ACCESS HEALTH INTERNATIONAL INC
1016 FIFTH AVENUE NO 11A C, NEW YORK, NY 10028 www.accessh.org

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Organizations Filed Purposes: OUR MISSION IS TO IMPROVE ACCESS TO HIGH QUALITY, AFFORDABLE HEALTHCARE IN LOW, MIDDLE, AND HIGH INCOME COUNTRIES. WE IDENTIFY AND DOCUMENT BEST PRACTICES IN HEALTHCARE SERVICES AND FINANCING, WE ADVISE NATIONAL AND REGIONAL GOVERNMENTS AND THE PRIVATE SECTOR ON THE DESIGN AND MANAGEMENT OF HEALTHCARE FINANCING AND DELIVERY SYSTEMS.

TO IMPROVE ACCESS TO AFFORDABLE QUALITY HEALTHCARE

CAPACITY BUILDING - ACCESS HEALTH ENGAGES, SUPPORTS AND STRENGTHEN COMPETENCIES, CREDIBILITY AND CONFIDENCE OF HEALTHCARE PRACTITIONERS, POLICY MAKERS AND NATIONAL AND STATE LEVEL INSTITUTIONS TOWARDS BUILDING LONG TERM CAPACITIES IN HEALTH SYSTEMS AND CONTRIBUTING TOWARDS IMPROVED HEALTH OUTCOMES FOR THE PEOPLE OF INDIA.

TECHNICAL SUPPORT NITI AYOG - THE GOAL OF THE HEALTH SYSTEM DESIGN PORTFOLIO IS TO MOBILIZE MOMENTUM TOWARDS EFFORTS WHICH REDUCE OUT OF POCKET EXPENDITURE AND INCREASE MINIMUM QUALITY ACCESS (INPATIENT AND OUTPATIENT) TO LOWER- AND MIDDLE-INCOME POPULATION OF INDIA.THERE ARE TWO KEY PILLARS OF THIS GRANT, BOTH VERY CLOSELY LINKED TO THE GOALS.RISK POOLING: CREATING POLICIES FOR RISK POOLING (ESI, REGULATORY FRAMEWORK ACROSS ALL RISK POOLS, INNOVATIONS ON RISK POOL) ALL LOOK TO INCREASING POOLED FUNDS AND DIRECTLY REDUCING OUT OF POCKET EXPENDITURE OF THE POPULATION. THIS IS THROUGH THE TWIN MECHANISM OF IMPROVING EFFICIENCY OF EXISTING POOLS ESI, COMMERCIAL INSURANCE THROUGH GOVERNANCE AND REGULATORY REFORMS, WHICH IN TURN COULD LEAD TO MORE FUNDS BEING DEPLOYED TO THESE. AS WELL AS CREATING INNOVATIONS AND POLICIES FOR EXPANSION OF ESI, AND OTHER CONTRIBUTORY MECHANISMS. THIS WOULD CREATE A ROADMAP FOR REDUCING OUT OF POCKET EXPENDITURE IN INDIA.PRIVATE SECTOR: THIS SEEKS TO CREATE MORE INVESTMENT IN SUPPLY OF CARE FOR AYUSHMAN BHARAT BENEFICIARIES IN SMALLER TOWNS, SEMI URBAN AREAS THROUGH POLICY SUPPORT (TAX INCENTIVES, OTHER SUPPORT ETC). THIS WOULD EFFECTIVELY AID IN INCREASING ACCESS WITH MINIMUM QUALITY. THIS WILL ALSO AIM AT CREATING PILOTS TO HELP FIELD TEST POTENTIAL STRATEGIES FOR AGGREGATION OF THE FRAGMENTED PROVIDER LANDSCAPE.THIS GRANT IS A FOLLOW UP TO THE NITI THEME PAPERS WORK WHICH HAS ALREADY HAPPENED AND BUILDS ON THIS WORK. THIS IS COMPLEMENTARY TO THE NHA/PMJAY WORK AND WILL HELP CREATE MORE SUPPLY FOR PMJAY. THROUGH THE WORK ON REGULATORY FRAMEWORK AND ESI THERE WOULD ALSO BE CONVERGENCE/STANDARDIZATION EFFORT ACROSS NHA/PMJAY/OTHER PURCHASERS, WHICH IS ONE OF THE LONG-TERM VISIONS OF AYUSHMAN BHARAT. A ROADMAP TO INCREASE MORE POOLED FUNDS, WOULD EASE THE FUNDING CONSTRAINT FOR BOTH THE LEGS OF AYUSHMAN BHARAT IN THE MEDIUM-LONG TERM TO A CERTAIN DEGREE. THIS INVESTMENT HAS BEEN REQUESTED BY NITI AND IS ALSO A KEY PRIORITY FOR OUR STRATEGY TO ENABLER THE ECOSYSTEM AROUND AYUSHMAN BHARAT.

PHC RAJASTHAN - THE GOVERNMENT OF RAJASTHAN HAS RECENTLY UNDERTAKEN THE TASK OF ENSURING BETTER PERFORMANCE OF ITS HEALTHCARE SYSTEM, WHICH FALLS BELOW THE INDIAN AVERAGE ON MANY COUNTS. IN ADDITION TO GOVERNMENT FINANCED HEALTH INSURANCE UNDER THE BHAMASHAH SWASTHYA SCHEME, THE GOVERNMENT OF RAJASTHAN HAS BEEN ACTIVELY SUPPORTING THE USE OF TECHNOLOGY, INNOVATION AND PROCESS REENGINEERING TO PROMOTE BETTER HEALTH OUTCOMES BY STRENGTHENING PRIMARY CARE AND ENSURING GOOD GOVERNANCE BY WAY OF BETTER ACCOUNTABILITY AND TRANSPARENCY.TO THIS END, THE ACCESS HEALTH INTERNATIONAL IN 2016, ENGAGED THE BOSTON CONSULTING GROUP TO HELP THE GOVERNMENT OF RAJASTHAN IN REVITALIZING ITS PRIMARY CARE SYSTEM. THIS IS BEING DONE THROUGH STAFF AND INFRASTRUCTURAL GAP FIXING OF 295 PRIMARY HEALTH CENTERS IN THE FIRST PHASE (OF A TOTAL OF ABOUT 2100), SYSTEM STRENGTHENING(E.G., VIA HR PROCESSES, MANAGEMENT INFORMATION SYSTEMS AND PROCESS REDESIGN) AND DISEASE-SPECIFIC INTERVENTIONS (E.G., TO REDUCE NEO-NATAL MORTALITY FROM THE CURRENT 3.2%).THESE TRANSFORMED PRIMARY HEALTH CENTERS WERE RELABELED AS ADARSH PRIMARY HEALTH CENTERS, AND HAVE HELPED INCREASE UTILIZATION AND AVAILABILITY OF CARE WITHIN THE PUBLIC PRIMARY CARE SYSTEM IN RAJASTHAN.IN ADDITION, COMMUNITY STRENGTHENING IS ALSO PLAYING A CRITICAL ROLE E.G., VIA TARGETED INFORMATION AND EDUCATION CAMPAIGNS AND FEEDBACK MECHANISMS.WHILE THE ENGAGEMENT HAS ACHIEVED SIGNIFICANT SUCCESSES, THE SELECTED FACILITIES WERE NOT AMONGST THE WORST PERFORMING FACILITIES IN THE STATE. NOW, THE OBJECTIVE IS TO SCALE UP THE EXPERIENCES FROM THE ADARSH INITIATIVE TO ALL PRIMARY HEALTH CENTERS IN THE STATE BY EARLY 2019. THIS WOULD ENTAIL ADDRESSING STRUCTURAL, PROCEDURAL AND MONITORING FUNCTIONS WITHIN THE PUBLIC HEALTH SYSTEM, WHILE ENSURING SUSTAINABILITY OF THE CHANGES UNDERTAKEN. TO ELICIT BROADER SYSTEMS ACCOUNTABILITY AND ENSURE SUSTAINABILITY, THE BOSTON CONSULTING GROUP AND ACCESS HEALTH INTERNATIONAL WILL WORK TOGETHER TO DEVELOP A MODEL TO IMPROVE ACCOUNTABILITY THROUGH A TOP DOWN, LOW TOUCH APPROACH, TO STRENGTHEN THE PRIMARY HEALTH SYSTEM. WITH BOSTON CONSULTING GROUP'S FIELD KNOWLEDGE IN RAJASTHAN, AND ACCESS HEALTH'S INVOLVEMENT IN DRIVING ACCOUNTABILITY IN OTHER STATES IN INDIA, THE TWO ORGANIZATIONS WOULD WORK IN TANDEM AND SYNERGIZE THEIR EFFORTS TO DEFINE THE PREREQUISITES FOR ENSURING ACCOUNTABLE PRIMARY CARE.THE OUTCOME WOULD INCLUDE A FRAMEWORK OR GUIDE FOR MONITORING PRIMARY HEALTHCARE PERFORMANCE AND ACCOUNTABILITY, WHICH WILL BE REPLICATED FROM RAJASTHAN, IN A STATE WHERE ADEQUATE POLITICAL BUY IN FOR CHANGE EXISTS.FINALLY, TO ADDRESS THE HIGH BURDEN OF NEONATAL DEATH IN RAJASTHAN, ACCESS HEALTH INTERNATIONAL WILL PROVIDE KNOWLEDGE SUPPORT TO THE BOSTON CONSULTING GROUP ON DEVELOPING CHANGE PACKAGES FOR REDUCING NEONATAL DEATHS IN THE STATE.THESE CHANGE PACKAGES HAVE BEEN DEVISED BASED ON ACCESS HEATH'S EXPERIENCES IN OTHER STATES ON CAPACITY BUILDING OF HEALTH WORKERS ON QUALITY IMPROVEMENT PROCESSES THROUGH EVIDENCE BASED PRACTICE. THE QUALITY IMPROVEMENT PROCESSES WILL FOCUS ON THE THREE MAIN CAUSES OF NEONATAL MORTALITY VIZ. SEPSIS, BIRTH ASPHYXIA AND COMPLICATIONS OF PREMATURITY. THIS CHANGE PACKAGE HAS BEEN TAKEN UP BY THE GOVERNMENT OF TELANGANA, UNDER THE AMBIT OF THE AAROGYASRI SCHEME, AND WILL SERVE AS AN ADDITIONAL TOOL TO FURTHER THE EFFORTS OF THE BOSTON CONSULTING GROUP IN DRIVING DOWN NEONATAL DEATHS IN THE STATE.ACCESS HEALTH INTERNATIONAL WILL ALSO PROVIDE TECHNICAL ASSISTANCE IN DEVELOPING SOLUTIONS FOR IMPROVING HOME BASED NEWBORN CARE, REFERRAL OF SMALL AND SICK NEWBORNS AND FOLLOW UP OF 'SPECIAL CARE NEWBORN UNITS' GRADUATES IN THE COMMUNITY THROUGH TESTED ACCOUNTABILITY MECHANISMS. SUSTAINABILITY OF THIS INITIATIVE WILL BE ENSURED THROUGH IDENTIFYING AND CAPACITATING LOCAL INSTITUTIONS, WHO WILL ENGAGE WITH LOCAL STAKEHOLDERS IN AN ONGOING MANNER TO ENSURE THE SUCCESS OF THIS INTERVENTION.FINALLY, ACCESS HEALTH AND BCG WILL EXPLORE OPTIONS OF TESTING THIS ACCOUNTABILITY MECHANISM OUTSIDE RAJASTHAN, ESPECIALLY AROUND PHC TRANSFORMATION. ONE OPTION WILL BE TESTING THIS HYPOTHESIS OF TRANSFORMING PHCS VIA TOP-DOWN ACCOUNTABILITY IN A DIFFERENT STATE, WHERE THERE IS SIGNIFICANT POLITICAL BUY IN - THIS WILL BE DONE BY DIVERTING SOME RESOURCES FROM RAJASTHAN TO THE OTHER STATE, AT THE END OF THE FRIST YEAR OF THE GRANT PERIOD.

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