IIT Madras helps to reduce public health expenditure

The Universal Health Care Pilot Project in Tamil Nadu has brought significant change in Tamil Nadu. An IIT Madras report has not only confirmed this but also confirmed much less expenditure than public and private providers. The study which was undertaken by Centre for Technology and Policy, Department of Humanities and Social Sciences, IIT Madras, has been submitted to the Department of Health and Family Welfare, Government of Tamil Nadu. Prof V.R. Muraleedharan and Prof Umakant Dash, Department of Humanities and Social Sciences, IIT Madras, S.D. Vaishnavi (SHReAs, Chennai), Rajesh M, R. Gopinath, M. Hariharan, R. Babu, P. Balamurgan, A. Emaya Varaman, S. Arul Kumar, A. Mariyan Devan and Contributors: Elna James Kattoor and Sudha Rani D participated in the project.

The UHC-pilot project was launched in early 2017 in Tamil Nadu in Shoolagiri Block (of Krishnagiri HUD), Viralimalai Block (of Pudukkottai HUD) and Veppur Block (of Perambalur HUD). Primary health care service was the first step in the design and rolling out of UHC-pilot which enabled the Health Sub-Centres (HSCs) to be the fulcrum of the UHC in Tamil Nadu. Interestingly, after the implementation of UHC Pilot, the HSCs now account for 17.8% of all OPs in Shoolagiri Block, 14.8% in Viralimalai Block, and 23.1% in Veppur Block, respectively; in all three blocks, HSCs accounted for less than 1% of all OPs during pre-UHC pilot. Meanwhile, the share of private hospitals for OP (out-patient) care has dropped significantly during pre-UHC pilot period (2015-16) and post-UHC pilot period (Dec.2017): from 51% to 21% in Shoolagiri block; from 47.8% to 24.2% in Viralimalai Block; from 40.9% to 23.9% in Veppur Block.

Regarding the success of the pilot project, Prof V.R. Muraleedharan, Department of Humanities and Social Sciences, IIT Madras, said, “To the best of my knowledge about health sector in India, this is perhaps the first time we have a robust survey on both household health seeking behaviour and facility based utilization before and after intervention any public health intervention”. The report looked to analyze the extent to which the UHC pilot has effectively improved access to HSCs and reduced OOPE for primary care in the community and also giving the outline and the proximity of the UHC pilot in serving proposed components/services of Health and Wellness Centres by Indian Government.

Prof Muraleedharan said, "The report provides unambiguous evidence in support of increased access to HSCs, diversion of patients from higher level public facilities, diversion of patients from private hospitals, significant reduction in OOPE for patients seeking care from both public and private facilities, and significantly lower cost of provision of OP care per visit in pilot HSCs, than when they are provided at higher levels of public facilities.”

The report also underlines key aspects which can be path breaking in near future. With time, VHNs can certainly perform and mature over time along with integrated approach to  HSCs with PHC/CHC which has been closely followed in the “hub and spoke” model which are being used for laboratory tests (between PHCs and CHCs). Commitment at all levels including bureaucratic and political levels has helped the project to perform well. As the UHC pilot has helped in access and reducing financial burden on the poor for primary care need immediate attention, it can implemented to boost public primary healthcare delivery system.