Health in India – Review 2012

Ministry of Health and Family Welfare implements several national level programmes /schemes to control Communicable and Non-communicable diseases. The National Rural Health Mission is the flagship programme of the Ministry. It focuses on the challenge of strengthening poor public health systems in the country.

Department of Health & Family Welfare

Since the launch of the National Rural Health Mission, over 1.57 lakh personnel have been added to the health system during 2005-12. Infrastructure has been strengthened by taking up 594 District Hospitals, 2,721 Community Health Centres, 5,459 Primary Health Centres and 31,001 Sub-Centres for new construction or renovation.

Due to constant effort of the Health Ministry, Infant Mortality Rate (IMR) has dropped by 3 points from 47 to 44 infant deaths per 1000 live births during 2011. IMR for rural areas has dropped by 3 points from 51 to 48 infant deaths per 1000 live births while the urban rate now stands at 29 from the previous 31/1000. Among the states, Goa and Manipur have the lowest IMR of 11 infant deaths followed by Kerala with 12 infant deaths per 1000 live births.

To improve health services, the Health Ministry has taken a series of path breaking initiatives to increase the human resources. To overcome the shortage of faculty in Medical Colleges, the following steps have been taken:-

1. Ceiling on age limit has been raised from 60 to 70 years.

2. DNB qualifications have been recognized for appointment as faculty.

3. To increase the number of students in PG, teacher-student ratio has been relaxed from 1:1 to 1:2 for post-graduate and super-speciality courses.

4. Ratio has been further liberalized to 1:3 for Anaesthesiology, Forensic Medicine, Radiotherapy, Medical Oncology and Surgical Oncology.

5. Medical Colleges have been permitted to start PG courses in pre and para clinical disciplines at the stage of 3rd renewal without waiting for recognition.

6. Postgraduate degrees of five English speaking countries (US, UK, Canada, Australia and New Zealand) have been recognized for teaching.

7. Land requirement relaxed from 25 acres to 20 acres. In Metropolitan cities and “A” Grade cities, requirement of land would be 10 acres.

8. In NE & Hill States, notified tribal areas, inaccessible UTs and 8 under-served states of Bihar, Chhattisgarh, Jharkhand, M.P., Orissa, Rajasthan, Uttar Pradesh and West Bengal land can be in two pieces at a distance of not more than 10 km.

To bring down the capital cost without compromising on the quality of education, the following steps have been taken:-

1. Requirement of infrastructure like institution block, library, auditorium, examination hall, lecture theatres, etc. has been rationalized for optimal use.

2. Companies registered under the Companies Act have been allowed to establish medical colleges.

3. Maximum intake at MBBS level has been raised from 150 to 250.

To encourage posting of Doctors in rural areas, the following steps have been taken:-

1. Additional marks will be given in the Post Graduate Entrance Examination at the rate of 10% for each year of rural service subject to a maximum of 30%.

2. 50% seats in post graduate diploma courses have been reserved for medical officers in Government service who have served for at least three years in remote and difficult areas.

As result, positive effects have been seen in the country. In just over three years’ time, the availability of MBBS seats has gone up from 32,892 to 44,302, including 300 seats in the new AIIMS, an increase of 11,410 seats. The number of PG seats has increased from 13,000 to 22,503, an increase of 9,503 seats. 66 new medical colleges have been established raising the number from 289 to 355 within this period.

To strengthen tertiary Health Care delivery in the government sector, the Ministry took up 19 state governments owned medical colleges for up-gradation under the Pradhan Mantri Swasthya Surakhsha Yojana. 6 institutions have been already completed and rest are likely to be completed by March-April 2013. In 2013, together with 6 new AIIMS and 19 up-graded institutions would provide speciality and super-speciality care in all disciplines with a net addition of 11,390 beds covering 27 locations.

To overcome the shortage of Nurses and ANMs, the Health Ministry has sanctioned 269 nursing schools with an outlay of Rs. 2,030 crores in the last two years, mostly in remote, inaccessible and under-served districts. These institutions will produce an additional 20,000 nurses annually. To give a boost to para-medical education and scale up the availability of para-medics, a National Institute of Paramedical Sciences (NIPS) at Delhi and 8 Regional Institutes have been sanctioned. A total of 10,760 paramedic professionals are expected to be trained annually when these institutes of excellence are fully functional.

In Delhi, there are 4 hospitals which are as follows:-

· All India Institute of Medical Sciences

· Safdarjung Hospital

· Dr RML Hospital

· Lady Hardinge Medical College

The Re-development of the Lady Hardinge Medical College and its associated hospitals is a part of the initiative taken by the Ministry to augment the healthcare services. Re-development will address the infrastructure requirements of the institute in a comprehensive manner and will result in the combined student intake at MBBS and PG levels going up by over 60 percent. Similarly, the Kalawati Saran Hospital for Children will have more beds and upgraded modern facilities. A state-of-the-art Super Specialty Block with 447 beds, including ICU, catering primarily to Cardio-Thoracic & Vascular Surgery, Cardiology, Neuro-surgery, Neurology, Oncology and Nephrology is being set up at Dr Ram Manohar Lohia hospital. An OPD & Paid Private Ward Block within the Super Specialty Block is also being set up. The total capital outlay for these additional facilities at RML Hospital is estimated at Rs.610 crores. Likewise, the Re-development Project of Safdarjung Hospital is being approved with an estimated outlay of Rs. 1,384 crores. The Super Specialty Block-cum-Paid Ward Block at Safdarjung Hospital will have 580 beds, including ICU. There will be 200 beds for a Paid Private Ward Block within the Super-Speciality Block and it is proposed to set up a Heart Command Centre. The Emergency & Casualty Block at Safdarjung Hospital will have 500 beds for Medical Emergencies.

AIIMS Delhi is getting a much needed uplift to take care of the ever increasing patient load. Measures being taken to upgrade Infrastructure at the institute include several new buildings such as convergence block, new hostel block, new residential towers, the Mother and Child and Surgical Blocks as well as an underground parking and a tunnel to connect the trauma centre. A Green-field development of the second campus of AIIMS at Badsha in Jhajjar district of Haryana is underway to provide state of the art facilities for teaching, patient care and research. An outreach OPD has been inaugurated on 24th November 2012.

The 19th meeting of Central Supervisory Board (CSB) was held on 20th July 2012. The Board approved the six months training syllabus for MBBS doctors for the purpose of using ultrasound machines under the PNDT Act. The Board also approved the proposal to incorporate a suitable provision in the PNDT Rules to facilitate online submission of Form-F on Government of India web-site to be suitable hyperlinked to related State Government portals.

The Ninth meeting of Mission Steering Group (MSG) of NRHM was held on 23rd October, 2012. The major issues discussed in the meeting were proposal for strengthening of National Programme Management of National Rural Health Mission and proposal for seeking approval for revalidation of unspent balances. Both the proposals were considered and approved by MSG.

The Board of Governors (BoG) of Medical Council of India was reconstituted in May 2012 and the term of BoG has been extended upto one year till further orders vide notification dated 14.05.2012. Curriculum for Bachelor of Science (Community Health) has been finalized in consultation with the Medical Council of India. The modalities of implementation of the course are being finalized. The matter is also being examined by the Department related Parliamentary Standing Committee on Health & Family Welfare. The National Commission for Human Resources for Health Bill was introduced in the Rajya Sabha on 22nd December 2011, which referred to the Bill to the Department related Parliamentary Standing Committee on Health & Family Welfare for examination. The recommendations of the Committee have since been received and the same are being examined.

Department of AYUSH

For the first time since the IMCC Act of 1970 was passed, Govt. of India has approved the “Minimum Standard Requirements” Regulation for Ayurveda colleges. It was notified on 18th July, 2012 by Central Council for Indian Medicine which is the regulatory body after intensive and extensive consultations with all groups of stakeholders. The Regulations lay down the required number of beds, bed occupancy. OPD attendance, hospital staff, teaching staff and other staff required, instruments, herbal garden etc. which a college must have. This regulation would go a long way in improving the quality of Ayurveda education in the country. On similar lines, regulation for Minimum Standard Requirements for Unani and Siddha colleges are under consideration.

1. In the current academic year 2012-13, the Department has set a record in conveying Govt. decisions to colleges regarding admissions. The cases of all existing colleges and new colleges, new courses and increase in admission capacity have been decided in time.

2. The Government of India has signed a Memorandum of Understanding (MoU) for ‘Country to Country’ corporation in the fields of Traditional Medicine with Trinidad and Tobago. MoUs are also being signed with the Governments of Serbia and Nepal, and is in pipeline with the Government of Sri Lanka. MoUs for setting up of AYUSH Chair at Durban University of Technology, South Africa and University of West Indies, Trinidad and Tobago were also finalized.

3. The Health Ministry has approved organizing of an international conference on Traditional Medicine for South East Asian Region by the Department of AYUSH in collaboration with WHO, during 12-14th February, 2013 at New Delhi.

4. AYUSH Information Cell has been set up – one each in Mexico and Port of Spain.

5. The Department of AYUSH along with National Medicinal Plants Board (NMPB) shifted to its own new office building, i.e., “AYUSH Bhawan, B-Block, GPO Complex, INA, New Delhi – 110023. The building has helped the Department in solving the problems of space constraint and necessary infrastructural requirements. The building was inaugurated formally by the Minister of Health and Family Welfare on 03.11.2012.

6. The Minister of Health and Family Welfare inaugurated a comprehensive national level AROGYA fair ay Hyderabad during October 12-15, 2012 on the sidelines of the Conference of Parties-11 (CoP-11) organized by the Ministry of Environment &Forests on the Convention of Biological Diversity. This AROGYA fair provided a platform to showcase India’s strength in the field of traditional medicine before the CoP delegates, in addition to fulfilling its primary purpose of a health fair.

7. The National Medicinal Plants Board under its Central Sector Scheme for Conservation, Development and Sustainable Management has covered 6 Medicinal Plants Conservation Areas (MPCA), provided support to 10 Joint Forest Management Committees (JFMCs), covered In-situ/Ex-situ land of 3979.90 Ha., funded 9 Research & Development projects and established 2 herbal gardens. Further, the Board through its Centrally Sponsored Scheme has sanctioned53 Nurseries and coverage of cultivation on 24,949.50 Ha. of land.

Department of AIDS Control

India has the third largest number of people living with HIV/AIDS in the world. Department of AIDS Control is working towards providing prevention, treatment, care & support services for HIV/AIDS without stigma & discrimination. NACP III (2007-12) has shown considerable gains in halting and reversing the HIV epidemic. The numbers of new annual infections have decreased by 56% over the past decade and the epidemic has begun to stabilize. NACP- III has been acclaimed globally as a successful programme. This is credited to its collaborative and participative approach supported by strengthening as well as scaling of existing structures to reach out to the unreached. Mainstreaming HIV is an effective approach towards a multi-sectoral response. Mainstreaming has been a strategic priority for India, getting support from highest political and bureaucratic leadership of the country.

As on 30th September 2012, a total of 16,72,875 people living with HIV/AIDS (PLHIV) are registered at 358 Antiretroviral Treatment (ART) Centres across the country. The transmission of HIV is obtained from the HIV positive cases detected at 10,515 Integrated Counselling and Testing Centres throughout the country and reported through Computerized Management Information System under National AIDS Control Programme. Based on this, the Heterosexual mode of HIV transmission accounts for 88.2% of HIV positive cases detected, mother to child transmission accounts for 5.0%, Infected Syringe and Needle 1.7%, Homosexual route 1.5% and contaminated blood and blood products account for 1.0% of HIV infections detected during 2011-12.

An innovative initiative of multi-media and multi-sectoral mass mobilization project of Red Ribbon Express Phase-III was flagged off on January 12, 2012. The RRE will conclude on 12th January 2013. The specially designed RRE will travel through 23 States and cover 162 halt stations. It has three exhibition coaches with exhibits on HIV and AIDS while the fourth exhibition coach on National Rural Health Mission (NRHM) has exhibits on Tuberculosis, Malaria, Reproductive and Child Health services, general health and hygiene. In addition to this, there is one coach for counselling and another for conducting trainings of local stakeholders such as members of Panchayati Raj Institutions, self help groups, health workers, youth organizations, teachers, police personnel etc.

Department of AIDS Control is implementing National AIDS Control programme as a 100% Centrally Sponsored Scheme. The key features of the programme are:

1. Preventing new HIV infections in high risk groups and general population through saturation of coverage of high risk groups with targeted interventions and scaled up interventions in the general population.

2. Providing greater care, support and treatment to larger number of PLHIV.

3. Strengthening the infrastructure, systems and human resources in prevention, care, support and treatment programmes at the district, state and national levels.

4. Strengthening the nationwide Strategic Information Management System.

Health for All

The Ministry of Health & Family Welfare would give emphasize on the following priority areas to provide health for all during 12th Five Year Plan period.

1. Scaling up of public expenditure on Health.

2. Focus on strengthening primary health care.

3. Free generic medicines in public health institutions.

4. Further expansion of human resources for health by setting up more medical colleges, nursing colleges and para-medical institutions.

5. Setting up of new and strengthening of existing tertiary health care facilities in the public sector to effectively address rising burden of NCDs.

6. Starting three year degree course to strengthen rural healthcare.

7. Strengthening District Hospitals to provide advanced level secondary and tertiary care and to use them as District Knowledge Centres to provide training and build local capacities.

8. Strengthen the drug regulatory system.