NHM Free Drugs Service Initiative
In the union budget 2014-15, the Government announced that two key initiatives i.e. Free Drug Service and Free Diagnosis Service would be taken up on priority to move towards “Health for All”.
Pursuant to the budget announcement, Operational Guidelines along with Model RFPs for implementing the NHM Free Drug Service Initiative were developed and shared with the States on 2nd July, 2015. The guidelines emphasis on procurement of generic drugs.
Under this Initiative under NHM, support is provided for provision of essential drugs free of cost in public health facilities. The support is not only for drugs but also for various components necessary for effective implementation of Free Drug Service Initiative viz. strengthening/setting up robust systems of procurement, quality assurance, IT backed supply chain management systems like Drugs and Vaccines Distribution Management Systems (DVDMS) developed by CDAC, warehousing, prescription audit, grievance redressal, Information, Education and Communication (IEC), training, dissemination of Standard Treatment Guidelines, etc.
All States have reported to have notified policy to provided free essential drugs in public health facilities. Under NHM incentives were provided to States to implement Free Drug Service Initiative.
NHM Free Diagnostics Service Initiative
Government of India under the National Health Mission launched the Free Essential Diagnostics Initiative to address the high out of pocket expenditure on diagnostics (10% OOPE on cost of diagnostics – 11% in OPD and 9.6% in IPD as per NSSO 71st round) and improve quality of healthcare services.
The objective of the Free Diagnostic Services Initiative program is to ensure availability and access to diagnostic tests at public health facilities so as to reduce out of pocket expenditure incurred by patients on diagnostics. Provision of appropriate diagnostics is necessary and critical in providing adequate comprehensive healthcare services in public health facilities.
In order to streamline the processes and standards related to diagnostic services, MoHFW has formulated the NHM Free Diagnostic Services guidelines that were shared with the States/UTs on 2nd July, 2015.
The Guidelines provide an illustrative list of essential diagnostics tests specific to various levels of care that includes 9 tests at Sub Centre level, 19 tests at PHC level, 39 tests at CHC level and 57 tests at SDH/ DH level. The tests encompass hematology, serology, bio-chemistry, clinical pathology, microbiology, radiology, and cardiology.
SC/PHC/CHC/SDH/DH facilities in states need to strengthen the public health facility to enable delivery of diagnostic services, especially low cost high volume diagnostic tests. However, in such facilities where the medical equipment, human resource, or infrastructure for performing tests does not exist, outsourcing (PPP) mechanism could be used.
Model RFP (Request for Proposal) documents are provided in guideline for State/UT to identify service providers via open tender and provide diagnostic services adhering with quality assurance mechanism.
The three components under the umbrella of the Free Diagnostics Service Initiative are:
1) Essential Pathology Initiative to assure every patient a range of essential diagnostic packages free of cost tailored to various levels of care, complementing other existing healthcare services. The three alternative delivery models illustrated for the State/UTs to adopt are
1. Hub and Spoke Model: Under this model, the samples are collected at peripheral facilities/collection centres (including Mobile Medical Units) and safely transported to a central laboratory which will act as the Hub ;
2. Outsourcing of diagnostics services: Outsourcing of high cost, technologically demanding and lower frequency diagnostic services to private service providers while High volume, low cost tests not requiring highly skilled manpower are undertaken within public health facilities and
3. Contracting-in: Contracting- in of the services of specialists, such as like radiologists, pathologists, microbiologists etc, where in house expertise is not available
FDI-Lab (Implementation Status as on 31st August 2018)
It has been implemented in total 31 States.
PPP mode in 9 States: Andhra Pradesh, Assam, Delhi, Maharashtra, Meghalaya, Uttar Pradesh, Odisha, Jharkhand, Manipur.
In-house mode in 22 States :A&N Island, Bihar, Chandigarh, Chhattisgarh, D&N Haveli, Daman & Diu, Goa, Gujarat, Haryana, Himachal Pradesh, Karnataka, Kerala, Lakshadweep, Madhya Pradesh, Puducherry, Punjab, Rajasthan, Sikkim, Tamil Nadu, Telangana, West Bengal, Jammu & Kashmir.
2) Tele-radiology initiative: Apart from infrastructure, lack of specialist clinicians especially radiologists have been a major challenge which denies the poor patient of essential radio-diagnosis. To bridge this gap a viable and cost effective PPP model has been devised under which digitized X-Ray films are transmitted to service provider and reports are received within a stipulated time frame.
FDI- Tele-radiology (Implementation Status as on 31st August 2018):
It has been implemented in total 9 States.
PPP mode in 9 States: Andhra Pradesh, Meghalaya, Rajasthan, Tripura, West Bengal, Assam, Odisha, Uttrakhand, Uttar Pradesh.
3) CT scan Services at District Hospital & Technology Support: Since CT is an expensive test and many districts in India do not have a single CT facility, this initiative is of great value – both in terms of health sector development in a given area as well as in reducing patient expenditure. Under NHM, States are being supported to setup CT Scan services at DH level (with population above 7.5 Lakhs) under PPP.
FDI CT scan (Implementation Status as on 31st August 2018):
It has been implemented in total 24 States.
PPP mode in 13 States: Andhra Pradesh, Himachal Pradesh, Jharkhand, Karnataka, Punjab, Rajasthan, Tripura, Uttar Pradesh, West Bengal, Assam, Delhi, Odisha, Madhya Pradesh.
In-house mode in 11 states: A&N island, Goa, Gujarat, Haryana, Kerala, Puducherry, Sikkim, Tamil Nadu, Telangana, Daman & Diu, Lakshadweep.
Under NHM, in FY 2018-19, an amount of Rs 1218.31 Crores have been provided to 33 States/UTs for implementation of NHM Free Diagnostics Service Initiative.