DMAI wants PAC to start auditing unspent govt funds for healthcare
|Suja Nair Shirodkar, Mumbai
Monday, December 31, 2012, 08:00 Hrs [IST]
The Disease Management Association of India (DMAI) has urged the Public Accounts Committee (PAC), set up for the auditing of government expenditures to various sectors, to seriously consider auditing of unspent funds to the healthcare sector. In a representation made to Dr Murali Manohar Joshi, chairman of PAC, the association stressed it is essential to bring in accountability and transparency on why the funds that have been allocated for the use in various sectors go unused in spite of the requirement.
DMAI stressed that it has been observed time and again that a huge chunk of the allocated funds go back to the government exchequer, because the officials handling the responsibility was not able to use it appropriately. This they fear is because the officials who handle the charge either does not understand the need of the sector or they remain carefree since they are not questioned.
Rajendra Pratap Gupta, president, DMAI, pointed out that in healthcare sector which requires a major financial thrust from the government for various programmes, it has been noticed that a most of the funds assigned are either not released on time or are at times not released for the benefit of the sector. “There is already a huge hue and cry over the lack of insufficient funds kept aside for the healthcare sector. To make matters worse even from that funds allocated for the upliftment of the sector, a huge share goes without being spent, unused back to the government. We feel that this is because the administers do not feel answerable to the money unspent, since as of now they are only accountable for the expenditure made by the government.”
Gupta further added that for better administrative purpose and to ensure effective and timely use of the allocated funds to development purpose it is essential to start questioning the officials on unused government money. PAC which consist of selected members from the parliament, was constituted by the parliament for the auditing the expenditure of the government. However the DMAI stressed that along with getting the accountability of all the expenditure there is also an urgent need to get reasons on why the government have been lacking behind in spending money on much needed plans when the money was already sidelined for the same under the budgetary plan.
After the meeting with the chairman of PAC it was agreed upon by both the parties that there is a need to address this issues at the earliest. It is understood that following the meeting Dr Joshi has asked DMAI to submit a detailed data on all the unused funds in the healthcare sector compared to its requirement based on which they will be taking the required action.
DMAI informed that they have already started the work on this matter and will soon be sending the data to the government with updated data for their perusal.
Rajendra Pratap Gupta
President & Member
Board of Directors
Shri Ghulam Nabi Azad
Union Minister of Health & Family Welfare October 10th, 2012
Government of India.
Nirman Bhawan, New Delhi – 110108.
Reference: Empowering people , ‘Pre-emptive care’ model & update on the Government Industry Dialogue
Dear Shri Azad ji,
Hope this finds you doing good.
I attended a workshop for health ministers of NDA two days ago . During the workshop , we also visited a village in Gadhchiroli ( A naxalite area in Maharashtra ). Here, I came across a 7th class failed lady who has been delivering healthcare information and advice in the village for many years on mother and child health, and out of the past five years , the village has been ‘Child death free’ for four years .
This service of the 7th class failed lady makes me believe that time has come to move from, ‘Health for All’ to ‘All for Health’ and under this ,
- Move to a system for self care
- We must come out with a healthcare booklet for all the citizens in regional languages
- Give generic names with prices for medicines ( OTC – Over the country or non-prescription pharma or non-pharma products ) , for common seasonal and acute ailments
- Also, the Government must make this booklet available to all the citizens on its website & as an application in Android / Nokia and other phone operating systems. It is time to empower people to take to primary and preventive care . Healthcare indications with OTC products application must be made mandatory in all languages for cell phones sold in India . May be, MOCIT ( Ministry of Communications & IT ) can take the lead in doing this .
More than 3 years back , I had written in the document titled ‘Healthcare reforms agenda’ (http://www.dmai.org.in/Healthcare_Reforms_Agenda.pdf ) , about ‘mass screenings’ for people, and I am glad that your ministry has accepted it , and has already done over 10 million screenings in the past 10 months , which is really commendable . Now , it is time for India to move from ‘Preventive’ care to ‘Pre-emptive’ care ( till now, I haven’t heard this word used for health ! ).
‘Pre-emptive healthcare’ ( Before teen age ) , starts before the age ( late twenties ), when ‘Preventive care’ starts . It would include ;
- Starting with health screening for children when they turn the age of 10 . Earlier the better ! So that children grow up healthy .
- The screenings will include obesity , blood pressure and diabetes screenings, every 6 months . These checks would not cost more than Rs. 10 a year , but can help in making India the healthiest nation !
- Also, major healthcare problems arise due to deficiency of vitamins A, D & B & Omega 3. We must recommend guidelines for all children to undergo tests for deficiency of these vitamins and Omega 3, and also tie up with national level labs for offering these tests at rates mutually agreed by the Government . I understand that currently , it is difficult to have a test for Omega 3 in India, even if one needs to get it done !
- Also, dental examination and eye check – ups must be made mandatory from the age of 6 years
We should, therefore, focus on drafting the child health guidelines and ensure that these become the basic requirement for school admissions and thus, are enforced nationally.
Lastly , on the Government Industry Dialogue (GID) for Healthcare that was organized by the Disease Management Association of India (DMAI) . I understand that you could not attend due to your pre-occupation, but I did receive the note conveying your good wishes for this initiative. This dialogue was a massive success with 60 CEO’s from the Healthcare sector companies attending the dialogue and was addressed by ;
- Dr.Sam Pitroda , Advisor to the Prime-Minister
- Shri Keshav Desiraju, Spl. Secretary , MOHFW
- Dr.Ashok Kumar – representing the DGHS , Dr.Jagdish Prasad
- Shri. Anil Swarup, Addl. Secretary, Ministry of Labour & Employment
- Dr.K.Srinath Reddy, President , PHFI & Chairman, High Level Expert Group on Universal Coverage
- Dr.Prathap C. Reddy, Chairman, Apollo Hospitals Group;
- Besides CEO’s & Managing Directors of leadings healthcare corporations
Besides , the dialogue was well attended by the media . Details of the deliberations are available on http://governmentindustrydialogue.org
This dialogue showed the keenness from both the sides ( Industry & the Government ) to work shoulder to shoulder to address the key healthcare challenges facing the nation .
Three areas of cooperation have emerged; i.e. adoption of districts under mass screening programs , companies willing to work on secondary prevention program in addition to the mass screening program , IT & mHealth companies willing to provide innovative solutions for managing chronic diseases and program evaluation tools, training front line health workers & Rural health . It would be good if the MOHFW now moves to focused meetings under the Government Industry Dialogue to decide the scope of collaboration specific to each program. I am sure that this will lead to more effective implementation of existing programs . I look forward to your guidance on the same.
Over the next couple of weeks, I will be attending meetings in USA – ‘International Wellness and Chronic Care Symposium’, and in Manila – ‘The Asia Pacific Leadership & Policy Dialogue’, hosted by WHO and the World Economic Forum for digital health . Will update you on the developments
With best regards ,
Rajendra Pratap Gupta
Dr.Manmohan Singh, Prime Minster, Govt. of India.
Dr.Sam Pitroda ,Advisor to the Prime Minister of India .
Shri Keshav Desiraju, Special Secretary, Health & Family Welfare, GOI.
Shri Anil Swarup, Addl Secretary, Ministry of Labour & Employment , GOI
Dr.K.Srinaty Reddy, President , PHFI & Chairman, HLEG- Universal Coverage
Dr.Jagdish Prasad, DGHS, Min. of Health & Family Welfare, GOI.
Rajendra Pratap Gupta
President & Member
Board of Directors
September 22, 2012.
Government of India
7, Race Course road, New Delhi -110001.
Reference: National Digital Health Plan (NDHP)
Dear Dr. Singh,
I am sending this note on behalf of DMAI – The Population Health Improvement Alliance.
About Disease Management Association of India (DMAI) Disease Management Association of India (DMAI – The Population Health Improvement Alliance), was formed by Executives from the Global Healthcare industry to bring all the stake holders of healthcare on one platform. DMAI has been successful in establishing an intellectual pool of top healthcare executives to become an enabler in building a robust healthcare system in India. India is on the verge of building its healthcare system, and it has a long way to go. DMAI is building the knowledge pool to contribute & convert ‘Ideas’ into ‘Reality’, for healthcare in India. DMAI is the only not-for-profit organization focused on population health improvement in India
Let me start by quoting Kathleen Sebelius, Health Secretary of the United States, “Mobile Healthcare is the biggest technology break-through of our time to address our greatest national challenge”. Ms. Sebelius said this last year at the mHealth summit in Washington DC. This statement is more relevant to our country as, though for the developed world, mHealth is another option for healthcare delivery but for a developing country like India, mHealth is the only option!
We urge upon your good selves to initiate the National Digital Health plan – NDHP (Digital Health means Telemedicine, mHealth & technology backed healthcare delivery) for India, and may be, consider to form an inter-ministerial group to give this a definite shape. According to WHO review in 2010, only a quarter of countries worldwide had drawn up a national telemedicine policy or strategy. Let us take the lead in setting up the National Digital Health Plan (NDHP).
With 6 billion mobile phones globally at the end of 2011 and about 960 million cell phones in India, mobile phones provide a matchless platform for delivering change at the grass roots and are a tool
To deliver programs aimed at economic & social inclusion & more importantly, inclusive healthcare.
We must think seriously & act now about incorporating Telemedicine & mHealth (mobile healthcare) in our healthcare system and building a road map of Digital Health for India. With over 800 million people living in rural India and about 640,000 villages as per the latest data of planning commission’s approach paper for the 12th five year plan, it is imperative that we build a national roadmap for telemedicine in India to address the issue of accessibility & affordability with sustainability on one side, and on the other side, for leveraging a global business opportunity for Indian entrepreneurs, like what IT (Information Technology) did to India’s growth story. It is time to replicate the IT success story this time using mHealth and help the industry build a few multi-billion dollar global corporations
Telemedicine is needed for delivering ‘Inclusive healthcare’ to India & also to serve across various sectors like in defence, help in job creation, veterans’ health and disaster management.
Defence services: We need Telemedicine through dedicated satellites for armed forces posted on Naval Ships and remote areas at the border and at Siachen. Also, the ECHS for ex-servicemen could have a healthcare facility through Telemedicine at various polyclinics .This must be initiated and the ECHS clinics must be connected with Army referral centers. US Veterans administration, for e.g., found that overall the practice of telemedicine / mHealth cuts hospitalization by 30 % & admissions for heart failure by 40 %
Disaster Management: During national disasters, Telemedicine & mHealth can be the only healthcare delivery channel for the affected areas and this calls for a Telemedicine road map under National Disaster Management Authority (NDMA), at the Prime Minister’s office. During Tsunami in Japan, Continua Health Alliance members came together and gave a solution in a record time. It would have been a double catastrophe, if such a Tsunami ever destroyed paper medical records and the patients had to be moved to a remote place for treatment. Nothing could have been worked without medical devices which were interoperable and an EMR hosted over a cloud. This calls for immediate planning to avoid healthcare disaster along with a natural disaster!
Chronic Diseases: In the USA, FDA (Food & Drugs Administration) has started approving mHealth applications and two of the insurance companies recently agreed to pay for mHealth applications for diabetic patients. mHealth holds the promise to address the biggest challenge facing our nation i.e. chronic diseases & the implementation of secondary prevention program
With approximately 960+ million cell phone users; healthcare in India will converge to mHealth, and ultimately, this is where all practitioners, payers and users will converge too! It is time to look at mHealth as a tool for ‘Inclusive Healthcare’. With mHealth, ‘Universal Healthcare’ will move faster from a dream to reality!
Earlier, it was said that, ‘An apple a day keeps a doctor away’, and now it is being said rightly that, ‘An app ( mobile application ) a day keeps a doctor away’.
According to the PWC & Economist Intelligence Unit (EIU) recent study – 2012, conducted in 10 countries including India, Patients believe that convenience, cost and quality of health in the next three years will change due to mhealth
According to this study;
59 % of the doctors and payers believe that the wide spread adoption of mhealth in their countries is inevitable
In the next 3 years,
57 % of the patients in emerging markets believe that mHealth apps / services will make healthcare more convenient
54 % of the patients in emerging markets believe that mHealth apps / services will improve the quality of care
53 % of the patients believe that mHealth apps / services will substantially reduce the overall cost of care
59 % of the emerging-market patients use at least one mHealth application or service.
The Department of Health, U.K. had set up a WSD (Whole System Denominator) program to help provide an evidence base for setting further policy in this field. This was claimed to be the largest randomized control trial of Telehealth & telecare in the world. The program was launched in May 2008 involving around 6200 patients and 238 GP practices. Early indications from WSD show that, if used correctly, Telehealth can deliver a 15 % reduction in accident & emergency visits, a 20 % reduction in emergency admissions, a 14 % reduction in elective admissions, a 14 % reduction in bed days and an 8 % reduction in tariff costs. They also demonstrate a 45 % reduction in mortality rates
According to Lord Nigel Crisp, Former CEO of NHS, U.K. (National Health Service) and Member, House of Lords, ‘In UK, NHS direct started free health advice service over phone. It has over 6 million subscribers, over 10% of the country’s population’.
For chronic disease patients, Home care based ‘Nuvola It Home Doctor system’ was developed by Telecom Italia in the Piedmont region. As a part of the policy to bring health services closer to the community, patients suffering from chronic diseases monitor certain biological parameters using traditional electro-medical devices and send them to the Telecom Italia data center, using a dedicated mobile phone provided by the hospital. Home-based care is estimated to cost 180 euros compared to 700-1000 euros in hospital. mHealth based home care can provide tremendous relief to geriatric patients in India, in addition to psychiatric patients with the existing ratio of psychiatrists: population nearing 1: 10, 00000
OPD workload in Government district hospitals: In India, the biggest problem in district hospitals is the patient overload in OPD (Outdoor patients department).
By using mHealth / telemedicine, we can provide right timely interventions at the point of care and cut this OPD overload anywhere by 30-60 %.
mHealth as a tool for diplomacy: A few years ago, ISRO had taken up some key initiatives along with the Ministry of External affairs for setting up the ‘PAN network’. It is time to revive that actively, and provide remote consultations, not just in India but in developing countries of Asia & Africa. Telemedicine can be a good tool for diplomacy. I had made a keynote presentation at Lahore, Pakistan under Aman-ki-Asha in May 2012, and telemedicine and mhealth was a key point of discussion to increase collaboration between the two countries. Healthcare is the most impactful tool for political diplomacy with our neighbours who have similar challenges when it comes to healthcare.
Rural Health: With over 640,000 villages where doctors are not willing to work, technology seems to be the best solution and mHealth appears to be the best technology
In Turkey, Acibadem Mobile runs a mHealth nutrition service with 450,000 members. Also, in less than two years, an emergency healthcare service offered in conjunction with Turkish Telecom has grown to 100,000 members. . In Mexico, Medicall Home has five million subscribers who pay US $5 a month on their phone bills in order to access medical advice
Across the border, in Bangladesh, Grameenphone has set up Healthlink to allow its customers to talk to the doctors 24 X 7. This service has fielded 3.5 million calls in the last six years
Strengthening India’s healthcare system: Also, India is presently building on its healthcare system, and the 12th Five Year Plan has been referred to as the ‘Plan for Health’! Now is the right time for the policy makers to ensure that technology is embedded in all programs that the Government is planning to rollout for healthcare delivery. In specific, mHealth has tremendous potential to reduce costs, improve the reach and access to Health Care, make the healthcare system more outcomes driven, and more importantly, help in establishing an ‘empowered patient’.
According to the EIU PWC report 2012, USA has been at the forefront of mobile health deployments in the world. Almost 40 % of the solutions deployed work towards strengthening the healthcare systems. mHealth is not just promising but truly transformative to healthcare. From pill reminder, training of health workers, reducing IM / MMR, T.B. – DOTS, HIV treatment compliance to quitting smoking to managing diabetes, obesity & emergency surgeries, mHealth is becoming an integral part of healthcare delivery. It is time for the best brains to work on mHealth with all stake holders in healthcare delivery
In my view, mHealth is the only option in India, where people pay 2/3rd of the healthcare costs and only 1/3rd get healthcare in the real sense.
Seeing the potential of telemedicine, & mHealth in particular, India needs a roadmap for mHealth / Telemedicine encompassing areas of rural health, tribal health, chronic disease management, disaster management, defense services, coastal healthcare services etc.
Following might be helpful in building the digital health road map for India
Focus areas that need to be considered in the NDHP Ministry / Deptt / Org. involved
- Incorporating Digital Health in Medical education / training MCI, NIFW, MOHFW
- ESIC clinics connected via Telemedicine & home care
facilities provided through mHealth for ex-servicemen MOD / ISRO
- Sub-centers in rural areas to be replaced gradually
with mobile health Units (MHU’s & this could Consider under MNAREGA,
also double as medical ambulances at the time NRHM – MOHFW
- of emergency in rural areas)
- mHealth national grid MOHFW/ML&E/ MOD/MIT
- National / Regional IVR Health helplines on the lines of 108 MOHFW / State Govts
- mHealth for Chronic disease management MOHFW
- Skills Development for Digital Health NSDC / MHRD
- Telemedicine / mHealth under Disaster Management – NDMA PMO
- Regulation of tariffs ( special tariffs for mHealth services) TRAI
- Mental health Telemedicine Network MOHFW
- Checking counterfeit & Spurious medicines using mHealth Deptt. of Pharmaceuticals
- Healthcare facilities in Jails Min. of Home Affairs
- National IT policy 2011 & health as a mission mode project Min. of Comm. & IT
- National Institute of telemedicine & mHealth MOHFW
- DST- TDB could set up ‘mHealth innovation village’
like the Startup village in Kochi DST, TDB / CHA
- Electronic Health Record – RSBY MOL & E / HIMSS / CHA
- ECHS / Naval Telemedicine / Siachen / borders MOD / MHA / ISRO
- mHealth for Tribal health & North Eastern states MDONER / MTA
- Civil Aviation / airports MOCA / ISRO
- Social media strategy for health Min. of Comm & IT / HIMSS
- Medical Devices standards & Interoperability Min. of Comm. & IT /CHA
- Electronic Health records for all new born’s MOCWD / CHA /HIMSS
- Treatment protocols for various diseases ICMR / PHFI / AIIMS
- Enactment National Telemedicine / Digital Health Act MOHFW/Min. of Legal Affairs
- Applications Venture fund for telemedicine TDB / DST
- Digital adoption lifecycle benchmarking of different states Planning Commission /HIMSS
- National Cloud computing policy for healthcare MIT / MOHFW / HIMSS
- Privacy / data security issues of patients MOHFW / BIS / CHA
- e-Prescription policy ( Electronic / digital prescription) MOHFW / MIT /HIMSS
On the acceptability & adoption front for telemedicine & mHealth, let me quote examples; a rural telemedicine service provider in Indi has done about 200,000 consultations with 30-40 % repeat visits, across states of U.P. , Bihar, Karnataka & Maharashtra . A leading eye care hospital does over 2.5 lac telemedicine consultations every year and another eye care hospital does over 1.5 lac telemedicine consultations in a year in India.
EMRI – 108 services in Andhra Pradesh is on a PPP model, and this service receives 58000+ calls per day with 4800+ emergencies a day and has saved 20165 lives. A true example of successful mHealth / telemedicine in our own country!
HMRI -104 (Health Management Research Institute, A.P.), is about providing information on health, counseling and healthcare services via health helpline. Till May, 2008, it received 51000 calls per day. Medical advice given to 40860, counseling attended- 7493, information of health facilities provided- 6331 & complaint calls received on healthcare facilities- 253. Top 10 ailments attended were recurrent abdominal pain, back pain, knee pain, cough, hair loss, chest pain, and eye pain or problems with eyelids, rash, pain in ankles or feet, belching, growing stomach or gas.
I had a chance to visit these facilities personally and observe the calls from patients / public, and I must say that this is something every Indian must have access to, rich or poor ! With an average cost per call of Rs.9, this is definitely a successful telemedicine & mhealth model for implementation in India. http://nrhm-mis.nic.in/UI/MEActivities/goa_web/PDFs/02-05-08_pdf/Pre%20Lunch/Goa%20presentation_AP.pdf
Also, I have visited remote places in Wardha district of Maharashtra, where mHealth has been used by rural health workers and has helped reduce maternal mortality from 91 per lac to 51 per lac in a period of about 1 ½ years with an approximate investment of Rs.4000 per village . There was a 43.95 % reduction in MMR using simple phones, through text messaging and covering high risk expectant mothers with the existing network of anganwadi workers
According to the GSMA deployment tracker, currently there are around 300 commercial deployments globally. (http://apps.wirelessintelligence.com/tracker/, extracted in Dec 2011).
So clearly, mHealth & telemedicine is fast pervading and showing its impact on the healthcare system in India
Digital Health & Medical tourism: India is fast losing to other South East Asian nations as a centre of excellence for medical tourism due to lack of IT usage in its hospitals and dismal usage of mhealth / telemedicine. International patients follow the international electronic data / medical records standards , and also would like to connect with their care givers using telemedicine , and if we do not promote EMR & telemedicine through hospitals , India is likely to lose billions of dollars in revenue which otherwise could accrue through foreign patients seeking treatment in Indian facilities
Healthcare program reporting, review & timely interventions: Currently, the healthcare data is reaching after months and in some cases well over two years. This could become live and actionable for timely interventions by using GPS enabled devices & e-reporting. Solutions are already available and are scalable. It is the right time to adopt the same in NRHM, and create a national household medical record (NHMR) for the families in rural / urban India. This will help us study the epidemiology & family health risk assessment. May be, we must make it compulsory to ensure that all the 18 million new born’s must have the electronic health record and then move upwards to put an electronic health record for all Indians, post the national screening program. At least, the next generation must be having a digital health record right from birth so we do not have to change the system backwards for them in future.
So, for sure, mHealth & Telemedicine is a proven model for care delivery, and we need to support it in a more structured and institutional manner for the next 5 years .
It is beyond doubt that , mhealth will add efficiency to affordability , acceptability , accessibility & efficiency on one hand , and create about 2 million jobs and also add about 0 .5 % of growth in the GDP at a minimum in the next 5 years .
Inclusive innovation & inclusive growth have now added a new dimension, i.e. ‘inclusive healthcare’, with digital health being the starting point. mHealth is the fastest solution to the oldest problem of reaching the unreachable! We must seriously consider deploying at least 3 % of our total healthcare budget on ICT, and this will certainly make the data live and lead to timely interventions and thus saving lives, establishing accountability of the service provider through periodic reviews and bring transparency in functioning of the various programs
US FDA has approved mobile health applications for diabetes management besides others, and two insurance companies have agreed to reimburse mobile health applications for treatment of diabetes. This development indicates that the big multi-billion untapped market of the developed world is waiting to be tapped and the government needs to step in, like it did to develop multi-billion dollar corporations in the field of Information Technology. According to the Economist Intelligence Unit (EIU) & Pricewaterhouse Coopers (PwC )report 2012, mHealth market is likely to be USD 23 Billion by 2017, and Asia Pacific market will be 30 % at USD 6.8 Billion .If we work towards setting the right enabling policies for mHealth, Indian companies would grab a major portion of this market, like we did for IT industry a few decades ago. Besides, given the technical & competent manpower in India, mHealth & telemedicine can do for country what IT revolution has done for India! This calls for a dedicated action group on Digital Health (mHealth & telemedicine) .
mHealth & Telemedicine is becoming the focus area for all the major healthcare systems across the world, and given India’s expertise in this area, India can become a global provider of products and services in the field of Telemedicine & mHealth. We believe mHealth can add at least 0.5 % to country’s GDP in the next 3 – 5 years, create at least 5 billion dollar companies in mHealth, and lead to creation of over 20,00,000 (2 million) jobs directly by becoming a Global leader in this space. If two persons are deployed in every village for Telemedicine, and considering that India has over 6,40,000 villages, we will create over 1.2 million jobs directly just in rural India and this could be a worthwhile project to be considered for funding under MNAREGA scheme that will not only create jobs, but also lead to better health for rural India and lead to tremendous savings under NRHM expense head!
The good point is that, we have a least complex healthcare system in India, and we are building it up. Also, we have quite receptive and friendly policy makers who are willing to try initiatives.
Hopefully, we will lead and show the world an outcome driven & a self-sustainable healthcare delivery model built on strong foundations.
Over the past few years, I had a good experience working with policy makers across geographies and it has been a wonderful experience, especially in India, working with different stake holders to discuss new ideas and policies aimed at better healthcare options for the common man.
This is not a complete or a reference document but just to initiate a few discussion points. Should your office or any concerned organization, department or ministry need more inputs or support, my colleagues at the World Economic Forum, The Telemedicine Society of India, HIMSS & Continua Health Alliance, would be more than glad to volunteer and assist. I am sure that this submission will also be considered positively by the various stake holders in the Government and acted upon, so that we can see large scale deployment of mHealth & telemedicine projects in all major departments and programs of the Government making healthcare accessible and affordable to provide timely advice & right interventions for the common man 24 X 7.
Yours in good health
Rajendra Pratap GuptaMember, World Economic Forum’s Global Agenda Council – Digital Health Board Member, Care Continuum Alliance, Washington DC. USA Executive Council member, Telemedicine Society of India President & Member of the Board, Disease Management Association of India (DMAI).
Mrs.Sonia Gandhi, Chairperson , NAC.
Dr.M.M.Joshi, Chairman, Parliamentary Accounts Committee .
Dr.Sam Pitroda, Chairman, National Innovation Council, GOI.
Shri A.K. Antony, Hon’ble Minister of Defence , GOI.
Shri Ghulam Nabi Azad, Hon’ble Minister for Health & Family Welfare, GOI
Shri Kapil Sibal, Union Minister for HRD/ Comm & IT, GOI
Shri Jairam Ramesh, Union Minister for Rural Development, GOI.
Shri Ajit Singh, Union Minister for Civil Aviation, GOI
Shri Salman Khurshid, Union Minister for Law, GOI
Smt. Krishna Tirath, Union Minister of state (I/C) for Women & Child Development, GOI
Shri Jitendra Singh, Union Minister of state for home affairs, GOI.
Shri Sachin Pilot, Union Minister of State for Comm. & IT, GOI
Dr.Syeda Hameed, Member, Planning Commission, GOI
Dr.K.Srinath Reddy, President, PHFI.
Shri. P.K.Pradhan, Secretary – HFW, GOI
Shri. Keshav Desiraju, Addl Secy – HFW, GOI
Shri. Anil Swarup, Joint – Secretary, Ministry of Labour & Employment, GOI
Mrs. Anu Garg, Joint Secretary – HFW, GOI
Shri Harkesh Mittal, Secretary, Technology Development Board, GOI
Shri Rajeev Aggarwal, Secretary, TRAI, GOI
Shri Shankar Aggarwal, Addl Secy, MOD, GOI
Dr.Jagdish Prasad, DGHS, GOI
Dr.V.M.Katoch, Secretary DHR & DG, ICMR. GOI
Director, NIFW, MOHFW, GOI
Dilip Chenoy, Managing Director, NSCDCL,
Board of HIMSS Asia Pacific India chapter
President, Continua Health Alliance
Board, Telemedicine Society of India
Board members, Disease Management Association of India.
NDHP: National Digital Health Plan
MOHFW: Ministry of Health & Family Welfare
MHA: Ministry of Home Affairs
PHFI: Public Health Foundation of India
HFW: Health & Family Welfare
DGHS: Director General of Health Services
MCI: Medical council of India
TDB: Technology Development Board
DST: Department of Science & Technology
NIFW: National Institute of Family Welfare
TRAI: Telecom Regulatory Authority of India
MOD: Ministry of defence
MNAREGA: Mahatma Gandhi National Rural Employment Guarantee Act
NRHM: National Rural Health mission
MOL & E: Ministry of Labour & Employment
MCWD: Ministry of Child & Women Development
MIT: Ministry of Information Technology
MHRD: Ministry of Human Resource Development
MDONER: Ministry of Development for North East Region
MTA: Minister of Tribal Affairs
PMO: Prime Minister’s office
MOCA: Ministry of Civil Aviation
ICMR: Indian Council of Medical Research
BIS: Bureau of Indian Standards
CHA: Continua Health Alliance
HIMSS: Healthcare Information Management & Systems Society
NSDC: National Skills Development Corporation
EMR: Electronic Medical Records
ISRO: Indian Space Research Organization
Reports referred in this note:
Touching lives through mobile health by PWC
A Better insight to mHealth adoption
Telehealth Report 2011 by Telemedicine Society of India ( www.telemedicinecongress.com )
Emerging mHealth: paths for growth by PWC
Rajendra Pratap Gupta
President & Member
Board of Directors
August 21, 2012.
Government of India
7, Race Course road , New Delhi -110001.
Shri. Ghulam Nabi Azad
Union Minister for Health & Family Welfare
Government of India.
Nirman Bhawan, New Delhi – 110108.
Reference: Faster, Sustainable & more inclusive Growth- An approach to the 12th Five year plan – Health
Dear Dr.Singh & Shri Azad ji,
Congratulations on pushing healthcare at the top of the agenda for the 12th five year plan . I am writing this note on behalf of the Disease Management Association of India – DMAI – The Population Health Improvement Alliance .
About Disease Management Association of India ( DMAI ) Disease Management Association of India (DMAI – The Population Health Improvement Alliance), was formed by Executives from the Global Healthcare industry to bring all the stake holders of healthcare on one platform. DMAI has been successful in establishing an intellectual pool of top healthcare executives to become an enabler in building a robust healthcare system in India. India is on the verge of building its healthcare system, and it has a long way to go. DMAI is building the knowledge pool to contribute & convert ‘Ideas’ into ‘Reality’ for healthcare in India. DMAI is the only not-for-profit organization focused on population health improvement in India
Through this note, we wish to draw your attention to the 12th Five Year Plan approach paper dated October’2011, on the Health chapter ( chapter 9, page 87-95) and put forth some suggestions for your kind consideration and action
The approach paper correctly highlights the areas of concern and seven measurable targets like; IMR- Infant Mortality Rate, MMR- Maternal Mortality Rate, TFR- Total Fertility Rate, Under-nutrition among children, anaemia among women and girls
( According to this plan paper , 55.3 % of the girls are anaemic ) , provision of clean drinking water for all & improving child sex ratio for age group 0-6 years .
Given the formidable challenge that the Indian healthcare system faces, of having 830 million rural population & 6,40,000 villages, we need to be innovative to find solutions that leads to better health outcomes at standards comparable to the best and with least price points that are sustainable in the medium and long term. Also, the role of technology ( Telemedicine and mobile Health) for rural health and chronic disease management, is missing from the plan paper. Without Telemedicine , the goal of ‘Inclusive healthcare’ will remain a distant dream.
Let me take the most critical issue for which India has invested billions of dollars , and still has been facing the flak of all the international bodies and i.e. the issue of Infant mortality and maternal mortality .
We have about 18 million births every year (about 34 per minute), with highest number of still births, according to a study by Lancet . So clearly, there has to be an action plan for 18 million mothers; right from the time of conception which includes awareness , education , sensitization , nutritional & medical support as an Integrated ‘Healthy Baby Mission’ for India . This will cost about Rs. 5000.00 per new born ( not including delivery charges and post natal care ). If we include all , this could reach around Rs.10000.00 to a maximum of Rs. 15000.00 per baby. So , a total budget of Rs. 18000 crores would be needed to fix the problem if we invest Rs.10,000 per new born baby every year . But assuming the number of rural births to be 12.6 million ( 70% of all births i.e 70 % of 18 million per year), of which 80 % i.e. 10.08 million only need financing ; and the number of births in urban India to be 5.4 million ( which is 30 % of all births i.e. 30 % of 18 million), of which 50 % i.e. 2.7 million need financing, the net investment comes to not more than Rs.12,780 crore per year taking an investment of Rs 10,000 per baby per year. To make this happen, a radical change in approach is needed. Also, hoping that population stabilization efforts will contain the cost of financing in the medium and long term.
Without innovating with radical changes, this program or any program that we are building for IMR –MMR, is not going to yield any results ! ICDS has spent thousands of crores for the past 35 years and we are still trying to figure out a new model for ICDS with an inter-ministerial group ! Hoping that the new program will deliver ! Despite the fact that the ICDS has a budget of Rs. 10,000 crore for 2011 / 12, and for the entire 11th five year plan had a budget of Rs. 38980 crore, still our IMR – MMR is amongst the highest in the world.
On page 90, point 9.18, the plan paper states that, “One of the major reasons for the poor quality of health services is the lack of capital investment in health for a prolonged period of time.
The National Rural Health Mission had sought to strengthen the necessary infrastructure in terms of Sub-centres, Primary Health Centres and Community Health Centres. While some of the gaps have been filled, much remains to be done. According to the Rural Health Statistics (RHS), 2010, there is a shortage of 19,590 Sub-centres; 4,252 PHCs and 2,115 CHCs in the country”.
According to point 9.19, “It is essential to complete the basic infrastructure needed for good health services delivery in rural areas by the end of the Twelfth Plan”.
The plan paper rightly talks about lack of human resources and the accountability of people recruited. Given the complexities of the challenges faced and the keenness of the Government to save the Indian healthcare system from the pain & irreversible damage being faced by the healthcare systems in USA, U.K. & Europe , it is imperative to focus on the plan papers note on point 9.34 on ‘Publicly Financed Healthcare’ . This is a very good move and will yield significant positive outcomes
According to the point 9.34, “Public financing of healthcare does not necessarily mean provision of the service by public providers. It is possible to have public financing , while the service itself is provided by private sector players, subject to appropriate regulations and oversight. This type of partnership is common in many areas, but its scope has not been fully explored in the health sector. However, a number of experiments are now in operation, which allow for private sector participation. At the Central level, the Rashtriya Swasthya Bima Yojana (RSBY), is a health insurance scheme available to the poor and other identified target groups where the Central Government and the State Governments share the premium in 75:25 ratio. RSBY covers more than 700 in-patient procedures with a cost of up to Rs. 30,000/-per annum for a nominal registration fee of Rs. 30/-. Cashless coverage, absence of any bar based on pre-existing conditions and age limit are other unique features of this scheme. A total of 2.4 crore families have been covered under RSBY and over 8,600 health care providers are enrolled in the selected districts across 29 States and Union Territories. In several Central Government hospitals, pathology and radiology services are outsourced to private providers”.
“State Governments are also experimenting with various types of PPP arrangements which at times also
include actual provision of healthcare by private practitioners. Public Private Partnership (PPP) as a mode to finance healthcare services, if properly regulated, can be of use to the intended beneficiaries. However, care needs to be taken to ensure proper oversight and regulation including public scrutiny of PPP contracts in the social sector to ensure freedom from potential conflicts of interest and effective accountability”.
Taking into account the recommendations of this plan document, contributions , achievements and learning from other sectors , I would like to highlight the following :
Private sector has clearly made commendable difference to oil exploration , road building , ports , airlines , news and media , education & telecom, besides other sectors. Not only have the services increased & improved drastically, but India has also attained global standards in many fields where private sector participated, bringing in more and better options to the public at affordable price points. In addition, this has created more employment than the public sector. According to the report by the Planning Commission and Directorate General of Employment and Training (DGET ) , Ministry of Labour and Employment, between 1994-2008, the employment has de-grown by -0.65 % in the public sector ,while it has grown by 1.75 % in private sector .
We have achieved a lot by actively engaging the private sector in various segments of the economy. We have also learned a lot during this journey . Now is the time to translate the learning and involve the private sector in government programs for healthcare, and make sure that we have a healthier nation, with investment in healthcare leading to positive outcomes . Not only that PPP’s in health will lead to better health outcomes with accountability but also lead to increased investments and employment generation.
Need of the hour is to implement the recommendations of the Planning Commission . We need to chart out the road map for private sector engagement , and also the guidelines to balance profits with outcomes and not trade one for another ! We lack an economic model for healthcare. If we madly rush for Universal Healthcare in the name of social mandate without a proper implementation roadmap and with checks and balances , we would have embarked on a road of irreversible financial losses to the exchequer with little or no impact on the healthcare outcomes. Past experience with various government run programs shows us that we have been running ICDS in the health sector for about four decades ,and we still are rated amongst the worst when it comes to Infant mortality and maternal mortality ! Time to immediately introspect and correct as in the approach paper of the 12th five year plan.
Recently, I have been approached by two international organizations ; MAMA Alliance and the MDG Alliance
The MAMA Alliance ( Mobile Alliance for Maternal Action) is a Private Public Partnership launched in May 2011 by the founding partners- United States Agency for International Development , Johnson & Johnson with supporting partners – the United Nations foundation , mHealth Alliance , and BabyCenter.
MDG Alliance is working with the support of UN Foundation , World Bank, UNICEF, PMNCH , and the Global Compact .
I have accepted to support them by joining them as the advisory board member / partner . Such organizations will do what is easily doable by the PPP models within India !
It is the time to seriously re-consider our approach for each program, and sit & discuss with the sector that brings phenomenal execution capability ( the private sector ) and work together to come out with an economic and health outcomes model for the Indian healthcare system
Without the private sector engagement healthcare will remain a ‘bottomless pit’ for the exchequer and accountability issue will never get addressed . But for sure , with the right PPP models , we will have a faster , sustainable and more inclusive growth in the 12th five year plan ; The goal of the government .
With best regards
Rajendra Pratap Gupta
Member, World Economic Forum’s Global Agenda Council.
Board Member, Care Continuum Alliance , Washington DC.
President & Board Member, DMAI – The Population Health Improvement Alliance
further details http://www.dmai.org.in
Dear Blog Readers,
Thanks for reading the blogs . Also , thousands of people ( I believe that you are all NRHM employees or their friends , relatives or well wishers ! ) have asked me a few important questions like:
Will NRHM get extended after March 2012 ?
What will happen to NRHM after 2017 ?
Why are the temporary / contractual workers not being made permanent ?
Let me attempt to answer your questions based on my interactions with the relevant people ( based on informal discussions only ).
Yes , the NRHM is getting extended beyond March 2012 till 2017 .
Beyond 2012, since the program has been the flagship program , the likely hood of extension beyond 2017 is ‘Politically’ certain.
Also, the government believes that , the permanent government employees don’t work as good as contractual employees , so the likelihood of your becoming permanent till 2017 looks ‘Bureaucratically’ difficult
Since these answers are based on my informal discussions at the highest levels , you can be certain about some quotes mentioned above
All the best .
Rajendra Pratap Gupta
Dear Friend ,
It is said that ‘Good things happen to good people and the best to the best’ . It was the best of speakers , delegates & exhibitors from all over the world that made Telemedicon’11 the best healthcare event in India . I must thank you on behalf of the Organizing committee of the ‘Telemedicine Society of India’, to have come and actively participated in this mega healthcare congress. I am happy to let you know that Telemedicon’11 has been rated by industry as the ‘Biggest Healthcare Congress ever happened in this country ‘ , and I wish to thank you for taking this congress to such a level. We have set a new benchmark in terms of speakers , agenda , delegates and industry participation . Thanks for being a part of this historical event
We had an overwhelming response from one and all which can be judged from the fact that all the exhibitor space was sold out weeks before the congress. Also that, we had to stop the registration process few days before the congress .
People from over 30 countries visited the congress and people from 121 countries have visited the congress website
We launched the Continua Health Alliance on 13th November at this congress , and this makes this congress a very special one
We have the policy makers commitment to taking the ‘Telemedicine Beyond the Pilot Phase’ . I am working on three projects to address the issues of, ‘Infant Mortality & Maternal Mortality’ , ‘Chronic diseases’ and ‘rural health’ – using technology. Three companies have already expressed the wish to actively participate in this venture . The impact of this venture would be showcased not only in the next Telemedicon , but also in all the leading healthcare conferences across the globe in 2012. If you also have a product or service in the domain , please do write back . Shri Sachin Pilot , Union Minister of State for Information Technology , Government of India ; Aneesh Chopra , Asst. to the President & USA’s CTO ; Shri Shankar Aggarwal , Addl. Secretary, DIT , Government of India ; Dr.Dale Alverson , Past President of American Telemedicine Association ; Iboun Sylla from Texas Instruments, USA ; Clint Mc Clellan , President , Continua Health Alliance ; Ashok Chandavarkar from Intel & Dr.Pramod Gaur , USA have agreed to help make this project a reality .
Blackberry is already working on three Game Changing Ideas put across at this International Telemedicine Congress, and will invest to make them a reality .
I am also in the final phase of drafting India’s first Telehealth Report for 2011 , and please send us a one pager of your organization , if you were a sponsor at Telemedicon by November 30th , 2011. The report would be ready in the next 45 days
Let’s work together to take Telemedicine to masses and show the world that India is the place for innovation in action
Keep visiting the website for latest updates on the proceedings of Telemedicon’11
We will be uploading the photographs & videos as well as presentations for you to download . Please do share your feedback
Thanks once again for your support and I look forward to working closely with you in the times ahead
Rajendra Pratap Gupta
Member , Executive Council
Telemedicine Society of India.
Email : email@example.com
DMAI urges govt to have a strong action plan on NCD policy
The Disease Management Association of India (DMAI) has urged the government to enter into public private partnership (PPP) with NGO’s and others mall scale and medium organisations for successful implementation of the non communicable disease (NCD) policy. It wants the government to frame a strong action plan so that it can be completed effectively.
Recently Union health minister Ghulam Nabi Azad had informed that the government is soon going to launch an NCD policy that will specifically deal with ways to prevent NCDs like diabetes, stroke, cancer and cardiovascular diseases, etc. and its complications so as to reduce its impact on individuals and society.
A policy expert, Rajendra Pratap Gupta who is also the president and director, DMAI informed that the policy is soon to come in as the government has already completed the discussion with the stakeholders on the same in September.
DMAI said that though the Governments take on the NCD Policy which is soon expected to be launched in the country is appreciative, it seems to be lacking the lasting impact as the government’s approach on the same is not realistic.
Gupta said that though the Government’s commitment to address this issue is commendable, the claims that the government is trying to make is too high. “I have personally given my suggestions for the policy and if steps are taken at proper directions lot can be done in this front. But right now all that the government is trying to do is create hype in this issue, all words and no action. It is imperative for the government to have a decent action plan before going on claiming high stands.”
This comes in after the tall claims made by the Union health minister recently at an international gathering where he said that India’s target is to screen about 150-200 million people by next March under this pilot project covering 20,000 rural sub-centres and urban slums.
Under the current plan, around Rs.2000 crore has been set aside by the government for the NCDs. A source from the industry informed that under the 12th Five Year Plan the government has demanded for around Rs.55,000 crore from the planning commission for the same.
“Government must be very careful when announcing plans especially at an international arena since we will be made accountable for it later. How can the Government claim to achieve something like this in an year’s time when it does not even have one partnership to boost off to take this ahead,” exclaimed Gupta.
He further added that the government’s conceptualization on the NCD policy is very novel but if not handled properly it will lead to mockery of the whole system in front the world. “The Government cannot handle this alone and it needs to involve other stakeholders also into this programme to make it successful. Our suggestion to the government is that it should engage itself till the policy making procedure and for the execution of the same it should let the functions be handed over to private parties like NGO, small and medium scale companies etc.”
He further suggested that to ensure that these organisations are undertaking their functions properly the Government should even do special audit on their activities to check for any discrepancies if any. “Only with a solid action plan in hand can we even think of going on fulfilling the claims made by the government. The government must be more reasonable while speaking out and sharing agendas so as to ensure that people take us seriously.”
DMAI wants the government to take initiatives on the line of public private partnership (PPP) and move ahead so that India can actually do something constructive in this front than just playing with words.