Department of Health & Family Welfare 1 Government Health - PowerPoint PPT Presentation

Department of Health & Family Welfare 1

Government Health Expenditure (GHE) and Out of Pocket Expenditure (OOPE) as % of Total Health Expenditure (THE) 2014 OOPE as % of THE GHE as % of THE 84 83.6 83.1 77.8 78.2 77 62.4 52.2 56.1 55.8 48.3 46.0 45.8 42.1 32.0 30 25.5 14.1 14.0 13.2 11.9 11.0 9.7 6.3 India Russia Sri Lanka China Brazil Sweden Japan Thailand USA UK France Germany GHE as % THE - India ranks 176 out of 191 countries OOPE as % of THE - India ranks 182 out of 191 countries 2

Tax to GDP ratio (%) (2015) in selected countries 34.1 25.4 20.1 18.2 16.6 16.3 16.2 14.5 13.6 12.8 12.4 Source- www.data.worldbank.org Prioritizing Health: Health Expenditure in Total Government Expenditure (%)-2015 18.5 15.8 15.3 10.9 9.9 9.7 9.4 8.6 8.4 7.3 3.1 3 Source : Global Health Expendidture Database, accessed on 11.4.2019

Year-Wise Health Expenditure by GOI (Rs. in Crores) 60000 52944.26 51381.89 50000 37671.3 33121.42 40000 30000 20000 10000 0 2015-16 2016-17 2017-18 2018-19 (Provisional) Expenditure of Health Expenditure on Health 4 Source: Detailed Demand of Grants, MoHFW

NHP 2017 Targets • Increase public health expenditure to 2.5% of GDP, in a progressive manner, by 2025. • Increase State sector health spending to more than 8% of their budget by 2020. • Primary Health Expenditure to be 2/3 rd of the total health expenditure. 5

Year wise Expenditure to achieve 2.5% of GDP ( Rs. in Lakh Crore ) GDP ( assuming growth@7.5% GDP with Expenditure 35% of 65% of at current Rate of Expenditure Year on Health as Expend. for Expend. for prices over Inflation on Health a % of GDP Centre State baseline of @4%only 2017-18) 1 2 3 4 5=4*2 7 8 2018-19* 1.4% 178.75 185.90 2.60 1.69 0.91 2019-20* 1.4% 199.83 207.84 1.89 2.91 1.02 2020-21 1.58% 223.42 232.36 3.67 2.39 1.28 2021-22 1.76% 249.79 259.78 4.57 2.97 1.60 2022-23 1.98% 279.26 290.43 5.75 3.74 2.01 2023-24 2.22% 312.22 324.70 7.21 4.68 2.52 2024-25 2.50% 349.06 363.02 5.90 9.07 3.17 6 .* Assuming that the Govt. health expenditure is 1.4% of GDP, as in 2017-18, as per Economic Survey, 2017-18

Organization & Key Programmes of MoHFW National Health Mission Support to • Ayushmaan Bharat – Health & Wellness Centres Primary & • Secondary Reproductive-Maternal-Neonatal-Child - Adolescent Health & Nutrition Care • Health System Strengthening • Communicable & Non-Communicable Diseases (NCDs) National AIDS Control Programme Ayushmaan Bharat – PMJAY Tertiary Care PMSSY, upgradation of DHs into Medical Colleges INIs & Central Institutions Tertiary care schemes HRH Medical, Nursing & Allied Professionals Institutions Strengthening/ Establishing Health institutions including new AIIMS, CG hospitals and the CGHS Regulation Drugs & Food, Clinical Establishment Medical, Dental, Nursing & Pharmacy Councils Allied Health Professionals (proposed) 7

Sustainable Development Goals - 17 Goals, 169 targets & 230 indicators - 1 Health Goal, 13 targets & 26 indicators 8

Health SDG3 is linked to other SDGs as contributor and beneficiary Target 6.1: achieve Target 1.3: universal & Implement equitable access to social protection safe and affordable systems for all drinking water Target 2.2: end Target 4.2: ensure malnutrition, achieve access to early targets for reductions childhood child stunting & development, care and wasting pre-primary education Target 16.1: reduce all Target 5.2: end all forms forms of violence and of violence against all related death rates women and girls … . everywhere Other SDGs e.g. 8 (productive employment and decent work), 10 (inequality), 11 9 (cities) etc

Initiatives taken by MoHFW 11

AYUSHMAN BHARAT – Rationale TERTIARY PMJAY SECONDARY Referral HWCs PRIMARY Unmet need: NCDs/other Preventive, Promotive, Chronic Existing Curative, Rehabilitative Diseases services: & Palliative Care RMNCHA CONTINUUM OF CARE – CPHC & PMJAY 12

AYUSHMAN BHARAT Aims to provide holistic care – prevention, health promotion, primary, secondary & tertiary care in an integrated manner • Operationalizing 1.5 lakh Health and Wellness Centres - To Deliver Comprehensive Primary Health Care services including prevention and health promotion • Financial protection for secondary and tertiary care hospitalisation through Pradhan Mantri Jan Arogya Yojana (PMJAY) 13

Key Milestones Operational Operationalization Inauguration of 1 st HWC Guidelines on of 1.5 Lakh Health Comprehensive and CPHC Application & Wellness Primary Health at Jangla, Bijapur Centres Care finalized Operationalization Budget of 18157 Health & FY 2019-20 National announcement Wellness Centres (Rs. 1600 Cr) Consultation on of HWCs Comprehensive FY 2018-19 Primary Health (Rs. 1200 Cr) Care 14 th April, Feb May July Feb May 10 th 2022 2018 2018 2018 2019 2018 2019 14

Expanded Continuu Service m of Care Financing Delivery – / Telehealth /Referral Provider Payment Reforms Expanding Key HR - Partnershi MLHP & Elements p for Multiskillin CPHC Knowledg g to Roll out e & through Implement HWC CPHC ation Medicines & Expandin g Infrastruct Diagnostic ure s Community Mobilisatio Robust n and IT Health System Promotion 15

HWC: Paradigm Shift at multiple policy and operational levels • Focus on curative care predominant • Focus on Preventive and Promotive Health care • HWC teams to manage majority of conditions • Continuum of care only for maternal including home and community based and child health follow up • Continuum of care for expanded range of services and linkage with PMJAY • Adding a Community Health Officer ( Mid • HSC led by One or two Multipurpose Level Health Provider) at HSC – HWCs workers, supported by ASHAs and multiskilling of primary health care team • Dispensing of medicines including • Supply of medicines and access to chronic care and essential diagnostics diagnostics at higher level facilities 16

HWC: Paradigm Shift at multiple policy and operational levels • Limited use of technology in • IT based application for continuum of consultation and capacity building care including linkage with PMJAY and development of electronic health record. • ECHO for regular tele mentoring and Teleconsultation to avoid patient hardship • Overcrowded secondary and tertiary • Comprehensive care close to community, centres / High loss to follow up/ High reduced OOPE, better compliance OOPE • Investment in infrastructure and branding. • Underused network of 1,50,000 peripheral facilities, selective care 17

Service Packages Services made available at HWC Services * being added in incremental manner 1. Care in Pregnancy and Child-birth. 8. Basic Oral Health Care 2. Neonatal and Infant Health Care Services 9. Screening and Basic Management of 3. Childhood and Adolescent Health Care Mental Health Ailments Services. 10. Care for Common Ophthalmic and 4. Family Planning, Contraceptive Services ENT Problem and other Reproductive Health Care Services 11.Elderly and Palliative Health Care 5. Management of Communicable Diseases: Services National Health Programmes 12.Emergency Medical Services including 6. General Out-patient Care for Acute Simple Burns and Trauma Illnesses and Minor Ailments 7. Screening, Prevention, Control and *Many states in south have started Management of Non-communicable adding above services Diseases and Chronic Communicable diseases like Tuberculosis and Leprosy . 18

Roll out Plan of Health and Wellness Centres 1.5 Lakh 1.1 Lakh 40000 52744 APPROVALS 70,000 40000 40000 ACHIEVEMENT 40,000 17149 30000 30000 30000 25000 25000 25000 25000 15000 15000 15000 15000 15000 2018-19 2019-20 2020-21 2021-22 Dec, 2022 19

PM-JAY achievements States/UTs 33 States/UTs signed 29 implementing MoUs 18 State/UT Governments have expanded PM- JAY coverage to additional beneficiaries at their own cost A robust IT platform has been developed PMJAY Status till 05/05/2019 Metric Overall E-Cards Issued 3,21,66,096 Beneficiaries Admitted in Hospital 2,30,2925 Amount Authorized for 07 17 Mixed Mode Trust Mode Admissions Rs.3071.5 Cr MoU yet to be Insurance 09 03 Hospitals Empanelled 15,075 signed Mode

National Health Mission (NHM) NHM NRHM- RCH NUHM Communicable NCDs Infrastructure Disease Programme programmes Maintenance Pool RCH Health System National Prog. For Prevention & Revised National TB Flexipool- Strengthening Control of Cancer, Diabetes, Control Prog Cardiovascular Diseases & (RNTCP) Stroke (NPCDCS) RMNCH+ A - Reproductive, Maternal, Neonatal, Child & National Vector Adolescent Health. National Prog. for Control of Borne Disease Blindness (NPCB) Control Prog Immunization- Routine (NVBDCP). Immunization & Pulse Polio National Mental Health Immunization. National Leprosy Prog.(NMHP) Elimination Prog (NLEP) National Tobacco Control Prog. (NTCP) Integrated Disease Surveillance Project (IDSP) National Prog. for Health Care 21 of Elderly (NPHCE)