2^nd July 2006

 

Comrade PK Sreemathi Teacher,

Minister for Health and Social Welfare

Government of Kerala

Thiruvananthapuram

Email: minister-health@kerala.gov.in

 

Sub: Prototype Models for Integrated Primary Health Centers

 

Dear Comrade Minister,

 

You have announced establishing a few model hospitals, maybe Primary Health Centers or Community Health Centers or both: You have not mentioned either, whether these will be Allopathic, Ayurvedic or Homeo institutions. Nevertheless, I wish to share a few thoughts with you in this regard.

 

1. At the outset let me quote some bare statistics (Year 2002) on government healthcare institutions in Kerala, from the Economic Review-2003 of State Planning Board:

 

Item	Total Numbers	Allopathic %	Ayurveda %	Homeo %
Institutions	2712	48	31	21
Beds	50805	91	7	2
Inpatients	1935696	95	4	1
Outpatients	80940260	48	22	30

 

2. At the primary level, there were 933 allopathic, 842 Ayurvedic and 555 Homeo institutions (2330 in all) and they were mostly dispensaries with very minimal or no inpatient facilities. They are Panchayat or municipal-ward level institutions, with less than five beds on the average, and mostly taking care of outpatients. In 2002, there were about 810 lakh outpatients treated by these institutions; 22% in Ayurveda, 30 % in Homeo and 48 % in Allopothic institutions.

 

3. Such a delivery profile of public healthcare systems is a unique experience at the national as well as global level. The situation therefore demands a unique treatment as well, for making optimum use of the resources at our command. These centers are located in different places and administered from the top, by various departments sitting in watertight compartments. It will make immense sense if these grass root level institutions are located in the same compound, preferably under the same roof, as Integrated  Primary Health Centers (IPHC).

 

4.  IPHC have several obvious advantages such as:

 

a)     A common integrated health center, functioning as a 7X24 emergency facility in the village/municipal ward, will be easily accessible by all local citizens.

b)    Patients can choose the treatment, Allopathic, Ayurvedic or Homeo and buy different medicines after reaching the IPHC.

c)      There could be a common registration center for keeping the patients’ case sheets and maintaining the medical history cards of all local citizens.

d)    IPHCs can substantially improve the quality of health statistics and provide better tools for healthcare planning: Registration with the local IPHC can be made obligatory. 

e)     Private practitioners of different disciplines in a locality may register with the IHPC and their services could be pooled with through appropriate Government schemes.

f)      Facilities maintained by IPHC, such as laboratory, X-ray and other diagnostic equipment and even bed-care could be shared by different disciplines.

g)     Doctors of different disciplines could easily consult with each other, and provide the best of service to the patients: Best of services could be mobilized in community medicine and in the control of epidemics.

h)     Close interaction of medical practitioners of diverse disciplines, at the grass root level, will lead to big improvements in the quality of outpatient care, which in turn will substantially bring down the demand for inpatient care.

i)       Experience gained through such grass-root level cooperation between diverse disciplines could be taken to the higher levels of healthcare viz community health centers, district hospitals and even specialty hospitals.

j)       Widespread practice of alternative medicine in Kerala, especially Ayurveda has attracted worldwide attention and even international agencies like the WHO will be interested in the IPHC innovations.

k)     Tourism is hijacking Ayurveda in an unhealthy manner and upholding the medical relevance of Ayurveda can check this trend: Panchakarma therapy could compete even with acupuncture in the international market for alternative medicines.

l)       IPHCs will ensure a minimum level of prenatal, postnatal and geriatric care, the principal concerns of the people, at a cost affordable by public exchequer.

 

4.. Primary Health Centers are already declared as the responsibility of Panchayats, who could be easily encouraged to bring Allopothic, Ayurvedic and Homeo units of their locality under the same roof, and to organize common infrastructure facilities. There is no need for any administrative compulsion: Changed work environment will encourage doctors and paramedical staff of diverse disciplines to discover ways and means of cooperation, in the best interest of their patients. Such methods of working together by different disciplines are successfully practiced in China, right from the early days of the revolution, under advice from Chairman Mao. In independent India too, there were moves at the higher levels for developing an Integrated System of Medicine: This could not take off due to lack of support and participation from grass root level. Healthcare statistics of Kerala quoted in the first paragraph show the feasibility as well as the desirability of building up an integrated health system in Kerala from grass-root level, from the village panchayats and municipal-wards upwards.

 

5. I may conclude this note with a request that, Comrade Minister for Health may setup a small task force to draw up a detailed scheme for the purpose, and identify ten panchayats/municipal divisions in each district, where IPHCs maybe as prototype models, to start with. These may be largely self-financing schemes with need-based financial or other inputs from Government. Detailed planning maybe left to the concerned Panchayats or municipal-wards with a minimum of guidelines as necessary.

 

6. I would very much like to meet you and explain the idea in more detail if necessary, as and when I come to Thiruvananthapuram next time. I will be only glad to send you more of explanatory notes, in the meanwhile, if you so desire.

 

I am copying this mail to the Chief Minister, the Minister for Panchayts as well as the Vice Chairman of State Planning Board and to a few other members of the public who are even more competent to debate on the subject.

 

 

With warm greetings from Kochi,

Yours fraternally,

K Vijayachandran

Chairman, Cochin Center for Policy Initiative.

35/194 Automobile Road, Palarivattom

Kochi 682025: Phone-0484-2344015

 

END