eHealth Magazine Sep 2018 Issue

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The Premier monthly magazine on the enterprise of healthcare in asia & the middle East volume 13 / issue 09 / SEPTEMBER-october 2018 / ` 100 / US $10 / ISSN 0973-8959

Expanding Horizon of Healthcare in Rajasthan

Vasundhara Raje Chief Minister of Rajasthan

Kali Charan Saraf Minister for Medical, Health & Family Welfare Government of Rajasthan

Veenu Gupta Additional Chief Secretary Medical, Health & Family Welfare Government of Rajasthan

Banshidhar Khandela State Minister for Medical, Health & Family Welfare Government of Rajasthan

Naveen Jain Secretary & MD, National Health Mission, Medical, Health & Family Welfare Government of Rajasthan

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september-october 2018 | Volume 13 | Issue 09

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COVER STORY

Rajasthan Poised to be Frontrunner in Healthcare Delivery policymakers’ Perspective – MP

industry perspective 34 Beware SAM is Life Threatening for Kids 38 Implementation of Quality Assurance & Kayakalp Programme in Rajasthan

15

Kali Charan Saraf

Minister for Medical, Health and Family Welfare Government of Rajasthan

18

Banshidhar Khandela

Minister of State for Medical, Health and Family Welfare, Government of Rajasthan

special article 42

UNFPA: Offering Right-based Family Planning Services in Rajasthan Healthcare initiative – Rajasthan 50

Chirayu: Making Every Life Count

Naveen Jain

21

Secretary & MD, National Health Mission, Medical, Health & Family Welfare, Government of Rajasthan

Ashish Modi

32

Joint CEO, RSHAA (Rajasthan State Health Assurance Agency)

Special Feature 24

India’s Poor Find New Hope in Ayushman Bharat feature

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Bhamashah Swasthya Bima Yojana – Taking Healthcare to All in Rajasthan

Arunachal HEALTHCARE Perspective 52 Dr Kinny Singh

Mission Director, National Health Mission, Special Secretary, Health and Family Welfare Department Government of Arunachal Pradesh

Focus: Bangladesh Healthcare Sector 54 Bangladesh, India Need to Strengthen Cooperation in Health Sector Syed Muazzem Ali High Commissioner of Bangladesh to India

Editorial Rajasthan creating robust healthcare delivery system With healthcare becoming a focus point, as reflected through Narendra Modi Government’s Ayushman Bharat scheme, the Government of Rajasthan doesn’t wish to lag behind as other States begin to make a concerted effort to provide an accessible and affordable healthcare ecosystem.

With a central focus of Rajasthan government to reduce out-of-pocket medical expenditure benefiting people of all sections of society, especially the marginalised ones, its Bhamashah Swasthaya Beema Yojana has been already in place much before the Ayushman Bharat.

Our latest cover story ‘Rajasthan Poised to be Frontrunner in Healthcare Delivery’ thus touches upon various aspects of this all-important healthcare sector. It highlights how Rajasthan Government has created an ideal healthcare delivery model with initiatives like Bhamashah Yojana which benefits around one crore families and is one of the most successful healthcare insurance programmes within the country.

We also have a special feature on Ayushman Bharat, the Centre’s flagship programme, through which the Government has decided to take healthcare facilities to over 100 million families.

The Rajasthan Government has taken slew of measures on every front including, policy, initiative and implementation. With eInitiatives including Integrated System for Monitoring of PCPNDT Act (IMPACT) Software, ASHA Soft, e-Aushadhi, the State is making a giant leap in creating a robust healthcare delivery system in the State.

We have also featured insightful interviews of Kali Charan Saraf, Minister for Medical, Health and Family Welfare, Government of Rajasthan; Banshidhar Khandela, Minister of State for Health and Family Welfare, Government of Rajasthan; Naveen Jain, Secretary & MD, National Health Mission, Medical, Health & Family Welfare, Government of Rajasthan.

We are honoured to have best wishes message from Hon’ble Chief Minister of Rajasthan Vasundhra Raje for this issue of eHEALTH magazine.

The magazine also carries article by Syed Muazzem Ali, High Commissioner of Bangladesh to India, where he talks about various steps taken up by the Bangladesh Government in healthcare sector.

The 4th Annual Healthcare Summit, Rajasthan & Precious Daughters of India Awards in Jaipur, the National Health Mission, Department of Medical, Health & Family Welfare, Government of Rajasthan along with Elets Technomedia, is all set to witness luminaries of healthcare sectors who will touch upon various contours of healthcare ecosystem.

With such a bouquet of articles, interviews and stories, we hope this edition will evoke an invaluable response from our esteemed readers.

Dr Ravi Gupta Editor-in-Chief, eHEALTH magazine & CEO, Elets Technomedia Pvt Ltd ravi.gupta@elets.in

cover story

Rajasthan Poised to be Frontrunner in Healthcare Delivery Determined to benefit people beyond demographic locations, caste and creed, Rajasthan is aiming to take healthcare to the last-mile benefitting even the most marginalised sections of society. From Bhamashah Swasthaya Bima Yojana (BSBY) to Daughters of India campaign, the State is set to leave an indelible mark in healthcare delivery, observe Mukul Kumar Mishra and Kartik Sharma of Elets News Network (ENN).

A

cursory glance at the wide array of initiatives undertaken by the Government of Rajasthan, showcases the government is making concerted efforts to cater people with comprehensive healthcare services.

With Narendra Modi government at the Centre focusing its efforts to make healthcare delivery accessible and affordable with schemes like Ayushman Bharat, launched recently on September 23, the Rajasthan Government has already launched initiatives to align itself with such an endeavour.

It may be noted that the Ayushman Bharat is arguably world’s largest medical insurance scheme having a provision of Rs 5 lakh per family insurance coverage to poor and vulnerable people.

The Rajasthan Government is undertaking a number of initiatives to enable people with better patient care. It has not only set an example with the announcement of many healthcare schemes but also ensured their proper implementation.

Bhamashah Swasthaya Bima Yojana (BSBY), which benefits around one crore families, is one of the most successful healthcare insurance programmes in Rajasthan.

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Under the scheme, the insurer gets Rs 30,000 for general illness and Rs three lakh for critical illness.

A section of experts believes the State’s BSBY scheme can provide blueprint for effective implementation of Ayushman Bharat, the Centre’s flagship healthcare insurance scheme.

This proves how the State has made tangible progress in making medical facilities easily accessible and affordable to people at large.

The Rajasthan Government has implemented various schemes to bring down the Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), providing universal access to public health services, prevention and control of communicable and non- communicable diseases etc.

Kushal Mangal Karyakram was launched for the management of high-risk pregnancies improving maternal health. Rajasthan is the first State to establish Special Newborn Care Units (SNCUs) at all district hospitals. It aims to provide curative services to neonates.

The State Government has been applauded for initiatives i.e care of the newborns, protection of girls through the “daughters are precious” campaign, promotion of breastfeeding through ‘Aanchal’ mother’s milk bank and

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cover story

arrangements for neonatal and mothers’ health care in the district hospitals.

Through Public-Private-Partnership (PPP) mode, the State Government has tried to improve healthcare infrastructure in rural areas. Primary Health Centres (PHCs) have been handed over to private players for better management.

The State is torchbearer in terms of technology and innovations that have been harnessed to benefit people.

The Government recently launched innovative software named ‘Nidaan’ for presumptive diagnosis and monitoring of seasonal and non-communicable diseases as well as the trends of ailments found in specific areas. The software is found to be helpful in formulation of specific action plans for control of diseases.

With the aim to screen newborns for hearing loss, a device called ‘SOHAM’ has been launched. This device would help doctors to detect and treat infants having hearing impairment.

Another mobile app based ECG device, ATOM, was also launched to screen patients at primary healthcare level.

Telemedicine centers have been established across the State to provide patients best medical facilities in their nearby areas. The goal for establishing telemedicine network is to provide accessibility of medical practitioners to the remotest regions through state-of-the art technologies with optimal economical outcomes. eInitiatives include Integrated System for Monitoring of PCPNDT Act (IMPACT) Software, ASHA Soft, e-Aushadhi, Pregnancy, Child Tracking & Health Services Management System (PCTS), e-Shubhalaxmi Yojna and eUpkaran Software.

The State government’s healthcare interventions to augment overall healthcare delivery enabling people to get better medical facilities in terms of quality, accessibility and affordability are: Mothers Milk Bank Rajasthan is the first State in the country to introduce community mother milk banking project. The bank collects excess breast milk from lactating mothers and provides it to infants deprived of it. The bank is very helpful for those mothers who are unable to feed infants due to clinical reasons, or those who are orphaned or abandoned.

Recently the State established its 18th center at Sirohi district hospital. With this, the Anchal/Divya Mother Milk Bank project in the State has now become the largest Human Milk Bank network in Asia, leaving China behind which has 17 Human Milk Banks. The districts having this facility include Beawar (Ajmer), Alwar, Banswara, Baran, Barmer, Bhilwara, Bharatpur, Bundi, Chittorgarh, Churu, Dholpur, Jalore and Karauli.

The State Government has banned the use of dairy and formula milk in hospitals where the milk banking

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Veenu Gupta, Additional Principal Secretary, Department of Medical, Health & Family Welfare, Government of Rajasthan, inaugurating hospital

units have been established.

As per the latest data (From Sept 2016 to March, 2018), over 23,839 lactating mothers have donated their milk to the Aanchal facility which in turn benefited about 14,808 infants and helping them improve their nutrition levels. Total 50.44 lakh ml milk was donated during this period.

Kushal Mangal Karyakram (KMK) With an aim to bring down maternal mortality ratio (MMR) in the State, the Government launched Kushal Mangal Karyakram (KMK) in 2015.

It is the scheme where high-risk pregnancies are identified.

These are such pregnancies which turn into mortality and add up to maternal mortality ratio. Under the programme, the Government provides facility of planned conception, HRP (Humanitarian response plan) tracking, follow up, planned institutional deliveries and post partum care.

On every Friday, the health department observes State Motherhood Day. Camps are organised at identified Community Health Centers (CHCs) every month.

Government gynaecologists provide antenatal care (ANC) services at these centers. Since October 2015, a total of 7,741 camps have been organised. 2.10 lakh beneficiaries & 23,927 high risk pregnancies have been identified till March-18.

Prasuti Niyojan Diwas is being observed every fourth Thursday of every month. Camps are organised to check birth preparedness, counseling for nutrition/ institutional delivery/ danger signs/ referral system (8th & 9th month of pregnancy)

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Community Awareness Campaign by Naveen Jain, Secretary, Department of Medical, Health & Family Welfare, and Mission Director of National Health Mission, Government of Rajasthan

Janani Shishu Suraksha Yojana (JSSY) Launched in 2011, the scheme entitles all pregnant women free deliveries including caesarian section with zero out of pocket expenses, accessing public health institutions. As the neonate mortality contributes approximately 75 percent of IMR(Infant mortality rate), therefore this group of children are provided free of cost facility for investigations, treatment, medicines and any referral facility from home to facility and back home facility.

Janani Suraksha Yojana(JSY) Under the scheme, the State Government pays special care to expecting mothers. A specific amount is paid to pregnant woman if she delivers her child in a government facility.

In rural areas, the amount is Rs 1,400 while in an urban area it is Rs 1,000.

Chirrau The Government launched Chirrau project, with the motive to reduce neonatal mortalities across the State. It aims at curbing infant deaths and promotes superior pre/post pregnancy maternal care at hospitals across the State. The scheme is successfully running in eight districts i.e Udaipur, Dholpur, Sawai Madhopur, Barmer, Sirohi, Karauli, Jalore and Rajsamand.

These districts have Sick Newborn Care Units (SNCUs), Newborn Stabilization Units (NBSUs) and Newborn Care Corners (NBCCs) which help to boost existing healthcare

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services for pregnant women, fetus and newborns at these centers to prevent birth complications.

Objective • It strengthens SNCU points and establish strong NBSU linkage • Strengthens C-section points • Improve LR & newborn care practices at high delivery points • Improve HRP identification & timely delivery planning • Line-listed tracking of neo-natal deaths • Improving accountability and reviews Rashtriya Bal Swasthya Karyakaram (RBSK) To protect the overall child health, the State Government initiated the scheme under which all children of Anganwadi Centres (0-6 yrs) and school going children up to 18 years are being screened for four Ds- Defects at birth, Diseases,

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Deficiencies, Developmental delays and Disabilities (30 identified illnesses) through dedicated Mobile Health Team. If a child is screened with any identified 30 diseases, he is being given free referral and follow-up, and surgical treatment, if required. Health of all school students and in Aganwadis is screened by AYUSH doctors based on 30 health parameters and if any child is found having health related problems, they are referred to the next higher-level facility.

‘Daughters are precious’ campaign Daughters, like sons, too bring an invaluable bundle of joy to any couple’s married life. They are priceless and an embodiment of love, care, kindness and sacrifices. As a symbol of good luck, they boost the sense of responsibility to any couple’s life from the day she comes into existence. Any parent would vouch for the same. Today, there is no field left where a girl hasn’t left her indelible mark while bringing a wave of love, laughter and pride.

With the motive to encourage girl child, the Rajasthan Government launched ‘Daughters are Precious Campaign’ in 2016. The aim was to ensure survival of girl child, as the State had one of the lowest girl child sex ratio in the country

september-october 2018

due to female foeticide. Since 2016, the State Government has brought out many schemes to encourage save girl child.

Mukhyamantri Shubhlaxmi Yojana To address the declining sex ratio in the State, the Government launched this scheme on 1 April, 2013 in the State. It aims to promote girl child birth and to reduce maternal mortality ratio. Under this scheme, an incentive of Rs 2,100 is given to mother on delivery at Government and private accredited health institutions other than JSY incentive.

Amount of Rs 2,100 is given after the child turns one and on complete immunisation of the girl child. Rupees 3,100 is given after five years of age at the time of admission in school. Thus, a woman can get monitory benefit of Rs 7,300 for her girl child.

Mukhyamantri Rajshree Yojana It is a special programme to encourage and empower girl child. It aims to secure girls’ future through different sum of amount at different intervals of time. With the motive to reduce infant mortality rate of girl child across the State, the Rajasthan Government started this scheme on 1 June, 2016.

It aims to make parents of the girl child financially strong so that they wouldn’t face financial constrain in educating their daughters to excel in different walks of life.

• A total amount of Rs 50,000 is paid under the programme.

• First installment at birth -- Rs 2,500 • Second installment (After completion of one year) -- Rs 2,500 • Third Installment at the time of admission in first class in Government school -- Rs 4,000, fourth installment on admission in sixth class -- Rs 5,000, fifth installment on admission in 10th class -- Rs 11,000 • Sixth installment on passing 12th class -- Rs 25,000

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Online JSY and Shubhlaxmi Payment System (OJAS) It is an online platform which facilitates the users to capture beneficiary wise details of payment for Janani Suraksha Yojana (JSY) scheme and Shubhlaxmi Yojna, after due eligibility at CHC & above government health institutions.

It ensures timely and seamless online payment for JSY and Shubhlaxmi beneficiaries. Started in August 2015, the online platform covers all public health institutions including CHCs and Sub Centers (SCs).

Payment transferred More than 4,000 JSY cases, 1,800 RSY & 700-800

SLY 2nd cases per day Online Sanction issued for Payment transfer – 1 August 15 to March 2018 • JSY – Rs 321.33 crore for 22.62 lakh cases • RSY – Rs 213.36 crore for 10.13 crore cases • SLY – Rs 113.40 crore for 5.38 crore cases Integrated Ambulance Project In a bid to strengthen the emergency referral transport services, the Rajasthan Government incorporated ‘108’ toll free ambulance yojana in September 2008, which is a free emergency response services. Another helpline toll free

Rajasthan is the first State in the country to introduce community mother milk banking project

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‘104’ medical advice service was launched in January, 2012.

It is a medical helpline which provides advice, counseling, information directory services and many more health related information.

Off late, the Government has integrated these emergency numbers. Now callers don’t need to call on separate number to avail services. Medical advice is being provided through same call center.

Telemedicine Services Project The Government has made available telemedicine services at different type of health institutions (District Hospital - 30/ Sub Division Hospital - 17/ Satellite Hospital - 4/ Community Health Centre – 49) across the State. The main objectives of the project are to cross geographical barriers to provide specialist healthcare services to people staying in rural & remote areas. eInitiatives As an enabler, technology has driven healthcare industry to reach extra mile. The Rajasthan Government has also harnessed its potential to benefit people at large. IT is a promising tool in healthcare that can provide new ways to healthcare providers to collect, store, retrieve and transfer information electronically. The Government has taken a slew of measures on this front.

Integrated System for Monitoring of PCPNDT Act (IMPACT) Software The web based Software IMPACT was launched on October 1, 2012. It provides online surveillance system of government for prevention of sex determination to save girl child.

Asha soft Launched in December 2014, the online platform facilitates the health department, to capture beneficiary wise details of services given by ASHA to the community. The online system enables the online payment (27 types performance incentives) of ASHA to their bank accounts. It generates various kind of reports to monitor the progress of the programme. Till date, Rs 318 crore (Rs 90.75 crore in 2017-18) have been paid to ASHA workers.

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e-Aushadhi It is a web-based application which deals with the management of stock of various drugs, sutures and surgical items required by different district drug warehouses of Rajasthan. e-Aushadhi helps in ascertaining the needs of various district drug warehouses such that all the required materials, drugs are constantly available to be supplied to the user district drug warehouses without delay.

Pregnancy, Child Tracking & Health Services Management System (PCTS) It is a online software used as an effective planning and management tool by Medical, Health & Family Welfare department, Government of Rajasthan. The system maintains online data of government health institutions in the State. This software helps in tracking of pregnant women for better health surveillance; it is a useful tool for improving institutional delivery. It also helps in tracking BPL and JSY cases. eUpkaran eUpkaran software was launched with the vision to streamline things on the front of equipment and diagnostics facility as it was found that . It is a comprehensive software solution to improve the inventory management & maintenance services of equipments in hospitals across the Rajasthan. The key objectives are effective inventory management, promotion of rational usage of equipments and ascertaining new demand of equipments and instruments, etc.

With above schemes and initiatives, the Rajasthan Government has tried to create an ideal healthcare delivery model to cater people of every stratum with best medical facilities. The Government is making tangible progress in terms of IMR (Infant mortality rate) and MMR (Maternal mortality rate) which has been a big roadblock jeopardizing healthcare accessibility and affordability till now.

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The Bhamashah Swasthya Bima Yojana has done very well in Rajasthan. Over 25 lakh people have benefitted so far under this scheme since its launch on 13 December, 2015… We are also executing many PPP projects in various district hospitals. We are also one of those States where chemotherapy is available in many district hospitals, says Kali Charan Saraf, Minister for Medical, Health and Family Welfare, Government of Rajasthan, recently in an interview with Elets News Network (ENN).

Q

Kali Charan Saraf

Minister for Medical, Health and Family Welfare, Government of Rajasthan

Since joining the Department in 2016, how do you view the status of Health Sector of Rajasthan?

I joined in December 2016 as Health Minister of Rajasthan. It is the geographically largest state of India with a less population density.

There are very poor people in the village areas. We have desert, tribal population and hilly areas, etc . Thus, the biggest challenge has been to provide health services to all. I, along with my team of officers have worked hard to start many new initiatives.

Today, these initiatives have given a new strength to our State. Hon’ble CM Vasundhara Raje has been kind enough to give full support to our Department. As a result, we have been able to do many things. Of these, recruitment of doctors is the single biggest achievement of my tenure.

Many new super specialist doctors and medical practitioners have joined us. Further, we are under the process of starting many new medical colleges in Rajasthan. Many of them will see the light of the day this year.

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policymaker’s perspective

‘Bhamashah Yojana Serving Lakhs of People in Rajasthan’

It’s not a small feat. In just two years, I have been given a chance to start so many medical colleges which normally people start in 30 to 40 years. And I am very much thankful to Government of India for providing all the resources to start these medical colleges. In future, these medical colleges will provide a new breed of medical graduate and postgraduates.

And the recruitment of doctors and nurses will give a new boost to health system. As vacancies have been a big challenge, now recruitment has started and a number of recruitment drives have already been completed.

Q

The department has gained a lot from your vision and hard work, how do you envision your next three months?

These are the last three months of the present government. I can see that the health sector has done a very commendable job in these four years and nine months. Going forward, in the remaining three months, definitely, along with election work I shall be concentrating on the ongoing

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policymaker’s perspective 16

project and people will not face any difficulty in getting health services.

Hon’ble CM Vasundhara Raje will give us all the blessings which we are getting so far. So I am sure that many things which we have started recently will continue giving good results and the State will be one of the most progressive States in terms of health soon. I’m sure due to our good work in health, our government will return to power. And we will start many new initiatives and consolidate some of the previous schemes like Bhamashah Swasthya Bima Yojana, India’s biggest health insurance scheme so far.

Q

What have been Bhamashah Swasthya Bima Yojana’s achievement and challenges?

Today, our health insurance scheme is the most talked about thing in the whole country. Now, hon’ble PM has started Pradhan Mantri Jan Arogya Yojana in the entire country where coverage of Rs 5 lakh is given to a family. About 10 crore families will be given benefits. Our BJP Government at the Centre has thought this unique idea after so many years of

september-october 2018

independence. But our honourable CM also thought on the similar lines earlier in Rajasthan.

Our scheme has done very well and more than 25 lakh people so far have taken benefits under the scheme since its launch on 13 December 2015. In last 2 years and 9 months, we have been able to empanel 1,400+ hospitals and many rare diseases and serious diseases have been cured.

We have cured people with heart diseases, brain diseases, cancer, and spinal diseases and we are sure that people will keep continuing getting these services. There are few challenges also as private hospitals do not get paid on time or there are stray incidents of some misbehavior with the patients.

But our state health insurance agency, under the able guidance of Additional Chief Secretary, takes care of these problems and we have been able to manage all these challenges very well.

Q

Can you share some of the things or initiatives that you would have done if you had the luxury

Telemedicine project was started during my tenure and honourable CM was very enthusiastic about this. She believes that these facilities must be given to people living in remote locations

of more time in the Government?

In my tenure, recruitment of doctors and the opening of new medical colleges were the biggest achievements. Along with that mobile dental vans were started in the entire

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policymaker’s perspective

State and Rajasthan is the only State so far in the country where mobile dental vans are going from village to village to offer medical help to the children diagnosed with dental problems. This is a very unique concept that has been designed by our NHM Mission director and has been implanted very well by them.

Along with that telemedicine project was started during my tenure and honourable CM was very enthusiastic about this. She believes that these facilities must be given to people living in remote locations.

Today, 100 remote centres have been connected to a central hub through our telemedicine system.

More than 10, 000 consultations are now being done (on an average) for the last one year. It is the greatest achievement for us because many Indian states have tried to start telemedicine projects in last one decade. But very little success has been achieved by them. And now many States are following our model.

We are also executing many PPP

CT scan, MRF, IVF and hemodialysis with private vendors in PPP mode are now available. The kind of services available at these district hospitals of Rajasthan is commendable and a lot of credit goes to our honourable CM and our official of the health department

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projects in many district hospitals.

We are also one of those States where chemotherapy is available in many district hospitals.

CT scan, MRF, IVF and hemodialysis with private vendors in PPP mode are now available. The kind of services available at these district hospitals of Rajasthan is commendable and a lot of credit goes to our honourable CM and our official of the health department.

If I get another chance to serve, I would start the remaining medical colleges which have been sanctioned

by Government of India. I would like to transform them into state-of-theart centres and try to give maximum facilities in all the districts.

As you know, honourable PM has started health and wellness centres, we would like to expand that concept in many more sub-centres.

I believe soon Rajasthan will be able to achieve more success in providing health services like many other progressive States. In brief, it would be no more a Beemaru states, as was once described.

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policymaker’s perspective

‘Making Healthcare Accessible to All in Rajasthan’

Ensuring health facilities accessible to all has been one of the major challenges for us for a long time. For instance, we have had a major issue of availability of sufficient number of doctors and super specialists. But to tackle it, the Government of Rajasthan has undertaken various initiatives, says Banshidhar Khandela, Minister of State for Medical, Health and Family Welfare, Government of Rajasthan, in an interview with Elets News Network (ENN).

Q

You have been working in the healthcare sector as State Minister for two years, how do you rate the performance of health system of the State?

Our Government came to power because of our work. For the last four years and 9 months, honourable CM has given us an exemplary guidance. I am lucky that I have been chosen for this Department. Along with Kali Charan, Hon’ble Health Minister, Rajasthan, we have tried to give my

level best to various endeavours of the Health Department. Today, more than 17 lakh pregnant women are delivering children across the State and we are able to provide them online payments. Today, Asha Sahyoginis are getting their monthly payments in their bank accounts. In many States, they get this payment after a lot of hardship. And this was the situation earlier in Rajasthan too. But during this Government, Ashasoft Scheme was implemented.

I can say a lot of relief has been Banshidhar Khandela

Minister of State for Medical, Health and Family Welfare, Government of Rajasthan

given so far to grassroots workers.

Then we have a very good system of e-Upkaran where biomedical equipment have been connected to a portal where people, hospitals can raise their complaints about malfunctioning of any equipment.

This concept has now been copied by many States. I can say that

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policymaker’s perspective

our department has been able to provide better services as well as use technology for the betterment of the health sector of the State. Our all initiatives are being monitored very closely by the Additional Chief Secretary and Mission Director NHM. I think all officials are doing a great job under the visionary leadership of honourable CM Vasundhara Raje.

Q

Tell us about some of the other initiatives aimed at improving the life of the common man of Rajasthan?

We have initiated many programmes aimed at improving the life of the common man of Rajasthan. A common man needs few basic things. Firstly, free consultations -- at our medical colleges, district hospitals, subcentres - free consultations are being given. Secondly, the common man of the State needs

Rajasthan Government spends a lot of money each year from its budget to purchase drugs and making them available to the common man.

These are mainly high-quality generic drugs

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the availability of drugs. Here, our Government spends a lot of money each year from its budget to purchase drugs and making them available to the common man. These are mainly highquality generic drugs. In this way, we are spending about Rs 400 crore annually on this initiative.

Thirdly, it is free diagnostic - across Rajasthan and across all district hospitals, 27 advanced test facilities have been started in Private-Public Partnership mode with Krishna diagnostic. As well as many diagnostic tests are available free of cost at all levels sub-centres.

So you see, a majority medical tests are currently being offered.

Fourth is the free insurance - as tertiary care is very expansive. So with Bhamashah Swasthya Bima Yojana (BSBY), we are now helping the common man. Under this, we provide Rs 3 Lakh coverage for serious diseases and Rs 30,000 for

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policymaker’s perspective 20

general diseases. More than 90 lakh families are covered till now.

time and all these measures will result in a healthy Rajasthan.

Q

Q

What is the status of medicalrelated vacancies in Rajasthan and what are your efforts in improving the situation?

Rajasthan is a State with less natural resources. We have lots of deserts, a sizeable rural population and many of our villages are in very remote locations too. So, I accept many new doctors, young doctors want good facilities for operating in the State. So sometimes, because of lack of facilities, they don’t like joining the government positions.

But in our tenure, many new nurses, doctors, paramedical staff, pharmacists, and lab technicians have joined the department. Also, through NHM, we have appointed many professionals now. Many new medical colleges have been also opened. So many new medical graduates will emerge in four years

september-october 2018

Tell us something about the challenges in the health department and how they are being addressed by you.

Rajasthan is the biggest States (areawise) of the country. Here, literacy rate is not as high as Kerala and Tamil Nadu. We have an average literacy rate. Here, people still prefer home remedies over going to hospitals. Sometimes, they do not get their children immunised due to local beliefs. Various awareness programmes are currently being implanted by our department for addressing this issue.

Pregnant ladies also do not go to hospitals for deliveries.

Further, Honourable CM has been promoting the cause of Girl Child and child sex ratio too so I can say, for sure, things are improving now.

Rajasthan is a State with less natural resources…many new doctors, young doctors they want good facilities for operating in the State. So, sometimes because of lack of facilities, they don’t like joining the government positions. In our tenure, many new nurses, doctors, paramedical staff, pharmacists, and lab technicians have joined the department.

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In recent times, a number of initiatives aimed at creating a holistic healthcare delivery mechanism have been undertaken across the State of Rajasthan, says Naveen Jain, Secretary & MD, National Health Mission, Medical, Health & Family Welfare, Government of Rajasthan, in conversation with Elets News Network (ENN).

Q

You have been at the helm at both Department of Medical, Health & Family Welfare, and at National Health Mission, Government of Rajasthan, if you were to reflect upon your tenure so far, how would you do that?

I have been in the department for last four years. When I started, I never imagined, I would be in this department for so long. In all these years, I tried my best to perform my duties. I have been a student of management and commerce.

With my 13 years of experience, I joined the department. Now, I have a total of 17 years of experience with four years of experience in the health sector, which is ever changing and is very dynamic. Here, I have been able to apply many management principles, logical thinking to various processes here, also using IT and technology for simplifying processes etc. I thank God for giving me this opportunity to serve a big State such as Rajasthan in this capacity because I have learnt a lot here.

I have been able to spend very quality time in the Department by starting many new initiatives.

I have an excellent team with me

now. Initially, team building was a bit challenging but once it was in place, we made use of it to launch many new schemes and implement them across the State. Now many of our programmes have emerged as an example for many States.

We have been able to run all our NHM initiatives very well. Also, we have been able to implement Bhamashah Swasthya Bima Yojana (BSBY) scheme very well. Now, it is an example for many states. Our integrated ambulance scheme was initially very challenging but after two years of its initiation, I can say that we have been able to increase the usage of ambulance extensively across the State and our system will be ranked as one of the best systems when any audit will be conducted of all the ambulance systems in the country.

I see my four years of tenure as very rewarding and fulfilling and at the same time, I can also say that when somebody leaves the department, generally they become very humble and say that they should have tried more on one thing or the other but for me, definitely I would not say that - since I am hundred per cent satisfied with my work so far and I believe

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policymaker’s perspective

Healthcare Delivery Being Given a Makeover

Naveen Jain

Secretary & MD, National Health Mission, Medical, Health & Family Welfare, Government of Rajasthan

that my four years’ stint will help me get more exposure to this particular segment. I believe, my work towards ‘Save the Girl Child’ and ‘Daughters are Precious’ programmes will be remembered in the times to come.

Q

Of the various initiatives launched in the Health Department, which one has been that you will cherish for a long time?

I think just as a father is not able to select a favourite child since all his

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policymaker’s perspective

children would be dear to him, so in the same way, I regard all my projects as my pet projects and all of them are close to my heart. And I have tried all my best to do justice to all of them. It started with Ashasoft that started just after five months of my joining. Today, the project is a big success story. It also received National Award by the Government of India for e-Governance in the second year of its implementation. Then our ‘Daughters are Precious Award’ programme was nominated for PM award on Civil Service day. Though it could not get the award, it was appreciated greatly by people of Rajasthan and from the entire country. Our efforts on ‘daughters are precious programme’ and our decoy operations have resulted in a better child sex ratio which is today visible across the state.

Under Our Rashtriya Bal Swasthya Karyakarm (RBSK) programme, that is very close to my heart, we achieved a rare feat of conducting free heart surgeries of more than 1,700 very poor children from deprived families.

All such programmes are very close to my heart and I have used all my learning from my school and college times in implementing these. Hence, I believe that these programmes are a

sort of management studies for us for which an out of out of box thinking was applied.

Q

Coming from a management background and being in healthcare sector, how do you think this paradox works?

It was not a paradox. It was a blessing in disguise. Because if I had been a medical practitioner, I would have been more involved in one particular segment. But because I was not from medical background I was good to everybody. What I want to say is that I worked hard for every segment and I was not biased towards any specific stream.

I believe, what a medical practitioner needs is a system, and an enabling ecosystem. We as health managers provide just that.

So, as a Mission Director, I work as a good manager. When the State government started Bhamashah Swasthya Bima Yojana, I worked as a corporate manager. I employed many management principles such as division of work, management by exception, out of the box thinking and many motivational theories and I can prove that by applying management into medical field, you

We have been able to run all our NHM initiatives very well. also, We have been able to implement Bhamashah Swasthya Bima Yojana (BSBY) scheme very well

can get very good results. Further, I think, my short study programme at IIM Ahmedabad turned out to be very beneficial to me, as I got very good case studies out of it. During my stint at National Health Mission, I could teach my staff, my team about these management theories and case studies.

Q

What has been the biggest challenging project for you so far?

When Bhamashah Swasthya Bima Yojana (BSBY) was initiated, I was a bit skeptical about the roadmap for its implementation. I was thinking this scheme may or may not work in Rajasthan. I also thought that all my hard work as MD, NHM will now be washed away and I may not get credit for my work as MD NHM. Instead, I may get brickbats for not running the BSBY scheme efficiently. However, once on the task, I observed the scheme closely and I noticed that we needed to clarify many guidelines. Then, I had a word with private hospitals, other stakeholders, insurance companies etc. I tried

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policymaker’s perspective

Community Awareness Campaign

to understand the basic problem associated with the scheme. I found that private hospitals needed a very concrete assurance. I could give them that assurance. Having done so, today I can say that private hospitals believed in my assurances. Secondly, the State Government supported us very well.

The honourable ACS madam, Chief Secretary Sir and all other higher officials supported us in all our endeavours.

Whenever there was any need, they were there for us. And this bureaucratic and political support was the real fuel behind the success of the scheme.

Thirdly, the minimum document protocol idea was great. I think the idea worked well because earlier the insurance players were asking for too many documents from the hospitals.

Further, use of Asha Sahyoginis in taking the schemes to its real beneficiaries was a gamechanger, I would say. Even the Government of India realised that Aasha Sahyagonis could be used to popularise those schemes that are meant for masses such as National Food Security Act beneficiaries and I believe the idea

Using Asha Sahyoginis in taking the schemes to its real beneficiaries was a gamechanger. Even the Government of India realised how Aasha Sahyagonis could popularise all those schemes meant for masses such as National Food Security Act beneficiaries

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of video conferencing with Aasha Sahyoginis was a wonderful idea.

Then we did a great use of social media. We thought like corporate and advertised our message just as a corporate player would do. As a result, we were able to break many barriers and all such initiatives led to BSBY becoming a popular scheme.

Q

How do you see the future of healthcare in Rajasthan?

In the last four years, I have learnt various systems, have attended many conferences. I have been able to learn about concepts such as nutrition malnutrition, NCDs, and all these learning I have used in making myself a good learner.

Going forward, I would like to see an integrated platform containing all health-related data on one single platform. Because today we collect various informations from various non-related platforms, and vendors who use different programmes, and hence a digital integration of all such information is one idea that I would like to see taking shape in the future.

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Special Feature

India’s Poor Find New Hope in Ayushman Bharat

The Narendra Modi government rolled out its ambitious medical insurance scheme — Ayushman Bharat — recently. Launched just ahead of the 2019 parliamentary elections, it seeks to benefit the poorest of the poor in Bharat (the rural India) and the have-nots of urban India, writes Sandeep Datta of Elets News Network (ENN).

R

eflecting its determination to take healthcare facilities to over 100 million families, the Centre’s flagship scheme is arguably world’s biggest health financing scheme. One can gauge its significance from the fact that it is aimed to cover 100 million families or, nearly 50 crore people!

During this year’s Independence Day speech, Prime Minister Narendra Modi had announced that while the scheme would initially cover 10 crore poor families as per the socio-economic census of 2011, in the coming days it will also benefit the

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lower middle-class, middle-class and upper-middle class in terms of jobs in the medical sector, as new hospitals will open in Tier-2 and Tier-3 cities.

On September 23, the Prime Minister launched Ayushman Bharat, the world’s largest governmentfunded healthcare scheme which has been renamed PM Jan Arogya Yojana (PMJAY). It was set to become operational two days later on the birth anniversary of Pandit Deendayal Upadhyay, the co-founder of the ruling BJP and an RSS ideologue.

The scheme was launched from Ranchi reportedly on the request

of Jharkhand Chief Minister Raghubar Das. All National Democratic Alliance (NDA) chief ministers launched the scheme from their respective States as well on September 23.

A section of experts has lauded the Government for taking landmark step in healthcare ecosystem.

“These initiatives will transform the healthcare infrastructure of the State. The roll out of the Scheme was slated to be on September 25 as per August 15 announcement, however, implementing it two days prior to the set schedule and selection

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“The health of the people of a country is directly responsible for the growth and progress of that nation. Healthcare delivery in India is at a decisive juncture and now after the launch of Ayushman Bharat, is uniquely poised to undergo a change at all its stages — prevention, diagnosis, and treatment,” Haldar said.

“I am hoping that Ayushman Bharat would successfully address the three fold challenge in healthcare – lack of infrastructure to treat chronic secondary and tertiary diseases, exorbitant treatment costs and high level of out-of-pocket expenses,” he added.

Anuj Gulati, MD and CEO, Religare Health Insurance, says “‘Ayushman Bharat’ will bring in the much needed revolutionary change to healthcare in India. It will surely transform the entire healthcare ecosystem. A healthy nation is what will make our country prosperous.”

Understanding Ayushman Bharat — Key Points • An annual cover of Rs 5 Lakhs per family for secondary and tertiary care

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Ayushman Bharat – National Health Protection Mission will have major impact on reduction of Out of Pocket (OOP) medical expenditure

Special Feature

of state to kick it off manifest the confidence of the government and its agencies in the readiness of the scheme,” Daljit Singh, President, Healthcare Federation of India (NATHEALTH) said.

Anjan Bose, Secretary General, NATHEALTH, believes Jharkhand and several other States in the country desperately need adequate healthcare infrastructure and insurance coverage.

“It is very encouraging to note that Jharkhand’s 85 percent population will be covered under the PMJAY. Private providers and other stakeholders such as health insurers responded very positively to the scheme and the success should be ensured in terms of quality and affordability,” Bose said.

Arindam Haldar, CEO, SRL Diagnostics, says the landmark scheme ushers in a new era of prosperity wherein access to quality and affordable healthcare for all Indians is no longer a dream.

However, he believes, the effective implementation, availability of adequate financial resources, management and monitoring will be the key drivers of success.

• No money required to be paid by family for treatment in case of hospitalisation • Avail free treatment by visiting public or empanelled private hospitals across the country • Carry any prescribed ID to receive treatment at the hospital • All pre-existing conditions are covered from day one of the policy • The benefit cover will include pre & post hospitalisation

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Special Feature • No restriction on family size, age or gender • All members of eligible families as present in SECC database are automatically covered • The beneficiaries can avail benefits in both public and empanelled private facilities.

• The scheme’s benefits are portable across the country. A beneficiary covered under the scheme will be allowed to take cashless benefits from any public/ private empanelled hospitals across the country.

Key Impact Ayushman Bharat – National Health Protection Mission will have major impact on reduction of Out of Pocket (OOP) expenditure on ground of: Increased benefit cover to nearly 40% of the population, (the poorest & the vulnerable) Covering almost all secondary and many tertiary hospitalisations (except a negative list) The State Exchequer’s Role Ayushman Bharat may cost the exchequer around Rs 5,000 crore

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this year because of the time taken to rollout the scheme. The scheme will cost Rs 10,000 crore when it is rolled out across India next year. While this year there are likely to be 8 crore beneficiaries, the target is to cover 10 crore by FY 20. The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue.

The Flip Side A section of the society opines Ayushman Bharat is very much required for people living in villages, towns, cities and States across India but not that much in South India. It is so because various healthcare schemes have been already existing and benefitting people in the South for a long time.

While appreciating the scheme, a few people look at it with questioning eyes in terms of implementation challenges, that are to determine its success or failure.

There is also a feeling that the Government must think of providing coverage for crop insurance and medical coverage reciprocal to land holding by increasing the annual land rent which will take care of farmers’ maladies.

Some others stress upon the absence of medicare scheme for the elderly retired people, as they simply cannot afford any costly medical insurance scheme as it is present with the insurance companies.

Conclusively saying, away from cynics’ capacity to foresee the brighter side of Ayushman Bharat, one cannot deny that this endeavour has raised a new hope of a real change.

No matter what but the Modi Government looks well-intended at least in taking healthcare to the most marginalised and the vulnerable people of the country awaiting it on the last-mile. At least the Ayushman Bharat has given birth to a new beginning, a new hope.

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feature

Bhamashah Swasthya Bima Yojana – Taking Healthcare to All in Rajasthan

Understanding the fervent publice desire to have a genuinely useful healthcare system, especially for the have-nots of the society, the Government of Rajasthan is reaching out to all with its flagship healthcare scheme -- Bhamashah Swasthya Bima Yojana (BSBY), observes Shashank Nautiyal of Elets News Network (ENN).

B

SBY, the cashless scheme meant to provide financial security to poor families in Rajasthan, is being implemented at 1899 empanelled hospitals which cover about 21 different specialties. Of these, at total of 519 are government hospitals, from the medical college to Community Health Centre (CHC).

It aims to provide quality healthcare to all beneficiary families of National Food Security Scheme.

Chief Minister of Rajasthan Vasundhara Raje first mentioned about the scheme in the budget 20142015.

It was primarily launched in 2015-end to benefit people in the marginalised sections of the society with quality healthcare, with an aim to cover about 1 crore eligible

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families of Rajasthan.

The first phase ended successfully on 12 December, 2017 and the second phase started on 13 December, 2017 for 2018 and 2019. .

Eligibility • Citizens covered under the National Food Security Act (NFSA) and Rashtriya Swasthya Bima Yojana (RSBY) are eligible to avail its benefits.

• No age bar to enroll for the scheme. Families of members are also eligible for enollment.

Features of Bhamashah Swasthya Bima Yojana • A complete cashless treatment scheme that pays for all health expenses incurred by the

enrolled patients • The insurer gets Rs 30,000 for general illness and Rs 3 lakh for critical illness • Empanelled government and private hospitals provides patient care to the enrolled ones • The scheme provides a stimulus package to all empanelled private hospitals, if they show interest in opening their branches in rural areas • Rates are pre-decided for secondary and tertiary illness • The scheme also covers existing illnesses • Pre-hospitalisation medical expenses are covered up to seven days before admission in a hospital • Post-hospitalisation medical expenses are covered for up to 15 days after discharge from the hospital • Initially, the scheme was for in-patient expenses, but later, extended to OPD medical expenses as well • Call centres are there to get relevant information on this scheme. A mobile application is also there to track the status of the policy.

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feature

Benefits Package: • Out of 1,401 total packages under the scheme; 738 are secondary packages; 663 are tertiary packages • Cashless IPD (In-patient department) treatment is provided at all empanelled hospitals for all 1,401 packages • 67 disease packages are reserved for government institutions.

Empanelled hospitals and specialties: In the current phase of BSBY, the scheme is being implemented at 1,899 empanelled hospitals which cover about 21 different specialties. Out of these, 519 are government hospitals, right from the medical college to CHC (Community health centre).

Budget: New India Assurance Agency (NIAC) is providing insurance coverage to beneficiary families.

Rajasthan State Health Insurance (RSHAA) is responsible for paying the insurance premium on behalf of the eligible persons to the successful bidder. So far, packages worth more than Rs 1,800 crores have already been booked. Presently, a premium of Rs 1263 per family per year is paid to NIAC. Progress: So far, more than 23.01 lakh patients benefitted

under the scheme covering 1,401 different diseases which cover 21 different specialties.

Major Stakeholders The scheme is owned by the Department of Medical, Health & Family Welfare and Department of Information Technology (DoIT) and the New India Assurance Co. Ltd. are key partners.

Swasthya Margdarshak (Health Guide): They are responsible to facilitate the complete process of BSBY scheme. Deputed to every hospital, their duty is to ensure eligibility of the visiting patients and to help them at every stage of treatment.

Role of ASHA: ASHA Sahyogini serve as the link between community and department. There about 46,000 ASHA Sahyogini are working in the State to aware eligible families about the scheme.

To make ASHA workers fully understand about the scheme and how they can reach out to the community, a video conference was also conducted under the chairmanship of the State Health Minister.

Three rounds of ‘ASHA Samwad’ were done through the conference.

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Given the big size of the scheme, the government established purpose committees for Grievance Redressal at State and district level under the Chairmanship of CEO of State Health Assurance Agency and District Collectors respectively

They were also provided with BSBY kit including dummy of Ration Card, Bhamashah Card, pamphlets of private hospitals, frequently asked questions etc.

Grievance Redressal: Given the big size of the scheme, the Government established purpose

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feature committees for Grievance Redressal at State and district level under the Chairmanship of CEO of State Health Assurance Agency and District Collectors respectively. These committees have been successfully addressing the complaints of people at empanelled hospitals Toll-Free Call Centre: A dedicated call centre has been established at Swasthaya Bhawan, the State’s headquarter to attend the queries of the beneficiaries and service provider.

The centre also welcomes various feedbacks from the beneficiaries for the further improvement in actions.

Results of the recent feedback of beneficiaries revealed that majority of the respondents were satisfied with the scheme. Most of the beneficiaries have said if there was no such scheme, they had to opt for a loan or to mortgage their lands.

Many citizens are also using this helpline to seek information on BSBY like empanelled hospitals, packages covered, no of illness covered under this scheme, and their eligibility for the scheme. People are also enquiring their remaining wallet balance of Bhamashah card through the toll free number.

“We have our in-house calling

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centre, which calls more than 50 percent of the beneficiaries to check their satisfaction level. As this is a total cashless scheme, we also confirm that not a single beneficiary is paying on the Bhamashah centres through calls, “said Ashish Modi, Joint CEO, Rajasthan State Health Assurance Agency (RSHAA).

IEC/BCC: A dedicated website is created to inform beneficiaries about latest orders, guidelines and notices.

Separate social media platforms are also created to share information and success stories of BSBY to engage more people. A widespread use of LED board can also be seen at BSBY empanelled hospitals to make beneficiaries aware about the scheme.

Under the scheme various tertiary care treatment are provided to BSBY beneficiaries at multi-specialty private and government hospital at free of cost as envisaged by the Government at the time of launch of the scheme.

To benefit newborns and pregnant women, there are separate packages related to the gynecological procedures for pregnant women and neonatal care for the newborn children in the scheme. The most important

To make ASHA workers fully understand about the scheme and how they can reach out to the community, a video conference was also held under the chairmanship of the State Health Minister.

Three rounds of ‘ASHA Samwad’ were done through the conference

package for pregnant women is comprehensive ANC (Ante Natal Checkup) package, which comprises four ANCs at the time of delivery.

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policymaker’s Perspective

Bhamashah Scheme Enabling People Better Patient Care The Rajasthan Government has reduced out of pocket medical expenses through the Bhamashah Scheme which has been enabling poor and vulnerable people to avail best medical facilities.

Since the inception of BSBY, we have booked packages worth more than Rs 1,800 crores, says Ashish Modi, Joint CEO, RSHAA (Rajasthan State Health Assurance Agency), in conversation with Sudheer Goutham of Elets News Network (ENN).

Q

You are running BSBY (Bhamashah Swasthya Bima Yojana) last few years. Kindly elaborate the scheme.

The Rajasthan Government had started this scheme on 13th December, 2015 and since then, the State has been running it successfully. The first phase of BSBY continued for two years till 12th December 2017. After that, many disease packages were revised based on our experience of implementation of BSBY and based on the changing needs of the people. The second phase of implementation of BSBY started from 13th December 2017 and it shall continue till 12th December 2019.

In the current phase of BSBY, we are having 1401 different diseases packages which cover 21 different specialties. As on today, We have 1418 empanelled hospitals. Out of these, we have 899 private empanelled hospitals

across rajasthan and 519 government hospitals, right from the medical college to the CHC (Community health centre) level. Since the inception of BSBY, we have booked packages worth more than Rs 1,800 crores in the State of Rajasthan. Out of 1401 packages, 778 are secondary and 623 falls into the category of tertiary packages.

Currently, we have packages for critical illnesses as well like kidney transplant, cardiac surgery, cancer treatment etc

Q

How this scheme is benefitting newborns and pregnant women?

There are many gynecological procedures related packages for pregnant women and neonatal care packages for the newborn children in the scheme. There is a comprehensive package for antenatal checkup and for delivery caesarean section. We have been successfully dealing with the

Ashish Modi

Joint CEO, RSHAA (Rajasthan State Health Assurance Agency)

complications in cases of complicated pregnancy like caesarean section, preeclampsia and asphyxia within the newborn babies with the help of our extensive network of government as well as private empanelled hospitals across the length and breadth of Rajasthan.

One of the most important package for pregnant women is comprehensive ANC (Ante Natal Checkup) package, which comprises four ANCs during the entire course of pregnancy.

Q

What are your future plans and strategy to further strengthen the insurance plan to benefit people at large?

The journey has been very enriching since the inception of the programme in 2015. These three years have been a learning experience and provided us with an enriched data set which will help us in improvising further. We have re-designed our packages on the basis of workability of disease packages in these years . We had found that more than 300 packages needed re-working.

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Q

What kind of challenges you have been facing to implement the scheme across the State?

Challenges are the part of any journey.

We too have been facing a lot of challenges on the go. However, we have always been open to learning from our mistakes which we come to know by interacting with patients and identifying the grey areas which are likely to be misused/misinterpreted.

BSBY is being implemented through Bhamashah card which rides on a well-designed IT platform to enable biometric identification of the beneficiaries. The Bhamashah card helps us in maintaining a wallet for the family which makes the IT platform robust and simpler.

Further, the photograph of the beneficiary is taken at the time of admission as well as discharge, which helps us to know the exact date and time of admission/discharge along with the longitude and latitude of the place.

It ensures beneficiary’s presence both at the time of admission and discharge in the hospital.

We have introduced some technological innovations in the BSBY software recently. Earlier, the patients used to wait for a long time at the discharge counter because all the papers had to be scanned and

uploaded. It usually used to take 10-15 minutes. Now, we have devised a new mobile application through which patients’ photographs can be taken and uploaded in the software instantly and remaining documents can be uploaded later. Thus, the waiting time for discharge is practically less than a minute!

In addition, we have also provision according to which if a claim is rejected by an insurance company, one can make an appeal to the office of JCEO, RSHAA (Rajasthan State Health Assurance Agency).

Earlier these appeals were made through email and Google forms.

Now we have incorporated that in the software to make the process simple and streamlined. Thus, using software, filing appeal of rejected cases has become a lot easier for the hospitals. It has also increased our capacity to hear appeals manifold. .

The entire decision-writing process has also been made online. Decisions shall automatically be dispatched through e-mail.

We have made IT intervention to tackle cases where patient cannot be identified biometrically.. It happens sometimes because of old age, or someone doesn’t have an Aadhar card or a Bhamashah card.

In that case, the treating doctor himself verifies the patient. As per the provision, before a doctor identifies patient through his signature, the patient has to try at least three times

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policymaker’s Perspective

Hence, we deleted, modified or replaced them with better options. At the same time we realised that some packages need to be added in the list.

The Bhamashah card helps us to maintain the health record of a family and the robust IT platform ensures a biometric verification of the beneficiary before he/she comes to avail the treatment

on a biometric machine to identify himself. If he fails, then only treating doctor can go for a MOIC (Medical officer in charge) verification.

Q

Do you have any monitoring system to keep a tab on the scheme?

We have a monitoring system i.e in-house calling centre, which calls BSBY beneficiaries to check their satisfaction level. As this is a complete cashless scheme, we also try to ensure that beneficiaries are not required to pay anything at the hospitals. At the same time, we regularly do field audit to promote good practices among the empanelled hospitals and beneficiaries.

Q

Do you like to add something for your eHealth magazine readers?

I would like to reiterate that people should focus more on preventive healthcare instead of curative care. Unless we focus on preventive healthcare, it would be really difficult to manage ever increasing number of citizens who are falling ill. We need to particularly focus on managing lifestyle diseases which can be reduced significantly if we follow a healthy routine.

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industry perspective

Beware SAM is Life Threatening for Kids

Severe Acute Malnutrition (SAM) remains a major killer of children under five years of age. Unfortunately, SAM can be seriously life threatening; it can directly cause child death, or indirectly lead to significantly increased risks of case fatality rate in children suffering from common childhood illnesses, such as diarrhoea and pneumonia, writes Elets News Network (ENN).

A Note on MTC Based on a review of existing studies of case fatality rates in several countries, the W.H.O. has shown that children with severe acute malnutrition face 9-10 times higher risk of death compared to their wellnourished counterparts.

Nutrition Situation in India and Rajasthan The available information has shown that prevalence of SAM in children is seriously high in India when interpreted as per the World Health Organisation’s (WHO) crisis threshold. Furthermore, there is a concern that the situation has not shown good progress over the last two survey periods (NFHS 3

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and NFHS 4). Till late Feb. 2017, the NFHS4 State Fact Sheets have been released for all states and the prevalence of SAM has increased in 18 states, including Rajasthan.

To prevent deaths due to severe acute malnutrition (SAM), specialised treatment and prevention interventions are required.

Programmatically, it is helpful to categorise children with SAM into ‘complicated and uncomplicated’ cases based on clinical criteria as: • Facility/hospital-based care for children with SAM and medical complications.

• Home/community-based care for children with SAM but without medical complications.

Children with SAM, when

managed in specialised units with skilled manpower and adequate resources for nutrition rehabilitation have very high levels of survival.

SAM is an important preventable and treatable cause of morbidity and mortality in children below five years of age in India.

Malnutrition Treatment Centre (MTC) Is a unit in a health facility where children with Severe Acute Malnutrition (SAM) are admitted and managed. Children are admitted as per the defined admission criteria and provided with medical and nutritional therapeutic care. Once discharged from the MTC, the child continues to be in the Nutrition Rehabilitation program till she/he attains the defined discharge criteria from the program (described in National Operational Guidelines for facility-based management of children with Severe Acute Malnutrition, 2011). In addition to curative care, special focus is given on timely, adequate and appropriate feeding for children; and on improving the skills of

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Objectives of facility-based management of SAM: • To provide clinical management and reduce mortality among children with severe acute malnutrition, particularly among those with medical complications.

• To promote physical and psychosocial growth of children with severe acute malnutrition (SAM).

• To build the capacity of mothers and other care givers in appropriate feeding and caring practices for infants and young children.

• To identify the social factors that contributed to the child slipping into severe acute malnutrition.

The services and care provided for the in-patient management of SAM children include: • 24 hours care and monitoring of the child.

• Treatment of medical complications.

• Therapeutic feeding.

• Providing sensory stimulation and emotional care.

The suggested staff requirement for the smooth functioning of a 10/20 bedded NRC is as follows: S. No. Staff Position Number foe 10 Number for 20 beded unit beded unit 1.

Medical Officer One Two 2.

Nursing Staff Four Eight 3.

Nutrition Counsellor One Two 4.

Cook cum care taker One Two 5.

Attendant/cleaner Two Two 6.

Medical Social worker One One

To prevent deaths due to severe acute malnutrition (SAM), specialised treatment and prevention interventions are required

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• Social assessment of the family to identify and address contributing factors.

• Counselling on appropriate feeding, care and hygiene.

• Demonstration and practice- by doing on the preparation of energy dense child foods using locally available, culturally acceptable and affordable food items.

• Follow up of children discharged from the facility.

Currently Rajasthan has 40 Malnutrition Treatment Centres in District Hospitals and Medical Colleges. Thirty six facilities (MTCs) are 10 bedded and 4 are 20 bedded.

The total number of children admitted in these MTCs in the financial year 2017-18 was 8104.

industry perspective

mothers and caregivers on complete age appropriate caring and feeding practices. In addition, efforts are made to build the capacity of mothers/caregivers through counselling and support to identify the nutrition and health problems in their child. Besides this a sum of Rs 100/- per day per child admitted in MTC is provided to the parents/ caregivers as wage compositions for the number of days of stay at the MTC.

Success Story of treatment at MTC: Reena daughter of Harsh (Names changed), age 4 years was admitted in MTC at Sirohi district hospital on 10 July, 2018 She was from a far of village of Reodar block with complain of loss of appetite and lethargy.

After her anthropometric check-up and biochemical test, she was diagnosed with Severe Acute Malnutrition along with Severe Anemia. Her Hb level was 4.1gm/ dl and therefore she was given ½ unit of blood. F-75 diet was started and gradually as she improved and regained her appetite she was put on F-100 and home-based diet for

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industry perspective 36

speedy recovery and weight gain.

Her mother was also taught about how to prepare and feed the child after discharge. By the time of discharge Reena (Name changed) had gained 2.5 KG and her weight became 10.120 KG from 7.545 KG. Her parents were very happy to see the recovery of their child and said that they will now take proper care of their daughter as they were taught to do during their stay in MTC and tell in their village about the facilities that are provided to ‘Kamzor’ SAM children in MTC and will get Reena for timely follow up visits to the hospital.

Success Story 2: One-year old Kamal (Name changed) who lives in Pasuniya village of Nathadwara block, Rajsamand District was brought to OPD at RNT Medical College, Udaipur with the complaint of severe diarrhoea, vomiting and fever. In the village, he was first taken to Bhopaji (spiritual man) for treatment, it was the same place where Kamal got his belly marked (daam) to keep away evil spirits when he was six months of age. After taking offerings of chicken, wine bottle, coconuts and money from the family the bhopaji tried to treat Kamal with his rituals called jhada, but to his dismay Kamal was not able to revive and surprisingly the bhopaji himself advised the family to take the child to the hospital. The child was brought in a serious condition to the emergency at 10 pm after travelling a distance of 57 km by local bus.

Kamal was breathing fast had fever and cough. He was immediately taken care of at the hospital. He was given glucose and fluids through IV as he had diarrhoea with lethargy and slow skin pinch as danger signs. Blood was drawn for glucose, malaria and hb tests. After screening for infections and taking anthropometric measurements

september-october 2018

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is very happy with his progress in the MTC. Nainu (Kamal’s mother) is a young girl of 16 years of age married for past 4 years. Kamal is her 1st child and was born at the same hospital. She was given advice for exclusive breastfeeding during her discharge, which she followed till six months but thereafter due to lack of information regarding complementary feeding she was not able to feed her baby according to the requirements for his growth, which led to deterioration in his health.

Kamal a low birth baby of

Malnutrition Treatment Centre (MTC) Is a unit in a health facility where children with Severe Acute Malnutrition (SAM) are admitted and managed

industry perspective

Kamal was sent to MTC where he was taken care of by the trained staff of the ward. Here he was kept warm covered in a blanket, close to his mother and after the first few hours he was shifted to F-75 therapeutic feed with antibiotic treatment. Later vitamins and minerals were also added in the therapy to build up his immune system and also make up for the electrolyte loss due to diarrhoea and vomiting.

The child started recovering and slowly gained some weight from 3.05 KG at the time of admission to 3.35 KG on the 13th day. His mother

1.20 KG received only the initial immunization in the hospital (BCG, OPV and DPT). Faulty feeding practices and lack of proper immunization led to repeated infections causing incidence of diarrhoea and vomiting in the child.

It is a common practices in the Scheduled Tribes of the state to get their girls married at a young age leading to early pregnancy and child birth at a young age. The mother’s weight in this case was 32 KG and she herself was undernourished.

But Nainu’s attachment with her child and the will to learn more about child rearing practices started showing in the improved health of Kamlesh. She stayed at the MTC for more than 10 days and not only learnt the skills of feeding and caring taught to her by the doctors and paramedics at the MTC but also communicated the same to the other women in the community.

According to the Operational Guidelines, Government of India 2011, the parents/caregivers are prepared for discharge. It is ensured that they understand the causes of malnutrition and how to prevent its recurrence by following correct breastfeeding and feeding practices (frequent feeding with energy and nutrient dense foods)

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Implementation of Quality Assurance & Kayakalp Programme in Rajasthan ‘Kayakalp’ scheme, an initiative taken under the Centre Government’s flagship programme Swachh Bharat Abhiyan, aims to improve cleanliness, hygiene and waste management practices at public health facilities, writes Elets News Network (ENN).

R

ajasthan is second largest State in India having 10 high priority districts & six tribal districts (Three under HPD). At the same time it also falls under the category of high priority State. the governmental setup is the main stay of healthcare in the State particularly for the poor and those living in rural areas who can’t afford private facilities.

Therefore, it becomes utmost important for the State to ensure quality services at its various public health facilities. Off late the Government run facilities have come under constant pressure due to increased awareness among common consumers. As a result, the need for quality improvement activities in public health facilities has gained importance in the State. Upsurge of demand for quality health services and lack of standardisation of care processes serve as key drivers for the implementation of quality programme.

Quality improvement programmes: ‘Kayakalp’ scheme, an initiative taken under the Centre Government’s

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flagship programme Swachh Bharat Abhiyan, aims to improve cleanliness, hygiene and waste management practices at public health facilities. Facilities go through internal and external assessment process against predetermined criteria. The best facilities are given cash award as well as felicitation at the State and National level.

National Quality Assurance Standards (NQAS) have been developed by the Government of India keeping in mind the specific requirements for public health facilities as well as global best practices. NQAS is currently available for District Hospitals, Community Health Centres (CHCs), Primary Health centres (PHCs) and Urban PHCs. Programme aims to recognise the good performing facilities and to improve credibility of public hospitals. Certification is provided against NQAS on meeting pre-determined criteria for three years. Certified facilities are also provided financial incentives as the recognition of their good work.

Challenges Vacant sanctioned position and

funds issues are among common challenges during implementation of the programme. However, continuous motivation and nonconfrontational attitude of the leading roles helped the staff to adapt new concept. Inadequate number of cadre was also an important issue. However, optimum use of the available human resource helped us in overcoming this problem.

How we began Quality was a new concept for public health facilities which were struggling with infrastructure, funds and human resources issues.

Ensuring standard practices, improving infection control practices, especially changing the behavior and attitude of staff was not an easy task. About 120 trainings were conducted both at the State and the district level in last three years by the State quality cell. During the trainings, emphasis was laid on improving the infection control & BMW (Bio-medical waste) management practices, adherence to technical protocols, importance of key performance indicators and use of quality tools.

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We created and shared sustainable practices related to improved cleanliness in public health facilities linked to positive health outcomes Besides training, due importance was also given to rigorous monitoring and continuous encouragement of the proactive facilities. Most importantly, it was the ownership of the staff working at the facility for implementation and sustainability of quality efforts that gave us the desired results.

Strategies Adopted • On-site study to analyse the prevalent status and practices to identify gaps (Infrastructure, equipment, documentation, processes and practices) were executed.

• Process mapping of critical activities • Development, review and implementation of standard operating procedure (SOP) for all departments.

• Defining, monitoring and evaluating the key performance indicators • Development of Quality Management System (e.g. Patient / employee satisfaction, clinical

•

• •

•

• • •

record indicators and quality indicators etc ) Upgradation of facility as per requirement e.g. infrastructure, human resource, equipments and training.

Calibration and testing of medical equipments.

Required civil construction work / structural re-allocation of departments was done Hospital compliance to the license, statutory acts and regulatory norms of the State.

Intensive and continuous trainings Regular process monitoring Regular mentoring and monitoring visit by the State team and continuous review at state level.

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Strategies used by the state for implemantation of the programme

RESULTS In 2015-16 we started implementing ‘Kayakalp programme’ in all District Hospitals and NQAS in only High Priority District. Now the programme has been taken up to the PHC level. Within one year, number of Kayakalp award winning facilities has increased from 46 in 2016-2017 to 131 in 2017-2018.

For NQAS programme, we started mentoring the District Hospital, Rajsamand, winner of Kayakalp award in 2015-16. The foundation was laid by enhancing the hospital environment through Kayakalp programme. Further emphasis was laid on improving the clinical practices, documenting the policies, implementation of workplace management method, fixing of the faulty machines & damaged

RK Hospital Rajsamand team members

PMO, RK Hospital Rajsamand Felicitated at National Level

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industry perspective

State Quality Team awarded with certificate of appreciation for rendering excellent services in implementation Of National Quality Assurance Programme in state at National Quality convention held on April 20-21’2018

parts of the building, patient safety practices and patient satisfaction etc.

Also, garbage dumping areas were transformed to waiting areas for the patients, car parks, and flower beds in order to make the surrounding more appealing. Staffs were motivated with success of Kayakalp programme and were further mentored for NQAS certification.

In the year 2017-18, facility was assessed against 5000 checkpoints of NQAS by a team of three empanelled external assessors for three days and became the first District Hospital of Rajasthan to be NQAS certified with 82%.

State adopted the strategy of handholding of Kayakakp award

winning facilities and till now eight facilities (3 District Hospitals, 2 Community Health Centres, 3 Primary Health Centres) have been State certified and application for their national assessment has been sent to the Government of India. Community Health Centre Bissau, district Jhunjhunu has already been assessed and has been NQAS certified with 95 percent score while the assessment of other institute will be completed by the Government of India by year end.

The programmes have resulted in improvement in infection control and biomedical waste management practices and have resulted in creating a healthy completion among the health facilities. Recognition provided

at various levels is encouraging other facilities to implement the program & improve subsequently.

The award money given to health facilities further motivated the staff to implement the programme.

Most importantly the State has been able to create a zeal for quality improvement among public health facilities. “Quality is not an act it is a habit” and to inculcate this habit in public health facilities will undeniably take some time but definitely a start has been made and “Q” word which earlier looked like a distant dream now seems achievable and has become reality for public health facilities also.

ICU of District Hospital Hanumangarh

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F

ujifilm has leveraged its imaging and information technology to become a global presence known for innovation in healthcare, photo imaging, graphic arts, recording media, industrial products, optical devices, highly functional materials and other high-tech areas.

The company is continuously innovating-creating new technologies, products and services that inspire and excite people everywhere.

Our products are best in terms of image quality. Major difference is quality and reliability of our products.

We have CR (computed radiography), DR (digital radiography) and digital mammography, Synapse PACS (Picture

Archiving and communication system), Endoscopy, Dry Chemistry analyser. We have over 30,000 plus installation base across India.

Our Full Field Digital Mammography - Amulet Innovality is the future of Mammography and certainly has much scope considering the rapid increase in the number of breast cancer cases going undetected in India. In order to provide timely diagnosis, Fujifilm has installed Amulet Innovality in several healthcare centers across the country.

In addition, the development of Tomo biopsies has a fundamental role in early detection of the disease. Tomoguided biopsy can be beneficial in situations such as lesions can only be seen on tomosynthesis, lesions visible in only one view, and presence of subtle masses and asymmetries.

With rising cases of breast cancer in women, there is a pressing need to raise awareness about early cancer detection at grassroots level. While innovations in healthcare technologies will empower and strengthen our efforts, the imperative today is to strengthen our reach with a shared vision of helping people fight this growing menace.

The company has been making concerted effort to raise awareness and promote early detection and treatment of breast cancer in India. It had held several roadshows across the country to create awareness of the disease and consistently supported the pink ribbon campaign via Pinkathon.

The company has tie up with more than 25 hospitals to raise awareness

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Chander Shekhar Sibal

Senior Vice President, Head of Medical Division, Fujifilm India Private Limited

Technology Perspective

Fujifilm Making A Splash with Innovation and promote early detection facilities.

Fujifilm firmly believe that with precise treatment and correct knowledge India can save many lives.

Fujifilm has recently organized a symposium with the message “Evolving Trends in Breast Imaging” in association with IGMC , Shimla and Government Medical College, Aurangabad. The event reached and impacted the minds of more than 300 Radiologists/Oncologist across North and West region.

We have released a clinical case study book on digital mammography titled “Identifying Breast Cancer with 3D Tomosynthesis” by Dr Shilpa Lad from NM Medical Mumbai.

Fujifilm has also partnered with the Indian Cancer Society to provide practical knowledge and quality screening for women of Delhi and NCR who cannot afford quality treatment.

Under the partnership Fujifilm is conducting medical camps to generate awareness about breast cancer and breast self-examination. Free breast cancer screenings will be organized for women above 40 years. It is an endeavor to utilize Fujifilm’s state-ofthe-art technology for the betterment of people at large.

(Writer is Chander Shekhar Sibal, Senior Vice President, Head of Medical Division, Fujifilm India Private Limited)

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special article

UNFPA: Offering Right-based Family Planning Services in Rajasthan

The United Nations Population Fund is working in Rajasthan to strengthen the implementation of Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) and Rashtriya Kishor Swasthya Karyakram (RKSK) initiatives, and ensure availability of right-based family planning services in the State, observes Elets News Network (ENN).

T

he United Nations Population Fund (UNFPA) is working to expand the possibilities for women and young people to lead healthy and productive lives. UNFPA has been assisting the Government of India since 1974 to provide family planning and health services, advance reproductive health and rights and improve maternal health. UNFPA’s 9th country programme (2018-2022) is aligned with the Government of India’s priorities, Sustainable Development Goals Framework and International Conference on Population and Development (ICPD) Agenda. UNFPA in the State of Rajasthan is closely working with the Department of Medical, Health & Family Welfare (DMH&FW) to strengthen the implementation of Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) and initiatives under the Rashtriya Kishor Swasthya Karyakram besides ensuring availability of quality of family planning services in the State.

Support for strengthening family planning programme As per the The National Family Health Survey-4 (2015-16), total fertility Rate (TFR) in the state has declined to 2.4 from 3.2 in 2005-06 (NFHS-3), however, there is a huge inter-district variation with several districts in the State having TFR

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FPLMIS (Family Planning Logistics Management Information System) and newer contraceptives in the state.

Some of the key activities undertaken in state for strengthening quality of family planning programme and improving its utilisation are:

of more than 3. Besides that, early pregnancy and less spacing between two children also contributes to high maternal and infant mortality.

Family planning services not only help couples in planning their family but it also contributes in reducing the maternal and infant mortality and improving overall quality of life.

UNFPA in the State of Rajasthan is closely working with the DMH&FW to strengthen the availability of right-based family planning services.

UNFPA has provided support for critical activities, including review of the family planning programme and orientation of officials on quality assurance guidelines and order by Supreme Court for strengthening quality of such services.

UNFPA’s support has resulted in increased pool of service providers, improved availability of family planning services, increased focus on quality of services, evidencebased planning and monitoring and strengthened roll-out of MPV (Mission Parivaar Vikas),

Strengthening family planning services In order to strengthen the implementation of family planning programme and development of action plan, UNFPA in the partnership with DMH&FW has facilitated orientation of State, district and block level officials. In 2018, two workshops were organised under the chairpersonship of Special Secretary and MD (Managing Director), National Health Mission in which detailed review of progress of family planning were undertaken and also block specific action plans were prepared to improve the availability and utilisation of services. During these workshops, orientation of the district and block level officials on the quality related issues were also undertaken. These workshops were attended by more than 350 participants. Organisation of these workshops helped in strengthening the planning and implementation of family planning services at the field level.

In order to orient district officials and service providers on quality related issues, a State level

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Launching e-initiatives Development of a website to improve the participation of private service providers in provision of FP services on the State – UNFPA is supporting DMH&FW in development of a website to reduce the delays in accreditation and release of payments to private sector. This will help in improving the participation of private sector in provision of family planning services. It will also strengthen the monitoring of performance of private sector service providers.

Development of E-Saadhan software In order to strengthen the supply chain of family planning commodities, UNFPA has provided technical support to DMH&FW in the development of the E-Saadhan software. The E-Saadhan was rolled-out till PHC level and it helped in the improving supply chain management of family planning commodities and provided data on real time basis of monitoring for decision making. A team of representatives from different development partners visited the State to observe the implementation of the E-Saadhan and learning from the visit, helped in designing FP Logistics Management Information System (FPLMIS) at the national level.

UNFPA is closely working with the FP Division at DMH&FW in rolling out of FPLMIS in the state.

waste management, equipment & supplies, sterilization of equipment, QAC functions and process for giving compensations. These protocols were distributed to the identified delivery points in the State. The usage of protocols is helping in strengthening counselling of FP services, improving quality and infection prevention practices.

special article

orientation workshop was organised. It was attended by senior officials from MoHFW & DMH&FW Division, districts and representatives from development partners.

Besides that, in previous years, UNFPA in partnership with DMH&FW and SIHFW, facilitated divisional level orientation workshops. These orientation workshops were attended by over 400 officials including joint directors, additional/deputy chief medical and health officers, block chief medical officers, service providers from DQACs, RMNCH+A counsellors and statistical assistants.

Evidence generation In order to strengthen the programme implementation and provide inputs for strengthening quality of services, UNFPA in the partnership with FP Division at the DMH&FW has facilitated different studies and assessments. UNFPA in partnership with DMH&FW and PGI Chandigarh has facilitated a study to assess the quality of PPIUCD services. Besides that, assessment of static centers and youth friendliness of services were undertaken to address the existing gaps & make services young people friendly.

Also, support is provided in strengthening the roll-out of injectables in the State through monitoring the quality and providing hand holding support in partnership with DMH&FW and PSS. Further, telephonic survey of availability of FP commodities with ASHA were undertaken on periodic basis to observe the status of availability of FP commodities at the field level.

Support for critical trainings UNFPA has closely worked with the FP Division in DMH&FW to facilitate the critical trainings related to FP programme. UNFPA has supported capacity building of counsellors, service providers, district, block & field level officials for strengthening availability & quality of FP services and roll-out of newer contraceptives, MPV and FPLMIS in the State.

Development of protocols In order to strengthen the quality of FP protocols, a set of 9 protocols were developed with UNFPA’s support and in partnership with DMH&FW & SIHFW. These protocols cover different components/ services related to FP including FP services available, fixed day services management,

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The Way Forward UNFPA is providing support for critical FP activities to DMH&FW and UNFPA’s support has resulted in improving availability and quality of family planning services in the State. UNFPA will continue to work with the department in improving provision of right based family planning services in the State.

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TECHNOLOGY PERSPECTIVE Technology Perspective 44 20

ASMAN: Leveraging Technology to Reduce Early Maternal and Neonatal Mortality The central goal of Alliance for Saving Mothers and Newborns (ASMAN) initiative is to reduce neonatal and maternal mortality through an innovative facility-based intervention that enables healthcare workers to provide quality care during child-birth, writes Dr. Bulbul Sood , , Country Director, Jhpiego, in conversation with Elets News Network (ENN).

T

he premise of the ASMAN program is that most maternal and neonatal mortality is centred around delivery (intra and the immediate postpartum period).

For example, 27% of maternal mortality is due to haemorrhage, 11% sepsis and 9% obstructed labour. 34% of neonatal death is due to infection and 19% due to birth asphyxia. us, by focusing on building healthcare workers’ capacity to provide quality of care, supported by high-impact innovations, during

september-october SEPTEMBER 2018 2018

the intra and postpartum period, ASMAN is likely to have a signi cant impact on the direct causes of maternal and neonatal mortality.

On April 30, 2015, the Government of India launched Dakshata – a national-level initiative for empowering health workers for high quality care during childbirth.

Jhpiego has been involved in this initiative since its inception. It has partnered with the Government to develop the programme design, learning resource package, and other programme tools. It is the

Dr Bulbul Sood

Country Director, Jhpiego

lead technical partner for the implementation of this programme in high-focus states of the country, including Rajasthan. Based on learnings from the implementation of Dakshata, in June 2017, Jhpiego decided to introduce technology as an additional driver for improved quality of care in labour rooms of public health facilities through ASMAN. ASMAN is an initiative for effectively driving the use of evidence-based best practices that reduce early maternal and newborn mortality by leveraging technology and is supported by a consortium of partners (Reliance Foundation, Tata Trusts, MSD for

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Mothers, Bill & Melinda Gates Foundation and USAID). e key stakeholders of this initiative are Governments of Rajasthan and Madhya Pradesh. is program is being piloted in four districts each of these two states, covering 39 and 42 facilities, respectively. Jhpiego is the lead implementing partner, Avalon Information Systems being the technology partner and Bodhi Foundation the gami cation partner.

Map of Rajasthan showing ASMAN intervention

Digital intervention: ASMAN application is a tablet-based ‘Intrapartum and Immediate Postpartum Monitoring and Decision Support Tool’.

Map of MP showing ASMAN intervention

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TECHNOLOGY PERSPECTIVE Technology Perspective

The ASMAN application is a useful tool for facility level implementing workers to state-level decision makers. This data-driven decision making tool, supported by targeted quality improvement activities, will help in achieving the goal of improved maternal and newborn health.

SALIENT COMPONENTS OF ASMAN APPLICATION ARE: Case Management: Digitized case sheet (admission notes, e-partogram, delivery notes, post-delivery monitoring, postnatal care, discharge slip, referral slip, events section, safe childbirth checklist) with integrated clinical rules from admission till discharge.

Dashboard and reports:System generated dashboards and reports for respective health facility and aggregations of data at district and state level for managers.

E- learning content: All the Government of India modules, guidelines and tutorials in the form of audio, video, or readable content.

ASMAN Complication Management Game by Bodhi Foundation: Scenario based game on intrapartum and immediate postpartum complication management for developing critical thinking skills of health workers around safe child delivery.

Safe Delivery App by Maternity Foundation: Direct and instant access to evidence-based and up-to-date clinical guidelines on Basic Emergency Obstetric and Neonatal Care.

Remote Support Centre: 24 X 7 availability of obstetricians and senior nurses for remote support. The remote support centre will have access to all the cases registered into the system within a state. The health workers of various health facilities in need of assistance will contact the remote support centre as and when required.

Snapshots of ASMAN application

22 46

SEPTEMBER 2018 2018 september-october

ASMAN is IS an AN initiative INITIATIVE ASMAN FOR effectively EFFECTIVELY for DRIVING the THE use USE OF driving EVIDENCE-BASED BEST of evidence-based best practices PRACTICES THAT that reduce early REDUCE EARLY maternal MATERNAL and AND newborn mortality NEWBORN MORTALITY

Health Information System which generates reliable, and quality data is one of the key components of a strong and functional health system. î ˘is initiative will not only improve the way data is collected but also improve the ability of the system to interpret, analyze, translate and use the data. We believe that ASMAN initiative will be a great leap towards improving decision making by service providers and the beginning of new dawn for informed data-driven decision making by the facility as well as district and state level oďŹƒcials. Jhpiego and alliance partners are looking forward to see the signi cant bene ts that improved data will bring to the overall healthcare system which will ultimately culminate in better maternal and newborn outcomes.

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Impact of BEMPU Hypothermia Pilot program in Rajasthan In Partnership with :

The BEMPU Bracelet is a device that provides 4 weeks of continuous temperature monitoring to a LBW newborn.

Emits an audio visual alarm

Improves weight gain

Promotes KMC

Recognitions: THE 25

COUNTRY PARTNERSHIPS Zimbabwe - Papua New Guinea - Benin

BEST INVENTIONS OF 2017

Support on implementation research

News Highlights

Latest from Health World PM Modi launches Ayushman Bharat scheme

The world’s largest government-funded healthcare scheme — Ayushman Bharat – was launched in Ranchi on Sunday by Prime Minister Narendera Modi. It has been renamed PM Jan Arogya Yojana (PMJAY).

It will became operational from September 25 on the birth anniversary of Pandit Deendayal Upadhyay.

The scheme has been launched from Ranchi reportedly on the request of Jharkhand Chief Minister Raghubar Das. It is the biggest health financing scheme in the world and offers an insurance cover of Rs 5 lakh, which will cover 100 million families or almost 50 crore people.

Private healthcare facilities may be assessed under ‘Kayakalp’ scheme Private healthcare facilities may now be assessed on parameters of the ‘Kayakalp’ scheme, a government initiative to promote cleanliness, hygiene and infection control practices.

Encouraged by the achievements of ‘Kayakalp’ scheme, the National Accreditation Board for Hospitals and Healthcare Providers (NABH) has decided to consider assessment of healthcare facilities in the private sector, the Health Ministry said in a statement.

The initiative is a part of the ‘Swachchta hi Sewa’ initiative that is being undertaken across various parts of the country to generate greater public participation towards cleanliness and is being organised in the run-up to the fourth anniversary of the Swachh Bharat Mission.

8, 02, 000 infant deaths reported in India in 2017: UN

Health Ministry ropes in Dell, Tata Trusts for nationwide prevention of NCDs The Ministry of Health and Family Welfare has collaborated with Tata Trusts and Dell to provide technological platform for nationwide prevention, control, screening and management program of non communicable diseases (NCDs), an official statement from Ministry said.

“Through implementation of the software, it will also be possible to track health trends across the country,” it said.

Speaking on the occasion, Anupriya Patel, Minister of State for Health and Family Welfare, said the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) stresses on the preventive and promotive aspects of healthcare.

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september-october 2018

As per United Nations Interagency Group for Child Mortality Estimation (UNIGME) report, about 8, 02,000 infant deaths were reported in India in 2017. While the death toll among children aged 5 to 14 was 1, 52,000.

“India continues to show impressive decline in child deaths, with its share of global under-five deaths for the first time equalling its share of childbirths,” said UNICEF India representative Yasmin Ali Haque.

However, the number of infant deaths has come down from 8.67 lakh in 2016 to 8.02 lakh in 2017.

In 2016, India’s infant mortality rate was 44 per 1,000 live births.

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Govt bans manufacture, sale of 328 drugs

The Supreme Court has agreed to examine a plea seeking a ban on nearly 85 pesticides, which have been posing health complications.

A bench of Justices Arun Misra and Vineet Saran issued notices to the Centre and other authorities concerned on the plea which sought to empower states to decide on prohibition and restriction related to pesticides.

“The continued use of deadly pesticides is a major threat to the Right to Life of farm workers and farmers. Just in terms of acute poisoning, without even getting into chronic health impacts, the situation is alarming and needs urgent action to remove deadly poisons from the scene,” the plea said.

News Highlights

Supreme Court to hear plea on banning 85 pesticides

The Government recently prohibited the manufacture for sale, sale or distribution for human use of 328 Fixed Dose Combinations (FDCs) with immediate effect.

The Ministry of Health and Family Welfare through an official statement also announced to have restricted the manufacture, sale or distribution of six FDCs subject to certain conditions.

FDCs which are combination of two or more drugs in a fixed ratio, may involve risk to human beings, the Ministry believes.

The move stems from the Government’s March 2016 decision where the ministry had prohibited manufacture for sale and distribution for human use of 344 FDCs under section 26 A of the Drugs and Cosmetics Act, 1940.

Alcohol responsible for 2.6 lakh deaths in India: WHO

NHA launches website, helpline no. to help Ayushman Bharat beneficiaries

As per the report of the World Health Organisation (WHO), Alcohol kills about 2.6 lakh Indians every year by causes like liver cirrhosis, cancer or drunk driving leading to road accidents.

The global status report released on Friday highlights the link between alcohol and health problems, alerting health experts to demand a national alcohol control policy like the one on tobacco.

“As health is a state subject, various states follow different rules,” said oral cancer surgeon, Dr. Pankaj Chaturvedi, Tata Memorial Hospital.

If the legal age limit for alcohol is 25 years in Maharashtra, it is 18 for certain drinks in Goa “It is time for a Central law to standardize norms for alcohol use across the country,” he added.

The National Health Agency (NHA), the apex body implementing the Ayushman Bharat, has launched a website and a helpline number to help beneficiaries check if their name is there in the final list.

One can visit the website mera.pmjay.gov.in or call up the helpline (14555) to check their enrolment.

This will also put an end to the fake websites promising PMJAY enrollment (Pradhan Mantri Jan Arogya Yojana). PMJAY aims to provide coverage of Rs 5 lakh per family annually and benefit more than 10 crore poor families.

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49

Healthcare initiative Rajasthan

Chirayu: Making Every Life Count

The Chirayu programme was launched in Rajasthan with a set goal of reducing the neonatal mortality rate, which is among the highest in India, with sharp focus on eight high burden districts of the state. After completing one year, there are clear indications that it has strengthened the infant related systems and processes for good, writes Vivek Ratnakar of Elets News Network (ENN).

O

f the 1,000 babies born in Rajasthan, 30 would die during the first 28 days of their birth. Even as this abysmal figure of neonatal mortality rate (NMR) is higher than the average of 24 for India—making the country as the 12th worst in terms of NMR in the world— Rajasthan’s laggard performance on this crucial health parameter continues to undermine the efforts being made in other sectors.

This required an inflexion to achieve targets set under the Sustainable Development Goals (SDGs)—a set of 17 goals aimed at ending poverty, fighting inequality and injustice, and tackling climate change by 2030. But since in Rajasthan there were no structured NMR-focused programmes or review mechanism, it was a tall order for the government.

The Chirayu programme, therefore, came into being with a set goal of reducing NMR with sharp focus on eight high burden districts of Rajasthan, namely, Barmer, Dholpur, Jalore, Karauli, Rajsamand, Sawai Madhopur, Sirohi and Udaipur. Four development partners and 16 office mentors were also assigned to make the programme effective.

Key Focus Areas under Chirayu The most important aspect of

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Chirayu programme is to prepare an action plan to prevent neonatal deaths.

The Health Department has taken steps to strengthen the healthcare services for neonates at sick newborn care units (SNCUs). Also, the department focuses on operationalising C-section points in districts to ensure that the pregnant women with complication receive caesarean deliveries facility immediately at the time of need.

Under the flagship neonatal programme, the health department puts emphasis on providing referral transport to ensure availability of vehicles for pregnant women. There is a provision to conduct line-listed tracking of deliveries and neo-natal deaths. Conducting still births and neo-natal death reviews is also an important part of the programme. Fixing accountability by taking punitive action against worse performing community workers is also built into it.

Basis expert advice and global researches, the following areas have been prioritised under Chirayu: 1. Ensure Special Newborn Care Unit (SNCU) coverage and improve SNCU practices 2. Improve labour room practices and improvement of high delivery points 3. Ensure First Referral Unit (FRU) operationalisation (improving C-section performance) and referral linkages 4. Improve Antenatal Care Coverage (ANC) coverage, Horseradish Peroxidase (HRP) identification and delivery planning 5. Fix Neo-natal death reporting 6. Ensure accountability and reviews

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Frequency Chaired by

Chirayu Core Group

Monthly

ACS, MD-NHM • Design decisions • Adherence of state action pts

Key Agenda Points

SNCU-LR Review

Monthly

PD CH, PD MH • Key SNCU metrics • e.g. Survival rate, occupancy • LR practice adherence • e.g. DakshataLR score

Chirayu District Reviews

Monthly

CMHOs

• Review of key reporting metrics & inputs fixing • e.g. NMR tracking, ANC / HRP

Category

Metric

Apr-Jun, 2017 (Chirayu)

Latest 2018 (Chirayu)

Outcomes / Outputs

NMR Reporting % SNCU survival rate (old SNCUs)

8.7 (24%) 78.1%

11.8 (33%) 80.5% (Apr-Jun)

Specialist Gap Fixing

18/35

22/35

Inputs / Outputs

C-sec points 11 Operational; 15 Operational; operational (>5 C-sec per month) 4 fac. @10% 7 fac. @10% New SNCU points fully functional (>50% occupancy)

0/6

2 new SNCU pts approved 6/6 operationalized 3/6 fully functional

ANC/ HRP Line-list

4ANC – 9%; HRP – 2%

4ANC – 18%; HRP – 3%

The Chirayu programme has completed one year in June this year, and there are clear indications that the focus on newborn mortality reduction is now percolating to the field

Governance mechanism To drive key focus areas under Chirayu, a comprehensive governance mechanism has been setup. The ultimate aim is to improve team behaviour in a holistic manner rather than one area. A sharp focus on transforming the practices and infrastructure is key to ensure success of the programme.

In addition, Chirayu key metrics and progress against target are also reviewed in the CMHO VC review chaired by ACS and MD-NHM.

such as breathing problem, infection and jaundice. Besides, newborn stabilisation units have been set up at select community health centres to prevent neonatal death due to birth asphyxia, infection, diarrhoea and hypothermia.

Translating efforts into results The Chirayu programme has completed one year in June this year, and there are clear indications that the focus on newborn mortality reduction is now percolating to the field.

Thanks to Chirayu programme, a new lease of life was given to a newborn at SNCU Dholpur earlier this year when the child weighing only 830 grams managed to survive all odds and was discharged after 56 days weighing 1.3 kg. It is one of the many success stories that will go a long way to establish the credibility of the programme.

At district and block level, Chirayu reviews are running independently enabled by automated dashboards provided by the state.

Under the programme, the infant related systems and processes are being strengthened, including data systems like PCTS, SNCU and LRMIS. The network of newborn services has been bolstered at primary health centres, community health centres and at district hospitals across the state.

As many as 53 sick newborn care units (SNCU) were set up in the state to provide necessary health services to neonates. The units were provided with radiator warmer, phototherapy machine, syringe infusion pump, pulse oximeter and other necessary equipment for the child care.

The Health Department also appointed trained staff to treat underweight neonates and premature babies and children suffering from various diseases

Transformation through Innovation In a bid to close the yawning gap between the demand and availability of specialists, the National Health Mission-Rajasthan recently conducted a ‘bidding process’ to appoint specialist doctors for operationalisation of First Referral Units and Comprehensive Obstetrics and Neonatal Care Centres.

Under the initiative, a salary of upto 2.5 lakh/month was offered to suitable candidates. Of the 150 applications received, 27 specialists were offered jobs through the process and six have joined their respective neonatal care facilities. Many labour rooms and Newborn Stabilisation Units across the state were given a facelift in order.

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september-october 2018

Healthcare initiative Rajasthan

Review Type

51

Arunachal HEALTHCARE Perspective 52

Dedicated Initiatives Improvising Healthcare Delivery in Arunachal With many initiatives including Mukhya Mantri Rogi Kalyan Kosh and a special flexi fund for districts, the State is embarking towards a better healthcare system. The State launched Chief Minister Arogya Arunachal Yojna before Ayushman Bharat. The academic session has also been started in the very first medical college of the State, says Dr Kinny Singh, Mission Director, National Health Mission, and Special Secretary, Health and Family Welfare Department, Government of Arunachal Pradesh, in conversation with Elets News Network (ENN).

Q

What steps have been taken to improve healthcare delivery across the State?

The State has launched Chief Minister Arogya Arunachal scheme which is an assurance based scheme covering all citizens of the State. It was launched before Centre’s Ayushman Bharat programme. The State Government has partnered with MD India (TPA) for smooth implementation of the scheme. Nine hospitals have already been empanelled across country.

Negotiations are going on with other big private hospitals as well.

Then there is Mukhya Mantri Rogi Kalyan Kosh where we provide flexible finances to districts to improve healthcare delivery. Rs 40

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crore have been earmarked to be decentralised to districts based on a calculated weightage criteria of OPD attendance, population and available health facilities. Districts can purchase emergency and life saving drugs, hire specialists and improve healthcare infrastructure from this flexi pool.

The Arunachal Government is also working towards implementation of tele radiology services and free diagnostics services in the State.

Q

MMUs are considered an effective tool in improvising rural healthcare delivery system. How many such units are functioning in the State?

To bring basic healthcare services

Dr Kinny Singh

Mission Director, National Health Mission, Special Secretary, Health and Family Welfare Department Government of Arunachal Pradesh

to the difficult / far-flung villages, mobile medical unit (MMUs) were introduced in 2007-08 in Arunachal Pradesh. Supported under National Rural Health Mission (NRHM), 16 MMUs (3 vehicles model) are running in 16 districts. They are equipped with diagnostics, drugs and required manpower to make people available medical facility on time.

The overall responsibility of operationalisation of MMUs in the districts rest with the District Health Society (DHS).

To provide maximum benefits through MMU, a fixed day and place approach is put in place. The schedule is made known to the people through IEC (Information, Education and Communication) through NGO / PRI / Clubs / Mahila Mandal / Self-help Group (SHG)/ Village Health and Sanitation Committee (VHSC).

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Q

Timely and effective healthcare system could reduce both direct cost and out-of-pocket expenditure. How is the model operating in the State?

The State has launched Chief Minister Arogya Arunachal Yojna on 15 August this year. It is a comprehensive healthcare insurance scheme where State provides an insurance coverage of four lakh rupees/year/family.

The State has also signed MoU

(Memorandum of Understanding) with Government of India for smooth implementation of Ayushman Bharat.

Q

How do you manage the supply, stock and requirement of various drugs and surgical items in remote areas?

The whole State is hilly and mountainous. The habitations are aligned to the natural topography adjusted to mountains, rivers etc.

There are few areas bordering Assam which are easily accessible.

Most of the districts of Arunachal Pradesh are remote areas. Currently, drugs and vaccines are being procured through the Central Procurement Board at State level. It is then supplied to districts where the drugs are received by District Health Society Board.

However, there is flexibility to districts for local purchasing of drugs for vertical programmes.

Soon, we are going to launch the online DVDMS (Drug and Vaccine Distribution Management System) to ensure uninterrupted supply of drugs and vaccines into the districts.

A comprehensive drug procurement policy is also underway.

Q

You have 52 PHCs providing round the clock healthcare services which is a big feat.

What have been your strategies on this front?

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Arunachal HEALTHCARE Perspective

PHC manpower is assured for health camps. It is fully assisted by members of the VHSC (including PRI member, AWW and ASHA) whenever there is a programme / Village Health Nutrition Day (VHND) / Health Mela organised through MMU. Local NGOs/ clubs / groups have been involved for community mobilisation and bringing the beneficiaries to the camps. Over the years, the performances of these units have not improved much. There are many issues because of which the expected outcome could not be achieved.

The poor road conditions in the mountainous / remote areas often limit the movement of the MMUs. In addition, lack of dedicated MMU team is also a big constrain. It is a fact that many districts are poorly staffed and taking out the team for outreach activities on a weekly basis is a big challenge.

We are going to launch the online DVDMS (Drug and Vaccine Distribution Management System) to ensure uninterrupted supply of drugs and vaccines into the districts. A comprehensive drug procurement policy is also underway

Priority of State Government is to place relevant / required manpower and to look into other requirements in these PHCs. Despite being operated in difficult and remote areas, the PHC are managed by dedicated technical manpower on 24 hour basis. Convergence with all vertical programmes have helped achieving this objective.

Regular monitoring and supportive supervision by the district health authorities ensure better output from these facilities.

Q

What digital initiatives have you taken in terms of ensuring healthcare to all in the State?

There are many initiatives including Health Management Information System (HMIS), Reproductive Child Health (RCH) portal, Drugs and Vaccine Distribution Management System (DVDMS) to be functional from September 2018, MeraAaspatal (to be implemented shortly), Mother and Child Tracking System (MCTS), Training Management Information System (TMIS), e-Hospital in one UPHC and 102 ERC.

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Focus: Bangladesh Healthcare Sector 54

Bangladesh, India Need to Strengthen Cooperation in Health Sector

H

ealth is Wealth, as the famous saying goes. It is most appropriate for a nation, as national ‘health’ forms the national ‘wealth’. Health status of a nation, indeed, is inextricably linked with the overall progress, growth and development of a nation and is truly one of the most important development issues for any country and society, particularly for the developing and least developed countries.

Ensuring healthy lives and promoting the well-being for all at all ages is a key to sustainable development. If we can ensure a healthy nation, all other things will automatically fall in place.

It is in this contour, global leaders had agreed to weigh on the importance of ‘Health’ in Millennium Development Goals (MDGs) incorporating three goals which are directly linked to health issues.

Post-2015, development agenda/ Sustainable Developments Goals (SDGs) also have one stand-alone goal on Good Health and Well-Being [Goal no-3: Ensure healthy lives and promote well-being for all at all ages].

The health sector is, therefore, one of the vital sectors for a nation in the context of the overall growth and development in the era of the post2015 development period.

The current Government of Bangladesh, led by Hon’ble Prime Minister Sheikh Hasina, is fully aware of the critical significance of health sector in the nation building

september-october 2018

process. In fact, we take inspiration from our Constitution. Article 18 of Bangladesh Constitution pledges to “… raise the level of nutrition and improvement in public health ...” as a primary duty for each citizen.

That is what our father of the nation, Bangabandhu Sheikh Mujibur Rahman, had dreamt four decades ago to build an aspired ‘Sonar Bangla’.

In that vein, Bangladesh Government has taken a lot of pragmatic initiatives in the health sector to ensure affordable and quality health, nutrition and family welfare services to the public. As a result, despite limited resources, Bangladesh has made commendable progress in achieving the health related MDGs such as life expectancy, total fertility rate, infant and under-five mortality rate etc. It is on right track to achieve the health related SDGs. Bangladesh has also made rapid progress in human resource development and is now categorised as a ‘Medium Human Development’ country.

In recognition to our outstanding performance, Bangladesh achieved GAVI Alliance Award in 2009 and 2012, which was given as recognition for achieving the health related Millennium Development Goals (MDG). In 2010, the Hon’ble Prime Minister received the ‘Millennium Development Goals’ award as a recognition of Bangladesh’s success in reducing infant and child mortality.

She was also bestowed with the ‘South-South Award 2011’ for facilitating health services using ICT.

Syed Muazzem Ali

High Commissioner of Bangladesh to India

Our phenomenal success in health sector has been made possible by Bangladesh’s strong commitment coupled with a few unique policy initiatives. One of the key determinants of Bangladesh’s success is that we have developed homegrown solutions and micro planning with a principle of “Think Globally, Act Locally”. Micro planning was done in each sub-district with the active participation of field workers, non-governmental organisation (NGO) workers, municipal workers and supervisors.

Apart from direct intervention in health sector, Bangladesh has tired to focus on some social factors which in turn contributed to better health.

Women education and women’s higher socio-economic status showed a positive relationship with health sector success. Within the broader

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Prime Minister of Bangladesh Sheikh Hasina receiving South South Award 2011 for facilitating health services in Bangladesh using ICT

exported to 145 countries. Drugs manufactured in Bangladesh have earned reputation globally. We have also declared our ‘Drug Policy 2016’ recently.

All the inclusive social policies and strategies including decentralisation and expansion of education for all, pro-people health and family welfare activities, target-oriented

One of the key determinants of Bangladesh’s success is that we have developed homegrown solutions and micro planning with a principle of “Think Globally, Act Locally

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social protection programmes, job creating-skill development-training and awareness building programmes pursued during the last 10 years resulted in unprecedented progress in social sector.

The maternal mortality rate has dropped to 1.76 per 1,000 live births which was 2.59 in 2009. At present, the rate of immunisation of infants less than one year is 82.3 per cent and the rate of feeding vitamin “A” capsule is 92 per cent. The child mortality rate has declined due to expansion of immunisation programme.

Currently, child mortality rate is 28 per 1,000 live births compared to 39 in 2009. Average life expectancy at birth has now increased to 71.6 years from 67.2 years in 2009. Success in health sector has also been translated in economic success. Poverty rate has now declined to 24.3 per cent from 31.5 percent in 2010 and extreme poverty rate has been reduced to 12.9 percent from 17.6 percent.

Having mentioned the laudable success of Bangladesh in the health sector, we acknowledge the complexity of the challenges. Our endeavour has not ended. The next challenge will be consolidating and sustaining our achievements.

Our next priority will be to take a “Qualitative Approach” to

eHEALTH Magazine

september-october 2018

Focus: Bangladesh Healthcare Sector

context, Bangladesh mainstreamed health and immunisation issues in the National Strategy/Policy for economic growth, poverty reduction and social development and adopted coherent national policies.

Bangladesh stressed effective multi-sectoral cooperation and ensured effective implementation at all levels.

To enhance accountability and effectiveness and to improve resource use, the Government adopted regular and systematic assessment of progress. It aligned international support to establish and implement our own national policies and strategies.

As part of these overarching initiatives, as many as 13,500 community clinics have been made operational by recruiting 13,842 healthcare providers to reach the health services to the doorsteps of the rural poor and the marginalised community.

Different Health Protection Programmes have been introduced for different classes of the society such as poor, destitute, pregnant mothers, people living below poverty line etc. Free consultancy services from physicians are now available 24 hours via ‘Health Window’. In last 10 years, a number of new hospitals has been constructed together with the increase in the number of beds and massive expansion of other health infrastructures in many hospitals. In addition, 15 Child Development Centres have been established for treatment of autism, neurological diseases and epilepsy.

Different courses on nursing have been introduced.

Our achievements in pharmaceutical production have already attracted global attention.

Drugs manufactured in Bangladesh are being exported to different countries after meeting 98 per cent of domestic demand. In 2017, medicines worth of worth 31.96 billion were

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Focus: Bangladesh Healthcare Sector 56

further improve the quality of health services. We would like to reach out each and every Bangladeshi across gender, region, geography etc within the country.

We are also aware that with the advent of development and technology, new dimensions and challenges of health issues are coming up. Communicable diseases are being curbed across South Asia, but noncommunicable diseases are emerging as a concern to reckon with – a major part of which involves the state of mental health.

As lifestyle changes with the developments in economy, stress, obesity, diabetes, cardiovascular problems are coming up in an ever-bigger way. Impact of climate change in the form of flood and other natural calamities often hampers access to affected communities and immunisation service delivery.

And off course, tackling all these challenges will need additional resources, knowledge, technology and support for capacity building. Support from our development partners will complement our national efforts.

While we are mobilising our own resources, in many of these areas, the global industry, policy and research community and philanthropy can also

september-october 2018

help us significantly.

Now, let me turn to health sector cooperation between Bangladesh and India. In recent years, BangladeshIndia relations have reached to a newer height, thanks to the commitment and able leadership of our Prime Ministers, Sheikh Hasina and Narendra Modi.

The relations now virtually cover all the areas of cooperation.

Unfortunately, the health sector cooperation between our two countries has not got the expected momentum. It is true that thousands of Bangladeshi patients travel to India for treatment and many Indian students come to Bangladesh to study medical sciences. A large number of technically qualified Indian nationals are also engaged in Bangladesh’s health sector. During a recent visit of Prime Minister Sheikh Hasina to India (April 2017), a Memorandum of Understanding (MoU) between Directorate General Medical Service (DGMS), Bangladesh Armed Forces and TATA Medical Centre, Kolkata, India had been signed.

Another Agreement for construction of 36 Community Clinics in Bangladesh (Sunamganj, Habiganj, Brahmanbaria, Jamalpur, Sherpur) was also signed during that visit.

However, we need to speed up substantial cooperation in health sector between two countries by putting public health collaboration high on our agenda.

We should complement each other in health sector collaboration in the area of joint venture, joint advanced medical research through formal agreements with longterm targets, pharma production, disease surveillance, exchange of medical professionals for sharing the experiences etc.

Apart from the bilateral cooperation, we also need to promote cooperation in the area of health care within the different sub-regional and inter-regional groupings in a sustainable manner through partnerships with different sectors/organisations. We may also expand our cooperation and joint collaboration with the South-East Asian region as well.

Within BIMSTEC, we have already seen such an initiative ‘JIPMER-BIMSTEC Telemedicine Network’, which was launched in July 2017 in Pondicherry. Bangabandhu Sheikh Mujib Medical University of Bangladesh is a partner with that initiative. I believe more similar kind of institutions could converge together to establish a stronger regional and sub-regional network in the health sector.

In conclusion, I would say that so far Bangladesh has done remarkably well in the health sector, but we still believe that we have to work harder to ensure good health to all our citizens.

Under the able stewardship of Prime Minister, Bangladesh has been on the front line in achieving the health targets in MDGs and is ready to take up the challenges to become a front runner in the post-MDG period as well.

(The writer Syed Muazzem Ali is the High Commissioner of Bangladesh to India)

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Industry perspective

Bringing Social Change with Determination

The idea to establish healthcare centre occured to me because there was a lack of healthcare facilities in our area and many deaths have occurred because of the same. Patients have to go to the other districts to avail basic healthcare facilities, says Sunil Purohit, Director, Sunmax Group, in conversation with Elets News Network (ENN).

Q

What prompted you to build a school and donat the same to the State Government?

I always wanted to contribute to the society. With this feeling, we established a primary school with the help of the Government in Rajasthan’s Jalore district. The purpose was to provide education to those poor children who can’t afford costly education.

Q

We have heard that you are building a hospital as well in your area. What is your vision towards making it?

We have planned to establish a subhealth centre in the district and the Government has already given nod for the same. I came up with the idea to establish this centre because there is shortage of healthcare facilities in our area and many deaths have occurred because of it. Patients have to go to the other districts of Rajasthan to access basic healthcare facilities. Pregnant women also face a huge problem.

Keeping these facts in mind, I decided to open a healthcare facility which will be equipped with all the advanced specialities to provide best healthcare facilities to the local people.

Q

There are a lot of people who wish to contribute to the society, but they always complain of not getting support from

58

september-october 2018

the Government. Did you face the same or you got full support from the Government’s side?

Yes, at times you face some problems on this front, but if your mission is to help the people, then nothing can stop you and everything falls in place. I got full support from the State to establish the school and also planning to upgrade it further. Apart from contributing to the society, one also has to motivate others to do good to the society.

Q

Since you are not living in Rajasthan, how do you ensure things going smoothly in your school?

I pay many visits to the school and monitor things personally. Today, we have 300 students from 30 students and the school has upgraded from 8th to 10th standard with the support from the State Government. Girl child needs more attention, as parents from rural

Sunil Purohit

Director, Sunmax Group

areas are still reluctant to send their daughters to the school. This is the second reason for me to open a school in my area. Today, there are about 40 girl students studying in our school.

Q

How do you view the State of healthcare in Rajasthan?

People from other States still perceive Rajasthan as a State with poor healthcare delivery system. Since last decade, things have been improved with many schemes and healthcare programmes, launched by the State Government. Still, a lot needs to be done in rural areas. The State must encourage health workers to ensure healthcare delivery to the last-mile.

It is not only the Governments’ efforts but individuals’ deeds also matter the most. People also need to change and do the needful to make other people aware about the State’s healthcare schemes.

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