Meeting of Health Ministers of SAARC Countries

Meeting of Health Ministers of SAARC Countries

The Health Ministers of the Member States of the South Asian Association for Regional Cooperation (SAARC) met on 8 April 2015 at New Delhi for their 5th Meeting.

Prior to the meeting of the Health Ministers, the meetings of the SAARC Technical Committee on Health and Population Activities, the SAARC Expert Group on HIV/AIDS and of the Senior Officials (Health Secretaries) were held during 6-7 April, 2015.

The Health Ministers resolved to strengthen health cooperation, with particular emphasis on following areas:

(i) Aim to make SAARC region polio-free. India offered support for technical missions from other SAARC countries for this purpose.

(ii) Commitment to set up SAARC Supra National Reference Laboratory for TB and HIV/AIDS.

(iii) To come together to negotiate better prices for TB drugs and diagnostics to make these more affordable and accessible.

(iv) Set up Expert Groups on vector-borne diseases and holding annual meetings on Noncommunicable diseases.

(v) Inclusion of mental health care into universal health care.

(vi) To promote access to medicines including through the use of flexibilities under TRIPS Agreement (World Trade Organization Agreement on Trade Related Intellectual Property Rights) and to promote these in the bilateral and regional trade agreements in order to protect public health interest.
(vii) Pursue mutual cooperation among the professional bodies regulating medicine/ nursing/ allied health, on training needs of Human Resources.

(viii) Promotion of Traditional systems of medicine.

The Health Ministers also adopted ‘Delhi Declaration on public health challenges’ at the close of the meeting, reflecting the commitments expressed and decisions taken collectively by the Health Ministers. A copy of the Delhi Declaration is given below:

SAARC Health Ministers: Fifth Meeting

DELHI DECLARATION ON PUBLIC HEALTH CHALLENGES
(April 08, 2015)

We, the Health Ministers of the Member States of the South Asian Association for Regional Cooperation (SAARC) have met today, the 8th of April, 2015 at New Delhi for the 5th Meeting of the SAARC Health Ministers, and adopt the following “Delhi Declaration on Public Health Challenges”:

Recognizing that the SAARC Member States account for nearly a quarter of the world population and face similar or even same challenges in the field of public health, prevention of diseases and providing better quality of life for our citizens;

Noting the past efforts emanating from the deliberation at previous meetings of SAARC Health Ministers including the meeting at Maldives in 2012, Dhaka in April 2006, Islamabad in 2005 and New Delhi in 2003, and the progress made for collaboration and cooperation among the Member States;

Guided by the emphasis placed by the Heads of States or Governments at the 18th SAARC Summit at Kathmandu, Nepal on 26-27 November, 2014 on the importance of achieving universal health coverage, improving health regulatory systems, preparedness for emerging and reemerging diseases and the challenges posed by antimicrobial resistance and non-communicable diseases;

Cognizant of the fact that infectious diseases and pathogens do not recognize political and geographical boundaries, global integration, trade, travel and commerce make all countries vulnerable to threat of outbreaks which may emerge from any part of the globe;

Concerned that health systems and response mechanisms require further strengthening in each country especially in countries with less financial and technical resources;

Recognizing the dedicated work done by healthcare workers for containing the recent Ebola virus disease outbreaks in certain countries, and that the public health emergency of international concern still continues including for the countries in the SAARC region;

Noting the recommendations made by the Fifth Meeting of Technical Committee Meeting on Health and Population Activities held on 6th April 2015, which discussed important issues impacting the SAARC Member States, including the need for high quality and high coverage immunization for vaccine preventable diseases along with modern monitoring systems; action for prevention and control of tuberculosis, vector borne diseases, hepatitis B & C; non-communicable diseases and mental health disorders; international health regulations and prevention of infectious diseases; preventing and containing the threat of antimicrobial resistance; providing access to medicines and enhancing the quality and availability of human resources for health;

Noting the recommendations made by the Expert Group on HIV/AIDS in the meeting held on 07-04-2015;

Noting that the Meeting of Senior Officials has duly considered the recommendations of the Technical Committee on Health and Population Activities, as also the Expert Group on HIV/AIDS;

Recognizing the need to accelerate efforts with the aim to end AIDS epidemic in the region by 2030, as proposed by 18th SAARC Summit;

Recognizing that 80% of premature deaths associated with chronic non-communicable diseases (NCDs) occur in developing countries, highlighting the need for a comprehensive response to NCDs;

Acknowledging the value and importance of traditional medicines for effective healing of mind and body by making them a holistic part of our healthcare as well as the need of sharing knowledge, experience and the regulatory mechanisms thereon of respective Member States for securing public health needs;

Affirm the commitment of SAARC Member States to work together to cooperate and collaborate for addressing the identified health issues;

Further agree to strengthen cooperation on mutually agreed agreements for prevention and control of infectious diseases and for sharing of information in accordance with international health regulations and strengthening capacities for surveillance and monitoring of disease, rapid response and expanding diagnostic facilities;

Strongly reaffirm the commitment to the decisions taken at earlier Meetings of the SAARC Health Ministers and call upon Member States for early implementation of those decisions;

Declare our resolve to strengthen cooperation to promote availability and effective coverage of affordable vaccines including pentavalent vaccine and to also strengthen our response to make SAARC region polio free;

Agree to take appropriate coordinated action which may be required to be adopted by the Member States for prevention and control of Hepatitis which is a major public health issue in the region;

Call upon the Member States to maintain the momentum of actions under the Regional Strategy on HIV/AIDS, to share experience and expertise in the areas of surveillance, existing and new strategies to prevent the spread of HIV, and in rapid scale up of affordable treatment to achieve the 90-90-90 HIV treatment target 2020, to rapidly reduce new HIV infection and AIDS related deaths including from tuberculosis, with a view to ending AIDS by 2030;

Welcome the proposed the SAARC Supra-national Reference laboratory for TB and HIV/AIDS, being established in Kathmandu, the support extended by the Member States for the same and India’s agreement to meet the balance cost not yet met by Member States contributions;

Reaffirm the commitments reflected while adopting the Resolution on Prevention and Control of non communicable diseases including an action plan and monitoring framework as per the World Health Assembly Resolution No. WHA66.10 dated 27 May 2013;

Reaffirm the commitments under the WHO Framework Convention on Tobacco Control (FCTC);

Agree to cooperate for combating mental disorders, including autism and neuro-development disorders, through a multi-prolonged approach encompassing a Mental Health Policy, a life cycle approach to address the needs of such individuals throughout life, sharing of innovations in the field of Mental Health Promotion, diagnosis and management and exchange of best practices and experiences amongst SAARC Member States;

Agree to extend cooperation amongst the Member States for capacity development of human resources in public health and clinical medicine;

Agree to attach high priority to combat anti-microbial resistance, on prevention, systems of infection control, correct prescription and consumption practices, access to antibiotics, R&D and impact of antibiotic use in agricultural and animal husbandry sectors, while also carrying out assessment of the financial and other resources required therefor;

Decide to enhance regional collaboration and partnership in health research among SAARC countries by identifying the nodal technical officers from respective health/medical research councils/units/departments, to provide list of scientists, researchers, investigators from each country to develop and undertake joint collaborative research projects in the prioritized areas, to provide the list of laboratories ready to offer training/ exchange expertise with other member states and to organize Research Methodology Workshops;

Agree to cooperate in improving the standards, clarification and regulatory mechanisms for drugs and pharmaceuticals with a view to promote availability of quality, safe, efficacious and affordable medicines in all SAARC Member States;

Reiterate our resolve to promote access to medicines including, if necessary, through the use of TRIPS flexibilities and encourage to take steps to promote these in the bilateral and regional trade agreements in order to protect public health interest;

Agree to cooperate in the field of traditional systems of medicines, including by encouraging visits of experts, organization of symposia, promotion of courses on traditional medicine under international fellowships or country support programmes, upgradation of educational standards, quality assurance and standardization of drugs, improving the availability of medicinal plant materials, research & development, awareness generation, etc.;

Agree to holding of annual meeting of the Technical Committee on Health and Population Activities to facilitate intra-regional cooperation and implementation of decisions taken in the earlier meetings of SAARC Health Ministers.

The decisions adopted in the SAARC Health Ministers’ Meeting will promote regional cooperation to address the common health challenges in the SAARC countries, including in India.

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.

**************

IVF Clinics

There are many unregistered ART clinics in India, however, no data regarding unregistered In-Vitro Fertilization (IVF) clinics is maintained by ICMR.

The Government of India had issued National Guidelines for Accreditation, Supervision and Regulation of ART Clinics developed by Indian Council Medial Research (ICMR) in 2005. So far only 308 ART Clinics have been enrolled with ICMR. The State/ UT wise list of enrolled ART clinics are given below:

LIST OF ASSISTED REPRODUCTIVE TECHNOLOGY (ART) CLINICS ENROLLED WITH INDIAN COUNCIL OF MEDICAL RESEARCH

(The D/o Health Research has framed a comprehensive bill titled “The Assisted Reproductive Technologies (Regulation) Bill” (ART Bill) which under final stages of drafting in consultation with M/o Law and Justice.

The Minister of State, Shri Shripad Yesso Naik stated this in a written reply in the Lok Sabha here today.

*********

List of High Priority Districts (HPDs) in the country

To ensure equitable health care and to bring about sharper improvements in health outcomes, the bottom 25% of the districts in every State according to the ranking of districts based on composite health index have been identified as High Priority Districts (HPDs). All Left Wing Effected districts and districts with majority tribal population, whose composite health index is below 50% are also categorized as HPDs. The List of 184 HPDs is given below:

List of High Priority Districts
(Bottom 25% districts within a State taken according to ranking based on Composite Index) plus LWE or Tribal districts falling in bottom 50%)

The implementation and progress of the National Health Mission (NHM) is reviewed at the national level through:

(i) Mechanisms that have included/include external surveys such as Sample Registration Survey (SRS), the District Level Household Survey (DLHS), Annual Health Surveys and National Family Health Survey (NFHS) which provide data on outcomes and service delivery.

(ii) The national program is subject to the CAG audit.

(iii) All States/districts are required to have a system of periodic concurrent audit and an annual audit.

(iv) Common Review Mission (CRM) which comprise of government officials from different Ministries and Planning Commission, public health experts and representatives of development partners and civil society to review NHM implementation in the states is undertaken every year.

(v) Monitoring is also done through Hospital Management Information System (HMIS) and Mother and Child Tracking System (MCTS) etc. HMIS is a web-based Monitoring system that has been put in place by MoHFW to monitor the performance of health programmes at facility and district level and help take timely corrective action. MCTS is a centralized name based, web based application, which facilitates monitoring of delivery of services to individual pregnant women and children.

(vi) Regular integrated monitoring visits from National Program Management Units to States & districts and from States to districts & blocks.

(vii) Monitoring through Regional Evaluation Teams (RETs) located in the Regional Offices of the Ministry which undertake evaluation of the NRHM activities including Reproductive and Child Health Programme (RCH) on a sample basis by visiting the selected Districts and interviewing the beneficiaries.

In addition to the above mechanism for monitoring implementation of NRHM, HPDs receive increased and focused attention in terms of resources and supportive supervision including through development and knowledge partners.

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.

**********

Implementation of RSBY

The ‘Rashtriya Swasthya Bima Yojana’ (RSBY) is being implemented in 19 States/Union Territories as on date covering Assam, Bihar, Gujarat, Haryana, Chhattisgarh, Himachal Pradesh, Jharkhand, Karnataka, Kerala, Manipur, Meghalaya, Odisha, Punjab, Rajasthan, Tripura, Uttar Pradesh, Uttarakhand, West Bengal and Puducherry.

The criteria/norms of selection of hospitals under RSBY are given below:
1. Eligible healthcare providers

Both public (including Employee State Insurance Hospitals) and private healthcare providers which provide hospitalization and/or day care services would be eligible for empanelment under RSBY, subject to such requirements for empanelment as outlined in this tender document.
2. Empanelment of healthcare providers
The Insurer shall ensure that the beneficiaries enrolled under the scheme are provided with the option of choosing from a list of empanelled healthcare providers for the purposes of seeking treatment. Healthcare providers having adequate facilities and offering services as stipulated in the guidelines will be empanelled after being inspected by a qualified technical team from the Insurance Company or their representatives in consultation with the District Nodal Officer, RSBY and approved by the District Administration/ State Government/ State Nodal Agency. If it is found that there are insufficient healthcare providers in a district or that the facilities and services provided by healthcare providers in a district are inadequate, then the State Nodal Agency can reduce the minimum empanelment criteria specified in this section on a case-by-case basis.
3. Criteria for Empanelment of Public Healthcare Providers
All Government hospitals (including Community Health Centres), as decided by the State Government and Employee State Insurance Scheme hospitals shall be empanelled provided they possess the following minimum facilities:

a. Telephone/Fax
b. The complete transaction enabling infrastructure
c. An operational pharmacy and diagnostic test services, or should be able to link with the same in close vicinity so as to provide ‘cashless’ service to the patient.
d. Maintaining of necessary records as required and providing necessary records of RSBY beneficiaries to the Insurer or their representative/ Government/Nodal Agency as and when required.
e. A Bank account which is operated by the health care provider through Rogi Kalyan Samiti or equivalent body.
4. Criteria for Empanelment of Private Healthcare Providers
The criteria for empanelling private hospitals and health facilities are as follows:

a. At least 10 functioning inpatient beds or as determined by State Nodal Agency. The facility should have an operational pharmacy and diagnostic test services, or should be able to link with the same in close vicinity so as to provide ‘cashless’ service to the patient.
b. Those facilities undertaking surgical operations should have a fully equipped Operating Theatre of their own.
c. Fully qualified doctors and nursing staff under its employment round the clock.
d. Maintaining of necessary records as required and providing necessary records of the insured patient to the Insurer or their representative/ Government/Nodal Agency as and when required.
e. Registration with the Income Tax Department.
f. NEFT enabled bank account
Telephone/Fax

The state-wise number of beneficiaries enrolled under this scheme during last three years is given below:

(Source: Information updated by insurance companies on RSBY portal)

Insurance companies do not pay any compensation to the beneficiaries. They make payment to the empanelled hospitals, who provide healthcare services to the enrolled beneficiaries. The State Nodal Agencies (SNA) pay premium to the insurance companies on the basis of no of cards issues to enrolled families. Information regarding amount of premium released by the SNAs to the insurance companies is not centrally maintained. The exact number of beneficiaries who availed benefits during 2012-13 and 2013-14 as received from respective insurance companies is given below:

*Only Ranga Reddy district in Telangana.

(Source: Information updated by insurance companies on RSBY portal)

However 2014-15, complete information is not available.

Under RSBY, payment is directly paid to the empanelled hospitals as per the approved package rates. The premium is determined through an open tender process.

The Insurance Company shall make sure that an adequate number of public and private healthcare providers are empanelled. The following are the minimum criteria to be met when empanelling health care providers.

· There should be at least one hospital for every 8,000 families enrolled in the scheme.
· At least two hospitals shall be empanelled in every block.

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.

********
Primary Health Centres

The details of Primary Health Centres (PHCs) functioning in the country including Maharashtra as per Rural Health Statistics Bulletin (RHS) 2014, are given below:

The State/UT wise information including that of Maharashtra regarding the shortage of doctors and other staff as per Rural Health Statistics Bulletin (RHS) 2014 at Primary Health Centres (PHCs) is given below:

Public health being a State subject, information on condition of buildings of PHCs is not maintained by Government of India (GOI).

Public Health being a State subject, the primary responsibility to ensure proper staffing of public facilities and to provide the requisite health infrastructure lies with the State Governments. Under the National Health Mission (NHM), support is provided to States/UTs to strengthen their healthcare systems including support for augmenting health human resource and for construction/ renovation of Public Health facilities, based on the requirements posed by State/ UTs in their Programme Implementation Plans (PIPs).

Further, to increase the availability of doctors, several initiatives have been taken to rationalize the norms in medical education, such as relaxation in land requirements, bed strength, increase in ceiling for maximum intake for undergraduates, enhancement of teacher-student ratio in Post Graduate Courses, etc which has resulted in substantial increase in number of undergraduate and post graduate seats. Government has also approved setting up of ANM/GNM Schools in different States.

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.

*******

Details of Drug Testing Facilities in the Country

The details of Central and State Government drug testing laboratories in the country along with their capacity are given below:

The existing strength of the Central Drugs Standard Control Organisation (CDSCO) also needs to be augmented to shoulder the increasing responsibilities for regulating the quality of drugs in the country.

The drug testing laboratories under the CDSCO are being provided with newer and sophisticated equipment and these are being constantly strengthened to expedite testing of drug samples in the country.

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.

****************

Super Speciality Hospitals

Under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), the Government plans to establish AIIMS like institutes in every State in a phased manner. The details of new AIIMS which have been established/announced to be set up are as given below:

Phase-I

(i) Bihar : AIIMS at Patna

(ii) Chhattisgarh : AIIMS at Raipur

(iii) Madhya Pradesh : AIIMS at Bhopal

(iv) Orissa : AIIMS at Bhubaneshwar

(v) Rajasthan : AIIMS at Jodhpur

(vi) Uttranchal : AIIMS at Rishikesh

Phase-II

(i) Uttar Pradesh : AIIMS at Rae Bareilly

(ii) West Bengal : To be taken up under Phase-IV

Phase-IV

During Budget Speech for the year 2014-15

(i) Andhra Pradesh

(ii) West Bengal

(iii) Vidharbha in Maharashtra

(iv) Poorvanchal in UP

During Budget Speech for the year 2015-16

(i) Assam

(ii) Himachal Pradesh

(iii) Jammu & Kashmir

(iv) Punjab

(v) Tamil Nadu

In addition, keeping in view the need to augment medical sciences in Bihar, it is proposed to set up another AIIMS like institution in these States.

The six new AIIMS at Patna (Bihar), Raipur (Chhatisgarh), Bhopal (Madhya Pradesh), Bhubaneshwar (Orissa), Jodhpur (Rajasthan) and Rishikesh (Uttaranchal) are operational.

Timeline for setting up of such tertiary level health care facilities depends upon the receipt of various due approvals.

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.

**************

Control of Tuberculosis

It is estimated that around 40 percent of Indian population is infected with Mycobacterium Tuberculosis, the bacteria that causes TB in human beings, but the vast majority of them have latent TB infection rather than TB Disease. According to latest WHO estimates, the incidence of TB disease in India is around 2.1 million cases annually.

Malnutrition/undernutrition, which reduces immunity, makes a person susceptible to many diseases, including TB. Social determinants like poverty, overcrowding, poor ventilation, under nutrition, etc., have a role in spread of TB.

Under the Revised National Tuberculosis Control Programme (RNTCP), diagnosis and treatment facilities including anti-TB drugs are provided free of cost to all TB patients. Designated microscopy centres have been established for quality diagnosis for every one lakh population in the general areas and for every 50,000 population in the tribal, hilly and difficult areas. More than 13000 microscopy centres have been established in the country. More than six lakh treatment centres (DOT Centres) have been established near to residence of patients to the extent possible. All government hospitals, Community Health Centres (CHC), Primary Health Centres (PHC), sub centres are DOT centres. In addition NGOs, Private Practitioners (PPs) involved under the RNTCP, community volunteers, Anganwadi workers, women self-help groups etc. also function as DOT providers/DOT Centres. Drugs are provided under direct observation and the patients are monitored so that they complete their treatment.

Programmatic Management of Drug Resistant TB (PMDT) services for the management of multidrug resistant tuberculosis (MDRTB) and TBHIV collaborative activities for TB HIV co- infection are being implemented throughout the country.

Under the universal immunization programme, BCG vaccine is administered for prevention of serious forms of childhood TB, like tubercular meningitis.

Government has also formulated Standards for TB Care in India which lay down standards for social inclusion for TB, providing information to vulnerable groups and developing synergies with the social welfare schemes.

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.