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Swasth Kutumb

Swasth Kutumb. Problem statement. To provide affordable and accessible quality primary health care with a particular focus on RCH services - to the urban poor population in the state. Situation Analysis.

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Swasth Kutumb

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  1. Swasth Kutumb

  2. Problem statement • To provide affordable and accessible quality primary health care with a particular focus on RCH services - to the urban poor population in the state.

  3. Situation Analysis • Health indices among the urban poor are consistently worse as compared to the rural population in the state. • Absence of appropriate & affordable health providing infrastructure/ services for urban poor

  4. Situation Analysis - II • Utilization of public health facilities very poor – just 6% of all deliveries take place in public health institutions • Infrastructure set up cost very high – yet no guarantee of optimal utilization • State has a robust private health sector with significant spare capacity – more than 75% people use pvt sector.

  5. Swasth Kutumb • Public Private Partnership model to provide quality healthcare to the urban poor. • Utilize the existing infrastructure and trained manpower in the private health sector. • The government provides back up support, monitoring and regulatory mechanism.

  6. Process of evolution of the project • MoHFW funds available for urban RCH projects. • Basic framework design in the dept of health • Wide ranging consultation with PHPs/IMA • Rapid urban survey to assess present health seeking practices • Iterative meetings with GoI • External assessment by AFF

  7. Beneficiaries • Urban poor in four district headquarters. • Includes the BPL population and families with a monthly income of less than four thousand per month. • An estimated 30% of the DHQ population would be covered.

  8. Basic mechanism • Identified Private Health Providers – PHPs would be assigned a beneficiary population approximately 1500 families (7500 population). • These PHPs would be responsible for the provision of the entire range of primary healthcare services including outreach services in the community through health workers. • The focus would be on RCH related services

  9. Payment Structure A total sum of Rupees one hundred per person per year would be payable to the PHP.

  10. PHP setup • Qualified medical personnel including a General Practitioner, Gynecologist and Pediatrician with others specialists in-house/on call • In-house facilities in terms of OT, LR, facilities for NB resuscitation and Path Lab • Meeting basic standards of hygiene and service quality • Proximity to urban slum clusters • Sufficient spare capacity in both OPD and IPD

  11. Government support & responsibilities • Providing free medicines/medical supplies under existing programs • Supply chain management support • Referral services at District Hospital • Promotion and awareness generation • Monitoring, co-ordination and supervision • Timely payment to PHP’s for their service

  12. Key Success Factors • Monitoring • No misuse • Maintenance of service standards • Impact assessment • Stakeholder’s selection • Beneficiaries • PHPs • NGO’s/ Co-ordinating agencies • Service Quality - PHPs • Standards of services; availability & quality KEY SUCCESS FACTORS • Financials • Affordability • Financial viability • Value for money • Service Quality - Govt. • Support services • Payment settlement • Grievance handling • Sustainability • IEC activities • Improving health seeking behaviour

  13. Beneficiary selection • All the BPL population in the DHQ • Survey of identified slum areas and inclusion of all the families within the slum area. • District administration, department of health and NGOs aid in identification of beneficiaries.

  14. PHP selection • Applications invited detailing infrastructure, manpower and present utilization levels. • The number of PHPs selected depends on the urban poor population identified • Proximity to a slum area is an important criteria. • Site visit and interview of the owner • Signing of contract

  15. Service Quality of PHPs Important Issues • Timely & fair treatment to beneficiaries • Availability of medical facilities/medicine • Focus on preventive & outreach services • Specialist & diagnostic facilities at fair price • Option of beneficiary to switch PHP • Option of terminating contract • Feedback from beneficiaries

  16. Service Quality - Govt • Ensuring free medicines/medical supplies under National Health Programs • Availability of generic drugs at fair price • Timely payment to PHPs • Back up referral services in place • Minimized paper work • Obtaining and acting on beneficiaries feedback/grievance

  17. Monitoring & Evaluation Focus Areas • Reduce/prevent the potential for misuse of funds/supplies • Service standards are maintained • Beneficiaries are not exploited • Tracking improvement through performance indicators

  18. M & E • Proposed system • Family health booklets for beneficiaries • Computerized tracking of all/most of the transactions between the beneficiaries • Sample verification of services provided • Fund flow system with independent auditing • Impact assessment survey • Grievance redressal mechanism • Record keeping by PHPs/Govt.

  19. Family Health Booklet ANC Details OCP

  20. Family Health Booklet Date_____________ Presenting Complaints Weight ______ B.P _________ Diag.______________ O/E Prescribed Treatment – Doctor’s signature Doctor’s signature

  21. Swasth Kutumb service rendered sheet Sheet No : Districtcode : Doctor/Staff Code: Service Provider code: Date of Visit : • Computerization cost per transaction – 6 Paise • Total characters=24 • Cost per service provider per year Rs. 500 approx

  22. Swasth Kutumb ANM service rendered sheet

  23. Appropriateness for beneficiaries • Easily accessible better health services at affordable costs • Arrangements for specialist and diagnostic services at fair price • PHPs to tie-up/provide in-house specialist, diagnostic service providers • Government financial support during initial stages

  24. Appropriateness for PHPs • Low incremental costs • Scope for additional income generation • Attractive revenue cost analysis • PHPs favorably inclined towards the scheme • Improved utilization of existing infrastructure • Fairly assured clientele base

  25. Appropriateness for the government • Improved financial resource utilisation • Gradually reducing financial liability of the government • No capital cost towards infrastructure • No gestation period • Registration and actual services provided based payment • Reduced cost of providing services

  26. Project Comparison: Public vs Private AFF estimates ProjectCostComparison (205 PHPs vis-à-vis 40 CHCs) * Assuming same number of patients treated in both the options • In the private option payment to PHPs for service delivery account for 80% of the total operating expenses • In the public option fixed staff costs account for 63%, drugs & Consumables for 28% of the total operating expenditure

  27. Challenges • Beneficiary selection • Regulation of the private sector / quality of care • Systems for supply chain management • An independent coordinating agency

  28. Only those who risk going too far can possibly find out how far they can go!! Thank You

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