Affordability, availability and accessibility of quality healthcare is our intent

Dr Sarveshwar Narendra Bhure, Mission Director (NHM), Chhattisgarh, in a free-wheeling interview, speaks on the innovative measures taken by the Chhattisgarh government to improve the healthcare delivery in the naxal heartland

What efforts have been taken by the Government of Chhattisgarh to improve healthcare of the state?

Government of Chhattisgarh has taken many innovative steps towards improving the healthcare delivery system. The state government intends to improved the affordability, availability and accessibility of quality health care to every citizen of the state. Towards this direction, the state has initiated Rashtriya Swasthaya Bima Yojana (RSBY) for the unorganised workers and Mukhyamantri Swasthaya Bima Yojana (MSBY) to provide protection to every uncovered household against the risk of health spending leading to poverty. Other major steps initiated are:

• Improved the number of doctors, nurses and pharmacists are appointed in the national healthcare system to overcome shortage of medical personnel
• Developed a healthcare system which will dedicatedly work for providing medical help in less time in rural areas through mobile medical units.
• Increased healthcare spending for healthcare development.
• Regulating distribution and sales of drug public pharmacies often run out of free medications it will help to reduced health service cost.
• Developed health infrastructure.
• Arranged different health checkup campaign for free in rural areas.
• Run different program to spread awareness about NCD’s and it’s awareness.
• Initiate transparency by accreditation of hospitals and healthcare providers.
• Engagement of private players and international health agencies.

Being a naxal hit area, what are the added challenges you face and how do you combat it and while you deliver healthcare to the insurgent-hit tribal areas? What steps have you taken to bridge acute shortage of doctors/ nurses in the state?

Bijapur, district in Chhattisgarh is now turned out to be a model which has elevated the healthcare availability and delivery of the tribal region, by designing attractive incentive for doctors, specialists of this district hospital has made tremendous improvement in healthcare. Bijapur is been highlighted in every healthcare forum pan India. Shortage of health human resource in these areas was the major challenge in delivering healthcare services. To check this Chhattisgarh Rural Medical Core scheme was implemented to provide both cash and non financial incentives to the health staffs who served in these areas. Deployments of 2nd ANM and Rural Medical Assistants had made a big change in scenario. Interrupted supply of electricity, which hampered the services has been tackled by installating solar panels at sub-health centres and primary health centres. HR outsourcing, transit hostels, fixed day out reach service camps, birth waiting homes, Sirha guniya sammelans are innovative initiatives taken for strengthening the health system.

How are vaccination and institutional delivery carried over in these areas, the ways in which they are improved? What efforts have been undertaken to upgrade the MMR/ IMR rates, neonatal intensive care units?

To achieve 90 per cent full immunisation coverage, various steps are taken as follows –

• The state conducted special immunisation drive at poor performing blocks.
• Number of left out and drop out children are vaccinated by conducting Mission Indradhanush in four  phases, state’s vaccination coverage was 96 per cent, 83 per cent, 8621 and 11520 in Phase 1,2,3,4 respectively.
• Strengthening of cold chain and vaccine logistic system through establishment of e VIN and EVM assessment is done in the state, according to the assessment result, improvement plan has been circulated to all districts.
• New cold chain point are established to deliver the vaccine at session site timely and after analysis of need based area.
• To achieve 90 per cent  full immunisation coverage districts are instructed to emphasis in following points
• Prepare micro-plan for routine immunisation based on head count and revised/updated micro-plan expected to be ready at a time.
• Session site should be open timely so that child won’t be missed by any vaccine.
• For effective vaccine delivery and coverage improvement, it is necessary to have vaccine delivered at right time and similarly return to cold chain point in the evening.
• Supervision by health supervisor (LHV, MO, BMO, DIO) & others (Mitanin trainer) is extremely important for supportive supervision of RI.
• District with difficult terrain, naxal hit area and tribal areas have immunisation session in mela, Haat bazaar, communicating with local leader and by AVDS.

How much dedication and hardwork is required by doctors, Asha’s, ANM’s to work in a state like Chhattisgarh? How do they manage it and what support do they get from NHM and the state government?

It is a very well known fact that human resource density is directly related to achievements in health outcomes such as Maternal Mortality Ratio (MMR), Infant Mortality Rate (IMR) or coverage with preventive and promotive interventions. Huge investments have been made in NHM over last 10 years to add contractual staff in service delivery and managerial positions. Number for nurses and doctors are really impressive. In addition, 70000 Mitanins at village level also provide much needed support for poor women and children to seek timely care. Skilled HRH are critical to achieve health policy goals. There has been a rapid expansion of medical colleges, dental colleges and nursing schools and colleges in past decade. Several concerns have been articulated about poor quality of training due to non-availability of faculty, lack of clinical material and present environment in examination system. Due to limited exposure in skill based training even fresh postgraduates are not confident and competent enough to perform simple clinical procedures such as interval tubectomies. To motivate and refresh them regular capacity building programmes have been conducted with the help of technical agencies like WHO, Unicef, HLFPP, Jhpiego etc.

Can you give us the status of NCD burden in the state?

In the National Family Health Survey (NFHS) the percentage of people having high blood sugar and blood pressure in the state has been surveyed. Based on the sample survey done, separate data of urban and rural are reported. Blood sugar level among women (age 15-49 years)  the data sheet highlights that the high blood sugar more than 140 range is seen in urban area with a percentage of 6.6 per cent whereas in rural areas it is 5.4 per cent and very high blood sugar of more than 160 range is seen in urban areas with 3.1 per cent than rural area which is less 2.4 per cent. In men (age 15-49 years), the data sheet highlights that the high blood sugar of more than 140 is high in urban areas with a percentage of 12.9 per cent whereas in rural areas it is 8 per cent and very high blood sugar of more than 160 is also very high in urban 7.2 percent than rural area which is less 3.7 percent. Male are more affected with high blood sugar levels. The status of hypertensive patients are again more in the urban population than the rural population.

When it comes to nutrition, women in the state are severely malnourished, particularly woman from Chhattisgarh Baiga tribal group. Any particular scheme implemented for the same?

NHPS is expected to provide a sum coverage of upto Rs 5 lakh per family per year for both secondary and tertiary care services. Currently, Rashtriya Swasthya Bima Yojana (RSBY) is providing Rs 30,000 sum insurance coverage primarily for secondary care services. The NHPS is expected to handle the treatment load of critical care diseases like cancer, cardiac, neurosurgery and trauma. The NHPS is also expected to attract corporate and bigger hospitals for the services provided by them.

Chhattisgarh was doing well under the Rashtriya Swasthya Bima Yojana (RSBY). With NHPS, what are the changes expected?

NHPS is providing equal opportunity for both public and private hospitals under the scheme. Public hospitals can earn additional fund by providing treatment under NHPS, same fund may be utilised for the development of hospitals and upgrading the services. RSBY and Mukhyamantri Swasthaya Bima Yojana scheme tries to include critical issues like:

• Provision of effective and affordable family care to the entire populations.
• Extension of tertiary care to poor people of rural areas.
• Decrease the out of pocket of pocket expenditure.
• Ensure access and quality of service to those with no influence.
• Protecting the poor from indebtedness and impoverishment resulting from medical expenditure.
• Ensure choice to patients among multiple service providers

What do you think would be the value addition to the public sector through NHPS?

Definitely NHPS will be leading to reduce the out of pocket expenditure in health. The economic burden of disease on common people may be reduced which further results into the prosperity and human development.

Are tele-medicince and digitisation used for healthcare delivery in these areas? How has the technology helped to reach such unreached places?

Department of Health and Family Welfare, Chhattisgarh has come up with an MoU with Arvind Netralaya, Madurai (Tamil Nadu) for setting up of vision centres in remote areas of Chhattisgarh, wherein consultation with doctors would be provided through telemedicine. Under this project, training of ophthalmologists is  on-going in Madurai. With the help of telemedicine and digitisation, healthcare services can be reached to unreached.

What is the role of private players in such areas?

The issue of public-private partnerships (PPPs) in health has been highlighted by the recent draft NITI Aayog document about a PPP arrangement for certain non-communicable diseases (NCD). The National Health Policy (NHP) 2017 clearly prioritises strengthening of public health systems as a key approach. However, it also recognises a critical gap-filling. Currently, under PPP we are running several health projects in Chhattisgarh. One is with GVK EMRI for providing referral transport services. 108 emergency ambulance service and 102 non-emergency services are provided under PPP model. The state is planning to run the diagnostics services under PPP for which process are under pipeline. Like this with the help of Hindustan Latex Family Planning Promotion Trust (HLFPPT), we are doing capacity building of frontline health workers for providing IUCD/ PPIUCD services under family planning programme.

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