Social Schemes - Ministry of Health and Family Welfare

 Social Schemes - Ministry of Health and Family Welfare

Schemes

1. Pradhan Mantri Swasthya Suraksha Yojana

Objective

• The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) aims at correcting the imbalances in the availability of affordable healthcare facilities in the different parts of the country in general, and augmenting facilities for quality medical education in the under-served States in particular.
• The scheme was approved in March 2006.

Implementation

First Phase

• The first phase in the PMSSY has two components - setting up of six institutions in the line of AIIMS; and upgradation of 13 existing Government medical college institutions.
• It has been decided to set up 6 AIIMS-like institutions, one each in the States of Bihar (Patna), Chattisgarh (Raipur), Madhya Pradesh (Bhopal), Orissa (Bhubaneswar), Rajasthan (Jodhpur) and Uttaranchal (Rishikesh) at an estimated cost of Rs 840 crores per institution.
• These States have been identified on the basis of various socio-economic indicators like human development index, literacy rate, population below poverty line and per capital income and health indicators like population to bed ratio, prevalence rate of serious communicable diseases, infant mortality rate etc.
• Each institution will have a 960 bedded hospital (500 beds for the medical college hospital; 300 beds for Speciality/Super Speciality; 100 beds for ICU/Accident trauma; 30 beds for Physical Medicine & Rehabilitation and 30 beds for Ayush) intended to provide healthcare facilities in 42 Speciality/Super-Speciality disciplines.
• Medical College will have 100 UG intake besides facilities for imparting PG/doctoral courses in various disciplines, largely based on Medical Council of India (MCI) norms and also nursing college conforming to Nursing Council norms.
• In addition to this, 13 existing medical institutions spread over 10 States will also be upgraded, with an outlay of Rs. 120 crores (Rs. 100 crores from Central Government and Rs. 20 crores from State Government) for each institution. These institutions are
  • Government Medical College, Jammu, Jammu & Kashmir
  • Government Medical College, Srinagar, Jammu & Kashmir
  • Kolkatta Medical College, Kolkatta, West Bengal
  • Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
  • Institute of Medical Sciences, BHU, Varanasi, Uttar Pardesh
  • Nizam Institute of Medical Sciences, Hyderabad, Telangana
  • Sri Venkateshwara Institute of Medical Sciences, Tirupati, Andhra Pradesh
  • Government Medical College, Salem, Tamil Nadu
  • J. Medical College, Ahmedabad, Gujarat
  • Bangalore Medical College, Bengaluru, Karnataka
  • Government Medical College, Thiruvananthapuram, Kerala
  • Rajendra Institute of Medical Sciences (RIMS), Ranchi
  • Grants Medical College & Sir J.J. Group of Hospitals, Mumbai, Maharashtra.

Second Phase

In the second phase of PMSSY, the Government has approved the setting up of two more AIIMS-like institutions, one each in the States of West Bengal and Uttar Pradesh and upgradation of six medical college institutions namely

• Government Medical College, Amritsar, Punjab
• Government Medical College, Tanda, Himachal Pradesh
• Government Medical College, Madurai, Tamil Nadu
• Government Medical College, Nagpur, Maharashtra
• Jawaharlal Nehru Medical College of Aligarh Muslim University, Aligarh
• B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak

The estimated cost for each AIIMS-like institution is Rs. 823 crore. For upgradation of medical college institutions, Central Government will contribute Rs. 125 crore each.

Third Phase

In the third phase of PMSSY, it is proposed to upgrade the following existing medical college institutions namely

• Government Medical College, Jhansi, Uttar Pradesh
• Government Medical College, Rewa, Madhya Pradesh
• Government Medical College, Gorakhpur, Uttar Pradesh
• Government Medical College, Dharbanga, Bihar
• Government Medical College, Kozhikode, Kerala
• Vijaynagar Institute of Medical Sciences, Bellary, Karnataka
• Government Medical College, Muzaffarpur, Bihar

The project cost for upgradation of each medical college institution has been estimated at Rs. 150 crores per institution, out of which Central Government will contribute Rs. 125 crores and the remaining Rs. 25 crore will be borne by the respective State Governments.

2. National AIDS and STD Control Programme

• The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/ AIDS in India.
• Over time, the focus has shifted from raising awareness to behaviour change, from a national response to a more decentralized response and to increasing involvement of NGOs and networks of People living with HIV (PLHIV).
• The NACP I started in 1992 was implemented with an objective of slowing down the spread of HIV infections so as to reduce morbidity, mortality and impact of AIDS in the country.
• In November 1999, the second National AIDS Control Project (NACP II) was launched to reduce the spread of HIV infection in India, and (ii) to increase India’s capacity to respond to HIV/AIDS on a long-term basis.
• NACP III was launched in July 2007 with the goal of Halting and Reversing the Epidemic over its five-year period.
• NACP IV, launched in 2012, aims to accelerate the process of reversal and further strengthen the epidemic response in India through a cautious and well defined integration process over the next five years.

NACP - IV - Objectives

• Reduce new infections by 50% (2007 Baseline of NACP III)
• Provide comprehensive care and support to all persons living with HIV/AIDS and treatment services for all those who require it.

Key strategies

• Intensifying and consolidating prevention services, with a focus on HIgh Risk Groups (HRGs) and vulnerable population.
• Increasing access and promoting comprehensive care, support and treatment
• Expanding IEC services for (a) general population and (b) high risk groups with a focus on behaviour change and demand generation.
• Building capacities at national, state, district and facility levels
• Strengthening Strategic Information Management System

Key priorities under NACP IV

• Preventing new infections by sustaining the reach of current interventions and effectively addressing emerging epidemics
• Prevention of Parent to Child transmission
• Focusing on IEC strategies for behaviour change in HRG, awareness among general population and demand generation for HIV services
• Providing comprehensive care, support and treatment to eligible PLHIV
• Reducing stigma and discrimination through Greater involvement of PLHA (GIPA)
• De-centralizing rollout of services including technical support
• Ensuring effective use of strategic information at all levels of programme
• Building capacities of NGO and civil society partners especially in states with emerging epidemics
• Integrating HIV services with health systems in a phased manner
• Mainstreaming of HIV/ AIDS activities with all key central/state level Ministries/ departments will be given a high priority and resources of the respective departments will be leveraged. Social protection and insurance mechanisms for PLHIV will be strengthened.

New Initiatives under NACP IV

• Differential strategies for districts based on data triangulation with due weightage to vulnerabilities
• Scale up of programmes to target key vulnerabilities

• Scale up of Opioid Substitution Therapy (OST) for IDUs
• Scale up and strengthening of Migrant Interventions at Source, Transit & Destinations including roll out of Migrant Tracking System for effective outreach
• Establishment and scale up of interventions for Transgenders (TGs) by bringing in community participation and focused strategies to address their vulnerabilities
• Employer-Led Model for addressing vulnerabilities among migrant labour e. Female Condom Programme

• Scale up of Multi-Drug Regimen for Prevention of Parent to Child Transmission (PPTCT) in keeping with international protocols
• Social protection for marginalised populations through mainstreaming and earmarking budgets for HIV among concerned government departments
• Establishment of Metro Blood Banks and Plasma Fractionation Centre
• Launch of Third Line ART and scale up of first and second Line ART
• Demand promotion strategies specially using mid-media, e.g., National Folk Media Campaign & Red Ribbon Express and buses (in convergence with the National Health Mission).

3. National Pharmacovigilance Programme

• The nationwide programme, sponsored and coordinated by the country's central drug regulatory agency – Central Drugs Standard Control Organization (CDSCO) – to establish and manage a data base of Adverse Drug Reactions (ADR) for making informed regulatory decisions regarding marketing authorization of drugs in India for ensuring safety of drugs.
• The National Pharmacovigilance Centre at CDSCO coordinates the programme. The National Centre will operate under the supervision of the National Pharmacovigilance Advisory Committee (NPAC) to recommend procedures and guidelines for regulatory interventions.

Objectives of the Programme:

Broad objectives of the Programme

• To foster the culture of AE notification and reporting
• To establish a viable and broad-based ADR monitoring program in India

Specific objectives of the Programme

• To create an ADR database for the Indian population
• To create awareness of ADR monitoring among people
• To ensure optimum safety of drug products in Indian market
• To create infrastructure for ongoing regulatory review of PSURs
• The National Pharmacovigilance Advisory Committee (NPAC) will oversee the performance of various Zonal, Regional and Peripheral Centres and will perform the functions of "Review Committee" for this program.
  • The NPAC will also recommend possible regulatory measures based on pharmacovigilance data received from various centres.
  • National Pharmacovigilance Programme comprises of twenty-four Peripheral Pharmacovigilance Centers pooling their data at five Regional Pharmacovigilance Centers, which in turn funnel their data to the two Zonal Pharmacovigilance Centers.

4. National Organ Transplant Programme

Background

• The shortage of organs is virtually a universal problem but Asia lags behind much of the rest of the world. India lags far behind other countries even in Asia.  It is not that there aren't enough organs to transplant. Nearly every person who dies naturally, or in an accident, is a potential donor. Even then, innumerable patients cannot find a donor.

Situation of shortage of organs in India

•  There is a wide gap between patients who need transplants and the organs that are available in India.
• An estimated around 1.8 lakh persons suffer from renal failure every year, however the number of renal transplants done is around 6000 only.
• An estimated 2 lac patients die of liver failure or liver cancer annually in India, about 10-15% of which can be saved with a timely liver transplant.
• Hence about 25-30 thousand liver transplants are needed annually in India but only about one thousand five hundred are being performed.
• Similarly about 50000 persons suffer from Heart failures annually but only about 10 to 15 heart transplants are performed every year in India. 
• In case of Cornea, about 25000 transplants are done every year against a requirement of 1 lakh.

Issues and Challenges

1. High Burden (Demand  Versus Supply gap)
2. Poor Infrastructure especially in Govt. sector hospitals
3. Lack of Awareness of concept of Brain Stem Death among stakeholders
4. Poor rate of Brain Stem Death Certification by Hospitals
5. Poor Awareness and attitude towards organ donation--- Poor Deceased Organ donation rate
6. Lack of Organized systems for organ procurement from deceased donor
7. Maintenance of Standards in Transplantation, Retrieval and Tissue Banking
8. Prevention and Control of Organ trading
9. High Cost (especially for uninsured and poor patients)
10. Regulation of Non- Govt. Sector

Objectives of National Organ Transplant Programme:

• To organize a system of organ and Tissue procurement & distribution for transplantation.
• To promote deceased organ and Tissue donation.
• To train required manpower.
• To protect vulnerable poor from organ trafficking.
•  To monitor organ and tissue transplant services and bring about policy and programme corrections/ changes whenever needed.

National Organ and Tissue Transplant Organization

• National Network division of NOTTO would function as apex centre for all India activities of coordination and networking for procurement and distribution of organs and tissues and registry of Organs and Tissues Donation and Transplantation in country.
• The following activities would be undertaken to facilitate Organ Transplantation in safest way in shortest possible time and to collect data and develop and publish National registry.

5. AYUSHMAN BHARAT

• Ayushman Bharat is a centrally sponsored programme anchored in the Ministry of Health and Family Welfare (MoHFW).
• It is an umbrella of two major health initiatives, namely Health and Wellness Centres (HWCs) and Pradhan Mantri Jan Arogya Yojna (PMJAY).
• Brief details of these components are as following:

 Ayushman Bharat-Health & Wellness Centres (AB-HWC)

• Delivery of comprehensive primary health care services through Health &Wellness Centres is a critical component of the newly announced Ayushman Bharat scheme. 
• It places people and communities at the center of the health care delivery system, making health services responsive, accessible and equitable.
• Nearly 1.5 lakh Sub-Centres and Primary Health Centres would be transformed as Health & Wellness Centres by 2022 to provide comprehensive and quality primary care close to the community while ensuring the principles of equity, affordability and universality.
• Till date, 4503 HWCs have been operationalized in various states.

Key components of AB-HWC:

• Additional Human Resource - New cadre of health care professional- referred to as the Mid-Level Health Provider- who is a nurse or an Ayurvedic Practitioner trained and accredited for a set of competencies related to primary health care and public health.   Mid-Level Health Provider will lead the team of MPWs and ASHAs at SHC level
• Multiskilling/ Training of existing service providers - upgrading skills to provide expanded package of services
• Efficient logistics system to ensure availability of wide range of drugs and point of care diagnostics.

• Robust IT system – to create unique health id and longitudinal health record of all individuals and provision of tele-consultation services
• Provision of services related to indigenous health system and yoga etc for promotion of wellness
• Linkageswith schools to train Health and Wellness Ambassadors to enable creating healthy habits in schools

The package of services envisaged at AB-HWC are:

1. Care in pregnancy and child-birth.
2. Neonatal and infant health care services
3. Childhood and adolescent health care services
4. Family planning, Contraceptive services and other Reproductive Health Care services
5. Management of Communicable diseases including National Health Programmes
6. Management of common communicable diseases and outpatient care for acute simple illness and minor ailments.
7. Screening, Prevention, Control and Management of non-communicable diseases.
8. Care for Common Ophthalmic and ENT problems
9. Basic Oral health care
10. Elderly and palliative health care services
11. Emergency Medical Services
12. Screening and Basic management of Mental health ailments

 Key benefits for community under AB-HWC:

• Expanded package of primary care services –ranging from maternal and child health, communicable diseases to non-communicable diseases (universal screening, prevention, control and management of five common communicable diseases: hypertension, diabetes and three common cancers – those of the oral cavity, breast and cervix,  primary health care for diseases for the eye, oral health, ENT, mental health, provision of palliative care and care for the elderly, and medical emergencies)
• Wide range of free drugs
• Point of care diagnostics at the centres.
• Tele-consultation services with Medical Officers for complications
• Continuum of care ensured through referral linkages and protocols
• Unique health id – longitudinal health record for each individual
• Services related to indigenous health system and yoga for promotion of wellness.

6. Ayushman Bharat–PM Jan Arogya Yojana

• Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is a Centrally Sponsored Scheme having central sector component under Ayushman Bharat Mission anchored in the Ministry of Health and Family Welfare (MoHFW).
• It is an umbrella of two major health initiatives, namely Health and wellness Centres and National  Health Protection Scheme.

Health and Wellness Centres

• Under this 1.5 lakh existing sub centres will bring health care system closer to the homes of people in the form of Health and wellness centres.
• These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.

List of Services to be provided at Health & Wellness Centre

• Pregnancy care and maternal health services
• Neonatal and infant health services
• Child health
• Chronic communicable diseases
• Non-communicable diseases
• Management of mental illness
• Dental care
• Eye care
• Geriatric care Emergency medicine

National Health Protection Mission (AB-PMJAY)

Benefits

• AB-PMJAY provides a defined benefit cover of Rs. 5 lakh per family per year. This cover will take care of almost all secondary care and most of tertiary care procedures.
•  To ensure that nobody is left out (especially women, children and elderly) there will be no cap on family size and age in the scheme.
• The benefit cover will also include pre and post-hospitalisation expenses.
• All pre-existing conditions will be covered from day one of the policy.
• A defined transport allowance per hospitalization will also be paid to the beneficiary.
• Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.
• The beneficiaries can avail benefits in both public and empanelled private facilities. All public hospitals in the States implementing AB-PMJAY, will be deemed empanelled for the Scheme. Hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on the bed occupancy ratio parameter.
• As for private hospitals, they will be empanelled online based on defined criteria.
• To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.
• The package rates will include all the costs associated with treatment. For beneficiaries, it will be a cashless, paper less transaction.
• Keeping in view the State specific requirements, States/ UTs will have the flexibility to modify these rates within a limited bandwidth.