India: Health Ministry Annual Updates On National Health Missions/Programs For Year 2017

Year 2017 was the year of health survey and regulatory reforms, as many survey reports were published in various areas of health such as – reports on Universal Health Coverage (UHC); Global Hunger Index (GHI); National Nutrition Strategy; Health of the Nation's state; and Global Status Report on Non-Communicable Diseases (NCDs). In the area of regulatory reforms, many new/updated guidelines were released for example – Institute of Chemical and Medicinal Research released "Handbook on Intellectual Property Rights & Technology Transfer", release of National Ethical Guidelines for Bio-Medical Research Involving Children, for Stem Cell Research, and for Biomedical and Health Research Involving Human Participants etc.

On December 18, 2017, the Minister of state, Ministry of Health and Family Welfare, has submitted the written annual updates of ongoing and planned health programs/missions in the Lok Sabha; some of the key programs are mentioned below -

1. Global Hunger Index
2. Licensed blood banks in the country
3. Fee Structure of Medical Colleges
4. Malnutrition Deaths
5. Charges on Health Services
6. National Nutrition Strategy
7. Cardiovascular Diseases in India
8. Patented Drugs
9. Additional Medical Seats
10. Prescribing Generic Drugs
11. Committed to advancing the agenda of Universal Health Coverage through affordable and accessible healthcare for all

1. Global Hunger Index: The International Food Policy Research Institute (IFPRI) publishes Global Hunger Index (GHI) every year. According to the GHI 2017 report, India ranks 100 out of 119 countries which indicates a serious hunger problem in the country.

To deal with the problem of hunger in the country and to improve the country's standing in GHI, the Government has implemented some interventions like - provision of food grains at highly subsidized prices to the targeted population through State Governments/ UT Administrations under the Targeted Public Distribution System (TPDS) in terms of Nation Food Security Act, 2013. Some other Welfare Schemes (OWS) are Mid-Day Meal Scheme, Integrated Child Development Services (ICDS) Scheme, and Rajiv Gandhi Scheme for Empowerment of Adolescent Girls, Annapurna Scheme, and National Nutrition Mission (NNM) etc.¹⁷

2. Licensed blood banks in the country: The Health Minister reported the total number of functioning licensed blood banks in various State/Union Territories (UT) till June 2017. There are 2903 total licensed blood banks in 36 state/UT¹⁸.

3. Fee Structure of Medical Colleges: Health Ministry also reported that the fee structure of private unaided medical colleges is decided by the Committee set up by the respective State Governments under the Chairmanship of a retired High Court Judge in pursuance of the directions of the Hon'ble Supreme Court of India. It is for the Committee to decide whether the fee proposed by an Institute is justified and the fee fixed by the Committee is binding on the Institute. Whereas, in case of Government medical colleges the respective State Governments are responsible for fixing the fee¹⁹.

4. Malnutrition Deaths: Malnutrition means the affected person is either undernourished or overnourished. Malnutrition is not a direct cause of death but can increase morbidity and mortality by reducing resistance to infections. Addressing malnutrition is a preventive strategy, as it has the potential to minimize the healthcare costs by reducing the requirement for curative healthcare.

The National Health Mission (NHM), under the Health Ministry, has implemented following schemes /pro- grams which address malnutrition:

• Promotion of appropriate Infant and Young Child Feeding (IYCF)
• Mothers' Absolute Affection (MAA) programme
• Treatment of sick children with Severe Acute Malnutrition (SAM) at Nutrition Rehabilitation Centres (NRCs)
• Vitamin A supplementation (VAS) for children till the age of 5 years.
• National Iron Plus Initiative
• National Deworming Day
• Intensified Diarrhoea Control Fortnight (IDCF)
• Rashtriya Bal Swasthya Karyakram (RBSK)
• Village Health and Nutrition Days (VHNDs)

The Supplementary Nutrition Programme is being implemented through the Anganwadi Centres (AWCs) for addressing undernourishment in pregnant and lactating women, children under the age of 6 years and out-of-school adolescent girls²⁰.

5. Charges of Health Services: The Government of India has enacted Clinical Establishments (Registration and Regulation) Act, 2010 to regulate hospitals including private hospitals. Further, Clinical Establishments (Central Government) Rules, 2012 has been notified for registration and regulation of the Clinical Establishments which has approved a standard list of medical procedures and a standard template for costing of medical procedures. Currently, the Act is applicable in 10 states, Sikkim, Mizoram, Arunachal Pradesh, Himachal Pradesh, Uttar Pradesh, Bihar, Jharkhand, Rajasthan Uttarakhand and Assam and all Union Territories except Delhi. Other States may adopt the Act under clause (1) of Article 252 of the Constitution²¹.

6. National Nutrition Strategy(NNS): The NNS was published by NITI Aayogin 2017 to reduce 3 point percentage underweight prevalence/year in children (0-3 years) by 2022 and a 1/3rd reduction in anemia in children, adolescent & Women of Reproductive Age (WRA) by nutrition specific interventions like:

• Infant and Young Child care and Nutrition,
• Infant and Young Child Health,
• Maternal Care, Nutrition and Health,
• Adolescent care, nutrition and Health,
• Addressing micronutrient deficiencies- including anaemia, and
• Community nutrition (Interventions addressing community)²².

7. Cardiovascular Diseases in India: According to a report released by ICMR"India: Health of the Nation's States – The India State Level Disease Burden Initiative", the disease burden trends in the States of India shows an increase in the contribution of Non-Communicable Diseases (NCDs) from 30% of total disease burden in 1990 to 55% in 2016.

Ischemic Heart Disease was the top cause of disease burden in the country in 2016. Unhealthy diet, lack of physical activity, harmful use of alcohol, overweight, obesity, tobacco use inter-alia, are the risk factors of Cardiovascular Diseases (CVDs).

To combat this risk factor, the Government of India has launched National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) which is implemented for interventions up to the District level under the National Health Mission. NPCDCS focuses on awareness generation for behaviour and life-style changes, screening and early diagnosis of people with high levels of risk factors and their treatment and referral (if required) to higher facilities for appropriate management for Non-Communicable Diseases (NCD) including cardiovascular diseases²³.

8. Patented Drugs: As per data submitted by Indian Patent Office (IPO) to Health Ministry, a total of 7083 patents have been granted by IPO in the pharmaceutical field from 2005-06 till October 2017.

Table 1: Number of patents granted annually from year 2005-06

9. Additional Medical Seats: The Health Ministry permitted 2990 additional Postgraduate seats in Clinical subjects/Courses in Government Medical Colleges for the year 2017-18 including 153 seats in Andhra Pradesh as a one-time measure to revise Teacher Student ratio in respect of Clinical subjects at Public Funded Government Medical Colleges, consequent to amendment to MCI Postgraduate Medical Education Regulations, 2000.

However, 54 Medical Colleges have not been granted renewal permission for the year 2017-18. Further, in three cases where the State Government has withdrawn Essentiality Certificate earlier granted to the College, such Colleges are ordered to be closed and the students in the College are allowed to be shifted to other Colleges of the State as proposed by the concerned State Government²⁴.

10. Prescribing Generic Drugs: The government has published a draft notification vide GSR 302 (E) dated March 30, 2017, for amendment of Rule 96 of the Drugs & Cosmetics Rules, 1945, which is to provide that the proper name of the drugs shall be printed in a conspicuous manner, and which shall be in the same font but at least two font sizes larger than the brand name or the trade name, if any.

Moreover, an amendment in Clause 1.5 of Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 was also notified; which stipulates that "every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs"²⁵.

11. Committed to advancing the agenda of Universal Health Coverage through affordable and accessible healthcare for all: The government has updated to the ongoing Health programs/missions -

National Health Policy 2017: Release of a new National Health Policy (NHP) for the country after a gap of 15 years. NHP 2017 addresses current and emerging challenges necessitated by the changing socio-economic, technological and epidemiological landscapes. The major commitment of the NHP 2017 is raising public health expenditure progressively to 2.5% of the Gross Domestic Product (GDP) by 2025. NHP 2017 has been duly supported by the Government through provision of Rs. 47352.51 crores to the Ministry of Health and Family Welfare (MoHFW) under the Union Budget 2017-18. The amount is 27.7% higher in allocation as compared to the previous year.

National Medical Commission (NMC) Bill, 2017: The Cabinet approved the National Medical Commission Bill 2017 on December 15, 2017, and envisages to:

• Replace the Medical Council 1956 Act.
• Enable a forward movement in the area of medical education reform.
• Move towards outcome based regulation of medical education rather than process oriented regulation.
• Ensure proper separation of functions within the regulator by having autonomous boards.
• Create accountable and transparent procedures for maintaining standards in Medical Education.
• Create a forward-looking approach towards ensuring sufficient healthcare workforce in India.

National Nutrition Mission (NNM): A joint effort of MoHFW and the Ministry of Women and Child Development (WCD), this mission aims to benefit more than 10 crore people by a life-cycle approach by interrupting the intergenerational cycle of undernourishment.

Mental Healthcare Act, 2017: The Act adopts a rights-based statutory framework for mental health in India, and strengthens equality and equity in provision of mental healthcare services in order to protect the rights of people with mental health problems to ensure that they are able to receive optimum care and are able to live a life with dignity and respect.

HIV & AIDS (Prevention & Control) Act, 2017: The Act aims to end the epidemic by 2030 in accordance with the Sustainable Development Goals set by the United Nations. A person living with AIDS cannot be treated unfairly at employment, educational establishments, renting a property, standing for public or private office or for healthcare and insurance services. The Act also aims to enhance access to healthcare services by ensuring informed consent and confidentiality for HIV-related testing, treatment and clinical research.

Universal Immunization Programme (UIP): One of the largest public health programmes in the world, UIP annually targets 3 crore pregnant women and 2.7 crore newborns. More than 90 lakh immunization sessions are conducted annually. Mission Indradhanush and Intensified Mission Indradhanush are new initiatives under UIP. Apart from this, some new vaccines have been introduced in UIP such as – Inactive Polio Vaccine (IPV), Adult Japanese Encephalitis (JE) Vaccine, Rotavirus Vaccine, Measles-Rubella (MR) Vaccine, and Pneumococcal Vaccine (PCV).

Labour room Quality Improvement Initiative - LaQshya: MoHFW has launched LaQshya to improve the quality of care that is being provided to pregnant mothers in the Labour Room and Maternity Operation Theatres; thereby, preventing the undesirable adverse outcomes associated with childbirth. The initiative will be implemented in Government Medical Colleges (MCs) besides District Hospitals (DHs), and high delivery load Sub-District Hospitals (SDHs) and Community Health Centres (CHCs).

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): The program aims to provide assured, comprehensive and quality antenatal care - free of cost, universally to all pregnant women on the 9th of every month. More than 90 lakh antenatal checkups have been conducted at PMSMA sites for comprehensive services under the programme, and more than 5 lakh high risk pregnancies have been identified under PMSMA.

Intensified Diarrhea Control Fortnight (IDCF): Every fortnight, health workers visit the households of under five children, conduct community level awareness generation activities and distribute ORS. In 2017 (July-August), more than 7.0 Crore children under 5 years of age were visited by ASHAs for Prophylactic ORS.

Rashtriya Kishor Swasthya Karyakram(RKSK): Is a comprehensive programme focusing on Sexual Reproductive Health, Nutrition, Injuries and Violence (including gender based violence), Non-Communicable Diseases, Mental Health and Substance Misuse with a promotive and preventive approach.

Health and Wellness Centers (HWCs): In 2017-18, the Ministry announced transformation of Sub-health Centres to Health and Wellness Centres (HWCs) to expand the basket of services of primary care to make it comprehensive. The HWCs are expected to provide preventive, promotive, rehabilitative and curative care for a package of services related to RMNCH+A, communicable diseases, non- communicable diseases, Ophthalmology, ENT, Dental, Mental, Geriatric care, treatment for acute simple medical conditions and emergency & trauma services.

Affordable Medicine and Reliable Implants for Treatment (AMRIT): 105 pharmacies have been set up across 19 states for providing medicines for Diabetes, CVDs, Cancer and other diseases at discounted prices to the patients. A total of more than 5000 drugs and other consumables are being sold at up to 50% discounts.

Revised National Tuberculosis Programme (RNTCP): As per the Global TB Report 2017, the updated estimate of incidence of disease is 27 lakh cases in 2016 as compared to 28 lakhs in 2015 (Rate: 211 per 100,000 population in 2016 as compared to 217 per 100,000 population in 2015)²⁶

Conclusion:

Merely launching a large number of healthcare programs will not help to achieve the Universal Health Coverage, unless they are also implemented at the ground level and serve the larger area and/or population. Progress in health services also demands continuous regulatory reforms and timely field research to reach the desired milestone.

Footnotes

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