New medical bill will affect quality of healthcare in Karnataka: Doctors

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The Karnataka Private Medical Establishments (Amendment) Bill 2017, which proposes to regulate private medical services by fixing prices for services and prescribing punishment for doctors in case of irregularities in pricing-related matters, has put the Karnataka chapter of Indian Medical Association (IMA) and the state government at loggerheads. The bill is scheduled to be tabled in the assembly next week.Private doctors have termed the bill draconian and are protesting three clauses – setting up of a grievance redressal cell as a supervisory body with powers to act against doctors up to the extent of jailing them, exclusion of government hospitals and price-capping on treatment in private hospitals.

The IMA and private practitioners want the government to consider recommendations made by the committee headed by former Chief Justice of Karnataka high court Vikramajit Sen. “Justice Sen had said there cannot be two sets of rules for private and government hospitals. However, this bill leaves government hospitals out of the ambit of legislation meant to ensure efficient and timely treatment for patients and curb malpractices,” said Rajshekar S Bellary, president, IMA Karnataka.

The government must bring all government-run hospitals under the ambit of KPME Act to ensure quality healthcare, said Madan S Gaekwad, president of the Private Hospitals and Nursing Homes Association (PHANA). “We don’t want any price control by the government. The patient charter should be included as a guideline for all doctors and not as a law,” he added.

According to H Nagendra Swamy, senior president at Manipal Hospitals, none of the proposals made by the Justice Vikramajit Sen Committee has been considered.”Following our protest in June, a joint select committee was formed. However, the government still came up with a bill that will neither benefit patients nor any other stakeholder,” he said.

“It is necessary that we take this extreme step (protest) as our survival is at stake,” a statement by the Surgeons’ Association said.

Govt begins ranking district hospitals to improve services

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Aiming to foster competition and nudge government hospitals to improve health services, Niti Aayog, along with the health ministry, has started ranking district hospitals on the basis of their performance on health indicators.

There are around 734 district hospitals across the country which provide secondary healthcare facilities to people. In addition, around 300 other hospitals, such as women’s hospitals at the district level, will also be rated. The decision to track the performance of district hospitals came as the Modi dispensation believed that despite large amounts pf money being allocated to these hospitals which have a critical role in providing healthcare, there was no comprehensive system to assess their performance based on measurable health outcomes.

The rating will create an environment to nudge hospitals towards improvement. The entire exercise will also provide an evidence base and help identify hospitals that need to be incentivised.

The indicators on which performance will be measured include OPD per doctor, number of laboratory tests per technician, stock out rate of essential drugs, bed occupancy rate, C-section rate, blood bank replacement rate and post-surgical infection rate. Number of functional hospital beds per 1,00,000 population, ratio of doctors, nurses and paramedical staff are other factors which will be taken into account while accessing the performance of district hospitals.

The index will also capture, for the first time, feedback from patients as high weightage has been assigned for patient satisfaction score.

Heal the nation

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It’s welcome that government think tank Niti Aayog, along with the health ministry and World Bank, has come up with a model of public private partnership to boost India’s abysmal record of healthcare delivery. Public health and hospitals in India come under the domain of state governments and the model is in the form of a template which can be used to augment treatment facilities of non-communicable disease in smaller cities. This is a useful channel to expand the provision of healthcare facilities for resource strapped governments and needs to be scaled up radically across the board, as public healthcare delivery managed solely by the public sector has had a poor record in which Indians, in general, have little faith.

To be sure, states have already experimented with PPP in healthcare delivery in a limited way. Odisha announced this year that it had picked a private healthcare provider to operate and manage a cardiac care hospital in Jharsuguda, while Karnataka and Andhra Pradesh have devised elaborate insurance schemes which make use of private healthcare facilities for surgical procedures. But there is much scope for expansion as well as a process of trial and error to see what works.

Debate in India too often gets bogged down in ideological debates on public versus private healthcare. But policy needs to be pragmatic and facilitate what works: if the capacities of government and private sector can be brought together in a synergistic way to get healthcare services to cover the entire population, there should be no objection. However, based on India’s experience so far, it is important to get the design of PPP right. In the Niti Aayog proposal, there is a benchmark for pricing. This needs to be complemented with proper oversight that will prevent unnecessary medical interventions as well as corruption.

Last but not the least, India has an abysmal doctor-patient ratio and a lot needs to be done to enhance the supply of doctors. Regulation of medical colleges emphasises more on curbs in supply than on ensuring that doctors with a licence to practice are of a minimum quality. Such irrational restrictions need to go, and Niti Aayog had some earlier suggestions to this effect which must be implemented as well. Unless India produces more doctors, whether for the public or private sector, healthcare delivery will not improve.

How India’s family planning programme places well-being and unlocking the potential of women at its centre

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Guest article by Shri JP Nadda, Minister of Health and Family Welfare, Govt. of India

The story of India in the 21st century has been one of extraordinary growth and innovation. We have revolutionised the data and information industry, and we produce medicine cheaper than anywhere in the world. We eliminated polio under incredibly challenging circumstances. But India has not even come close to reaching her full potential, because we have only leveraged half of our resources into that effort. We’ve yet to unlock much of the potential of the other half: India’s women.

Only when India’s women are on an equal footing with India’s men will we be the nation we want to become. The government has already taken significant steps to provide health and development to women.

In India, though maternal and infant mortality have dropped precipitously in recent years, 200 women still die every day in child birth. Part of the problem is that not all pregnant women have easy access to the best ante-natal care. The Pradhan Mantri Surakshit Matritva Abhiyan, which was launched late last year, guarantees every woman in her second or third trimester free ante-natal care by private doctors at designated hospitals all over the country on the 9th of every month.

More than 50 lakh women have been given quality ante-natal checkups under this scheme. More than 56 lakh pregnant women have been immunised under Mission Indradhanush and the MAA campaign, through awareness and counselling, continues to promote better health and nutrition to mothers and children at community level.

Family planning is one of the most critical and long standing health programmes in India. Here too India has made impressive progress, with the fertility rate dropping from 2.7 to 2.1 over the last decade. But even today 31 million married women are not using any contraception at all; about two thirds of the rest are using sterilisation, which is effective but doesn’t help women delay their first pregnancy or space their later children at healthy intervals.

As a result, too many women are either having more children than they want, having children sooner than they want, or not leaving enough time between children for their bodies to recover fully from pregnancy. Realising this massive gap, the government has introduced three new contraceptive methods into the health system, including injectables and a once-a-week pill, so that more and more women will be able to plan their families.

Among those women who do get pregnant, almost half are between the ages of 15 and 25, so we’re also starting an intense awareness campaign aimed at this age group to make sure that they know the contraceptive options and feel empowered to exercise them. A complementary campaign will target men, since contraception isn’t always a choice a woman can make on her own. The better men understand family planning, the more supportive they’re likely to be when it comes to planning their families together with their wives.

The need for better contraception and ante-natal care is not spread evenly around the country. A quarter of India’s mothers who live in the poorest areas are twice as likely to see their babies die than the rest. That is why we launched Mission Parivar Vikas on World Population Day on Tuesday, doubling down our efforts in 145 districts in 7 states – districts responsible for half of the country’s infant deaths – for intensive improvement in family planning and ante-natal care services.

As part of this Mission we want to ensure that supplies are available at all facilities at all times for which we are developing a robust Family Planning Logistics Management Information System. This is a web and mobile based decision-making tool to monitor and manage the flow of contraceptive supplies – to reduce inventory fluctuations – and improve the programme’s effectiveness at all public health facilities.

We estimate that in 2017 nearly 137 million women in India are using modern method of contraception. As a result of this usage, 39 million unintended pregnancies will be prevented; nearly 12 million unsafe abortions, 16 million total births and 43,000 maternal deaths will be averted. We firmly believe that family planning is critical for our nation’s economic development, and is a big first step towards growth, equality and sustainable development that opens the door to opportunity and prosperity for women and families.

Government urged to make primary healthcare a speciality

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The Academy of Family Physicians of India on Tuesday urged the government to recognise primary healthcare as a “speciality”, saying their experts (family physicians) are the first point of contact for healthcare for most people.

The body asserted that strengthening primary healthcare would be a major step towards achieving the goal of mitigating the burden of diseases at advance state.

It is mainly provided by general practitioners but community pharmacists, opticians and dentists are also primary healthcare providers. The aim is to provide an easily accessible route to care, whatever the patient’s problem, it said.

“By strengthening primary healthcare (PHC), burden of diseases at advance stages can be prevented. It needs effective planning and future road map to reach the target. The PHC forms the anchor around which entire healthcare delivery system is organised,” said Raman Kumar, President of the Academy of Family Physicians of India.

Currently, primary healthcare by the general physicians is not recognised by the Medical Council of India as any form of specialty.

The World Health Organisation has identified five key elements as part of the primary healthcare, reducing exclusion and social disparities in health, (universal coverage reforms), organising health services around people’s needs and expectations (service delivery reforms) and integrating health into all sectors.

“Primary healthcare is not yet recognised by the Medical Council of India (MCI) as a specialty, although MCI has advocated for the creation of a diploma course in family medicine. Primary healthcare practitioners therefore have no formal system for career progression. They have lower pay and worse working conditions than their hospital colleagues,” said Kumar.

After 5 decades, doctors may get a cadre like IAS, IPS

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More than five and a half decades after a central committee had recommended the setting up of an All India Medical Service cadre along the lines of the Indian Administrative Service (IAS) or the Indian Police Service (IPS), the central government has moved a proposal to create such a cadre. Health being a state subject, the union health secretary has written to the chief secretaries of all states soliciting the views of the states.

“The creation of an All India Medical Service under the All India Service Act 1951, like IAS, IPS, etc. for creating a body of professional doctors across the country has been under the consideration of the government for quite some time. Considering the fact that health is a state subject and the major requirement of health professionals is at the state level, it has been decided to solicit the views of all state governments on this issue,” stated the letter sent to the states.

The letter, dated June 9, went on to state that doctors of the Central Health Service (a Group A service under the health ministry dealing with monitoring of various health programmes/schemes) have never worked in the states and hence “do not have an appropriate perspective of the problems being faced by the state governments”. Creating the All India Medical Service could help bridge this gap and “improve technical leadership and management both at the Centre and state levels,” the letter said.

 

The Health Survey and Planning Committee, better known as the Mudaliar Committee, which submitted its report in 1961 had observed that three areas — provisioning of adequate medical care, both preventive and curative; training of medical and paramedical personnel; and those for dental care and for research — were interlinked and that it was only through a coordinated programme of action in which centre and states cooperated “satisfactory and speedy results” could be achieved. Hence it had recommended the formation of a central health cadre in which senior posts in the Central and state health ministries would be included.

 

Such a central cadre, which existed before independence, the Indian Medical Service (IMS), was abolished in August 1947. The committee’s report noted that most of the highest administrative and specialist posts in the states were manned by officers of IMS, the Women’s Medical Service and the Medical Research Department, who were officers of an all-India cadre, thus “providing a certain measure of coordination between the Centre and states in spite of the fact that health was a ‘transferred subject’ under the Government of India Act 1935”.

 

More recently, in 2005, the report of the National Commission on Macroeconomics and Health (NCMH) chaired jointly by then finance minister P Chidambaram and health minister A Ramadoss had stated that it was necessary to take a bold decision “to constitute an All India Cadre of Public Heath Services, on lines like the IAS/IPS”.

 

“It is a great move if the government can pull it off. This is much needed, as those in the existing Central Health Services have no experience in the states and are often restricted to Delhi postings or to central government institutions in the states. They have no clue about rural health or how public health is delivered through the various tiers of the government health system. They get no training or an all-India perspective like the IAS or IPS officers receive in Mussoorie followed by their postings to rural districts. We need a complete revamp of the Directorate of Health Services so that they can function like they are meant to, as the technical and policy advisory wing for the health ministry,” said former health secretary Sujatha Rao, who was also a member of the NCMH.

SATH program launched by NITI Aayog

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Furthering the agenda for cooperative federalism, NITI Aayog has launched SATH, a program providing ‘Sustainable Action for Transforming Human capital’ with the State Governments. The vision of the program is to initiate transformation in the education and health sectors. The program addresses the need expressed by many states for technical support from NITI .

SATH aims to identify and build three future ‘role model’ states for health systems. NITI will work in close collaboration with their state machinery to design a robust roadmap of intervention, develop a program governance structure, set up monitoring and tracking mechanisms, hand-hold state institutions through the execution stage and provide support on a range of institutional measures to achieve the end objectives. The program will be implemented by NITI along with McKinsey & Company and IPE Global consortium, who were selected through a competitive bidding process.

To select the three model states, NITI defined a three-stage process – expression of interest, presentations by the states and assessment of commitment to health sector reforms. NITI invited all states and UTs to participate in the program. Sixteen states expressed prima facie interest, of which fourteen made their presentations. Andhra Pradesh, Assam, Bihar, Chandigarh, Goa, Gujarat, Haryana, Jharkhand, Karnataka, Madhya Pradesh, Odisha, Punjab, Telangana and Uttar Pradesh presented their project proposal to a Committee headed by Member of NITI Aayog, Shri Bibek Debroy and comprising of CEO, Amitabh Kant as well as a representative from the Ministry of Health and Family Welfare.

Of these fourteen states, five have been shortlisted. Subsequently, three will be selected on the basis of further evaluations and objective assessment of criteria affecting the potential for impact and likelihood of success. Metrics such as MMR, IMR, incidence of malaria and others have been considered for determining potential impact while density of doctors and nurses, compliance to IPHS norms are some of the metrics used to determine likelihood of success. The program will be launched in the three selected states after the signing of MoUs.

WHO to confer special award on Health Minister Nadda

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The World Health Organisation (WHO) has conferred a special recognition award on Union Health Minister J P Nadda for his commitment to advancing tobacco control in the country.

The global health body said that Nadda will be conferred the Director Generals Special Recognition Award for accelerating India’s tobacco control initiatives and taking bold measures to protect people against hazards of tobacco use.

Interestingly, sources said that one of the main proposers for the award was K S Reddy, president of the Public Health Foundation of India (PHFI), which was recently barred from getting foreign funds by the government.

WHO has also selected health ministers of the Maldives and Bhutan among five individuals or institutions from the WHO South-East Asia Region for this years World No-Tobacco Day Award.

“Nadda has accelerated India’s tobacco control initiatives, taking bold measures to protect people against multiple health, economic, social and development hazards of tobacco use,” said Poonam Khetrapal Singh, Regional Director, WHO South-East Asia.

India’s recent initiatives include making graphic health warnings covering 85 per cent of all tobacco products mandatory beginning April 2016 and establishing national tobacco testing laboratories last year.

The initiatives also include launching cessation services in 2015 and, as part of this, a National Tobacco Quit line a year ago.

These have all been made possible by the strong commitment and focused efforts of the Minister of Health and Family Welfare, the Regional Director said in a WHO-South East Asia Regional Office (SEARO) statement.

Nadda is among the two recipients of the special global award this year.

The Ministry of Finance and Economic Affairs of the Republic of the Gambia is the other awardee.

Singh added that by pursuing tobacco control measures, countries across the region are striving to advance public health at the same time as accelerating development.

“Tobacco consumption not only threatens and undermines public health, it has major social, economic and environmental consequences.

“On World No-Tobacco Day, we must pledge to continue our efforts to strengthen implementation of Framework Convention on Tobacco Control (FCTC), to address tobaccos threat to public health and sustainable development,” Singh said.

Sources said that Nadda will be conferred the award at an event scheduled next month.

From the WHO South-East Asia Region, Health Minister of Maldives, Abdullah Nazim Ibrahim, has been conferred the World No-Tobacco Day Award for promoting tobacco cessation services and launching the anti-tobacco I Choose Life campaign last year.

Bhutan’s Health Minister Tandin Wangchuk, has been selected for the award for implementing measures, as chairperson of Bhutans Narcotic Control Authority, to ban production and sale of tobacco in the country.

An MP from Bangladesh, Saber Hossain Chowdhury, has been selected for the World No-Tobacco Award for initiating inclusion of tobacco control in the countrys seventh five- year plan in 2015, for sustainable resources for the programme.

The CEO of Thai Health Promotion Foundation, Supreda Adulyanon and Sri Lankas National Authority on Tobacco and Alcohol control are among the others selected for the award from the region this year.

Govt considering to introduce helicopter-based ‘Air Clinics’ for North-East Region

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The union government is considering a proposal to introduce “Air Clinics” with helicopter-based outdoor facility for a large section of population which has no access to health centre or medical clinician, according to Dr Jitendra Singh, Union Minister of State (Independent Charge) for Development of North Eastern Region (DoNER); Minister of State, PMO, Personnel, Public Grievances, Pensions, Atomic Energy and Space.

Presiding over a Conclave of Health Ministers from all the eight North-Eastern States in Guwahati on Tuesday, Dr Jitendra Singh referred to a suggestion which originated after discussion with the Government of Manipur, and said, the concept of having “Air Clinics” with helicopter-based outdoor facility has been mooted with both the Ministry of Health as well as the Ministry of Civil Aviation. “If successful, this could be a boon for a large section of population which has no access to health centre or medical clinician,” he said.

Addressing the meeting, which was also attended by representatives from Adayar Cancer Institute, Chennai; Patanjali; and Yog Sansthan, Bengaluru, the minister also proposed PPP (Public-Private Participation) model to supplement and extend healthcare services up to district level in the eight states of the North-Eastern Region (NER).

Speaking about the last three years of health related initiatives undertaken by the Ministry of DoNER, Dr Jitendra Singh disclosed that Dr Barooah Cancer Institute, Guwahati has been affiliated with the Tata Memorial Cancer Centre, Mumbai under the aegis of the Department of Atomic Energy, as a result of which, the faculty and the supplementary teaching cum clinical services will get upgraded. From last year, he said, super-specialty MCh course in Cancer Surgery has already started and hopefully from this session, super-specialty DM Cancer Medicine will also start.

The minister also acknowledged the collaboration from Adayar Cancer Institute, Chennai in imparting a six-month training to one physician and one surgeon each from each of the eight North-Eastern States, so that they can go back and offer better healthcare in their respective states, considering the high prevalence of cancer in the region.

Dr Jitendra Singh said, “The Ministry of DoNER, with the consensus of all the state governments, will go forward in inviting the interested private healthcare partners from other parts of the country, so that depending upon their capacity and capability, they may be able to supplement the health services in the region. The impetus to healthcare services will be wholesome and holistic, thus also imbibing all the alternative systems of medicine and in this regard, the leading players like Patanjali could have a significant contribution to make.”

Referring to a proposal from the Assam Government for setting up a modern Cancer Hospital with the collaboration of the Ministry of DoNER, Dr Jitendra Singh said, “The officers in the DoNER Ministry are engaged in deliberations with the state health secretariat officers to work out its feasibility and viability.”

In the field of tele-medicine also, Dr Jitendra Singh said, “The Ministry of DoNER will try to facilitate support and help from the private sector so that the people living in the remotest areas of the difficult terrain are not deprived of the benefit of specialized medical consultation.”

Dr Jitendra Singh also disclosed that a number of private corporate sector hospital chains are coming forward to venture in the Northeast. The minister further said that he would seek the help of the Ministry of Health and other related Ministries to consider these cases on the principle of mutual benefit.

Malaria to be eliminated from 15 states by 2020: Government

Malaria to be eliminated from 15 states by 2020: Government

There has been a progressive decline in the number of cases of malaria and deaths due to it and the disease is likely to be eliminated from at least 15 states in another three years, according to the government.

“By 2020 we will be able to eliminate malaria from 15 states with an annual parasite incidence (API) of less than one case per thousand population. We are sure to eliminate malaria from these states by 2020,” Dr AC Dhariwal, Director of the National Vector Borne Disease Control Programme (NVBDCP) in the health ministry, told PTI.

He asserted that states like Jammu and Kashmir, Himachal Pradesh, Uttarakhand, Punjab, Sikkim, Tamil Nadu and Kerala and union territories including Daman and Diu, Lakshadweep and Puducherry will be free from malaria.

He, however, mentioned certain districts in Odisha, Chhattisgarh, Jharkhand, Madhya Pradesh, Maharashtra, Andhra Pradesh, Telangana, Meghalaya, Mizoram and Tripura as malaria transmission risk areas.

“The API in some of these areas are more than two per thousand population. In some areas the scenario is worse like more than ten,” he said.

In fact, a couple of districts in West Bengal were considered to be risk areas where the API was two per thousand people, he said.

“Some districts of Meghalaya and Tripura having borders with Bangladesh are also places where malaria is still a threat,” Dhariwal stated.

The overall situation in India, however, has improved compared to what it was in the last century, he said.

“There has been a decline not only in the number of cases of malaria incidence but also in the number of deaths because of the disease. It’s mainly because of the efforts of Bivalent Rapid Diagnostic Test (RDT) tests,” he said.

Malaria cases have consistently declined from two million in 2001 to 0.88 million in 2013, although an increase to 1.13 million cases occurred in 2014 due to focal outbreaks, a data released by the National Framework For Malaria Elimination in India said.

The malaria burden in India has reduced significantly, thanks to the introduction of new interventions for case management and vector control, namely Rapid Diagnostic Tests (RDT), Arteminisinin based combination therapy (ACT), Long Lasting Insecticidal Nets (LLINs) and effective Monitoring and Evaluation, Dhariwal added.

Within a year of agreeing to the Asia Pacific Leaders Malaria Alliance (APLMA) goal of a region free of malaria by 2030, about 70 per cent of districts of India had no indigenous cases or no cases reported, he said.

“But at the same time in 807 districts we have high transmission of the disease. In these districts we have set up a target of 13 years ahead,” he said.

Talking about the problems in dealing with malaria in areas of “high risk”, the NVBDCP director said besides man power, threat of Naxalites has been a challenge for them to address people in these districts.

“These problems are mainly in tribal areas of Odisha, Jharkhand and Chhattisgarh,” he said.

“We need to have a local specific strategy for these places. We need to rope in local persons as well as local in intra-personal commentator and local preachers for areas like these,” he pointed out.