Telemedicine: Odisha shows the way
Topic: Important aspects of governance
Why in news?
A telemedicine project started by an Odisha-based social entrepreneur is slowly going national after the Central government adopted it as a model project two years ago.
About the project:
Through this micro-entrepreneurship programme the government attempts to tackle two problems- unemployment and bad health.
- Started in 2009, the unique model that focusses on sustainability involves training of local youth in e-medicine services and enables them to set up e-health centres in government-run primary health-care centres (PHC), community health centres (CHC) and subdivisional hospitals. These centres have created job opportunities for over 500 youth in Odisha and reached out to over five lakh patients.
- Under the project, local youth are trained for a month in an e-health assistance programme, after which they can apply for a bank loan to start an e-health centre in PHCs and CHCs. On average, the cost of starting a telemedicine centre goes up to ₹6 lakh. A centre needs a staff of four people, including the entrepreneur.
- Typically, a centre is equipped with a laptop with video camera and basic diagnostic testing facilities like blood glucose meter, urine analyser, heart rate monitor, etc. So far, 127 such centres have been opened in Odisha at the village and district level.
- The revenue comes from charges for tests and tele-consultation fees. In case patients are covered under any health scheme for the poor, these charges are borne by the scheme. The charges for tests and consultation are fixed by the government; a basic consultation costs ₹100 while that with a super-specialist costs ₹300.
- At no cost to the government, these centres help in offering basic testing facilities. Patients suspected to have major illness get the benefit of the telecommunication facility for consultations with senior doctors. These telemedicine centres also create a database of personal health records of every patient walking in for future reference.
India, China to join Indian Ocean exercise
Topic:Bilateral, regional and global groupings
Why in news?
Indian Navy will be joining the People’s Liberation Army (PLA) Navy in a maiden maritime search and rescue exercise to be chaired by Bangladesh at the Indian Ocean Naval Symposium (IONS) in November this year.
Bangladesh, the current Chair, is scheduling a maiden International Maritime Search and Rescue Exercise (IMMSAREX) in November in the Bay of Bengal to be attended by ships and aircraft of the members and observers of the IONS.
What you need to know about IONS?
The IONS is a regional forum of Indian Ocean littoral states, represented by their Navy chiefs, launched by India in February 2008. It presently has 23 members and nine observers.
- It is a voluntary initiative that seeks to increase maritime co-operation among navies of the littoral states of the Indian Ocean Region by providing an open and inclusive forum for discussion of regionally relevant maritime issues and, in the process, endeavors to generate a flow of information between naval professionals that would lead to common understanding and possibly agreements on the way ahead.
- Under the charter of business adopted in 2014, the grouping has working groups on Humanitarian Assistance and Disaster Relief (HADR), Information Security and Interoperability (IS&I) and anti-piracy now renamed as maritime security.
Gaj Yatra’ to mark World Elephant Day 2017
Why in news?
Gaj Yatra’, a nationwide campaign to protect elephants, was launched on the occasion of World Elephant Day. The campaign is planned to cover 12 elephant range states. The elephant is part of India’s animal heritage and the Government celebrates this day to spread awareness about the conservation of the species.
The 15 months campaign will be led by the Wildlife Trust of India (WTI). The campaign aims to create awareness about elephant corridors to encourage free movement in their habitat.
WORLD ELEPHANT DAY:
World Elephant Day is an annual global event celebrated across the world on August 12, dedicated to the preservation and protection of elephants. The goal of World Elephant Day is to create awareness about the plight of elephants and to share knowledge and positive solutions for the better care and management of captive and wild elephants.
- African elephants are listed as “vulnerable” and Asian elephants as “endangered” in the IUCN Red List of threatened species. As per the available population estimates, there are about 400,000 African elephants and 40,000 Asian elephants.
- World Elephant Day is celebrated to focus the attention of various stakeholders in supporting various conservation policies to help protect elephants, including improving enforcement policies to prevent illegal poaching and trade in ivory, conserving elephant habitats, providing better treatment for captive elephants and reintroducing captive elephants into sanctuaries.
A strange amalgamation: Privatizing Public health care
Topic: GS-3, Economy and Health
The Health Ministry and the NITI Aayog have developed a Public Private Partnership (PPP) framework to let private hospitals run services within district hospitals, on a 30-year lease for three non-communicable diseases i.e. cardiac disease, pulmonary disease, and cancer care.
- First in the world, the Aayog is all set to push states to privatise well functioning district hospitals in the Tier 2 and 3 cities like Pune, Baroda, Visakhapatnam, Madurai and so on.
- The proposed model consists of leasing out for 30 years a portion of the hospital to a private company to provide treatment for the three diseases i.e. cardiology, cancer and pulmonology that account for 35 per cent of mortality in India.
- It is also a fact that three-quarters of the specialists, equipment and beds are in the private sector. Thus, partnership is therefore inevitable.
- However, States like Tamil Nadu have rejected the scheme stating they have been able to provide quality care through the state health insurance scheme that covers 70% of the population at 10% of the health budget.
Public–private partnership is not new:
- India has a plethora of public–private partnership (PPPs) in health, starting with handing over free land and extensive custom duty waivers for imported equipment, to “strategic partnerships” under which public hospitals have been handed over to large corporates, outsourcing of diagnostics and dialysis units and so on.
- The largest PPPs are, however, under the government sponsored insurance schemes where treatment costs for eligible patients are reimbursed by government at agreed package rates.
- Niti Aayog’s proposal pushes for PPPs focussed on cancers, heart conditions and respiratory tract diseases in non-metros.
- It would see private healthcare service providers bid for a 30-year contract to upgrade and operate these facilities within district hospitals.
- The scheme is designed to address the acute shortage of trained personnel and infrastructure in public hospitals, particularly those situated away from large cities and metropolitan centres.
- The Niti Ayog asserts that the scheme will lead to infusion of resources by the private sector, and will expand access to healthcare services.
- The private entity will have its own staff and personnel, laboratories, pharmacy, ambulances and common services like cafeteria and bookshops down to the ATM.
- The private sector will also have an assured market, access to all confidential records and information and freedom to charge user fees.
- Complicated cases will, however, be referred to bigger hospitals — their own or of government.
- A Grievance Redressal mechanism is proposed. Overall accountability is confined to submitting some annual reports to the government. In case of any violation of conditions, the government will need to seek judicial relief.
- The State governments will give Viability Gap Funding (VGF), or one-time seed money, to private players to set up infrastructure within district hospitals.
- The private parties and State health departments will share ambulance services, blood banks, and mortuary services.
- Beneficiaries of the government insurance schemes will be able to get treatment at these hospitals but there will be no reserved beds or quota of beds for free services. General patients will also be allowed to seek treatment.
The major drawbacks:
The challenge in the Niti Aayog hybrid model is its implementation.
- It brings forward the question that how does public and private managements coexist in the same physical space?
- Because, a hospital is a living institution that cannot have partitions.
- Salary streams, motivation levels, working methods, prescription practices, monitoring and accountability systems, work expectations, all vary. Such as:
- Every day, there are instances of patients being denied treatment in private hospitals till payment is made or preferring paying patients to the government insured ones or levying additional charges in addition to the sum reimbursed.
- Private hospitals are also known to overcharge devices like stents and drugs that are the key revenue earning centres.
The model does not provide any information on the pricing strategy and its impact on public budgets.
- Under the Aayog model, several costs are being subsidised, rates charged ought to be half of the CGHS rates.
An implementation of the proposal will further worsen inequity in access to healthcare services.
- Private providers, following the money trail, will stay away from poor and remote districts, leaving these to the public sector to manage.
- This will further weaken the ability of public hospitals to attract and retain trained doctors and other health workers, as public services will be restricted to the poorest areas where working conditions are the most difficult.
- The simple remedy could be to significantly enhance investment in public healthcare services, including in the training of health workers.
- On a positive note, this initiative certainly provides effective diagnostic facilities at affordable cost for the life threatening diseases.
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