Access to Healthcare

Access to Healthcare:
Scaling up best practices
Shri Bhasker Iyer
Chairman, ASSOCHAM National Council on Drugs and
Look ahead on the day’s agenda
Today’s focus
• Address by dignitaries
• Plenary sessions focused on two areas –
• State of Indian Healthcare System
• Innovative Models in Healthcare Delivery
India’s Health Record – Key
achievements in the last decade
Systemic thrust in healthcare
Improvements in health
• Focus through 11th 5-year
plan and NRHM
• Maternity Mortality Rate
(MMR) decreased by ~50%
• Shift from disease focused
approach to integrated
health-systems approach
• Infant Mortality Rate (IMR)
decreased by ~25%
• Increased private
participation - healthcare
facilities, insurance
• Certified Polio-free by WHO
• Tuberculosis and Leprosy –
Significant improvement in
detection and cure rates
Source: McKinsey-CII document on India healthcare, Dec-2012, Press search
However, major challenges persist
• Public spending on health is extremely low
• Physical access remains a challenge with substantial
infrastructure gap co-existing with under utilization
• Health work-force remains inadequate and underutilized
• Affordability challenge – Out of Pocket spend
continues to be high
• Public private partnerships haven’t reached scale
Defining access
“The ability to reach, obtain or afford entrance to services”
1. Physical accessibility/ location
IMS study2
(June-2013) –
Healthcare access
in India”
2. Availability/ Capacity
3. Quality/ Functionality
4. Affordability
from ‘Access to Healthcare’ report -2011 of ASSOCHAM (Frost & Sullivan)
IMS access study-2013, sponsored by OPPI
Healthcare access in India’s context
Definition of Universal Health Coverage
“Ensuring equitable access for all Indian citizens, resident in
any part of the country, regardless of income level, social
status, gender, caste or religion, to affordable, accountable,
appropriate health services of assured quality (promotive,
preventive, curative and rehabilitative) as well as public health
services addressing the wider determinants of health
delivered to individuals and populations, with the government
being the guarantor and enabler, although not necessarily the
only provider, of health and related services.”
High Level Expert Group on Universal Health Coverage
constituted by planning commission in 2010
Government commitment towards
Universal Healthcare Access
• Finance minister reference to Universal Health Care
(UHC) in Interim Budget speech on 17th Feb 2014
• Prime Minister’s speech on 11th Feb 2014 – emphasis on
strengthening public health systems.
• NAC meeting on 29th Nov 2013 (chaired by UPA
President Sonia Gandhi) – Progress on NAC
recommendations on UHC briefed by then health secy.
Role of key players in driving UHC
Universal Health Care
Role of Government
Role of Industry
• Increased spending on healthcare
is key to improving access
• Partnering with government on
‘priority health issues’
• Effectiveness in the procurement
and utilization of essential drugs
• Building relevant and tailored
product portfolio
• Choice between playing ‘primary
payor’ v/s ‘primary provider’
• Innovative ways of supporting
access and awareness
• Better utilization of the existing
A few examples of Industry initiatives
towards improving access
• Abbott’s Puducherry project
• Novartis India – Arogya Parivar
• MSD Wellness trust Hilleman Laboratories
• Pfizer’s Patient Assistance program
• Sanofi – Prayas
• Bristol Myers Squibb - Delivering Hope
Lessons on Universal Health Access
journeys of other countries - Brazil
Brazil’s journey (1975 – till
• 1920s – 1970s : Low physician
density, coverage restricted
• 1970s-1990s : Improved financial
access by increasing coverage
through SUS, their Unified Health
System; Funding decentralized
• 2000s onwards : Focus on
reducing inequity and improving
quality of care
Improvements in key
• Nearly 100% insurance coverage
• Doctor density of 1.7 per 1000 in
2008 (up from 0.4 in 1960s)
• Public expenditure as share of
GPD of 4.2% in 2010 (up from
2.8% in 1995)
• MMR of 56 per 100,000 live
births in 2010 (~1/4th of India)
• IMR of 15 per 1000 live births in
2010 (~1/3rd of India))
Source: McKinsey document for CII “India Healthcare – Inspiring possibilities, challenging journey (Dec-2012)”
In conclusion
• Willingness exists in both government and private sector
to broaden healthcare access
• Sustainable policy solutions needed to meet healthcare
financing, infrastructure, and human resource challenges
Thank you