Premature mortality from chronic diseases is becoming a worrying issue in India. At National Health Mission (NHM), director Sanjeev Kumar has taken a series of measures to meet the challenges posed by non-communicable diseases (NCDs). He spoke to The Indian Express about the NHM’s activities.
What is the current focus of the National Health Mission?
The National Health Mission was launched in 2005 and its main focus has been on maternal and child health. However, to respond to the epidemiological shift of diseases, the focus of the NHM is also being modified to tackle the burden of NCDs in society. There is a concerted effort to promote healthy lifestyles and revitalise local health traditions, apart from mainstreaming ayurveda, yoga, unani, siddha and homeopathy. The hallmark of the NHM is financial decentralisation to rural health institutions and empowering doctors to take decisions at these places.
What is the burden of NCDs in Maharashtra?
A report on the state of disease burden by the Indian Council of Medical Research (ICMR) reveals that in Maharashtra, 68 per cent of all deaths could be attributed to NCDs in all age groups. Ischemic heart diseases, stroke, COPD (chronic pulmonary obstructive disease), chronic kidney disease and diabetes are among the top 15 causes of deaths in 2016. So, the NHM is gearing up to respond to the challenge by strengthening and converting our 10,000 sub-centres in the state into ‘Health and Wellness Centres’ which would provide 12 different types of services. The focus will be on prevention, screening, early diagnosis and treatment.
As part of Ayushman Bharat, an important initiative is the operationalisation of Health Wellness Clinics at 1,100 sub-centres in various blocks in Maharashtra. The National Programme for the Prevention and Control of Diabetes, Hypertension, Cardiovascular Diseases, Cancer and Stroke (NPCDCS) is being implemented in 34 districts, and a total of 18.47 million people have been screened for common NCDs. Of these, around five lakh diabetes and seven lakh hypertension cases are confirmed and are being treated. Now, the programme is heading towards universal screening of everyone above the age of 30 for diabetes, hypertension and three common cancers, oral cancer, breast cancer and cervical cancer.
The Prime Minister has announced an ambitious National Health Protection Scheme. How is Maharashtra going to implement it?
In Maharashtra, we have been implementing our health insurance scheme for more than two crore families, providing Rs 1.5 lakh in insurance cover. So, it will not be difficult for us to integrate our scheme with the National Health Protection Scheme (NHPS). The details of NHPS are being worked out at the national level. As part of the NHPS, patients who would need further care will get quality treatment in both private and government hospitals. Collectively, it is called Ayushman Bharat.
What are the strategies to bring down infant and maternal mortality rates?
As per the Sample Registration Survey 2016, published in September last year, the infant mortality rate (IMR) in the state has come down from 22 per thousand live births in 2015 to 19 in 2017. One of the important steps taken to reduce IMR is home-based newborn care (HBNC). Here, every newborn is visited by an accredited social health activist (ASHA) on certain days after birth. ASHA identifies any unusual symptoms and refers the child to a higher centre if required. At the sub-district and district hospitals, the special newborn care units are functional to admit sick neonates. In the last decade, we have ensured that almost every delivery takes place at a health institution, and this has been made possible because of more than 60,000 ASHA workers, the free and timely referral transport and improvements in the service delivery of our health institutions.
Similarly, various steps have been taken towards reducing maternal mortality rates, including institutional deliveries and schemes like Janani Suraksha Yojana and Pradhan Mantri Matru Vandana Yojajna.
After infant deaths were reported in Nashik last year, what efforts have been taken to upgrade neonatal intensive care units and tackle staff shortage?
When a large number of sick newborns, both from community and private hospitals, are admitted in ‘special newborn care units’ (SNCUs), just to focus on deaths in that facility may not be an appropriate indicator of neonatal mortality in the community. Having said that, we had a hard look at the deaths in SNCUs and constituted a special committee of neonatologists from medical colleges and private hospitals. New and revised protocols were prepared by the experts and they have been rolled out in the SNCUs. A state-level training workshop for staff of 36 SNCUs was conducted and the SNCU online software has been put in place to monitor each baby. A regular SNCU death audit is conducted on a weekly basis. We have planned to set up two more neonatal intensive care units in Amravati and Nashik.
How is the government planning to ensure the mainstreaming of AYUSH?
Ayurved and unani doctors in Maharashtra are allowed to practice ‘cross-pathy’ as per an amendment in the Maharashtra Medical Practitioners Act, 1961. Homeopathy doctors are also allowed to do cross practice after completing the one-year pharmacy bridge course offered by the Maharashtra University of Health Sciences. A full-fledged programme of mainstreaming of AYUSH was launched under the umbrella of National Rural Health Mission in the year 2005. In 2014, the National AYUSH Mission was launched by the ministry, including provisions of AYUSH health services, upgradation of educational institutes and quality control of AYUSH drugs. As per the NITI Aayog implementation plan 2017-2020, AYUSH services have to be provided at all government health facilities at primary to tertiary level.
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