Nachiket MorThe Banyan Academy of Leadership in Mental Health
Nachiket Mor
PhD (Economics)
About
107
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Introduction
Nachiket Mor has a PhD in Economics from the University of Pennsylvania. His current work is principally focused on the design of national and regional health systems.
He was a member of the Planning Commission’s High-Level Expert Group on Universal Health Care, the Primary Care Task Force of the Ministry of Health and Family Welfare, the Health Commission for the State of Himachal Pradesh, and the Task Force on Global Health at the Academy of Medicine in Washington DC. He helped create a new model for comprehensive primary care, pioneered by SughaVazhvu Healthcare in remote rural parts of Tamil Nadu, and offers a seminar on Health Systems Design at the Chennai based Banyan Academy of Leadership in Mental Health.
Profile: https://www.linkedin.com/in/nachiketmor/
Education
September 1990 - December 1994
Publications
Publications (107)
Stress has evolutionary roots that help human beings evolve and survive. Existing workplace mental health models typically view stress as the direct cause of poor mental health, like depression, anxiety, and burnout. Therefore, such models focus on strategies to eliminate it. In this paper, we start with the assumption that stress is an inalienable...
The non-medical factors influencing a person’s health are called the social determinants of health (SDOH). Given rapid urbanisation, urban neighbourhoods that do not strengthen SDOH are at a higher risk of disease, crime, and violence. While there are several important social determinants of health, we prioritise the ones that are implementable in...
With an estimated 230,000 opioid dependents, drug addiction is a serious and growing problem in Punjab state in India. It is driven by a combination of the culture of masculinity, peer pressure, social disturbances, separating families, unemployment, and easy availability of drugs. Amongst those dependent on opioids, 28% were injecting drug users (...
With its track record over the last five years, ABPMJAY has the capacity needed to propel India towards UHC. However, for this to become a reality, several design changes will need to be implemented, which include the following:
i. Move away from indemnity approaches towards managed care.
ii. Purchase care from integrated service delivery organis...
The challenges associated with enhancing the wellbeing of adolescents and youth of India are significant, not least because of the sheer size of the population of young people to be addressed. However, for that very reason, ensuring their wellbeing is particularly important to us as a country. Since this is a formative stage, it is imperative to en...
This case study attempts to draw more general lessons from the city of Austin’s
efforts to address its growing challenge of Opportunity Youth. Despite its unique character, several broader lessons emerge from even this brief study of the city’s approach. These include the following.
• It is important to gather granular data on the size and nature...
With 7.6% of children suffering from severe wasting in 2019-21, with no change in this number at the national level in the last five years, malnutrition is a serious problem in India that needs urgent attention. In this note, a set of strongly evidence-based nutrition interventions are outlined, which are focused on children and their mothers. Thes...
In India, 200 million people are estimated to be living with poor mental health conditions. Eight out often not receiving treatment further compounds the problem. Without interventions that collectively target mental health promotion, prevention, treatment and recovery, we expect this burden of disease to double by 2040. Given the multifactorial na...
In a recent workshop organised on January 30, 2024, by the Centre for Social and Economic Progress, Dr. Vinod Paul, Member NITI Aayog, beautifully outlined the vision of the government for the Indian health system. He generously invited attendees to offer their thoughts and suggestions on how the government could bring this vision to life and build...
This is the documentation of the protocols that were used by SughaVazhvu Healthcare in their primary care clinics in Thanjavur District of Tamil Nadu
Introduction
Primary care is an essential component of any health system, but building high-quality primary care has proven to be a challenge for most developing countries. Among the multiplicity of providers in South Asia, one of the most ubiquitous channels through which not only medicines are obtained but also primary care advice is sought is th...
Globally, zoonotic diseases pose an enormous and growing public health challenge, and developing countries like India are at the epicentre of it. Although there is general recognition of this reality, governments around the world have struggled to organise appropriately to respond to it. The widely held view is that organising for One Health requir...
Introduction
Comprehensive primary care is a key component of any good health system. Designers need to incorporate the Starfield requirements of (i) a defined population, (ii) comprehensive range, (iii) continuity of services, and (iv) easy accessibility, as well as address several related issues. They also need to keep in mind that the classical...
This is the presentation associated with a full-credit course on Indian Health Systems that was taught at the Indian School of Business in April 2023.
This is a brief discussion on the rationale for any form of insurance using the Law of Large numbers and Expected Utility Maximisation as the two core arguments.
Financing of health systems is an enduring concern world wide. Yazbeck and colleagues in their paper make an important point that when there is a choice between financing in which contributions from citizens take place in the form of generalised taxes versus those in which they are in the form of insurance premiums, the overwhelming evidence sugges...
Reforming systems in any sector is a complex task. There is a need to continually assess the changing landscape and, most importantly, the underlying momentum and direction of movement of the existing system before recommending changes that can, at best, hope to gently modulate that movement in the hope that over a period of time it moves closer an...
Background:
Universal Health Coverage (UHC) has been high on national and international agendas since its adoption as one of the Sustainable Development Goals (SDGs). Within India, there is a wide variation in the total amounts per capita spent by each state government (Government Health Expenditure or GHE) on healthcare. Bihar, with a GHE of 556...
The Theory of Change (ToC) approach is one of the methodologies that the Lancet Citizens' Commission has chosen to build a roadmap to achieving Universal Healthcare (UHC) in India in the next 10 years. The work of the Citizens' Commission is organized around five workstreams: Finance, Human Resources for Health (HRH), Citizens' Engagement, Governan...
Even though at 3.3% of GDP, it could be argued that India spends an adequate amount of money on health care, its state-level health systems are amongst the worst in the world with regard to health outcomes, the level of financial protection they offer, and the degree of responsiveness they exhibit towards their customers. Healthcare inherently suff...
Rapid urbanisation is an inevitable and desirable aspect of the growth trajectories of most developing countries. From a One Health perspective, for example, continued deforestation, particularly in the developing world, represents one of the most significant threats. The rate of deforestation is a function of factors such as low agricultural produ...
At Rs.674 per capita, the government of Bihar is the lowest spender on healthcare. This is well below any estimates for the amounts needed for UHC. Currently, in a manner similar to other low and high-spending governments, it spreads out this limited amount of money very thinly in an attempt to offer essential public health, primary care, secondary...
With an expenditure of Rs.2,479 per capita on healthcare, the government of Kerala is one of the highest spenders among Indian states. Despite these high expenditures, it seems not to be getting any closer to UHC but, if anything, perhaps even further away. With an out-of-pocket expenditure proportion of 68.6%, it is behind only Uttar Pradesh (71.3...
Community health worker (CHW) programs are essential for expanding health services to many areas of the world and improving uptake of recommended behaviors. One of these programs, called Accredited Social Health Activists (ASHA), was initiated by the government of India in 2005 and now has a workforce of about 1 million. ASHAs primarily focus on im...
These are the slides for an introductory course in Public Mental Health. It was first taught at the Banyan Academy of Leadership in Mental Health in 2022. It was spread over five sessions, each of two hours duration.
Building good health systems is an important objective for policy makers in any country. Developing countries which are just starting out on their journeys need to do this by using their limited resources in the best way possible. The total health expenditure of a country exerts a significant influence on its health outcomes but, given the well-und...
Importance:
High out-of-pocket expenditure (OOPE) on health in India may limit achieving universal health coverage. A clear insight on the components of health expenditure may be necessary to make allocative decisions to reduce OOPE, and such details by sociodemographic group and state have not been studied in India.
Objective:
To analyze the re...
Biomedical health interventions now have global reach and interact in complex and often poorly understood ways with traditional medical rituals that precede biomedicine. People often experience biomedical practices and treatments as rituals because they are very similar from an experiential perspective.¹ Yet the global public health community often...
We know from the theory of the firm that for the Board of Directors as a group to ensure that goals are achieved, it has to maintain a level of engagement with the management that is somewhere in between the entirely passive role that shareholders play and the fully engaged role played by the management of the firm. This is typically done by the Bo...
In this paper, we analyse the political determinants of improved health outcomes, making a case for political attention to healthcare, through increased investments, healthcare reforms and improved capacity to deliver curative and public health. We build on both theoretical frameworks and global and sub national experience, to develop hypotheses fo...
India has made very good progress on financial inclusion over the last decade but with a 2020 credit-to-GDP ratio of only 55.3\% in 2020 when compared to China's 182.4\%, USA's 216.3\%, and Thailand's 160.3\%, the banking sector remains small, acting as perhaps the single most important impediment to India's growth. Similarly, if financial access i...
Background
The rate of caesarean delivery has increased markedly both globally and within India. However, there is considerable variation within countries. No previous studies have examined the relative importance of multiple geographic levels in shaping the distribution of caesarean delivery and to what extent they can be explained by individual-l...
The COVID-19 pandemic represents one of the most difficult periods in India's history. The pain, suffering, and the loss of life that it inflicted reached out to touch each and every Indian family no matter how rich or poor. However, during this time while there was also much that happened, often behind the scenes, that was remarkable. This note fo...
Background
Maternal malnutrition is a major source of regional health inequity and contributes to maternal and infant morbidity and mortality. Bihar, a state in eastern India adjacent to Jharkhand and West Bengal, has relatively high neonatal mortality rates because a large portion of infants are born to young mothers. Bihar has the second-highest...
The use of AI-ML is still at an early state in public health settings but the examples from
Disease Surveillance, Public Health Education, and Public Health Research suggest that
some progress has indeed been made already and that there is enormous scope for further application of these ideas in the future. Such approaches could allow developing co...
Healthcare deviates considerably from the standard image of a clinical-medical model and involves a number of complex issues that have a deep influence on the health and well being of individuals and communities. However, despite the importance of these issues, the field of medicine has few, if any, solutions to offer on its own, and is likely to b...
The article explains why Oxygen therapy in primary care settings holds the key to an effective COVID-19 response in India and in other developing countries. It also emphasises that such a primary care focused COVID-19 response has the potential to strengthen overall long-term health systems capacity in developing countries.
In this article the Control Knobs framework is used to examine how states in India perform on intermediate and eventual outcome indicators, with the help of some recent evidence. This is followed by a deeper examination of the Indian health system using one of the Control Knobs, namely financing, and to propose some reforms on that front. Using C-S...
While COVID-19 infection rates are likely to be high around the world, what will vary considerably, after accounting for differences in age profiles, and will be critically dependent on the level of preparedness, will be the eventual death rates. This suggests that while the current measures to slow the spread of the virus need to continue, the tim...
The objective of the current study is to examine the cultural ecology of health associated with mitigating perinatal risk in Bihar, India. We describe the occurrences, objectives and explanations of health-related beliefs and behaviours during pregnancy and postpartum using focus group discussions with younger and older mothers. First, we document...
This is an indicative protocol for a first level oxygen therapy centre for patients with suspected or confirmed COVID-19. Patients with COVID-19 have a risk of experiencing rapid decompensation and should ideally be treated in centres which have the on-site ability to offer advanced oxygen therapy to them. However, most patients, even those that ar...
In the fight against the COVID-19 epidemic, the emerging evidence suggests that the front-line NGOs and PCPs are going to be at the forefront of the battle against this disease, and not merely spectators, and need to prepare themselves accordingly.
It is clear from the emerging evidence that the response to COVID-19 will have to be mounted on multiple fronts and that the community, NGOs, and primary care providers (PCPs) are going at the front-lines of this battle, not merely spectators. However, to do this well they will need to enhance the knowledge and financial resources available to them...
This document is intended to provide a summary of the resources available to help primary care providers (PCPs) as they seek to address the needs of their patients during the current COVID-19 epidemic.
India has a very wide variation in Cesarean Section (C-Section) rates across the country. While in several Districts, driven by resource constraints, the rates are extremely low, in some of the Districts in the richer States of India, they are particularly high, exceeding, for example, 75% in the Karimnagar District of Telangana. And, while the rat...
An Approach Towards Health Systems Design in India
West Virginia is amongst the poorest States in United States with some of its counties, such as the McDowell County, showing life-expectancy and poverty rates comparable to those of developing countries. It has a high Suicide Mortality Rate, which has been rising at the rate of about about 6% annually, and is, for the most part, concentrated amongs...
Comprehensive primary care is a key component of any good health care model. There is good evidence that health systems that effectively address sources of ill-health, and identify and treat diseases early in their life-cycles, deliver far better health outcomes for the same level of expenditure, than do others which leave people to their own devic...
It is clear from global and local experience that primary care is an essential component of any health system and there are several models globally that have been well-studied. However, there are a number of barriers that need to be overcome before this kind of primary care becomes a reality within India.
Comprehensive primary care is an essential part of all high-performing health systems. Only way developing countries like India, will be able to provide such services within their available-resources envelope is by fully harnessing the power of technology. However, to be truly effective, these solutions will need to have several key components whic...
A wide variety of health worker roles are possible within the current regulatory framework. There are also a number of organizations, both government owned as well as outside the government that have worked with multiple types of health workers. However, there are several areas in which improvements are needed and there is an urgent need for growth...
There is much that needs to be done to craft a sustainable financing strategy for primary care. While there are several global and local benchmarks that one can learn from, ultimately a great deal of local experimentation and research will be needed to develop strategies that work in each context. The note explores the twin challenges of high price...
Primary care is an essential part of any health system and is offered in multiple settings in both developed and developing country contexts. Primary care often is the first, and sometimes the only, point of contact with patient, and providers in these settings generally encounter patients who are either asymptomatic or have some presenting complai...
India has a very large cohort of young people, between the ages of 0 to 24, many of whom do not stay in school beyond the primary level, and those that do "disconnect" from the school system, do not have job. Additionally, those that do remain in the schooling system, have very poor learning outcomes and have basic capabilities in mathematics and l...
Worldwide incidence of obesity has tripled since 1975, and in 2016, more than 1.9 billion adults were overweight, over 650 million of whom were afflicted with obesity. India is currently estimated to have 135 million obese individuals overall, with a number of States having obesity rates in excess of 25% of the adult population. Evidence seems to i...
Using the standard Solow Model augmented with Human Capital and a specific formulation of the dynamics associated with it, the implications on the per-capita growth rates of an economy are explored. The model and its associated dynamics suggest that, within a “reasonable” overall savings (investment) rate (s = 25% in the model), a “reasonable” prop...
The global community has taken the position that tax-based financing is the only viable route towards universal health care for developing countries and getting governments to allocate 4 to 5% of their GDP for this constitutes a pre-requisite for beginning this journey. However, many governments of developing countries, including large ones like In...
The supply of medical doctors is a critical problem in many countries, including India. One of the significant issues limiting this supply is the unavailability of student loans for medical education, which restricts the number of students that can be admitted, and which in turn, limits the number of medical colleges that can be sustainably run. Th...
India's health care sector provides a wide range of quality of care, from globally acclaimed hospitals to facilities that deliver care of unacceptably low quality. Efforts to improve the quality of care are particularly challenged by the lack of reliable data on quality and by technical difficulties in measuring quality. Ongoing efforts in the publ...
The paper explores the role that Social Health Insurance (SHI), as an organisational mechanism for raising and pooling additional funds, can play in financing health services in India. It formulates an SHI concept and its aims for India and examines case studies of different countries that have sought to finance their health services through SHI to...
With a low Tax to GDP ratio of only 17%, despite allocating 10% of its revenues to healthcare, India will be unable to finance all of her healthcare needs from public expenditures. Therefore, the only way to ensure that all of her citizens get good healthcare, is for the Indian government to emerge as a single payer and design a high quality, prima...
In the world of Microfinance women’s collectives have acquired a great deal of prominence around the world. A strongly held belief is that the formation of these groups has had a transformative impact on the lives of women and this is mainly attributed to the improvement in financial status of women due to the direct links between the microcredit o...
This note advances four inter-related arguments to suggest that building a high quality health system that is intended to address only MCH goals is unlikely to deliver on MCH goals in a cost-effective manner. The note argues that, medically, since the most important drivers of infant, child, and maternal mortality, now are complications such as hae...
Designing health systems is a complex challenge. It is made all the more complex in a large and diverse country like India because of the extent and magnitude of variations in it. An attempt is made in this note to carefully study the Indian State of Himachal Pradesh as a case study and to develop a health systems design for it by carefully analyzi...
Given the high burden of disease and the already high amount of money spent by the government and the population, there is no reason why a Managed Care model cannot be experimented with by both the government and the private sectors either in partnership with each other or entirely on their own. This note describes just such a Managed Care model fo...
A case for government intervention can be made where it can be argued that either there is market failure or that a market based solution even though efficient is not optimal according to the government’s definition of welfare. The provision of healthcare faces many problems of market failure and welfare loss that are accentuated by the fact the co...
Good health is an essential component of human development but while there has been a gradual improvement in the average health status of human beings, countries around the world have struggled to build health systems which have the capacity to ensure the best possible health of every human being in an affordable way. The principal reason for this...
The core purpose of banks and finance companies is to assume manageable levels of maturity risk and credit risk, and to generate a level of return consistent with it. This is hard to do, even in relatively small financial institutions because of the fact that each risk is being assumed by the institution on a near continuous basis and not just in h...
The aim of the conceptual research is to discuss the work done by PHFI in developing National Essential Health Package for India focusing on issues and challenges of political and administrative structure in federal states.
Owing to the fact that health being state government’s prerogative, promoting universal health coverage at National level in f...
The note shows that there are several links between financial development and health. Using multiple pathways, these operate through both the Growth Channel and the Volatility Channel. However the note points out that both healthcare and financial access have special characteristics that have an important influence on how the benefits of financial...
This document develops a framework for an Essential Health Package comprising 34 health categories. It provides detailed care pathways and associated costs and path-dependent conditional probabilities for Anaemia, Cardio Vascular Disease, Diabetes, and Tuberculosis. Using the frameworks developed here designers of health systems can provide detaile...
Health is a State subject in India. For most States it is clear that given the level of financing that is available for the provision of healthcare, it would not be possible to offer universal healthcare no matter what method of purchasing is used or whether the private sector or the public sector emerge as the principal providers. For these States...
In this paper, we present two stylized models of the financial system. We make the case that in order to realize the potential of a well-functioning complete financial market, financial system designers and financial service providers will need to think about ways to deliver financial propositions that are customized to individual households by res...
A quiet revolution in education has been underway in Indian schools—from 2002–03 to 2006–07, the number of elementary schools increased by 40 percent and today 98 percent of households are located within 1 km of a primary school and 84 percent are located within 3 km of an upper primary school.1 In addition, the public school system has hired appro...
In the paper it is argued that there exist a set of market based approaches, which use subsidy and grant resources in a parsimonious manner but have the potential to address poverty on a scaled basis. At the heart of this approach is building universal access to financial services as a starting point. It is suggested that such access is best provid...
Besides facilitating overall economic growth, finance can help individuals smooth their income, insure themselves against risks and broaden investment opportunities. Empirical evidence shows that inclusive financial systems significantly raise growth, alleviate poverty and expand economic opportunity. This paper lays out several principles that sho...
Besides facilitating overall economic growth, finance can help individuals smooth their income, insure themselves against risks and broaden investment opportunities. Empirical evidence shows that inclusive financial systems significantly raise growth, alleviate poverty and expand economic opportunity. This paper lays out several principles that sho...
This chapter focuses on access to finance for the rural and urban poor in India. It provides a brief overview of the current situation, including some measurement issues. It discusses various dimensions of access relevant to universal access and describes India’s current regulatory approach. Some policy initiatives that might have an impact on univ...
Nachiket Mor (nachiket.mor@icicibank.com) is a member of the Board of Directors and a Deputy Managing Director at ICICI Bank, India; a member of the Board of Governors of the Institute for Financial Management and Research (IFMR), Chennai, India and the Chairman of its Managing Committee; and a member of the Board of Directors of CARE USA. Sanjeev...