Description
This is a presentation about Emmanuel Hospital Association, Organizational Objectives, Health Care Financing -India, Medical expenses and impoverishment and Price variations in drugs.
Hospitals and Community Health & Development
Outline of the Presentation
• Community health & development in EHA • Role of the hospital • Changes in the context. Redefining the relationship between hospitals and community based programmes. • Principles of primary care that should be incorporated in to hospital services and care.
Emmanuel Hospital Association
• Federation of 20 Christian mission hospitals.
– Started in 1971 – 37 years old – 15 hospitals are rural – 5 hospitals semi-urban
• 29 community health & development projects.
– 20 locations – 18 are linked to hospitals and 2 are stand alone. – The projects cover 3 million people
EHADevelopment Units in India Status Map
Development of Community Health in EHA
• 70’s – Hygiene education / Community Outreach. • 80’s – Primary Health Care. 1984 EHA’s first PHC project started (SHARE project started by Dr.Ted Lankaster. • 90’s – Expansion of the Community Health involvement. • 2000 – Repositioning of Community Health Projects in the context of over all development.
EHA Vision for communities
Empowered communities that are healthy, learning, prospering, caring, stewards of their natural resources, living in harmonious relationship, living in a clean and safe environment, worshiping the true and living God and reaching out to others in need.
Determinants of health
EHA Organizational Objectives
A. The major disease burden of the communities served by our institutions and projects are reduced equitably, through their participation and at a cost that they can afford. B. Communities prosper economically, demonstrating good stewardship of their available resources, living in a safe and clean environment, constantly learning, demonstrating mutual trust, cooperation and caring attitudes towards other communities. C. Individuals, families and communities become disciples of Jesus Christ
Profile of our Current Community Work
Disease Specific HIV Tuberculosis Malaria
Basic Health Care for common illness
Water, Sanitation & Hygiene
Literacy & Education – Formal, Nonformal, Vocational
Advocacy & Community Mobilization
Thrift/Savings Micro-finance Income generation / Livelihood
Nutrition / Food security
Village health plan Micro birth plan
Advocacy
Community Analysis using 4 delays
Maternal Child Health
Community Based Monitoring
Capacity building
Service delivery
SHG role/support activities
Community level sensitization
Challenges & choices
• Shift from a hospital / disease focus to a community health focus.
Social Determinants of health
Health Promotion
Preventive
Medicine
Primary Care
Secondary Level Care
Rehabilitation
Role of the hospital
• Initiate the Community Project. – Hospital reputation is important for entry in to the community. • Administrative support • Technical resource persons
– Health care – Training
• Facilities shared reducing overhead expenses.
Role of the hospital
• Important to support communities initiatives with critical / emergency care. • Financing • Accountability • Provide a faith community and family support to community health programme staff. • Provide linkages with partners
Disadvantages
• Ownership • Suspicion or mistrust • Conflict of interests
– sharing of resources
• • • •
Attitudes of hospital staff Pre-conceived notions Different time frameworks Ghetto or “mission compound” mentality
A different drumbeat
Changes in the context
Non communicable Diseases
• The new killers – CVD, Diabetes, Mental Illness including substance abuse, Injuries which include Accidents, RTA and Suicide, Asthma and COPD • Dual burden of disease. • Risk-reduction / behaviour change • Need for integrated “continuum of care” programmes
Health Care Financing -India
• 82.4% of health care expenditure occurs in the private sector of which 77.5% is from out-of pocket payments. • Of the 5% of GDP spent on health care the government contribution is only 17.8% which amounts to 0.9% of GDP. • Health care in India is the most privatized in the world
Medical expenses and impoverishment
• Survey conducted in 3 districts in Gujarat and Andhra Pradesh - 85% of the households in Gujarat and 74% of those in AP health expenses was the main reason for their economic decline. • World Bank estimates that OOP pushes 2.2 % health users in poverty and 1in 4 among those hospitalised.
Catastrophic Health Expenditure
• A adverse health condition that necessitates more than 10% of the household income in medical expenses (Pradhan 2002) • Illness leads to loss of income and significant extra expenditure. The combination pushes people in to poverty. • 9% of households in India experience catastrophic health expenditure • Catastrophic health expenditure is more common in the low income group, but it can also effect the middle income group.
Access to Essential / Life Saving drugs
• WHO lists 270 drugs as essential – take care of 95% of the health problems. • 60,000 to 80,000 brands of various drugs in India • 10 of the top 25 drugs sold in the Indian market are non essential, irrational or hazardous. • 56% of the people in India still do not have access to essential drugs (WHO 2004) • Deregulation of drug price control has led to spiralling of costs with profit margins being increased to 75-100%
Price variations in drugs
Medicine Brand Company Price in INR Difference
Ofloxacillin 200 mg Levofloxacillin 500 mg
ZO
Tarivid Levoflox
FDC
Aventis Cipla
3.2
31 6.82 969%
Amlodepine 5 mg
Travanic Aventis Amoloda c Zidus Amlogar d Pfizer
95
1.51 6
1392%
397%
Income Inequalities
Disparities across income groups
Health Status Indicator Infant Mortality Poorest Quintile Richest Quintile Poor/ rich risk ratio
109
44
2.5
Under 5 Mortality
Childhood Underweight Total Fertility Rate (births/woman age:15-49)
155
60 4.1
54
34 2.1
2.8
1.7 2.0
Social Disparities: IMR & U5MR
Impact of Climate Change
• Migration of families in search of livelihood. • Increase in natural disasters
Impact on the programs
• Health disparities: Averages cannot the only way to summaries data and it is important to look at the data in different groups. • Hospitals need to synchronize with community based initiatives. Joint planning • Good quality health care is an important adjuvant to community programmes • Engage with Government programmes • Establish linkages with Government programme and to access available resources – privatepublic partnerships.
Can the principles of Primary Health Care be incorporated in to hospitals to synchronize them with community based programmes?
Applying the Principles of “Primary Health care” to hospitals
• Demystifying medicine – strengthen patient education. Using patients to educate others in the community. • Participation of the family and the larger community (volunteers) in caring for the patients. • Using the community as gatekeepers for directing services. • Community advisory committee in hospitals • Making healthcare affordable. • Vertical equity – differential pricing / cross subsidization
Applying the Principles of “Primary Health care” to hospitals
• Rational drug therapy • Use of only appropriate/ cost-effective technology.
Conclusions
• Hospitals can be a good launch pad for community based health programmes • There are potential synergies in having community health programmes
Thank you
doc_433145809.ppt
This is a presentation about Emmanuel Hospital Association, Organizational Objectives, Health Care Financing -India, Medical expenses and impoverishment and Price variations in drugs.
Hospitals and Community Health & Development
Outline of the Presentation
• Community health & development in EHA • Role of the hospital • Changes in the context. Redefining the relationship between hospitals and community based programmes. • Principles of primary care that should be incorporated in to hospital services and care.
Emmanuel Hospital Association
• Federation of 20 Christian mission hospitals.
– Started in 1971 – 37 years old – 15 hospitals are rural – 5 hospitals semi-urban
• 29 community health & development projects.
– 20 locations – 18 are linked to hospitals and 2 are stand alone. – The projects cover 3 million people
EHADevelopment Units in India Status Map
Development of Community Health in EHA
• 70’s – Hygiene education / Community Outreach. • 80’s – Primary Health Care. 1984 EHA’s first PHC project started (SHARE project started by Dr.Ted Lankaster. • 90’s – Expansion of the Community Health involvement. • 2000 – Repositioning of Community Health Projects in the context of over all development.
EHA Vision for communities
Empowered communities that are healthy, learning, prospering, caring, stewards of their natural resources, living in harmonious relationship, living in a clean and safe environment, worshiping the true and living God and reaching out to others in need.
Determinants of health
EHA Organizational Objectives
A. The major disease burden of the communities served by our institutions and projects are reduced equitably, through their participation and at a cost that they can afford. B. Communities prosper economically, demonstrating good stewardship of their available resources, living in a safe and clean environment, constantly learning, demonstrating mutual trust, cooperation and caring attitudes towards other communities. C. Individuals, families and communities become disciples of Jesus Christ
Profile of our Current Community Work
Disease Specific HIV Tuberculosis Malaria
Basic Health Care for common illness
Water, Sanitation & Hygiene
Literacy & Education – Formal, Nonformal, Vocational
Advocacy & Community Mobilization
Thrift/Savings Micro-finance Income generation / Livelihood
Nutrition / Food security
Village health plan Micro birth plan
Advocacy
Community Analysis using 4 delays
Maternal Child Health
Community Based Monitoring
Capacity building
Service delivery
SHG role/support activities
Community level sensitization
Challenges & choices
• Shift from a hospital / disease focus to a community health focus.
Social Determinants of health
Health Promotion
Preventive
Medicine
Primary Care
Secondary Level Care
Rehabilitation
Role of the hospital
• Initiate the Community Project. – Hospital reputation is important for entry in to the community. • Administrative support • Technical resource persons
– Health care – Training
• Facilities shared reducing overhead expenses.
Role of the hospital
• Important to support communities initiatives with critical / emergency care. • Financing • Accountability • Provide a faith community and family support to community health programme staff. • Provide linkages with partners
Disadvantages
• Ownership • Suspicion or mistrust • Conflict of interests
– sharing of resources
• • • •
Attitudes of hospital staff Pre-conceived notions Different time frameworks Ghetto or “mission compound” mentality
A different drumbeat
Changes in the context
Non communicable Diseases
• The new killers – CVD, Diabetes, Mental Illness including substance abuse, Injuries which include Accidents, RTA and Suicide, Asthma and COPD • Dual burden of disease. • Risk-reduction / behaviour change • Need for integrated “continuum of care” programmes
Health Care Financing -India
• 82.4% of health care expenditure occurs in the private sector of which 77.5% is from out-of pocket payments. • Of the 5% of GDP spent on health care the government contribution is only 17.8% which amounts to 0.9% of GDP. • Health care in India is the most privatized in the world
Medical expenses and impoverishment
• Survey conducted in 3 districts in Gujarat and Andhra Pradesh - 85% of the households in Gujarat and 74% of those in AP health expenses was the main reason for their economic decline. • World Bank estimates that OOP pushes 2.2 % health users in poverty and 1in 4 among those hospitalised.
Catastrophic Health Expenditure
• A adverse health condition that necessitates more than 10% of the household income in medical expenses (Pradhan 2002) • Illness leads to loss of income and significant extra expenditure. The combination pushes people in to poverty. • 9% of households in India experience catastrophic health expenditure • Catastrophic health expenditure is more common in the low income group, but it can also effect the middle income group.
Access to Essential / Life Saving drugs
• WHO lists 270 drugs as essential – take care of 95% of the health problems. • 60,000 to 80,000 brands of various drugs in India • 10 of the top 25 drugs sold in the Indian market are non essential, irrational or hazardous. • 56% of the people in India still do not have access to essential drugs (WHO 2004) • Deregulation of drug price control has led to spiralling of costs with profit margins being increased to 75-100%
Price variations in drugs
Medicine Brand Company Price in INR Difference
Ofloxacillin 200 mg Levofloxacillin 500 mg
ZO
Tarivid Levoflox
FDC
Aventis Cipla
3.2
31 6.82 969%
Amlodepine 5 mg
Travanic Aventis Amoloda c Zidus Amlogar d Pfizer
95
1.51 6
1392%
397%
Income Inequalities
Disparities across income groups
Health Status Indicator Infant Mortality Poorest Quintile Richest Quintile Poor/ rich risk ratio
109
44
2.5
Under 5 Mortality
Childhood Underweight Total Fertility Rate (births/woman age:15-49)
155
60 4.1
54
34 2.1
2.8
1.7 2.0
Social Disparities: IMR & U5MR
Impact of Climate Change
• Migration of families in search of livelihood. • Increase in natural disasters
Impact on the programs
• Health disparities: Averages cannot the only way to summaries data and it is important to look at the data in different groups. • Hospitals need to synchronize with community based initiatives. Joint planning • Good quality health care is an important adjuvant to community programmes • Engage with Government programmes • Establish linkages with Government programme and to access available resources – privatepublic partnerships.
Can the principles of Primary Health Care be incorporated in to hospitals to synchronize them with community based programmes?
Applying the Principles of “Primary Health care” to hospitals
• Demystifying medicine – strengthen patient education. Using patients to educate others in the community. • Participation of the family and the larger community (volunteers) in caring for the patients. • Using the community as gatekeepers for directing services. • Community advisory committee in hospitals • Making healthcare affordable. • Vertical equity – differential pricing / cross subsidization
Applying the Principles of “Primary Health care” to hospitals
• Rational drug therapy • Use of only appropriate/ cost-effective technology.
Conclusions
• Hospitals can be a good launch pad for community based health programmes • There are potential synergies in having community health programmes
Thank you
doc_433145809.ppt