Practitioners/ Tea Gardens CHCMI/ VHSC Sanitation/ ICDS/ Iodine/ Vitamin A/ Iron
  • 12. What Is To Be Done Outreach -Need Based Plans -Flexibility Brick Kilns Bidi Workers -Additional Funds SHG/ NGO role
  • 13. What Is To Be Done Clinic/ Facility - Government- Quality - NGO/ PPP- Access - Continuum of Care (MCH/ Neonatal)‏ - AMO - Certification of Private Providers (ISO)
  • 14. What Is To Be Done Support and Monitoring - Drug Supply - Laboratory - IT (mobile/ internet/ tele- medicine) - Surveillance - Verbal Autopsy/ Death Review Primary Health Care- Indian Scenario WHO Country Office for India (HSD) August 2008
  • 15. First-sustain rapid diagnostic kits, ACT and funds. Reach sufficient coverage (80%) of bed nets, particularly to BPL Second, orient MO in PHC -early referral of malaria with complications. Third, community awareness to seek prompt treatment. Fourth, spray teams must catch up DDT spraying Fifth, orient private practitioners -appropriate anti-malarials, management of severe malaria and early referral. PPP with tea gardens Risk factors for malaria deaths in Jalpaiguri district, West Bengal, India: evidence for further action J Sarkar et al Malar J. 2009; 8: 133. Published online 2009 June 16
  • 16. The Way Forward Improving health in India will require building up the health system in the next ten to twenty years. Five core concerns emerge when facing the challenge of improving health in India: (i) promoting equity by reducing household expenditure on total health spending and experimenting with alternate models of health financing; (ii) restructuring the existing primary health care system to make it more accountable; (iii) reducing disease burden and the level of risk; (iv) establishing institutional frameworks for improved quality of governance of health; IV. ( Regulations and institutional infrastructure for coping with health markets) (v) investing in technology and human resources for a more professional and skilled workforce and better monitoring Report of National Commission for Macroeconomics and Health 2005
  • 17. Reducing household expenditures of the poor: Options for financing comprehensive health care 1. a core package consisting of public goods and costing Rs 150 per capita, to be made universally accessible at public cost; 2. a basic package consisting, in addition to the above, surgery and medical treatment costing Rs 310 per capita; and 3. a secondary care package costing Rs 700 per capita and consisting of treatment for vascular diseases, cancer and mental illness, and referrals Innovative financing models must be tried to ensure that such packages are universally accessible Report of National Commission for Macroeconomics and Health 2005

Notes de l'éditeur

  1. High Level Expert Group (Planning Commission)- Universal Health Care Access Oct 2010 World Health Report 2010: Health Systems Financing, the path to universal coverage National Commission for Macroeconomics and Health 2005 Peoples Health Assembly Savar (Dhaka)‏ Health for All 2000
  2. Boat Clinics Districts- Government of India list Blocks- Health on the March (Literacy, CBR)‏ Backward Villages- Womens Literacy, Womens Participation in Income Generating Activities Urban Slums
  3. Goalpokher-II & Karandighi have RI coverage Less than district coverage for last three years. -NPSP/ MIS of Health Deptt
  4. India ANC 11.5 % for poorest quintile 47.4 % for highest quintile
  5. - Immunization 45.3 % for illiterates - India 76.6 % for 12 years in school - ANC 12 % for illiterates -India 50.5 % for 12 years in school - ANC 11.5 % for poorest quintile - India 47.4 % for highest quintile
  6. Sub Centre 60.5% West Bengal - 18.9 % India AWC - 5.4% West Bengal - 25.6 % India Govt Hospital 16.6% West Bengal - 24.2 % India PHC 4.4% West Bengal - 12.5 % India Private 5.7 % West Bengal - 10.2 % India Outreach 7.4% West Bengal - 8.7 % India
  7. Diarrhoea Treatment- 9.2 % by Government WB - 65.7 % by private No Treatment outside 25.6% ARI Treatment- 12.9 % by Government WB - 67 % by private No Treatment outside 22.2%