Highlights from January 2023
Health Systems Transformation Platform
HSTP is a not for profit organisation. Enabling Indian Health Systems Respond to People's Needs.
January is named after Janus, the Roman god of all beginnings, transitions, time, and choices. In spirit with the promising beginning of the year, this edition of The Transformation Tracker looks back at the first month of the new year, focusing on new journeys and beginnings at HSTP and the expansion of the avenues we set up in the past year. The year began for HSTP with a solid vote of confidence, being given the responsibility of handling the National NCD (non-communicable diseases) portal management by the Tata Trusts and we will share more on that in the newsletter. This edition also talks about our steps forward in our health assurance and health service delivery verticals. In 2024, HSTP looks forward to building networks, creating linkages, aligning existing systems to standards, and using data and technology for good to strengthen the public health ecosystem of the country.
The edition covers:
HSTP commences work on the National Programme for NCD to support the National NCD portal
Rajeev Sadanandan (CEO, HSTP) writes
The Tata Trusts have been working on reducing the burden of non-communicable diseases (NCDs) in India in partnership with Dell Technologies and the Government of India through its NCD portal. We are happy to share that the Tata Trusts have collaborated with the Health System Transformation Platform (HSTP) for the management of the NCD portal. This is a significant step forward for HSTP in its mission to impact the healthcare ecosystem of our country positively.
Nearly 65% of all deaths and a corresponding level of morbidity in India are due to Non-Communicable Diseases (NCDs). WHO estimates suggest that every year around 5.8 million people die from NCDs (CVD, lung diseases, cancer, and diabetes) and that every 1 in 4 Indians has a risk of dying from NCD before reaching the age of 70 years.
The cornerstone of the Government of India’s (GoI) National Programme for Non-Communicable Diseases is the screening of the population estimated to be at risk of NCDs. The NCD programme design managed via the NCD app is a step forward to influence the health-seeking behaviour of the population with proactive screening of the eligible population, and a robust tracking programme to manage the continuum of care of the persons put on treatment.
In line with the idea of simplifying health management, digitalising the NCD database to strengthen and streamline the process was prioritised by the Government. The app enables efficient management of cases by health workers to track, record and monitor patients' progress, thus improving care standards. It has adopted the CPHC NCD Application (now called the ‘National NCD IT portal’) developed and deployed by the Tata Trusts and their technology partner Dell Technologies. This has since been deployed across 33 States and UTs covering more than 600 districts. At the end of the first phase in 2023, more than 308 million individuals had been registered, 137 million individuals screened for NCDs, and 10.5 million persons had been put on treatment.
It was to build on the achievements of the first phase, that Tata Trusts entrusted the HSTP with the management of the next phase of the management of the NCD portal. HSTP will aim to optimize the use of the program data for improving the efficiency of early detection and long-term management of patients in addition to sustaining and expanding the use of the portal to the frontline health workers In line with the mission of HSTP we will deploy data analytics and data mining of the data gathered in the National NCD IT Portal linked to other health data sources to improve planning and delivery of NCD services.
HSTP will aim to combine the IT architecture created under the NCD Portal with the ABDM architecture using the ABHA to track patients across their life course across different parts of the health system including treatments for downstream complications of NCDs and explore the possibility of utilising the NCD platform to combine various data collected at the HWCs and PHCs on different health conditions of the same individual. HSTP will collaborate with the central and state governments to analyse anonymized data to generate evidence for policymaking and health system planning and financing for the future including estimating the requirement for hospital services, human resources for health (HRH), and finances, and to support states to develop plans to address the assessed need.
The NCD app aims to prevent, control, and monitor the spread of NCDs with proactive screening measures, digital health records, and a smooth referral system. The app not only simplifies the health workers’ tasks by eliminating paperwork but also empowers them with data-driven tools for more effective and efficient healthcare delivery. It enables comprehensive health data management, streamlines workflows, data-driven decision-making for patient-centric care and an improved follow-up process. With the hope of new learnings and insights for improvement, HSTP is looking forward to this journey so as to impact NCDs in India. With the application of technology in the continuum of care and its impact within communities across India, we hope to see increased awareness and improved health-seeking behaviour and making treatment and control more accessible.
Equity, Efficiency, and Action: HSTPs Holistic Approach to Health Assurance
At HSTP, our Health Assurance approach primarily centres around advancing Universal Health Coverage (UHC). The goal is to improve accessibility and affordability to healthcare services by strengthening state financial protection schemes for individuals and families.
Recently, the Health Assurance team has made significant strides in our efforts to promote equity and improve the efficiency of the state health protection schemes. The team spearheads the discussion on the roadmap towards achieving UHC by 2030.
Our efforts have yielded notable results, and we continue to pursue better healthcare outcomes for all.
Impact of Gender Equity in State Financial Protection Scheme in Odisha
We collaborated with the Government of Odisha, represented by the Department of Health & Family Welfare (DoHFW) and the State Health Assurance Society (SHAS), to document Odisha's transformative journey towards universal health and gender equity. This initiative is a collective effort of a team of experts, including Shalini Pandit from DoHFW; Dr. Brundha D, Subhanand Mohapatra, and Dr. Bishnu Mohapatra from SHAS; and Rajeev Sadanandan , Dr. Sudha Chandrashekar , Dr. Abdul Aziz Kattakath and Abhishek Raj from HSTP.
This comprehensive narrative underscores our collective commitment to transforming the health paradigm in Odisha. The team's work resonated with the 2024 theme of "Geopolitics, Human Security, and Health Equity in an Era of Polycrises" at the Prince Mahidol Award Conference (PMAC) in Bangkok, Thailand. It was selected for presentation at this prestigious global health forum.
The presentation at PMAC 2024 showcased the transformative impact of the targeted policy intervention in the Biju Swasthya Kalyan Yojana (BSKY), Odisha's flagship health protection scheme, to foster equitable access to healthcare services, aligning seamlessly with the Sustainable Development Goal (SDG) target 3.8, which advocates equitable access to healthcare services.
The policy intervention introduced by BSKY is a testament to Odisha's dedication to the principle of "Leave No One Behind," marking a significant step towards a healthier and more inclusive future. The joint presentation by the HSTP team and the Odisha state representatives at PMAC 2024 showcases our achievements and serves as a call to action for fostering equity in universal health coverage.
Enhancing Efficiency in State Health Protection Schemes
The efficacy of implementation is as crucial as inclusivity and equity in state health protection schemes. In partnership with Odisha, Chhattisgarh, and Meghalaya state governments, the HSTP team is driving significant reforms to enhance the efficiency of their respective financial protection schemes.
In Odisha, HSTP's collaboration with the Biju Swasthya Kalyan Yojana (BSKY) has yielded notable progress. A key achievement is the introduction of the BSKY Claim Adjudication Manual, a comprehensive guide ensuring standardised, fair and accurate evaluation of BSKY claims. The document is now accessible on the BSKY and HSTP websites. To further augment the efficiency, the team is finalising additional guidelines, the BSKY Anti-Fraud Guidelines, Empanelment and De-empanelment Guidelines, and Grievance Redressal Guidelines, to streamline processes and ensure transparency.
In Meghalaya, the HSTP team extends its expertise to the State Health Agency (SHA), aiming to optimise the state-funded health protection schemes. The HSTP team has provided expert guidance for transitioning from insurance to assurance mode of implementing MHIS and has developed a comprehensive roadmap to facilitate the transition. Furthermore, the team has also provided inputs on integrating the Meghalaya Employee Health Scheme with the MHIS, thereby streamlining operations and eliminating redundancy. The state is currently reviewing the recommendations put forth by the HSTP team.
Expanding its reach, the Health Assurance team has partnered with the Chhattisgarh state to optimise its health protection schemes, such as the Dr. Khoobchand Baghel Swasthya Sahayata Yojana (DBKSSY) and the Mukhya Mantri Vishesh Swasthya Sahayatha Yojana (MVSSY). Specifically, the team is providing technical support in developing state-specific packages for tertiary care specialities, including the development of the Standard Treatment Guidelines (STGs) for these packages to ensure their judicious use and prevent misuse. Future plans include simplifying the implementation of the MVSSY scheme and enhancing the IT system for improved operational efficiency.?
The Health Assurance vertical of HSTP is dedicated to creating a paradigm shift in how health protection schemes operate, focusing on promptness, accuracy, and efficiency. With the ever-evolving challenges in healthcare, these initiatives aim to build more resilient health systems. Looking ahead, HSTP is committed to developing more efficient, inclusive, and robust health protection schemes in its focus states, ultimately contributing to improved health outcomes and equity in healthcare access.
Time for Action: Achieving UHC by 2030
Around Universal Health Coverage (UHC) Day 2023, HSTP actively participated in various forums, contributing to the discourse on achieving the Sustainable Development Goal (SDG) Target 3.8 by 2030.
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Dr. Sudha Chandrashekar participated in a pivotal panel discussion at the Times Health Excellence – Telangana & AP – 2023 event organised by The Times Group and IndiGlobal Media Network. The discussion focussed on 'Accessible and Affordable Quality Healthcare' - a subject of paramount importance in the contemporary healthcare landscape. Dr. Sudha emphasised the urgency of achieving UHC amid the evolving healthcare landscape and the SDG 2030 deadline. Advocating a State-Centric Approach, she highlighted the significance of each state’s achievements in India's journey towards Universal Health Coverage due to varying levels of commitment. She stressed the importance of enhancing primary healthcare at health and wellness centres and the need for India to create and implement customised designs based on global models rather than follow the latter. Advocating a holistic approach, she reiterated the importance of ensuring financial risk protection and prioritising quality care and gender equality in the journey towards UHC.
On December 11, HSTP, in collaboration with Karnataka Association of Community Health (KACH), Department of Health and Family Welfare, Govt. of Karnataka and Access Health International, organised a webinar, “Health for All: Time for Action”. The panel included distinguished public health representatives from the state Governments of Kerala (Dr Rathan U Kelkar IAS), Odisha (Dr Bishnu Prasad Mohapatra), Karnataka (Dr Pushpalatha B S), Former Special Secretary of Niti Aayog (K Rajeshwara Rao IAS Retd.), The World Bank (Sheena Chhabra), WHO (Dr Grace Achungura), Access Health International (Himani Sethi), and HSTP (Rajeev Sadanandan). Key insights, which are crucial for advancing healthcare goals, were shared by the panel. The importance of UHC in ensuring access to quality care while reducing hardships was acknowledged, along with the need for continuous adjustments to address evolving health needs. The discussions advocated a synergistic strategy, emphasising government health insurance like Ayushman Bharat and recognising the diverse approaches needed in India. Innovative financing was highlighted as crucial for sustainability, aiming to lower out-of-pocket expenses and address critical areas like maternal and child health and non-communicable diseases.
The discussion also pointed out the significance of focusing on the following as a way forward:
HSTP values the concept of accessible and affordable quality healthcare, and therefore, we build solutions around it while strengthening public health systems to achieve UHC. Having state health protection cover helps reduce OOP expenditure on healthcare, reduces disparities, and promotes health-seeking behaviour among the marginalised. It is one of the ways healthcare becomes accessible and affordable for the people. However, it's not the only one, nor does it ensure the quality of healthcare services. Therefore, HSTP looks at an integrated approach - strengthening primary healthcare services by building the competencies of the primary healthcare workers, building the leadership of the mid-level public health officials, and improving access to essential medicines in public facilities. For quality healthcare to be accessible and affordable, public health systems must see holistic improvements.
Roadmap to Resilience: Strengthening Emergency Care Systems
The Ministry of Road Transport & Highways, Government of India is observing the ‘National Road Safety Month’ from 15 January to 14 February 2024. In the light of this, let’s look at the Emergency Care Systems (ECS) through the lens of Road Safety.
The ECS is a lifeline that delivers timely healthcare services for acute illnesses and injuries across all age groups. The essential functions of an integrated ECS include human resources, equipment, and technology that extend from initial care at the scene, during transportation, and at healthcare facilities, as per the WHO Emergency Care System framework.
The 72nd World Health Assembly deliberates upon the integrated ECS for universal health coverage, ensuring timely care for the acutely ill and injured including linkages with other relevant actors, and aligning with Sustainable Development Goal Target 3.6 to reduce global deaths and injuries from road accidents by 50% by 2030.
An organised and integrated emergency care system has the potential to prevent millions of deaths and disability cases. However, ECS is often challenged by issues including patient transfer delays, limited capacities of health facilities, inadequate referral linkages and a lack of standardised guidelines and ambulance readiness.
In India, NCDs, and injuries including road traffic crashes, represent a critical public health concern and a leading cause of death. The Government of India's Operational and Technical Guidelines on Emergency Care Services at District Hospitals (2023) recognise the need for restructuring, reorganization, training, and protocol integration within the healthcare system to address emergency care promptly.
To enhance ECS within the Indian public health systems, HSTP aims to:
One of the aspects of building a robust ECS for improving patient outcomes is to strengthen the ambulance services by establishing centralised databases, expanding the National Ambulance Code, ensuring well-trained ambulance personnel, conducting mandatory inspections, and guaranteeing affordability and standardisation of the cost of private ambulance service.
As part of HSTP's commitment to generate a body of work for strengthening health sector regulations, a report titled 'Regulation of Health Care Delivery in India - A Landscape Study' was published by Sunil Nandraj , Pallavi Gupta , and Dr Sonali Randhawa from Team HSTP in 2021. The report also delved into the regulatory aspects of Ambulances, covering licensing and registration, quantity, cost of care and mechanisms for patient protection.
Sonali and Sunil also developed a resource guide, titled ‘Ambulances In India: Lifesavers On Wheels’, with contributions from experts, which provides information on ambulance services, necessary medical consumables and personnel, including how to access and who to contact in case of grievances.
Taking the work in this space further, they co-authored an article on the Ambulance Services in India and their critical role in pre-hospital emergency medical care in transporting patients to health facilities within the ‘golden hour’. The article, ‘Ambulance Services in India – Are the sirens loud enough!’ has recently been recognised and included in the India Competition and Regulation Report (ICRR) 2023, a biennial publication of CUTS International and CUTS Institute for Regulation & Competition. The ICRR 2023 delves into the theme of “Regulatory Deficit in Access to Equitable Healthcare”.
Committed to our aim of making information available and accessible, HSTP’s website hosts an open-access repository where one can access legislation and regulations on ambulances in India as well. You can access the repository here.
Expanding our work in the area of Emergency Care Systems, this year the HSTP team is working with partner states, Chhattisgarh and Odisha, to strengthen system strategies, develop action plans and facilitate evidence-based decision-making.
?Stay tuned to our progress on these vital projects through our website, social media, and further editions of The Transformation Tracker!
About HSTP
Health Systems Transformation Platform (HSTP), a not-for-profit Indian organisation, aims to generate evidence on health policy and systems and promote the use of that evidence in policymaking. HSTP's strategy is to analyse the state of the healthcare system, identify opportunities for improvement, propose solutions to the state government, support them in the implementation of the accepted ones, and validate them through implementation research. We then turn our analysis, implementation research and findings into knowledge products, that are available for use in alternative situations so that our research can achieve a scale large enough to make a difference at the national level.
HSTP is a not-for-profit organization registered in the name of 'Forum for Health Systems Design and Transformation', a company licensed under section 8 of the Indian Companies Act 2013.