Health interventions: Better but still need nursing

A banker for over two decades, Nachiket Mor is no stranger to healthcare.

He has worn many hats on health, from helping the Government strategise on delivering primary healthcare to serving on expert committees on universal health.

In March, Nachiket took charge as India head of the Bill and Melinda Gates Foundation (BMGF), a job that will blend his expertise in financial services and health. Months into the job, he gave BusinessLine a birds eyeview of some positive health interventions.

The projects to improve maternal and child health in Bihar and Uttar Pradesh, he says, have given everyone the confidence that engaging with the government can deliver results. Bihar, for instance, has shown consistent progress on several health indicators, he adds.

But what worries him, as it does many health workers, are the many challenges in healthcare delivery: inadequate national funding, human resource shortages, and supply chain issues.

Bihar’s success Countering the pessimists who think that systems can work in Tamil Nadu, but not in UP or Bihar, Nachiket says, “there’s evidence that’s not true.” Fieldworkers and nurses want to do well and they do with a little “hand-holding” and mentoring, he says.

In 2012, the Bihar government launched a nurse mentoring programme in public health facilities, with technical support from BMGF. This was to address the high maternal, neonatal and child death rates in the State; most were preventable with basic interventions and care for the mother and baby. The programme involved training nurses in public health facilities to improve the quality of care provided by them (to the woman and her baby) in the labour room before, during and after the delivery. The nurse trained by the master nurse mentor in turn trained other staff nurses for a week every month over 6-8 months.

Thanks to the training, in 600-plus deliveries in facilities where the training was done saw nurses practising improved clinical processes. This meant more maternal and newborn lives were saved. And the rate of still-births, for instance, reduced from 19 per 1,000 deliveries to 14. The programme has run in 330 public health facilities in Bihar and targets 430 of 600 facilities by end of 2016, the Foundation said.

Challenges too But the inadequate national funding of health, hovering at 1 per cent of GDP, continues to be a challenge, says Nachiket. Thailand, Brazil, South Africa, Mexico, China, and Malawi all spend significantly more than India. And these countries, which had a similar spend as India 25 years ago, now spend 6 per cent of their GDP on health.

The shortage of human resource, surgeons for example, the inability to offer emergency care to mothers and children in distress, and supply-chain problems in delivering healthcare also need to be redressed, he points out.

Putting the banker hat on healthcare funding, he says, the way ahead is to tax those with taxable income and spend the money to offer free healthcare to the rich, the non-poor and the poor. Many countries, the United Kingdom being the most notable example, have taken this approach.

And since the tax-funded approach may not be enough, there is value in mandating that the non-poor also pay into the pool. ESIC (Employees State Insurance Corporation) does this with workers from the formal sector paying for their services.

The pooled money, along with funds coming from taxes, is used to purchase healthcare from public and private sector providers.

The Foundation has faced its own challenges with questions asked of its funding and operations in India. The Foundation is registered under local laws and engages with the Government and the Reserve Bank of India so all compliances are met, he says.

And while the Foundation keeps its eyes on how that pans out, it hopes to carry some of its successful health models to other States. There is a lot of interest, says Nachiket, and “If anything, we are finding it difficult to respond to all requests.”

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