Jharkhand has made significant improvements in terms of providing accessible, affordable and inclusive healthcare to the last mile. This transformation is underscored by improved health indicators, emergence of health and wellness centres to provide quality and comprehensive primary healthcare services and more number of medical colleges planned to boost availability of doctors and healthcare professionals across the state. The State government aims to provide National Quality Assurance (NQA) Certification to all the hospitals in order to provide quality medical facilities to masses, says Dr Nitin Madan Kulkarni, Secretary, Department of Health, Medical Education & Family Welfare, Government of Jharkhand in an exclusive interview with Gopi Krishna Arora and Mukul Kumar Mishra of Elets News Network (ENN).

Q How do you assess evolving healthcare delivery system of Jharkhand which aims to provide quality care to people at large?

Jharkhand has made a significant improvement in healthcare delivery through its careful planning and execution of healthcare programmes. We have been constantly evolving to enable people of all strata to avail accessible and affordable care.

National Health Mission (NHM) has helped the State of Jharkhand to build better capabilities for healthcare, be it in terms of infrastructure, better healthcare resources or better trained personnel.

After the launch of NHM in Jharkhand public health services have become more flexible and the government of Jharkhand is able to address more maternal and child health-related issues.

Regarding health indicators, we have improved in several aspects. IMR reduced from 72 (in 2000) to 29 (SRS 2016), MMR reduced from 400 (in 2000) to 165 (SRS 2016) and TFR reduced from 3.2 (NFHS 3 -2007-08) to 2.5 (SRS 2016). The State eradicated Polio in 2014-15. HSCs, PHCs and UPHCs have evolved into health and wellness centres to provide quality and comprehensive primary health care services that have become more accessible to the people.

More number of medical colleges will be started in Jharkhand to improve the doctors’ availability across the state. In addition, the State Government is planning to provide National Quality Assurance (NQA) Certification to all the hospitals in order to provide quality medical facilities to masses.

Q Shed some light on the schemes and initiatives which have been undertaken by the NHM in order to improve accessibility and affordability factor.

To provide accessible, quality and affordable medical facilities with minimum out-of-pocket expenditure to the last person of the last village following schemes have been initiated under NHM:

1. Free referral services through 108 ambulance service and Mamta Wahan.

2. Free diet, free drugs, free diagnostics under JSSK, both for mother and infant.

3. Free dialysis facility in some of the district hospitals

4. Telemedicine services in 100 PHCs.

5. Tele-helpline through 104.

6. Cash incentive to beneficiaries under JSY, Family Planning Schemes and Nikshay Poshan (for Tuberculosis patients) Due to above initiatives, in 2015-16, Jharkhand ranked second in reducing out-of-pocket expenditure.

Q Though the State has registered a remarkable progress in delivery of care, maternal and neonatal care are big challenges which require urgent attention…What steps are being planned on this front?

To improve maternal health, strengthening of FRUs, JSY, JSSK, PMSMA has been initiated. To improve Neonatal health, SNCU, NBSU, NBCC, MTC, HBNC is on board. For facility strengthening to provide quality care, Kayakalp, Laqshya, NQAS and various other certification processes has been started.

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 As community health workers Auxillary Nurse Midwives (ANMs) and General Nurse Midwives (GNMs) play a key role to boost healthcare in rural areas…Can you further elaborate their role in context of Jharkhand?

ANMs and GNMs are playing a major role in boosting healthcare in rural areas. They are engaged in community sensitisation programmes to provide accessible and affordable services the people on village level as per the need. In order to meet the shortage of GNMs, we have employed more ANMs in the field.

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.

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 What is your viewpoint on National Medical Commission Bill and its role to bring radical change in medical education in India?

As there is a shortage of doctors in Jharkhand, NMC Bill is a positive step to enhance the quality of medical education in the state. The Bill aims to provide an education system with improved access to quality and affordable medical education, ensure availability of adequate and highquality medical professionals.

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