Human Face of Universal Health Care

- Dhruv Mankad1

Tips about what is to be done and what is not to be done for Human Resources for
UHC i

1. Five Facets of a Universal Health Care (as per MFC’s Concept Paper)

• Whole population of a country can access same range of quality services.

• Access should be according to needs and preferences.
• Access should be regardless of income level, social status, gender, caste, religion,
urban/rural or geographic residency, social or personal background.
• It offers a comprehensive range of curative/symptomatic, preventive. promotive
and rehabilitative health services.
• It offers it at primary, secondary and tertiary levels, including common acute life
saving interventions.

2. Five Tenets Regarding Human Resources for UHC

• Whole population should have access to the same range of health care providers
with ability to provide same quality of services – here the qualifications and
competency level of the providers has to be same.
• Access to them should be according to the health care seekers’ needs and
preferences – a plural approach for providers qualified in all ‘pathies’ is essential.
• Health Care Providers should be able to provide the services to patients regardless of
income level, social status, gender, caste, religion, urban/rural or geographic
residency, social or personal background.
• The comprehensive range of health care providers for curative/symptomatic,
preventive-promotive and rehabilitative health services should be available,
accessible and affordable to the health care seekers.
• Human resources should be available and able to provide primary, secondary and
tertiary level of health care, including common acute life saving interventions.

3. Five Needs of Human Resources for UHC

• Whole population of Human Resources should have the availability, accessibility

and affordability of same range of education and trainings, responsibilities, quality of
services and quality of life

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Email:<dhrvmankad@gmail.com>

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 • Access to them should be according to the needs and preferences of their families
and they themselves
• Health Care Providers should be enabled to provide the services to patients
regardless of their own income needs, social status, gender, caste, religion,
urban/rural or geographic residency, social or personal background.
• A comprehensive plan for opportunities to provide curative/symptomatic,
preventive-promotive and rehabilitative services should be available, accessible
and affordable to the health care providers as per their needs, expertise and
experiences.
• Human resources should be enabled to provide primary, secondary and tertiary
level of health care, including common acute life saving interventions.

4. Five Do’s to Ensure the Five Tenets about and Five Needs of the Human Resources
for UHC (suggested doers are in brackets)

• Prepare a blue print for number of providers, locations where they are needed for
primary, secondary and tertiary care, for the variety of expertise including in public-
private health sector [SHSRC with a HR repository]
• Restructure admission processes in Government medical colleges to students from
rural background (HSC from a tehsil or selected district junior colleges, vernacular
language proficiency as added credit) [State Ministry overviewing medical education
in tandem with state medical and paramedical councils]
• Compulsory placement in public health services [State Ministry overviewing medical
education in tandem with state medical and paramedical councils]
• Initiate a Universal Health Services (UHS) cadre: [POLITICAL WILL in tandem
with MCI in consultation with Army Medical Corps, AMC]
o A short service 3 to 5 years convertible to Permanent service if desirable by
staff or required by public health. Both should have attractive monetary and
non monetary rewards –
o a comprehensive career plan for UHS cadre including family/ non family
placements, e.g., remote PHCs can be considered as non family placements
with residential, school, transport facilities for families at ‘family base
stations’ (In Maharashtra, PHCs in several districts would fall under such
categories.
o a mandatory optimum level of quality of life, of quality of services, quality of
placements and remunerations etc.
o their career development – quality continuing education, supervision and
training using new technologies, in new subjects e.g. after 3 years of working
at PHC/Rural Hospital, on job DNB courses be allowed in selective RHs.
(Add academic allowance to the faculty)

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 o Plan and implement induction processes including management and
communication skills from PHC to above level
• Encourage a parallel cadre of health care providers to fill in the pyramid of primary
care – multipurpose workers, pharmacists, licensed family doctors etc. [State Ministry
overviewing medical education in tandem with state medical and paramedical
councils in consultation with AMC]

5. Five Don’ts to ensure the Five Tenets about and Five needs of the Human
Resources for UHC (the suggested regulators are in brackets)

• Do not allow cross-practices under the shadow of ‘plurality’. An allopathic doctor not
trained with Ayurvedic Ras-Shastra prescribing a bhasma is as much a bogus
‘ayurvedic’ doctor as an ayurvedic doctor not trained with clinical pharmacology
using an antibiotic as a bogus ‘allopathic’ doctor. [State Ministry overviewing
medical education and public health services in tandem with state medical and
paramedical councils, respective medical associations]. This also requires to regulate
cross practices between different levels of professional protocols, e.g., a neurosurgeon
should stick to tertiary level intervention only of neurosurgery. [Respective medical
and paramedical councils, accreditation authorities, medical and paramedic
associations.]
• Do not allow any unprofessional practices – “yes, I have a medical shop also and I am
having a beauty parlor, too! Yes, I am also working in a government hospital and
having my personal clinic.” These practices are not only illegal and unethical but
thoroughly unprofessional. [Respective medical and paramedical councils,
accreditation authorities, medical and paramedic associations]
• Do not encourage ‘contract-labor’-ness of medical and paramedical staff,
‘contracting’ professionals is different from employing them on ‘contract’. [State
level Ministry overviewing public health services, Ministry of Labour, respective
medical associations]
• Do not place technical experts as financial administrators – the required professional
expertise and perspective are quite different sometime opposite (unless they are
trained as financial forensics during their career) [State level Ministry overviewing
public health services, CAG, respective financial profession associations, IRDA etc.]
• Do not protect the ‘non’-protectable lapses - breach of rules, ethics, management
norms and procedures [State Ministry overviewing public health services, respective
medical and paramedical councils, accreditation authorities, medical and paramedic
associations]

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Some Caveats

1. For the Five Do’s - Some of them seem to be Old Wines in New Bottles but actually they
are Old Wines in Old Bottles; not opened earlier correctly so spilt over. They are some
of course New Wines in New Bottles.
2. For the Five Don’ts - Enforcement requires a political will, impartiality and objectivity.
Are we prepared to universalize it?

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Almost all Do’s and Don’ts are based on evidences in Human Resources at Brazil, Thailand, China and selective
health services in India – the Army Medical Corps. Some selective literature is listed here:

I. Thoresen SH, Fielding A. Inequitable distribution of human resources for health: perceptions among Thai
healthcare professionals, Qual Prim Care. 2010; 18(1):49-56.
II. Wibulpolprasert, Suwit and Pengpaibon, Paichit: Integrated strategies to tackle the inequitable distribution
of doctors in Thailand: Four decades of experience, Human Resources for Health 2003, 1:12.
III. Ellen M Peres , Ana M Andrade , Mario R Dal Poz and Nuno R Grande: The practice of physicians and
nurses in the Brazilian Family Health Programme – evidences of change in the delivery health care model,
Human Resources for Health 2006, 4:25
IV. Angelica Sousa, Ajay Tandon, Mario R. Dal Poz, Amit Prasad and David B. Evans: Measuring the
efficiency of human resources for health for attaining health outcomes across subnational units in Brazil,
Evidence and Information for Policy World Health Organization Geneva, March 2006.
V. Fabio Ferri-de-Barros, Andrew W. Howard, Douglas K. Martin: Inequitable Distribution of Health
Resources in Brazil: An Analysis of National Priority Setting, Acta Bioethica 2009; 15 (2): 179-183
VI. Prof. Sudhir Anand DPhil, Victoria Y Fan SM, Junhua Zhang PhD , Lingling Zhang SM, Prof Yang Ke
MD, Prof Zhe Dong PhD , Lincoln C Chen MD China's human resources for health: quantity, quality, and
distribution: The Lancet, Volume 372, Issue 9651, Pages 1774 - 1781, 15 November 2008
VII. Policy Guidelines Army Medical Officers. January 2004 (http://www.scribd.com/doc/14124223/Posting-
Policy)