Mission Indradhanush was launched in 2014 to cover all those children who have been partially vaccinated or not vaccinated during routine immunization rounds. The objective of Mission Indradhanush is to increase full immunization coverage in India to at least 90% children by 2020. Four rounds have been implemented so far.
- Until August 22, 2017, more than 2.53 crore children and around 68.43 lakh pregnant women have been immunized under Mission Indradhanush which was launched to reach the unreached.
- Around 72.99 lakh Vitamin A doses have been distributed along with 68.16 lakh ORS packets and 2.3 crore Zinc tablets.
- A total of 528 districts have been covered in the four phases of Mission Indradhanush. During the three phases and ongoing fourth phase of Mission Indradhanush, as on August 22, 2017, around 2.53 crore children were reached of which 66.16 lakh children were fully immunized. Further, 68.43 lakhs pregnant women were also vaccinated with Tetanus Toxoid.
- The first two phases of Mission Indradhanush led to an increase of 6.7% in the full immunization coverage across the country as per the report of Integrated Child Health & Immunization Survey (INCHIS).
Intensified Mission Indradhanush –
India is now aiming to achieve 90% full immunization coverage of its children by December 2018. In order to achieve this ambitious Intensification of Mission Indradhanush in 170 districts including 52 districts of north-eastern states and 17 urban areas has been launched by Prime Minister Narendra Modi on October 6, 2017.
‘Intensified Mission Indradhanush’ is being built upon as an improvisation of ‘Mission Indradhanush’ where attempts have been made to address the challenges encountered in previous phases of Mission Indradhanush.
New Vaccines –
- Inactivated Polio Vaccine (IPV): In concurrence with the World Polio End Game strategy, IPV was introduced in November 2015 in six states and expanded throughout the country by June 2016. Till August 2017, around 2.79 crore doses of IPV have been administered to children since its introduction.
- tOPV to bOPV switch: India has switched from tOPV to bOPV on April 25, 2016, wherein tOPV has been completely replaced by bOPV in both polio campaigns and Routine Immunization.
- Rotavirus Vaccine: This vaccine was launched in March 2016 in four states of Andhra Pradesh, Haryana, Himachal Pradesh and Odisha, to reduce the burden of diarrhoea caused by Rotavirus. It has been expanded to five more states namely Assam, Madhya Pradesh, Rajasthan, Tripura and Tamil Nadu. Approximately 88.73 lakh doses of Rotavirus vaccine have been administered to children since its introduction till August 2017.
- Rubella vaccine as Measles Rubella (MR) vaccine: MR vaccination campaign targeting children from 9 months up to 15 years of age, was launched on February 5, 2017, in five states viz. Karnataka, Tamil Nadu, Goa, Lakshadweep and Puducherry, where subsequent to completion of the campaign the MR vaccine has been introduced in routine immunization replacing measles-containing vaccine 1 and 2 at 9-12 months and 16-24 months of age. A total of 3.3 crore children were vaccinated in MR campaign in these states giving a coverage of 97%. The next phase for 8 states/UTs has started in August’17 with vaccination ongoing in 7 states/UTs namely Andhra Pradesh, Chandigarh, Daman & Diu, Dadra & Nagar Haveli, Telangana, Kerala and Himachal Pradesh where around 2.39 crore children have been vaccinated as on October 9, 2017.
- Adult JE vaccine: Japanese Encephalitis vaccination in children was introduced in 2006. However, the vaccine was expanded to the adult population of districts with a high disease burden of adult JE in 2015. A total of 35 districts have been identified for adult JE vaccination in the states of Assam, Uttar Pradesh and West Bengal. Adult JE vaccination campaign has been completed in 31 districts during which 3.29 crore adults were vaccinated with JE vaccine.
- Pneumococcal Conjugate Vaccine (PCV): This vaccine is provided to reduce child deaths due to pneumonia – which is a major cause of child mortality. It has been launched on May 13, 2017, in 3 states i.e. Himachal Pradesh (12 districts), Uttar Pradesh (6 districts) and Bihar (17 districts) in the first phase. Until August 2017, around 1.74 lakh children have been covered under it.
Rashtriya Bal Swasthya Karyakram (RBSK) –
This initiative launched in February 2013 entails provision for Child Health Screening and Early Intervention Services through early detection and management of 4 Ds i.e. Defects at birth, Diseases, Deficiencies, Development delays including disability and free management of 30 identified health conditions including surgery at tertiary health facilities. Children between 0-18 years of age are expected to be covered in a phased manner across the country. About 59.2 Crore children have been screened under this programme, until February 2017.
Children that are screened are referred to higher facilities for free treatment including surgeries for conditions like congenital heart disease, cleft lip and correction of clubfoot etc. Till February 2017 a total of 1.27 Crore children have received treatment under the programme.
India-Iran MoUs on Health and Medicine Approved by the Cabinet
India and Iran share several common features in their language, culture and traditions, and also share a common legacy of using herbal medicines.
The Cabinet on Wednesday approved two MoUs inked between India and Iran on cooperation in the field of health, medicine and traditional systems of medicine.
The Union Cabinet chaired by Prime Minister Narendra Modi has given its ex-post facto approval for the MoU in the field of health and medicine which was signed on February 17 during the visit of Iranian President Hassan Rouhani to India, an official statement said.
The main areas of cooperation include exchanging experience and training of doctors, and other health professionals, assistance in the development of human resource, setting up healthcare facilities and regulating pharmaceutical, medical devices and cosmetics, it said.
It also includes cooperation in the field of medical research, new technologies and knowledge-based initiatives, public health and sustainable development goals among others.
A working group will be set up to elaborate the details of cooperation and to oversee the implementation of this MoU.
The other MoU signed in the field of traditional systems of medicine will enhance bilateral cooperation and will be of immense importance to both the countries considering their shared cultural heritage, the statement said.
It said India is blessed with well-developed systems of traditional medicine including medicinal plants, which hold tremendous potential in global health scenario.
India and Iran share several common features in their language, culture and traditions, and also share a common legacy of using herbal medicines, the statement said.
Both countries have huge biodiversity and are home to rare medicinal plants which are frequently used in traditional systems of medicine.
Moreover, Iran has endorsed the status of India as a true leader in the field of traditional systems of medicine backed by strong infrastructure and state of the art production units, the statement said.
The Ministry of AYUSH, having the mandate to promote, propagate and globalise traditional systems of medicine, including Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy, has inked MoUs with China, Malaysia, Bangladesh, Nepal and Mongolia among others for cooperation in the field traditional medicine.
Modicare: Getting Universal Health Coverage in India Right
India’s NHPS (‘RSBY’) could become the largest government health insurance programme in the world.
The recently announced National Health Protection Scheme succeeds Rashtriya Swasthya Bima Yojana(RSBY), which provided health insurance for short-term hospital visits to the poorest 300 million Indians. Based on their large-scale study of RSBY in Karnataka, Malani and Kinnan put forth some important lessons for the new programme.
India’s Prime Minister, Narendra Modi, has just announced a bold new programme to provide government health insurance to its citizens. The new programme, called the National Health Protection Scheme (NHPS), will cover up to 500 million poor and near-poor Indians for up to Rs. 500,000 (US$7,785) in hospital expenses. Once rolled out, NHPS could become the largest government health insurance programme in the world, measured by the number of households covered.
Modicare, as the programme is commonly called, is not India’s first public health insurance scheme. It succeeds Rashtriya Swasthya Bima Yojana (RSBY), translated as the National Health Insurance Scheme, which provided health insurance for short-term hospital visits. It also builds upon a number of state schemes in Andhra Pradesh and Karnataka that cover longer-term hospital stays.
NHPS could be a game changer. It is over 15 times more generous than RSBY, which only covered Rs. 30,000 (US$467) in short-term hospital care, and is between 2-3 times more generous than state programmes for long-term hospital care. Whereas RSBY targeted just the poorest 300 million Indians, Modicare would cover an additional 200 million people. With an estimated 7% of India’s population pushed into poverty each year due to medical expenditures, the programme could provide an essential safety net for the poor.
But the programme will come at a significant cost. With insurance premiums estimated at Rs. 1,100-1,200 (US$18) per household per year, the full programme could cost up to Rs. 12,000 crore (US$1.87 billion). Like Medicaid, the US’s public health insurance programme for the poor, the costs are to be split between the central government and state governments. The central government is responsible for Rs. 7,000 crore of the total cost, Rs. 5,000 crore more than has been allocated in the current Union Budget.
With so much at stake, it is essential that India get the rollout of NHPS right. We are part of a research team that just finished a large-scale study of health insurance in the state of Karnataka. The core of the study was a randomised controlled trial (RCT) that examines the impact of RSBY on the health and financial security of roughly 50,000 Indians in that state1. We also conducted a study of hospitals in the state. One of us also heads a programme called International Innovation Corps which supported the Ministry of Health’s Suvarna Arogya Suraksha Trust in implementing RSBY in Karnataka, a state with 64 million residents. From these, we have learned some important lessons for Modicare.
People must enrol in Modicare
No matter how generous the eligibility criteria and coverage of Modicare, it will have limited effect unless eligible households actually enrol in the programme. Its predecessor, RSBY, suffered low uptake rates. Although it costs participants just Rs. 30 (US$0.47) to enrol, only 54% of eligible families offered the insurance enrolled, lower than Medicaid take-up rates in the US.
By contrast, we were able to achieve 79% enrolment rates in our study when we offered households free insurance. While participants in our study were wealthier than typical RSBY households, our enrolment rates were 60%, above government levels, even when we sold insurance at cost (roughly Rs. 200, or US$3.15), with no government subsidy. We achieved this with an enrolment drive that went door to door to inform households that they were eligible for insurance and helped them enrol.
Certain states in India have also achieved similarly high enrolment rates. For example, the state of Chhattisgarh reports an 85% uptake rate for RSBY. Other state insurance programmes have achieved nearly 100% enrolment rates by automatically enrolling eligible patients at hospitals. So it is possible to achieve high uptake at scale with the right design and effort.
The poor must be able to use Modicare:
The impact of Modicare will also be blunted if households enrol but do not actually use the programme to obtain necessary medical care. A case in point: RSBY only increased utilisation by 1 percentage point, to 2.8% of households. In some states, the hospital-going rate remained below 1%. In states like Karnataka, this came as a surprise. When RSBY started, the premium the state negotiated with insurers was nearly Rs. 500 (USD$7.79). But because of low utilisation, those premiums have fallen to roughly Rs. 200 in recent years.
Our study provides insight into why RSBY did not facilitate utilisation. While we found that RSBY did indeed increase utilisation by 30% percent or more, a significant number of households attempted to use the card but failed. When we probed why households were unable to use RSBY, we found that a third of the time individuals forgot their insurance card or did not know it could be used. More distressing, about half the time the hospital or insurance company could not process the insurance card or refused to cover the care.
These problems are correctable. The government must expend more effort on information and education campaigns. Insurance is a new product, especially for poorer Indians. Structural changes planned under Modicare, such as using Aadhaar2 and hospital-based biometric ID, should reduce the paperwork and hassle costs for beneficiaries. In addition, Modicare must make sure that hospitals that register under the scheme have functioning payment systems and do not turn away NHPS patients.
Many worry about the financial burden of NHPS. They focus on stopping beneficiaries from overusing care or hospitals prescribing unneeded care. Economists call this “moral hazard”. Given India’s low rate of health care utilisation, we believe overspending is not a primary concern in the short run. In the long run, if utilisation levels rise, Modicare can be modified to add a deductible or co-pay and more extensive utilisation review to ensure the government is getting value for its spending.
Supply is as important as demand:
It is obvious, but worth repeating, that health insurance is of no value if there are no accessible healthcare facilities. This is a critical obstacle for Modicare. Nearly half of all Indian children live in villages with no healthcare facilities. India would need to increase the number of hospitals by 10% and clinics by 50% to satisfy basic needs. Providing health insurance cannot solve that in the short term. But in the long term, it can encourage the private sector to build more facilities.
But for Modicare to be successful, it is not enough that India builds more hospitals. They must actually participate in Modicare. We found that, although 33% of hospitals participated in RSBY in Karnataka, 55% of participating hospitals filed no claims. In other words, they reported they were open to RSBY participants, but did not actually treat them.
An important reason is that RSBY, like Medicaid, pays hospitals lower-than-market rates for care. To address that, Modicare must pay more for treatment, otherwise, hospitals will attempt to refuse care. Recent research has shown the importance of incentives for health facilities and their staff in improving access to quality care (Dhaliwal and Hanna 2017).
But Modicare should set payments intelligently. Following the lead of Medicare, the US’s health insurance program for the elderly, it should set a price schedule for different services and then apply a scaling factor that increases payments for hospitals in high-cost areas such as big cities, and lowers costs for rural areas. It can also adjust that scaling factor to encourage new hospitals in underserved areas.
India must leverage its IT prowess:
The recipe for a well-functioning insurance plan requires equal parts healthcare facilities, sound financing, and a strong data infrastructure. The first two ingredients get a lot of attention, but our experience helping Karnataka run RSBY taught us that the third is no less important. The data backbone is what ensures that claims are tracked and paid. Without that, beneficiaries may not get the care they need and hospitals will not get the payments they are promised. Participation will decline and the scheme may fail.
A strong data backbone will also help the government mitigate the risk of fraud. By monitoring claims, the government can look for statistical anomalies, such as males getting gynaecological procedures and dis-empanel hospitals that appear to be abusing the programme. With “big data,” Modicare can avoid excessive spending on unneeded care or care that was not actually provided.To tackle this challenge, Modicare must set up a management information system (MIS) that tracks hospital claims directly and does not rely on insurance companies to do so. Karnataka faced challenges getting insurers to give RSBY timely and clean data on claims. This made it difficult to determine what services people actually demanded and to detect fraud.
Ideally, Modicare will integrate its claims data with electronic health records so that it can hold hospitals to quality standards.
Finally, Modicare, like Medicare in the US, should make an anonymised subsample of its data available to the public to provide transparency and to leverage think tanks and universities to help improve the programme.
The financial structure of Modicare:
The antecedents of Modicare – RSBY and state programmes – followed different models of insurance. With RSBY, the government paid private insurers to provide coverage for beneficiaries. By contrast, Andhra Pradesh and Karnataka, among others, cut insurance companies out and paid claims directly.
The choice comes down to whether it is better for the government to serve as the ultimate insurer (trust model) or contract out insurance to companies (insurance model). In the US, Medicare coverage for hospital and physician care (Parts A and B), as well as Medicaid, follow the trust model, while Medicare support for private coverage (Part C) and drugs (Part D) follow the insurer model.
One advantage of the trust model is that the government does not have to monitor misbehaviour by the insurance company. But an advantage of the insurance model is that the government does not have to bear the financial risk of higher-than-expected claims.
Modicare has left it to states to decide which approach to take. But the right choice is not obvious. Solving the problem of misbehaviour by insurance companies is a daunting challenge, which suggests a trust model. However, the government does not have a comparative advantage in running a health insurance programme.
India can mitigate the risk of bad behaviour by insurance companies by implementing a strong data backbone and making claims processing uniform across insurers. So in the long run, as health spending and monitoring capacity rise, the insurer model may be the better choice. It should also consider data sharing to allow new entrants into the insurance market and carefully regulate it to ensure insurers pay all legitimate claims.
Modicare is a bold step. Developed countries spend more on healthcare (as a percentage of their gross domestic product), so it is natural that India is making moves to do just that as it continues to grow. But it must avoid the US’s fate on costs. The US uses roughly the same amount of care per person as in the UK but spends double per person of what the UK does. India must be diligent in designing its health care financing system to get value. The key is sound implementation.
- A randomised controlled trial operates like medical trials used to test whether a drug works or not. Some households are provided treatment (in our study, access to health insurance), while others are left alone and employed as a comparison or control group. Whether a household is offered insurance or not is determined by random chance to ensure that any differences between the health of households that are offered insurance and those that are not caused by access to insurance and not by which households were chosen to receive insurance.
- Aadhaar or Unique Identification number (UID) is a 12-digit individual identification number issued by the Unique Identification Authority of India (UIDAI) on behalf of the Government of India. It captures the biometric identity – 10 fingerprints, iris and photograph – of every resident, and serves as a proof of identity and address anywhere in India.
Views expressed are of the authors and do not necessarily reflect the views of League of India or of any of its partners.
Reprinted with permission from Ideas for India
Bio-Degradable Sanitary Pads to be Available at 8,000 Railway Stations
Union Railway Minister Piyush Goyal on Monday said he wants to run a campaign, ensuring that all women are provided with the benefit of bio-degradable sanitary pads in rural areas.
“We should run a campaign across the country to ensure all women get the benefit of such pads. We have to get economies of scale. We should produce these on a large scale and instead of the expensive pads produced by big companies; women can get it for Rs 1-Rs 1.5,” said Goyal.
Goyal was attending the event and was speaking on the ‘Relevance of Economic Philosophy of Pandit Deendayal Upadhyaya in Today’s World’ as part of the RSS ideologue’s birth centenary celebrations.
Speaking on the campaign, Goyal asserted that he wanted to run a campaign to ensure that every woman in India had access to sanitary pads.
“I have started speaking with Manekaji (Maneka Gandhi) on the issue,” he said. The Railway Minister also said that he was exploring the possibility of facilitating manufacturing units for cheap and bio-degradable sanitary pads at 8,000 railway stations of the country. “The railways will help as much as possible, be it providing manufacturing facility on railway stations…such pads can be manufactured on 8,000 locations,” he said.
Goyal further emphasised that self-help groups can manufacture such pads. “Women themselves can make them in hygienic conditions. Railway stations have terraces where they can work. Machines used for the purpose are also not that expensive,” he added.
Goyal also said the aim should be to provide women with a benefit for Rs 100 annually. “Even if there are three women in the house, the expense is 80 paisa per day for this. Most households will be able to afford it,” he said.
On February 20, Union Minister for Women and Child Development Maneka Gandhi launched a menstrual hygiene campaign. The objective of the campaign called “#Yes I Bleed” is to create a holistic approach to the issue of menstruation, which is an experience that transcends culture, class, and caste.
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