Man With A Vision J P Nadda

J P Nadda, Union Minister for Health and Family Affairs, is on a mission to find out holistic solutions for healthcare issues in India. Ever since taking charge of the Union Health Ministry on November 10, 2014, he has formulated and executed crucial public health programmes and policies to achieve universal health coverage. One of them is Mission Indradhanush that aims to cover all those children by 2020 who are either unvaccinated or are partially vaccinated against seven vaccine preventable diseases which include diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B. In an exclusive interview with Amresh Kumar Tiwary, Editor-in-Chief of Double Helical, J P Nadda underlined that the government’s Immunization Programme is one of the key interventions for protection of children from life-threatening conditions, which are preventable.

The minister is determined to improve the patient-doctor ratio in the country, for which he emphasises on building up the primary and secondary health infrastructure with the co-operation of states. He has also launched AMRIT stores that distribute affordable cancer and heart disease drugs. Under National Health Mission (NHM), the health ministry is paying special attention to maternal and child care. Significantly, tuberculosis and HIV numbers are in decline. His ministry is also focussing on Digital Health. “We want to bring about improvements in Indian public healthcare delivery by progressively using information & communication technology under the overall objective of Digital India,” he said.

The minister is also keen on “National Medical Commission (NMC) Bill” which provides for constitution of NMC in place of Medical Council of India (MCI). Excerpts…
Excerpts from the interview…

Q: What steps has your ministry initiated to fulfil the mission for quality and affordable universal healthcare in India?
Ans: The ministry has taken up several initiatives in this regard. Besides sustaining India’s Polio free status, India is the first country to be officially acknowledged as being Yaws-free (much before the WHO global target year of 2020.). Also, India was validated for Maternal and Neonatal Tetanus Elimination (MNTE) in April 2015, much ahead of the global target date of December 2015.
What is perhaps noteworthy is that India’s Under-five Mortality Rate and Maternal Mortality Ratio declined at a higher pace than global average. The percentage annual compound rate of decline in IMR during the period of the Mission also accelerated from 2.1% to 4.5%.
There has been a significant decline in Total Fertility Rate (TFR). The TFR in India declined from 3.8 in 1990 to 2.9 in 2005 to 2.3 in the year 2013. 24 States/UTs have already achieved replacement level of less than 2.1.
We have further taken up several new initiatives such as Mission Indradhanush, Kayakalp, AMRIT, Introduction of new vaccines (IPV, MR, Rotavirus and Adult JE), Pradhan Mantri Surakshit Matritav Abhiyaan (PMSMA), MAA (Mother’s Absolute Affection), various digital initiatives (E-Hospital, E-Blood Banking, MCTS, Mobile Academy, Kilkari, ANMOL, Mera Aspataal etc.).
Steps have been taken for AIDS control, TB control and Family planning etc. and appropriate ground work has been done for a big leap forward.
• Under NPCDCS, a massive awareness drive on NCDs and lifestyle diseases named “Chalo Banayein Swasth Bharat” has been initiated.
• The Transplantation of Human Organs Act (THOA), 1994 has been enacted to regulate the removal, storage and transplantation of human organs for therapeutic purposes and to prevent commercial transactions. Subsequent amendments in the Act and revised rules have incorporated provisions for promotion of organ donations from cadavers too.
• It is a matter of pleasure that we have started taking decisive steps for harvesting of cadaver organs and tissues and hope that in the near future, we will be able to optimally utilise this vast national resource. Government of India is implementing the National Organ Transplant Programme (NOTP) to promote organ donation from brain stem dead persons and thereby increase the availability of organs for transplantation.

Q: Don’t you think it is imperative for the government to increase its health budget to strengthen the country’s healthcare delivery system– plagued by an acute shortage of staff, poor infrastructure and lack of equipment –as per global standards?
Ans: There is no paucity of funds. In three years, expenditure in health has gone up from Rs 22476 crore (2013-14) to Rs 31300 crore (2016-17, projected).
• A net increase of Rs 8824 crore.
• Percentage increase of 39%.
For NHM, Rs 19000 crore has been provided during 2016-17.
• This is an increase of Rs 705 crore over the last year.
• With the earlier sharing pattern (75:25), the state share was Rs 5351.90 crore, which has now become Rs 10746.69 crore in the 60:40 pattern of sharing which is an increase of 25.8%
NHM continues to support the State Governments in strengthening their health systems. More than Rs 1,40,376 crore has been released to the states/UTs as grants-in-aid till 31st March 2016.

Strengthening the Infrastructure: During the last 2 years (2014-2016), 3492 new constructions and 1030 renovations of health facilities including SC, PHC, CHC, SDH and DH were sanctioned, whereas 4917 constructions and 3543 renovations have been completed.

Q: The country’s population is under threat by consumption of tobacco, alcohol, drugs and other substance abuse. What measures has your ministry been taking to curb such habits?
Ans. Tobacco is one of the important risk factors of the NCDs like cancer, Diabetes and CVDs. We have implemented 85% pack warning to reduce the demand. Cigarette & Other Tobacco Products Regulation Act has been enacted in 2003 to reduce consumption of tobacco and its products and to protect the society from second hand smoking. We have banned the sale of Gutkha in open market. India also ratified the WHO-Framework Convention on Tobacco Control (WHO-FCTC) in February 2004. Further, in order to facilitate the effective implementation of the Tobacco Control Law, to bring about greater awareness about the harmful effects of tobacco as well as to fulfil the obligations under the WHO-FCTC, the Union Ministry of Health and Family Welfare launched the National Tobacco Control Programme (NTCP) in 2007- 08 in 42 districts of 21 States/Union Territories of the country. We are trying to expand the Programme to almost all the states and UTs during the Twelfth Five Year programme.

Q: Challenges to human well-beings such as AIDS, Dengue, and Chikungunya, and lifestyle ailments are very common these days. What preventive measures has the Union Health Ministry undertaken to eliminate these enemies of good health?
Ans: Various initiatives have been taken for the prevention of HIV/AIDS
• National AIDS Control programme is now 100% Central Sector Scheme.
• National Strategic plan for Elimination of Parent to Child transmission of syphilis launched on 25 February 2015.
• 1,00,000 additional patients brought under the ambit of Anti Retro Viral (ARV) treatment by increasing the threshold of CD4 count for ART from 350 to 500.
• A third line treatment has been started to patients of HIV/AIDS.
• A total of 14 MOUs with ministries/department have been signed till date. Out of these, 6 MoUs have been signed during the past 12 months.
• Transportation of blood samples from Patient to Viral Load testing Labs has been made easier after validation of Dried Blood Spot (DBS).

We are committed to malaria elimination. The National Framework for Malaria Elimination (NFME) was launched on 11th February 2016. Preventive measures by source reduction, engineering methods, use of Long Lasting Insecticidal Nets (LLIN), Indoor Residual Spray (IRS), repellents etc., early case detection, complete treatment are part of the strategy. Also, Kala-azar is targeted for elimination by 2017 and Lymphatic Filariasis by 2020; as of now, it’s eliminated in 502 out of 625 endemic blocks (80%) in Bihar, Jharkhand, West Bengal and Uttar Pradesh

Q: There is growing concern over the global spread of Zika via international travel. Are we fully prepared to tackle Zika virus disease if it does strike India?
Ans: The Ministry reviewed the risk perception, prevention and control measures to be taken, advisories to be issued etc, in a series of meetings for both Ebola and Zika virus disease. The surveillance at Point of Entries (ports and airports) and in the community was strengthened to detect cases at these places and those emerging in the community.
The Integrated Surveillance Disease Programme (IDSP) tracked such passengers who do not report symptoms of Ebola at the time of arrival at ports and airports, but they are categorized as prone to the risk of acquiring the disease. Latest diagnostic technology is available at the National Institute of Virology (NIV), Pune and National Centre for Disease Control, Delhi to test any emerging pathogens including Ebola and Zika virus. Further, 10 additional laboratories were identified and strengthened to test samples of these viruses.
All states identified isolation facility/hospital for managing cases of the Ebola virus disease.
The Ministry of Health & FW conducted training for Master Trainers, training of State Rapid Response Teams and mock drills for public health preparedness and response to the Ebola virus disease. The training of Rapid Response Teams was also done for Zika virus disease. Adequate stock of Personal Protective Kits (PPE) has been kept for managing the Ebola virus disease.
Joint Monitoring Group under DGHS is regularly monitoring the global outbreak of these viral diseases and continuing to assess the risk posed to our country. 24Xx Control Room-cum-helpline is functioning under the Directorate General of Health Services (Dte.GHS). All guidance documents, fact sheets and frequently asked questions (FAQs) have been put up on the website of Ministry of Health & Family Welfare. Awareness has been also been created among public about Ebola and Zika virus disease, through targeted awareness campaigns.

Specifically for Zika virus disease:
a. The Rashtriya Bal Swasthya Karyakaram (RBSK) has instituted surveillance for weekly reporting of Microcephaly from about 50 identified health institutions.
b. National Vector Borne has alerted all these field units for enhanced vector control of Aedes Mosquito, the vector transmitting Zika virus disease.
c. Laboratories under ICMR are testing the Aedes mosquitoes for presence of Zika virus in them (Zeno Diagnosis)

Q: What is your action-plan to reduce the maternal and infant mortality rate in the country?
Ans: We aim to tackle child mortality overall i.e. Neo-natal, Infant and Under 5 Child mortality. Our committed efforts have achieved the following:

INDICATOR 2014 TARGETS
Infant Mortality Rate (IMR) 39 25 (NHM’s target for 2017)
Neo-natal Mortality Rate (NMR) 28 <20 (NHM’s target for 2017)
<12 (SDG target for 2030)
Under 5 Mortality Rate (U5MR) 45 42 (MDG target for 2015)
25 (SDG target for 2030)
The specific new initiatives to improve these rates are:
1. India Newborn Action Plan (INAP)
2. Intensified Diarrhoea Control Fortnight (IDCF)
3. National De-worming Day (NDD)
4. MAA (Mother’s Absolute Affection) Programme
Apart from that, to reduce the infant mortality caused by vaccine preventable diseases, the Government of India provides vaccination against 10 vaccine preventable diseases namely Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood Tuberculosis, Hepatitis B and Meningitis & Pneumonia caused by Hemophilus Influenza type B across the country; and Japanese Encephalitis in JE endemic districts and Rotavirus diarrhoea in selected states. The Government is planning to introduce Pneumococcal conjugate vaccine (PCV) and expand rotavirus vaccine across the country to reduce the mortality and morbidity due to pneumonia and diarrhea respectively. Further, to reduce the burden of Congenital Rubella Syndrome, Rubella vaccine is also being planned for introduction as Measles-Rubella Vaccine in a phased manner across India.

Q: How do you intend to leverage the ‘Make in India’ and ‘Digital India’ campaigns to bring healthcare services to the doorsteps of the poor and underprivileged sections?
Ans: Information & Communication Technology (ICT) can improve the delivery of healthcare services and management of the public health system. The Vision of eHealth in India is to create “An integrated health information system which serves the needs of all stake-holders and improves efficiency, transparency, and delivery of better health outcomes in terms of access, quality, and affordability”. The following components have been included under Digital India relating to healthcare which is outlined under Pillar 4 – eKranti- “Electronic Delivery of Services”.
• Online medical consultation,
• Online medical records,
• Online medicine supply and
• Pan-India exchange of patient information.
Ministry of Health & FW has envisaged establishing a system for interoperable Electronic Health Records (EHRs) of citizens to be created, made available and accessible online to facilitate continuity of care, better affordability and better health outcome and better decision support system.To achieve this goal, MoHFW is also in process of developing an Integrated Health Information Platform (IHIP) for interoperability amongst various health IT systems and for pan-India exchange of electronic health records (EHRs) of citizens. This platform will enable EHRs of citizens to be made available and accessible nationwide.
“Aligned with the “Make in India” and “Digital India Programme”, Ministry of Health & Family Welfare has undertaken various initiatives with the key focus primarily on bringing health services within the reach of citizens through different technology platforms such as mobile, internet, telephone etc. such as:
• Online Registration System (ORS): A system to offer services for online registration, appointment, other patient centric services like viewing lab reports, blood availability status etc. As on date, 59 hospitals on board and till date more than 550,000 appointments transacted online.
• Mera Aspataal: This is an initiative to capture patient feedback for the services received at the hospital through user-friendly multiple channels such as SMS, Outbound Dialling (OBD), mobile application and web portal.The patient can submit the feedback in seven different languages on mobile app and web portal; for the hospitals visited in last 7 days also can check the already submitted feedback

This initiative was launched on 29th August, 2016 and as on date 96 hospitals are on-board at this portal and more than 140000 feedbacks have been received from different patients.
• National Health Portal (NHP): It serves as a single point access for information on Health and Diseases including health messages; on Regulations, Standards, Policies, Programs, Commissions etc.; Directory Services – Hospitals, Blood Banks, Ambulances. NHP also has toll free national number 1800-180-1104 for providing information related to health, diseases, lifestyle, first aid, directory services, and health programs etc. Total web users till date are over 26 lakhs.
• Mobile Apps: For further supplementing the accessibility of the services for citizens, various Mobile Applications have been launched especially in areas of immunisation, healthy lifestyle, health facility directory etc. such as:
– Indradhanush Immunization (for immunisation tracker),
– India Fights Dengue (enables a user to check Dengue Symptoms, get nearest Hospital / Blood bank information and also share feedback);
– NHP Swasth Bharat (Disease, Lifestyle, First Aid),
– Mera Aspataal Mobile App (for patient feedback on services in hospitals),
– NHP Directory Services Mobile App (provides information related to Hospital and Blood banks across India). This user friendly application accesses the user location and enables a person to find nearby hospitals and blood banks.);
– No More Tension Mobile App (stress management),
– Pradhan Mantri Surakshit Matritva Abhiyan Mobile App (reporting pregnancy care related information from across states).

• Mother and Child Tracking System (MCTS)/Reproductive Child Health (RCH) application: individual-based tracking system across all the States & UTs to facilitate timely delivery of antenatal and postnatal care services and immunization to children with an objective of improving IMR, MMR, & morbidity; providing alerts about the services due list and service delivery gaps; appropriate health promotion messages to beneficiaries. During 2016-17, 1.22 crore pregnant women and 92.30 lakhs children were registered in MCTS and RCH portal combined as on 30th Dec, 2016.

– Under this, various other programmes have been initiated:
i. Mother and Child Tracking Facilitation Centre (MCTFC)
ii. Kilkari: It an audio-based mobile service, to deliver free, weekly, time-appropriate audio messages about pregnancy, child birth and child care delivery to families’ mobile phones.
iii. Mobile Academy: It is a free audio training course designed to expand and refresh the knowledge base of Accredited Social Health Activists (ASHAs) and improve their communication skills.
iv. ANM On Line (ANMOL): a tablet based application for Integrated RCH Register which acts as a job aid to the ANMs

• SUGAM – Central Drugs Standards Control Organisation: It enables online submission of applications, their tracking, processing & grant of approvals online mainly for drugs, clinical trials, ethics committee, medical devices, vaccines and cosmetics. It provides a single window for multiple stakeholders (Pharma Industry, Regulators, Citizens) involved in the processes of CDSCO.
SUGAM Portal has been shortlisted for smart e-Governance award by Computer Society of India.

• Drugs and Vaccines Distribution Management System (DVDMS): an IT Application to improve supply chain of the drugs, sutures, surgical items etc. by automating the workflow. Implemented in 9 States. Also under implementation in 7 States.

• Health Management Information System: Facilitate Collection and Collation of data, reporting on health service delivery. Currently, around 2 lakh public health facilities (across all states/ UTs) are reporting aggregate monthly data related to health service delivery under national health mission. Monthly information includes maternal and child care, immunization, family planning, mortality, child morbidity, OPD/IPD and major and minor surgeries.

• Nikshay: Nikshay is a Tuberculosis control programme to monitor and track services and status relating to screening, diagnosis, medication, treatment and follow-up of tuberculosis cases
• Tobacco Cessation Programme– a mobile-based interventional initiative for tobacco cessation. Currently, more than 19 lakhs users are registered.
• mDiabetes Program – a mobile-based initiative for prevention and care of diabetes. Currently more than 1 lakhs users registered for mDiabetes
• eRaktKosh- A centralized blood bank management system for all the licensed blood banks in public and private health facilities in states/UTs. Mobile version with citizen interface is also available. Services are management of workflow in blood bank, information to citizens about nearest blood bank, and information about blood camps. This initiative has been piloted in Madhya Pradesh, West Bengal and IRCS Delhi.
• Food Safety and Standards Authority of India (FSSAI)- FSSAI has been created for laying down science based standards for articles of food and to regulate their manufacture, storage, distribution, sale and import to ensure availability of safe and wholesome food for human consumption. Its various online services include online license, clearance, and product approval to the food business operators.
• Indian Nursing Council: The Indian Nursing Council is an autonomous body under the Government of India to establish a uniform standard of training for nurses, midwives and health visitors. The various services are online registration of nursing institutions, and online forms for enhancement of seats, renewal/validity.
• For student community- Online registration of candidates, online payment through payment gateway, online issuance of Admit Card for candidates and online filing of OMR Sheets for All India Pre-Medical Test; online medical counselling etc are being provided by Ministry
• Online Approval System for Medical Colleges- The system provides approval for UG/PG courses in medical colleges; services include online application and approval for UG/PG courses

Digital Health has huge potential of improving the healthcare delivery system and is capable of changing the landscape of healthcare in the Country. The Government of India has been increasingly focusing on Digital Health to bring about improvements in Indian public healthcare delivery by progressively using Information & Communication Technology under the overall objective of Digital India.

Q: What is your ministry doing to tackle the problem of malnutrition, unavailability of safe drinking water and lack of hygiene and sanitation across the country?
Ans: In 2015, the Ministry of Health and Family Welfare (MoHFW), as part of its contribution towards ‘Swachh Bharat Abhiyan’ , rolled out the Kayakalp Award scheme for Central Government hospitals and for public health facilities in states/UTs under the National Health Mission, aimed at encouraging and incentivizing public health facilities in the country to demonstrate high levels of cleanliness, hygiene and infection control practices through a cycle of periodic assessments and certification.
The Ministry of Drinking Water and Sanitation (MDWS) launched its ‘Total Swachhata Campaign’ encompassing safe drinking water, proper disposal of human excreta, environmental sanitation, personal and food hygiene, solid and liquid waste management activities and making Gram Panchayats Open Defecation Free (ODF) through construction of toilets and behavioural change. While 700 blocks in the country have been declared Open Defecation Free (ODF), assessment of PHCs for Kayakalp awards is already underway.
To complement and leverage the efforts and achievements made so far, the MDWS and the MOHFW have launched a joint initiative – Swachh Swasth Sarvatra.

The three key components of Swachh Swasth Sarvatra are:
• CHCs in ODF Block supported to achieve Kayakalp certification
• Gram Panchayat of Kayakalp PHC prioritized to become ODF
• Training in WASH of CHC/PHC nominees
In blocks where, through efforts of the MDWS and local community, open defecation has been eliminated, the MOHFW will provide the Community Health Centre (CHC), a grant of Rs 10 lakhs to ensure that the facility achieves the quality benchmarks for sanitation, hygiene and infection control with a minimum score of 70 under the Kayakalp assessment. Improved sanitation practices of the community are expected to complement the high level of sanitation and hygiene in the healthcare facility, and consequently reduce the disease burden related to water borne diseases.
The MDWS will undertake ODF activities in the Gram Panchayats of Kayakalp award winning PHCs. MDWS will also provide WASH training to a nominee of those CHCs and PHCs. This complementarity will enable stakeholders to work together for a joint vision and become accountable for common goals.

Q: How does you ministry propose to deal with the unsatisfactory progress registered by the country regarding organ donation in the country?
Ans: The Government of India has launched National Organ Transplant Programme for carrying out the activities as per Transplantation of Human Organs and Tissues Act, 1994 training of manpower and promotion of organ donation from deceased persons. Under the said programme, an apex level organization, National Organ and Tissue Transplant Organization (NOTTO) has been set-up at Safdarjung Hospital, New Delhi for national networking, national registry to provide an online system for procurement and distribution of organs & tissues and to promote deceased organ and tissue donation.
• Government has taken various steps to simplify organ donation law/rules and procedures such as Website of National Organ & Tissue Transplant Organisation (www.notto.nic.in) that provides updated information and online facility for registering pledges for organ donation.
• A 24×7 call centre with toll free helpline number (1800114770) has been established for providing information on organ donation and coordinating matters relating to retrieval and allocation of organs recovered from cadaver donors.
• National Organ and Tissue Donation and Transplant Registry (NOTTR) have been launched. NOTTO has launched National Registry for maintaining National Waiting list of patients who require organs/ tissue.
• The networking of transplant and/or retrieval hospitals has been started initially in Delhi and NCR. Five regional level organizations called Regional Organ and Tissue Transplant Organization (ROTTO) have been identified in the states of Tamil Nadu, Maharashtra, Assam, West Bengal and UT of Chandigarh for networking and coordinating procurement and distribution of organs. Operational guidelines for National Organ Transplant Programme have been released.
• Policy and criteria for organ allocation in case of kidney, liver, heart & lung and cornea have been approved. Standard Operating Procedures for various vital organs has been approved and uploaded on NOTTO website.
• More than 1 lakh pledges for organ donation received.

Q: Could you brief us about the progress of the government’s immunization programmes to get rid of the scourge of small pox, diphtheria, Hepatitis B, and many other vaccine preventable diseases?
Ans: Universal Immunization Programme (UIP) is one of the key interventions for protection of children from life threatening conditions, which are preventable. It is one of the largest immunization programmes in the world and a major public health intervention in the country targeting more than 2.6 crore newborns & close to 3 crore pregnant women annually through more than 90 lakh immunization sessions. As mentioned earlier, it provides vaccination against ten life threatening diseases. Through successful implementation of Universal Immunization programme, we have eradicated polio and eliminated maternal & neonatal tetanus from our country and riding on that success, the government is planning to introduce new vaccines like Measles-Rubella Vaccine & Pneumococcal Conjugate Vaccine and expand the geographic reach of rotavirus vaccine to bring down the mortality & morbidity in children due to these diseases.

Q: Why has the government not been able to strictly enforce laws whereby the poor can afford best treatment at expensive private hospitals?
Ans: The Government of India has proposed to launch a new improved health care Scheme viz. National Health Protection Scheme which is under finalization that envisages health cover of up to Rs. 1.0 lakh per family for poor and economically weak families. For senior citizens of aged 60 years and above in this category there is an additional top-up package up to Rs 30,000. The senior citizen component has been implemented w.e.f. 01.04.2016. Apart from that, we have launched several initiatives that will help the poor in accessing best possible care like Pradhan Mantri National Dialysis Programme, etc. In order to provide relief to poor people from the rising cost of cancer drugs, our government has also started AMRIT scheme.
• Medicines for treatment of cancer are being made available at a discount of up to 90%.
• 16 such outlets have already been started.
• Drugs worth more than Rs 58 Crore have already been sold with Rs 35 Crore Savings to patients.
• The treatment of cancer is either free or subsidized in the Government Institutions. Financial assistance to poor patients is also provided under Health Minister’s Discretionary Grant (HMDG), Rashtriya Arogya Nidhi (RAN) and Health Minister’s Cancer Patient Fund (HMCPF) within the Rashtriya Arogya Nidhi.

Q: What is your take on the proposed National Medical Commission (NMC) Bill, 2016 which stipulates the appointment of regulators by a broad-based search cum selection committee?
Ans: A four-member committee headed by Vice Chairman NITI Aayog was constituted to examine all options for reforms in MCI and suggest the way forward. The Committee has framed a draft “National Medical Commission (NMC) Bill” which provides for constitution of NMC in place of MCI.The draft NMC Bill was placed on the official website of NITI Aayog seeking comments of Public/ Experts. Various comments including that of state governments were received in this regard. After extensive deliberations, some suggestions have been incorporated by the Committee while submitting the final NMC Bill.