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The problem of access to health care in developing countries (India…
The problem of access to health care in developing countries
Bulgaria
Info
Healthcare: One of the reasons why Bulgaria is melting down
Bulgarian journalists Krasen Nikolov reveals shocking facts about the Bulgarian Health System
Joined EU in 2007; since then referred to as "The poorest and most corrupt state in the EU
Inefficient Spending and Postponed Reforms
Large number of hospitals (345) for 7 million people
Study shows that 20% of the hospitalisation can be avoided, however, hospitals keep accepting people in order to get funding from the state
As a result
larger hospitals are being under-funded, not being able to provide adequate treatments for patients
Postponing the introduction of European Electronic Health card for over 5 years
Mortality Rate
One of the world's fastest decreasing populations
Extremely high mortality rate, 15 per 1000 people
Statistic is comparable to the case of the most heavily plagued by the AIDS epidemic African countries in which the health system was in practice inexistent
Personal
The call > Arrival > Arrogant attitude > Terrible Conditions
Sent to private seller for expensive herb supplements
Tracheostomy
Independent case review
First emergency centre lacking
thrombolysis
(national requirement for every emergency centre or ambulance to be equipped with)
In the hospital: Saturday; no one bothered to form a team
Funding for
Hyper-acute stroke unit (HASU)
at the very same hospital two years before. Money just disappear. The HASU is build 7 months after we fired the investigation (hopefully other people will live)
India
Implications of Intra-state Inequality
Due to the large
cultural and linguistic diversity
and
inequality
Indian states differ vastly in terms of access, as well as the quality of the healthcare provided within them
Inequality
is reflected in many of the state's health indicators
The Northern state of Uttar Pradesh
has an under-five mortality rate of 64 of 1000 (comparable to that of Mozambique)
The Southern state of Kerala
has an under-five mortality rate of 6 of 1000 (comparable to that of the USA)
Wealth Distribution
Patterns in healthcare mimic the patterns of wider wealth distribution
Uttar Pradesh
GDP per capita $2,853 Purchasing Power Parity
Kerala
has GDP per capita $8,869 PPP
Demographic Distribution
2016 stats: 67% of population lives in rural areas
where access to healthcare is significantly more difficult than
urban areas
Urban part of India
has access to 66% of hospital beds
Doctor Shortfall
1:1,674 current doctor-patient ratio
Deficit of 500,000 doctors according to the World Health Organisation standard of 1:1000
Uneven distribution of doctors across states; a lot more doctors in more developed states
Private Healthcare
Has become the largest industry in the country
Lack of regulations
As a result registered cases where patients are treated for inexistent diseases
Some cases of stolen infants for human traffic
Recent Reforms
PM Narendra Modi increases public spendings on health to 2.5% of GPD
Regulation in the private health centres, where small amount of money from each patient will fund those who cannot afford it
Sierra Leone
Info
1990-2001 Civil War
which lead to displacement of over half the population and the deaths of tens of thousands of people
During the war a health care in the country was inexistent
One of the poorest countries int he world
Mortality Rate
Nowadays, life expectancy is 55 years
One of the highest mortality rate of women after giving birth
One of the highest mortality rate of death under five
Investments
World Bank and the World Health Organisation often urge developing countries to invest in National Health Systems
Shortly after the war, a Health System was established in Sierra Leone
In 2010 for the first time the government made a reform in the system
The Free Healthcare Initiate for pregnant women, breastfeeding mothers and children under five was introduced. Really the first positive step for years
Unfit Health Centres
During the recent Ebola epidemic in West Africa, countries like Sierra Leone urged to build a lot of
health centres
700 health facilities - end of civil war
1300 (nearly) health facilities today for 7 million people
Unfortunately
, most of those facilities are unfit for purpose with no running water, no shelves and no proper equipment
Sometimes, due to poor conditions, epidemic are spread faster
Resources
Main
(1)Healthcare: One of the reasons why Bulgaria is melting down
(2)Why health clinics may hinder developing countries efforts
(3)India's Health Care Paradox by Milan Singh-Cheema
ThoughtWorks Contribution
TW: Humanitarian Software Program
TW: Global Health
TW: OpenMRS
TW: Bahmni
Supporting
Sierra Leone
Uttar Pradesh records India's worst infant and under-five mortality rate
ThoughtWorks
AMPATH
Academic Model for Providing Access to Healthcare
Global consortium of academic health centres working with Kenya's Ministry of health to deliver health services and provide research
It addresses the health needs of a population of 3.5 million people in Western Kenya, treating HIV infected patients at more than 500 clinics in urban and rural sites
AMRS (AMPATH Medical Record System)
is an implementation of OpenMRS and is highly recommended by Kenyan Ministry of Health
OpenMRS
Open source medical record system
It allows medical workers to track and store medical information
HSP
Humanitarian Software Program
ThoughtWorks, as part of its HSP, has been working with AMPATH since December 2013. Under HSP, they assist impactful open source projects improve the word with the help of technical
ThoughtWorkers help AMPATH with their OpenMRS implementation as well as other non-technical tasks
Current focus is to finish the development of Merge Concepts Module, which allows to merge duplicate concepts in OpenMRS database