Public private partnership in health sector

Empower & Inspire: Spread Health & Wellness

Indian Health Minister Dr. Anbumani Ramadoss has called for public-private partnership in health sector to meet the gap between supply and demand.

Speaking at a plenary session on “Health for all: Role of Diaspora” the Minister encouraged participation of the Indian Diaspora in developing healthcare facilities in India.

Following is the text of speech by the Minister:

It is my pleasure to be here today afternoon amongst the august gathering on this important occasion. I feel proud and happy to have been associated with medical community of Indian Origin residing far away from us. This is a gathering of eminent experts and scientists in the field of medical science and related sciences and hope that there may be useful deliberations on the issue for ‘Health for All: Role of Diaspora’.

The overriding objective of economic and social development is to improve the quality of lives that people lead, to enhance their well-being, and to provide them with opportunities and choices to become productive assets in society. In 1952, India was the first country in the world to launch a National Programme, emphasizing family planning to the extent necessary for reducing birth rates ‘to stabilize the population at a level consistent with the requirement of National Economy’. After 1952, sharp declines in death rates were, however, not accompanied by a similar drop in birth rates.

The National Health Policy, 1983 stated that replacement levels of total fertility rate (TFR) should be achieved by the year 2000. While global population has increased threefold during this century, from 2 billion to 6 billion, the population of India has increased nearly five times from 238 million (23 crores) to 1 billion in the same period.

India’s current annual increase in population of 15.5 million is large enough to neutralize efforts to conserve the resource endowment and environment. Our population is 16 percent of the world’s population on 2.4 percent of the globe’s land area. If current trends continue, India may overtake China in 2045, to become the most populous country in the world.

Deteriorating environmental conditions are a major contributory factor to poor health and poor quality of life and hinder sustainable development. Poor environmental quality is directly responsible for around 25% of all preventable ill-health in the world today, with diarrhoeal diseases and ARI heading the list. Other diseases such as malaria, schistosomiasis, other vector-borne diseases, chronic respiratory diseases and childhood infections are also strongly influenced by adverse environmental conditions. Acute diarrhoeal diseases have been recognised as the major cause of morbidity, under nutrition and mortality. Nearly 0.7 million children die every year due to diarrhoea. Respiratory illnesses are one of the leading causes of morbidity. Diagnosis of outbreaks and their control pose a serious challenge. The Government of India has initiated Integrated Diseases Surveillance Programme (IDSP) in the country which is likely to enhance rapid response capabilities.

National Rural Health Mission was launched by Hon’ble Prime Minister on 12th April, 2005. Plan of Action includes, increased public expenditure on Health, reducing regional imbalances in Health, pooling resources, optimization of Health Manpower, community participation and ownership, operationalising CHCs into functional hospitals. 75 % of health services is provided by private sector. Private public partnership brings convergence of private sector interests and public sector goals. Aim is to optimally utilize and enable increased access to vast rural poor. Professional association’s participation is envisaged in Mission steering group, Empowered programme committee, State and District health missions etc. Professional associations would understand the strategies under NHRM and actively associate with Govt. in implementation. The Mission is an articulation of the commitment of the Government to raise public spending on Health from 0.9% of GDP to 2-3% of GDP. It aims to undertake architectural correction of the health system to enable it to effectively handle increased allocations as promised under the National Common Minimum Programme and promote policies that strengthen public health management and service delivery in the country.

National Urban Health Mission is also being taken up as another challenge. For strengthening health and family welfare services in urban areas core strategies under National Urban Health Mission will be Focus on the urban poor and marginalized segments like slum dwellers etc., Community-based women’s self-help thrift group, an Honorary Health Worker (HHW)/ Link Worker to facilitate delivery of services, Urban Health Centers (UHC) as first interface for curative care, accreditation of clinics and hospitals in the private and non-government sectors for delivery of services on special terms of NUHM target families and Risk-pooling and Health Insurance systems on differential terms for urban poor and non-poor families.

Today the Non Communicable Diseases (NCDs), especially Cardiovascular Diseases (CVD’s), Diabetes Mellitus, Cancer, Stroke and Chronic Lung Diseases have emerged as major public health problems, due to an ageing population and environmentally driven changes in behaviour. Current statistics on cardiovascular diseases (CVD) and stroke in India are incomplete. An increasing trend in CVD has been witnessed and has become the leading cause of deaths from non- communicable diseases. Surveys in India reveal that about 10 % of adults suffer from hypertension. The increase in cardiovascular disease prevalence and mortality rates is expected to continue in the coming years in the majority of countries of the Region. The number of deaths due to Ischemic Heart Diseases in India is projected to increase from 1.2 million in 1990 to 1.6 million by the year 2000, and to 2 million by 2010. The premature morbidity and mortality in the most productive phase of life is posing a serious challenge to Indian society and its economy. It is estimated that in 2005 NCDs accounted for 5,466,000 (53%) of all deaths (10,362,000) in India.

Health promotion is a key component for the prevention and control of NCDs. It must combine educational activities with policy interventions to provide a supportive environment. It is pertinent to mention that Health promotion for NCD control can be carried out with simple messages e.g. use of less salt & sugar, exercise, avoiding stress, tobacco & alcohol and increased use of vegetable and fruits. These simple interventions can prevent or delay many of the NCDs.

Pilot Project of the National Program for Prevention and Control of Diabetes, Cardio-vascular Diseases and Stroke (NPCDS) has been launched in ten states with one district each. Total plan allocation envisaged for 11th plan is Rs 1620.5 crores. This is tentative and final allocation would be made by the planning commission. Meanwhile IEC would be intensified from the central level and you would be seeing healthy lifestyle messages shortly. Unless people understand that these illnesses (Diabetes, Hypertension etc.) can affect them, they would not get themselves checked and disease may progress unknowingly.

Respiratory problems are caused by smoking. The Indian Parliament has passed the Cigarettes and other tobacco products bill 2003 in April 2003 and it became an Act on 18th may 2003. Rules were formulated in 1st May 2004 and are being vigorously implemented throughout India. National Tobacco Control Programme has also been initiated to intensify efforts in this regard. It is hoped that Tobacco use would reduce after its implementation.

Several new initiatives have been taken in the field on non communicable diseases e.g. National Deafness Control Program, National Program for health care of elderly, National Oral health Program. Efforts are being made to utilize the advancement in the field of IT for health care through telemedicine. I understand that there are several issues which needs to be settled like unique national ID for purpose of health care (medical records), uniform standards in health care equipments etc (for compatibility of various models). Assessment of hazards from mobile and other gadgets I believe should also needs to be looked into since we have maximum no. of mobile users next to China. Disposal of waste generated out of electronic gadgets is also very important and I am happy to note that some major mobile manufacturing companies have initiated the recycling drive in this regard.

Transplant of Human organs Act has been implemented for over 14 years. Still there are unsatisfactory services for major transplantations like kidney, lever and heart in the country. There is lack of awareness that six organs of body can be donated i.e. i.e. 2 kidney, 2 eyes, 1 liver & 1 heart without much problem by patients who are brain dead, resulting in opening of possibility of disease free active life to 6 otherwise sick patients by transplantation. National Organ Transplant Program is being initiated with focus on (i) enhancing the facilities for organ transplantation throughout India, (ii) establishing network for equitable distribution of retrieved deceased organs, (iii) increasing the organ availability through change in attitude and facilitating the retrieval of deceased organs and (iv) building up human resource. Recently amendments have been made in THOA rules to make the functioning of Authorisation committees more transparent and effective.

Health insurance appears to be the viable solution in financing the ever increasing costs in health care. India’s needs are different from other countries and therefore alternative patterns for sustainable health care delivery and financing in this region are required. System can be made to generate better health outcomes, enable participation of civil society, widen choice of provider, provider accountability, optimize utilization of existing capacities and promote more need-based deployment of resources. Now, I would like to give the successful example of Revised National Tuberculosis Control Program (RNTCP). Based on the WHO recommended strategy of Directly Observed Treatment, Short course (DOTS) one billion population is covered. More than 1 lakh patients are put on treatment under DOTS every month. Since 1998, RNTCP has saved more than 1.7 million additional lives. The treatment success of new infectious TB cases under RNTCP has consistently exceeded the global benchmark of 85%.

The support of Indian Diaspora can be very crucial. They can support Government of India by ensuring sustained financial support, which can be through International funding agencies, international civil society organization working in India and also by creating awareness among international travellers regarding precautions and for continuing treatment and also by following international guidelines in order to reduce the spread of TB. In addition, the Indian who travel to India and have been diagnosed with TB should ensure that they take care of international guidelines for travellers and also complete TB treatment in India.

Vector borne diseases, viz., malaria, filaria, kala-azar, Japanese encephalitis, dengue are responsible for considerable sickness and infirmity. The National Vector Borne Disease Control Programme (NVBDCP) is an umbrella programme for prevention and control of vector borne diseases viz., Malaria, Filariasis, Kala-azar, Japanese Encephalitis, Dengue/Dengue Hemorrhagic Fever (DF/DHF) and Chikungunya.. These diseases pose immense public health concern and are major impediments in the path of socio-economic development Chikungunya fever has reappeared in the country after almost 30 years. A comprehensive, long term Action Plan for prevention and control of Chikungunya has been prepared and disseminated to the states. Special Programme for elimination of Kala-azar has also been initiated with a focus on nine endemic districts of Bihar.

The first HIV positive case in India was detected in 1986. Recent estimates based on sentinel surveillance 2007 suggest that there are about 2.35 million HIV positive persons in the country. In order to reiterate the Government’s commitment to prevent the spread of HIV and to facilitate a strong multi-sectoral response to combat it effectively, a National Council on AIDS headed by the Prime Minister of India provides the leadership at the national level. World’s largest mass mobilization drive, the Red Ribbon Express was launched at New Delhi’s Safdarjung Railway Station, on the World AIDS Day in December 2007. Seven coaches carrying HIV prevention messages traverse over 27,000 km making 180 halts, covering 166 districts across the country, reaching out to crores of people in over 50,000 villages for scaling up ground level mobilization activities. Anti retro viral therapy is available free to all who need it. Indian Diaspora can play big role in collaborative research and capacity building.

The Plan of Action to implement National Programme for Control of Blindness during the X Plan has been prepared in the line with Global initiative “Vision 2020: The right to Sight”. Revised scheme approved for the 10th Plan focuses on development of comprehensive eye care services targeting common blinding disorders including cataract, refractive errors, glaucoma, diabetic retinopathy and corneal blindness. National Cancer Control Program is also now being revamped. Capacity building and technology transfer can be supported by Indian Diaspora.

India like any other has its own share of vulnerability. We improved from the lessons learned from Super Cyclone in Orissa in October, Bhuj earthquake in January 2001 and the Tsunami in December 2004. These major disasters though caused substantial damage to life and property also gave an opportunity to develop capacity to mitigate such events. Since then the Government has given highest priority in setting up a legal and an institutional frame work for disaster management in India. The Disaster Management Act was enacted by Parliament in 2005 and the National Disaster Management Authority was constituted under the able guidance of Hon’ble Prime Minister. Similar structures are envisioned for the States and Districts.

An estimated 275 persons are killed and 4,100 injured in our roads every day. In view of this fact, we initiated the National Highway Trauma Care Project which is an ambitious project in its scale and reach intending to cover the entire Golden Quadrilateral and North-south-east-west corridors with over 200 hospitals being upgraded with pre hospital care and integrated communication system. We are also procuring a mobile hospital system having facilities for operation theatres, pathology labs, imaging units and other support functions which can be moved or airlifted to the disaster site at very short notice.

The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) envisages setting up of six AIIMS like institutions and strengthening 13 other existing medical institutions.

For managing Avian Influenza and for pandemic preparedness my Ministry took adequate measures that included contingency plans, rapid response teams, adequate stocks of oseltamivir and personal protective equipments, coordination with all concerned especially with Department of Animal Husbandry. These preparedness measures were put to test during outbreaks in 2006 and 2007 when we successfully contained the outbreaks and the authorities declared India free from Avian Influenza. Partnering with Global community India hosted the New Delhi International Ministerial Conference on Avian and Pandemic Influenza in December 2007 in which more than a hundred countries took part. The Conference culminated with a Vision and a Road Map proposed by our country. This Road Map sets out the actions that a Nation intends to implement for establishment achievable benchmarks. India also pledged two million dollars for this cause. Role played by Indian Diaspora is laudable and we wish it would continue.

Public health emergencies with mass casualty potential are another area which concerns all of us. We are in the process of bringing in legislation for public health emergencies. The implementation would be supported by the Integrated Disease Surveillance with laboratories of international bio-safety standards to support diagnosis and satellite and terrestrial information technology system for data management. Under the IDSP Project Network, a total of 800 sites in the country are being provided connectivity, out of which half will be through broadband and VSAT and half through broadband only. It will cover all the State Hqs., Districts, Govt. Medical Colleges, Premier Institutions and State Institutes of Health & Family Welfare.

There are milestones to be achieved by countries known as the Millennium Development Goals (MDGs). These are eight goals to be achieved by 2015 that respond to the world’s main development challenges. The MDGs are drawn from the actions and targets contained in the Millennium Declaration that was adopted by 189 nations-and signed by 147 heads of state and governments during the UN Millennium Summit in September 2000.

The eight MDGs break down into 21 quantifiable targets that are measured by 60 indicators.

Goal 1: Eradicate extreme poverty and hunger ; Goal 2: Achieve universal primary education ; Goal 3: Promote gender equality and empower women ; Goal 4: Reduce child mortality ; Goal 5: Improve maternal health ; Goal 6: Combat HIV/AIDS, malaria and other diseases ; Goal 7: Ensure environmental sustainability ; and Goal 8: Develop a Global Partnership for Development

The MDGs synthesise, in a single package, many of the most important commitments made separately at the international conferences and summits of the 1990s; recognise explicitly the interdependence between growth, poverty reduction and sustainable development; acknowledge that development rests on the foundations of democratic governance, the rule of law, respect for human rights and peace and security; are based on time-bound and measurable targets accompanied by indicators for monitoring progress; and bring together, in the eighth Goal, the responsibilities of developing countries with those of developed countries, founded on a global partnership endorsed at the International Conference on Financing for Development in Monterrey, Mexico in March 2002, and again at the Johannesburg World Summit on Sustainable Development in August 2002. India is trying to achieve the MDG goals as best as possible.

The public health challenges facing the nation require comprehensive, holistically designed responses for capacity building in the areas of public health education and research. To cater to this need, the Public Health Foundation of India (PHFI) has been set up, as a public-private partnership. We are in the process of revising medical education curriculum also for Medical Colleges in the country to meet the challenges of 21st century.

As stem cells can now be grown and transformed into specialized cells with characteristics consistent with cells of various tissues such as muscles or nerves through cell culture, their use in medical therapies is being done. Medical researchers believe that stem cell therapy has the potential to dramatically change the treatment of human disease. A number of adult stem cell therapies already exist, particularly bone marrow transplants that are used to treat leukemia. In the future, medical researchers anticipate being able to use technologies derived from stem cell research to treat a wider variety of diseases including cancer, Parkinson’s disease, spinal cord injuries, Amyotrophic lateral sclerosis and muscle damage, amongst a number of other impairments and conditions. Indian Diaspora involved in these technologies should facilitate the development of these specialized areas in India.

Gene replacement therapy is a way to generate normal human proteins in deficient cells, making cures possible for certain genetically inherited enzyme deficiencies, metabolic diseases, and cancer. Nanotechnology has the potential to create many new materials and devices with wide-ranging applications, such as in medicine, electronics, and energy production. Future possibilities appear promising in these areas. I am sure our experts abroad must be leading in these areas too and extend expertise to India in sustained manner.

New international agreements, including the WTO TRIPS agreement and the WTO agreement on Technical Barriers to Trade (TBT), will undoubtedly affect access to medicines in developing countries. Drug prices are only part of this challenge. Access to essential medicines depends on a nucleus of key factors: rational selection, affordable prices, sustainable financing, and reliable supply systems. These four components of the strategy are inter-dependent. Lower prices attract government financing; radically increasing drug availability boosts health systems development; more effective supply systems mean greater coverage; and more coverage increases sales revenues. High quality health care depends on choosing those medicines with the best combination of safety, efficacy, quality and health impact. Over 1500 new medicines have been introduced during the last 25 years. Many of these represent genuine therapeutic innovations, which can and should have a major public health impact. Health systems and health care providers everywhere struggles to select those drugs which best suit their needs.

The process of drug discovery is so expensive that drugs are never confined to a limited number of markets. It is commercially viable only when the drugs are marketed across wide regions of the world. India can harness its inherent strengths for becoming the global hub for clinical research only when the tenets of GCP are imbibed and fostered by everyone engaged in the process. That will be the only way to ensure that data generated in India is accepted internationally.

India has the 2nd highest number of qualified doctors in the world. Of every six medical doctors in the US, one is Indian. India’s huge population and the prevalence of a wide spectrum of disease conditions offer a wide patient-resource for clinical trials. While clinical trials cost approximately $300 to 350 million in US, they cost only about $25 million in India. India’s advantage in pharma industry includes excellent chemical synthesis skills, successful scaling up of laboratory processes to plant-size, cost-effective and commercially viable non-infringing processes, pool of low-cost and highly skilled medical professionals, manufacturing facilities of international standards, quick absorption of new technology.

India now has Hospitals comparable with the west. Accreditation of the Hospitals would give impetus to Medical Tourism. Indian Diaspora can play crucial role here by promoting Medical Tourism for treatment of foreign patients in India. Needles to mention, they would get quality treatment with cost advantage. The patient and family would be able to see culturally rich hospitable incredible India too.

Climate change is a threat to mankind! Since the end of the 19th century the earth’s average surface temperature has increased by 0.3-0.6 ?C. Over the last 40 years, the rise has been 0.2-0.3 ?C. Recent years have been the warmest since 1860, the year when regular instrumental records became available. Some important aspects of our lives can be affected through changes in weather patterns. All of us should join hands for his purpose.

I would like to highlight that women empowerment through education and social upliftment is the way to achieve health in women. The women Health should not be neglected as the whole family depends on her and timely prevention or early treatment avoids the suffering due to advanced disease when it becomes almost incurable. Indian Diaspora should give priority to women health projects in India.

There are several areas in health sector where reforms are progressing ahead while there is need to move in some other directions also. Indian Diaspora community can play vital role by extending the youth energy and technological power behind our sustained efforts in alleviating the suffering of our population.

I wish the Annual Event of MOIA and the CII all continued success.

Thank you all.

Source: Press Information Bureau, India

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