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‘Jharkhand Gearing Up for Better Healthcare Delivery Model’

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In comparison to nearby States with Trust Model, Jharkhand is performing better on all parameters be it BIS pendency, hospital claim payment, claims generated, or portability numbers, says Dr Nitin Madan Kulkarni, Principal Secretary, Department of Health & Family Welfare, Government of Jharkhand, in conversation with Elets News Network (ENN).

Q: Tells us about the initiatives undertaken by the Government of Jharkhand to boost State healthcare delivery system.

Jharkhand is predominantly a rural and tribal society. We have 26 percent tribal population. Half of the areas are far-flung and hilly terrain. 15 districts are LWE (Left Wing Extremism) affected. Obviously, taking rural healthcare to people’s doorsteps is a big challenge. The State has taken many initiatives to improve the healthcare system of the State. Some of them are:

• Free diagnostic and free radiological on PPP mode in all district hospitals
• Free dialysis on PPP mode at district hospitals
• 108 ambulance service to provide emergency services
• 104 toll free service for health advice
• Separate cadre for specialist doctor and recruitment through bidding system under NHM
• All HSC and PHC are in the process of being converted into health and wellness centre. Till now we have converted    290 such centres to HWC
• Telemedicine service for 100 PHC is ready to be rolled out
• Running of CHC and HSC on PPP mode
• Apart from that equipment maintenance by PPP mode, MMU service for rural area

Q: Ayushman Bharat scheme was launched from Jharkhand last year. How has the scheme benefitted poor and vulnerable people to avail secondary and tertiary care?

Since 23 September, 2018, a total of 60,051 claims have been accepted under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojna (AB-PMJAY) scheme, of which 18,338 beneficiaries were from the SECC category (as per centre scheme) and 41,712 from PDS card holders. Both these categories of families are from the poor and vulnerable sections of society.

As per the claims initiated under AB PMJAY Mukhya Mantri Swathya Bima Yojna (MSBY) in Jharkhand, till 22 January, 2019, the package type used by the beneficiaries is as under mentioned. More than 6,000 beneficiaries from the poor and vulnerable sections of the society have used tertiary type of high value package treatment from this scheme:

We have various success stories where poor people got their prolonged illness and surgeries done under the scheme.

Q: Jharkhand has used hybrid model to implement Ayushman Bharat scheme. Shed some light on advantages of this insurance model.

The pricing of any risk from an insurance point of view would always be based on the amount of coverage being asked for. Since under the Ayushman Bharat, the insured sum of Rs 5 lakh for each family per annum has been fixed and hence going for absolute insurance model with Rs 5 lakh coverage would have been costly for the government. Our analysis and historical data taken from various other States have shown that number of claims for over Rs 1 lakh would not be more and hence we fixed the threshold limit for insurance to Rs 1 lakh and decided to settle directly all the claims beyond this limit.

Also read: Jharkhand Boosting Its Healthcare Ecosystem

Hence, the State government saved a lot in terms of premium. Out of the total about 60 thousand claims, till date there have been only 0.01% number of claims which exceeded one lakh. This itself proves that the model, which our State has opted, is better suited. With hybrid model we are able to utilise the experience and strength of the insurance company and simultaneously keep all the controls and monitoring with SHA (State Health Agency) to avoid any leakages.

However, we didn’t go with the complete trust model because of constraints in terms of manpower and experience in running such a mass scheme directly. Today, in comparison to nearby States with Trust Model we are performing better on all parameters; be it BIS pendency, hospital claim payment, claims generated, and portability numbers.

Q: Access to nutrition and medicine is a major issue among people residing in remote tribal districts. What steps have been taken to improve infrastructure in rural districts?

Undernutrition and malnutrition remain the most crucial challenge for the State. In spite of the best of efforts from the government, the figures are still daunting. Malnutrition treatment centres are functional throughout the State. We regularly conduct school health checkup programme, vit-A , Deworming, ORS rounds in the State.

Infrastructure and manpower are being upgraded to IPHS standards. However, availability of trained manpower and reluctance of doctors to work in rural areas remain key issues.

Q: Tell us about the Government’s strategy to contain Tuberculosis (TB) which is coming to fore as a major challenge.

Treatment of TB is provided free of cost to drug-sensitive as well as drug-resistant patients under RNTCP (Revised National TB Control Programme). The objective of the programme is to provide treatment at the earliest; to cut down the transmission chain. For this, in the State there is a network of around 340 DMCs, 36 CBNAAT Labs, one Intermediate Reference Lab at Ranchi and about 20,000 treatment providers. Emphasis is now to get TB patients notified from private doctors and chemists on priority. They are being sensitised regularly for the same.

For knowing the status of drug resistance, diagnosed TB patients are subjected to tests for drug resistance. Now all districts can directly start treatment of drug resistant TB, as there are five nodal DRT centres and 19 District DRT centres in place.

TB patients are also being provided Rs 500 per month during entire period of treatment for nutritional support under Nikshay Poshan Yojna w.e.f 1.4.18.

For better engagement of community, TB forums are being formed in each district along with regular community meetings and patient – providers meetings.

Active case finding campaign was conducted in targetted vulnerable population and similar campaign with LCDC adopted in entire population of seven districts.

The State has signed MoU with Medanta to launch TB free Jharkhand with active cooperation from the PSU located in the State. We are trying our best to achieve the goal of TB free State by 2022.

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