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January 2018

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WHAT’s Inside

Introduction

National Health Policy 2017

HRoundtable Discussion on
Pre-Pooling/Risk-Sharing in
Health Insurance: Innovative
Financing Mechanism to Improve
Health Coverage in India

Biomedical Science & Innovation Summit

First World NCD Congress, Chandigarh

Multi-Country Analysis Report

Second National Civil Society Consultation on Non-Communicable Diseases

PARTNERSHIP TO FIGHT CHRONIC DISEASE (PFCD) INDIA IN 2017

Introduction

After continuous efforts of over four years, including engagement with over 150 key opinion leaders across all stakeholder groups and organizing six multi-stakeholder discussions across multiple locations, Partnership to Fight Chronic Disease (PFCD) India got the results with the launch of the National Health Policy 2017 in the earlier part of the year. It was an overwhelming experience for the PFCD to note that NCDs was mentioned in a big way in the Health Policy. PFCD can proudly associate themselves in the transformation of the policy narrative from “a government with NO NCD agenda to a focused policy on NCDs”. The key takeaways in the Health Policy in regard to NCDs are completely in line with the recommendations mentioned in the evidence-based National Blueprint – “SANKALP- Disha Swastha Bharat ki”, developed by the PFCD in 2015.

PFCD’s work in 2017 mainly focused towards health care financing as it is one of the major components while addressing NCDs. The chronic disease results in high out-of-pocket expenditure, and lack of any insurance cover or government support drags millions into poverty every year. Therefore, PFCD advocated towards the need to consider diverse financing, cost-cutting and reimbursement options to meet the health care needs of all citizens, including the expansion of government-supported, commercial health and employer insurance options, other innovative financing models, and public-private partnerships.

Health care in India suffers from serious mismatch between declared objectives versus actual reality and within that, health care financing does not figure in the priority list of policymakers. There are wide disparities among the uninsured across India, and with the growth in state funded health insurance schemes, the percentage of uninsured in India varies dramatically by state. Moreover, there are also substantial differences across the health insurance schemes regarding the scope of benefits covered. In general, most of the plans do not cover primary care, an essential component for preventing and managing non-communicable diseases.

Moving forward in our endeavor to address NCDs and health care financing, PFCD undertook several initiatives throughout the year. Following are some of the key milestones for PFCD India in 2017:

National Health Policy 2017

The Union Cabinet under the chairmanship of Prime Minister Narendra Modi approved the much-awaited National Health Policy 2017 on March 15, 2017. This policy came after a gap of 15 years, since the last National Health Policy was framed in 2002. The Draft National Health Policy was placed it public domain on 30th December 2014, resulting in receiving over 5,000 suggestions. This was followed by consultations with the state governments and other stakeholders for further fine tuning of the policy. The policy was placed before the Central Council for Health & Family Welfare, the apex policy making body and was unanimously endorsed by it.

Some of the salient features of the policy include:

(i) Raising public health expenditure to 2.5% of the GDP in a time bound manner by 2025
(ii) Tackling the emerging challenge of NCDs by supporting an integrated approach where screening for the most prevalent NCDs with secondary prevention would make a significant impact on reduction of morbidity and preventable mortality
(iii) Providing a larger package of assured comprehensive primary health care including NCDs
(iv) focusing on preventive and promotive health care and universal access to quality health services without anyone having to face financial hardship as a consequence.

The release of the National Health Policy 2017 was termed as one of the biggest achievements for PFCD as our constant efforts resulted in transforming the policy narrative from “a government with NO NCD agenda to a focused policy on NCDs”. Most of the points in the Health Policy in regard to NCDs are in line with the recommendations in the National Blueprint developed by PFCD in 2015, including increase in public expenditure on health, focus on preventive and promotive care, emphasize on screening and surveillance, among others. The PFCD regularly pushed for NCDs and health care financing in the policy agenda through its regular engagement with senior policy makers and other prominent stakeholders as well as multi-stakeholder discussions across multiple locations.

Roundtable Discussion on Pre-Pooling/ Risk-Sharing in Health Insurance:

After two successful roundtable discussions on health care financing in 2015 and 2016 respectively, PFCD decided to conduct a roundtable to further identify diverse financing options. Therefore, PFCD organized a multi-stakeholder discussion, titled “Innovative Financing Mechanisms to Improve Health Coverage in India” on August 10, 2017 at Le Meridien Hotel in New Delhi. The main objective behind organizing the roundtable was to look at the feasibility of adopting an innovative health care financing model through pre-pooling and risk-sharing in the context to India’s finances and demographics. The National Health Policy 2017 informs and prioritizes the role of the Government in shaping health systems in all its dimensions – investment in health, organisation and financing of health care services and prevention of diseases. The Policy envisages raising public health expenditure to 2.5% of the GDP by 2025, with an increase in state sector health spending to more than 8% of their budget by 2020. The Policy has also emphasised reducing the proportion of households facing catastrophic health expenditure by 25%, by 2025.

To achieve the desired goals, pre-pooling/risk-sharing can be seen as one of the most effective and promising health care financing options that can be explored further to address India’s financing needs. India spends only 1.2% of its GDP on health, an amount that cannot meet the financing implications posed by dual disease burden of communicable and non-communicable disease. An efficient health care financing system will help ensure that all people have access to needed health services – prevention, promotion, treatment and rehabilitation – without facing undue financial burden.

The roundtable saw participation from several prominent policy makers and other stakeholders, including Alok Kumar, NITI Aayog; Dr Ramesh Bhat, Indian Health Economics and Policy Association (IHEPA); Dr Shakthivel Selvaraj, Public Health Foundation of India (PHFI); Dr Sanjiv Kumar, International Institute of Health Management Research (IIHMR); Alexo Esperato, Bill & Melinda Gates Foundation (BMGF); Ali Mehdi, Indian Council for Research on International Economic Relations (ICRIER); and Dr Mukta Lonkar, Health Insurance TPA of India

The roundtable also had a panel discussion, titled “Risk Pooling in Health Financing: Key to Achieving Universal Health Coverage” where the experts deliberated on the key issue of health care financing and suggested few broad action areas:

  • Adoption of Multi-Payer System
  • Create Awareness about Health Insurance
  • Expansion of Public and Private Health Insurance
  • Inclusion of NCDs in Health Insurance Schemes
  • Strengthening of Primary Health Care System
  • Proactive Role of State Governments

Biomedical Science and Innovation Summit

Partnership for Safe Medicines (PSM) India in collaboration with the Partnership to Fight Chronic Disease and The Indian Alliance of Patient Groups convened a multi-stakeholder roundtable on 4th August 2017, titled “Unlocking India’s Potential in Biomedical Science & Innovation to Improve Health Care in India and the World”. The key objectives of the roundtable were:

(i) To deliberate on biomedical science and biopharmaceutical innovation – including global advancement in developing and delivering new ways to detect, treat and cure disease
(ii) To discuss and highlight the top biomedical science and innovation today in India and identify the gaps that must be bridged in order to move up the value chain in biomedical research/biopharmaceutical innovation
(iii) To agree on a vision for biopharmaceutical innovation in India; assessing our capacity for innovation by harnessing the existing talent pool and the available resources in a collaborative and partnership mode.

The purpose of the roundtable was to build a consensus on the subject and agree on a way forward as it is an opportune time for leveraging new technologies and the growing scientific understanding of many rare diseases. The roundtable emphasized on a fact that India has the potential to take a leadership role in the world, encourage innovation in the interest of the patients, and operationalise the process of discovery in the area of biopharmaceutical research.

The roundtable conducted discussions on several key topics, including:

  • India and the Biomedical and Biopharmaceutical Innovation Today and Vision for the Future
  • Innovation Performance in India Today: Global, National and State Perspectives
  • Drivers of Innovation –What Stakeholders in India Say is Needed
  • Patient Perspective on Biomedical Science and Innovation

Several prominent policy makers and experts participated in the roundtable, including:

  • Prof N.K. Ganguly, former Director General, Indian Council of Medical Research (ICMR)
  • Dr. Vinod Kumar Paul, Member, NITI Aayog
  • Dr. Randeep Guleria, Director, AIIMS
  • Dr. G. N. Singh, Drugs Controller General India
  • Neeraj Sinha, Scientist G/Advisor, Office of the Principal Scientific Advisor to the Prime Minister, Government of India
  • Dr. K.K. Aggarwal, President, Indian Medical Association
  • Dr. Ali Mehdi, Project Leader, Health Policy Initiative, ICRIER

First World NCD Congress, Chandigarh

The First World NCD Congress 2017, themed “Preventing Non-Communicable Diseases: Realizing Sustainable Development Goals (SDGs)” was organized between November 4 and 6 in the Union Territory of Chandigarh. The Congress was conceptualized by World NCD Federation (WNF), a Professional Association working for Global Health Agenda for Universal Health Care for non-communicable diseases (NCDs), in association with Postgraduate Institute of Medical Education and Research (PGIMER), a national centre of medical excellence in India. The Congress was designed keeping in mind Sustainable Development Goals (SDGs) to be achieved by 2030. The four SDGs pertaining to NCDs were discussed at length during the three-day event, accompanied with several knowledge sharing presentations highlighting the NCD scenario along with solution-seeking approaches.

PFCD played a crucial role in the NCD Congress as it co-organized the Parliamentary Forum along with the World NCD Federation and the World Health Organization (WHO). The Forum saw participation from several national and international Parliamentarians: Ms Kirron Kher, Member of Parliament, Chandigarh; Dr Dharamvira Gandhi, Member of Parliament, Patiala; Dr Jetn Sirathranont, Secretary-General, Asian Forum of Parliamentarians on Population and Development, Thailand; and Hussain Rasheed, Minister of State, Ministry of Health, Government of Maldives.

The Forum conducted discussions over the targeted key issues like use of innovative technology to provide personalized health management; inclusion of healthy food and lifestyle; and public health approaches to improve healthy food access, eating behaviors and health outcomes. The Parliamentarians from India emphasized on the need to increase expenditure on health by the Government as mentioned in the National Health Policy 2017 as well as the implementation of Universal Health Coverage, citing examples from Thailand. The Parliamentarians also underlined the need to promote preventive care through the proactive role of state governments. Meanwhile, they also urged the people to adapt yoga practices and make it a way of living. The discussions also focused on eating healthy and nutritious diets while preventing cheat meals and junk food as it is better to “adopt prevention rather than depending on cure”.

Meanwhile, Aman Gupta, Country Representative, PFCD was invited as a key panelist for a plenary session, titled “Partnership and Resource Mobilization to Address NCDs”, where he was asked to provide perspective on civil society organisations (CSOs). During his address, he referred the PFCD work as a case-in-point, and said “the importance of civil society is seen and felt at many levels. On the international stage, the expertise, influence and advocacy offered by CSOs have been critical factors in creating a strong case to spread awareness and preventive measures for NCDs. Additionally, partnerships between the government and

CSOs can contribute considerably to improving health outcomes”. He added that “CSOs can assist in ensuring that government policies and practices are in the public interest as well as contribute towards empowering the public with knowledge to make informed decisions”. “CSOs can contribute towards generating and utilizing evidenced-based data to bridge the gap between research and policy-making by formulating policy options and suggesting directions, then communicating them through networking with stakeholders”.

Multi-Country Analysis Report

PFCD released the Multi-Country Analysis report, titled “Options for Increased Investment in India’s Health Care System”. India lacks a comprehensive system of health care financing which would pool financial risk and reduce the burden on patients and their families. With health care financing emerging as a major concern, it is important to identify measures to contain high out-of- pocket expenditures by households. Therefore, the report objective is to review alternative mechanisms and plan ahead with potential options.

The report was authored by PFCD Chairman Dr Kenneth Thorpe, and outlines some novel approaches that India could adopt to increase investments in the health care sector. The report provides description of the current health insurance and financing landscape in India as well as options for expanding public and private health insurance.

The report compared health care financing models of five different countries, and explained how these countries paid for the expansions through some combination of public and private insurance while moving toward universal coverage. It also provided two recommendations in context to India – i) Expand RSBY (a publicly-financed plan) to those above the poverty line; and ii) Develop a multi-payer model that would increase enrollment in current central and state government plans and expand private health insurance for those not eligible for government plans.

The Multi-Country Analysis report was used as a reference document to set the context for the RTD on pre-pooling/risk sharing in August as well as shared with senior officials in the Ministry of Health and Family Welfare and NITI Aayog.

Second National Civil Society Consultation on Non-Communicable Diseases

Healthy India Alliance in association with the Ministry of Health and Family Welfare, Government of India and the World Health Organization Country Office for India organized a two-day event, titled “Second National Civil Society Consultation

on Non-Communicable Diseases (NCDs)”, on July 11-12, 2017 at India Habitat Centre, New Delhi. This Consultation was aimed at convening multi-sectoral stakeholders from various ministries, UN partners and Civil Society Organisations (CSOs), to discuss and deliberate on India’s national NCD response, with a specific focus on strategies and opportunities to strengthen the engagement of both health and non-health CSOs, as envisaged in the National Multi-Sectoral Action Plan.

The two-day event saw participation from over 100 stakeholders including representatives from the MoHFW, WHO, academia, and a broad range of CSOs. On the occasion, the Healthy India Alliance also released “India Civil Society Status Report on NCDs”. The consultation deliberated on several key areas like Developing Guidelines to Engage CSOs in the National NCD Response; Capacity Building Workshop for CSOs; Civil Society Action in India for NCD Prevention and Control; Sharing Best Practices in Advocacy and Governance; Identifying Opportunities for Civil Society Action in the Current Policy Context; and Preparing for 2018: Monitoring the National NCD Targets.

Aman Gupta, Country Representative, PFCD was invited to participate in the event. After reviewing our work in the area of NCDs, the event organizing committee provided an exclusive 30-minute slot to PFCD. The topic of the presentation was “Multi-Stakeholder Engagement for NCD Prevention and Control”, where he talked about the development of the National Blueprint and the importance of Health Care Financing, with an emphasis on the need for expanded/improved health care financing and insurance.

This opportunity for PFCD reflects the years of investment and focus on NCDs as a means to engage a broad range of stakeholders on the big picture policy issues affecting access to quality health care and medicines.


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