1. INDIAN HEALTH SYSTEM- AN OVERVIEW

2. MAN AND MEDICINE :TOWARDS HEALTH FOR ALL

4. Medicine was dominated by magical and religious beliefs which were an integral part of ancient cultures and civilizations.

6. Since man’s knowledge was limited, the primitive man attributed disease, all human sufferings and calamities to wrath of gods, invasion of body by evil spirits and malevolent influence of stars and planets

7. The concept of disease is known as “supernatural theory of disease”

8. They used to perform surgeries like circumcision, amputations and trephining of skulls with improvised stone and flint instruments

10. Ayurveda by definition implies the “knowledge of life” or the knowledge by which life may be prolonged. Its origin is traced back to the Vedic times, about 5000 B C.

11. Hygiene was given an important place in ancient Indian Medicine. Medical Historians admit that Indian medicine has played in Asia the same role as the Greek Medicine in West for it has spread in Indochina, Indonesia, Tibet, Central Asia, and Japan, exactly as the Greek Medicine has done in Europe and Arab Countries.

13. Egyptian Medicine – one of the oldest civilizations in about 2000 B. C where art of medicine was mingled with religion.

14. Mesopotamian Medicine – “Cradle of Civilization” 6000 years ago.

15. Greek Medicine – 460 – 136 B. C; the Greeks enjoyed the reputation – the civilizers of the ancient world, taught people to think in terms of why and how

16. Roman Medicine – First Century B.C; While the politics of the world became Roman, medicine remained Greek.

18. Revival of Medicine – 1453 – 1600 A D – an age of individual scientific endeavor; Paracelsus helped turn medicine towards rational research; Fracastorius, an Italian physician enunciated the “theory of contagion”; Ambriose Pare advanced the art of surgery.

19. 17th and 18th Centuries – Harvey’s discovery of the circulation of blood, Leeuwenhoek’s microscope, Jenner’s vaccination against small pox etc

20. Sanitary Awakening in England in mid nineteenth century

21. Rise of Public Health in England around 1840.

23. After 1900, medicine moved towards specialization. Multi-factorial causation of disease was put forward by Pettenkoefer.

24. Development of anti-viral vaccines like for Polio, Small Pox

25. Discovery of synthetic insecticides such as DDT, HCH, malathion etc

26. Discovery of drugs, chemoprophylaxis

27. Concept of disease eradication

29. Healthcare revolution in terms of

30. Health for all by 2000

31. Concept of Primary Healthcare

32. Millennium Development Goals in 2000

35. 325 languages spoken – 1,652 dialects

36. 18 official languages

37. 29 states, 5 union territories

38. 3.28 million sq. kilometers - Area

39. 7,516 kilometers - Coastline

40. 1.1 Billion population.

41. 5600 dailies, 15000 weeklies and 20000 periodicals in 21 languages with a combined circulation of 142 million.

42. GDP $576 Billion. (GDP rate 8%)

43. Parliamentary form of Government

44. World’s largest democracy.

45. World’s 4th largest economy.

46. World-class recognition in IT, bio-technology and space.

47. Largest English speaking nation in the world.

48. 3rd largest standing army force, over 1.5Million strong.

49. 2nd largest pool of scientists and engineers in the World.

50. 5,000 year old ancient civilization

51. 325 languages spoken – 1,652 dialects

52. 18 official languages

53. 29 states, 5 union territories

54. 3.28 million sq. kilometers - Area

55. 7,516 kilometers - Coastline

56. 1.1 Billion population.

57. 5600 dailies, 15000 weeklies and 20000 periodicals in 21 languages with a combined circulation of 142 million.

58. GDP $576 Billion. (GDP rate 8%)

59. Parliamentary form of Government

60. World’s largest democracy.

61. World’s 4th largest economy.

62. World-class recognition in IT, bio-technology and space.

63. Largest English speaking nation in the world.

64. 3rd largest standing army force, over 1.5Million strong.

66. But in terms of service delivery it is more concerned with the state.

67. The center is responsible for health services in union territories without a legislature and is also responsible for developing and monitoring national standards and regulations, linking the states with funding agencies, and sponsoring numerous schemes for implementation by state governments.

69. FAMILY PLANNING 1952

70. GREEN REVOLUTION 1967 - 1977

71. NATIONAL HEALTH PROGRAMS – From 1957

72. NATIONAL HEALTH POLICY – 1982 & 2002

73. NRHM 2005

77. Public health investment 0.9% of GDP

78. Budget allocation for health 1.3% of central budget

79. Govt expenditure 25%

81. State budgetary allocations reduced from 7% to 5.5%

82. India's health budget has gone up by nearly Rs.4000 crore to Rs.21113.33 crore ($4.35 billion) (www.thaindian.com/newsportal/.../public-health-infrastructure )

83. India’s medical infrastructure at a glance 5,097 hospitals 8,70,161 hospital beds 5,03,900 doctors 7,37,000 nurses 162 medical colleges Source: Review of Health Care in India, 2005

86. Reducing Infant Mortality Rate (IMR) to 28 per 1000 live births

87. Reducing total fertility rate (TFR) to 2.1

88. Providing clean drinking water for All by 20009 and ensuring no slip backs

89. Reducing malnutrition among children of age group 0-3 to half its present level

90. Reducing anemia among women and girls by 50%

94. Rural Hospital

95. District Hospitals/health centres

96. Specialist Hospitals

100. Public and Private sectors The majority of healthcare services in India are provided by the private sector. At present, India’s healthcare burden has gone beyond the Government’s budgetary applications. The increased spending power middle class is driving growth opportunities for corporate healthcare providers. Factors like privatization of medical insurance are making the market more attractive for international and national corporate players. The Government has taken an initiative to institutionalize a mechanism of public-private partnerships (PPP) in healthcare, right up from the district level.

102. Yet shortfall by 16% in PHCs and 58% in CHCs

103. PHI not satisfying as service delivery hampered by policy and management concerns

104. Non availability of staff

105. Weak referral system

106. Recurring funding shortfalls

108. Poor availability and access

109. Unsatisfactory work of the PHI

110. So poor seeking private health care

111. Only 20% of OPD and 45% of inpatient care obtained from govt health infrastructure while the rest is from the private sector

113. The Mission adopts a synergistic approach by relating health to determinants of good health viz. segments of nutrition, sanitation, hygiene and safe drinking water.

115. pooling resources

116. integration of organizational structures, optimization of health manpower

117. decentralization and district management of health programmes

118. Community participation and ownership of assetsInduction of management and financial personnel into district health system

119. Operationalizing community health centers into functional hospitals

120. Meeting Indian public health standards in each block of the countrySource: http://www.mohfw.nic.in/NRHM.htm

121. PUBLIC Health foundation of india The Public Health Foundation of India (PHFI) is a response to redress the limited institutional capacity in India for strengthening training, research and policy development in the area of Public Health. It is a public private partnership that was collaboratively evolved through consultations with multiple constituencies *Source: www.phfi.org

123. The PHFI focuses on broad dimensions of public health that encompass promotive, preventive and therapeutic services, many of which are frequently lost sight of in policy planning as well as in popular understanding.*Source: www.phfi.org

125. Inpatient care more in govt sector since low cost rather than quality

126. Emphasis on secondary and tertiary care

127. Not mandatory to register so no clear picture

128. Unregulated, with serious complaints of poor quality, over charging, and unethical behavior.

129. Accounts for

130. 1. 67% of total 30,000 hospitals

131. 2. 33% of 1,000,000 beds

133. No of doctors per 1000 low as per WHO norms

134. Investment range to bridge gap in next 10 yrs from 100,000 to 140,000 crores

135. Can create huge income and employment growth in next 10 years

136. Govt should encourage private, social and community insurance

138. Health insurance

139. Regional licensing of HI business and HI schemes as Yeshaswini etc

140. Cost benefit analysis of ESI

141. Cost of care can be contained

142. Improvement in public sector service levels

143. Referral systems enforcement

144. Controlling infectious diseases

146. Private firms are now thought to provide about 60% of all outpatient care in India and as much as 40% of all in-patient care.

148. STATISTICS

149. Achievements Through The Years - 1951-2000 Source: National Health Policy 2002

150. Achievements Through The Years - 1951-2000 Source: National Health Policy 2002

151. Differentials in Health Status Among States Source: National Health Policy 2002

153. Eliminate Leprosy 2005

154. Eliminate Kala azar 2010

155. Eliminate Lymphatic Filariasis 2015

156. Achieve zero level growth of HIV/AIDS 2007

158. Reduce IMR to 30/100 and MMR to 100/Lakh 2010

160. Further Increase to 8% of the budget 2010Source: National Health Policy 2002

161. Differentials in Health status Among Socio-Economic Groups Source: National Health Policy 2002

162. Indicators

163. Public Health Spending in select Countries

165. Declining Public Investments and Expenditures in Health and Healthcare

166. Breakdown of the Public Health System

167. Access to Basic Healthcare Declining

168. Absence of Regulation and Control, and Quality Standards in Private Healthcare

171. A survey by NCAER, an independent economics research agency, suggests that per-capita expenditures on healthcare rise with higher education levels. Households that have higher education levels tend to spend more per illness than households with lower education levels.

173. With diagnostic tests in India being inexpensive, India also has the potential to emerge as a hub for preventive health screening.

176. Pathology Services: The US$ 500 million domestic pathology industry has been growing over the last five years at an estimated Compound Annual Growth Rate (CAGR) of 20 per cent per annum. It currently comprises almost 2.5 per cent of the overall healthcare delivery market. The major players are Dr. Lal’sPathlabs, Metropolis, SRL Ranbaxy, Thyrocare, and Nicholas Piramal.

178. Apart from state of the art facilities, India provides low-cost treatments which is what makes it so attractive to foreign customers.According to a joint study by the Confederation of Indian Industry and McKinsey, Indian medical tourism was estimated at $350 million in 2006 and has the potential to grow into a $2 billion industry by 2012.4. To encourage the growth of medical tourism, the government also is providing a variety of incentives, including lower import duties and higher depreciation rates on medical equipment, as well as expedited visas for overseas patients seeking medical care in India.

180. India has the potential to attract one million medical tourists eachyear, which could contribute $5 billion to the economy, according to the Confederation of Indian Industries

182. Due to liberalization and a growing middle class with increased spending power, there has been an increase in the number of insurance policies 2001-02, 7.5 million policies were sold. By 2003-4, the number of policies issued had increased by 37%, to 10.3 million policies issued in the country.

183. In the wake of liberalization, health insurance is projected to grow to $5.75 billion by 2010, according to a study by the New Delhi-based PHD Chamber of Commerce and Industry

184. In order to spur the private health insurance sector, the Insurance Regulatory & Development Authority (IRDA) has increased the FDI limit from 26 per cent to 51 per cent.

186. Data capture

187. Documentation

188. Commercial

189. Administration

190. Human resources

191. Customer careTelemedicine: Only 25% of India’s specialist physicians reside in semi-urban areas, and a mere 3 % live in rural areas. As a result, rural areas, with a population approaching 700 million, continue to be deprived of proper healthcare facilities

192. One solution is telemedicine—the remote diagnosis, monitoring and treatment of patients via videoconferencing or the Internet. Telemedicine is a fast-emerging trend in India, supported by exponential growth in the country’s information and communications technology (ICT) sector, and plummeting telecom costs. Several major private hospitals have adopted telemedicine services, and a number of hospitals have developed public-private partnerships (PPPs), among them Apollo, AIIMS, NarayanaHrudayalaya, Aravind Hospitals and SankaraNethralaya.

194. National Accreditation Board of Hospitals and Healthcare Providers (NABH)- committee to make provisions for access, assessment, care of patients and protect patient’s rights.

195. Clinical Establishment Act, 2006: Low cost and Good quality healthcare.

196. Policy decision on easy provision of ‘medical visas’.

197. National Rural Health Mission

198. Increased foreign investments in various Healthcare segments such as Insurance.

199. Development of competent technology.

201. Private and public spending in Indian health sector would touch $14.2 billion in 2013, at an annual growth rate of 5.8 percent from 2009