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This document discusses India's health expenditure and initiatives by the Ministry of Health and Family Welfare. It provides data showing that India ranks low globally in terms of government and out-of-pocket health expenditures as percentages of total health expenditure. The National Health Policy 2017 aims to increase public health expenditure to 2.5% of GDP by 2025. Key programs discussed include Ayushman Bharat, which aims to deliver comprehensive primary healthcare through Health and Wellness Centers and provide financial protection through Pradhan Mantri Jan Arogya Yojana. The National Health Mission supports primary healthcare services and programs related to reproductive, maternal, child, adolescent health as well as control of communicable diseases.

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Department of Health & Family Welfare 1
Government Health Expenditure (GHE) and Out of Pocket Expenditure (OOPE) as % of Total Health Expenditure (THE) 62.4 45.8 42.1 32.0 25.5 14.1 14.0 13.2 11.9 11.0 9.7 6.3 30 52.2 56.1 55.8 46.0 84 83.6 77 77.8 48.3 83.1 78.2 India Russia Sri Lanka China Brazil Sweden Japan Germany Thailand USA UK France OOPE as % of THE GHE as % of THE 2 GHE as % THE - India ranks 176 out of 191 countries OOPE as % of THE - India ranks 182 out of 191 countries 2014
3 34.1 25.4 20.1 18.2 16.6 16.3 16.2 14.5 13.6 12.8 12.4 Source- www.data.worldbank.org Tax to GDP ratio (%) (2015) in selected countries Prioritizing Health: Health Expenditure in Total Government Expenditure (%)-2015 18.5 15.8 15.3 10.9 9.9 9.7 9.4 8.6 8.4 7.3 3.1 Source : Global Health Expendidture Database, accessed on 11.4.2019
Year-Wise Health Expenditure by GOI (Rs. in Crores) 33121.42 37671.3 51381.89 52944.26 0 10000 20000 30000 40000 50000 60000 2015-16 2016-17 2017-18 2018-19 (Provisional) Expenditure of Health Expenditure on Health 4 Source: Detailed Demand of Grants, MoHFW
NHP 2017 Targets •Increase public health expenditure to 2.5% of GDP, in a progressive manner, by 2025. •Increase State sector health spending to more than 8% of their budget by 2020. •Primary Health Expenditure to be 2/3rd of the total health expenditure. 5
Year wise Expenditure to achieve 2.5% of GDP (Rs. in Lakh Crore) Year Expenditure on Health as a % of GDP GDP ( assuming growth@7.5% at current prices over baseline of 2017-18) GDP with Rate of Inflation @4%only Expenditure on Health 35% of Expend. for Centre 65% of Expend. for State 1 2 3 4 5=4*2 7 8 2018-19* 1.4% 178.75 185.90 2.60 0.91 1.69 2019-20* 1.4% 199.83 207.84 2.91 1.02 1.89 2020-21 1.58% 223.42 232.36 3.67 1.28 2.39 2021-22 1.76% 249.79 259.78 4.57 1.60 2.97 2022-23 1.98% 279.26 290.43 5.75 2.01 3.74 2023-24 2.22% 312.22 324.70 7.21 2.52 4.68 2024-25 2.50% 349.06 363.02 9.07 3.17 5.90 6
Organization & Key Programmes of MoHFW 7 Support to Primary & Secondary Care National Health Mission • Ayushmaan Bharat – Health & Wellness Centres • Reproductive-Maternal-Neonatal-Child - Adolescent Health & Nutrition • Health System Strengthening • Communicable & Non-Communicable Diseases (NCDs) National AIDS Control Programme Tertiary Care Ayushmaan Bharat – PMJAY PMSSY, upgradation of DHs into Medical Colleges INIs & Central Institutions Tertiary care schemes HRH Medical, Nursing & Allied Professionals Institutions Strengthening/ Establishing Health institutions including new AIIMS, CG hospitals and the CGHS Regulation Drugs & Food, Clinical Establishment Medical, Dental, Nursing & Pharmacy Councils Allied Health Professionals (proposed)
Sustainable Development Goals 8 - 17 Goals, 169 targets & 230 indicators - 1 Health Goal, 13 targets & 26 indicators
Target 1.3: Implement social protection systems for all Target 6.1: achieve universal & equitable access to safe and affordable drinking water Target 5.2: end all forms of violence against all women and girls …. Target 4.2: ensure access to early childhood development, care and pre-primary education Target 16.1: reduce all forms of violence and related death rates everywhere Other SDGs e.g. 8 (productive employment and decent work), 10 (inequality), 11 (cities) etc Health SDG3 is linked to other SDGs as contributor and beneficiary 9 Target 2.2: end malnutrition, achieve targets for reductions child stunting & wasting
Initiatives taken by MoHFW 11
12 AYUSHMAN BHARAT – Rationale PRIMARY SECONDARY TERTIARY CONTINUUM OFCARE – CPHC & PMJAY Unmet need: NCDs/other Chronic Diseases Existing services: RMNCHA PMJAY Referral Preventive, Promotive, Curative, Rehabilitative & Palliative Care HWCs
AYUSHMAN BHARAT Aims to provide holistic care – prevention, health promotion, primary, secondary & tertiary care in an integrated manner 13 • Operationalizing 1.5 lakh Health and Wellness Centres - To Deliver Comprehensive Primary Health Care services including prevention and health promotion • Financial protection for secondary and tertiary care hospitalisation through Pradhan Mantri Jan Arogya Yojana (PMJAY)
Feb 2018 14th April, 2018 May 2018 July 2018 Operational Guidelines on Comprehensive Primary Health Care finalized Operationalization of 18157 Health & Wellness Centres Inauguration of 1st HWC and CPHC Application at Jangla, Bijapur Budget announcement of HWCs FY 2018-19 (Rs. 1200 Cr) Key Milestones 14 National Consultation on Comprehensive Primary Health Care May 10th 2019 2022 Operationalization of 1.5 Lakh Health & Wellness Centres FY 2019-20 (Rs. 1600 Cr) Feb 2019
CPHC through HWC Continuu m of Care – Telehealth /Referral Expanded Service Delivery Expanding HR - MLHP & Multiskillin g Medicines & Expandin g Diagnostic s Community Mobilisatio n and Health Promotion Infrastruct ure Financing / Provider Payment Reforms Robust IT System Partnershi p for Knowledg e & Implement ation 15 Key Elements to Roll out CPHC
HWC: Paradigm Shift at multiple policy and operational levels • Focus on curative care predominant • Continuum of care only for maternal and child health • HSC led by One or two Multipurpose workers, supported by ASHAs • Supply of medicines and access to diagnostics at higher level facilities • Focus on Preventive and Promotive Health care • HWC teams to manage majority of conditions including home and community based follow up • Continuum of care for expanded range of services and linkage with PMJAY • Adding a Community Health Officer (Mid Level Health Provider) at HSC – HWCs and multiskilling of primary health care team • Dispensing of medicines including chronic care and essential diagnostics 16
HWC: Paradigm Shift at multiple policy and operational levels • Limited use of technology in consultation and capacity building • Overcrowded secondary and tertiary centres / High loss to follow up/ High OOPE • Underused network of 1,50,000 peripheral facilities, selective care • IT based application for continuum of care including linkage with PMJAY and development of electronic health record. • ECHO for regular tele mentoring and Teleconsultation to avoid patient hardship • Comprehensive care close to community, reduced OOPE, better compliance • Investment in infrastructure and branding. 17
Service Packages 1. Care in Pregnancy and Child-birth. 2. Neonatal and Infant Health Care Services 3. Childhood and Adolescent Health Care Services. 4. Family Planning, Contraceptive Services and other Reproductive Health Care Services 5. Management of Communicable Diseases: National Health Programmes 6. General Out-patient Care for Acute Simple Illnesses and Minor Ailments 8. Basic Oral Health Care 9. Screening and Basic Management of Mental Health Ailments 10. Care for Common Ophthalmic and ENT Problem 11.Elderly and Palliative Health Care Services 12.Emergency Medical Services including Burns and Trauma 18 Services made available at HWC Services* being added in incremental manner 7. Screening, Prevention, Control and Management of Non-communicable Diseases and Chronic Communicable diseases like Tuberculosis and Leprosy. *Many states in south have started adding above services
Roll out Plan of Health and Wellness Centres 2018-19 2019-20 2020-21 2021-22 Dec, 2022 15000 15000 15000 15000 15000 25000 25000 25000 25000 30000 30000 30000 40000 40000 40000 40,000 70,000 1.1 Lakh 1.5 Lakh 17149 52744 ACHIEVEMENT APPROVALS 19
PM-JAY achievements PMJAY Status till 05/05/2019 Metric Overall E-Cards Issued 3,21,66,096 Beneficiaries Admitted in Hospital 2,30,2925 Amount Authorized for Admissions Rs.3071.5 Cr Hospitals Empanelled 15,075 States/UTs implementing 29 18 State/UT Governments have expanded PM- JAY coverage to additional beneficiaries at their own cost A robust IT platform has been developed 33 States/UTs signed MoUs 17 09 07 03 Trust Mode Insurance Mode Mixed Mode MoU yet to be signed
National Health Mission (NHM) 21 NHM NRHM- RCH Pool RCH Flexipool- RMNCH+ A - Reproductive, Maternal, Neonatal, Child & Adolescent Health. Immunization- Routine Immunization & Pulse Polio Immunization. Health System Strengthening NUHM Communicable Disease Programme Revised National TB Control Prog (RNTCP) National Vector Borne Disease Control Prog (NVBDCP). National Leprosy Elimination Prog (NLEP) Integrated Disease Surveillance Project (IDSP) NCDs programmes National Prog. For Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS) National Prog. for Control of Blindness (NPCB) National Mental Health Prog.(NMHP) National Tobacco Control Prog. (NTCP) National Prog. for Health Care of Elderly (NPHCE) Infrastructure Maintenance
Additional Human Resources excluding 10 lakh ASHAs & Mid-Wifery Cadre in 21 States New Constructions Renovation/ Upgradations FRUs operationalized PHCs made 24X7 3 fold increase over baseline About 2.34 lakh Over 31811 Over 38547 Over 25000 Around 3104 Around 9930 3 fold increase over baseline Ambulances operational Interventions under NHM 22
FreeDrugsServiceInitiative: EssentialMedicines  Flexibility with the State / UT to increase the number of medicines in EML as per disease burden. 31 States / UTs have facility wise EML. FDSI guidelines suggests EML to be displayed at each facility. 23 Type of Facility Indicative number of Medicines / Formulations SHC 57 PHC 285 CHC 455 DH 544
Source : Central DVDMS portal as on 6.04.2019 54 115 169 221 225 262 266 291 306 338 450 516 564 573 618 633 758 0 100 200 300 400 500 600 700 800 Jharkhand Uttar Pradesh Punjab Madhya Pradesh Manipur Tripura J&K Meghalaya Bihar Himachal Pradesh Chhattisgarh Andhra Pradesh Gujarat Uttarakhand Telangana Maharashtra Rajasthan NumberofMedicinesinEML–asreportedonDVDMS dashboard 24
Asontoday: 15 States have implemented DVDMS (CDAC) 3 States are in the process of implementing DVDMS - Sikkim, Arunachal Pradesh and Assam. 9 States and 1 UT have systems other than DVDMS. oTamil Nadu, Odisha, Karnataka, Haryana, Kerala, West Bengal and Goa are yet to integrate data with the Central DVDMS Dashboard. One common application has been proposed for the remaining 6 UTs. Only 2 States without an IT backed medicine supply chain system - Mizoram & Nagaland. 25
SettingupasystemforPrescriptionAudit  14 States / UTs have initiated the process.  “Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs .” o Code of (Professional Conduct, Etiquette and Ethics) Regulations 2002. Advisory issued by MoHFW to both central Government facilities/institutions and to States/UTs for compliance. 26
GrievanceRedressalSystems: 19 States / UTs have a mechanism in place. QualityAssurance: • Results ofNational Drug Survey 2014-16: • Not ofStandard Quality (NSQ) medicinesinretail outlets:3%. • NSQ inpublic health facilities :10%. • 14 States with NSQ %greater than thenational average.  Quality testing byNABL accreditedlab is available in28States /UTs. 27
FreeDiagnostics ServiceInitiative • Gujarat, Rajasthan andAndhra Pradesh are providing alltests listed intheFDI guidelines. • Andhra Pradesh (under PPP) and Telangana (in-house) have implementeda hub and spoke model for laboratory services. • Rajasthan isalso using hub and spoke model for the outsourced advancedtests. • InGujarat, samples for few tests are transported to the district central laboratory from all health facilities. • Nagaland, Uttarakhand, Mizoram and Arunachal Pradesh are yetto implementFree Diagnostics ServiceInitiative. 28 Type ofFacility Indicativenumberof Tests SHC 7 PHC 19 CHC 39 DH 56
• AllStatestofast-trackimplementationofDVDMS–uptoHWC–PHC/SClevel. • States to ensure data integration with the Central DVDMS dashboard. (Tamil Nadu, Odisha, Karnataka, Haryana,Kerala,WestBengalandGoa) • EnsurePointofCareDiagnosticsatHWC-PHC :62andHWC-SHC :15tests–HubandSpokeModel. • ExpansionoffacilitylevelEML: Includemedicinesforexpandedservicepackages. Same medicines to be made available at all levels of care (i.e, SHC-PHC-CHC-DH) to improve treatmentcompliance. 29
30 BMMPhasbeenimplementedin27States/UTs:21States/UTsinPPPmode(AndhraPradesh, ArunachalPradesh,Assam,Chhattisgarh,JammuandKashmir,Jharkhand,Kerala,MadhyaPradesh, Maharashtra,Meghalaya,Mizoram,Nagaland,Puducherry,Punjab,Rajasthan,Telangana,Tripura, Uttar Pradesh,WestBengal,GoaandManipur) In-housein6States/UTs(Daman&Diu,Dadra&NagarHaveli,Delhi,Gujrat,TamilNadu, Lakshwadeep BMMP:
31 To award those facilities displaying outstanding swacchta and infection control protocols for promotion of cleanliness, hygiene and good infection control practices. Almost 27,000 facilities assessed, 2,885 public health facilities including 271 DHs, 748 SDH/CHCs, 1,724 PHCs and 142 Urban health facilities have been awarded. Kayakalp :
32 Joint initiative of Ministry of Health and Family Welfare (MoHFW) and Ministry of Drinking Water and Sanitation (MDWS). One SDH / CHC in each of the Open Defecation Free (ODF) blocks to receive additional funding of Rs. 10 lakhs. MDWS to enable Gram Panchayats where Kayakalp awarded SDH/PHCs are located to become ODF. Further MDWS to build capacity through training in Water, Sanitation and Hygiene (WASH) to nominees from such CHCs and PHCs. Swachh Swasth Sarvatra (SSS) :
33
Programme Specific Data Sets S no Progra mmes Indicators Latest Available 4 RCH • Maternal Death Surveillance and Response (MDSR) Report. • Trainings report (SBA, Daksh, Dakshta, RTI/STI, EmOC, LSAS, BeMOC. • Comprehensive Abortion Care . • Number of JSY beneficiaries. • Facility Based - SNCU, NRC Report. • Community Based (HBNC etc.) • Rashtriya Bal Swasthya Karyakram (RBSK). • Mothers’ Absolute Affection (MAA). • Peer educator selection and training Status. • Menstrual Hygiene Scheme coverage. • Adolescent Friendly health service trainings of MOs, ANMs, and counsellors. Quarterly 5 • Infrastructure of SNCU, NBSU, NBCC, NRC. • Intensified Diarrhoea Control Fortnight (IDCF). • National Deworming Day (NDD) Annual 34
Decadal Growth Rate- declined from 21.54% in 1991-2000 to 17.64% during 2001-11 (census India - 2011). Reproductive Health: Key Initiatives and Results Expanding contraceptive basket- Injectable MPA, Centchroman and POP has been recently introduced Mission Parivar Vikas Strengthening Supply chain through FP-LMIS ASHA (CHW) Schemes Total Fertility Rate (TFR)- 2.2 in 2016 (NFHS IV). Spacing between Births improved from 42.6% (2012) to 51.9% (2016) (SRS). Current modern contraceptive usage is 47.8% (NFHS IV). 24 States/UTs have achieved replacement level of TFR (i.e. 2.1). Strategies and Interventions 35
Maternal Health: Key Initiatives& Results • Janani Surksha Yojana (JSY) • Janani Shishu Suraksha Karyakram (JSSK) • Strengthening FRUs, Delivery Points & MCH Wings • Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) • LaQshya: Labour Room and Maternity OT Quality Improvement Initiative 36 • MMR in India declined 59 % faster than the global MMR • MMR reduced from 556 in 1990 to 130 in 2014-15
Essential Newborn Care Home Based Newborn Care (HBNC) Home Based Care of Young Children (HBYC) Mother’s Absolute Affection (MAA) Promotional activities for Breastfeeding/ Complementary feeding. Intensified Diarrhoea Control Fortnight (IDCF) National Deworming Day (NDD) Screening and management of children with 4Ds- RBSK program Child Health: Key & Recent Initiatives New Initiatives Preventive and curative mechanisms through a 6X6X6 strategy AMB Launched in April’ 2018 37 U5MR reduced from 126 in 1992 to 39 in 2015-16
Initiatives to Strengthen Immunization • MI launched to achieve full immunization coverage to 90% and sustain it through RI. • 554 Districts covered under MI. • One of the flagship schemes under Gram Swaraj Abhiyan (GSA) & Extended GSA. • 3.39 crore children and 87.2 lakh pregnant women vaccinated. Mission Indradhanush Inactivated Polio Vaccine (IPV) Rotavirus Vaccine (RV) Launched in 11 States. Pneumococcal Conjugated Vaccine (PCV) Launched in 5 States (UP and Rajasthan partially). Measles-Rubella Vaccine (MR) MR Campaign in 32 States. New Vaccines 38
Immunization: Coverage trends 39 Recent survey in 190 IMI districts has shown an average increase of 18.5 percentage points in FIC from NFHS-4 35.4 42.0 43.5 54.5 61.0 65.0 64.1 70.8 0 10 20 30 40 50 60 70 80 NFHS -1 1992-93 NFHS -2 1998-99 NFHS -3 2005-06 DLHS 2007-08 CES 2009 RSOC 2012-14 INCHIS - 1 March 2015 INCHIS - 2 & 3 combined 2015-16 Percentage Average 1% increase every year from 1992 to 2014 MI & IMI rounds 6.7% increase within a year
40 Revised NationalTuberculosis Control Programme- Achievements & Recent initiatives Achievements in 2018 • Incidence reduced from 300(1990) to 204 (2017) • Mortality Reduced from 76 in 1990 to 31 in 2017 • 21.5 lakh TB cases notified - Increase of 18% over 2017 • Universal Drug susceptibility testing introduced • Daily Fixed Dose Combination drugs benefiting 19.3 lakh TB patients • Treatment for 5.5 lakhs patients made more patient friendly (injection free) • Nikshay Poshan Yojana (NPY)  Largest and the fastest expanding TB control programme in the world  Provides quality assured free diagnostics and treatment services to all TB patients New Initiatives • National TB Prevalence Survey to determine state-wise burden of disease. • NIKSHAY Sampark – call centre services expanded to all States with counselling support and grievance redressal offered in 14 languages • Community Engagement • Working with identified Ministries • Incentives for achievement of targets
MALARIA • National Strategic Plan for Malaria Elimination- 2017-2022 • 40 Million LLINs distributed in the NE States, Odisha, Chhattisgarh & Jharkhand • + cases reduced by 28% in 2015-17 • Reported deaths reduced by 73% • 58.80% reduction in the mortality rate and 42.45% reduction in the incidence of Malaria in 2015 as against 2000, further decline of 24% in 2017 & 54.44% in 2018 41 MALARIA& LEPROSYCONTROL LEPROSY - 3 pronged strategy • Leprosy case detection • Focus Leprosy Campaign • Special Plan for Hard to reach area • Achievement - Grade II disability has started reducing.
HIV/AIDS 42 End the epidemic of AIDS • Reduce new HIV infections by 75% (Baseline 2010) • Achieve treatment targets of 90-90-90 • Eliminate HIV-related stigma and discrimination • Eliminate Mother to Child Transmission of HIV & Syphilis 2020 SDG Goal 3, Target 3.3 2030 Fast Track Targets 90-90-90 By 2020 • 90% of all people living with HIV will know their HIV status • 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy • 90% of all people receiving antiretroviral therapy will have viral suppression • 80 % decline in new infections since 1995 against global average of 47% • 71 % decline in AIDS related deaths since 2005 against global average of 51%
Nutrition Promotion 43 POSHAN Abhiyaan – India’s flagship programme to improve nutritional outcome of children, adolescent, pregnant and lactating mothers by leveraging technology, targeted approach and convergence Facility based management of sick SAM children by Nutrition Rehabilitation Centres 39.1 million adolescents covered under WIFS programme
Food Regulation • Food Safety Standards (Fortification of Foods) Regulation, 2018 • Formulation of standards for fortification of key staples – Edible oil ad milk (with Vitamin A & D), wheat flour and rice (with iron, folic acid and vitamin B12 and salt with iron (in addition to iodine) to address micro nutrient deficiencies • Fortified staples used Integrated Child Development Services (ICDS) and Mid-day meal scheme • Streamline licensing and registration of Food Business Operators (FBOs) 44
Drug Regulation •The Medical Device Rules, 2017- regulating manufacture, import, clinical investigation & sale of Medical devices Provisions for improving transparency and accountability •Risk based classification criteria for medical devices. •Manufacture of high risk medical devices category – to be regulated by the Central Licensing Authority, & others will be regulated by State Licensing Authority. 45
IT Status & Plans 46 46 Policy Framework •A National Resource Centre for EHR standards estd. •Report of National Health StackCommittee submitted to MoHFW •A pan India Telemedicine Network established Glimpse of ongoing IT Initiatives •Mother and Child Tracking System •My Health Record •Hospital Management system •Integrated Health Information Platform •NCD application •Nikshay •Drug & Vaccine Distribution Management System •eVIN •Mera Aspatal •Online Registration System Global Agenda •India concluded 4th Summit of Global Digital Health Partnership (GDHP) and assumed Chair of GDHP •Participation from 35 countries + Academia + Industry + Start- ups Vision: to create secure and interoperable Electronic Health Record (EHR) of every citizen which will facilitate continuum of care •Mother and Child Tracking System •My Health Record •Hospital Management system •Integrated Health Information Platform •NCD application •Nikshay •Drug & Vaccine Distribution Management System •eVIN •Mera Aspatal •Online Registration System •Mother and Child Tracking System •My Health Record •Hospital Management system •Integrated Health Information Platform •NCD application •Nikshay •Drug & Vaccine Distribution Management System •eVIN •Mera Aspatal •Online Registration System
Medical Education - Centrally Sponsored Schemes •Establishment of new Medical Colleges attached with existing district/referral hospitals •Up-gradation of existing State Government/Central Government medical colleges to increase MBBS seats in the country •Strengthening and upgradation of State Government Medical colleges for starting new PG disciplines and increasing PG seats 47
Achievements in Medical Education •118 New Medical Colleges •Increase of 15600 MBBS seats •13000 PG seats , 18635 UG seats increased •NEET examination •6 New AIIMS established with 318 PG seats and 2200 beds. •National Medical Commission Bill, 2017 48
PRADHAN MANTRI SWASTHYA SURAKSHA YOJANA (PMSSY) 22 New AIIMS being set up Completed / Functional : 06 Sanctioned by cabinet : 15 (Total Cost : 20756 Cr ) In Pipeline : 1 (in Bihar , Estimated cost : Rs. 1200 Cr ) PMC appointed : 11 (bids invited for 3 more) Turnkey tender awarded : 8 ( In progress for 3 more) HEFA loan sanctioned : Rs. 1015 Cr (for 8 AIIMS and in process for 5 more)  75 GMC up-gradation projects (Total cost : 12408 Cr ) Completed : 15 (Upto March 2018) + 16 (during 2018-19) Work in Progress : 44 49
Key Datasets 50
No Data Set Key Indicators Latest Available 1 SRS CBR, CDR, IMR, NNMR, U5MR, MMR, TFR, Life Expectancy at Birth 2012-16 2 Rural Health Statistics No. of PHCs, CHCs, SCs, DHs, MMUs No of Human Resources in Public Health facilities 2018 3 NFHS Fertility – Birth order, birth intervals, teenage pregnancy, sex preference indicators, contraceptive use and preferences, Antenatal care indicators, Delivery and post natal care, delivery costs, maternal care indicators, ICDS services, breastfeeding practices, nutrition, TB prevalence, HIV/ AIDS, Status of Blood sugar, blood pressure, Gender issues 2015-16 4 HMIS Key Demographic Indicator, Key Child Health & Maternal health indicators and Family planning and Home/institutional deliveries , Safe Abortion services related indicators Monthly 51
Programme Specific Data Sets S no Programmes Indicators Latest Available 1 NACO -Service Delivery -Epidemiologi cal Individual service uptake data of HIV positive clients HIV prevalence and related risk behaviour data Monthly 2 NVHCP No of serological tests done for diagnosis of viral hepatitis B/C No of new patients initiated on treatment of hepatitis B/ C No of new patients completed treatment of Hepatitis C No of patients put on treatment continuing on treatment for Hepatitis B Monthly 3 RCH Portal RMNCAH indicators, name wise Realtime 4 RCH Programmes Data Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), LaQshya, Weekly Iron folic acid supplementation (WIFS), MDR etc Monthly, Quarterly 52
Programme Specific Data Sets S no Programmes Description Latest Available 5 NSSO Consumer expenditure survey on Health Awaited after gap of 10 yrs 6 IDSP Epidemic outbreak Surveillance Daily, Monthly 7 TB NIKSHAY Portal Monthly, Realtime 8 CPHC Application Screening Portal Monthly 9 Mapping of health facilities National Health Resource Repository Process Ongoing 10 NHA Health accounts – health financing sources, health expenditure Annual 53

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NHM_orientation.pptx

  • 1.
    Department of Health& Family Welfare 1
  • 2.
    Government Health Expenditure(GHE) and Out of Pocket Expenditure (OOPE) as % of Total Health Expenditure (THE) 62.4 45.8 42.1 32.0 25.5 14.1 14.0 13.2 11.9 11.0 9.7 6.3 30 52.2 56.1 55.8 46.0 84 83.6 77 77.8 48.3 83.1 78.2 India Russia Sri Lanka China Brazil Sweden Japan Germany Thailand USA UK France OOPE as % of THE GHE as % of THE 2 GHE as % THE - India ranks 176 out of 191 countries OOPE as % of THE - India ranks 182 out of 191 countries 2014
  • 3.
    3 34.1 25.4 20.1 18.2 16.616.3 16.2 14.5 13.6 12.8 12.4 Source- www.data.worldbank.org Tax to GDP ratio (%) (2015) in selected countries Prioritizing Health: Health Expenditure in Total Government Expenditure (%)-2015 18.5 15.8 15.3 10.9 9.9 9.7 9.4 8.6 8.4 7.3 3.1 Source : Global Health Expendidture Database, accessed on 11.4.2019
  • 4.
    Year-Wise Health Expenditureby GOI (Rs. in Crores) 33121.42 37671.3 51381.89 52944.26 0 10000 20000 30000 40000 50000 60000 2015-16 2016-17 2017-18 2018-19 (Provisional) Expenditure of Health Expenditure on Health 4 Source: Detailed Demand of Grants, MoHFW
  • 5.
    NHP 2017 Targets •Increasepublic health expenditure to 2.5% of GDP, in a progressive manner, by 2025. •Increase State sector health spending to more than 8% of their budget by 2020. •Primary Health Expenditure to be 2/3rd of the total health expenditure. 5
  • 6.
    Year wise Expenditureto achieve 2.5% of GDP (Rs. in Lakh Crore) Year Expenditure on Health as a % of GDP GDP ( assuming [email protected]% at current prices over baseline of 2017-18) GDP with Rate of Inflation @4%only Expenditure on Health 35% of Expend. for Centre 65% of Expend. for State 1 2 3 4 5=4*2 7 8 2018-19* 1.4% 178.75 185.90 2.60 0.91 1.69 2019-20* 1.4% 199.83 207.84 2.91 1.02 1.89 2020-21 1.58% 223.42 232.36 3.67 1.28 2.39 2021-22 1.76% 249.79 259.78 4.57 1.60 2.97 2022-23 1.98% 279.26 290.43 5.75 2.01 3.74 2023-24 2.22% 312.22 324.70 7.21 2.52 4.68 2024-25 2.50% 349.06 363.02 9.07 3.17 5.90 6
  • 7.
    Organization & KeyProgrammes of MoHFW 7 Support to Primary & Secondary Care National Health Mission • Ayushmaan Bharat – Health & Wellness Centres • Reproductive-Maternal-Neonatal-Child - Adolescent Health & Nutrition • Health System Strengthening • Communicable & Non-Communicable Diseases (NCDs) National AIDS Control Programme Tertiary Care Ayushmaan Bharat – PMJAY PMSSY, upgradation of DHs into Medical Colleges INIs & Central Institutions Tertiary care schemes HRH Medical, Nursing & Allied Professionals Institutions Strengthening/ Establishing Health institutions including new AIIMS, CG hospitals and the CGHS Regulation Drugs & Food, Clinical Establishment Medical, Dental, Nursing & Pharmacy Councils Allied Health Professionals (proposed)
  • 8.
    Sustainable Development Goals 8 -17 Goals, 169 targets & 230 indicators - 1 Health Goal, 13 targets & 26 indicators
  • 9.
    Target 1.3: Implement social protection systemsfor all Target 6.1: achieve universal & equitable access to safe and affordable drinking water Target 5.2: end all forms of violence against all women and girls …. Target 4.2: ensure access to early childhood development, care and pre-primary education Target 16.1: reduce all forms of violence and related death rates everywhere Other SDGs e.g. 8 (productive employment and decent work), 10 (inequality), 11 (cities) etc Health SDG3 is linked to other SDGs as contributor and beneficiary 9 Target 2.2: end malnutrition, achieve targets for reductions child stunting & wasting
  • 11.
  • 12.
    12 AYUSHMAN BHARAT –Rationale PRIMARY SECONDARY TERTIARY CONTINUUM OFCARE – CPHC & PMJAY Unmet need: NCDs/other Chronic Diseases Existing services: RMNCHA PMJAY Referral Preventive, Promotive, Curative, Rehabilitative & Palliative Care HWCs
  • 13.
    AYUSHMAN BHARAT Aims toprovide holistic care – prevention, health promotion, primary, secondary & tertiary care in an integrated manner 13 • Operationalizing 1.5 lakh Health and Wellness Centres - To Deliver Comprehensive Primary Health Care services including prevention and health promotion • Financial protection for secondary and tertiary care hospitalisation through Pradhan Mantri Jan Arogya Yojana (PMJAY)
  • 14.
    Feb 2018 14th April, 2018 May 2018 July 2018 Operational Guidelines on Comprehensive PrimaryHealth Care finalized Operationalization of 18157 Health & Wellness Centres Inauguration of 1st HWC and CPHC Application at Jangla, Bijapur Budget announcement of HWCs FY 2018-19 (Rs. 1200 Cr) Key Milestones 14 National Consultation on Comprehensive Primary Health Care May 10th 2019 2022 Operationalization of 1.5 Lakh Health & Wellness Centres FY 2019-20 (Rs. 1600 Cr) Feb 2019
  • 15.
    CPHC through HWC Continuu m of Care – Telehealth /Referral Expanded Service Delivery Expanding HR- MLHP & Multiskillin g Medicines & Expandin g Diagnostic s Community Mobilisatio n and Health Promotion Infrastruct ure Financing / Provider Payment Reforms Robust IT System Partnershi p for Knowledg e & Implement ation 15 Key Elements to Roll out CPHC
  • 16.
    HWC: Paradigm Shiftat multiple policy and operational levels • Focus on curative care predominant • Continuum of care only for maternal and child health • HSC led by One or two Multipurpose workers, supported by ASHAs • Supply of medicines and access to diagnostics at higher level facilities • Focus on Preventive and Promotive Health care • HWC teams to manage majority of conditions including home and community based follow up • Continuum of care for expanded range of services and linkage with PMJAY • Adding a Community Health Officer (Mid Level Health Provider) at HSC – HWCs and multiskilling of primary health care team • Dispensing of medicines including chronic care and essential diagnostics 16
  • 17.
    HWC: Paradigm Shiftat multiple policy and operational levels • Limited use of technology in consultation and capacity building • Overcrowded secondary and tertiary centres / High loss to follow up/ High OOPE • Underused network of 1,50,000 peripheral facilities, selective care • IT based application for continuum of care including linkage with PMJAY and development of electronic health record. • ECHO for regular tele mentoring and Teleconsultation to avoid patient hardship • Comprehensive care close to community, reduced OOPE, better compliance • Investment in infrastructure and branding. 17
  • 18.
    Service Packages 1. Carein Pregnancy and Child-birth. 2. Neonatal and Infant Health Care Services 3. Childhood and Adolescent Health Care Services. 4. Family Planning, Contraceptive Services and other Reproductive Health Care Services 5. Management of Communicable Diseases: National Health Programmes 6. General Out-patient Care for Acute Simple Illnesses and Minor Ailments 8. Basic Oral Health Care 9. Screening and Basic Management of Mental Health Ailments 10. Care for Common Ophthalmic and ENT Problem 11.Elderly and Palliative Health Care Services 12.Emergency Medical Services including Burns and Trauma 18 Services made available at HWC Services* being added in incremental manner 7. Screening, Prevention, Control and Management of Non-communicable Diseases and Chronic Communicable diseases like Tuberculosis and Leprosy. *Many states in south have started adding above services
  • 19.
    Roll out Planof Health and Wellness Centres 2018-19 2019-20 2020-21 2021-22 Dec, 2022 15000 15000 15000 15000 15000 25000 25000 25000 25000 30000 30000 30000 40000 40000 40000 40,000 70,000 1.1 Lakh 1.5 Lakh 17149 52744 ACHIEVEMENT APPROVALS 19
  • 20.
    PM-JAY achievements PMJAY Statustill 05/05/2019 Metric Overall E-Cards Issued 3,21,66,096 Beneficiaries Admitted in Hospital 2,30,2925 Amount Authorized for Admissions Rs.3071.5 Cr Hospitals Empanelled 15,075 States/UTs implementing 29 18 State/UT Governments have expanded PM- JAY coverage to additional beneficiaries at their own cost A robust IT platform has been developed 33 States/UTs signed MoUs 17 09 07 03 Trust Mode Insurance Mode Mixed Mode MoU yet to be signed
  • 21.
    National Health Mission(NHM) 21 NHM NRHM- RCH Pool RCH Flexipool- RMNCH+ A - Reproductive, Maternal, Neonatal, Child & Adolescent Health. Immunization- Routine Immunization & Pulse Polio Immunization. Health System Strengthening NUHM Communicable Disease Programme Revised National TB Control Prog (RNTCP) National Vector Borne Disease Control Prog (NVBDCP). National Leprosy Elimination Prog (NLEP) Integrated Disease Surveillance Project (IDSP) NCDs programmes National Prog. For Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS) National Prog. for Control of Blindness (NPCB) National Mental Health Prog.(NMHP) National Tobacco Control Prog. (NTCP) National Prog. for Health Care of Elderly (NPHCE) Infrastructure Maintenance
  • 22.
    Additional Human Resources excluding10 lakh ASHAs & Mid-Wifery Cadre in 21 States New Constructions Renovation/ Upgradations FRUs operationalized PHCs made 24X7 3 fold increase over baseline About 2.34 lakh Over 31811 Over 38547 Over 25000 Around 3104 Around 9930 3 fold increase over baseline Ambulances operational Interventions under NHM 22
  • 23.
    FreeDrugsServiceInitiative: EssentialMedicines  Flexibilitywith the State / UT to increase the number of medicines in EML as per disease burden. 31 States / UTs have facility wise EML. FDSI guidelines suggests EML to be displayed at each facility. 23 Type of Facility Indicative number of Medicines / Formulations SHC 57 PHC 285 CHC 455 DH 544
  • 24.
    Source : CentralDVDMS portal as on 6.04.2019 54 115 169 221 225 262 266 291 306 338 450 516 564 573 618 633 758 0 100 200 300 400 500 600 700 800 Jharkhand Uttar Pradesh Punjab Madhya Pradesh Manipur Tripura J&K Meghalaya Bihar Himachal Pradesh Chhattisgarh Andhra Pradesh Gujarat Uttarakhand Telangana Maharashtra Rajasthan NumberofMedicinesinEML–asreportedonDVDMS dashboard 24
  • 25.
    Asontoday: 15 States haveimplemented DVDMS (CDAC) 3 States are in the process of implementing DVDMS - Sikkim, Arunachal Pradesh and Assam. 9 States and 1 UT have systems other than DVDMS. oTamil Nadu, Odisha, Karnataka, Haryana, Kerala, West Bengal and Goa are yet to integrate data with the Central DVDMS Dashboard. One common application has been proposed for the remaining 6 UTs. Only 2 States without an IT backed medicine supply chain system - Mizoram & Nagaland. 25
  • 26.
    SettingupasystemforPrescriptionAudit  14 States/ UTs have initiated the process.  “Every physician should prescribe drugs with generic names legibly and preferably in capital letters and he/she shall ensure that there is a rational prescription and use of drugs .” o Code of (Professional Conduct, Etiquette and Ethics) Regulations 2002. Advisory issued by MoHFW to both central Government facilities/institutions and to States/UTs for compliance. 26
  • 27.
    GrievanceRedressalSystems: 19 States /UTs have a mechanism in place. QualityAssurance: • Results ofNational Drug Survey 2014-16: • Not ofStandard Quality (NSQ) medicinesinretail outlets:3%. • NSQ inpublic health facilities :10%. • 14 States with NSQ %greater than thenational average.  Quality testing byNABL accreditedlab is available in28States /UTs. 27
  • 28.
    FreeDiagnostics ServiceInitiative • Gujarat,Rajasthan andAndhra Pradesh are providing alltests listed intheFDI guidelines. • Andhra Pradesh (under PPP) and Telangana (in-house) have implementeda hub and spoke model for laboratory services. • Rajasthan isalso using hub and spoke model for the outsourced advancedtests. • InGujarat, samples for few tests are transported to the district central laboratory from all health facilities. • Nagaland, Uttarakhand, Mizoram and Arunachal Pradesh are yetto implementFree Diagnostics ServiceInitiative. 28 Type ofFacility Indicativenumberof Tests SHC 7 PHC 19 CHC 39 DH 56
  • 29.
    • AllStatestofast-trackimplementationofDVDMS–uptoHWC–PHC/SClevel. • Statesto ensure data integration with the Central DVDMS dashboard. (Tamil Nadu, Odisha, Karnataka, Haryana,Kerala,WestBengalandGoa) • EnsurePointofCareDiagnosticsatHWC-PHC :62andHWC-SHC :15tests–HubandSpokeModel. • ExpansionoffacilitylevelEML: Includemedicinesforexpandedservicepackages. Same medicines to be made available at all levels of care (i.e, SHC-PHC-CHC-DH) to improve treatmentcompliance. 29
  • 30.
  • 31.
    31 To award thosefacilities displaying outstanding swacchta and infection control protocols for promotion of cleanliness, hygiene and good infection control practices. Almost 27,000 facilities assessed, 2,885 public health facilities including 271 DHs, 748 SDH/CHCs, 1,724 PHCs and 142 Urban health facilities have been awarded. Kayakalp :
  • 32.
    32 Joint initiative ofMinistry of Health and Family Welfare (MoHFW) and Ministry of Drinking Water and Sanitation (MDWS). One SDH / CHC in each of the Open Defecation Free (ODF) blocks to receive additional funding of Rs. 10 lakhs. MDWS to enable Gram Panchayats where Kayakalp awarded SDH/PHCs are located to become ODF. Further MDWS to build capacity through training in Water, Sanitation and Hygiene (WASH) to nominees from such CHCs and PHCs. Swachh Swasth Sarvatra (SSS) :
  • 33.
  • 34.
    Programme Specific DataSets S no Progra mmes Indicators Latest Available 4 RCH • Maternal Death Surveillance and Response (MDSR) Report. • Trainings report (SBA, Daksh, Dakshta, RTI/STI, EmOC, LSAS, BeMOC. • Comprehensive Abortion Care . • Number of JSY beneficiaries. • Facility Based - SNCU, NRC Report. • Community Based (HBNC etc.) • Rashtriya Bal Swasthya Karyakram (RBSK). • Mothers’ Absolute Affection (MAA). • Peer educator selection and training Status. • Menstrual Hygiene Scheme coverage. • Adolescent Friendly health service trainings of MOs, ANMs, and counsellors. Quarterly 5 • Infrastructure of SNCU, NBSU, NBCC, NRC. • Intensified Diarrhoea Control Fortnight (IDCF). • National Deworming Day (NDD) Annual 34
  • 35.
    Decadal Growth Rate- declinedfrom 21.54% in 1991-2000 to 17.64% during 2001-11 (census India - 2011). Reproductive Health: Key Initiatives and Results Expanding contraceptive basket- Injectable MPA, Centchroman and POP has been recently introduced Mission Parivar Vikas Strengthening Supply chain through FP-LMIS ASHA (CHW) Schemes Total Fertility Rate (TFR)- 2.2 in 2016 (NFHS IV). Spacing between Births improved from 42.6% (2012) to 51.9% (2016) (SRS). Current modern contraceptive usage is 47.8% (NFHS IV). 24 States/UTs have achieved replacement level of TFR (i.e. 2.1). Strategies and Interventions 35
  • 36.
    Maternal Health: KeyInitiatives& Results • Janani Surksha Yojana (JSY) • Janani Shishu Suraksha Karyakram (JSSK) • Strengthening FRUs, Delivery Points & MCH Wings • Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) • LaQshya: Labour Room and Maternity OT Quality Improvement Initiative 36 • MMR in India declined 59 % faster than the global MMR • MMR reduced from 556 in 1990 to 130 in 2014-15
  • 37.
    Essential Newborn Care HomeBased Newborn Care (HBNC) Home Based Care of Young Children (HBYC) Mother’s Absolute Affection (MAA) Promotional activities for Breastfeeding/ Complementary feeding. Intensified Diarrhoea Control Fortnight (IDCF) National Deworming Day (NDD) Screening and management of children with 4Ds- RBSK program Child Health: Key & Recent Initiatives New Initiatives Preventive and curative mechanisms through a 6X6X6 strategy AMB Launched in April’ 2018 37 U5MR reduced from 126 in 1992 to 39 in 2015-16
  • 38.
    Initiatives to StrengthenImmunization • MI launched to achieve full immunization coverage to 90% and sustain it through RI. • 554 Districts covered under MI. • One of the flagship schemes under Gram Swaraj Abhiyan (GSA) & Extended GSA. • 3.39 crore children and 87.2 lakh pregnant women vaccinated. Mission Indradhanush Inactivated Polio Vaccine (IPV) Rotavirus Vaccine (RV) Launched in 11 States. Pneumococcal Conjugated Vaccine (PCV) Launched in 5 States (UP and Rajasthan partially). Measles-Rubella Vaccine (MR) MR Campaign in 32 States. New Vaccines 38
  • 39.
    Immunization: Coverage trends 39 Recentsurvey in 190 IMI districts has shown an average increase of 18.5 percentage points in FIC from NFHS-4 35.4 42.0 43.5 54.5 61.0 65.0 64.1 70.8 0 10 20 30 40 50 60 70 80 NFHS -1 1992-93 NFHS -2 1998-99 NFHS -3 2005-06 DLHS 2007-08 CES 2009 RSOC 2012-14 INCHIS - 1 March 2015 INCHIS - 2 & 3 combined 2015-16 Percentage Average 1% increase every year from 1992 to 2014 MI & IMI rounds 6.7% increase within a year
  • 40.
    40 Revised NationalTuberculosis ControlProgramme- Achievements & Recent initiatives Achievements in 2018 • Incidence reduced from 300(1990) to 204 (2017) • Mortality Reduced from 76 in 1990 to 31 in 2017 • 21.5 lakh TB cases notified - Increase of 18% over 2017 • Universal Drug susceptibility testing introduced • Daily Fixed Dose Combination drugs benefiting 19.3 lakh TB patients • Treatment for 5.5 lakhs patients made more patient friendly (injection free) • Nikshay Poshan Yojana (NPY)  Largest and the fastest expanding TB control programme in the world  Provides quality assured free diagnostics and treatment services to all TB patients New Initiatives • National TB Prevalence Survey to determine state-wise burden of disease. • NIKSHAY Sampark – call centre services expanded to all States with counselling support and grievance redressal offered in 14 languages • Community Engagement • Working with identified Ministries • Incentives for achievement of targets
  • 41.
    MALARIA • National StrategicPlan for Malaria Elimination- 2017-2022 • 40 Million LLINs distributed in the NE States, Odisha, Chhattisgarh & Jharkhand • + cases reduced by 28% in 2015-17 • Reported deaths reduced by 73% • 58.80% reduction in the mortality rate and 42.45% reduction in the incidence of Malaria in 2015 as against 2000, further decline of 24% in 2017 & 54.44% in 2018 41 MALARIA& LEPROSYCONTROL LEPROSY - 3 pronged strategy • Leprosy case detection • Focus Leprosy Campaign • Special Plan for Hard to reach area • Achievement - Grade II disability has started reducing.
  • 42.
    HIV/AIDS 42 End the epidemicof AIDS • Reduce new HIV infections by 75% (Baseline 2010) • Achieve treatment targets of 90-90-90 • Eliminate HIV-related stigma and discrimination • Eliminate Mother to Child Transmission of HIV & Syphilis 2020 SDG Goal 3, Target 3.3 2030 Fast Track Targets 90-90-90 By 2020 • 90% of all people living with HIV will know their HIV status • 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy • 90% of all people receiving antiretroviral therapy will have viral suppression • 80 % decline in new infections since 1995 against global average of 47% • 71 % decline in AIDS related deaths since 2005 against global average of 51%
  • 43.
    Nutrition Promotion 43 POSHAN Abhiyaan– India’s flagship programme to improve nutritional outcome of children, adolescent, pregnant and lactating mothers by leveraging technology, targeted approach and convergence Facility based management of sick SAM children by Nutrition Rehabilitation Centres 39.1 million adolescents covered under WIFS programme
  • 44.
    Food Regulation • FoodSafety Standards (Fortification of Foods) Regulation, 2018 • Formulation of standards for fortification of key staples – Edible oil ad milk (with Vitamin A & D), wheat flour and rice (with iron, folic acid and vitamin B12 and salt with iron (in addition to iodine) to address micro nutrient deficiencies • Fortified staples used Integrated Child Development Services (ICDS) and Mid-day meal scheme • Streamline licensing and registration of Food Business Operators (FBOs) 44
  • 45.
    Drug Regulation •The MedicalDevice Rules, 2017- regulating manufacture, import, clinical investigation & sale of Medical devices Provisions for improving transparency and accountability •Risk based classification criteria for medical devices. •Manufacture of high risk medical devices category – to be regulated by the Central Licensing Authority, & others will be regulated by State Licensing Authority. 45
  • 46.
    IT Status &Plans 46 46 Policy Framework •A National Resource Centre for EHR standards estd. •Report of National Health StackCommittee submitted to MoHFW •A pan India Telemedicine Network established Glimpse of ongoing IT Initiatives •Mother and Child Tracking System •My Health Record •Hospital Management system •Integrated Health Information Platform •NCD application •Nikshay •Drug & Vaccine Distribution Management System •eVIN •Mera Aspatal •Online Registration System Global Agenda •India concluded 4th Summit of Global Digital Health Partnership (GDHP) and assumed Chair of GDHP •Participation from 35 countries + Academia + Industry + Start- ups Vision: to create secure and interoperable Electronic Health Record (EHR) of every citizen which will facilitate continuum of care •Mother and Child Tracking System •My Health Record •Hospital Management system •Integrated Health Information Platform •NCD application •Nikshay •Drug & Vaccine Distribution Management System •eVIN •Mera Aspatal •Online Registration System •Mother and Child Tracking System •My Health Record •Hospital Management system •Integrated Health Information Platform •NCD application •Nikshay •Drug & Vaccine Distribution Management System •eVIN •Mera Aspatal •Online Registration System
  • 47.
    Medical Education -Centrally Sponsored Schemes •Establishment of new Medical Colleges attached with existing district/referral hospitals •Up-gradation of existing State Government/Central Government medical colleges to increase MBBS seats in the country •Strengthening and upgradation of State Government Medical colleges for starting new PG disciplines and increasing PG seats 47
  • 48.
    Achievements in MedicalEducation •118 New Medical Colleges •Increase of 15600 MBBS seats •13000 PG seats , 18635 UG seats increased •NEET examination •6 New AIIMS established with 318 PG seats and 2200 beds. •National Medical Commission Bill, 2017 48
  • 49.
    PRADHAN MANTRI SWASTHYASURAKSHA YOJANA (PMSSY) 22 New AIIMS being set up Completed / Functional : 06 Sanctioned by cabinet : 15 (Total Cost : 20756 Cr ) In Pipeline : 1 (in Bihar , Estimated cost : Rs. 1200 Cr ) PMC appointed : 11 (bids invited for 3 more) Turnkey tender awarded : 8 ( In progress for 3 more) HEFA loan sanctioned : Rs. 1015 Cr (for 8 AIIMS and in process for 5 more)  75 GMC up-gradation projects (Total cost : 12408 Cr ) Completed : 15 (Upto March 2018) + 16 (during 2018-19) Work in Progress : 44 49
  • 50.
  • 51.
    No Data SetKey Indicators Latest Available 1 SRS CBR, CDR, IMR, NNMR, U5MR, MMR, TFR, Life Expectancy at Birth 2012-16 2 Rural Health Statistics No. of PHCs, CHCs, SCs, DHs, MMUs No of Human Resources in Public Health facilities 2018 3 NFHS Fertility – Birth order, birth intervals, teenage pregnancy, sex preference indicators, contraceptive use and preferences, Antenatal care indicators, Delivery and post natal care, delivery costs, maternal care indicators, ICDS services, breastfeeding practices, nutrition, TB prevalence, HIV/ AIDS, Status of Blood sugar, blood pressure, Gender issues 2015-16 4 HMIS Key Demographic Indicator, Key Child Health & Maternal health indicators and Family planning and Home/institutional deliveries , Safe Abortion services related indicators Monthly 51
  • 52.
    Programme Specific DataSets S no Programmes Indicators Latest Available 1 NACO -Service Delivery -Epidemiologi cal Individual service uptake data of HIV positive clients HIV prevalence and related risk behaviour data Monthly 2 NVHCP No of serological tests done for diagnosis of viral hepatitis B/C No of new patients initiated on treatment of hepatitis B/ C No of new patients completed treatment of Hepatitis C No of patients put on treatment continuing on treatment for Hepatitis B Monthly 3 RCH Portal RMNCAH indicators, name wise Realtime 4 RCH Programmes Data Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), LaQshya, Weekly Iron folic acid supplementation (WIFS), MDR etc Monthly, Quarterly 52
  • 53.
    Programme Specific DataSets S no Programmes Description Latest Available 5 NSSO Consumer expenditure survey on Health Awaited after gap of 10 yrs 6 IDSP Epidemic outbreak Surveillance Daily, Monthly 7 TB NIKSHAY Portal Monthly, Realtime 8 CPHC Application Screening Portal Monthly 9 Mapping of health facilities National Health Resource Repository Process Ongoing 10 NHA Health accounts – health financing sources, health expenditure Annual 53

Editor's Notes

  • #7 *
  • #9 MDG Success factors: Few goals and targets, widely accepted Some limitations: Variable progress, vertical approach  Unfinished MDG agenda SDGs: Too Many Goals= Having No Goals? Copenhagen consensus 2 Questions: Health is well placed and What has changed- Speaking about latter first…
  • #10 Example: Contributor: A healthy child will attend the school and learn well………. while a sick child cannot attend the school- So health contributes to better education Beneficiary: An educated person is more likely to take better care of his health and seek timely and appropriate care …..and vice versa- So health benefits from education
  • #13 NCDs account for 62% mortality; 55% Premature, 62% OOPE of Total Health Expenditure NSSO data (71st Round. 2014) shows 11.5% and about 4% in rural and urban areas respectively sought any form of Outpatient care - at or below the CHC (secondary health centres) (except for Childbirth). Presently the Sub centre and Primary Health centre- currently provide preventive care mostly related to maternal and child health, The need for primary health care is met by unqualified practitioners. particularly in the high focus states, There is a huge unmet need for early detection and management of Non-communicable diseases and other chronic conditions. NCDs currently account for 62% mortality of which 55% is premature mortality. Studies show that losses associated with physical NCDs is expected to be about $3.55 trillion by 2030
  • #23 Source: HMIS database-June 2018
  • #30 New slide – same medicines sub point
  • #49 499 MEDICAL COLLEGES