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| IHS
Mission & Goals: |
Groom Skills,
Gather
Evidence and
Generate Knowledge for
people's health.
To Improve the Efficacy,
Quality & Equity
of Health Systems. |
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| IHS
Activities ...
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Research
and Consultancy
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The Institute conducts research and
offers consultancy services in four major areas;
(a)
National Burden of Disease (b) Health System Performance
Assessment (c) Health Care Quality Assurance (d) Health
Sector Reforms
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| National
Burden of Disease (NBD) | |
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Epidemiological transition, increasing
cost of health care, the unfinished agenda of
controlling infectious and parasitic diseases and
persisting gaps in access to primary health care, has
made the job of health care policy and planning more
complex than ever. The complexities of dealing with
multifarious health problems, have lead to refocused
world wide attention on descriptive epidemiology and
burden of disease. The Andhra Pradesh Burden of Disease
(APBD) Study was started in 1993, in collaboration with
the Administrative Staff College of India (ASCI),
immediately after publication of the Global Burden of
Disease Study results in the World Bank’s World
Development Report, 1993. The study provided an
opportunity for a comprehensive estimation of disease
burden in AP during the 1990s. Using the case of Andhra
Pradesh in India, the study examined available sources
of data and describes their usability. Deficiency in
availability of local data was highlighted to draw
attention to the need for improving vital statistics,
cause of death and epidemiological surveillance systems.
The Burden of Disease estimates arrived at in this study
are of importance from two different policy
perspectives. Firstly, National Burden of Disease (NBD)
estimates will be of immediate interest to those
concerned about health policy of the National or
sub-national entity for which the study is made.
Secondly, this study has highlighted the need for
reliable and valid local data for National Burden of
Disease Estimates. Recognizing the importance of NBD
estimates in health care and planning, the GOI -
Department of Family Welfare, commissioned the IHS to
estimate burden of disease among women and children in
India. The Institute’s contribution was incorporated
as a chapter in the report of the Planning Commission’s
working group on Women and Children’s Health.
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Prof.
Christopher JL Murray, Director, EIP, World Health
Organisation, who has pioneeredGlobal Burden of
Disease estimation giving a lecture on "Trends
and Challenges in globalhealth and Health
Systems", at the IHS on 8th May, 1999. | |
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To
build national capacity in quantification of disease
burden, the Institute has pursued many connected areas
of research. These include studies on; (a) Causes of
death (b) Health status
measurement (c) Indirect estimation of mortality by
smaller areas, and (d) Descriptive epidemiology
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Cause
of Death Studies
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Reliable
statistics on causes of death in a population are
essential for setting of priorities in the health
sector. Most developed cause of death reporting
systems rely on medical certification of cause of
death according to the International classification of
Diseases (ICD - 10), and have invariably achieved near
total coverage. Developing countries like India depend
on lay reporting of the cause of death for rural
areas, where adequate medical facilities are not
available, using a Sample Registration System (SRS).
Usability of the cause of death statistics in India is
questioned in view of poor coverage, and poor
compliance with guidelines for cause of death
reporting, coding and classification. Research work on
cause of deaths started in IHS around 1993 and is an
ongoing activity supported by various sources of
funding and when no funding is available, by time
contributions from faculty and staff. Work at the
Institute lead to identification of Maharashtra and
Goa states, where a large number of deaths are
medically certified. A pilot study on cause of deaths
in rural areas of AP provided some preliminary
information about the Survey of Cause of Death (SCD) -
Rural statistics. Accordingly the Global Burden of
Disease study, 1996 used the Maharashtra medically
certified cause of death (MCCD) data to estimate cause
of death pattern for urban areas and the applied some
corrections to the SCD-Rural data to estimate the same
for rural India. Further work at the IHS on cause of
death reporting system in India lead to the
publication of two landmark articles1 ,2 in the
National Medical Journal of India. These articles
reviewed the performance of cause of death reporting
system in India and argued for its improvement. A
small group of researchers in India and abroad got
together and offered to collaborate with the Registrar
General of India (RGI) to systematically design the
SRS based cause of death reporting system. The IHS was
a co-founder of this SRS-Collaborative group. Review
of the world literature on verbal autopsy and
systematic assessment of India’s verbal autopsy
based cause of death reporting system contributed to
appreciation of the SCD-Rural statistics and
appropriate design of the newly introduced SRS based
cause of death reporting system. Results of the study
to estimate cause of deaths in rural areas of AP
contributed to the National Burden of Disease
estimation for Andhra Pradesh and has provided more
accurate cause of death statistics for policy
analysis. The Institute has also developed a computer
software for processing of cause of death reports by
municipal health offices, state vital statistics
offices as well as research and analysis teams.
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| Health
Status Measurement | |
|
Health status measurement is an important
step in quantification of disease burden due to non
fatal health outcomes. Ideally, burden of disease
estimates should use community valuation of different
health states. As community level health state valuation
tend to be difficult and time consuming, most disease
burden studies use expert rated disability weights. The
AP Health State Valuation study conducted by the
Institute in 1999 was the first community valuation of a
set of health states in a developing country. The study,
attempted to measure peoples preferences about various
health states. Two distinct sources of assessment was
used in measuring people’s opinion. Firstly, a series
of workshops was conducted with the educated population
from various professional backgrounds. Health state
valuation was done using four procedures viz., card
sort, Visual Analogue Scale, Time Trade-off & Person
Trade-off methods. Second part of the study involved
measurement of valuations given by general population
through household surveys. Respondents were requested to
give their valuations using card sort followed by visual
analogue scales. The study had to deal with the unique
challenge of communicating health state descriptions to
semiliterate, illiterate population. This was overcome
by development
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Surveyors
interviewing respondents during the Health State
Valuation Survey | |
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of
a pictorial description system. This study is an
important contribution to theoretical advances in
health state valuation. The 6D5L health state
description systems developed for this study3 ,
theoretical and empirical aspects of community based
health state valuation, their reliability and validity
issues4 were incorporated in the WHO publication on
summary measures of population health. | |
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| Indirect
estimation of mortality by smaller areas | |
|
Conventional measures of premature
mortality, like Infant Mortality Rate (IMR) continue to
play an important role in health policy. Reduction of
IMR is an important goal set by the National Health
Policy. Currently the Sample Registration System (SRS)
is the primary source of IMR estimates in the country.
Unfortunately the SRS does not provide IMR estimates for
smaller areas below the state level. Availability of IMR
estimates for small areas will facilitate identification
of areas with very poor population health status and
targeting of public health programmes. The District
Family Health Survey (DFHS) piloted by the Institute
studied the feasibility of generating IMR estimates at
the sub district level. This study was conducted in
three districts of Andhra Pradesh, Chittoor, Nellore and
Mahboobnagar, representative of the three political
regions of AP. The indirect methods of estimation such
as children ever born (CEB) technique for IMR, and
Sisterhood Survival Method for Maternal Mortality Rate (MMR)
were used. The sample was selected using a two-stage
proportional stratification followed by random selection
of clusters within strata assigning probability
proportionate to population size. IMR estimates show
significant variation in mortality in different
districts and revenue divisions. One revenue division in
Mahboobnagar district had IMR as high as 125/1000 live
births, which is twice as high as the state average IMR
of 66 / 1000 live births. We hope that identification of
such high mortality risk areas would help in better
targeting of public health interventions. The results of
this study highlight the need for decentralised area
specific planning and implementation of public health
programmes.
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Descriptive
Epidemiology
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Descriptive epidemiology is about
understanding the natural history of diseases,
estimation of disease frequency and mapping of known
risk factors. These are important contributors to
estimation of disease burden. They help in identifying
linkages between risk factors and disease burden. For
example, the Institute’s study comparing prevalence of
morbidity and nutritional status of child labourers in
aqua culture industry and other children did not show
any significant difference. An exploratory study to
identify social, economic and cultural processes that
are of relevance for management of asthma5 , revealed
that there is a large social and economic burden on
account of asthma. The study threw light on the existing
social sharing of asthma morbidity and the institution
of family as a particularly useful means of the coping
up process. The study provided useful insights for the
WHO task force on global strategy for asthma management.
Government of Andhra Pradesh commissioned the Institute
to prepare comprehensive manuals to achieve better
control of the gastroenteritis (GE) and malaria
situation in the state. Descriptive epidemiology studies
for this purpose included analysis of seasonal pattern
and geographic localization of gastroenteritis in AP,
malaria trend in the state, etc.
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The
Institute conducted a household survey as part of a
collaborative study to develop a predictive model of
exposures to indoor air pollution (IAP) from
qualitative information about fuel use, and housing
characteristics. The study revealed that households
using mixed fuels have the highest Respirable
Particulate Matter (RSPM) concentrations (732 mg/m3).
Households with poor kitchen ventilation had a twofold
risk of having high kitchen concentrations of RSPM
compared to households with good ventilation. The IHS
has been commissioned by Environmental Protection
Training & Research Institute (EPTRI) to develop
an initial estimation of the health impacts of ambient
air pollution in Hyderabad, based on available
secondary data. The health effects analysis project is
essentially a correlation study, involving the
determination of a statistical association between the
frequency of a given health outcome and concurrent
PM10 concentrations. This task will draw upon existing
data on ambient air pollution impacts on mortality and
morbidity of selected health endpoints. Economic
valuation of health impacts for both indoor and
ambient air quality, will also be done using the Human
Capital Approach (HCA) method. A study designed to
understand the epidemiology of risk factors associated
with high level of road traffic accidents in Hyderabad
has been recently approved by the ICMR. Causative
linkages between accidents and road design, road user
behaviour, traffic regulation, and road worthiness of
vehicles will be explored.
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| Health
System Performance Assessment (HPA) | |
| Health
system performance measurement is important: first as
a means of identifying the shortcomings of health
systems, as in explaining why countries with similar
levels of income fail to achieve similar levels of
health; secondly, for providing indicators that allow
evaluation of a health system over time. Both these
activities in turn could contribute in the future to a
pool of evidence that can provide the basis for
confirming or rejecting if specific financing and
provision mechanisms are particularly appropriate
under given socioeconomic conditions. A more efficient
health system would mean that more health care
services are provided for the same level of resource
use. Improving efficacy of health systems through
operations research and performance assessment is one
of the important objectives of the Institute. Keeping
with this objective, the Institute has fostered many
research areas such as: (a) Hospital Performance
Analysis (b) Patient Satisfaction Surveys (c)
Responsiveness Surveys (d) National Health Accounts. | |
| Hospital
Performance Analysis | |
| The
Institute’s goal is to make public hospitals more
efficient and responsive. As people become more aware
of the hospital performance analysis they are more
sensitive to accept required remedial actions for
further improvement. The IHS was commissioned by the
AP Vaidya Vidhana Parishad (APVVP) to undertake a
performance analysis of APVVP hospitals on monthly
basis. Every month hospital activity indicator and
service mix data were collected from the APVVP
hospitals. Hospital wise performance analysis was
done. Each month the Institute’s researchers visited
about 20 hospitals to collect qualitative information
and to verify data accuracy. The field reports and
monthly analysis were furnished to the hospital
management. The Institute assisted the APVVP for about
three years between July 1998 to 2002. There after the
APVVP is doing their performance analysis in-house.
Starting May 2002, the Institute has been assisting
the government of Maharashtra in improving efficiency
and quality of service of hospitals under the
Maharashtra Health Systems Development (MHSDP), using
performance measurement and analytic techniques on a
regular basis. The MHSDP hospital statistics is
analysed for its consistency and based on the
performance indicators, outlier hospitals are
identified. Internal consistency of data is analyzed
using a set of consistency indicators and by expert
appreciation of the figures. A sub set of hospitals
are identified each month for field visit to
understand the potential sources of poor performance
and to provide on job training to the hospital data
compilation personnel. | |
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| Patient
Satisfaction Survey | |
| Patient
satisfaction survey is a reliable yardstick to assess
the quality of health care extended by the health care
institutions. The aim is to generate statistically
accurate estimates of patient’s feed back for each
hospital, so that inter hospital comparison is
possible. It generates data for theoretical importance
and for practical purposes such as planning,
administration and evaluation of health care services.
The Institute of Health Systems conducted a study on
the Demand for services and Satisfaction with the
Mauritius Health System. The project was orchestrated
by the Burden of Diseases Unit at the Harvard Center
for Population and Development Studies (HCPDS). A
systematically selected sample of in patients (IP) and
out patients (OP) were interviewed using a structured
questionnaire. Focus groups were conducted with
members drawn from households and members of Local
Health Committees (LHC) who were closely associated
with the functioning of the peripheral health delivery
institutions. The published HCPDS report titled
"The Health Sector in Mauritius", contains
substantial sections on the Demand and Satisfaction
study conducted by IHS. The Institute was commissioned
by the AP First Referral Health Systems Project (APFRHSP)
to conduct patient satisfaction surveys in APVVP
hospitals at half yearly intervals between June 1999
and March 2002. These surveys provide useful feedback
on functioning of different areas in the respective
hospital and helpful insights about patients’
preference. The Institute brought out five half yearly
reports on the survey beginning June 1999. The study
on structure and dynamics of private health sector in
AP included a patient exit interview component to
compare the level of satisfaction among patients
attending private and public health care institutions
respectively. An early work in this area, is the study
of patient satisfaction of Karimnagar district
hospital. | |
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| Responsiveness
Surveys | |
|
Health
system performance involves three discrete aspects:
medical, responsiveness and fair financing. The AP
Health System Responsiveness Survey measured
responsiveness of the health system in AP to
individuals’ expectations regarding the non-clinical
enhancing aspects of the health system. The survey
sought to measure eight distinct aspects of health
system responsiveness pertaining to elements related
to respect for human beings as individuals, that are
largely subjective and judged primarily by the client,
and the more objective elements related to how a
system meets commonly expressed concerns of patients /
clients and their families as consumers of health
system. The study provided valuable insights into
responsiveness of the health system to patient/client
needs and expectations. Respondents in urban areas had
better access to health care institutions than those
in rural areas. The average time taken for people to
access health care was 56 minutes and 142 minutes in
urban and rural areas respectively. It was found that
people in urban areas have better access to public
health care institutions than those in rural
areas.
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IHS
Surveyors taking details of rural households during
the Andhra Pradesh Health System Responsiveness Study | |
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Respondents
in rural areas preferred to go to a private provider
as they could not rely on the primary health centre
for any serious health care need. Of the eight
dimensions of health system responsiveness studied
(respect for dignity, respect for confidentiality,
respect for autonomy over treatment, prompt attention,
communication, basic amenities, social support and
choice of provider), 53% of the respondents rated
prompt attention to their needs as most important.
Communication of information relating to health
condition and respect of dignity of patient was rated
as most important by 23% and 14% of the respondents
respectively. Only 3% of the respondents rated choice
of provider as most important. The survey found that
36% of the respondents did not seek any health care
because they could not afford it. About 16% of the
respondents said that they were refused health care
because they could not afford it. | |
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| National
Health Accounts (NHA) | |
|
National health
accounts (NHA) document total health care financing
and expenditure within a particular health system.
Health expenditure consists of financial outlays that
service the health system. NHA trace the resources
invested and consumed in the production of health and
facilitates further research and meaningful policy
analysis.
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In
the Indian context, state level studies are at least
as important as overall national analyses. In some
respect, state health accounts (SHA) are more
important, because many of the major policy decisions
concerning resource allocation to health and social
sector are made at the state level. The analysis of
government expenditure on health in AP happens to be
one of the first contributions
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Prof.
William Hsiao, Harvard School of Public Health,
deliveringa lecture on "Comparing health systems
and their financing.What countries can learn from each
other"- 14 April 1993. | |
| towards
building up of state health accounts in India. This
study covered not only standard medical programs like
curative and preventive care, but also health related
activities such as primary education, water supply,
sewerage, sanitation, housing, and community
development. Such an approach has the important
advantage of producing a much clearer picture of
government’s overall orientation toward social
development. The study found that during the 1980s
APgovernment expenditure on public health nearly
tripled in real terms. This was complemented by large
increases in health related expenditure as well. For
example, expenditures on primary education more than
tripled, and the amount of funds spent on housing and
community development increased more than eight fold.
This is not to say that everything went well. First
referral (district and sub district level) hospitals
received inadequate attention relative to urban
tertiary hospitals. Too little was invested in
training for nurses and paramedical personnel compared
with the amounts spent on educating medical doctors.
The amount provided for sewerage and sanitation
programs was very low. Results of these studies have
been published in journals6 ,7 and others8 in addition
to the IHS publications. To facilitate appropriate
analysis of health expenditure of the state, the
Institute has compiled data on public spending on
health and related areas from 1980 - 1993. This was
one of the first electronic compilation of government
budget and accounts data. A software called Government
Expenditure Analyst (GEA) was developed to allow
researchers analyse expenditure data upto the sub head
level. Expertise gained at the IHS in electronic
compilation of government budget data contributed to
preparation of the first budget data on disk in India.
The first Budget Data on Disk of the Andhra Pradesh
Government was released by the State Finance Minister
in 1998. The IHS was one of the collaborating
Institutions contributing to development and delivery
of this new service. The Institute is currently
developing more comprehensive State Health Accounts
for Andhra Pradesh. In addition to health services
provided by the government (Central, State and Local
Bodies), the study focusses on health care revenues
and expenditure of NGO’s, voluntary and charitable
organizations, public and private sector firms, social
insurance schemes such as CGHS and ESIS,private
insurance, households etc. The findings of the study
is expected to contribute to the Government of Andhra
Pradesh medium term financing strategy for the health
sector. | |
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| Health
Care Quality Assurance (HQA) | |
|
Quality
of care delivered by health care institutions is a
matter of public concern. The Institutes research
activities in this area started with an early study to
assess the need for and designing of an accreditation
system. This pilot study asked patients discharged
from private hospitals about their experience and
concerns of quality of care. There appeared to be some
awarenes and felt need for quality assurace in health
care. A subsequent study9 of expressions of need for
quality assurance revealed that the level of awareness
about the need for quality assurance in health, among
general public was low. However, legislators, medical
professionals, and consumer interest groups are
increasingly conscious of the need for quality
assurance in health sector. The Institute has been
actively studying various aspects of the private
health sector, with special emphasis on standards and
quality assurance. A study was conducted to ascertain
the perceptions and expectations of the women
regarding quality of reproductive health care offered
in private hospitals of Andhra Pradesh. The Institute
then developed standards for selected reproductive
health procedures, viz., normal deliveries, Caesarean
section, medical termination of pregnancy, etc. Actual
quality situation was assessed against these standards
using various qualitative research methods, to assess
quality gaps in the provision of reproductive health
care. During the course of the study on the structure
and dynamics of the private health sector in AP, the
Institute has developed a framework for assessment of
health care quality. An early study sponsored by the
government of Andhra Pradesh, documented quality
concerns of the users and non users of family planning
methods.
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Dr.
C.L. Venkata Rao, Member, Medical Council of India
makes a point at
the Private Health Sector Workshop held by IHS. To his
left are Dr. U.Eswara Rao, General Secretary, APHNA
and Dr. M. Thyagaraja Reddy, President,
Indian Medical Association, AP. | |
| Social,
cultural, economic and related factors affecting the
acceptance of family planning methods were studied.
This study has found a positive appreciation of
vasectomy by its adopters as opposed to the negative
biases of its non adopter males and also females, and
also thrown important clues on quality of family
welfare that is being provided. A UNICEF sponsored
study, conducted in the year 2001, assessed the
infrastructure for Emergency Obstetric Care (EmOC) in
Medak and Adilabad districts. Effective availability
of EmOC equipment and health care personnel such as
obstetricians, and anaesthetists were found to be a
major hindrance in provision of quality services. The
study built up an inventory of private EmOC facilities
around primary health centres (PHC) equipped to
provide round-the-clock EmOC services. Functional
status and adequacy of facilities in PHCs, Area and
District Hospitals were assessed. To develop national
capacity in health care quality assurance, the
Institute has built up a collection literature about
accreditation systems in other parts of the world. The
Institute’s President visited, in 1992, the Joint
Commission for Accreditation of Health Care
Organisations (JCAHO) in USA and had a two month
attachment in an American hospital to study compliance
with accreditation system from the hospital
perspective. Another faculty while on a research
fellowship with the Harvard University studied the
accreditation system in the USA. | |
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| Health
Sector Reform | |
| Health
Sector Reform is a sustained process of fundamental
change in policies and institutional arrangements of
the health sector, usually guided by the government.
Any meaningful reform process ought to be based on
evidence and information about the current state of
affairs, and potential effect of alternative policy
choices. Many of the Institute’s research activities
take place with the objective of generating evidence
and information for health policy. For example, the
study of hospital autonomy, documented the experiences
of the AP Vaidya Vidhana Parishad in Andhra Pradesh11
. Some studies in this area describe and compare
different health systems mainly in the developed (Organisation
of Economic Cooperation and Development, OECD)
countries12 . Many studies have been taken up to
understand the Private Health Sector including both
for profit and nonprofit health care institutions. | |
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Dr.
Than Sein, Director, EIP, WHO-SEARO delivering a
lecture on "Role of Private Hospitals in Health
Care", on 8th December, 2002 | |
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An
early study taken up by the Institute was about the
management of financial resources in voluntary health
agencies13 . Insights gained from the Institute’s
study of organisation and management of community
public trusts and civil society institutions were used
to develop systems and procedures for Nandi
Foundation, a community public trust based in Andhra
Pradesh. The study on social evolution of hospitals
and its relevance for health policy was an example of
history of health care and its current policy
relevance. The IHS was commissioned by the AP First
Referral Health Systems Project (APFRHSP), to take
stock of the private health sector in Andhra Pradesh
and identify appropriate policy choices for their
overall development.
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Shri
M. Nagarjuna, Project Director, APFRHSP, addressing
the Private Health Sector in Andhra Pradesh workshop
as Dr. Alex George, Former Director of the Institute
looks on. | |
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A workshop was organised in May
1998, with participants from the private health sector
and public health officials. Result of the studies
spearheaded by the IHS were presented in the workshop
and various issues were discussed. A comprehensive
report on the private health sector in AP and policy
recommendations regarding the private sector has been
brought out. In 1999, the Institute started a more
detailed study to understand the structure and
dynamics of the private sector in Andhra Pradesh. The
study was commissioned by the Government of India,
Ministry of Health. This study collected data from
within AP and reviewed literature from elsewhere in
the world. The study found that there is hardly any
difference in terms of efficiency and quality of care
between private for profit, non profit and public
health care institutions. Public and nonprofit health
care institutions are clearly more accessible to the
poor.
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Dr.
Anji Reddy, Commissioner, APVVP and Director General,
Health Services, AP. congratulating Dr. Peter Berman,
Professor HSPH, after he delivered a public health
lecture on "Reforming Health Systems : What have
we Learned?" on 2nd March, 2002. | |
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One advantage of private forprofit health care
institutions is their quick response to changing
demand for services. The study recommends encouraging
nonprofit health care institutions, and development of
quality assurance infrastructure. The IHS was
commissioned by the Government of AP to prepare a
State Action Plan for reproductive services and heath
sector reform. Review of the time trend and current
status of reproductive and child health in the state,
reproductive and child health program implementation
in the state, focus group discussion with ANMs and PHC
Medical Officers in the state, available results of
other studies commissioned by the government in this
regard, as well as the states vision 2020 health
goals, contributed to the development of a state
action plan. Major recommendations in the state action
plan include; (a) basic package of services, drugs,
equipment, supplies and furniture to be made available
at the Sub center; (b) improvement of locational
convenience and accessibility of PHCs and sub centres;
(c) expansion of a scheme to increase institutional
deliveries, using private partnerships, etc. The IHS
was appointed as the State Consultant, by the
Government of AP for the development of medium term
financing strategy for the health sector. The reform
strategy is to fulfill the State’s structural
adjustment targets pertaining to financing of primary
health care. The Institute conducted a strategy
development workshop in April 2001 to kick start the
strategy development process. The DFID of the
Government of United Kingdom which is likely to
provide partial financial support for the reform
process, appointed Harvard School of Public Health -
International Health System Group (IHSG) to continue
the strategy development work in a two phase process.
In Phase One, the Institute introduced the Harvard
IHSG team members to key stake holders, and
familiarised them with relevant official documents and
literature and provided other inputs gained from our
experience in working with the AP health system. In
addition, the IHS reviewed existing information and
analysis on burden of disease in AP, suggested
important gaps in current priorities and highlighted
strengths of current priorities from a burden of
disease perspective.
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Phase two of the exercise
involves analysis and projection of the resource
envelope for the health sector, development of
specific strategies including the priority areas
identified in phase one, and formulating a Medium Term
Strategy Expenditure Framework in collaboration with
the state government. The IHS role during this second
phase is to contribute towards preparation of state
health accounts for AP. The Institute was assigned the
task of developing community health insurance based
family health protection plans by the GOI - Department
of Family Welfare. The report of the study, presented
to the government by end of March, 2003, recommends an
income line for health and housing higher than the
poverty line, for purposes of administration of state
financing of health insurance coverage to families.
The benefit package in the proposed family health
protection plans include comprehensive ambulatory
primary care, and access to first referral hospital
services. The plans would mostly use private clinics
for the ambulatory care and public or nonprofit
providers for hospital services. Minimum quality of
service standard have been recommended for clinics.
The plans will provide better access to public
hospitals and help improve their utilisation.
Nonprofit mutual health organisations are envisaged to
underwrite the health care coverage risk and
administer the plans. The proposal is under active
consideration of the government. The Institute has
made modest contributions by being available to the
Prime Minister’s Office (PMO) and in rendering
assistance, according to its capacity. The Institute’s
comments on the draft new national health policy was
sought. Accordingly a presentation was made at the PMO
on 17 Jan 2002. Senior officers from the PMO and
various ministries of the GOI were present.
Suggestions and comments about expanding the health
care coverage to ex-servicemen, sought by the PMO, was
submitted. The Institute’s Director is a member of
the Task Force on Public Private Partnership, which
works from the PMO. Institute has been contributing
towards generation of creative ideas and
identification of opportunities for public private
partnerships to improve public health. | |
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