1. INFRASTRUCTURE AND HEALTHCARE BT08B023-Rohit kumar BT08B047-Utsav Saxena BT08B013- Kemun

2. Infrastructure is the basic physical and organizational structures needed for the operation of a society or enterprise, or the services and facilities necessary for an economy to function. The term typically refers to the technical structures that support a society. Healthcare infrastructure includes the Hospitals, Medical equipments, Ambulance service,working staffs and so on. Healthcare Infrastructure

3. Working staff Equipments Ambulance Health Education Hospitals Components

4. POST-INEPENDENCE

5. Challenges Before Government Very few hospitals and unavailability of equipments and ambulances. 30-40 medical colleges producing meager amount of doctors etc. Burden of Diseases, epidemics and adding to the problem is high cost of drugs?? Vast ever booming population, almost impossible to be taken care off with the scarce resources it had. Crippled in short.

6. The Path Taken: 5-6% of GDP Indian Healthcare market has grown to USD 35 billion in 2008 and is projected to grow to nearly USD 40 billion by 2012. The private sector accounts for over 80% of total healthcare expenditure in India?? Primary Health Centres- 23,000 Community Health Centres- 2,935 District Hospitals- 4,400 State Owned Hospitals- 1,200

7. Results

8. In span of 60 years, is it worth enough of infrastructural growth in Healthcare, one of the most prior and needy sector?? Broken hospitals Obsolete Instruments

9. But we are far from achieving that vision Beds Physicians Nurses Per ’000 population, 2005* 1.5 4.3 7.4 India Other low income countries (e.g., sub- Saharan Africa) Middle income countries (e.g., China, Brazil Thailand, South Africa, Korea) High income countries (e.g., US, Western Europe, Japan) 1.8 1.0 1.2*** 0.5** World average 3.3 1.5 3.3 0.9 1.6 1.9 7.5 Escorts Heart Institute & Research Centre Ltd, New Delhi, INDIA

11. Quite clear from the graph that not just the growth rate, even the total number of different centers had decreased. India’s healthcare infrastructure has not kept pace with the economy’s growth. Rural infrastructure is worse hit because of negligence at government part as well as peoples resistance to work in rural places. Roughly two-thirds were public, after years of under funding, most public health facilities provide only basic care.

12. Hospitals An institution for health care providing patient treatment by specialized staff and equipment. It should have skilled nursing facility, operation theatres, ICUs, OPDs etc. Inspite of this scenario, there are Centres of Excellence spread all across India and to name a few: Apollo Hospitals, Escorts Heart Institute & Research Centre, Wockhardt Hospitals, Fortis Healthcare, Tata Memorial Cancer and Leelawati Hospital, Manipal Hospital

13. INDIAN HOSPITALS CAN OFFER MEDICAL SERVICES AT A FRACTION OF THE US / EUROPEAN COST PROCEDURECOST (US$) 7,500 ------- 8,000 3,500 6,000 26,000 69,000 6,000 2,000 USUK 23,000 1,50,000 2,00,000 12,000 10,000 Heart Surgery Bone Marrow Transplant Liver Transplant Knee Replacement Cosmetic Surgery 40,000 2,50,000 3,00,000 20,000 INDIA THAILAND

14. HEALTH INFRASTRUCTURE IN RURAL INDIA

15. In the case of health the term infrastructure takes on a wider role than mere physical infrastructure. Healthcare centres, dispensaries, or hospitals need to be manned by well trained staff with a service perspective. UMHFW

17.  The sub-centre is the most peripheral institution and the first contact point between the primary healthcare system and the community.  Each sub-centre is manned by one ANM and one MPW(M).  An LHV is in charge of six sub-centres each of which are provided with basic drugs for minor ailments and are expected to provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhoea control, and control of communicable diseases.  Sub-centres are also expected to use various mediums of interpersonal communication in order to bring about behavioural change in reproductive and hygiene practices.

18. Primary Health Centre  A medical officer is in charge of the PHC supported by fourteen paramedical and other staff.  It acts as a referral unit for six sub-centres. It has four to six beds for inpatients.  Each PHC covers a population of 1,00,000 and is spread over about 100 villages.  A Medical Officer, Block Extension Educator, one female Health Assistant, a compounder, a driver and laboratory technician look after the PHC.  It is equipped with a jeep and necessary facilities to carry out small surgeries.

19. The primary health center deals with:  Medical care.  Mother and child health care including family planning.  Safe water supply and basic sanitation.  Prevention and control of local diseases.  Collecting statistical information.  Health education.  Training of health guides, health workers, dayees.  Basic laboratory investigations.

20.  Community Health Centres (CHC) forming the uppermost tier are established and maintained by the State Government under the MNP/BMS programme.  Four medical specialists including Surgeon, Physician, Gynaecologist, and Paediatrician supported by twenty-one paramedical and other staff are supposed to staff each CHC.  Norms require a typical CHC to have thirty in-door beds with OT, X-ray, Labour Room, and Laboratory facilities.  A CHC is a referral centre for four PHCs within its jurisdiction, providing facilities for obstetric care and specialist expertise. There were 3346 CHCs in the country, almost a 50 per cent shortfall.

21. Human Resource: Manpower Shortfall

22. Absenteeism: Status of Health Infrastructure in Villages:

23. Access to Infrastructure:

24. IT for Accessible Healthcare Provisioning PRIMARY HEALTHCARE: Objective: To equip PHCs with basic diagnostic equipment that can be operated by paramedics or ANMs, with doctors providing expert interventions from a distance. Remote diagnostic devices that allow even novices to measure and record basic parameters like blood pressure, temperature, and chest sounds. The device has a stethoscope, sphygmomanometer, and thermometer, along with a simple video-conferencing application that can connect over even a basic dial-up line.

25. Computer-based symptom-based diagnostic application can guide the paramedic/nurse in handling common ailments directly by administering simple remedies, and only refer to secondary care for the more complex problems. All of these will eventually create a dispersed network of computerized, internet-enabled centres in rural areas, all managed by technically competent, functionally English- literate young men and women, who will form a resource pool through which such health services will flow. While villagers may initially be reluctant to visit such a centre for medical purposes, the stationing of the ANM or paramedic inside the centre will lend it credibility.

26. SECONDARY CARE:  OPDs of all government hospitals : cowded  Online connectivity of the hospitals to the PHC can reduce the queues, as primary diagnosis is completed at the village itself.  Only patients referred to a doctor by the nurse/paramedic will need to visit the hospital.  Thus the hospital can utilize its resources in the treatment of more serious ailments and patients are saved the trouble of travelling to the hospital for small problems.

27. MOBILE HEALTHCARE:  Mobile diagnostic Clinic equipped with X-Ray, ultrasound, pathology lab (for blood and urine tests) and ECG, facility to dispense medicines.  A doctor travels along with the Mobile Clinic providing up to secondary level consultation. Only those patients who require specialist consultation are referred to a tertiary care hospital.  Today, mobile pharmacies are not licensed in India. A policy change making this possible will allow for life-saving drugs to be dispensed through these or similar clinics.  On the same lines, the Christian Medical College, Vellore, has developed a mobile blood donation unit.

28. TELE-PREVENTIVE MEDICINE: Use of the internet to collect information from large number of people (both healthy and sick) to prevent outbreak of disease. A UNICEF sponsored study in West Africa used GIS to map villages with high rates of Guinea-worm disease and evaluate the effectiveness of policies designed to combat it. The National Institute of Epidemiology in India has done similar work in using GIS to map the effect of leprosy vaccine trials.

29. Expanding Presence of Private Players in Healthcare Landscape:

30. Do Private Practitioners Necessarily Provide Better quality of Medical Service for the Prices They Charge? FINDING QUALITY HEALTHCARE SOLUTIONS: PUBLIC, PRIVATE OR PARTNERSHIPS

31. National Rural Health Mission ASHA :  one per village  link b/w health centres and villagers  will be trained to 1.advise village populations about sanitation 2.hygiene 3.Contraception 4.immunization to provide primary medical care for diarrhoea, minor injuries,fevers 5.to escort patients to medical centers 6.direct observed short course therapy for tuberculosis and oral rehydration, and 7.to alert authorities of unusual outbreaks of disease.

32. HEALTHCARE INFRASTRUCTURE FOR URBAN POOR

33. POLICY RELATED CHALLENGES

35. ON THE OTHER HAND: OPPORTUNITIES