Universal Access to Health Care Primary, secondary and tertiary health care provided to all citizens free of cost Tax-based financing Government runs most, if not all, health centres  Standards of care  Regulation/socialization of private sector

Health care in Bangalore city BBMP Health & Family Welfare Ministry Medical Education ESI Private Sector

NUHM: National Urban Health Mission ರಾಷ್ಟ್ರೀಯ ನಗರ ಆರೋಗ್ಯ ಮಿಷನ್

NUHM National Framework Address health concerns of urban poor City-specific planning to be institutionalized  Identification of urban poor and vulnerable populations  Existing health facilities  Partnerships with NGOs Differentiates between for-profit and not-for- profit Communitization

NUHM in Bangalore city November: Health Ministers' conference in Delhi November 30th: Meeting chaired by principal secretary December 5th & 12th: NUHM Roundtables at PHFI campus December 21st: Meeting at Vikasa Soudha chaired by Principal Secretary, attended by Health Minister Plan was to be released on January 25th

NUHM Roundtables - Discussions Primary Health Care  Ward as unit for PUHC, not 50,000 population  Comprehensive primary health care Diagnostic services with Lab technician Comprehensive counselor Rehabilitation services  Available and accessible to all free of cost  Evening hours  Convergence with all departments providing direct and indirect services

NUHM Roundtables - Discussions Facilities  Atleast IPHS  As close to poor communities as possible  Rent or lease if necessary Human Resources  Ongoing recruitment and buffer staff  No contract workers, only permanent staff  Good salaries for USHAs etc., not incentive- based pay  Bigger role for nurses

NUHM Roundtables - Discussions Secondary and tertiary care  Referral and counter-referral systems  Robust public infrastructure needed High dependence on user fees in autonomous institutions  Medical colleges and the private sector to be involved through clearly defined mechanisms  Regulation of private sector  Insurance schemes hotly debated

NUHM Meeting on December 21st Urban Health Centres (UHCs) in all 198 wards of the city. Primary health care will be universal and free Proposed budget for is Rs. 250 crore Health Minister: 100-bed secondary level hospitals in each of the 28 assembly constituencies and specialty 500-bed hospitals in each of the 8 zones

Questions Primary care  Will it be truly comprehensive?  Wards/areas with high poor populations and lack of space  Agreements with private players? Medical Education Department and Autonomous Institutions  Currently run most tertiary care institutions  No representation on State- and City-level committees  Financing of autonomous institutions

Questions Financing  Long-term sustainability  Untapped/unconsidered funds such as Construction workers' fund Communitization  Functioning of ward committees ESI

The way forward...