The Andhra Pradesh state government has been a trend setter in the health sector. Its health department has created and implemented exemplary models of health programmes under the public-private partnership to address the challenges of extending free diagnosis and healthcare services to the poor, says Poonam Malakondaiah, Principal Secretary, Health, Medical and Family Welfare Department, while sharing much more in an interaction with Sudheer Goutham of Elets News Network (ENN).
Tell us about the idea behind the health programme NTR Vaidya Pariksha. Brief us on the level of its implementation.
With an aim to achieve health for all and provide quality healthcare service to the poor at government health facilities in the state, the NTR Vaidya Pariksha, the next level of free lab diagnostics programme (under Dr. NTR Vaidya Seva Scheme) was introduced in January 2016. This programme is intended to build faith in public healthcare facilities among the people.
All the essential diagnostic lab tests have been outsourced. These tests, provided free of cost to the poor people, include 60 in area and district hospitals (AH and DH), 40 in community health centres (CHCs) and 19 in primary health centres (PHCs). Among the tests provided, the low-cost, high-volume tests are done in in-house facilities and lowvolume, high-cost tests are done in outside facilities. There are over 1,156 PHCs, 192 CHCs, 31 AHs and 8 DHs in the state.
How are essential standards maintained in these diagnostic labs? What are the plans in place to plug the leakages?
All the 103 labs that have been set up under this programme have directed to get the NABL accredition within two years from the commencement of the programme. The timeline has been set keeping in mind the oneyear process NABL accreditation takes. Further, for constant quality monitoring of the investigations, which is very important in such PPP models, the drug control authority conducts raids on these labs every month. Also, on a daily basis, the labs have been mandated to update the State Programme Implementation Office (SPIO) on the kind of reagents (which have specific codes) that are being used.
Generally, in outsourcing models of the health sector, consequences like cost increase or blackmailing by external agencies is feared. What steps have been taken in the model to prevent repetition or duplication of tests done by the agencies on a single patient?
One of the best features of NTR Vaidya Pariksha is the cost to the service provider or agency is calculated on sample basis and is not test based. Here, each sample equals to one individual patient. The patient may undergo different tests that may usually cost anywhere between Rs.600–2,000 or more in the market, but for us it is only one sample and we pay the agency Rs. 235 per sample. It was the condition that was set right from the time of tender processing. As a result, the cost of tests and diagnosis to the state government is 57-60 per cent less than those standard CGHS rates that are issued by the Government of India annually.
Please explain how it serves as the “basket programme” encompassing ‘hemoglobinopathies’, ‘NCD screening’, etc?
For instance, if a patient is suggested heamoglobinpathies test, which actually costs Rs. 640 in the market, we (the state government) will pay only Rs235 to the agency. If a patient is prescribed to undergo over 40 tests that also includes heamoglobionpathies tests, which may cost more than Rs 2,000, we only pay Rs 235 as it is only a single sample for us.
What is the level of transparency maintained in dealing with the service provider?
All the payments to the service providers or agencies are done through electronic mode. There is no need for the service provider to walk into our offices for payments, but only for the review of the services. We get the physical invoice from the service provider, following which our analytical team verifies it through the data available online. So, the physical interaction between the government and implementing agency for finances is zero. The review of the services is done every month.
How is the model or initiative different from those implemented in other states?
It’s a phenomenal programme, as any patient coming from across the state will have an assurance of undergoing the entire essential tests needed for the treatment. Establishing 103 labs and setting up centres in 1,300 locations was a huge task that we could achieve in three months. In the last eight months, over 1.15 crore investigations took place which is 85 lakh more investigations than that were taken up last year before the programme was implemented. This programme has directly saved (even if we consider a modest cost of Rs. 100 for each investigation) Rs1,15,000 crores out of the pocket money of 37 lakh poor people who availed the services. If we calculate the expenditure in other areas like free medicine and healthcare, it multiplies into many times. The ultimate goal of the government will be providing health services, diagnosis and medicines supported by a doctor to the patient. Thus this ecosystem with free diagnosis, medicines and doctors service in one place is usually lacking in other states due to gaps in their models. Over Rs. 280 crores has been earmarked for drugs to the patients. Thus a patient who visits the public facility in the state, will get checked by the doctor, diagnosis report will come to the same doctor and eventually the patient will go back home with chunk of essential drugs for the treatment at the facility. The entire ecosystem of health, without any loose ends, has been established. This has been implemented in line with the National Health Mission.
How has been the response to the programme so far and what is size of eligible people for these services?
Of the total five crore population in the state, over 90 per cent are white card holders. The response has been tremendous to the programme. Prior to its implementation, a baseline survey had shown that over 52 per cent of the people had poor access to diagnostic facilities. However, since the implementation of the programme the numbers have fared well. In 2015, the total footfall of patients was five crore. However, since the implementation of the programme there is already an additional inflow of 30 lakh patients. Thus there is an increase in in-patients by 25 per cent.
• NTR Vaidya Pariksha offers all the essential diagnostic lab tests free of cost to the poor people
• 103 labs have been set up under the pioneering programme
• 60 tests are offered in area and district hospitals (AH and DH), 40 in community health centres (CHCs) and 19 in primary health centres (PHCs)
• The cost to the service provider is calculated on sample basis and is not test based
• The cost of tests and diagnosis to the state government is 57-60 per cent less than those standard CGHS rates that are issued by the Government of India annually
• The drug control authority conducts regular raids on the labs to check frauds
• All the payments to the service providers or agencies are done through electronic mode
• The health history and data of each patient is linked to the individual Aadhar card
What are the further plans for up gradation of this programme?
The programme has been fully implemented. Even the health history and data of each patient is linked to the individual Aadhar card. So, a patient who wants to undergo treatment in private health facility can go with same health reports without any need to undergo similar tests again.
Tell us about the demographic disease profile linking with e-aushadhi and e-HMS aspect of the programme.
Every disease is geographically localised due to climatic conditions. For instance, dengue is prevalent in urban areas, malaria in tribal areas, while some regions are prone to filariasis. So, based on the demographic reports and profile of diseases, the department is coming up with better planning solutions that will help in setting up required facilities, services restructuring the existing human resource there in order to deal with it effectively.