In the past four years, the Narendra Modi government has attempted to transform the healthcare landscape of India.
The most important healthcare reform in the manifesto stated that the party would assure health care assistance to all Indians, and reduce the out-of-pocket spending on healthcare with the help of state governments.
The Modi government is trying to bring more people under health insurance cover with the National Health Protection Mission. Billed as the world's largest health assurance scheme-dubbed Modicare-it aims to provide free health insurance of Rs 5 lakh per family to nearly 40% of the population, or more than 100 million poor and vulnerable families based on socio-economic caste census.
Ministry of Health and Family Welfare led by J P Nadda also intended to focus on the key factors that are detrimental to our health, such as sanitation and drinking water, to help reduce the number of water-borne diseases in the country.
As the Modi-led government turns four on May 26, let's take a look at the initiatives
Mission Indradhanush for immunization of children is regarded as one of the key schemes of the National Democratic Alliance (NDA) government. It has impacted more than 25.3 million children and 6.8 million pregnant women by providing life-saving vaccines in four phases since 2014.
MI was launched in December 2014, to drive vaccination against TB, poliomyelitis, hepatitis B, diphtheria, pertussis, tetanus and measles, in 201 districts that had very low immunisation coverage.
By July 2017, 2.55 crore children under two years of age and 68.7 lakh pregnant women had been covered in 528 districts across the country.
Recently, the Centre launched the Intensified Mission Indradhanush (IMI) to reach 90% immunisation in 173 districts by December 2018.
Mission Indradhanush has completed four phases covering 528 districts wherein:
- 2.55 crore children vaccinated
- 66.57 lakh children fully immunised
- 68.78 lakh pregnant female immunised
- 73.49 lakh vitamin A doses administered
- 68.57 lakh ORS packets distributed
- 2.345 crore zinc tablets distributed
Ending Open Defecation: Starting in October 2014, the government launched their national campaign to end open defecation by 2019. In India, around 70% of the population who live in villages defecate in the open. Open defecation is more common in India than it is in the poorer countries of Bangladesh, Malawi, Republic of Congo, Rwanda and Burundi. This urged Prime Minister Modi to take up a vow to eliminate open defecation in his Independence Day Speech in 2014.
1. Swachh Bharat Cess: In November 2015, the government levied a cess of 0.5% on all services to boost their clean India initiative. The tax, known as the Swachh Bharat Cess, has been levied on all services liable for GST. By January 2016, the government had managed to collect Rs. 1,917 crores under this cess.
2. E-Health: In July 2015, the Prime Minister launched his Digital India campaign, and E-Health was one of the initiatives launched with the campaign. The broad aim of e-health is to provide effective, economical and timely healthcare services to all individuals, and especially to those people who have little access to healthcare services.
This service will be linked to Aadhaar numbers, which will make getting lab reports and OPD appointments easier. An eHospital App has also been launched with an Online Registration System (ORS). This initiative allows us to skip the hassles of registration and other formalities required at hospitals, as we can simply identify ourselves by our Aadhaar numbers.
3. Manufacture of Medical Equipment: Over the last few years the government has introduced a few new policies that are in sync with growth in the medical equipment industry. This has led to an increase in the domestic manufacturing of medical equipment, increasing its affordability and accessibility. The Union Cabinet has also given its approval to sign a Memorandum of Understanding (MoU) between India and Papua New Guinea on cooperation in the field of healthcare and medical sciences. This pact will encourage the health ministries of both countries through joint initiatives.
In February 2017, the government capped the prices of bare metal stents at Rs7,260 and drug-eluting and biodegradable stents at Rs29,600, which was almost 85% lower than the prevailing market prices. It also provided free medicines through Jan Aushadhi Kendras.
Inactivated Polio Vaccine (IPV):
In concurrence with the World Polio End Game strategy, IPV was introduced in November 2015 in six states and expanded throughout the country by June 2016. Till December'17, nearly 3.87 crore doses of IPV have been administered to children across the country since its introduction.
- Launched in March 2016 in 4 states- Andhra Pradesh, Haryana, Himachal Pradesh and Odisha, to reduce the burden of diarrhea caused by Rotavirus.
- It has been expanded to 9 states namely Andhra Pradesh, Haryana, Himachal Pradesh, Odisha, Assam, Tripura, Rajasthan, Tamil Nadu & Madhya Pradesh.
- Nearly 1.42 crore doses of Rotavirus vaccine have been administered to children by December'17
Measles Rubella (MR) vaccine:
- MR vaccination campaign targeting children from 9 months up to 15 years of age, was launched on 5th February 2017 in 5 states -Karnataka, Tamil Nadu, Goa, Lakshadweep & Puducherry.
- MR campaign has been completed in 13 states/UTs namely, Tamil Nadu, Karnataka, Goa, Puducherry, Lakshwadeep, Andhra Pradesh, Chandigarh, Daman & Diu, Dadra & Nagar Haveli, Telangana, Himachal Pradesh, Uttarakhand and Kerela (ongoing in Arunachal Pradesh and Odisha).
- Around 7.7 crore children have been vaccinated till 19th March 2018 in these states.
Japanese Encephalitis vaccination in India:
- Japanese Encephalitis vaccination in children introduced in Routine Immunization in 230 JE endemic districts subsequent to the completion of JE campaign in these districts in 2015.
- Around 15.6 crore children aged 1-15 years have been vaccinated with JE vaccine. Special JE re-campaign was carried out in all 38 JE endemic districts of Uttar Pradesh where 99.20 lakh children were administered JE vaccine.
- Adult JE campaign has been completed in all identified 31 districts. Under this campaign, around 3.29 crore adults were vaccinated with JE vaccine
Pneumococcal Conjugate Vaccine (PCV):
- To reduce child deaths due to pneumonia, a major cause of child mortality.
- It has been launched on 13th May, 2017 in 3 states i.e. Himachal Pradesh , Uttar Pradesh (6 districts) and Bihar (17 districts).
- Subsequent expansion of the vaccine to entire state of Bihar and Madhya Pradesh, and parts of Rajasthan and Uttar Pradesh over a period of three years has been planned.
- Till January'18, more than 14 lakh doses of PCV have been administered to children across above mentioned areas.
Pradhan Mantri Surakshit Matritva Abhiyan-PMSMA
To provide assured, comprehensive and quality antenatal care, free of cost, universally to all pregnant women on the 9th of every month.
PMSMA guarantees a minimum package of antenatal care services to women in their 2nd / 3rd trimesters of pregnancy at designated government health facilities.
- More than 1.16 crore antenatal check-ups conducted.
- Conducted at over 12900 health facilities across all State/UTs
- Over 4900 volunteers registered on PMSMA portal across all State/UTs
- More than 6 lakh high risk pregnancies have been identified
Six Months Maternity Leave
Maternity Benefit Act amended to enhance maternity leave period for working women from 12 weeks to 26 weeks
Elimination of Diseases
Elimination of Communicable diseases - Action plans to eliminate Leprosy by 2018, Measles by 2020 and Tuberculosis by 2025 being implemented.
'Affordable & Quality HealthCare for All' - Availability of Cheaper Medicines
1054 essential medicines, including lifesaving drugs, brought under Price Control regime after May 2014, giving the consumer total benefit Rs. 9113 crores (As on 29th September, 2017).
Modi government launched the world's largest government-funded health programme called National Health Protection Scheme (NHPS), covering 10 crore families or approximately 50 crore population, with Rs 5 lakh insurance cover per family per year. The scheme is for secondary and tertiary healthcare, mainly for hospital care.
This flagship scheme is likely to benefit more than 37% of the population, meaning that nearly all the poor and vulnerable families will be covered. The government will require Rs 12000 crore for it's implementation, with cost shared on a 60:40 basis between central and state governments.
The Ayushman Bharat programme is apparently driven by two main aims: 1) to strengthen primary health care which has been lacking in the country and 2) to offer finacial protection from catastrophic expenditure, often encountered once a family member is sick and needs long-term health care.
National Health Policy
- Health Ministry formulated the National Health Policy 2017, after a gap of 15 years, to address the current and emerging challenges necessitated by the changing socio-economic and epidemiological landscapes since the last National Health Policy was framed in 2002.
- Focus is on preventive and promotive health care while the Primary healthcare is to be comprehensive and universal. Patient centric approach listening to the voice of patients, quality care, inter sectoral convergence, access, affordability and use of technology are among its salient features.
Mental Healthcare Act- 2017
- The Act adopts a rights-based statutory framework for mental health in India and strengthens equality and equity in provision of mental healthcare services to protect the rights of people with mental health problem to ensure that they are able to receive optimum care and are able to live a life of dignity and respect.
HIV & AIDS (PREVENTION & CONTROL) ACT, 2017
- It aims to end the epidemic by 2030 in accordance with the Sustainable Development Goals set by the United Nations.
- A person living with AIDS cannot be treated unfairly at employment, educational establishments, renting a property, standing for public or private office or providing healthcare and insurance services
Affordable Medicines and Reliable Implants For Treatment (AMRIT)
The AMRIT pharmacies provide drugs for cancer and cardiovascular diseases along with cardiac implants at a 60 to 90 per cent discount on prevailing market rates.
The drugs having MRP Value of Rs. 566.34 Crores have been dispensed at Rs. 254.36 Crores, resulting on saving of Rs. 311.99 Crores to the patients.
NATIONAL Organ Transplant Program
- Apex level National Organ & Tissue Transplant Organisation (NOTTO) has been set-up for establishing country-wide network of transplant and retrieval hospitals and tissue banks.
- Five Regional Organ and Tissue Transplant Organizations (ROTTO) have been established in Tamil Nadu, Maharashtra, Assam, West Bengal and Chandigarh UT.
- National Registry to provide online system for procurement and distribution of organs and tissues has been established under NOTTO.
- 24x7 Toll free Helpline No. 1800114770 has been made operational.
- Organ Donation Rate (number of deceased organ donors per million population) has increased by four times since 2012-13.
REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM
- Treatment for drug sensitive TB is provided through a network of more than 400,000 DOT Centres
- Diagnosis of Drug Resistant TB drug susceptibility testing at 74 culture & drug susceptibility testing (C-DST) laboratories, of which 55 laboratories are also equipped with rapid molecular test namely Line Probe Assay (LPA).
- House to house screening of TB symptoms covering 5.5 crore population under Active Case Finding.
- Rs. 500 per month for nutritional support to all TB patients for the duration of TB treatment through DBT
NATIONAL AIDS CONTROL PROGRAM:
- Test and Treat' Policy launched for covering all patients with Anti Retro Viral (ARV) irrespective of CD count orclinical stage. More than 1 lakh additional HIV infected people brought under the ambit of ARV treatmentin 8 months since launch of "Test and Treat" policy
- More than 11.75 lakh people infected with HIV are on ARV treatment; 54% higher than the March'14
- More than 2 Crores pregnant women are being tested for HIV in a year with a goal to achieve elimination of Mother to Child Transmission of HIV by 2020
- Medical Device Rules 2017 notified. These provide for risk-based classification, licensing and regulation of medical devices.
- 344 irrational fixed dose combinations (FDCs) prohibited.
- New National List of Essential Medicines (NLEM, 2015) finalized. It now includes 376 medicines.
- Coronary stents added in NLEM, 2015 and their ceiling prices fixed to provide relief to patients.
NATIONAL Tobacco Control Program
Packaging and Labelling Rules: Size of specified health warnings on tobacco products enhanced w.e.f. 1st April, 2016 to 85% of the principal display area of tobacco product packs.
Quitline number has been included in new specified health warnings which will come into effect on 1st September, 2018.
Inclusion of Bidi in Tax Net: Bidi has been covered in the tax net and kept along with all tobacco products in the slab of 28% under the Goods and Service Tax (GST).
Reduction in prevalence of tobacco use: As per findings of Global Adult Tobacco Survey (2016-17), the prevalence of tobacco use has reduced by six percentage points from 34.6% to 28.6% during the period from 2009-10 to 2016-17. The number of tobacco users has reduced by about 81 lakh (8.1 million).
National Tobacco Control Programme (NTCP) has been expanded to all the States/UTs covering about 405 districts against 21 States covering 42 districts in 2013-14.
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME
- Reduction of 28% in reported positive cases of Malaria 840838 in 2017 (provisional) as compared 1169261 in 2015.
- Reported deaths due to malaria reduced by 73 % in 2017 to as compared in 2015.
- National Strategic Plan for Malaria Elimination (2017-22) launched in 2017.
Dengue & Chikungunya:
Upscaled diagnostic facilities from 394 in 2013 to 618 in 2018
The Case Fatality Rate (CFR) for Dengue (deaths per 100 cases) was sustained at 0.2% in last 3 years
Japanese Encephalitis (JE)/ Acute Encephalitis Syndrome (AES):
- JE vaccination campaign in children (1-15 yrs) completed in 229 out of 231 JE endemic districts.
- Adult vaccination Completed in all 31 districts identified in Assam, Uttar Pradesh and West Bengal.
- Kala-azar (KA):
- Reduction of 37.7% in cases of Kala-azar: from 9241 in 2014 to 5758 in 2017
- Reported deaths due to Kala-azar reduced to 100% 11 in 2014 to Nil deaths in 2017.