As the Gujarat Nephrology Association (GNA) launched a three-day strike on Monday against "imparity in dialysis rates" under the Pradhan Mantri Jan Arogya Yojana (PMJAY), all 120 members of the association threatened to stop providing services under the government scheme if their grievances were not heeded in three days. Even as the association aimed to step up pressure on the government, the state's Health Department said that no patient was faced with inconvenience due to the protest. “If the government does not come up with a solution in these three days. as a last resort, all 120 nephrologists will withdraw their names from the PMJAY scheme and mass resign. This would be the first such case when all experts of a field will together resign from the PMJAY scheme,” Dr Jigar Srimali, representative of the Gujarat Nephrology Association, told The Indian Express. The association called for a protest over the reduction of dialysis rates under the PMJAY from Rs 2,300 to Rs 1,950, effective from July 11, among other issues. Amid the strike, more than 100 patients were provided with free dialysis services on Monday in Ahmedabad, the GNA said. Meanwhile, assuring that no patient was faced with inconvenience, the Gujarat Health Department said the state government is prepared for dialysis under such circumstances. A helpline was also launched. “An average of 1 lakh dialysis per month is done at the 272 government dialysis centres in the state. The state government has a well-thought-out plan in place so that not a single patient in the state would suffer while undergoing dialysis. In addition, the state government has started a helpline service - 1800 233 1022 / 9059191905 - for any patient who has difficulty in undergoing dialysis under PMJAY for their complaints and necessary information,” Additional Chief Secretary of Health and Family Welfare Department Manoj Aggarwal said on Monday in his address to media about the current situation. Under the A-One Dialysis programme, the state government has commissioned a total of 272 free dialysis centers up to the taluka level in addition to the free dialysis services being provided in civil hospitals of the state. Further adding, Aggarwal said, “The prevailing rates of dialysis at PMJAY empanelled private hospitals are higher than the average rates provided in other states of the country. The state government has allocated Rs 1,650 per dialysis and Rs 300 round trip fare for the patients, thus a total of Rs 1,950.” According to the National Health Authority, he said, the average amount given for dialysis in empanelled hospitals under PMJAY in other states of the country is Rs 1,500. However, on the other hand, the nephrologists alleged the state government - despite repeated requests to increase the amount - reduced it by 17 per cent without any consultation or prior intimation. “When we asked them for a review, they said we can not do that being a triparty agreement and it will be done after a year. With this rate, it will be impossible to sustain,” the association stated. Questioning the government’s claims to manage the situation, Dr Srimali said, “Take for instance, 1.3 crore total dialysis procedures that were conducted during the last one year (July 2022-July 2023) in Gujarat. Out of these, 1.02 crore were done in private dialysis centres which is 78 per cent. The government does not have that much capacity. While there are a total of 120 nephrologists in GNA, only five are with the government. that too at one centre- the Institute Of Kidney Disease And Research Centre. This also means that out of a total of 272 government dialysis centres, only one has nephrologists.” The association has also questioned the quality of dialysis which is provided at these centres. “While one nephrologist is handling 54 dialysis centres (only five nephrologists for 272 government centres), they are forced to provide teleconsultation services. It is like having medication without a prescription from doctors. Also, as per the state government, a private nephrologist can join three centres but look at the government ones-five are running 272 centres,” the association’s representative Dr Srimali, who is a nephrologist in Ahmedabad, added. On a daily basis, around 35,000-40,000 dialysis procedures are carried out at private centres while 5,000-7,000 are conducted at government centres. On Monday, a large number of patients and dialysis technicians in all cities of Gujarat filed a petition with the Collector and Mamlatdar offices. Patients submitted that 80 per cent of PMJAY dialysis is done in private hospitals. "If PMJAY dialysis is stopped in private hospitals due to the reduced rate, then the government hospital will be able to provide this facility. Besides, there is no nephrologist available in the government hospital except Kidney Hospital Ahmedabad, so how can we take dialysis without a nephrologist?" a statement underlined in a representation to the government. The Ahmedabad Hospitals and Nursing Home Association (AHNA) has also supported the GNA's protest and has requested Chief Minister Bhupendra Patel to intervene and bring immediate redressal. In Vadodara, SSG Hospital and Gujarat Medical Education and Research Society (GMERS)-run Gotri Hospital on Monday cancelled leave of staff of the Nephrology Department on August 15 and August 16 (on account of Pateti) to keep the dialysis treatment available for all patients in view of the strike call. According to the officials of SSG, the hospital is also coordinating to ensure that patients arriving from the district areas of Vadodara, due to the protest, can be referred to Community Health Centres locally in Padra, Savli, Jarod, Dabhoi and Bajwa, where dialysis facilities are available. SSG has 16 dialysis machines while GMERS-Gotri has 12. (with inputs from ENS, Vadodara)
