J&K Improving Health Status via Primary Healthcare

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Dr Mohan Singh
Mission Director,
National Health Mission, J&K

The healthcare industry in J&K has experienced a proliferation of innovations aimed at enhancing life expectancy, quality of life, diagnostic and treatment options, as well as the efficiency and cost effectiveness of the healthcare system, says Dr Mohan Singh, Mission Director, National Health Mission, J&K, in an interaction with Rajbala of Elets News Network (ENN).

Share with us the initiatives undertaken to improve the health system and the health status of the people in the State.

To provide equitable and quality primary healthcare services to the urban population with special focus on slum and vulnerable sections of the society, we seek to improve the health status by facilitating their access to quality primary healthcare.

• Some of our initiatives include reduction in infant mortality rate – early Neonatal Mortality Rate has dipped from 22 to 18, Neonatal Mortality Rate has declined from 26 to 20 and under 5 Mortality Rate reduced from 35 to 28.

• Our efforts also led to an increase in Institutional Deliveries. As per National Family Health Survey (NFHS), institutional deliveries have increased from 52.2 per cent in 2005-06 (NFHS 3) to 85.7 per cent in 2015-16 (NFHS 4).

• We have achieved improvement in Full Immunisation. As per National Family Health Survey (NFHS), full immunisation in children has increased from 52.2 per cent in 2005-06 (NFHS 3) to 85.7 per cent in 2015-16 (NFHS 4).

• Free Drug Policy – Free Drug Policy has been implemented in the State where under identified free drugs are being provided to the patients accessing District Hospitals, CHCs, PHCs and Sub Centers.

• Critical Care Ambulances – As many as 23 critical care ambulances have been procured for deployment to the district hospitals to meet the requirement of accidental and emergency cases. These ambulances are well equipped to provide the Advance Life Support/Basic Life Support services to the accidental cases as well as sick patients requiring referral out of the state.

• Bridge Course in Community Health – Under Universal Health Coverage, the Bridge Course in Community Health has been rolled out by the State. 2 District Hospitals in each of the division have been selected as Programme Study Centres. 50 candidates selected for undergoing the Bridge Course in Community Health for nurses. Ministry of Health & Family Welfare, GoI has introduced a new concept of “Health & Wellness Centres” whereby, the existing Sub Centres will be transformed to serve as first point of care for comprehensive primary health care closer to the community which will include screening for Non-Communicable Diseases like Hypertension, Diabetes and Cancer.

• The Nurses trained for Bridge Course in Community Health shall be deployed in the selected Sub Centres to work as middle level health providers (Community Health Officers).

• Pradhan Mantri Surakshit Maitritiva Abhiyan – It was launched in the State on 9th of June 2016, an initiative for detecting high risk pregnancies to reduce maternal morbidity and mortality in the State. Hot Cooked food is being provided to the pregnant woman during ANC check-ups (on 9th of every month) in convergence with the ICDS department. This initiative was started on 9th February, 2017 in the selected districts of the State.

Technology has been playing a vital role in improving the health care service delivery of the State .

• With this initiative, State envisions to improve coverage and quality of absolute neutrophil count (ANC) among pregnant women and to promote inter-sectoral convergence among departments of same goals and interests.

• ‘Mother’s Absolute Affection’, a new initiative for promotion of breastfeeding has been launched in the State with an aim to reduce the neo-natal infections, mal-nutrition and reduction in Infant Mortality Rate. Training of Trainers (ToTs) has been completed in both the divisions and ASHAs are also being sensitized.

Box-- Pradhan Mantri National Dialysis Programme
Request for Proposal (RFP) for Public Private Partnership (PPP) between State Government and service provider was floated but not a single bid was received. To provide benefits to patients suffering from Renal Diseases state has decided to implement this programme in the first instance in two districts of the state through State resources. 10 District Hospitals (5 in each of the division) have been identified for implementation of Pradhan Mantri National Dialysis Programme.

How integration of technology is supporting the monitoring and evaluation of the healthcare service delivery in J&K? Please share with us some technology initiatives.

Technology has been playing a vital role in improving the healthcare service delivery of the State. We have launched the various portals for the monitoring and evaluation of healthcare delivery which involves web portal of NHM J&K, PCPNDT Portal, Human Resource Management Information System (HRMIS) Portal, Drugs and Vaccine Distribution Management System (DVDMS) –e Aushadi Portal.

The webportal provides the detail information to the public regarding the vision, mission and various activities of the health department including the details of the various schemes as well as the list of beneficiaries under JSY, JSSK, RBSK, etc is in the public domain.

To monitor and evaluate the progress of implementation of PCPNDT act in the state, the State has launched the web portal which provides complete information regarding the Ultrasound Clinics, uploading of Form F, the activities being carried out in various districts for improving the sex ratio and Beti Bachao Beti Padao programme.

The State has recently launched Human Resource Management Information System portal wherein the manpower of the state is being uploaded in the web portal to improve management and accountability of public health services. We have have introduced dedicated e Aushadi portal for management of drugs and Vaccines distribution system from procurement to end user. The state is using the various portals of Government namely HMIS, RCH, TMIS, Mera Aspataal etc

NCDs have become threat to life which needs to be controlled at fast pace. To reduce risk factors of NCDs among the people of the State, what steps are you implementing to prevent, manage and keep check on NCDs?

Epidemiological Transition shows deaths from the four major NCDs –Cancer, CVD, Diabetes, and all respiratory diseases which accounts nearly 60% of all mortality The State has taken initiative for screening of 30 plus population for common Cancers (Breast, Cervix and Oral) and Non Communicable Diseases like Hypertension, Diabetes at CHC, PHC and Sub Centre level. 4 Districts of the State viz. Udhampur, Doda, Anantnag and Kupwara have been selected on pilot basis. State Trainers for ANMs and ASHAs have been trained by NHSRC and District Trainers are trained at the State level. The District level trainings are completed and ASHA’s are trained to roll out population enumeration – creating a family folder/health record.

State is using the services of dedicated staff of RBSK and RKSK programmes for dissemination of information regarding risk factors of common NCDs and the measures thereof in the adolescents and general population. Similarly the staff of National Tobacco Control Programme (NTCP) is providing IEC and BCC activity and dedicated Tobacco Cessation Centers have been made functional. Leh District has been notified as Tobacco Free District in the state.

Box-- Pradhan Mantri National Dialysis Programme
State is moving forward in implementation of Comprehensive Primary Health Care. 75 Health and Wellness centers are being established for providing comprehensive primary health care in first instance. These are going to be upgraded Sub Centres, wherein additional staff either GNM or Ayurvedic Doctor with six months training in Community Health (Bridge Course) will be posted as middle level health provider.

Partnerships are key to tackle global rise in Non- Communicable Diseases. Have you adopted any Partnership model to root out NCDs? And, what’s your opinion on government and private partnership in this regard.

Given the complex nature of health systems and the diversity of needs and expectations from a large heterogeneous population belonging to various socio-economic and cultural groups, no single agency can satisfactorily address the health needs. Hence governments, corporate sectors, NGOs and other sectors of societies have to enter into mutually beneficial partnership to serve the health needs of the poor and the lower income vulnerable population. These partnerships have to be well thought out, structured and open to independent assessment to ensure transparency and outcome.

The State has entered into various partnerships after floating NIT for screening of Breast Cancers in the four districts of the state in first instance. The private partners will provide services in the four identified districts, wherein the screening of the women will be done for detection of breast cancer.

What have been your achievements?

Unique Institutionalization of ASHA Support Structure in J&K State has been selected as the Best/ Replicable practice by the Ministry of Health & Family Welfare at the National Summit held on 29th of August 2016 to 31st August 2016 at Tirupati, Andhra Pradesh, and by the Govt. of Rajasthan during the 2nd Annual Healthcare Summit and Awards on 23rd September, 2016 at Jaipur, Rajasthan.

• NHM, J&K has also received Best Practices/ Innovations award for Screening and Orientation of ASHAs and ANMs on Non –Communicable Diseases, by Ministry of Health & Family Welfare at the ‘National Summit on Good and Replicable Practices and Innovations in Public Healthcare Systems’ held on 6th to 8th July 2017 at Indore, Madhya Pradesh.

• Kashmir Skills and Simulation Centre has been established at Regional Institute of Health & Family Welfare, Dhobiwan, Kashmir. This centre is first of its kind in the public sector across the country. The centre is deliberating immense increase in skills and expertise among the health personnel and shall be very relevant if this simulation centre is replicated across country. Health Personnel of Directorate of Health Services, Kashmir are being trained on regular basis on various training simulation modules.

The State has entered into various partnerships after floating NIT for screening of Breast Cancers in the four districts of the state in first instance.

• All the trainings conducted on these mannequins and simulators are being continuously monitored and regular feedback from the trainees is being analysed. In addition, impact assessment studies are being regularly conducted in institutions where the trained staff is being deployed. Considering the feedback this institution and the skill based interventions are providing huge dividends to the Department.

• This simulation lab has also bagged an award by Ministry of Health & Family Welfare at the ‘National Summit on Good and Replicable Practices and Innovations in Public Healthcare Systems’ held on 6th to 8th July 2017 at Indore, Madhya Pradesh.

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