Pilot project improving primary care: Indian Institute of Technology study

CHENNAI: Recent research by Indian Institute of Technology - Madras has shown that Universal Health Care (UHC) Pilot Project in three rural blocks of Tamil Nadu has improved access to primary care at sub-centre level. UHC pilot was launched in three rural blocks of Shoolagiri, Viralimalai and Veppur in Krishnagiri, Pudukkottai and Perambalur districts.

The study, titled ‘Universal Health Coverage-Pilot in Tamil Nadu: Has it delivered what was expected?’ - was undertaken by Centre for Technology and Policy, Department of Humanities and Social Sciences, IIT Madras. The UHC-pilot was launched in early 2017 in three blocks of the state to strengthen the primary health care services.

Being the closest delivery points to the community, Health Sub-Centres (HSCs) were identified as the main building blocks of the project. The research attempted to find the extent to which the UHC pilot has effectively improved access to HSCs and reduced out of pocket expenditure for primary care in the community. The study revealed that the UHC pilot brought about a significant fall in the overall dependence on private providers, particularly those seeking care from private hospitals. It also brought about a substantial fall in the out of pocket expenditure among those seeking out patient care from both public and private providers.

After the implementation of UHC Pilot, the HSCs now account for 17.8 percent of all out-patients in Shoolagiri block, 14.8 per cent in Viralimalai block and 23.1 per cent in Veppur block. Shares of private hospitals for outpatient care have dropped significantly during pre-UHC pilot period in 2015-16 and post-UHC pilot period in December 2017. While it changed from 51 per cent to 21 per cent in Shoolagiri block, Viralimai and Veppur block had a change from 47.8 per cent to 24.2 per cent and from 40.9 per cent to 23.9 per cent respectively.

IIT Madras has submitted the report on the research to the Department of Health and Family Welfare, Government of Tamil Nadu. Speaking about the research, Prof V.R. Muraleedharan, Department of Humanities and Social Sciences, IIT Madras, said, “The report provides evidence in support of increased access to HSCs, diversion of patients from higher level public facilities and diversion of patients from private hospitals.

There is significant reduction in out of pocket expenditure 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.”