Ayushman Bharat is a centrally sponsored programme anchored in the Ministry of Health and Family Welfare (MoHFW). It is an umbrella of two major health initiatives, namely Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojna (PMJAY). Brief details of these components are as following:
Ayushman Bharat-Health & Wellness Centres (AB-HWC)
Delivery of comprehensive primary health care services through Health &Wellness Centres is a critical component of the newly announced Ayushman Bharat scheme. It places people and communities at the center of the health care delivery system, making health services responsive, accessible and equitable.
Nearly 1.5 lakh Sub-Centres and Primary Health Centres would be transformed as Health & Wellness Centres by 2022 to provide comprehensive and quality primary care close to the community while ensuring the principles of equity, affordability and universality.
Till date, 4503 HWCs have been operationalized in various states.
Key components of AB-HWC:
- Additional Human Resource – New cadre of health care professional- referred to as the Mid-Level Health Provider- who is a nurse or an Ayurvedic Practitioner trained and accredited for a set of competencies related to primary health care and public health. Mid-Level Health Provider will lead the team of MPWs and ASHAs at SHC level
- Multiskilling/ Training of existing service providers – upgrading skills to provide expanded package of services
- Efficient logistics system to ensure availability of wide range of drugs and point of care diagnostics
- Robust IT system – to create unique health id and longitudinal health record of all individuals and provision of tele-consultation services
- Provision of services related to indigenous health system and yoga etc for promotion of wellness
- Linkages with schools to train Health and Wellness Ambassadors to enable creating healthy habits in schools
The package of services envisaged at AB-HWC are:
- Care in pregnancy and child-birth.
- Neonatal and infant health care services
- Childhood and adolescent health care services
- Family planning, Contraceptive services and other Reproductive Health Care services
- Management of Communicable diseases including National Health Programmes
- Management of common communicable diseases and outpatient care for acute simple illness and minor ailments.
- Screening, Prevention, Control and Management of non-communicable diseases.
- Care for Common Ophthalmic and ENT problems
- Basic Oral health care
- Elderly and palliative health care services
- Emergency Medical Services
- Screening and Basic management of Mental health ailments
Key benefits for community under AB-HWC:
- Expanded package of primary care services –ranging from maternal and child health, communicable diseases to non-communicable diseases (universal screening, prevention, control and management of five common communicable diseases: hypertension, diabetes and three common cancers – those of the oral cavity, breast and cervix, primary health care for diseases for the eye, oral health, ENT, mental health, provision of palliative care and care for the elderly, and medical emergencies)
- Wide range of free drugs
- Point of care diagnostics at the centres.
- Tele-consultation services with Medical Officers for complications
- Continuum of care ensured through referral linkages and protocols
- Unique health id – longitudinal health record for each individual
- Services related to indigenous health system and yoga for promotion of wellness.
Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) aims to cover over 10 crore poor and vulnerable families (approx. 50 crore beneficiaries) providing coverage up to Rs. 5 lakh per family per year for secondary and tertiary hospitalization.
PMJAY has been launched on September 23, 2018. After the launch of PMJAY, RSBY and SCHIS got subsumed in it.
- PMJAY is an entitlement based scheme. This scheme covers poor and vulnerable families based on deprivation and occupational criteria as per SECC (Socio-economic caste census) data.
- As on 30.12.2018:
- Number of Hospitals Empanelled: 16,112
- Beneficiaries Admitted: 6,81,825
- E-cards Issued: 39,48,496
- PMJAY provides cashless and paperless access to services for the beneficiary at the point of service in any (both public and private) empanelled hospitals across India. All beneficiary families of RSBY and SCHIS are entitled for benefits under PMJAY.
- Under PMAJY, the States are free to choose the modalities for implementation. They can implement the scheme through insurance company or directly through the Trust/ Society or mixed model.
- There is no restriction on family size, ensuring all members of designated families specifically girl child and senior citizens get coverage.
- At National level, National Health Agency (NHA) in the form of Society has been registered under the Societies Registration Act, 1860, to implement the scheme. NHA is responsible for all operational matter of PMJAY. NHA is functioning w.e.f. 11.05.2018.
- MoU has been signed between National Health Agency, Government of India and 31 States/UTs namely, Uttar Pradesh, Andaman & Nicobar Island, Lakshadweep, Dadra & Nagar Haveli, Daman & Diu, Chhattisgarh, Mizoram, Jharkhand, Bihar, Puducherry, Madhya Pradesh, Assam, Haryana, Uttarakhand, Jammu & Kashmir, Manipur, Meghalaya, Gujarat, Himachal Pradesh, Chandigarh, Tripura, Nagaland, Arunachal Pradesh, Sikkim, West Bengal, Rajasthan, Goa, Maharashtra, Tamil Nadu, Karnataka and Andhra Pradesh.
- Out of these 31 States/UTs, 25 states/UTs namely Arunachal Pradesh, Tripura, Chhattisgarh, Mizoram, Manipur, Gujarat, Nagaland, Sikkim, West Bengal, Dadra & Nagar Haveli, Himachal Pradesh, Tamil Nadu, Daman & Diu, Haryana, Jharkhand, Assam, Uttar Pradesh, Chandigarh, Maharashtra, Uttarakhand, Goa, Bihar, Lakshadweep, Madhya Pradesh, Andaman & Nicobar have launched PMJAY on 23.09.2018.
- Ayushman Bharat National Health Protection Mission Council, as an Apex body has been set up to provide policy direction to the scheme.
- More than 1350 packages have been finalized by an expert committee headed by Director General, Health Services and peer reviewed by NITI Aayog.
- Operational Guidelines on various operational matters of PMJAY, Model tender documents etc are in place. Details are available on official website i.e. www.abnhpm.gov.in.
AUGMENTATION OF ASHA BENEFITS:
The Cabinet Committee on Economics Affairs had on 19th September, 2018 approved a proposal to introduce an ASHA Benefit Package w.e.f from October, 2018 (to be paid in November, 2018) with two components, namely, coverage of ASHAs and ASHA Facilitators meeting the eligibility criteria under the Pradhan Mantri Jeevan Jyoti Bima Yojana and Pradhan Mantri Suraksha Bima Yojana and an increase in the amount of routine and recurring incentives under National Health Mission for ASHAs from Rs. 1000/- per month to Rs. 2000/-per month. The total estimated cost of the Scheme is Rs 1905.46 Crore of which Central share is Rs 1224.97 Crore for two years i.e 2018-19 and 2019-20.
As part of this ASHA Benefit Package, the Union Cabinet has also approved proposal of enhancing supervisory visit charges for ASHA Facilitators from Rs. 250/-per visit to Rs. 300/- per visit for 2018-2019 to 2019- 2020 w.e.f from October 2018 (to be paid in November, 2018) on 24th October 2018. ASHA Facilitator will undertake about 20 supervisory visits per month. With this approval ASHA Facilitators would receive about Rs 6000 per month against Rs 5000 per month that is an increase of Rs 1000/- per month. The estimated additional expenditure to be incurred is Rs 74.53 crore in 2018 -19 and 2019-20 with central share of Rs.46.95 crore comprising of Rs 15.65 crore during 2018-19 (for six months) and Rs. 31.30 crore during 2019-20.
- Estimated 1063670 ASHAs and ASHA Facilitators to be covered under Pradhan Mantri
- Jeevan Jyoti Bima Yojana (PMJJBY)
- Estimated 9573032 ASHAs and ASHA Facilitators to be covered under Pradhan Mantri Suraksha Bima Yojana
- Estimated 10,22,265 ASHAs will get at least minimum of Rs`2000 per month from current Rs 1000 per Month for routine and recurring activities.
- 41,405 ASHA facilitators to be benefitted with increased supervisory charges.
NATIONAL HEALTH POLICY 2017
The National Health Policy of the country was launched after a gap of 15 years. The Cabinet in its meeting held on 15th March, 2017 approved the National Health Policy (NHP) 2017. NHP 2017 addresses the current and emerging challenges necessitated by the changing socio-economic, technological and epidemiological landscape. The process of formulation of the new Policy entailed wide consultation with multiple stakeholders and regional consultations before its approval by the Central Council of Health and Family Welfare and Group of Ministers.
The major commitment of the NHP 2017 is raising public health expenditure progressively to 2.5% of the GDP by 2025. It envisages providing larger package of assured comprehensive primary healthcare through the Health and Wellness Centres. The Policy aims to attain the highest possible level of health and well-being for all at all ages through a preventive and promotive healthcare and universal access to quality health services without anyone having to face financial hardship as a consequence. This would be achieved through increasing access, improving quality and lowering the cost of healthcare delivery. NHP 2017 advocates allocating major proportion (two-thirds or more) of resources to primary care and aims to ensure availability of two beds per 1,000 population distributed in a manner to enable access within golden hour. The Policy also takes a fresh look at strategic purchase from the private sector and leveraging their strengths to achieve national health goals and seeks stronger partnership with the private sector.
Besides this, the highlights of the Policy are as following:
- Assurance based approach – The Policy advocates progressively incremental assurance-based approach with focus on preventive and promotive healthcare
- Health Card linked to health facilities- The Policy recommends linking the health card to primary care facility for a defined package of services anywhere in the country.
- Patient Centric Approach- The Policy recommends the setting up of a separate, empowered medical tribunal for speedy resolution to address disputes /complaints regarding standards of care, prices of services, negligence and unfair practices, standard regulatory framework for laboratories and imaging centers, specialized emerging services, etc
- Micronutrient Deficiency- There is a focus on reducing micronutrient malnourishment and systematic approach to address heterogeneity in micronutrient adequacy across regions.
- Quality of Care- Public hospitals and facilities would undergo periodic measurements and certification of level of quality. Focus on Standard Regulatory Framework to eliminate risks of inappropriate care by maintaining adequate standards of diagnosis and treatment.
- Make-in-India Initiative- The Policy advocates the need to incentivize local manufacturing to provide customized indigenous products for Indian population in the long run.
- Application of Digital Health- The Policy advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system and aims at an integrated health information system which serves the needs of all stake-holders and improves efficiency, transparency, and citizen experience.
- Private sector engagement for strategic purchase for critical gap filling and for achievement of health goals.
NHP 2017 has been duly supported by the Government through provision of Rs. 47352.51 crores to MoHFW under the Union Budget 2017-18. The amount is a 27.7% increase in allocation over previous year’s allocation. Further, in 2018-19 as well, increase of 11.5% in the outlay of health over 2017-18 with allocation of Rs.52,800 crore. Also, Rs. 24,908.62 crore provided for NHM in 2018-19, Rs. 2967.91 crore more than last year.
ALLIED AND HEALTHCARE PROFESSIONS BILL, 2018
The Union Cabinet approved the Allied and Healthcare Professions Bill, 2018 on 22nd November 2018 for regulation and standardisation of education and services by allied and healthcare professionals. The Bill provides for setting up of an Allied and Healthcare Council of India and corresponding State Allied and Healthcare Councils which will play the role of a standard-setter and facilitator for professions of Allied and Healthcare.
- Establishment of a Central and corresponding State Allied and Healthcare Councils; 15 major professional categories including 53 professions in Allied and Healthcare streams.
- The Bill provides for Structure, Constitution, Composition and Functions of the Central Council and State Councils, e.g. Framing policies and standards, Regulation of professional conduct, Creation and maintenance of live Registers, provisions for common entry and exit examinations, etc.
- The Central Council will comprise 47 members, of which 14 members shall be ex-officio representing diverse and related roles and functions and remaining 33 shall be non-ex-officio members who mainly represent the 15 professional categories.
- The State Councils are also envisioned to mirror the Central Council, comprising 7 ex-officio and 21 non-ex officio members and Chairperson to be elected from amongst the non-ex officio members.
- Professional Advisory Bodies under Central and State Councils will examine issues independently and provide recommendations relating to specific recognised categories.
- The Bill will also have an overriding effect on any other existing law for any of the covered professions.
- The State Council will undertake recognition of allied and healthcare institutions.
- Offences and Penalties clause have been included in the Bill to check malpractices.
- The Bill also empowers the Central and State Governments to make rules.
- Central Govt. also has the power to issue directions to the Council, to make regulations and to add or amend the schedule.
- Bring all existing allied and healthcare professionals on board during the first few of years from the date of establishment of the Council.
- Opportunity to create qualified, highly skilled and competent jobs in healthcare by enabling professionalism of the allied and healthcare workforce.
- High quality, multi-disciplinary care in line with the vision of Ayushman Bharat, moving away from a ‘doctor led’ model to a ‘care accessible and team based’ model.
- Opportunity to cater to the global demand (shortage) of healthcare workforce which is projected to be about 15 million by the year 2030, as per the WHO Global Workforce, 2030 report.
NOTIFICATION FOR MEDICAL DEVICES RULES, 2017
MoHFW has notified Medical Devices Rules, 2017 for comprehensive regulation of Medical devices notified under the Drugs and Cosmetics Act, including their import, clinical investigation, manufacture, sale and distribution. The new rules are harmonised with the international regulatory practices and provide comprehensive legislation for the regulation of Medical Devices to foster India specific innovation and provide a fillip to ‘Make in India’. A separate and dedicated wing is set up under Drug Controller General of India for effective implementation of New Medical Devices Rules, 2017 with effect from 1.1.2018. Presently 15 notified categories of medical devices are regulated under the provisions of Drugs and Cosmetics Act, 1940 and Rules 1945.
FIXED DOSE COMBINATIONS (FDCs) REGULATION
MoHFW has prohibited the manufacture for sale, sale or distribution for human use, of select Fixed Dose Combinations (FDCs) with immediate effect from 12th September, 2018. It has also restricted the manufacture, sale or distribution of select FDCs subject to certain conditions. MoHFW, in exercise of powers conferred by section 26A of the Drugs and Cosmetics Act, 1940, has prohibited the manufacture for sale, sale or distribution for human use of 328 FDCs through its gazette notifications dated 7th September 2018; it has also restricted the manufacture, sale or distribution of six FDCs subject to certain conditions.
NATIONAL MEDICAL COMMISSION BILL, 2017
- Cabinet approved the National Medical Commission Bill 2017 on 15th December, 2017
- The Bill envisages to:
- replace the Medical Council 1956 Act.
- enable a forward movement in the area of medical education reform.
- move towards outcome-based regulation of medical education rather than process-oriented regulation.
- ensure proper separation of functions within the regulator by having autonomous boards.
- create accountable & transparent procedures for maintaining standards in Medical Education.
- create a forward-looking approach towards ensuring sufficient health workforce in India.
- Expected benefits of the new legislation:
- End of heavy handed regulatory control over medical education institutions and a shift towards outcome based monitoring.
- Introduction of a national licentiate examination. This will be the first time such a provision is being introduced in any field of higher education in the country, as was the introduction of NEET and common counseling earlier.
- Opening up the medical education sector will lead to significant addition in the number of UG and PG seats and substantial new investment in this infrastructure sector.
- Better coordination with AYUSH systems of treatment.
- Regulation of up to 40% seats in medical colleges to enable all meritorious students to have access to medical seats irrespective of their financial status.
NATIONAL NUTRITION MISSION (NNM)
- The Cabinet has recently approved the National Nutrition Mission, a joint effort of MoHFW and the Ministry of Women and Child development (WCD) towards a life cycle approach for interrupting the intergenerational cycle of under nutrition.
- The impact of the mission is envisioned to reduce the level of stunting, under-nutrition, anemia and low birth weight babies. It will create synergy, ensure better monitoring, issue alerts for timely action, and encourage States/UTs to perform, guide and supervise the line Ministries and States/UTs to achieve the targeted goals.
- The mission aims to benefit more than 10 crore people.
- It shall be launched in December 2017 with a three year budget of Rs.9046.17 crore commencing from 2017-18, to cover 315 districts in 2017-18, 235 districts in 2018-19 and remaining districts in 2019-20.
- Major components/features of the Mission:
- Mapping of various Schemes contributing towards addressing malnutrition
- Introducing a very robust convergence mechanism
- ICT-based real time monitoring system
- Incentivizing States/UTs for meeting the targets
- Incentivizing Anganwadi Workers (AWWs) for using IT based tools
- Eliminating registers used by AWWs
- Introducing measurement of height of children at the Anganwadi Centres (AWCs)
- Social Audits
- Setting-up Nutrition Resource Centres, involving masses through Jan Andolan for their participation on nutrition through various activities, among others.
MENTAL HEALTHCARE ACT, 2017
- The Act adopts a rights-based statutory framework for mental health in India and strengthens equality and equity in provision of mental healthcare services in order to protect the rights of people with mental health problem to ensure that they are able to receive optimum care and are able to live a life of dignity and respect.
- The Act strengthens the institutional mechanisms for improving access quality and appropriate mental healthcare services.
- The Act increases accountability of both government and private sectors in delivery of mental healthcare with representation of persons with mental health problem and their care-givers in statutory authorities such as Central and State Mental Health Authority.
- The most progressive features of the Act are provision of advance directive, nominated representative, special clause for women and children related to admission, treatment, sanitation and personal hygiene; restriction on 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.
HIV & AIDS (Prevention & Control) Act, 2017
- It aims to end the epidemic by 2030 in accordance with the Sustainable Development Goals set by the United Nations.
- A person living with AIDS cannot be treated unfairly at employment, educational establishments, renting a property, standing for public or private office or providing healthcare and insurance services
- The Act also aims to enhance access to healthcare services by ensuring informed consent and confidentiality for HIV-related testing, treatment and clinical research.
- Every HIV infected or affected person below the age of 18 years has the right to reside in a shared household and enjoy the facilities of the household.
- The Act prohibits any individual from publishing information or advocating feelings of hatred against HIV positive persons and those living with them.
- No person shall be compelled to disclose his/her HIV status except with their informed consent, and if required by a court order.
- Every person in the care and custody of the State shall have right to HIV prevention, testing, treatment and counselling services.
- The Act suggests that cases relating to HIV positive persons shall be disposed’ off by the court on a priority basis and duly ensuring the confidentiality.
Universal Immunization Programme (UIP)
India’s UIP is one of the largest public health programmes in the world. It targets 3 crore pregnant women and 2.7 crore new borns annually. More than 90 lakh immunization sessions are conducted annually. It is the most cost-effective public health intervention and largely responsible for reduction of vaccine preventable under-5 mortality rate.
New initiatives under UIP:
- Mission Indradhanush: Government of India has launched Mission Indradhanush (MI) in December 2014, a targeted programme to immunize children who have either not received vaccines or are partially vaccinated. The activity focuses on districts with maximum number of missed children. Four phases of Mission Indradhanush have been completed wherein 3.38 crores children have been vaccinated, of which 81.67 lakh children have been fully immunized. In addition, 86.88 lakh pregnant women were vaccinated against tetanus. Under Mission Indradhanush, the annual rate of increase of full immunisation coverage has increased from 1% to 6.7 % during the two rounds.
The sixth phase of MI is ongoing in 75 districts across 17 States/UTs from October – December 2018.
- Intensified Mission Indradhanush (IMI) has been launched by Hon’ble Prime Minister of India on 8th October 2017 from Vadnagar, Gujarat. The Intensified Mission Indradhanush has been carried out in 121 districts in 16 States, 52 districts in the North Eastern States and 17 urban areas where immunization coverage has been very low in spite of repeated phases of Mission Indradhanush and in UIP, with an aim to rapidly build up full immunization coverage to more than 90% by December 2018.
Introduction of new vaccines
- Inactivated Polio Vaccine (IPV): India is polio free but to maintain this status, the Inactivated Polio Vaccine (IPV) was introduced. Till August 2018, around 6.4 crore doses of IPV have been administered to children since its introduction.
- Adult Japanese Encephalitis (JE) Vaccine: Japanese Encephalitis is a life-threatening viral disease affecting brain mainly in children aged less than 15 years. However, National Vector Borne Disease Control Programme (NVBDCP) had identified 31 high burden districts from Assam, Uttar Pradesh and West Bengal for adult JE vaccination in the age-group of 15-65 years. The Adult JE vaccination campaign has been completed in all 31 districts of Assam, UP, West Bengal, wherein more than 3.29 crore beneficiaries aged 15-65 years were vaccinated.
- Rotavirus Vaccine: Rotavirus is one of the leading causes of severe diarrhoea and death among young children. At present, Rotavirus vaccine has been introduced in 9 States – Andhra Pradesh, Haryana, Himachal Pradesh, Odisha, Madhya Pradesh, Assam, Rajasthan, Tamil Nadu and Tripura. Approximately 2.6 crore doses of Rotavirus vaccine have been administered to children since its introduction till September 2018.
- Measles-Rubella (MR) Vaccine: Rubella vaccine has been introduced in UIP as Measles-Rubella vaccine to provide protection against congenital birth defects caused by Rubella infection. The campaign has been completed in 20 states/UTs (namely, Andaman & Nicobar Islands, Andhra Pradesh, Arunachal Pradesh, Chandigarh, Dadra & Nagar Haveli, Daman & Diu, Goa, Haryana, Himachal Pradesh, Karnataka, Kerala, Lakshadweep, Odisha, Puducherry, Tamil Nadu, Telangana, Uttarakhand, Mizoram, Manipur, Punjab) and ongoing in 8 states/UTs (namely, Assam, Chhattisgarh, Gujarat, J&K, Jharkhand, Meghalaya, Nagaland, Tripura). A total of 13.04 crore children vaccinated till 29th October 2018.
- Pneumococcal Vaccine (PCV): PCV was launched in a phased manner in UIP in May’17 for reducing infant mortality and morbidity caused by pneumococcal pneumonia. It has been launched on 13th May, 2017. PCV is given in entire Bihar, Himachal Pradesh, Madhya Pradesh, 12 district of Uttar Pradesh and 9 districts of Rajasthan. Till September 2018, around 59.48 lakh children have been covered under it.
NATIONAL VIRAL HEPATITIS CONTROL PROGRAM
MoHFW launched the National Viral Hepatitis Control Program on World Hepatitis Day, 2018 – 28th July. MoHFW also released the Operational Guidelines for National Viral Hepatitis Control Program, National Laboratory Guidelines for Viral Hepatitis Testing and National Guidelines for Diagnosis and Management of Viral Hepatitis. The program has been launched with the goal of ending viral hepatitis as a public health threat in the country by 2030. The aim of the initiative is to reduce morbidity and mortality due to viral hepatitis.
The key strategies include preventive and promotive interventions with focus on awareness generation, safe injection practices and socio-cultural practices, sanitation and hygiene, safe drinking water supply, infection control and immunization; co-ordination and collaboration with different Ministries and departments; increasing access to testing and management of viral hepatitis; promoting diagnosis and providing treatment support for patients of hepatitis B & C through standardized testing and management protocols with focus on treatment of hepatitis B and C; building capacities at national, state, district levels and sub-district level up to Primary Health Centres (PHC) and health and wellness centres such that the program can be scaled up till the lowest level of the healthcare facility in a phased manner.
LABOUR ROOM QUALITY IMPROVEMENT INITIATIVE – LaQshya
- MoHFW launched LaQshya to improve the quality of care that is being provided to the pregnant mother in the Labour Room and Maternity Operation Theatres, thereby preventing the undesirable adverse outcomes associated with childbirth.
- The goal is to reduce preventable maternal and new-born mortality, morbidity and stillbirths associated with the care around delivery in Labour room and Maternity OT and ensure respectful maternity care.
- The initiative will be implemented in Government Medical Colleges (MCs) besides District Hospitals (DHs), and high delivery load Sub- District Hospitals (SDHs) and Community Health Centres (CHCs).
- Currently incentives are being given to facilities achieving the targets outlined:
- Rs.6 lakhs for Medical Colleges
- Rs.3 lakhs for District Hospitals
- Rs.2 lakhs for SDH/CHCs
- The initiative plans to conduct quality certification of labour rooms.
PRADHAN MANTRI SURAKSHIT MATRITVA ABHIYAN (PMSMA)
- The program aims to provide assured, comprehensive and quality antenatal care, free of cost, universally to all pregnant women on the 9th of every month.
- PMSMA has been rolled out in all States/ UTs.
- Over 1.7 crore quality antenatal checkups have been conducted at PMSMA sites for comprehensive services under the programme.
- More than 8 lakh high risk pregnancies have been identified under PMSMA.
- PMSMA is conducted at over 13100 government health facilities across all State/UTs.
- Approx 5250 volunteers are enrolled on PMSMA portal across all State/UTs.
INTENSIFIED DIARRHEA CONTROL FORTNIGHT (IDCF)
- Observed during July–August every year since 2014 with the ultimate aim of ‘zero child deaths due to childhood diarrhea’.
- IDCF is being implemented as a campaign for control of deaths due to diarrhoea across all States & UTs.
- Main activities include intensification of advocacy activities, awareness generation activities, diarrhoea management service provision, establishing ORS-zinc demonstration sites, ORS distribution by ASHA through home visitation, detection of undernourished children and their treatment, promotion of Infant and Young Child Feeding (IYCF) activities by home visits by ASHA and establishing IYCF corners.
- Nearly 28 crore under-5 children have been reached since 2014 by ASHA with Prophylactic ORS.
RASHTRIYA BAL SWASTHYA KARYAKRAM (RBSK)
- Launched in February 2013 for child screening and free treatment for 4 Ds i.e. Defects at birth, Diseases, Deficiencies and Development delays including disability.
- Provisions free management of 30 selected health conditions.
- As on date:
- 11020 teams in 36 State/UTs are in place.
- 92 District Early Intervention Centres (DEICs) are functional.
- Nearly 82.5 crore children were screened and 1.96 crore children availed services for treatment since inception.
NATIONAL DEWORMING DAY (NDD)
- To combat STH infections, the Health Ministry has adopted a single day strategy called NDD, wherein single dose of albendazole is administered to children from 1-19 years of age group through the platform of schools and anganwadi centres.
- Till February 2018, 26.68 crore children have been administered albendazole. Further, more than 114 crore doses of Albendazole were administered to children 1-19 years, since 2015.
RASHTRIYA KISHOR SWASTHYA KARYAKRAM (RKSK)
- Started in 2014 as a comprehensive programme focusing on Sexual Reproductive Health, Nutrition, Injuries and violence (including gender based violence), Non-Communicable Diseases, Mental Health and Substance Misuse with a promotive and preventive approach.
- The interventions are carried out using health facilities, community and schools as platforms:
- Adolescent Friendly Health Clinics (AFHCs): These act as the first level of contact of primary health care services with adolescents. Till Sept’18 7459 AFHCs have been established across the country and around 30.93 lakh adolescent clients availed the services of AFHCs during Apr ’18 to Sept ’18 . Total 1681 Adolescent Health Counselors are in place to provide counseling services. Linkages have also been established with Integrated Counselling and Testing Centres (ICTC) for management of HIV/AIDS and treatment of RTI/STI cases.
- Weekly Iron Folic Acid Supplementation (WIFS) Programme: It entails provision of weekly supervised IFA tablets to in-school boys and girls and out-of-school girls and biannual albendazole tablets, besides Nutrition & Health Education. The programme aims to cover a total of 11.9 crore beneficiaries including 9.4 crore in-school and 2.5 crore out-of-school beneficiaries. Around 4 crore beneficiaries (3.38 crores in school adolescents and 63 lakhs out of school adolescent girls) were covered under WIFS every month during Apr ’18 to June ’18.
- Menstrual Hygiene Scheme: The scheme is being implemented for adolescent girls in the rural areas. From 2014 procurement of sanitary napkins has been decentralized. In FY 2018-19 Rs. 4254 Lakhs have been allocated through NHM to 15 States/UTs for decentralised procurement of sanitary napkins through the process of competitive bidding. States are in the process of implementing MHS.
- Peer Education Programme: Under the programme four peer educators (Saathiya) – two male and two female are selected per 1000 population to orient the adolescents on health issues. The Peer Education programme is being implemented in 214 districts and till date 2.19 lakh PEs have been selected and training of ANMs and Peer Educators is under process.
MISSION PARIVAR VIKAS (MPV)
- Launched in 146 districts of 7 States for substantially increasing the access to contraceptives and family planning services in districts with TFR of 3 and above.
- MPV encompasses the following gamut of activities
- Roll out of Injectable Contraceptives
- Sterilization Compensation Scheme
- Condom Boxes in public health facilities
- MPV Campaigns and Saarthi (IEC vehicle)
- Nayi Pehl Kits to the newly married couples
- Saas Bahu Sammellan
FAMILY PLANNING – LOGISTICS MANAGEMENT INFORMATION SYSTEM (FP-LMIS)
- Launched to strengthen the supply-chain management system.
- The National training of trainers (ToT) has been completed.
- State level trainings have been completed in 28 states and 17 States/ UTs have also initiated the district level trainings.
PRADHAN MANTRI NATIONAL DIALYSIS PROGRAMME
- ‘National Dialysis Programme’ to be supported in all district hospitals in a PPP mode under NHM; the program has been implemented with states support in 445 districts across 28 states/UTs. Under NHM support is provided to States/UTs for provision of free dialysis services to the poor.
- So far, 647 operational dialysis units/centers and 3953 Dialysis Machines have been made operational and nearly 35 lakh dialysis sessions have been conducted.
FREE DRUGS & DIAGNOSTICS SERVICES INITIATIVE
- MOHFW has provided an indicative list of drugs & diagnostics investigations to be provided at each level of health care facility. However, the state may provision for additional number of drugs & diagnostic services.
- In PHCs, 285 medicines and 19 types of test available.
- In CHCs, 455 medicines and 39 types of test available.
- In District Hospitals, 544 medicines and 56 types of test available.
- Since 2015, more than Rs. 16631 crore has been accorded to the States/UTs.
BIOMEDICAL EQUIPMENT MANAGEMENT & MAINTENANCE PROGRAM
- MoHFW organized consultations with officials from states to devise appropriate mechanisms to ensure that medical equipment already purchased are used and properly maintained. An extensive exercise was undertaken to map the inventory of all Bio-medical equipment including their functionality status.
- The mapping has been completed in 29 States. 7,60,849 number of equipment in 29,115 health facilities costing approximately Rs 4646.37 Crore were identified. Equipment in range of 13% to 34% was found dysfunctional across states.
- BMMP has been implemented in total 26 States
- 20 States in PPP mode in the state of Andhra Pradesh, Arunachal Pradesh, Assam, Chhattisgarh, Jharkhand, Kerala, Madhaya Pradesh, Maharashtra, Meghalaya, Mizoram, Nagaland, Puducherry, Punjab, Sikkim, Telangana, Tripura, Rajasthan, Uttar Pradesh,West Bengal, Jammu & Kashmir.
- In house mode of 6 States – Gujarat, D&N Haveli, Daman & Diu, Delhi, Lakshadweep, Tamil Nadu.
- The tender to outsourcing is in progress in 6 States- Goa, Haryana, Karnataka, Uttarakhand, Odisha and Manipur.
SWACHHTA HI SEWA
Encouraged by the achievements of Kayakalp Scheme, National Accreditation Board for Hospitals & Healthcare Providers (NABH) has decided to consider assessment of healthcare facilities in the private sector on the lines of parameters of Kayakalp Scheme. The Health Ministry will recognise the outstanding work done by the private hospitals on an annual basis. This is an initiative as part of the Swachchta Hi Sewa cleanliness and sanitation campaign being undertaken across various parts of the country.
The initiative has resulted in bringing significant improvement in the sanitation and hygiene, patient satisfaction, behavioural change in the staff & employees of the Hospitals/Institutions, patients and their attendants towards cleanliness. Public perception towards cleanliness & hygiene in public healthcare facilities has also been changing.
NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER, DIABETES, CARDIOVASCULAR DISEASES AND STROKE (NPCDCS)
- In order to prevent and control major Non-Communicable Diseases, Government of India 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.
- Progress so far:
- 36 State NCD cells established
- 515 District NCD cells established
- 548 District NCD Clinics and 2591 NCD Clinics at CHC set up
- 167 Cardiac Care Units (CCU), 152 District Day Care Centers set up
- More than 3.32 crore persons screened at NCD Clinics upto September 2018 in 2018-2019
- Strengthening of Tertiary Care for Cancer
- 35 State Cancer Institutes/Tertiary Care Cancer Centers approved to mentor all Cancer-related activities in their respective areas.
- National Cancer Institute being set up at Jhajjar in Haryana.
- The second Campus of Chhitaranjan National Cancer Institute being set up in Kolkata
POPULATION-BASED PREVENTION, CONTROL, SCREENING & MANAGEMENT FOR DIABETES, HYPERTENSION AND COMMON CANCER (ORAL, BREAST and CERVICAL)
- Recently launched population-based initiative for Diabetes, Hypertension and Common Cancers is an important move. Services of ASHAs will be used for risk profiling and front-line health workers and primary & secondary health care infrastructure will be leveraged for screening and service delivery. This activity will generate awareness on risk factors of NCDs as well.
- Operational Guidelines for Screening and Management of NCDs as part of Comprehensive Primary Care under NHM has already been developed and circulated. Training of Trainers for Medical Officers, Staff nurse, ANMs and ASHAs have been completed and 70853 ASHAs, 20532 ANM/MPWs, 3160 staff nurses and 4111 medical officers have already been trained.
- As on 1st October 2018, screening has been initiated in about 215 districts 12 states and 2 UTs and 96,60,870 people have been screened.
- A software & tablet application has been developed and being deployed. This application will capture all processes and will help in efficient program management, quality service delivery, treatment adherence and awareness generation.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND CHRONIC
KIDNEY DISEASE (CKD)
- In order to prevent and manage the COPD and CKD, also major causes of death due to NCDs, their intervention has been included under NPCDCS.
- Till date, CKD intervention as part of NPCDCS has been implemented in 40 districts and COPD intervention in 121 districts
NATIONAL MULTISECTORAL ACTION PLAN
National Multisectoral Action Plan to prevent and control NCDs has been developed with consultation with a range of stakeholders including 39 departments of Union Government. The plan and process of its development has led to scaling up of a number of interventions, having direct impact on NCDs, but outside the health sector. India’s multisectoral efforts in prevention and control of NCDs have been recognized by United Nations.
AMRIT (AFFORDABLE MEDICINE AND RELIABLE IMPLANTS FOR TREATMENT)
- 146 pharmacies have been set up across 23 states for providing medicines for Diabetes, CVDs, Cancer and other disease at discounted prices to the patients.
- A total of more than 5200 drugs and other consumables are being sold at upto 50% discounts.
- As on 30th November 2018, 104.75 Lakh patients have benefitted from AMRIT Pharmacies.
- The value of drugs dispensed at MRP is Rs. 986.67 Crores and there is a savings of Rs. 526.26 Crore thereby reducing their out of pocket expenditure.
REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME
The Government of India (GoI) launched the National TB Programme in 1962 to address TB in India. The Revised National TB Control Programme (RNTCP), based on the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy, was launched in 1997 expanded across the country by 2006. In 2007, GoI introduced the Programmatic Management of Drug Resistant TB (PMDT) to combat drug resistance and achieved full geographical coverage by 2013.
The Ministry has developed the National Strategic Plan (NSP) for Tuberculosis (2017-25) which builds on the success and learning of the last NSP and encapsulates the bold and innovative steps required to achieve sustainable development goal on TB in India by 2025, five years ahead of the global timelines.
Achievements of RNTCP:
- More than 2 Crore patients on treatment & saved more than 35 lakh lives in India.
- Treatment success rates have tripled from 25% in pre-RNTCP era to 88% presently (TB India 2018) & TB death rates have reduced from 29% to 4%.
- Currently TB incidence is declining by about 3.3% per year
- 18.62 lakh TB patients notified, of which 4.4 lakh were form private sector from January to 30th November 2018.
- Implemented with through more than 16,574 Designated microscopy Centers & treatment available in every village through 4 lakh DOT centers.
- Standards for TB Care in India (STCI) developed.
- In May 2012, TB made a notifiable disease & developed NIKSHAY – a case based web based system of reporting and monitoring TB patients.
- More than 12 lakh TB patients reported from private health care providers.
- Country achieved MDGs related to Tuberculosis in 2016.
- Incidence of TB declined by 28% & mortality declined by 58% since 1990.
- Since 2007: Collaborative efforts being implemented by RNTCP & NACP to take care of patients suffering from both TB & HIV.
- Single Window for Delivery of Care for HIV and TB at all ART Centres has been started. The services for HIV-TB have been expanded with use of CBNAAT for diagnosis of TB, daily FDC treatment, information communication technology (ICT) based adherence support, INH Preventive Therapy and Air Borne Infection Control measures are taken care at all ART centres.
- Shift over to daily regimen from intermittent regimen for treatment of TB.
- Entire country is covered by daily regimen since 30th October 2017.
- Till date > 10 Lakhs patients initiated on daily regimen across the country.
- Access of drug for the private sector patients.
Drug Resistant TB Services
- It is estimated that there are 1.35 lakh drug resistant TB patients in India.
- 41,250 drug resistant TB patients have been diagnosed from January to September 2018.
- Bedaquiline is a new anti-TB drug, discovered after 40 years.
- 428 District level Drug-Resistant TB Centres including 148 specialized DR-TB Centres, have been established.
- Delamanid containing regimes introduced from 22 centre in 7 states
- Shorter drug regimen and Bedaquiline rolled out in all States. During Jan – November 2018, 12529 MDR/RR-TB patients have been initiated on shorter regimen and 1964 MDR/RR-TB patients have been initiated on newer drug containing regimen (Bedaquiline or Delamanid) throughout the country.
- Expansion of rapid molecular diagnosis
- Total 1180 CBNAAT machines are operational as on date.
- During Jan – Sept 2018. 17.09 lakh CBNAAT test have been performed in 2018 as compared to 7.48 lakh during the same period in 2017.
- CBNAAT utilization has increased from 118 tests per lab per month in 1st Quarter 2017 to 185 tests per lab per month in 1st Quarter 2018.
- TrueNat – an indigenous rapid molecular diagnostics have been tested for feasibility at 100 sites. This will be expanded for diagnosis of TB and DR-TB in phased manner.
- Universal Drug Susceptibility Testing (UDST)
- Universal DST is being implemented across the country since 1st January 2018.
- Campaign mode – Active Case Finding through systematic active TB screening among clinically & socially vulnerable population.
- During Jan – November 2018, 6.5 crore population has been screened and 17,223 cases have been diagnosed.
- 23 States in 337 Districts have conducted ACF in 2018.
- Private Sector Engagement
- MoU has been signed on 10th May 2018 with Indian Medical Association (IMA) for wide dissemination of services for TB patients through RNTCP. Under this MoU, private providers will be sensitized in 1000 out of 1700 IMA branches. On a campaign mode a registration drive for enrolling private practitioners in Nikshay will be carried out in collaboration with IMA.
- Using Global Fund Grant, public private support agency interventions have been initiated through JEET (Joint Effort for Elimination of TB) Consortium in 45 large cities and 348 districts where in, intensified efforts for notification from private sector use of rapid molecular tests and Govt. provided drugs is accelerated.
- NIKSHAY Poshan Yojana for providing financial assistance for nutrition support at rate of Rs. 500/- per month has been initiated since April 2018.
- Since 1st April to November 2018, Rs. 49.37 Crore have been processed for 4.69 lakh beneficiaries through DBT for NPY.
- E-Health advances – programme management and surveillance.
- Programme is enhancing its ICT based surveillance tool NIKSHAY.
- IT enabled adherence monitoring tool 99 DOTS have been used for all HIV-TB patients across the country. It has been expanded for all TB patients
- NIKSHAY Aushadhi – drugs distribution management system has been implemented across the country – 24,846 stores are reporting through NIKSHAY Aushadhi (All State, District and Block level drug stores and 50% of PHC level stores are reporting drug inventory through NIKSHAY Aushadhi)
- 20,000 tablets have been provided for accelerating NIKSHAY uptake and NIKSHAY Aushadhi implementation
- Call Centre with capacity of 90 seats has been established to cater to Maharashtra and Uttar Pradesh and expanded to other states gradually.
- Echo – Technical capacity building sessions being conducted with all 148 nodal DR-TB centres
- Community Engagement and Multi-stakeholder efforts
- For patient centric and community led response to TB, National TB Forum has been established to engage community. Similarly, State and District level forums are being established. Network of TB Champion will be created from existing network of 4 lakh treatment supporters and past TB patients and people affected due to TB.
- RNTCP has been included as a member of Joint Working Group of NACO and Ministry of Labour & Employment and the Department has been working with the Ministry of Labour and Employment on workplace policy on TB.
- RNTCP has engaged with Department of Post to provide sample transport services across the country
- Research & Development – collaboration with ICMR, TB Research consortium has been established by various research departments – ICMR, DBT, DST, and others.
- Inter-ministerial meeting for involvement in TB response was held on 16th August, 2018 which was attended by over 25 ministries. Individual ministries are being followed up.
- Pilot project with Department of Posts has been initiated on 19th September 2018 for utilizing postal services for sputum sample transportation.
Advocacy Communication and Social Mobilization (ACSM) is one of the most important components of the Revised National Tuberculosis Control Programme (RNTCP) to make the people aware on various aspects of the TB disease.
- 2 months campaign in 15 DD and 91 National / Regional Channels.
- 1-month campaign in 25 AIR Channels and 242 private FM Channels.
- Digital media campaign in 3023 theatres with one spot / show / day.
- Media campaign during ASIA Cup cricket series & India –West Indies Cricket Series on DD Sports which availed 3 Crore viewership.
- 1 month campaign at 7 states (302 locations) Bus Terminals PAN India.
- Participation in Perfect Health Mela and Partners Forum Meet 2018.
- More than 750 tweets have been posted through twitter handle (Sept 2017 – Nov 2018).
- Allied & Healthcare Professionals’ Database Portal. More than 3000 professionals have already registered on the portal during the testing phase. The website portal is a2hp.mohfw.gov.in.The portal has a capacity of capturing more than 10 lakhs Allied and Healthcare Professionals’ data. It will help the Government to track the number of professionals and streams of allied and healthcare professions in the country. It may further prove helpful in expediting the envisaged processes viz. licensing of professionals, workforce policy planning and bringing transparency in the system by maintaining standards of educational and clinical practice etc.
- Budget Dashboard on Budget, Expenditure and Bill Payment position of MoHFW. The Budget Dashboard also incorporates Ministry of AYUSH and Department of Health Research. Budget and expenditure is available in a snapshot and also drilled down details in various categories, such as flagship schemes, Central sector expenditure, North East, SC/ST, Centrally Sponsored Schemes, etc. Various related presentations, Demand for Grants and all relevant budget circulars are also available on the dashboard. The dashboard has the unique feature of Bill Position for All India Pay & Accounts Offices (PAOs) of this Ministry and also reason for return of bills. It is another step towards transparency.
- Soft-launch of the Integrated Disease Surveillance Programme (IDSP) segment of Integrated Health Information Platform (IHIP) in seven states. The path-breaking initiative will provide near-real-time data to policy makers for detecting outbreaks, reducing the morbidity and mortality and lessening disease burden in the populations and better health systems. The first one-of-its-kind initiative by the GoI, IHIP uses the latest technologies and digital health initiatives. The State Secretaries have been urged to be earnest in adopting this platform to strengthen early outbreak detection and informed public health response. Further, for effective implementation of the platform, 32,000 people at the block level, 13,000 at the district level and 900 at the state level have been trained. The IHIP vision and a ready-reckoner have also been launched to navigate the platform.
- National Health Portal (NHP) is functioning as citizen portal for healthcare providing health related information to citizens and stakeholders in different languages (currently six languages). A voice portal, providing information through a toll-free number 1800-180-1104 and Mobile App has also been launched. It serves as a single point access for information on Health and Diseases including health messages; on Regulations, Standards, Policies, Programs, Commissions etc.; Directory Services – Hospitals, Blood Banks, Ambulances.
- Hospital Information System (HIS) is being implemented in hospitals for automation of hospital processes to achieve better efficiency and service delivery in Public Health facilities upto CHC level.
- A case based web based reporting system called NIKSHAY is established and this has been scaled-up nationwide to capture all TB cases in the public health system.
- For adherence monitoring 99DOTS has been implemented wherein the patient just has to give a missed call to a toll free number and the system captures the adherence information.
- E-CGHS card enables self-printing of CGHS cards from any location.
- SUGAM by Central Drugs Standards Control Organisation (CDSCO) enables online submission of applications, their tracking, processing & grant of approvals online mainly for drugs, clinical trials, ethics committee, medical devices, vaccines and cosmetics. Provides a single window for multiple stakeholders (Pharma Industry, Regulators, Citizens) involved in the processes of CDSCO.
- Drugs and Vaccines Distribution Management System (DVDMS) (‘eAushidhi’) deals with purchase, inventory management and distribution of various drugs, sutures and surgical items to various District Drug Warehouses of State / UT, District Hospitals (DH), their sub stores at CHC, PHC etc by automating the workflow of procurement, supply chain, quality control and finance department in State / UT level.
- eRakt Kosh is being rolled out for all the licensed blood banks in public and private health facilities in States / UTs. eRakt Kosh piloted in blood banks in the State of Madhya Pradesh, West Bengal and IRCS Delhi.
- Mother and Child Tracking System (MCTS)/Reproductive Child Health (RCH) application is an individual-based tracking system across all the States & UTs to facilitate timely delivery of antenatal and postnatal care services and immunization to children with an objective of improving IMR, MMR, & morbidity. A total of 15.31 crore pregnant women and 13.11 crore children aged registered on MCTS / RCH portal.
- Kilkari application has been launched to deliver free weekly audio messages about pregnancy, child birth and care. Assam, Bihar, Chhattisgarh, Delhi, Haryana, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand are presently covered under Kilkari. Approximately 16.93 crore successful calls (average duration of content played in each call: approximately 1 minute) were made under Kilkari.
- Mobile Academy is a free audio training course designed to expand and refresh the knowledge base of ASHAs and improve their communication skills. Launched in 2016, Bihar, Chhattisgarh, Delhi, Haryana, Himachal Pradesh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand are presently covered under Mobile Academy. A total of 1.52 Lakh ASHAs registered in MCTS / RCH portal have started the Mobile Academy course, out of which 1,22,194 ASHAs have completed the course till November, 2018.
- ANM on Line (ANMOL) a tablet based application for Integrated RCH Register which allows ANMs to enter and update data for beneficiaries of their jurisdiction has been piloted in the State of Andhra Pradesh and Currently 11,941 ANMs in Andhra Pradesh are using ANMOL. It is being further rolled out in Madhya Pradesh, Orissa and Telangana.
- MERA ASPATAAL
- MoHFW has designed an ICT-based Patient Satisfaction System (PSS) for implementation in public and empanelled private hospitals. The application has been named ‘मेरा अस्पताल’ (‘My Hospital’ in English). A multi-channel approach i.e. web portal, mobile application, Short Message Service (SMS) and Interactive Voice Response System (IVRS) is being used to collect patients’ feedback. The application automatically contacts the patient to collect information on patient’s experience in government hospitals.
- Under Phase I, more than 1000 hospitals have been covered and more than 14 lakh feedback received so far.
- ONLINE REGISTRATION SYSTEM (ORS) is a framework to link various hospitals for online registration, payment of fees and appointment, online diagnostic reports, enquiring availability of blood online etc. As on date, around 124 hospitals including Central hospitals like AIIMS –New Delhi & other AIIMS (Jodhpur; Bihar, Rishikesh, Bhubaneswar, Raipur, Bhopal); RML Hospital; SIC, Safdarjung Hospital; NIMHANS; Agartala Government Medical College; JIPMER etc. are on board ORS. So far around 13 lakh appointments have been transacted online.
- MOBILE APPS: Various mobile apps have been launched namely
- Indradhanush (for immunisation tracker)
- India Fights Dengue (enables a user to check Dengue Symptoms, get nearest Hospital / Blood bank information and also share feedback)
- NHP Swasth Bharat (information dissemination on Disease, Lifestyle, First Aid)
- NHP Directory Services Mobile App. (provides information related to Hospital and Blood banks across India have been hosted.
- No More Tension Mobile App. (information on stress management related aspects)
- Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) Mobile App. (for providing pregnancy care by volunteer doctors across states)
- National Medical College Network (NMCN) is being established with the purpose of e-Education and e-Healthcare delivery, wherein 50 Government Medical Colleges are being interconnected, riding over NKN (National Knowledge Network – high speed bandwidth connectivity). National Resource Centre has been established at SGPGI, Lucknow.
– National Telemedicine Network (NTN): It is envisaged to provide Telemedicine Services to the remote areas by upgrading existing Government Healthcare Facilities (MC, DH, SDH, PHC, and CHC) in States. In the current financial year 4 States/UTs (previous 7) have been provided financial assistance for providing Tele-Medicine services by establishes NTN.
– Tele-Medicine Nodes at Pilgrim places: In line with the Prime Minister vision of using space technology to deliver health services, MoHFW & Department of Space (DoS) jointly have been taking steps to set up Satellite communication based Telemedicine nodes at various unreachable geographical locations including Chardhams and other important pilgrimage centres (Amarnath, Ayappa and Kedarnath)for health awareness, screening of non-communicable disease (NCD) and for providing specialty consultation to the devotees visiting these places. So far, Telemedicine nodes have been setup at Amarnath Cave-J&K, Ayappa Temple-Kerala, Dwarkadheesh Temple-Gujarat, Kashi Vishwanath Temple-U.P and Vidhyanchal Devi Temple, UP.
– Tele-Evidence: Tele-evidence is a modality via which doctors can testify in the judicial process utilizing the video conferencing facility without visiting the courts in person. This service was launched by Hon’ble HFM on 30.12.2015 at PGIMER, Chandigarh. As per reports, till date more than 4000 Tele-Evidences have been successfully conducted. After this successful implementation MoHFW has decided to rollout the service in every State/UT.
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP)
- India is committed to malaria elimination by 2030 in response to the global call by WHO for eliminating malaria by the end of the year 2030.
- In response to the above, India drafted National Framework for malaria elimination and was launched by HFM in February, 2016 which was followed by drafting of National Strategic Plan (NSP) for malaria elimination (2017-2022). Both the above documents give clear vision as well as time bound strategies for malaria elimination by 2027.
- After the call for malaria elimination, India strengthened its interventions by providing and increasing the outreach of malaria diagnosis by using Rapid Diagnostic Kits (for both Pv&Pf), effective anti-malarials like Artemisinine combinations, provision of Long Lasting Insecticidal Nets (LLINs) – 50 million already distributed in North-eastern states and Orissa (more in pipeline for high endemic areas of Chhattisgarh, Odisha and Jharkhand).
- Decrease in total malaria cases from 805804 in 2017 to 375845 (53.36% decline) in 2018 till November.
- Decrease in Pf cases from 509229 in 2017 to 183889 (63.89% decline) in 2018 till November.
Dengue & Chikungunya
- Disease surveillance is carried out through identified Sentinel Surveillance Hospitals (SSHs) with laboratory facility networked across the country and linked with Apex Referral Laboratories (ARLs) with advanced diagnostic facility for backup support.
- Number of SSHs and ARLs increased to 646 and 16 respectively.
- Case Fatality Rate (deaths per 100 cases) for Dengue is sustained at less than 1.0% (National target) since 2008 due to training of clinicians on case management as per National guidelines.
- May 16 observed as National Dengue Day throughout country.
- Dengue cases declined by 36% and deaths by 33% compared to 2017.
- Chikungunya cases declined by 22% in 2018 compared to 2017.
Japanese Encephalitis (JE)
- Constitution of National Programme for Prevention and Control of JE/AES to reduce morbidity, mortality and disability due to JE/AES.
- A total of 139 Sentinel Surveillance Site Laboratories (SSSHs) and 15 Apex Referral Labs identified in the country for testing of JE in AES cases.
- JE vaccination campaign in children (1-15 yrs) completed in 229 out of 231 JE endemic districts.
- Adult vaccination (15-65 years): Completed in all 31 districts identified in Assam, Uttar Pradesh and West Bengal.
- States have been requested to make JE a Notifiable disease.
- Kala-azar is a notifiable disease in all four endemic states.
- Kala-azar elimination programme has made significant progress, Reduction of 70.6% in cases of Kala-azar from 13869 (2013) to 4073 (2018 Till Nov.).
- Reported deaths due to Kala-azar have also reduced to 100% as being Nil deaths in 2017 as compared to 11 in 2014. There is Nil death reported in 2018 (Nov.)
- Intensification of disease surveillance activities to identify the cases early and ensuring their complete treatment.
- Single day single dose treatment with Liposomal Ambisome, is available for cases of visceral leishmaniasis, which has improved the treatment compliance and outcome.
- Synthetic pyrethroid is used for indoor residual spraying, in all the endemic areas.
- GoI is providing wage loss compensation of INR. 500 to the Kala-azar cases and INR 4000 to cases of Post Kala-Azar Dermal Leishmaniasis for complete treatment.
- An incentive of INR. 500/- to ASHA workers for ensuring complete treatment of kala-azar case and INR. 200/- for two rounds during Indoor Residual Spray (IRS) for generating community awareness and community mobilization.
- Out of 256 Lymphatic Filariasis endemic districts, till 2018 99 (36.8%) districts have cleared Transmission Assessment Survey (TAS) and Mass Drug Administration (MDA) compare to 5 districts clearing TAS by 2013.
- A new intervention Triple Drug Therapy, Ivermectin+DEC+Albendazole (IDA)has been approved and to be implemented in 5 districts namely Arwal (Bihar), Simdega (Jharkhand), Nagpur (Maharashtra), Yadgir (Karnataka) and Varanasi (Uttar Pradesh).
- IDA has been successfully launched in Arwal district.
- A common National Entrance Exam viz. National Eligibility cum Entrance Test (NEET) has been made mandatory for admission to all medical courses in the country. Indian students can also pursue medical education abroad and have to qualify a Screening Test called Foreign Medical Graduates Exam (FMGE), for registration to practice in India after obtaining primary medical qualification (MBBS) overseas.
- The proposal of Medical Council of India (MCI) to amend the Screening Test Regulations, 2002, making it mandatory to qualify NEET to pursue foreign medical course has been approved by MoHFW. Indian Citizens / Overseas Citizen of India intending to obtain primary medical qualification from any medical institution outside India, on or after May 2018, shall have to mandatorily qualify the NEET for admission to MBBS course abroad. The result of NEET shall be deemed to be treated as the Eligibility Certificate for such persons, provided that such persons fulfils the eligibility criteria for admission to the MBBS course prescribed in the Regulations on Graduate Medical Education, 1997.
- Other achievements are:
- Up-gradation of existing State Government Medical Colleges: A total of 36 Medical Colleges with 2615 MBBS seats have been approved. Rs. 1471.30 Crore has been released for 36 Medical Colleges till date.
- New medical colleges attached with existing District/ Referral hospitals: MoUs received from all States/UT; 57 proposals approved so far, Rs.7125.45 Crore released for 57 medical colleges till November 2018. out of 57 approved medical colleges, 22 have become functional.
- Total PG seats is 37630 (including 4454 INI) till November 2018 and the DNB seats, which are equivalent to MD/MS are 6737 as on 30 October 2018. Total UG (MBBS) seats stand at 70412 till November 2018.
- With the amendment in Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 Act, it has been stipulated that every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs.
- An MoU with Indira Gandhi National Open University (IGNOU) has been signed to scale up the short term healthcare courses through its available robust platform. Under this MoU, curriculum for 10 courses especially designed for the health sector, will provide more than 14 lakh trained manpower by 2025.
PRADHAN MANTRI SWASTHYA SURAKSHA YOJANA (PMSSY)
The PMSSY envisages creation of tertiary healthcare capacity in medical education, research and clinical care, in the underserved areas of the country. It aims at correcting regional imbalances in the availability of affordable/reliable tertiary healthcare services and also augmenting facilities for quality medical education in the country. PMSSY has two components- setting up of new AIIMS like institutes in underserved regions of the country: and up-gradation of existing Govt Medical Colleges (GMCs). Under PMSSY, the progress so far is:
˗ The derailed contractual arrangements for six new AIIMS (AIIMS-Patna, AIIMS-
Rishikesh, AIIMS-Jodhpur, AIIMS-Bhopal, AIIMS-Bhubaneswar and AIIMS-
Raipur) put back on track and construction expedited. Since July 2014, 3000 hospital
beds added in the six functional AIIMS (including about 1000 beds added in the last one
year). 2 new AIIMS announced for Jharkhand and Gujarat in 2017-18.
˗ Basket of services in six AIIMS expanded and presently, on an average, about 3000 major surgeries are getting performed every month.
– OPD services started in AIIMS Rae Bareli.
˗ Sites finalized for 3 AIIMS in Jammu, Kashmir, and Gujarat and
sanction of Cabinet obtained for AIIMS in Maharashtra, Andhra Pradesh, W. Bengal,
Punjab, Poorvanchal in UP, Assam, Himachal Pradesh, Jharkhand, Telangana and Tamil Nadu.
– Undergraduate MBBS courses started at AIIMS Mangalagiri & Nagpur with
induction of first batch of 50 students each.
˗ Construction of Super Specialty Block in 10 GMCs Trauma Centres in f our GMCs completed.
– Construction work of Super Specialty Block in progress for 01GMCs under Phase-I &
II and 39 GMCs under Phase-III of PMSSY.
– 15 Government Medical Colleges taken up for upgradation in Phase-IV & V(A) out
of which work has been awarded for 11 GMCs upgradation projects.
CENTRE FOR INTEGRATIVE MEDICINE AND RESEARCH (CIMR) AT THE ALL INDIA INSTITUTE OF MEDICAL SCIENCES (AIIMS)
The Center for Integrative Medicine and Research is a pioneering initiative by AIIMS, New Delhi in the quest for convergence of contemporary medicine with India’s ancient and traditional medical practices and has been envisioned as a “state of the art” research center. It has been designed as a perfect platform for rigorous research to establish the efficacy of our traditional methods of healing.
- India is a regular participant and leading speaker at global events viz. World Health Assembly 2017, UN Health Assembly, BRICS 2018 and The Astana-Global Conference on Primary Healthcare 2018.
- India is the interim Chair of the high level advisory group as well as member of the Executive Committee of the PMNCH (Partnership for Maternal, Neo-natal and Child Health) Board. India has played a leadership role in development of the updated Global Strategy for Women, Children & Adolescents and was the implying force in getting adolescent health to be included in the global strategy. PMNCHs global Partners’ Forum 2018 was hosted by MoHFW in Delhi from 10th-14th December, 2018.
- India and Macedonia signed a Memorandum of Understanding (MoU) on cooperation in the field of Health. The MoU covers the following areas of cooperation:
- Capacity building and short term training of human resources in health;
- Exchange & training of medical doctors, officials, other health professionals and experts;
- Assistance in development of human resources and setting up of health care facilities;
- Any other area of cooperation as may be mutually decided upon.
- India and Jordan signed an MoU on cooperation in the field of Health & Medical Science. The MoU covers the following areas of cooperation:
- Universal Health Coverage (UHC);
- Health System Governance;
- Services and Information Technology in Health;
- Health Research;
- National Health Statistics;
- Health Finance and Health Economy;
- Chronic Disease Control;
- Tobacco Control;
- Diagnosis, Treatment and Medication in Tuberculosis;
- Regulation of Pharmaceuticals and Medical Devices; and
- Any other area of cooperation as may be mutually decided upon.
- India and Iran signed an MoU on cooperation in the field of Health, on 17th February, 2018 during the visit of the President of Iran to India. The MoU covers the following areas of cooperation:
- Exchange experience in training of medical doctors and other health professionals;
- Assistance in development of human resources and setting up of health care facilities;
- Regulation of pharmaceuticals, medical devices and cosmetics and exchange of information thereon;
- Cooperation in the field of medical research, new technologies and knowledge based initiatives;
- Public health, Sustainable Development Goals (SDGs), and cooperation in international health; and
- Any other area of cooperation as may be mutually decided upon.
- To further strengthen collaborative work between India and World Health Organization (WHO) in achieving improved health outcomes, MoHFW and WHO signed a Memorandum of Agreement (MoA).
- The Union Cabinet approved the MoU on cooperation in the field of regulation of medical products for human use, amongst the medicine regulatory agencies of the BRICS countries. The MoU would facilitate better understanding about the regulatory aspects between the parties and could help in increasing India’s export of medical products to BRICS countries.
- The Union Cabinet approved the signing of a Cooperation Arrangement between Food Safety & Standards Authority of India (FSSAI), MoHFW and Ministry of Agriculture, Irrigation & Livestock (MAIL), Afghanistan for cooperation in the field of food safety and related areas. The areas of cooperation include the following:
- Establishment of a mechanism of information exchange and communication;
- Facilitating technical exchange on identified topics of interest especially about import procedures, quality control operations, sampling, testing, packaging and labelling;
- Facilitating/organization of joint seminars, workshops, visits, lectures, training programme, etc;
- Other areas of interest to the participants within their responsibilities as they may mutually determine.
- The cooperation arrangement will facilitate information sharing training and capacity building measure and learning from each others best practice to improve food safety ecosystem.
- The Union Cabinet gave ex-post facto approval to the MoU between India and Denmark regarding cooperation in the areas of food safety. The MoU was signed on 16th April 2018. The MoU will help deepen bilateral ties, mutual understanding and trust, eventually strengthening both sides in their capacity building efforts towards food safety. It will further promote understanding of the best practices in the areas of food safety in both countries and in faster resolution of issues related to food safety. It will help improve food safety standard setting by getting access to best practices and facilitating food trade of important commodities.
- The Union Cabinet gave ex-post-facto for the MoU between the India and Swaziland on cooperation in the field of health and medicine. The MoU was signed on 9th April 2018.The MoU covers the following areas of cooperation:
- Drugs & Pharmaceutical products;
- Medical Consumable products;
- Medical Research;
- Medical Equipment;
- Public Health;
- Communicable Disease Control & Surveillance;
- Health Tourism; and
- Any other area of mutual interest.
- India and Bahrain signed an MoU on cooperation in the field of Health. The MoU covers the following areas of cooperation:-
- Exchange of information including publications and research outcomes;
- Exchanging visits by governmental officials, academic staff, scholars, teachers, experts and students;
- Participating in workshops and training courses;
- Encouraging health and medical research activities at both the private-sector and the academic level; and
- Any other forms of cooperation as may be mutually decided upon.
- MoU was signed in March, 2018 between the Indian Council of Medical Research (ICMR) and the Institut National de la Santeet de la Recherche Medicale (INSERM), France. The MoU will further strengthen relations between ICMR and INSERM within the framework of international scientific and technological cooperation in fields of mutual interest. The scientific excellence on two sides will help to successfully work on health research in specified areas. The MoU aims at cooperation in areas of common interest within the medical, life sciences and health research fields. Based on scientific excellence on both sides, the parties have agreed to have a specific focus upon:
- Diabetes and Metabolic disorders;
- Bio-ethics with focus on Ethics and regulatory issues of Gene editing techniques;
- Rare diseases; and
- Any other areas of mutual interest can be considered after discussions between the two sides.
- MoHFW signed an MoU with the Norwegian Ministry of Foreign Affairs, Government of Norway to extend the cooperation within health sector through the Norway India Partnership Initiative (NIPI) for a period of three years starting from 2018 to 2020. This cooperation between India and Norway is aligned with the development goals of GoI as outlined in its National Health Policy 2017 for achievement of Sustainable Development Goals (SDGs). The cooperation shall also focus on global health issues of common interest. The partnership shall also include areas related to maternal, new-born, child health, and shall build on experiences from NIPI phase I and II. The cooperation will continue to focus on innovative, catalytic and strategic support, and stride in taking the Indian Government’s Intensification Plan for accelerated maternal and child survival in India.
- MoU signed between the Central Drugs Standard Control Organization (CDSCO), India and National Agency for Drug and Food Control (BPOM), Indonesia on cooperation in the field of pharmaceutical products, pharmaceutical substances, biological product and cosmetics regulatory functions. The MoU was on signed on 29th May, 2018 in Jakarta. The MoU is expected to forge better understanding about each other’s regulatory requirements and would be beneficial to both the countries. It could also facilitate India’s export of pharmaceutical products and will also establish a framework for fruitful cooperation and exchange of information between the two countries in matters relating to Pharmaceutical products regulation on the basis for equality, reciprocity and mutual benefit. Further, it will facilitate better understanding between the regulatory authorities of the two countries.
- India and Uzbekistan signed an MoU on cooperation in the field of Health. The MoU covers the following areas of cooperation:-
- Expanding opportunities for the development of business cooperation in the field of medical equipment, including equipment for teaching and research laboratories of institutions of medical education, and pharmaceutical products;
- Strengthening of primary health care and setting up of health care facilities;
- Medical and health research development, as well as exchange of experience in these areas;
- Exchange of experiences and technologies in the field of telemedicine and electronic-health information systems;
- Maternal and child health protection;
- Development and improvement of the techniques and strategies for epidemiological surveillance and communicable and non-communicable diseases control;
- Regulation of drugs and pharmaceutical products;
- Any other areas of cooperation of mutual interest.
- Memorandum of Cooperation (MoC) between India and Japan in the field of Healthcare and Wellness signed on 29th October, 2018. The MoC covers the following areas of cooperation:
- Promoting specific projects:
- Developing human resource in the field of acute medicine, surgery and trauma care including focus on new areas of competency in each field;
- Establishing an advanced joint testing laboratory for clinical examination;
- Establishing a Japanese language education centre for trainee candidates of care workers;
- Establishing collaborations among tertiary care centres in both countries such as AUMS; and
- Supporting sending organisations to provide pre-lectures about elderly care for technical intern training programmes of care-workers through sending out certificated care workers from Japan and providing a curriculum and textbooks so as to provide trained care-givers to Japan.
- Development of infrastructure:
- Establishing a centralised management healthcare distribution centre;
- Improving sanitary environment by increasing access to hygienic and affordable toilets such as on-site processing one;
- Promoting institutional collaboration on patient data analysis and information and Communication Technology & Artificial Intelligence in medicine;
- India-Japan Innovation Hub in India;
- Establishing high end mobile BSL 3 Lab facilities in India; and
- Collaboration on getting high end medical devices including Point of Care Diagnostics with a special focus on establishing manufacturing units in India under “Make in India”.
- Human development:
- Developing human resource, research and project promotion for health self-management such as ME-BYO and Ayurveda; and
- Holding an India-Japan public and private healthcare forum.
(d) Any other areas as may be mutually decided upon to promote the synergies between AYUSHMAN Bharat Programme and other initiatives and AHWM; and
(e) Any other areas as may be mutually decided upon to promote cooperation as envisaged under this MOC.
- Secretary, MoHFW, has been elected to serve as President of the COP Bureau (the Conference of the Parties to the WHO Framework Convention on Tobacco Control (FCTC)) from 2017-19.
- India is the founding member of the Partners in Population & Development (PPD) – an Inter-Governmental Organization, formed during the International Conference on Population and Development (ICPD) in 1994 for promoting South-South Cooperation in the field of Reproductive Health, Population and Development. India is currently the Vice Chair of the PPD Board.
- MoHFW is working towards strengthening India’s leadership on AMR (Anti Microbial Resistance) and a revised and robust National Action Plan to combat AMR has been released early this year.