inter-sectoral coordination in health care

INTER SECTORAL COORDINATION : 

INTER SECTORAL COORDINATION Intersectoral collaboration refers to the promotion and co-ordination of the activities of different sectors. Health planners have often identified agriculture, education, water and sanitation, and the environment as those sectors that can, and that should, collaborate in helping to reduce inequities in health.

Guiding Principles : 

Guiding Principles 1. Development is basic to health 2. Equity 2.3. Promoting economic capacity of the people (poor) Asset creation and development Capital formation Employment opportunities in the private or public sector Access to market avenues

3. Health and Agriculture : 

3. Health and Agriculture Some of the factors of agriculture that have direct influence on the health of the people are: 1. Adequate farm income 2. Income from agricultural labour 3. Enough food (energy) for agricultural work 4. Nutritional value of the food eaten 5. Health hazards of agricultural technology

Impact of Agriculture on Health : 

Impact of Agriculture on Health Policies: Food crop vs. cash crops Shift in consumption (locally grown food vs. meal processed in cities) Investment (productive regions vs. poor regions) Land fertility Crops with harmful effects (dangerous to health) – e.g. health of farm labourers Food with direct health hazards (toxic substances) Agricultural products with major health hazards (tobacco and narcotics) Equity in accessibility to food

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4.1. Poverty and Environment 4.2. Population and Environment 4.3. Water, Air, Land and Health 5. Education and Health 6. Action for Co-ordination 6.1. Asset Creation and Development 6.2. Capital Formation 6.3. Employment 6.4. Marketing Linkages

PUBLIC-PRIVATE PARTNERSHIP IN HEALTH CARE : 

PUBLIC-PRIVATE PARTNERSHIP IN HEALTH CARE Public private partnership can be designed to work at primary, secondary and tertiary levels.

ACTIVITIES : 

ACTIVITIES A. Financial Incentives to Private Sector partners • Contracting out clinics or services within hospitals to NGOs • Contracting for marketing of health products to underserved rural areas • Provision of free or discount supplies to private providers • Joint investments in return for services, e.g. Fixed percentage of beds for poor • Fee-based payments for special card holders (e.g., Medicine, poverty card) Community financing or health insurance for preventive or curative subsidies Tax breaks, other subsides to expand private medical services

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B. Regulatory harnessing of the private Sector • Accreditation of doctors and clinics for quality of services • Pricing of products and services • Allowing dual use of public facilities and dual practice by Govt providers (public and private clinics) • Allocation of licenses for products or services (e.g.. Hospital beds) based on current levels and projected needs • Decreased restrictions on advertising of health products and services

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C. Information Sharing and improved joint efficiency of Private and Public services • Sharing of health goals and allocation of resources via decision –making forums • Training and update of both public and private health providers • Allocation of urban services to provide sector and rural/remote to NGO’s and Government. • Limiting access of wealthy to public health services and subsidized products

PPP IN INDIA : 

PPP IN INDIA In India, contracting out of primary health care services has been successfully tried in Tamil Nadu, Gujarat and Andhra Pradesh. The Tamil Nadu government encouraged local industry to adopt a PHC, health sub-centre or district hospital. Industry was responsible for building, maintaining and equipping the facility, while the government provided supplies and staff. In Gujarat, SEWA-Rural was funded to provide health services to one whole district with the provision that it meet government health targets. Results have been successful enough to continue the contract.

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In Andra Pradesh a pilot project to contract out facilities to NGO’s was so successful that Andhra Pradesh recently contracted out all urban health and family centres to NGO’s. In West Bengal, private doctors have been hired on contract basis to staff PHC’s. In Uttar Pradesh, there are similar efforts to contract private doctors to fill empty rural health centres and also special transport funds to provide outreach services. The key in this case is training of nursing home staff and promotion of services availability to the public.

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Delhi, the private hospitals were to set aside beds, plus free services and medicines, for the poor. This has been achieved with varying success. Rajasthan has also been the site of many recent regulatory advances involving private sector medical providers and alternative financing. Private practitioners, including non-MBBS doctors, have routinely been involved in training in family planning and other health areas. Medicare Relief Societies have been introduced to supplement existing service provision in public hospitals, through collection of user fees and revenues from in-hospital pharmacies. In Andra Pradesh, sterilization acceptors are now offered “Arogya Raksha “ or health insurance to cover them and their children for two years for health services from private hospitals.

Use of Marketing Contracts Distribution System : 

Use of Marketing Contracts Distribution System Since chemist shops and the market distribution system reach deep into rural areas, the use of marketing forces is another excellent private sector resource. Many countries provide contracts for social marketing organizations or commercial firms to expand the delivery of health care goods and services. These can include such items as:- Oral contraceptives, condoms, iron folate tablets, ORS anti-malarials, bed –nets, clean delivery kits, nutrition supplements, and others.

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Many of these products require the development of demand, a skill in which these organizations excel. Public sector IEC often informs, but seldom persuades so well. The key condition must be market segmentation-so that the wealthy are not buying subsidized product more than poor. Pharmaceutical firms can also be used to spread public health messages, as research shows that doctors at all levels get most of their updates from medical representatives.

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In UP, State Innovation in Family Planning Services Agency (SIFPSA) has worked with two models. The first is a performance – based contract with Hindustan Latex Ltd. to ensure increasing sales of condoms and Oral Contraceptives, plus availability, of product in shops in villages of 1,000-5,000 population. This has resulted in more product availability, but not always strong promotion. Therefore SIFPSA is trying a new approach –to contract in-depth marketing in an assigned rural territory to an organization on a competitive basis-and fund them to promote many products at once to the rural population. The latest contract with PSI is for OC’s , condoms, IFA tablets, ORS, disposable delivery kits, and other products.

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In Bihar , Janani has developed a system to work rural doctors to stock condoms and OC’s and refer to urban clinics. In urban North India, a USAID project works with private pharmaceutical firms to promote OC’S (Goli ke Hamjoli) and recently, WHO formulations of ORS. This approach uses private sector firm’s influence with doctors and chemist to encourage use of public health products. In UP, SIFPSA also encourages NGO’s and dairy cooperatives to sell OC’s and condoms, rather than given them away free (unproven use).

Considerations for Public-Private Partnership at Primary And Secondary levels : 

Considerations for Public-Private Partnership at Primary And Secondary levels 1. Contract for outreach services and package of primary care interventions for underserved areas to NGO’s or other medical groups. 2. Contact for marketing of specific health products to build both demand and supply, especially in remote areas. 3. Improve the quality of both public and private medical services in tandem. 4. Consider schemes for sharing of services and supplies between private and public facilities 5. Develop alternative sources for health financing for client services

Policy Review for Public-Private Partnership in Health : 

Policy Review for Public-Private Partnership in Health An intensive review and inventory of the current private and public resources – which areas are adequately covered by private sector, which by public facilities and which still underserved –should be undertaken before implementation of the above possibilities. This applies to both geographic coverage and technical health activities.

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For geographical coverage, a Global Information System study could map out where the underserved areas are located. It could also show urban areas that are adequately covered by private clinics and hospitals where the only need may be ensure that the poor are also given place in these facilities. For remote areas, a geographic area could be mapped out which could be contracted out to a competent NGO or other medical group for all essential even curative services.

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For technical and functional areas, a health system review could highlight those areas where the private sector role is integral to improved health. For example, if PHC’s have difficulty delivering IFA tablets to all pregnant women, then this is a good opportunity to use the private sector to market use and sales of IFA tablets to pregnant women. A marketing contract could ensure reach state-wide or in rural areas, and use the growing media opportunities. If certain specialty areas are under –represented in the state, such as Obstetrics/ Gynaecology, then special tax concessions or other joint investment activities may to increase services in this area.

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State level policy changes may be required to harness the power of private providers. These may include accreditation programs for MBBS and alterative system doctors and may also require consideration of training and/or regularization of unregistered rural medical practitioners. It would be best to work with the joint investment of the professional associations. Consideration may also be given to formalizing the private practices of government doctors, so that there is synergy rather than competition.

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A review of successful programs in other states such as Rajasthan and Andra Pradesh may provide some valuable lessons in implementing policy changes. These two states have been at the forefront of private-public partnerships, with mostly successful results. They have used tax concession, subsidies, training, joint investment, accreditation and other tactics to gather the maximum use of their private sector and save public resources for use with the poorest of the poor.

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The primary lesson to be learned from public –private partnerships around the world is that clients are already going to the private sector for most of their health services. Given public sector financial and logistical constraints, it makes sense to use this natural progression to harness the private practitioners and private market system to meet health goals. A government health department needs to monitor and control carefully to ensure quality services are available at affordable prices.

CONSUMERISM AND HEALTH SECTOR : 

CONSUMERISM AND HEALTH SECTOR As a result of recession in a number of industrial sectors, many corporate houses have turned to the health sector. Health sector has grown at the rate of 11 percent in the last 10 years. Nobody talks about professional ethics. Growing consumerism has put pressure to earn more and more money. Given this, doctors are motivated to make more money, causing a change in attitude from a profession of service to a profession of earning money. Commercialization of medical education is another reason. With Consumer Protection Act, doctors prescribe more tests as defensive mechanism.

CHALLENGES IN HEALTH CARE DELIVERY : 

CHALLENGES IN HEALTH CARE DELIVERY Population explosion and changing population trends Increasing disasters Increasing social problems Availability of money Shifting cultures Over the counter drugs and counterfeit drugs Climatic changes. Emerging and re-emerging diseases. Vast geographical area. Lack of political commitment.

CONCLUSION : 

CONCLUSION Intersectoral collaboration refers to the promotion and co-ordination of the activities of different sectors. Public private partnership can be designed to work at primary, secondary and tertiary levels. India faces various problems in health care delivery system and the challenges can be solved to an extend through better Intersectoral coordination and public private partnerships.

REFERENCES : 

REFERENCES Gulani K.K. Community Health Nursing- Principles and Practices.1st edition. Kumar Publishing House;Delhi: 2006. Marcia Stanhope. And Jeanette Lancaster. Public Health Nursing Population – Centered Health Care in the Community. 7th edition. Mosby Elsevier; Canada: 2008 Maurer F.A. and Smith C.M.Community /Public Health Nursing Practice, Health for Families and Populations. 3rd edition. Sounders Elsivier; USA: 2005 Health system trust. Intersectoral coordination. Retieved on November 15, 2009 from http://en.wikipedia.org/wiki/Healthcare_in_India Dr. Raj S. Arole. Comprehensive Rural Health Project, Jamkhed, India. Inter-Sectoral Co-ordination for Primary Health Care. Retrieved on November 15, 2009 from http://www.jamkhed.org/Readings/InterSectCoordination.pdf world Health Organization. Intersectoral Coordination between Health and Agriculture: Zoonoses, Food Safety and Foot-and-Mouth Diseas. Retrieved on December 12, 2009 from http://apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=63&codcch=156

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Wikipedia. Non-governmental organization. Retrieved on October 09, 2009 from http://en.wikipedia.org/wiki/Ngo Wikipedia. Ngos role in health care. Retrieved on January 23, 2010 from http://en.wikipedia.org/wiki/Ngos_role_in_health_care World Health Organization. News & Highlights. Retrieved on January 23, 2010 from http://www.whoindia.org/EN/Index.htm Pubmed. Ngos and Inter sectoral coordination. retrieved on February o1, 2010 from http://www.ncbi.nlm.nih.gov/sites/entrez Gill Walt. What sort of international cooperation in health 2055? JRSM. 2005 April;98 (5): 235-237 Ind EU.The India-Eu Strategic Partnership Joint Action Plan. RETRIEVED ON February 11, 2010 from http://commerce.nic.in/trade/India_EU_jap.pdf Uttarakhand health and family welfare society. Intersectoral coordination. Retrieved on February 22, 2010 from http://gov.ua.nic.in/health/intersectorial.aspx Kerala faces heat waves. Malayalamanorama. 2010 March 14; 1 (col.2) Diethylcarbamazine: government withdraws the medicine. Malayalamanorama. 2010 march 2: 1 (col.2)