Dr Harsh Vardhan, Union Health Minister, laid out for the national media here today his objective of giving 1.2 billion Indians a health system that is at once accessible, affordable and equitable.

 

He said, “The early days of a new regime are a time of contemplation on the road ahead as well as wrapping up the unfinished business of the previous government. We have done well in both respects.”

 

ShriNarendraModi government’s health policy has the poorest of poor Indians as its focus, he stated. The majority hasbeen deprived of accessible and affordable healthcare for far too long. Dr Harsh Vardhan is determined to reverse this situation forever.

 

He told reporters, “I don’t believe in bringing politics into the health administration. I am working closely with health ministers of all states, regardless of political colour. Some of them have become my close friends. I am implementing the programmes started by the previous government and often infusing new energy into them.”

 

Already the first fruits of rapid conceptualising are evident. On July 3, the Prime Minister announced the expansion of India’s Universal Immunisation Programme (UIP) to cover–Rotavirus, diarrhoea,Rubella, Polio and adult cases of Japanese Encephalitis. This will cover 2.7 crore children and give momentum to India’s aim of achieving Millennium Development Goal (MDG-4) targets that include reducing child mortality.

 

On September 18, India followed up by launching the India Newborn Action Plan, a package of measures and interventions, to reduce the number of neonatal deaths from 29 per 1,000 live births at present to a single digit by 2030 –well ahead of the global deadline set for the country, 2035.

Concerned by the high mortality rate of child diarrhoea (about 2 lakh per year), Dr Harsh Vardhan launched for the first time the Intensified Diarrhoea Control Fortnight (IDCF) for the period covering July 28 to August 14. It had the slogan, “Zero child death due to diarrhoea” and comprised a set of activities to prevent deaths due to childhood diarrhoea across the country.

These included the intensification of advocacy programmes, awareness generating activities, providing diarrhoea management services, establishing ORS-Zinc corners and organising their distribution through ASHA volunteers, etc.

The past eight weeks have seen the Ministry launch extraordinary steps for combating the Encephalitis outbreaks in Bihar and West Bengal. Earlier, in the third week of June, the Health Minister personally went to parts of Bihar where encephalitis had broken out and supervised a large-scale immunisation drive.

A Kala-azar detection test procedure developed by Indian Council for Medical Research (ICMR) was dedicated to the nation in Patna on September 2 as part of a Revised Kala-azar Elimination Strategy.

Heightened surveillance and tracking systems were put in place at India’s air and sea ports after World Health Organisation (WHO) put out an international alert in the last week of August against the dreaded Ebola Virus Disease.  The Health Minister personally inspected New Delhi and Bangalore international airports to supervise the systems. Till date not a single Ebola case has been found in India.

In September, when Srinagar and Jammu, along with other parts of Jammu and Kashmir, were hit by the most serious floods in living memory, the Ministry arranged for massive airlifting of medicines, medical equipment and emergency material. Dr Harsh Vardhan visited Poonch, Jammu and made two trips to Srinagar to personally supervise relief and rehabilitation.

“Thanks to the tireless efforts of the Ministry’s doctors, officials and health workers, as well as doctors of Delhi Medical Association, Indian Medical Association and other voluntary groups, we could provide skeletal services to the affected population. Their brave and dedicated work prevented the outbreak of post-flood, water-borne diseases,” he pointed out.

The Ministry has initiated action to establish All India Institute of Medical Sciences (AIIMS) –like institutions in every state. Already 12 statechief ministers have been communicated the offer and 200 acres of land has been asked for.

Six new AIIMS coming up at Bhopal, Bhubaneswar, Jodhpur, Raipur, Patna and Rishikesh, originally conceived during AtalBihariVajpayee’sregime are to be dedicated to the nation by the end of the year. The Health Minister has visited four of these and announced that each of them would house an institute of public health, an AYUSH department and a department of environmental and occupational health.

Health Assurance

Soon after coming to power, Dr Harsh Vardhan set up an Expert Group to prepare the roadmap to the Universal Health Assurance Mission (UHAM), which also figured in the President’s inaugural address to Parliament on June 9.

Headed by Dr Ranjit Roy Chaudhury, retired Professor-Emeritus of Post-Graduate Institute of Medical Education and Research, Chandigarh, the committee submitted its report within eight weeks. It is now under consideration of the Minister.

The highlights of the proposed UHAM are: Fifty essential drugs (in generic form) with a package of diagnostics and about 30 Ayush drugs will be made available to all citizens at government hospitals and health centres across the country; a solid package of preventive and positive health information will be made available to all citizens; the Universal Health Insurance component in UHAM is poised to become the world’s largest public health insurance programme which would be free for those below the poverty line and low-premium for the rest of the population.

“At present health insurance touches about 25 percent of the population. We will spread the population of the insured rapidly, resulting in sharp fall in premium rates and many consumer benefits. An autonomous oversight body, UHAM Agency, will be formed to ensure above-board operations and genuine protection of the insured,” Dr Harsh Vardhan announced.

Social mobilisation

 

Dr Harsh Vardhan said there was need to enhance the budgetary and Plan outlays for the Health sector because the present financial outlay which works out to just about 1 percent of GDP is universally acknowledged as inadequate.

 

He added, however, that till such time as the outlays are increased, the Ministry would do its best to optimise every available Rupee. This would be possible to a large extent by introducing transparency-induced efficiency and public participation through a social movement over health.

 

Dr Harsh Vardhan noted, “Every human body is a stakeholder in the health sector of India. That is why every individual must be motivated to a lead healthy life and thereby keep the burden on the public health infrastructure to the minimum.  Thankfully, we are a young nation. With 65 percent of the population under the age of 35, it should not be too difficult to make optimal use of every available Rupee.”

 

In 1994, few were willing to give polio eradication a chance in India considering the huge costs involved and the awesome logistics that needed to be marshalled. But public participation ensured the success of pulse polio. In March 2014, thanks to eager support on the part of volunteers, India was able to eradicate polio—the last new case was detected in 2011.

 

“I have directed the Ministry to mobilise mass opinion and movements on special days of the year to be henceforth declared as ‘National Cancer Awareness Day,’ ‘National Hypertension Day’, and so on”, the Minister announced.

 

The conditions and diseases selected for similar focus are heart disease, diabetes, anaemia, hypertension, blindness, deafness, malnutrition, obesity, mental conditions, issues related to infant and maternal mortality and voluntary blood donation.

 

“Our partners will be drawn from among NGOs, faith-based organisations, educational institutions, medical professionals of the government and private sectors, clubs and related social forums. Such pointed campaigns will be instrumental in forging public-private and government-citizen coalitions for promotive and preventive health. Eventually, there will be fewer people going down with these conditions and the country’s health profile will improve,” the Minister stressed.

 

Dr Harsh Vardhan said that UHAM will have disease prevention as its bedrock. Substantial resources will be deployed to promote lifestyles that bring down the non-communicable disease burden.

 

“We are resolved to eradicate/eliminate from this country communicable diseases like measles, neonatal tetanus, filaria and kala-azar. This will be possible through a social movement backing the government’s programmes just as it did in the case of polio,” the Minister remarked.

 

The attitude of the new Health Ministry is also attuned to modern sentiments. Dr Harsh Vardhan, who has already pledged donation of his own body after death, has decided to launch a social movement to popularise organ donation and body pledging.

 

On August 7, he declared, “I wish to see a body pledging and organ donation revolution in India. But before that I will put in place a state-of-art interface system between organ donors and recipients. At present only a handful of private hospitals are controlling information on organ availability, which is making costs prohibitive for the common man. Soon public institutions will make possible for speedy and effective distribution of kidneys, hearts, lungs, bones, tissues, cornea, skin and cells at token cost to those who can pay and free to the poor.”

 

On September 1, the Minister inaugurated the first web-based interface between organ donors and recipients on the waiting list set up by the National Organ and Tissue Transplantation Organisation (NOTTO). Under NOTTO, which is housed at New Delhi’s Safdarjung Hospital, there will be regional organ and tissue transplantation organisations in Kolkata, Chennai, Mumbai, Chandigarh and Guwahati. Six state level organisations are also planned at the new All India Institutes of Medical Sciences at Patna, Jodhpur, Rishikesh, Raipur, Bhubaneswar and Bhopal.

 

Holistic Medicine

 

Though an allopathic ENT specialist himself, Dr Harsh Vardhan believes that the day of single-line treatment is over. India stands to benefit more if its traditional, evidence-based medical streams are allowed to join the public health mainstream.

 

So he has placed strong emphasis on holistic medicine. An expert group under Prof. H.R. Nagendra, Vice-Chancellor of S-Vyasa University, Bangalore,has been formed to develop treatment protocols and areas of integration.

 

“Ayurveda’s ancient wisdom has always fascinated me. That is why I have decided that the government will host for the first time the World Ayurveda Congress.  It will be held in New Delhi between November 7 and 9 and attract over 4,000 delegates. Twenty four ministers from 40 countries will participate in this important event,” he said.

 

The Minister also expedited the completion of the All India Institute of Ayurveda, New Delhi. Faculty posts have been sanctioned and it is expected to be opened soon.

 

On September 15, the Union Cabinet approved the National Ayush Mission which envisages focussed action on traditional systems of Indian medicine on a mission mode.

 

Ayurveda, Yoga, Unani, Siddha and Homoeopathy have been given pride of place in the country’s public health system. The existing AIIMS in New Delhi and the six new ones coming up in Bhopal, Raipur, Jodhpur, Patna, Rishikesh and Bhubaneswar are to have AYUSH departments.

 

Preventive approach

 

“Prevention is better than cure” is an axiom. The Ministry of Health, in its preventive approach to the health sector has focused on tobacco use as oral cancers represent a deadweight on the limited financial resources of the government.

 

The Health Ministry argued successfully in favour of the highest ever rate of tax on smoking and non-smoking tobacco –11 to 72percent increase. It is a step not only to discourage smoking but also increase the government’s revenue income. According to estimates, about Rs 3,500 crore will be raked in through the enhanced taxes – enough to build three new AIIMS every year.

 

“We are following up with recommendations for strict measures against smoking. Fines are going to go up and it is going to be very difficult to hawk smokes in India. An expert group has been constituted for coming up with recommendations,” Dr Harsh Vardhan said.

 

The war on tobacco consumption is only the earliest aspect of this new mission. Also planned are initiatives to reduce the impact of lack of public hygiene, environmental degradation including noise pollution, consumption of junk foods, promotion of exercise, etc.

 

The Swachh Bharat Campaign is expected to have a significant impact on public health and sanitation as it will lead to the curtailing of water borne as well as vector borne diseases.

 

Transparency=Efficiency + Savings

 

Dr Harsh Vardhan recalled that on May 27, his very first day in the Ministry, he had announced a zero tolerance policy on corruption and inefficiency, and laid stress on complete transparency. He is convinced that only information technology-based systems can end corruption. That is why he did not lose time to take the following steps:

 

*Put in place online food product approval systems which got operational on September 9.

 

*Central Drug Standards Control Organisation has started uploading on its website all details of pending applications.

 

*Launched e-prescription in government institutions in a phased way, and gradually plan to make it mandatory for all doctors in the country.

 

*Central Government Health Service since September 1 has been uploading on its website all information regarding medical claims that are pending for more than 30 days. This addresses the complaints over opaqueness of the process of reimbursing claims. There were also complaints of CGHS doctors prescribing branded drugs beyond the approved list. Taking all factors into consideration, it has been decided that all beneficiaries and the public at large ought to know which drugs are on the list and so they will be on view on the web site.

 

*Steps initiated to make drug procurement completely IT-guided and their delivery to government institutions across the country to be tracked online and by installing GPS on trucks to prevent diversion.

 

Dr Harsh Vardhan said, “I expect the health system’s delivery to grow manifold and the efficiency of its personnel to double by rewarding diligence and outmatching the corrupt.”

 

E-Connectivity, provided by the National Knowledge Network, will be key to strengthening health services, medical education and research. This will lead to efficiency and bridging of the logistical divide which deprives millions of people living in difficult terrain from proper health services.

 

 

Research Thrust

 

Dr Harsh Vardhan said, “Since ancient times India has pioneered medical research. There is no reason why we cannot regain that stature. We will strive to become a world leader in research through optimum usage of cutting edge technologies like stem cell, nanomedicine, molecular medicine and bioengineering. I have directed scientists in central Health Ministry foundations to dedicate themselves to developing panacea for indigenous diseases and deadly ones like cancer”.

 

On September 2, the Minister unveiled the first non-invasive kala-azar detection tests developed by scientists of Indian Council for Medical Research. He said the country’s leading premier research organisation has also been given full freedom to work in partnership with other science departments and industry to develop diagnostics, drugs, vaccines and pharmaceuticals which would be affordable for the common man and, at the same time, being globally competitive.

 

The new government has attached special importance to empowering the states so as to enable them find solutions to localised health problems.

 

The new government also decided to set up model rural health research units in Odisha, Chattisgarh, Madhya Pradesh and Andhra Pradesh. These are to focus on research into rural specific issues and introduce new technologies into rural health care.

 

A Regional Rural Medical Research Centre will come up in Gorakhpur, Uttar Pradesh for research on communicable, non-communicable, maternal and child health, nutrition, environmental and other aspects relevant to the region.

 

India is shortly to have the highest number of virology diagnostic research laboratories in the world. Recently, the Ministry has approved the setting up of 21 new laboratories, taking the total number up to 50 spread across the country. Over the next two years, the number is expected to rise to 160.

 

“I have decided to establish the Centre for Policy Research on Vaccine Preventable Diseases in New Delhi,” Dr Harsh Vardhan announced. “It will serve as a think tank for public health policy for national vaccination programmes.”

 

Three new Bills to regulate health research and facilitate clinical practices in areas like surrogacy and new systems of medicine have been finalised. These are: The Biomedical and Health Research Regulation Bill, 2014 –to regulate ethical aspects of health research; The Assisted Reproductive Technology (Regulation) Bill, 2014 which will oversee medical, legal and social issues linked to surrogacy, and, The Recognition of New Systems of Medicine Bill, 2014 to determine the distinctive characteristics of alternative systems of medicine.

 

North-East region

Dr Harsh Vardhan has laid particular emphasis on addressing the health needs of the North-East region. “This part of the country deserves concentrated action. I plan to organise a detailed visit covering the region,” he said.

 

On July 13, online entrance examinations were held in 13 towns of the region for filling up the north-east “open” category seats for the MBBS course of NEIGRIHMS, Shillong. Also, the number of seats for the post-graduate course in MD (General Medicine) was increased from 14 to 20.

 

Two new Model Rural Research Units have been opened in Assam and Tripura.  Apart from that, four Virology Diagnostic Research Laboratories have been approved for Tripura, Manipur and Assam.

 

The Minister has also expedited the completion of the North-East Institute of Ayurveda and Homoeopathy, Shillong, which will have facilities for graduate courses in the five systems. It will be the first such institution in the region outside Assam.

 

In conclusion, Dr Harsh Vardhancommented that he has discerned a sea change in the attitude of India’s medical community towards the public health sector.

 

“We have been able to motivate doctors from all backgrounds to come forward with their support and expertise. The gap between government-service doctors and private practitioners has become narrower. I intend solidifying the coalition which worked so well during the pulse polio campaign and the recent Srinagar floods,” he remarked.

 

MV                                                          *****