JP Nadda,

Union Min­is­ter of Health and Fam­ily Wel­fare

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Af­ter the Prime Min­is­ter’s let­ter to Chief Min­is­ters on TB, sev­eral States/UTs have es­tab­lished re­view com­mit­tees un­der the Chair­man­ship of Health Min­is­ter or Sec­re­tary (Health) at the State level. Sim­i­larly, the States/UTs have also es­tab­lished re­view com­mit­tees un­der the Dis­trict Col­lec­tors / Mag­is­trates at the dis­trict level. The State level re­views are con­ducted quar­terly, and the Dis­trict level re­views are con­ducted monthly. The Cen­tral Govern­ment is reg­u­larly mon­i­tor­ing the State Gov­ern­ments on im­ple­men­ta­tion of the Re­vised Na­tional Tu­ber­cu­lo­sis Con­trol Pro­gramme (RNTCP) and has guided the States to es­tab­lish State / Dis­trict level fo­rums in­volv­ing all stake­hold­ers for en­sur­ing a holis­tic ap­proach and com­mu­nity led re­sponse to­wards ad­dress­ing the prob­lem re­lated to Tu­ber­cu­lo­sis These State / Dis­trict level re­views track progress on key pri­or­i­ties and help the State and Dis­trict to im­prove per­for­mance on newer ini­tia­tives un­der­taken by RNTCP like Daily Reg­i­men, Uni­ver­sal Drug Sus­cep­ti­bil­ity test­ing, ac­tive TB case find­ing in vul­ner­a­ble groups, molec­u­lar di­ag­nos­tics ex­pan­sion, Bedaquiline based drug re­sis­tant TB treat­ment ex­pan­sion, in­cen­tives un­der Nik­shay Poshan Yo­jana for nu­tri­tional sup­port, etc. The Min­is­ter of State (Health and Fam­ily Wel­fare), Shri Ash­wini Ku­mar Choubey stated this in a writ­ten re­ply in Ra­jya Sabha.

Spe­cial Pro­vi­sion for Treat­ment of BPL/AAY Pa­tients in Hos­pi­tals

The Min­istry of Health & Fam­ily Wel­fare is im­ple­ment­ing Rashtriya Swasthya Bima Yo­jna (RSBY). Un­der this scheme, Health In­sur­ance Cov­er­age of Rs. 30,000/- per fam­ily per an­num is pro­vided to BPL and 11 de­fined cat­e­gories of un­or­ga­nized work­ers, on the ap­proved pack­ages and pack­age rates in the em­pan­elled hos­pi­tals (both pub­lic and pri­vate). The Govern­ment has ap­proved the launch of Ayush­man Bharat- Na­tional Health Pro­tec­tion Mis­sion (ABNHPM) dur­ing the year 2018-19 which will cover over 10 crore poor and vul­ner­a­ble fam­i­lies (ap­prox. 50 crore ben­e­fi­cia­ries) pro­vid­ing cov­er­age upto Rs. 5 lakh per fam­ily per year for se­condary and ter­tiary hos­pi­tal­iza­tion. The ben­e­fi­ciary fam­i­lies un­der the AB-NHPM are iden­ti­fied based on SECC de­pri­va­tion cri­te­ria for ru­ral area and 11 de­fined oc­cu­pa­tional cat­e­gories for ur­ban ar­eas. Also, the Govern­ment of In­dia has en­acted Clin­i­cal Es­tab­lish­ments (Reg­is­tra­tion and Reg­u­la­tion) Act, 2010 for reg­is­tra­tion and reg­u­la­tion of all clin­i­cal es­tab­lish­ments (both Govern­ment and Pri­vate) in the coun­try. In ac­cor­dance with the Clin­i­cal Es­tab­lish­ments (Cen­tral Govern­ment) Rules, 2012 un­der the said Act, the clin­i­cal es­tab­lish­ments in the States / Union Ter­ri­to­ries where the said Act is ap­pli­ca­ble are in­ter-alia re­quired to dis­play the rates charged for each type of ser­vices pro­vided and fa­cil­i­ties avail­able, at a con­spic­u­ous place and charge the rates for each type of pro­ce­dure and ser­vices within the range of rates de­ter­mined from time to time in con­sul­ta­tion with the State Gov­ern­ments. The Na­tional Coun­cil for Clin­i­cal Es­tab­lish­ments has ap­proved a stan­dard list of med­i­cal pro­ce­dures and a stan­dard tem­plate for cost­ing

of med­i­cal pro­ce­dures and shared the same with the States and Union Ter­ri­to­ries for ap­pro­pri­ate ac­tion by them. The clin­i­cal es­tab­lish­ments are also re­quired to fol­low stan­dard Treat­ment Guide­lines is­sued by the Cen­tral Govern­ment or State Govern­ment. The Act is cur­rently ap­pli­ca­ble in eleven States and all Union Ter­ri­to­ries ex­cept Delhi. The im­ple­men­ta­tion and en­force­ment of the said Act falls within the re­mit of the States/Union ter­ri­to­ries. The Min­is­ter of State (Health and Fam­ily Wel­fare), Smt Anupriya Pa­tel stated this in a writ­ten re­ply in the Ra­jya Sabha.

Multi Drug Re­sis­tant TB pop­u­la­tion in In­dia

As per Global TB re­port 2017, es­ti­mated num­ber of Multi Drug Re­sis­tant ( MDR) TB pa­tients are 6,01,000 glob­ally, of which 147000 (1/4th) are es­ti­mated from In­dia. Bedaquiline drug was in­tro­duced in In­dia in 2016 un­der con­di­tional ac­cess pro­gramme for se­lec­tive group of the Multi drug re­sis­tant TB pa­tients based on drug sen­si­tiv­ity re­sults of sec­ond line anti TB drugs. Bedaquiline drug is man­u­fac­tured by Janssen & Janssen, a sub­sidiary of John­son and John­son, at 100% ex­port Spe­cial Eco­nomic Zone (SEZ), Ban­ga­lore, In­dia. In In­dia, this drug is avail­able through Re­vised Na­tional TB Con­trol Pro­gramme (RNTCP) only and open mar­ket sale of Bedaquiline is not per­mit­ted by Drug Con­trol Gen­eral – In­dia as of now. As pub­lished in a me­dia re­port, No­bel Lau­re­ate Sir John Walker had raised con­cern about the al­ready known car­diotox­i­c­ity as­so­ci­ated with the drug Bedaquiline. The Min­is­ter of State (Health and Fam­ily Wel­fare), Shri Ash­wini Ku­mar Choubey stated this in a writ­ten re­ply in the Ra­jya Sabha.

Cen­tralised health record for cit­i­zens

Govern­ment of In­dia has is­sued guide­lines/ stan­dards with an ob­jec­tive to in­tro­duce a uni­form stan­dards based sys­tem for cre­ation of Elec­tronic Health Records (EHRs) by the Health care providers by for­mu­la­tion EHR Stan­dards 2016. This uni­form stan­dard helps en­sure the in­ter­op­er­abil­ity within dif­fer­ent sys­tem. The Min­istry has set up Na­tional Re­source Cen­tre for EHR Stan­dards (NRCeS) to aug­ment fa­cil­i­ta­tion for adop­tion of the no­ti­fied EHR Stan­dards in tech­ni­cal as­so­ci­a­tion with Cen­tre for Devel­op­ment of Ad­vanced Com­put­ing (C-DAC), Pune for pro­vid­ing as­sis­tance in de­vel­op­ing, im­ple­ment­ing and us­ing EHR stan­dards ef­fec­tively in health­care In­for­ma­tion Tech­nol­ogy (IT) ap­pli­ca­tions. The es­ti­mated cost is Rs. 23.59 Crores, out of which an amount of Rs.4 crores have been re­leased to Cen­tre for Devel­op­ment of Ad­vanced Com­put­ing (C-DAC), Pune for set­ting up of Na­tional Re­source Cen­tre for EHR Stan­dards (NRCeS). The Min­is­ter of State (Health and Fam­ily Wel­fare), Smt Anupriya Pa­tel stated this in a writ­ten re­ply in the Ra­jya Sabha.

Health Min­istry signs MoU with Min­istry of Elec­tron­ics and In­for­ma­tion Tech­nol­ogy to fa­cil­i­tate ac­cess of AB–NHPM to the last mile

Na­tional Health Agency (NHA) un­der Min­istry of Health and Fam­ily Wel­fare, the apex body for the im­ple­men­ta­tion of Ayush­man BharatNa­tional Health Pro­tec­tion Mis­sion (AB-NHPM), and Com­mon Ser­vice Cen­tres (CSC) scheme un­der the Dig­i­tal In­dia Pro­gramme, have signed an MoU to pro­vide in­for­ma­tion and el­i­gi­bil­ity val­i­da­tion ser­vices to ben­e­fi­cia­ries, es­pe­cially in re­mote ar­eas. Shri J P Nadda, Min­is­ter of Health and Fam­ily Wel­fare and Shri Ravi Shankar Prasad, Union Min­is­ter for Law and Jus­tice & In­for­ma­tion Tech­nol­ogy presided over the MoU sign­ing cer­e­mony. As the ben­e­fits un­der AB-NHPM are based on en­ti­tle­ment and not on en­rol­ment, over 3 lakh CSCs spread across the ru­ral In­dia can be­come the key point of in­for­ma­tion for po­ten­tial ben­e­fi­cia­ries and help in val­i­dat­ing their en­ti­tle­ment. The MoU was signed by Dr. Indu Bhushan, CEO, Na­tional Health Agency (NHA) and Dr. Di­nesh Tyagi, CEO, CSC-SPV. Shri JP Nadda, Union Health Min­is­ter said “With this MoU, the dream of Dig­i­tal In­dia is tak­ing a big leap. In Ayush­man Bharat shall ben­e­fit 55 Cr peo­ple across the coun­try. The 3 lakh CSCs in 2.5 lakh Pan­chay­ats shall be a great help in the im­ple­men­ta­tion of the scheme. ” He added, “I am con­fi­dent that CSCs would be a big mile­stone in the ac­cess of uni­ver­sal health­care in our coun­try.” Shri Ravi Shankar Prasad said that, “To­day, I am very happy that CSC

VLEs are go­ing to be the sol­diers of health­care-Ayush­man Bharat in In­dia. The iden­tity and reg­is­tra­tions of ben­e­fi­cia­ries would be done through CSCs. I would like to con­grat­u­late Shri J.P. Nadda that his min­istry has cho­sen CSCs for the im­ple­men­ta­tion of the largest health­care scheme of the world.” Dr. Indu Bhushan, CEO, Na­tional Health Agency (NHA), said that this in­te­gra­tion will not only cre­ate more ac­ces­si­bil­ity and trans­parency in the ben­e­fi­ciary val­i­da­tion process, but will also spread aware­ness among the tar­geted ben­e­fi­cia­ries. The net­work of CSCs is the cor­ner­stone of Dig­i­tal In­dia and they will pro­vide sup­port to the flag­ship mis­sion for build­ing a healthy In­dia. AB-NHPM tar­gets ap­prox­i­mately 10.74 crore poor, de­prived fam­i­lies and has iden­ti­fied oc­cu­pa­tional cat­e­gory of ur­ban work­ers’ fam­i­lies as per the lat­est So­cio-Eco­nomic Caste Cen­sus (SECC) data, for both ru­ral and ur­ban In­dia. CSC will be pro­vided ac­cess to Ben­e­fi­ciary Iden­ti­fi­ca­tion Sys­tem (BIS), which helps in con­firm­ing ap­pli­ca­tion from ‘en­ti­tled’ ben­e­fi­cia­ries us­ing SECC and RSBY data­bases. Val­i­da­tion of en­ti­tled ben­e­fi­ciary through BIS will en­sure timely in­for­ma­tion upto the last mile, fa­cil­i­tat­ing ben­e­fits un­der Ayush­man Bharat. The BIS has al­ready been de­signed and pilot test­ing is un­der­way across var­i­ous States.

Life­style dis­eases in In­dia

In­dian Coun­cil of Med­i­cal Re­search (ICMR) and other In­sti­tutes con­duct stud­ies on life­style dis­ease. Ac­cord­ing to ICMR In­dia State-Level Dis­ease Bur­den Study re­port “In­dia: Health of the Na­tion’s States”, the es­ti­mated pro­por­tion of all deaths due to Non-Com­mu­ni­ca­ble Dis­eases (NCDs) has in­creased from 37.09% in 1990 to 61.8% in 2016. As per the Na­tional Fam­ily Health Sur­vey (NFHS); 2015-16, 11% of women (1 in 10) and 15% of men (1 in 7) of age 15-49 are hy­per­ten­sive. The sur­vey has also found that about 60.4% of per­sons screened have ever had their blood pres­sure mea­sured. As per ICMR’s can­cer registry data, the es­ti­mated in­ci­dences of can­cer pa­tients in In­dia are 13,28,229, 13,88,397, 14,51,417 and 15,17,426 dur­ing the years 2014, 2015, 2016 and 2017, re­spec­tively. While es­ti­mated deaths due to can­cer dur­ing these years are 670541, 701007, 732921 and 766348, re­spec­tively. The Govern­ment has for­mu­lated the Na­tional Health Pol­icy, 2017, which aims at­tain­ment of the high­est pos­si­ble level of good health and well-be­ing for all at all ages, through a pre­ven­tive and pro­mo­tive health care ori­en­ta­tion in all the de­vel­op­men­tal poli­cies, and uni­ver­sal ac­cess to good qual­ity health care ser­vices with­out any­one hav­ing to face fi­nan­cial hard­ship as a con­se­quence. The pol­icy seeks to move away from Sick- care to Well­ness, with thrust on pre­ven­tion and Health pro­mo­tion. The pol­icy, in­ter alia, seeks to re­duce pre­ma­ture mor­tal­ity from car­dio­vas­cu­lar dis­eases, can­cer, di­a­betes or chronic res­pi­ra­tory dis­eases. Govern­ment of In­dia is also im­ple­ment­ing Na­tional Pro­gramme for Pre­ven­tion and Con­trol of Can­cer, Di­a­betes, Car­dio­vas­cu­lar Dis­eases and Stroke ( NPCDCS) un­der the Na­tional Health Mis­sion. The ob­jec­tive of the pro­gramme in­cludes aware­ness gen­er­a­tion for Can­cer pre­ven­tion, screen­ing, early de­tec­tion and re­fer­ral to an ap­pro­pri­ate level in­sti­tu­tion for treat­ment. For Can­cer, the fo­cus is on three Can­cer namely breast, cer­vi­cal and oral. Fur­ther, for early di­ag­no­sis, pop­u­la­tion level ini­tia­tive of pre­ven­tion, con­trol and screen­ing of com­mon NCDs (di­a­betes, hy­per­ten­sion and can­cers viz. oral, breast and cer­vi­cal can­cer) has been rolled out in over 150 dis­tricts of the coun­try in 2017-18 un­der NHM, as a part of com­pre­hen­sive pri­mary health­care. This ini­tia­tive will not only help in early di­ag­no­sis but also will gen­er­ate aware­ness on risk fac­tors of com­mon NCDs. Un­der Prad­han Mantri Swasthya Su­rak­sha Yo­jana(PMSSY), 6 new AIIMS have been set up and upgra­da­tion of iden­ti­fied med­i­cal col­leges has been un­der­taken which will also im­prove ter­tiary care fa­cil­i­ties for NCDs in­clud­ing Di­a­betes. In col­lab­o­ra­tion with the Min­istry of AYUSH, an ini­tia­tive to use the knowl­edge avail­able in AYUSH sys­tem of medicines for pre­ven­tion and con­trol of Non-com­mu­ni­ca­ble Dis­eases is be­ing im­ple­mented in 6 dis­tricts on pilot ba­sis. The Min­is­ter of State (Health and Fam­ily Wel­fare), Smt Anupriya Pa­tel stated this in a writ­ten re­ply in the Ra­jya Sabha.

JP Nadda, Union Min­is­ter of Health and Fam­ily Wel­fare

Anupriya Pa­tel, Min­is­ter of State for Health and Fam­ily Wel­fare

Ash­wini Ku­mar Choubey, Min­is­ter Of State Min­istry Of Health And Fam­ily Wel­fare

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