ACCESS Health India works closely with partners to create systems level change for the benefit of all Indians.
ACCESS Health India works closely with the government, donor organizations, and national and international researchers address issues at the systems level and improve and strengthen the overall healthcare system in India. Our research and programs have addressed issues ranging from primary care, digital health, risk pooling, and strategic purchasing to drive quality and accountability.
ACCESS Health India’s work focuses on the building blocks of a healthy nation.
ACCESS Health India’s work is organized around five core elements within a health system: Health Systems Governance, Health Finance, Healthcare Provision, Digital Health, and Community Health. The work aligns with the five Centers of Excellence at the Institute for Health Systems Strengthening (IHSS).
1. Health Systems Governance (Policy, Monitoring and Evaluation, Regulation)
Strategies for Private Sector Engagement to Mobilize Resources for Healthcare Infrastructure in Underserved Areas
Even though the Indian government has committed to increasing public health expenditure from ~1.2% of GDP to 2.5%, there is limited fiscal space for health due to the ongoing national and international economic slowdown. Against this backdrop, ACCESS Health India and PwC, is developing policy recommendations to increase investments in healthcare, especially in tier II and tier III cities and towns. These investments would help meet the anticipated rise in demand caused by the recent rollout of the national public health insurance program, Pradhan Mantri Jan Arogya Yojana. ACCESS Health is also part of a consortium studying innovative financing models for cancer care and consumer health financing using fintech solutions.
Risk Pooling Strategies
Despite efforts to increase financial coverage for people living in poverty, out of pocket expenses still make up two thirds of total health expenditure in India. Employees in the formal sector have health coverage through their work, ninety percent of the Indian labor force exists in the informal sector where no such coverage exists. Rising costs of healthcare are becoming unaffordable even to the middle class, the majority of whom do not have any form of health finance protection. Interstate migrants, most of whom come from poorer sections of society, are denied public health insurance benefits. Given the highly fragmented payer system, there is a compelling case for the need for feasible plans to aggregate these pools to make the payer system most efficient and effective. ACCESS Health India, in partnership with national and international institutions, is working on modalities of risk pooling for policy uptake.
India continues with a decades old system of supply side line item budgeting for the public healthcare delivery system, despite the fact that this approach is inherently ineffective and inefficient. While the bundled payment system adopted by state and national public health insurance programs has introduced some efficiencies, the principles of strategic purchasing have yet to be adopted by the system at large. ACCESS Health and other international expert organizations are actively engaged with agencies implementing these insurance programs at the national level and in certain states on strategic purchasing with a goal to improve efficiencies across the health system.
Public Health Finance Management
In the face of limited public health expenditure, many states never realize the full potential of their allocated budget, with some states leaving nearly a third of their allocated budget on the table and unused due to inefficient finance management. ACCESS Health is working with the state government of Assam, USAID, and other strategic partners in India to optimize public health finance management. Other states may adopt similar improvements as well.
2. Health Finance (Mobilization, Pooling, Strategic Purchasing, Public Finance Management)
Research and Analysis of the Indian Health System
ACCESS Health India acted as the nodal center for in depth research and analysis of the Indian health system. Working closely with national and international experts and researchers in health financing, healthcare provision, and digital health, ACCESS Health India developed a portfolio of strategies for policymakers to choose from. The main body of the work was compiled in a book under the aegis of NITI Ayog, the national think tank for Indian policy.
Building Health Systems Research Consortium in India
ACCESS Health India was awarded the Secretariat role in a new health systems research consortium currently being developed in India. As the Secretariat, ACCESS Health India will coordinate research with a goal to providing guidance for health policy and implementation.
3. Healthcare Provision
Resources for Health
Human, material, machinery, and technology resources are vital inputs for a robust healthcare delivery system. ACCESS Health is partnering with US Pharmacopeia to study quality assurance in public drug procurement and supply systems across three states in India, with the goal of identifying gaps and best practices and sharing these findings with other states. ACCESS Health has begun an analysis of the current human resources for health situation in India, which is the most critical of all resources to achieve universal health coverage by 2030. The study will result in policy recommendations to strengthen this aspect of the health system.
Quality of Care
While financial protection for health is expected to improve with the rollout of the Ayushman Bharat program, many lives continue to be lost and many left disabled d due to poor quality of care in both public and private healthcare facilities. ACCESS Health India, in partnership with Health Care Services (HCS) Group, has created a performance improvement framework and tools to improve quality while reducing costs of delivering care. Some of the quality improvement learnings from our earlier flagship program on quality of care, Safe Care, Save Lives, were incorporated in the design of the framework. ACCESS Health is also focusing on evolving modalities to drive quality using strategic purchasing through state health authorities as a financial lever of in public and private health insurance programs.
Models of Care
Along with HCS Group, ACCESS Health has developed a 5 ‘P’ model for disease prevention and management programs: People, Pathways, Practice guidelines, Platform, and Performance measurement. We offer these models to digital health platforms for adoption. We are also working with partners to create a project to test the extension of benefit packages by social insurance programs for outpatient management of hypertension. The project will test the usual care approach against a team based disease management approach. We are also working with tech platforms to aggregate fragmented primary care networks to enable purchasing of primary care services from these networks. In addition, these platforms are being tested to integrate primary care with hospital-based care as an extended care model.
4. Digital Health
Digital Health for Universal Health Coverage
Based on the prior work on digital health strategies for transforming Indian health system for universal health coverage of quality care, ACCESS Health’s work has been instrumental in incorporation of some of the ideas in to recently published National Digital Health Blueprint (NDHB) that lays down the roadmap for digital health transformation. It created a Start-up Ecosystem Accelerator (SEA) to guide in adopting the standards articulated in NDHB. ACCESS Health Digital has been participating in various symposia and workshops to disseminate the plans articulated in NDHB.
Health Informatics Course to build capacity towards DH transformation
ACCESS Health is partnering with educational institutions to design and offer the courses to build human resources needed for digital health transformation.
e-Objects – a unique design concept
Along with metadata standards, ACCESS Health has introduced unique concept of e-Objects (e-discharge summary, e-claims, e-prescription etc.,) to further standardize core elements involved in health insurance information systems (HIIS), healthcare delivery information systems (HDIS), electronic health records (EHR), and personal health record (PHR) modules. ‘E-Claims’, designed by ACCESS Health is being adopted in the latest version of HIIS being commissioned by National Health Authority (NHA), the implementing body of PM-JAY.
5. Community Health
Community-based Cardio-vascular disease (CVD) Prevention Program – a longitudinal study
IHSS, in partnership with HCS group, is commencing a community-based CVD prevention program incorporating the principles of allied health professional team-based disease prevention and management program. In addition to studying the effectiveness of the structured program over long time, it will also evaluate financing models for adoption by healthcare payer systems.
National Registry of ASHA workers
As part of NDHB plans, national registers are being created for healthcare professionals, providers, and payers etc., to have accurate data for formulating policies. ACCESS Health Digital is actively engaged in designing the digital tools for these registers.
All about ACCESS Health India
Digital Financial Services for Health Regional Conference – Asia 2023
In 2019, ACCESS Health International (AHI) Southeast Asia, with support from the MetLife …
Financial Inclusion for Universal Health Coverage Summit 2022
ACCESS Health International Southeast Asia co-hosted the Financial Inclusion for Universal Health …
ACCESS Health India organizes stakeholders’ consultation with the Government of Uttar Pradesh on AB-PM-JAY
ACCESS Health India in collaboration with the State Agency for Comprehensive Health Insurance and …