Aarogya-Swaraj An empowerment model of health care Abhay Bang SEARCH, Gadchiroli
Outline • Current challenge of health care. • Data and learning from Gadchiroli. • Alternative model of health care.
Health Care cost in India Health care cost : 5% of the GDP $ 100 per capita per year (at ppp) 20% by the public sector 80% by the private sector
Health status of the people in India • 2 million new cases of TB annually • 55% women anemic • 43% children underweight • 1.5 million child deaths each year
The quest for Universal Health Care How to provide UHC? *
The US medical care cost : $ 6000 per capita/year
Cost of Health Care % of GDP 2010 2050 2100 US 17 % 37 % 97% Europe 10 % 25 %60%
The medical care models from the West are wasteful * UHC = MEGs A Medical Employment Guarantee Scheme
Medical Nemesis Health care of ventilators What is the alternative?
SEARCH Society for Education, Action & Research in Community Health
India New Delhi Maharashtra Bombay Gadchiroli
Laboratory of 86 villages SEARCH, Gadchiroli
What are the health care needs of the people? 1. Ask them 2. Population based data 3. Hospital data SEARCH, Gadchiroli
The priorities expressed by the people (not in any order of ranking) • Communicable diseases (diarrhea, malaria, TB, filariasis) • Respiratory problems (cough and breathlessness.) • Back-ache and musculo-skeletal pains • Sexual, reproductive and uro-genital problems. • Weakness – (anemia, malnutrition ?) • Blood pressure and stroke • Alcohol and tobacco • Anxiety
Interestingly, missing were the national vertical program priorities such as the Maternal Mortality, Family Planning, Polio, HIV. Universal Health Care must move beyond the few vertical programs and incorporate people’s priorities. *
Causes of death in children ( 0-5 Year) Govt. Program area ( 2004-2010) ( Deaths : 314 , Live births : 5146) Cause Specific Mortality Rate per 1000 Live Births Causes
Causes of death In age group above 15 years (SEARCH 86 villages 2002-2009) ( person years : 520,162 , Total deaths : 5003 ) Cause specific mort. rate per 100000 popul.
Population based morbidity studies in Gadchiroli Expected cases / village of 1000 A) Newborns and Children 1) Newborn morbidities - Incidence of morbidities in newborns 2) Childhood ARI - Acute Respiratory Infections in children - Incidence of cough and cold - Incidence of Pneumonia 15 74 % 6 episodes per child / year 600 13 % of children / year 13
Population based morbidity studies in Gadchiroli Expected cases / village of 1000 B) Women 3) Maternal morbidities - Incidence of Maternal morbidities during - pregnancy, delivery , post partum : 59 % - Emergency Morbidities : 13 % 12 3 4) Gyneacological morbidities- Gynecological and sexual morbidities prevalence ( n=650) : 92 % 340 5) Prevalence of anemia in women - Anemia in women ( n= 2019) - During pregnancy : 59% - non pregnant women : 43 % 12 159
Population based morbidity studies in Gadchiroli Expected cases / village of 1000 C) Men 6) Prevalence of health complaints in males - - Non-reproductive symptoms : 70 % - Reproductive, urogenital, sexual : 68 % 259 252 7) Prevalence of Alcohol consumption - Prevalence of alcohol consumption - Prevalence of alcohol consumption : 36 % - Prevalence of daily alcohol consumption : 4 % 133 15
Population based morbidity studies in Gadchiroli Expected cases / village of 1000 D) Population 8) Prevalence of tobacco consumption - Tobacco consumption : 50.4 % 504 9) Prevalence of hypertension - Hypertension (n= 879) in Males : 6.5% in females : 13.5 % 24 50 10) Prevalence of sickle cell gene - Prevalence of sickle cell gene Homozygous ( S – S ) : 0.80 % Heterozygous ( A – S ) : 15.60 % 8 156
The health care needs of population are enormous in magnitude, multiple, and are often chronic.( 2600) • Health care must be designed appropriately
Rs. 140 million District Development plan Rs. 200 million spent on alcohol * “Now we know why are we poor”
Government of Maharashtra accepted the demand Introduced prohibition in Gadchiroli District in 1993.
Private expenditure on tobacco versus the Government’s annual expenditure on three national schemes in the Gadchiroli district (2008-09,Rs Crore) Crore Rs. NREGA- National Rural Employment Guarantee Act Scheme ICDS- Integrated Child Development Services NRHM – National Rural Health Mission
Social Determinants of Health (e.g. alcohol, sanitation ) - Policy change - Regulation - People’s education through public campaign - Corrective measures
What Next ? What type of health care do people need ?
Tribal friendly hospital • 26,000 patients from 1000 villages • Cerebral malaria • Snake bites • 500 major operations • Spine surgery, Gynec surgery • Mental Health OPD • Oral & dental health OPD
Newborns in India 27 million newborns are born each year 30 % born at home Even the hospital delivered mother and newborns are sent home < 24 hr. Newborn health care must visit where the neonates are. * SEARCH, Gadchiroli