The Ministry of Health and Family Welfare is involved in formulating the health policy in India. It is also responsible for all government programmes related to family planning. The ministry comprises of the departments of Health & Family Welfare and Health Research. The Department of Health deals with health care which include awareness campaigns and immunisation campaigns among others. The Department of Family Welfare deals with family welfare, reproductive health, maternal healthand paediatrics.
Faggan Singh Kulaste, Minister of State for Health and Family Welfare, GoI, spoke to BE’s Madhu Raina.
◄ Faggan Singh Kulaste
. What is national licentiate examination and what would be its benefit?
A. In the draft National Medical Commission Bill, 2017 a national licentiate examination is provided for at the undergraduate level for Indian students passing MBBS in India and from outside the country for granting licences to practise as medical practitioner in India. Licentiate exam would be an outcome based quality control mechanism instead of focusing on verification of infrastructure.
Q. The health services today have gone beyond the reach of the common people due to escalating costs. Are there any steps being taken to make the health services affordable?
A. As per National Health Accounts 2013-14, the out of pocket expenditure on healthcare as share of total health expenditure is 64.2%. A Report titled 'Health in India' brought out by the National Sample Survey, Ministry of Statistics and Programme Implementation in April, 2016 based on NSS 71st Round (January-June, 2014) states that around 25% rural households and 18% urban households reported borrowing as the source of finance for meeting the medical expenditure.
‘Public Health & Hospitals’ being a state subject, the primary responsibility for providing free and affordable health services lies with the respective state and union territory administration. Technical and financial support under the National Health Mission (NHM) is being provided by the central government. Under the NHM, the central government is supporting states for provision of a host of free services including maternal health, child health, adolescent health, family planning, universal immunisation programme, and for major diseases such as tuberculosis, HIV/ AIDS, vector borne diseases such as malaria, dengue, kala azar, leprosy, etc. Other major initiatives for which states are being supported for free healthcare services include Janani Shishu Suraksha Karyakram (JSSK), Rashtriya Bal Swasthya Karyakram (RBSK), Rashtriya Kishor Swasthya Karyakram (RKSK), etc.
To reduce out of pocket expenditure and making healthcare affordable to all the citizens, we are also supporting the states with the provision of free essential drugs and diagnostics under NHM Free Drugs Services Initiative and NHM Free Diagnostics Services Initiatives. The government has recently launched the Pradhan Mantri National Dialysis Programme under NHM for provision of free dialysis services to poor and free universal population based screening and management of common NCDs. Under the Rashtriya Swasthya Bima Yojana (RSBY), a centrally sponsored scheme, cashless treatment for hospitalisation cases is provided for a family of five with insurance up to `30,000/- per annum for BPL and 11 specified categories of unorganized workers. Further, Senior Citizens Health Insurance Scheme (SCHIS) as top up over existing RSBY scheme has been implemented from 01.04.2016 for senior citizens aged 60 years and above which provides additional coverage of ` 30,000 per senior citizen in the family enrolled under RSBY.
Q. Is there any scheme to regulate the charges levied by private hospitals to make it accessible to poor?
A. The Government of India has enacted the Clinical Establishments (Registration and Regulation) Act, 2010, and has also notified the clinical establishments (Central Government) Rules, 2012, for registration and regulation of all clinical establishments in the country with a view to prescribe the minimum standards of facilities and services provided by them. Currently, the Act is applicable in 10 states namely Sikkim, Mizoram, Arunachal Pradesh, Himachal Pradesh, U.P., Bihar, Jharkhand, Rajasthan, Uttarakhand and Assam and all Union Territories except Delhi.
In accordance with the said rules, the clinical establishments (where the said Act is applicable) are to charge the rates for each type of procedures and services within the range of rates determined and issued by the central government and in consultation with the state governments. The National Council for Clinical Establishments has approved a standard list of medical procedures and a standard template for costing of medical procedures and the same have been shared with the states and union territories. The clinical establishments are also required to display the rates charged for each type of services provided and facilities available at a conspicuous place in their premises, both in the local language and in English. However, implementation of the said Act and rules is with the state and union territory administration.
Q. What is the action taken by the government to strengthen the medical colleges and general hospitals?
A. Our ministry administers a centrally sponsored scheme for establishment of new medical colleges attached with existing district/referral hospitals. 58 districts in 20 states and UTs have been identified under this scheme. The sanctioned cost of establishment of one medical college under the scheme is `189 crore with fund sharing between the central and state governments in the ratio of 90:10 for north eastern and special category states and 60:40 for other states. As on date, 55 new medical colleges have been approved. Eight medical colleges i.e. at Port Blair, Andaman and Nicobar Islands, Rajnandgaon & Sarguja in Chhattisgarh, Gondia, Maharashtra, Nahan and Chamba in Himachal Pradesh and Baripada (Mayurbhanj) and Koraput in Odisha are already functional. Funds to the tune of ` 4,357.42 crore have been released to the state governments and UT administration.
In addition, there are two other centrally sponsored schemes regarding increasing MBBS and PG seats in government medical colleges in the country. They are -
I) Upgradation of existing state government/ central government medical colleges to increase MBBS seats in the country: The funding pattern is 90:10 by the central and state governments respectively for north eastern states and special category states and 60:40 for other states with the upper ceiling cost pegged at `1.2 crore per seat. 22 medical colleges have been approved under the scheme to increase 1715 UG seats. Funds to the tune of `311.52 crore have been released to the state governments till date under this scheme.
II) Strengthening and upgradation of State Government Medical Colleges for starting new PG disciplines and increasing PG seats: The scheme was launched in the XI Plan period with the objective to strengthen and upgrade
state / central government medical colleges to create new PG seats. A total of 72 government medical colleges in 21 states and UTs are covered under the scheme for increasing PG seats. Funds to the tune of ` 791.78 crore have been released under the scheme till date.