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Affordable Health Care

Healthcare in Budget 2017-18

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Health sector policy making is extremely challenging and complex. The backdrop for policy formulation are low public spending and high out of pocket expenditures. The out of pocket expenditure on health care as a proportion of total household monthly per capita expenditure was 6.9 percent in rural areas and 5.5 percent in urban areas. Depsite India providing free care in public hospitals for maternity, new born and infant care, the burden of out of pocket expenditures remains quite high. The major policy direction is to enhance public health expenditure to 2.5% of GDP (from the present low level of ~1%) in 5 years.

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The 2017 Union Budget estimates for health show an appreciable increase of more than 27%, from Rs. 37061.55 cr in 2016-17, the budget estimate for 2017-18 has been increased to   Rs. 47352.51 cr. Further the Government has prepared an action plan to eliminate Kala-Azar and Filariasis by 2017; to eliminate Leprosy by 2018, Measles by 2020 and to eliminate Tuberculosis by 2025.

The sustainable development goals envisage that the global maternal mortality ratio will be reduced to 70 per 100,000 live births. From a baseline of 560 in 1990, the Nation has achieved an MMR of 167 in 2011. From a baseline of 126 in 1990, the Nation has achieved an U5MR of 39 in 2014. In the run up to the 2017 Union Budget, Government has formulated an action plan to reduce IMR from 39 in 2014 to 28 by 2019, and MMR 167 in 2011 to 100 by 2020. The challenges remain in the six large States of Bihar, Uttar Pradesh, Rajasthan, Madhya Pradesh, Jharkhand and Chattisgarh which account for 42 percent of national population and 56 percent of annual population increase.

India has developed a vast organization for public health care delivery and Primary care services. Infrastructure and Human Resource Development in Primary and Secondary Care Hospitals has been a key priority area. The 2017 Union Budget seeks to upgrade 1.5 lakh health sub-centres to health wellness centers and introduce a nationwide scheme for pregnant women under which Rs. 6000/- for each case will be transferred.  These steps represent significant additions to the ongoing schemes for provision of free dugs, free diagnostics and free emergency care services and free transport system for the people. A well-functioning primary health system reduces the burden on high cost secondary/ tertiary care facilities and the 2017 Union Budget takes substantial steps in this direction.

AIIMS is a national and global brand – built on more than six decades of evolution and performance of our Institute. It is the bench mark for other centres of excellence in healthcare and academics, and a fountainhead of best practices in education, research and clinical standards. The unique status of AIIMSs has been reinforced in the 2017 Union Budget by significant infusion of financial resources for major expansion. India’s Apex Medical Sciences University has enabled us to address one of the great weaknesses of Indian society – the iniquitous utilization of modern health services. High out of pocket expenses on chronic conditions can push millions of people below the poverty line.

The Government has placed a lot of emphasis on creation of several AIIMS like Institutions across India. The 2017 Union Budget has proposed establishment of 2 new AIIMS in Jharkhand and Gujarat. This would provide a huge boost to tertiary care services in public sector. Additional resource allocations for primary, secondary and tertiary care sectors lays down a roadmap for India’s path to achievement of sustainable development goals. The replication of AIIMS is quite complex because of the high-end clinical services that it encompasses. It has been a challenge to get competent faculty especially at the senior level and to retain it. Infrastructure delays have affected the utilization.

Human resources represent a vital component of India’s health care. The 2017 Union Budget seeks to create 5000 Post Graduate seats per annum to ensure adequate availability of specialist doctors to strengthen secondary and tertiary levels of healthcare. The Union Government has indicated its commitment to take necessary steps for structural transformation of the Regulatory framework of Medical Education and Practice in India. The increased availability of PG seats along with a centralized entrance exam represent major steps in reform of medical education in the country. The expansion of postgraduate medical education is a priority as the shortage of PG medical seats in the country affects not only the availability of specialist doctors but also the ease of getting faculty for medical colleges.

The collaboration between Medical Colleges and Medical Research is being firmly established. India has 32 publically funded Department of Health Research institutions. The emphasis is on evidence for policy, medical product innovation and basic research; operations research; drug discovery; frugal innovation; antimicrobial resistance; partnerships for research; and creation of databases.

The Health for All policy that the Nation had envisaged in the mid 1970s, continues be relevant to this day.

*Author is a senior civil servant, an IAS officer of 1989 batch, presently serving as Deputy Director Administration, AIIMS New Delhi.

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The National Cancer Institute, AIIMS

One Year in the Making of India’s Largest Cancer Hospital

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The Health Minister has called the National Cancer Institute, the largest public health investment project of Independent India. With 710 beds, 26 Operation Theaters, 15 laboratories for Principal Investigators, a separate Diagnostics Block – the National Cancer Institute is the behemoth of Indian cancer care. Bhumi_Pujan2.jpg

At full capacity it will deploy 2700 employees and cater to 10 lac patients per annum. The design of the largest cancer hospital of India brought together India’s best cancer experts for conceptualization and design.

The National Cancer Institute is the state of the art Tertiary Cancer care cum Research Institute, being constructed at the AIIMS Jhajjar campus
in an area of 31.2 acres. It is the nodal Institution for all activities related to cancer in the country and will have linkages with all Regional Cancer Centers and other Institutes of India.Research.jpg

As India’s premier institute of cancer, its responsible for identifying priority areas for Research & Development carrying out basic and applied research in molecular biology, genomics, proteomics, cancer epidemiology, radiation biology and cancer vaccines. It is also to act as the premier center for development of human resource in various branches of cancer management depending on the needs of our country.

The Objectives of National Cancer Institute are:

(a) To provide affordable quality tertiary cancer care to cancer patients;

(b) To act as the principal agency of the country in the field of oncology;

(c) To carry out innovative research and the development of novel interventions to prevent and treat cancer;

(d) To undertake clinical trials of newer drugs as well as vaccines;

(e) To carry out transnational research and incorporate newly developed techniques in cancer therapy into clinical practice.

(f) To create international linkages with major cancer centers for exchanging cancer related information and for establishing exchange programmes for training and education.

The National Cancer Institute will have 710 beds  dedicated to treatment of those cancers which are based on research protocols. It will have equipment with latest technology.BDNCI.jpg Research will be conducted in collaboration with other cancer centers. The total personnel deployment for the National Cancer Institute has been projected at 2705. A Project Monitoring Committee under the chairmanship of Health Secretary supervises implementation and a sub-committee chaired by Head National Cancer Institute monitors the day to day progress of the project.

Following Cabinet approval for Rs. 2035 crores, the commencement of civil works took some time. The project commencement necessitated statutory approvals from local authorities. The environmental impact assessment for the National Cancer Institute required approvals from 34 agencies in the Government of Haryana. Subsequent to the Environment Impact Assessment sanctions, civil works for the Institute Block and residential block of the National Cancer Institute were awarded. The stipulated date for completion of works is March 2018 for the Institute Block and August 2018 for the Residential Block. The Machinery and Equipment Procurement will be completed by July 2018.

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December 2016 marks one year of commencement of civil works on the National Cancer Institute. The Institute Block of the National Cancer Institute comprises of several buildings namely the hospital and OPD block, Diagnostics block, Administration block, Academics block, Research Hostel for 200 students, and Service block.

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The 710 bedded, 8 storey Hospital Block has been divided between Surgical Oncology (200 beds), Medical Oncology (200 beds), Radiation Ocology (120 beds), Palliative Care (40 beds), and the remaining between Nuclear Medicine, Anaesthesia, Emergency, ICU and Day care. Necessary approvals from the Atomic Energy Regulatory Agency were obtained to commence works in the Hospital Block.

The Diagnostics Block comprises of Laboratory space for Microbiology, Central Instrumentation Facility, Haemato-Pathology, Histo-Pathology, Cytopathology, Tumor Immunology and Advanced Diagnostics Centre.

The National Cancer Institute would also have a Research (Basic Sciences) Block with 15 Principal Investigator Laboratories.

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The Academic Block would have Conference Halls, Auditorium, Office Spaces and the Faculty Cafeteria. The Research Hostel would also have a studio residence for visiting researchers and the Head NCI suite. In addition there would be the Administration Block for Office Space.

The Residential Block comprises of 216 Type III dwelling units, 84 Type IV dwelling units, 56 Type V dwelling units, 16 Type VI dwelling units, a total of 37 dwelling units.

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In addition a Hostel Block to house 440 nurses, 154 Junior Residents and 46 Senior Residents is being constructed. In 2016, a financial progress of Rs. 171 crores has been achieved. An average labor deployment of 600 per day was witnessed.

The National Cancer Institute attracted a lot of international attention in 2016 with senior faculty visits from the National Cancer Institute of Baltimore and the MD Anderson Cancer Centre Houston to AIIMS. In addition the French Academy of Medicine conducted a workshop in Toulose for a collaboration with the National Cancer Institute of France.

Looking ahead the National Cancer Institute would be amongst the great public Cancer hospitals in the world setting new benchmarks in translational research and patient care. We eagerly look forward to timely completion of works and the project being fully operationalized in 2018.

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*Author is a senior civil servant, an IAS officer of 1989 batch, presently serving as Deputy Director Administration, AIIMS New Delhi.

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