Transcript NGOs and NPISHs in Health Sector: Possibilities and Policy

Special IARIW-SAIM Conference on “Measuring the Informal Economy in
Developing Countries”, Kathmandu, Nepal, September 24-26,2009
NGOs and NPISHs in Health Sector:
Possibilities and Policy Options;
An Exploratory Study in the Indian Context
P.M. Mathew
Christ University
Bangalore, India
Discussant
M.R. Narayana, Ph.D
Professor of Economics
Institute for Social and Economic Change
Bangalore, India
FOCUS AND METHODOLOGY OF THE PAPER
FOCUS
• Description of the role of NGOs (specially, voluntary organizations)
in delivery of health services in India with special reference to their
health expenditure
• Brief review of literature on NGOs in health sector
• Distinction of types of NGOs
• Select problems of NGOs
• Policy options, supported by case studies
METHODOLOGY
• Descriptive and positive analysis
• Based on secondary data
• Case studies
Role and advantages of NGOs
• Supplementary to existing service providers with focus on
vulnerable sections of society (e.g. poor, slum dwellers and tribal
populations) in rural areas (mainly village based)- useful to fill in
health gaps
• Low cost delivery of services, due to less expenditure on salaries
and wages, and voluntary services by people
• Close to people with more opportunities for identifying
disadvantaged people and their health needs
• Open for diversified participation: charitable institutions, religious
organizations, internal and external individuals and institutions
through donations and collaborations
• Flexibility in operations – combining health care delivery with income
generation programmes – Integrated development programmes
Size of health care NGOs and their
services: Select estimates
Independent Commission of Health in India 1997: Number
of NGOs =7000
Directory of Hospitals 1998 – 10 percent of all hospitals
(937) and 13 percent of all beds (74498) in non-profit
sector
Background paper for National Commission on
Macroeconomics and Health 2005 - Christian missionary
hospitals leads the provisioning of health services – 47
percent of all beds in private sector and 17 percent of all
private hospitals/dispensaries
Health care expenditure by NGOs:
Select estimates
National Health Accounts India (NHAI) 2001-02:
0.1 percent of total expenditure (Household expenditure=72 percent)
National Commission of Macroeconomics and Health 2005: 0.3
percent of total expenditure (Household expenditure=70 percent)
Major items of expenditure: Curative medicine & recurring About 98 percent
Major sources of financing – NHAI 2001-02
Grants from government=26.7 percent; User charges in hospitals and
dispensaries=38.9 percent; and external assistance=25.5 percent
Problems of health care NGOs
• Insufficient resources- non-remuneration for health staff
and workers and inadequate training; high turnover of
middle-level staff; dependency on donor agencies
• Inefficient management including commercial operations
(e.g. charging higher user fees) to meet with insufficient
resources
• Superficial forms of local participation
• Lack of community ownership
• Lack of policy directions – non-announcement of
National Policy on Voluntary Sector
Policy options (specially for additional
resource mobilization and subsidization)
• Community Health Insurance (CHI) – Ashwini in Niligiri
Hills in Tamil Nadu state since 1992 – CHI for tribal
population covering 13000 members – insurance
reimbursements contributed around 50 percent of total
hospital income in 2006-07
• Boutique Healthcare – an instrument of crosssubsidization – L.V. Prasad Eye Institute in Hyderabad
(LVPEI)– 50 percent of patients are treated free of cost –
Aravind Eye Hospital in Madurai – 70 percent are treated
free of cost
• Healthcare-Microfinance Linkages – National
Dawakhana in Nanded city empowers women and
improves their ability to pay for health services
Policy options (specially for additional
resource mobilization and subsidization)
• Donor Marketing and Product sales – LVPEI
• Private-public partnerships – co-operative sharing of health facilities
(West Bengal government in 2004) – management of PHC by Sewa
Rural at Jhagandia block in Baruch district for ten years from 1989
to 1999- MNGO/FNGO/SNGO programme for RCH services in
Orissa
• International collaborations – Project ORCHID in Manipur in
collaboration with Australian International Health Association and
Emmanuel Hospital Association-Ankur Project-SEARCH in
Maharashtra in collaboration with Save the Children USA and Bill
and Melinda Gates Foundation
• Consultancy Services – through creations of Centres of Excellence
Discussion points
• Relative efficiency between NGOs and other providers of
health care services
• Role of health care NGOs in Indian System of Medicine
• Distinction between NGOs, voluntary organizations and
NPISHs, and their relationship with informal sector
• Corporate social responsibility through foundations and
NGOs
• Beneficiaries of health care NGOs and informal workers
and their dependents
• Lessons from experiences in other developing countries
THANKS