UHC Archives - InnoHEALTH magazine

Healthy Lives: Everyone, Everywhere

InnoHEALTH Magazine — Tue, 16 Apr 2019 09:22:43 +0000

Good health is the most precious thing anyone can have,” says Dr TedrosAdhanom Ghebreyesus, WHO Director-General. “When people are healthy, they can learn, work, and support themselves and their families. When they are sick, nothing else matters. Families and communities fall behind. That’s why WHO is so committed to ensuring good health for all.”

World Health Day

April 7th marks the birth anniversary of the World Health Organisation (WHO) and along with drives worldwide attention by spreading the message of the importance of global health each year.

Ranging from imperative issues such as food safety, diabetes, depressions, etc., this year the World Health Day embarks the mission of people-centered care irrespective of their financial hardships. The 2019 theme envisions the Universal Health Coverage (UHC), i.e., health for all. There are millions of people who have no access at all to healthcare. Majority of the populations are forced to choose between healthcare and other daily needs such as food, clothing, and shelter. In India, a lot of efforts need to be put in to ensure adequate medicines, affordable health policies, and financing strategies to enable everyone to get access to equal healthcare. “Universal” in UHC means “for all”, without discrimination, leaving no one behind, i.e. providing healthcare facilities which are

• Accessible
• Affordable
• Available
• Appropriate
• Adequate

Addressing the Financial Crisis

“Universal health coverage is also about ensuring access to essential quality care and financial protection,” says Dr. Mahjour. It aids in enhancing people’s health at large and increasing their life expectancy. Under this, many countries are protected from epidemics and the risk of hunger. This paves a way for new jobs, enhanced economic growth, and gender equality.

To make the phenomenon of Universal health coverage achievable globally, there should be concrete roadmaps which highlight the gaps and obstacles patients face in accessing proper healthcare. This can be done only when there are identified challenges, key actions and sustainable goals to be taken care of.

• There must be a holistic range of health and related services
• Quality care is a must
• There must be an end to discrimination and stigma
• The healthcare products and services should be affordable
• Sustainable investment in health is another prerequisite

Where India Stands – The New “Health-Y” Politics

The much-awaited general election will be held in India in April 2019 when the Indian voters will go to the polls. It is anticipated that whichever government comes into play will surely set a course for newer and better health policy.

Recent researches reveal an alarmingly rapid epidemiological transition. The occurrence of diseases such as cardiovascular diseases, diabetes, and cancer are rapidly on a rise. For instance, since 1990, the number of Indians with diabetes has increased from 26 million to approximately 65 million to date. The incidence of all cancers has increased by 28% between 1990 and 2016, with new cases of cancer emerging each year. India not only seems terribly engulfed in the swirling epidemic of non-communicable diseases, but it is also in the grip of a mental health emergency. The rate of global suicide deaths is speculated to be 1.1 times higher among women and 1.4 times higher among men than global averages in 2016.

It would be unfair if we highlight only the negative side of the picture. After many years of neglect, the Government of India has finally recognized and considered the perils of public discontent relating to health. Prime Minister Narendra Modi has initiated a new programme called Ayushman Bharat, which along with focusing on preventive health, emphasizes affordable health.

Ayushman Bharat majorly comprises two new flagship programmes. First, the creation of 1.5 lakh health and wellness centers across the whole country. These centers will primarily be responsible for providing primary healthcare facilities to provide health coverage for all. The second includes the National Health Protection Mission (NHPM)—a system of health insurance that intends to cover 500 million people. It covers secondary and tertiary care for the poorest and most vulnerable strata of society. These twin programmes together must help India improve access to quality health services and reduce out-of-pocket health expenditures.

Modi is the first Indian Prime Minister who has grasped the importance of health for Indian citizens and has prioritized universal health coverage as part of his political platform. “Modicare” as it is sometimes addressed to, can become a decisive issue in the upcoming general elections.

Way Forward for a Healthy Nation
Does Universal health Coverage still seem a distant goal in India!

The scant funding from the Central and state governments seems the root cause and the major hindrance in achieving UHC. The Central Government has recently announced a massive expansion of healthcare facilities.

Through its ambitious National Health Protection Scheme (NHPS), the Government of India provides a framework for universal health coverage in which it prioritizes healthcare delivery and its easy access. By reducing out-of-pocket payments, expanding service coverage, improving quality of services, and ultimately advancing UHC, countries and in particular, India with schemes like NHPS in place can transform the health of their people and bring drastic changes in society. As stated by WHO Director-General: “No one should have to choose between death and financial hardship. No one should have to choose between buying medicine and buying food.” UHC indeed is a way to go ahead.

About the author

Dr. Jasmeet Kaur is a Doctorate in Immunology and whenever she gets free time from the full-time job she loves to read and write about imperative issues in healthcare.

The post Healthy Lives: Everyone, Everywhere appeared first on InnoHEALTH magazine.

Medical Devices in India Witness Churning

InnoHEALTH Magazine — Fri, 28 Dec 2018 06:53:12 +0000

“We are moving into a bold era, defined by advanced medical technologies and artificial intelligence. But healthcare will always remain a human business”. For Dominic Asquith, British High Commissioner to India that is the crux of the current situation, but a razor-sharp competitive business in medical devices across the world has a different narrative because of market compulsions vis-a-vis human business.

India’s strong position on heart stents’ price regime triggered debate and the price war snowballed into tough positions and international players gaped with bewilderment. Many institutions and professional bodies flew into action and debated price structures while the country’s federal government unveiled its world’s largest health coverage scheme for millions, virtually creating a colossal potential in the health sector. If the government extends healthcare services to its 1.25 billion population as part of India’s Universal Health Coverage (UHC) agenda, it will be a challenge to devise ways to reduce catastrophic Out Of Pocket (OOP) expenditure on healthcare and ensure affordable access to essential healthcare for the entire population with the limited resource envelope.

Amid ongoing trading tussle between US and China, many apprehend that ripple effect will also percolate down in India as the latter is going ahead with its price regimes and its moves to bring down stent and knee implant devices had raised many eyebrows.

A section of media has reported that AdvaMed (Advanced Medical Technology Association)in its briefing memo for US Commerce Secretary and US Trade Representative last year had conveyed that “Made in India” scheme has been used by parts of the Indian government to justify protectionist measures such as import tariff hike sand preferential market access policies.

The Economist newspaper recently carried a write-up which quoted China Digital times, a California based website, that Chinese media had been advised to play down China’s global dominance in various technological sectors, known as “Made in China 2025”.Such developments indicate that India should also dial down the hype on “Made in India”.

The 2014 World Bank Report estimated the OOP spending on healthcare in India to be as high as 89%. India is the only country, out of the major world economies, where out-of-pocket expenses are increasing, despite a concurrent increase in public spending. This effectively means that more people are availing private healthcare services due to rising incomes or are forced to spend due to inadequate public expenditure.

Official sources say big schemes can be ensured with the help of Health Technology Assessment (HTA), which is a widely used methodology internationally for optimization of resource allocation in health. HTA is a method of evidence synthesis that considers aspects pertaining to clinical effectiveness, cost-effectiveness, social, ethical and legal implications of the use of “health technology” for healthcare intervention.

The Indian healthcare industry was valued at over USD 100 billion in 2016 and is expected to reach more than USD175 billion by 2020, resulting in a CAGR (Compound Annual Growth Rate) of 20%. The medical device industry is valued at USD 6 billion. The medical device industry was accorded the status of an independent industry in 2014. The medical device sector today is clearly small and indicates low penetration in the country.

“The path to realizing healthcare goals is complex, and various fundamental issues and challenges need to be addressed and solved holistically. Long-term plans need periodic policy and regulatory interventions to ensure fair conduct within the industry while providing the support needed for profitable and sustainable growth. These activities will enable the medical device industry to accelerate rapidly and play a key role in making India healthier and stronger.” Mr. Guljit Singh, Executive Chairman of SKP Business and Abby Pratt, Vice President for Global Strategy and Analysis at AdvaMed said in their forward of the study. AdvaMed had partnered last year with SKP to publish the study entitled – Medical Device Industry in India –the evolving landscape, opportunities, and challenges.

The study also examined various policies and regulations impacting the industry and attempts to make recommendations on the way forward from the perspective of different stakeholders.

The study made a slew of recommendations like cap trade margins and not price to the dealers, should be capped after a detailed evaluation of each medical device segment and the role of trade. Trade margins should be fixed differentially for different categories of devices, based on service requirements and role of distributors.

It says allow the dealers to compete with each other and provide a fair price to the hospitals based on the terms and conditions of services and payments. There is a need to work towards bundled payment models as used in many other countries to better align incentives for hospitals and their business models. Increase government healthcare spending as a percentage of GDP; India lags behind the other BRICS in this regard.

Adequate utilization of government infrastructure to reduce the cost to private players – PPP model could be an attractive alternative to explore. Specify certain quantities/ proportions of supply of different stents at lower prices to specified government agencies for use with underprivileged sections. It advocated to empower the Medical Technology Assessment Board (MTAB) to evaluate the model of tiered pricing as observed in the French healthcare ecosystem, wherein the NPPA caps the generic products and leaves the latest generation products with incremental value out of the ‘essentiality purview’.

The incremental value could be on account of efficacy, material used, ease of delivery and shortened recovery time. Various combinations are possible here such as: an increase in the number of tiers, allowing new introductions to be free of price intervention for a certain number of years. Identify priority medical devices and procedures that demonstrate the greatest need stemming from disease burden. MTAB, alongwith other regulators for medical devices, should ensure that there are minimum quality parameters – in terms of safety, clinical efficacy, and cost-effectiveness – for medical devices that get used in the public and private health system, such that long-term costs are lowered over a patient’s lifespan, with need for fewer hospital readmissions, lowered need for medication, and overall better health outcomes.

The report said factors such as changing demographics, rising life expectancy, growing incomes and public awareness have contributed to a higher demand for medical care. A more focused approach from the government, with increased public expenditure on health, greater utilization of technology, vibrant private sector participation, and continued innovation can transform the sector and move India closer to its goal of providing quality universal healthcare.

Some of the key issues faced by the Indian healthcare industry are evident: with India’s disease burden shifting from acute to chronic diseases, large number of the population continue to not have access to basic healthcare services. Public health infrastructures are poorly equipped to deal with this shift towards NCDs.

While the government and value chain participants are undertaking several steps to address these issues, they have been executed in silos. Medical service providers are not only inadequate but are also not evenly distributed across rural and urban areas. This shortfall occurs despite an increase in the number of medical colleges from 23 in 1947 to 398 in 2014. The quality and availability of healthcare deteriorate as one moves away from large urban centers to lower-tier towns and rural areas. The Indian medical device industry, the report found, is highly fragmented. Currently, these sectors are dominated by MNCs with 70-75% of the demand being met through imports.

Approximately 30% of the domestically manufactured devices are exported, in which the consumables and disposables segment has the largest share.

On a mix of technologies such as engineering, electronics, material sciences and information technology – innovation, capital and technology drive the industry. However, India has not been able to bridge the gap between investments, skilled resources, and innovation to fully capitalize on these opportunities. Numerous factors underlie the prevalence of higher imports in the country.

Some of these are: no clear comparative cost advantage in view of other emerging markets; policy issues like inverted duty structured do not help in creating a positive environment; lack of favorable policy and regulatory framework, the report, compiled last year said.

On segments, the study said, hearing aids and pacemakers form major part of patient aid segment and constitute 70% of the segment collectively. Most of the products are sourced from Australia, China, Ireland, Singapore, South Korea and US.

The medical disposables and consumables sector consists of products such as plastic syringes, blood bags and many others. This segment is dominated by domestic players in India due to its low technology requirements. Needles and syringes constitute majority of the sales. However, wound management products and medical apparels are the fastest growing products in this segment. The Indian implants segment has witnessed an encouraging growth rate of CAGR 25%.

With a healthy mix of both domestic companies and MNCs, this segment has witnessed intense competition between players due to strong pricing pressure. The domestic players have realized the market potential which demands customization and differentiated product quality. The equipment and instruments section is the largest segment of the medical device industry constituting nearly 54% of the segment and is dependent on imports.

MRI machines, CT scanners, ultrasound machines, dental drills, dental chairs, dental x-ray machines are some of the key products of this segment. It is dominated by MNCs like GE Healthcare, Philips Healthcare, Schiller Healthcare, Danaher Corporation, and Roche.

Drug-eluting stents and bare metal stents form a major part of the stents segment and constitute more than 70% of the segment collectively. Most products are sourced from US and Europe. While domestic companies are manufacturing cost-competitive products, they still face competition from international players on account of quality. Diagnostics segment is growing due to advanced technology being increasingly applied in medical procedures.

The report had said government initiatives control regulation and the new Public Procurement Policy- the Preferential Market Access – do not fully reflect this and has alarmed many industry participants.

A clear long-term vision and roadmap for the industry and predictability of policy would excite the industry. The government needs to provide policy support for both the supply and demand side of the medical device industry to successfully accelerate growth. Industry and government need to work together to improve awareness, access has made rapid progress in the last decade, but significantly lags behind other nations in availability and quality of equitable medical care and services for citizens.

This, in turn, presents an enormous opportunity given the large population, growing economic prosperity, and the disease burden. Major issues such as availability of adequate infrastructure, trained human resources, geographic spread, rapidly changing disease burden, and high/often catastrophic out of pocket expenditures are challenges that the government is keen to address, the report said.

The Indian government is committed to raise public expenditure on health to 2.5% of the GDP. Public and private sectors need to play equally important but different roles in bringing rapid change to the healthcare scenario in the coming decade.

Around opening up, FDI and infrastructure development are welcome initiatives that will enhance the ecosystem for investment. The Indian medical device industry appreciates government’s efforts to remove bureaucratic hurdles and improve the ease of doing business, but believes that additional steps can be taken to strengthen its approach.

The study identified challenges and said growth in the healthcare industry has been attractive. However, much more needs to be done. Despite the advent of private players and better government spending, most Indians can only afford and/or have access to basic healthcare. Hence, the path to universal healthcare coverage is challenging.

Some of the obstacles faced are – real estate prices and high capital costs limit the growth of delivery infrastructure; insufficient attention by policymakers and a complex tax regime are also responsible for the sector’s underdevelopment; the lack of a comprehensive policy and focus to develop the healthcare ecosystem; low penetration: the per capital medical device spending of USD 3 compared to USD 7 in China and USD 42 in Russia is significantly low.

Another study early this year – “Medical devices in India – an agenda to effective healthcare delivery” said to attract world’s top med-tech players to establish their research and development (R&D) operations in the country and to establish a firm footing in the global market, the Government needs to adopt a robust policy and regulatory framework. India can replicate some of the models being adopted by other nations that have succeeded in attracting leading medical players. The contents of this report are based on a study commissioned by AdvaMed and conducted by IQVIA on behalf of AdvaMed.

It said that the government can provide financial incentives in form of extended tax holidays or weighted tax reduction for R&D investments; boost local demand for medical devices by stepping up public healthcare spending which in-turn could catalyze investments in this sector. Further, the government should focus on creating an enabling regulatory landscape by creating a separate legislation system for medical devices.

The report said while, Medical Devices Rules 2017 is a welcome step towards regulating the medical devices sector, the setting up separate notified body and distinct legislation system for devices with a focus on the following could further boost growth of the industry like Grant product approvals; Instituting quality standards; Setting up monitoring mechanisms for devices; Expedite patent approval process for medical devices.

Medical devices form more than USD 200-billion global industry, which develops and manufactures essential healthcare equipment. The Indian industry is currently valued at USD 4.4 billion with about 700 medical device makers, India’s medical device market is currently the fourth-largest in Asia (after Japan, China and South Korea) and ranks among the world’s top 20.

Imports constitute a substantial part of the medical device market in India. An estimated 80% of India’s demand for medical devices is currently met by imports, nearly 30% of which are supplied by the US. Imported medical devices are often those that are critical, innovative and high-risk in nature – either life-saving or life-enabling, and therefore undergo rigorous testing. These complex, innovative devices are designed to address the growing expectations of India’s population in the country’s rapidly evolving healthcare system, this report said.

The medical device industry has been very encouraged by the Prime Minister’s recognition of the critical role of medical devices in addressing India’s healthcare challenges. The Adva Medwebsite says in general, we have a received a strong message from the government that they are interested in promoting the medical devices sector and creating an environment that fosters innovation. This is great news not only for manufacturers of medical devices but more importantly for patients who desperately need access to high quality yet affordable lifesaving and life-enhancing medical technologies.

The PM’s call to medical device manufacturers is a welcome recognition of this separate and important part of the healthcare system. Several of AdvaMed’s member companies have already established manufacturing units in India, and India is being increasingly viewed as an R&D base.

The website says, the medical device industry in India has grappled with challenges for several years around recognition and regulation. While the Global Medical Device Nomenclature (GMDN) lists more than 14,000 different product types, the current regime only regulates a relatively modest portion of these products.

Moreover, these devices/products are regulated as “drugs” under the Drugs and Cosmetics Act of 1940. This is problematic because medical devices are very different from drugs in terms of diversity, product development, patent structures, types of failures, scientific disciplines involved in assessing performance/efficacy.

In addition to the arbitrary application of the rules for drugs to medical devices, which hinders the development, quality of and access to medical devices, there is also a lack of predictability in the regulatory system. The industry is also concerned about the lack of standardization in line with global best practices.

The post Medical Devices in India Witness Churning appeared first on InnoHEALTH magazine.

An Interaction with J.P. Nadda on Health Plan

InnoHEALTH Magazine — Mon, 14 May 2018 10:23:03 +0000

World’s Largest Health Scheme Unspooled in India

Apparently bracing up to showcase India’s achievements in Health Sector management during general elections due within a year and a half, Union Health and Family Welfare Minister Jagat Prakash Nadda, who recently hogged limelight during mega health plan announced in the Union Budget 2018-19, and also played prominent role in the ruling party activities at the national and states’ level, says the NDA government is committed to advancing Universal Health Coverage (UHC) agenda. World Health Organisation Director-General Dr Tedros Adhanom Ghebreyesus has recently said that India should have UHC.

In an interaction with InnoHEALTH magazine, the Minister asserts that the government would herald a new era of healthcare and the plan announced in the Union Budget would be implemented with full sincerity. It will take a few months to roll out all nitty-gritty’s of implementation. He dismisses apprehensions of those sceptical of the plan in wake of massive funds required for the implementation of the world’s largest healthcare plan. There would be no laxity in the successful implementation of the scheme and it had nothing to do with elections but it is a well-thought-out plan to ensure holistic healthcare to common people. Massive machinery has started churning out plans to bring the scheme to the ground reality. Informatively, a plan to provide health coverage to 50 crore people has been proposed in the current budget 2018-19 and is being viewed as a precursor to the UHC.

WHO’s definition of UHC — one of the goals of sustainable development — includes financial risk protection (against medical expenses), access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

The National Health Policy 2017 approved last year envisages the attainment of the highest possible level of health without anyone having to face financial hardship as a consequence. The Ministry of Health & Family Welfare (MoHFW) has taken concrete steps to reduce the Out of Pocket Expenditure (OOPE).

Mission Indradhanush launched in 2014 which was one of the largest global public health initiatives. In its four phases till date, Mass Immunisation (MI) has successfully reached over 25 million children in over 528 Districts. The focus is also on increasing the basket of vaccines. Since 2014, Rotavirus vaccine, Pneumococcal Conjugate Vaccine (PCV), and the Measles-Rubella (MR) vaccine, and also the JE vaccine for adults have been launched.

Under Pradhan Mantri Dialysis Program (PMDP) 1.43 lakh patients have availed free services from 1,069 Dialysis Units and also under Free Drugs and Diagnostics Program; Affordable Medicine and Reliable Implants for Treatment (AMRIT) outlets nearly 47 lakh patients have benefitted and through the purchase of subsidized medicines from AMRIT Pharmacies.

To provide comprehensive primary care, the Government has announced of transforming 1.5 lakh sub-health centres to Health and Wellness centres i.e. MoHFW is now moving towards the provision of comprehensive primary care through the Health and Wellness Centres.

The MoHFW has initiated universal screening of common Non-Communicable Diseases (NCDs) such as diabetes, hypertension and common cancers at the sub-centre and Primary Health Centre (PHC), which will enable the strengthening of preventive and promotive health, improve patient referral and access to secondary care.

Excerpts

Q. Please share some major highlights of 2017 in promoting health initiatives?

I am proud to say that there have been several achievements. Few on top of my mind are—Release of the new National Health Policy 2017 after a gap of 15 years, the Passing of HIV & AIDS (Prevention & Control) Act, 2017, the Cabinet approves the Mental Healthcare Act 2017, and the most recent National Medical Commission Bill, 2017.

Besides these policy and legislature decisions, the MoHFW launched some major health initiatives. Starting with the most recent National Nutrition Mission 2017 with Ministry of Women and Child Development (WCD), the intensified Mission Indradhanush. After the success of MI, the annual rate of increase of full immunisation coverage has increased from 1% to 6.7 % during the two rounds. We increased the basket of Universal Immunization Programme (UIP) with the introduction of new vaccines i.e. Rotavirus vaccine, MR vaccine and the PCV.

The PMSMA (Pradhan Mantri Surakshit Matritva Abhiyan) has helped detect more than 5 lakh high-risk pregnancies. Similarly, MoHFWs Rashtriya Bal Swasthya Karyakram (RBSK) has screened 11.7 crore children, 43.4 lakh children were referred to secondary tertiary facilities, 27.8 lakh children availed services in secondary tertiary facilities. The MoHFW also launched the Mission Parivar Vikas (MPV) in 146 Districts of 7 states for substantially increasing the access to contraceptives and family planning services in Districts with Total Fertility Rate (TFR) of 3 and above.

The MoHFW announced transformation of sub-health centres to Health and Wellness Centres (HWCs) to expand the basket of services of primary care to make it comprehensive. The HWCs are expected to provide preventive, promotive, rehabilitative and curative care for a package of services related to reproductive, maternal, newborn, child, and adolescent health (RMNCH+A), communicable diseases, non- communicable diseases, ophthalmology, ENT, dental, mental, geriatric care, treatment for acute simple medical conditions and emergency and trauma services. In addition, the recently launched population-based Screening of Diabetes, Hypertension and Common Cancers (Oral, Breast & Cervical) represents a massive step in identifying and addressing the risk factors at the community level itself. More than 150 Districts are taking up in 2017-18.

There are global achievements in terms of India being declared Infective Trachoma free. The MoHFW has also signed MoUs with Italy, Morocco and Cuba.

Q. What challenges did you aim to achieve next year?

Provisioning UHC and to restrict the growing burden of Non – Communicable Diseases. We have initiatives in place to manage both.

Q. How to address the fund crunch issue?

There is no fund crunch. In 2017-18 Union Budget, the health allocation was increased by 27.7%. The MoHFW is committed to 2.5% of GDP to healthcare in a phased manner under the National Health Policy 2017. So I don’t foresee any fund crunch.

Q. Your comments on private sector role in healthcare? Is their contribution satisfies you?

Private sector engagement is a part of new National Health Policy 2017 for a reason. They have a very significant and important contribution to the country’s health services landscape. In terms of real-time support, we are satisfied with their contribution to the Pradhan Mantri Swasthya Matritva Abhiyan (PMSMA) and provisioning dialysis services through PPP under the Pradhan Mantri Dialysis Program.

Q. Please throw light on Universal Health Coverage initiatives?
There are several, however, I can list a few:-

• In 2017-18, the MoHFW announced transformation of subhealth Centres to Health and Wellness Centres (HWCs) to expand the basket of services of primary care to make it comprehensive. The HWCs are expected to provide Preventive, Promotive, Rehabilitative and Curative Care for a package of services related to RMNCH+A, Communicable diseases, Non-Communicable Diseases, Ophthalmology, ENT, Dental, Mental, Geriatric Care, treatment for acute simple medical conditions and emergency and trauma services. The indicative package of services envisaged is

a. Care in pregnancy and childbirth
b. Neonatal and infant health care services
c. Childhood and adolescent health care services
d. Family planning, contraceptive services and other Reproductive Healthcare services
e. Management of Communicable diseases: National Health Programmes
f. Management of Common Communicable Diseases and General Out-Patient care for acute simple illnesses and minor ailments
g. Screening and management of Non-Communicable diseases
h. Screening and basic management of mental health ailments
i. Care for common Ophthalmic and ENT problems
j. Provision of basic dental health care
k. Geriatric and palliative health care services
l. Trauma Care and Emergency Medical Services

The Health and Wellness Centre (H&WC) will deliver comprehensive primary healthcare using a team-based approach and would be led by a mid-level service provider with a primary healthcare team including ANMs, ASHAs, and AWWs, of the sub-centre area. Altogether, 4000 sub-centres are targeted to be transformed to HWCs by March 2018 and 1.25 lakh HWCs by March 2022. So far approval has given for 3871 HWCs.

• National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS)— -In order to prevent and control major NCDs, the MoHFW is implementing the NPCDCS in all states across the country with the focus on strengthening infrastructure, human resource development, health promotion, early diagnosis, management and referral. As on date, the programme is under implementation in total 436 Districts, with setting up of NCD clinics in 435 District Hospitals, and 2145 Community Health Centres. Cardiac Care Units have been set up in total 138 Districts and Day Care Centres for Cancer Chemotherapy have been set up in 84 Districts. Provision has been made under the programme to provide free diagnostic facilities and free drugs for NCD patients attending the clinics at the District and CHC levels.

• Population-based screening for Diabetes, Hypertension and Common Cancer (Oral, Breast & Cervical)—The recently launched Population-based Screening of Diabetes, Hypertension and Common Cancers represents a massive step in identifying and addressing the risk factors at the community level itself.

More than 150 Districts are being taken up during 2017-18. As of September 2017, approvals given for about 170 Districts in 16309 sub-centres and screening has been initiated in about 60 Districts, 12 states, 2 UTs and 20,15,474 people have been screened.

Q. How the Ministry ensures safe pregnancy in rural/remote and tribal areas where access to hospitals is not that easy?
The issue focuses on our entire Reproductive Child Health (RCH) programme and National Health Mission To list a few viz.-
a. Janani Suraksha Yojana (JSY)
b. Janani Shishu Suraksha Karyakram (JSSK)
c. HBNC/HBIC (Home-Based Neonatal Care/Infant Care)
d. National Ambulance Service (108/104)
e. Tribal Birthing/Waiting Homes
f. Pradhan Mantri Swasthya Matritva Abhiyan (PMSMA)

Q. What message do you want to share with the community in their fight against dengue and chikungunya?

I want to focus solely on prevention viz. preventing water logging around the house. And other measures which we keep reiterating through our regular Information, Education, and Communication (IEC) campaigns. This requires community partnership and ownership.

Q.8. What has been the status of constructing of new AIIMS across the country?

The Government has been at the forefront to strengthen the tertiary care. As such six new AIIMS are functioning and six will come up in due course.

Q. Pl throw light on MoU signed with Morocco. What will be the major gains?
The main areas of cooperation include the following:
a. Non-communicable diseases, including child cardiovascular diseases and cancer
b. Drug Regulation and Pharmaceutical quality control
c. Communicable Diseases
d. Maternal, child and neonatal health
e. Hospital twinning for the exchange of good practices
f. Training in administration and management of health services and Hospitals
Q. Generic medicines: How to address availability issue?

The MoHFW recently issued a draft gazette notification making it mandatory for Pharma companies to carry the generic name of drugs on packs that are at least two fonts larger than the brand name. This clause will be a legal provision as a rule under the existing Drugs and Cosmetics Act. And any violation will be punishable under the provisions of the law. The Ministry has sought public comments on the draft, after which it is likely to become part of the drug law.

Also, issued orders to the Medical Council of India (MCI), state governments and all central government hospitals asking them to ensure that doctors write prescriptions with generic names of medicines in legible handwriting.

In last three years, the government has capped prices of around 700 essential medicines. It has also capped prices of stents and is working to make drugs for critical diseases like cancer and heart disorders available through various schemes. It has also launched several programmes to make free drugs and diagnostics available under the National Health Mission.

Also, our AMRIT stores provision generic drugs. 19 states have set 105 pharmacies for providing medicines for Diabetes, CVD, Cancer and other diseases at discounted prices to the patients. A total of more than 5000 drugs and other consumables are selling at up to 50% discounts.

As of 15th November 2017, 44.54 lakh patients benefitted from AMRIT pharmacies. The value of drug dispensed at MRP is Rs 417.73 crore and savings of Rs. 231.34 crore from AMRIT stores thereby reducing theirs out of pocket expenditure.

Q. Doctors’ shortage: What measures should be put in place to address the concern?

• The MoHFW has granted permission for the establishment of 83 new medical colleges in the last 3 years including 31 in the government sector. The country has today 479 medical colleges with more than 67,000 MBBS seats.

• The Ministry has taken various measures to facilitate the setting up of new colleges viz.

a. norms for medical colleges rationalized
b. urban areas have dispensed with the minimum area of land within notified
c. Companies have to allowed to set up medical colleges.

• The MoHFW is implementing a Centrally Sponsored Scheme namely “Establishment of new medical colleges attached with existing district/referral hospitals”

• Under this Scheme, 58 Districts in 20 States/UT has identified to establish new Medical Colleges attached with existing district/referral hospitals. Out of these, 56 have been approved to date.

• Out of 56 approved medical colleges, 8 are functional and 29 have applied for MCI’s permission to start new medical colleges from the academic year 2018-19.

• The increase of PG seats:

• In January 2017 the teacher-student ratio was revised in government medical colleges in clinical subjects and consequently around 3,000 PG seats added as a one-time measure.

• In the normal course of permission under IMC Act added 700 seats. Combined with the increase of DNB seats, the ministry could achieve an increase of nearly 5800 PG seats in 2017.

• The country has today around 38,000 PG seats including Diplomate of National Board (DNB).

Q. Please throw light on Mental Healthcare Act, 2016. What steps the did government plan to create awareness on this?

• The Act adopts a rights-based statutory framework for mental health in India and strengthens equality and equity in the provision of mental healthcare services in order to protect the rights of people with the mental health problem to ensure that they are able to receive optimum care and are able to live a life of dignity and respect.

• Mental Healthcare Act strengthens the institutional mechanisms for improving access quality and appropriate mental health care services.

• The Act increases accountability of both government and private sectors in the delivery of mental health care with the representation of persons with the mental health problem and their caregivers in statutory authorities such as Central and State Mental Health Authority.

• The most progressive features of the Act are the provision of advance directive, nominated a representative, special clause for women and children related to admission, treatment, sanitation and personal hygiene; restriction on the use of Electro-Convulsive Therapy and Psychosurgery.

• Decriminalization of suicide is another significant facet of the Act, which will ensure proper management of severe stress as a precursor for suicide attempts.

Finance Minister Arun Jaitley recently has announced two major initiatives in the health sector, as part of Ayushman Bharat programme. This is aimed at making path-breaking interventions to address health holistically in primary, secondary and tertiary care systems, covering both prevention and health promotion.

THE INITIATIVES ARE AS FOLLOWS:-

(i) Health and Wellness Centre:- The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health system. Under this 1.5 lakh centres will bring healthcare system closer to the homes of people. These centres will provide comprehensive healthcare, including for non-communicable diseases and maternal and child health services.

These centres will also provide free essential drugs and diagnostic services. The Budget has allocated Rs. 1200 crore for this flagship programme. In adopting these centres is also envisages the contribution of the private sector through CSR and philanthropic institutions.

(ii) National Health Protection Scheme:- The second flagship programme under Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to 5 lakh rupees per family per year for secondary and tertiary care hospitalization. This will be the world’s largest government-funded healthcare programme. Adequate funds will be provided for smooth implementation of this programme.

In order to further enhance the accessibility of quality medical education and healthcare, 24 new Government Medical Colleges and Hospitals will be set up, . This would ensure that there is at least 1 Medical College for every 3 Parliamentary Constituencies and at least 1 Government Medical College in each state of the country.

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