Access to Healthcare: Scaling up best practices Shri Bhasker Iyer Chairman, ASSOCHAM National Council on Drugs and Pharmaceuticals

Look ahead on the day’s agenda Today’s focus Address by dignitaries Plenary sessions focused on two areas – State of Indian Healthcare System Innovative Models in Healthcare Delivery

India’s Health Record – Key achievements in the last decade Systemic thrust in healthcare initiatives Improvements in health outcomes Focus through 11 th 5-year plan and NRHM Shift from disease focused approach to integrated health-systems approach Increased private participation - healthcare facilities, insurance coverage Maternity Mortality Rate (MMR) decreased by ~50% Infant Mortality Rate (IMR) decreased by ~25% Certified Polio-free by WHO Tuberculosis and Leprosy – Significant improvement in detection and cure rates Source: McKinsey-CII document on India healthcare, Dec-2012, Press search

However, major challenges persist Public spending on health is extremely low Physical access remains a challenge with substantial infrastructure gap co-existing with under utilization Health work-force remains inadequate and under- utilized Affordability challenge – Out of Pocket spend continues to be high Public private partnerships haven’t reached scale

Defining access “The ability to reach, obtain or afford entrance to services” 1 Parker Quoted from ‘Access to Healthcare’ report of ASSOCHAM (Frost & Sullivan) 2 IMS access study-2013, sponsored by OPPI IMS study 2 (June-2013) – “Understanding Healthcare access in India” 1. Physical accessibility/ location 2. Availability/ Capacity 3. Quality/ Functionality 4. Affordability

Healthcare access in India’s context Definition of Universal Health Coverage “Ensuring equitable access for all Indian citizens, resident in any part of the country, regardless of income level, social status, gender, caste or religion, to affordable, accountable, appropriate health services of assured quality (promotive, preventive, curative and rehabilitative) as well as public health services addressing the wider determinants of health delivered to individuals and populations, with the government being the guarantor and enabler, although not necessarily the only provider, of health and related services.” High Level Expert Group on Universal Health Coverage constituted by planning commission in 2010

Government commitment towards Universal Healthcare Access Finance minister reference to Universal Health Care (UHC) in Interim Budget speech on 17 th Feb 2014 Prime Minister’s speech on 11 th Feb 2014 – emphasis on strengthening public health systems. NAC meeting on 29 th Nov 2013 (chaired by UPA President Sonia Gandhi) – Progress on NAC recommendations on UHC briefed by then health secy.

Role of key players in driving UHC Universal Health Care (UHC) Role of GovernmentRole of Industry Increased spending on healthcare is key to improving access Effectiveness in the procurement and utilization of essential drugs Choice between playing ‘primary payor’ v/s ‘primary provider’ Better utilization of the existing work-force Partnering with government on ‘priority health issues’ Building relevant and tailored product portfolio Innovative ways of supporting access and awareness enhancement

A few examples of Industry initiatives towards improving access Abbott’s Puducherry project Novartis India – Arogya Parivar MSD Wellness trust Hilleman Laboratories Pfizer’s Patient Assistance program Sanofi – Prayas Bristol Myers Squibb - Delivering Hope

Lessons on Universal Health Access journeys of other countries - Brazil Brazil’s journey (1975 – till date) Improvements in key indicators 1920s – 1970s : Low physician density, coverage restricted 1970s-1990s : Improved financial access by increasing coverage through SUS, their Unified Health System; Funding decentralized 2000s onwards : Focus on reducing inequity and improving quality of care Nearly 100% insurance coverage Doctor density of 1.7 per 1000 in 2008 (up from 0.4 in 1960s) Public expenditure as share of GPD of 4.2% in 2010 (up from 2.8% in 1995) MMR of 56 per 100,000 live births in 2010 (~1/4 th of India) IMR of 15 per 1000 live births in 2010 (~1/3 rd of India)) Source: McKinsey document for CII “India Healthcare – Inspiring possibilities, challenging journey (Dec-2012)”

In conclusion Willingness exists in both government and private sector to broaden healthcare access Sustainable policy solutions needed to meet healthcare financing, infrastructure, and human resource challenges

Thank you