Consulatation Paper

Consulatation Paper

ADDRESSING NON-COMMUNICABLE DISEASES IN INDIA THROUGH INNOVATION AND MULTI-SECTORAL APPROACH

CONSULTATION PAPER

Jointly published by the Partnership to Fight Chronic Disease (PFCD) and Strategic Partners Group (SPAG Asia)

January 2015

Burden of Non-Communicable Diseases (NCDs) in India

Non-communicable diseases (NCDs) are the major cause of mortality in India. According to the Non Communicable Diseases Country Profiles 2014 released by WHO, NCDs are the biggest global killers accounting 38 million deaths every year with a whopping 28 million in low and middle-income countries, including India. As per the report, NCDs account for nearly 6 million of the total mortality in India, which is 60% of the total mortality reported annually in India. A progressive rise in the disease pattern of NCDs foretells a serious public health issue.

WHO – Non-communicable Diseases (NCDs) Country Profiles, 2014

WHO – Non-communicable Diseases (NCDs) Country Profiles, 2014

Heart and vascular diseases, common cancers, chronic lung disease, diabetes, mental illness and injuries are the major NCDs prevalent in India, causing mainly due to alcohol and tobacco use, unhealthy diet, physical inactivity and psychosocial stress. It has also been noted that the prevalence of NCDs as a result of lifestyle patterns have increased twofold in the last decade compared to communicable diseases.

Some of the major findings related to NCDs are:

  • More than 20% of the population in India has at least one chronic disease and more than 10% of the people have more than one
  • It is estimated that 61.3 million people aged 20-79 years live with diabetes in India (2011 estimates). This number is expected to increase to 101.2 million by 2030
  • In India, 118 million people were suffering from hypertension in 2000, and this number is likely to increase to 213 million by 2025
  • The rate of cardiovascular disease mortality in India in the 30-59-year age group is double that in the U.S.
  • Indians get diabetes on average 10 years earlier than their Western counterparts
  • Lifestyle changes have lead to decreased physical activity, increased consumption of fat, sugar and calories, and higher stress levels, affecting insulin sensitivity and obesity
  • The implementation of simple interventions that lower NCD risk factors can result in reducing pre-mature deaths by half to two-third

[1]http://www.who.int/nmh/countries/ind_en.pdf?ua=1

Role of Partnership to Fight Chronic Diseases (PFCD) in Tackling NCDs in India

The Partnership to Fight Chronic Disease (PFCD) is a global organization committed towards raising awareness about NCDs and finding sustainable solutions to tackle the growing disease burden. The PFCD has been working in India for a few years now and has held several multi-stakeholder discussions, with participation from policy makers, public health experts, medical practitioners, patient groups, and pharmaceutical and diagnostic companies.

After conducting two successful back-to-back multi-stakeholder discussions in New Delhi and Mumbai in August 2014, the PFCD hosted two further rounds of discussions on the similar format in Chennai and Ahmedabad in December 2014. The discussions served as the platform to highlight the growing burden of NCDs along with the role of different stakeholders in fighting this epidemic. These discussions brought together experts and opinion leaders from all related fields including policy, medical, academic, research, pharmaceutical, medical technology and patient groups.

Role of Partnership to Fight Chronic Diseases (PFCD) in Tackling NCDs in India

The main objective behind the discussions was to develop innovative policies related to NCDs as the PFCD believes it is best to have multi-sectoral approach involving policy makers and stakeholders in tackling the chronic disease burden. Through these initiatives, the PFCD ensures that policymakers, communities, and individuals have the information they need to make the right decisions regarding health and health policy.

These strategic interventions become all more important as the newly elected Indian government has set its vision to establish a universally “accessible, affordable and effective” healthcare system in the country, addressing an issue of paramount importance to achieve inclusive growth. As the government takes its initial steps towards shaping a healthy India, this initiative is aimed towards garnering the attention of policy makers towards developing innovative policies in mitigating NCDs, which will be instrumental in realizing the vision set by the new government.

Outcome of Panel Discussions

The four high-level panel discussions titled “Facing Our Future: Countering Non-Communicable Diseases in India through Investments in Innovation” witnessed participation from more than 40 prominent personalities including policy makers and public health experts.

The discussions provide opportunity to speakers, specialize in different areas of NCDs, to come together on a single platform and share their expertise and experience so that more focused approach can be reached.

Based on the discussions, several key intervention areas emerged:

Strengthen primary healthcare system – The healthcare system in India is still not fully competent to deal with the rising threat posed by NCDs. The best possible, evidence-based care in modern, well-equipped tertiary hospitals is only accessible to the higher socio-economic section of the society, while the poor is still deficient of even basic care. It is rightly said out that no screening would be good if you do not give the treatment. The strengthening of primary healthcare facilities and infrastructure would contribute in providing effective evidence based preventive and chronic care outside hospital. The strengthening of primary healthcare system becomes all more imperative keeping in mind a fact that the hospital is not often the most appropriate place for management of chronic diseases; and primary care physicians and healthcare workers are often the frontline in disease diagnosis.

Provide training to healthcare workers – The training of healthcare workers even at the very basic community level is the major component of strengthening primary healthcare system. The studies have shown that the large majority of care in primary healthcare level is not provided by modern physicians, MBBS and doctors but by so-called alternate systems of medicine or even unqualified people. It has also been observed that in poorer areas, in slums there are hardly any physicians. The well-equipped and qualified health teams including nurses and para-health professionals would better respond to the needs of patients with chronic diseases. Continuous care, access to treatment and self management are the key aspects in tackling NCDs.

Change in lifestyle – It has been rightly said that the awareness starts with intervention in lifestyle behavior. Whether it is tobacco consumption, alcohol consumption, inappropriate diet or physical inactivity, you need to hit at behaviors if you want to reverse this trend and lower the prevalence of NCDs. Several studies have shown that healthy eating, nutrition and regular exercise reduces risk of overweight, obesity and blood pressure, which are the common risk factors for NCDs.

Universal health coverage to save out-of-pocket expenses – The microeconomic impact of NCDs on families and individual is huge as there is no pre-payment mechanism in India that protects people against financial insecurity. A combined study by the Public Health Foundation of India in Kerala found that 73% survivors of cardiovascular event experienced catastrophic health expenditure, 50% had to resort to distress financing that mean they had to sell property, and 40% lost sources of income. These are totally unacceptable loses and clearly these are trends which project rising tide of NCDs in India. It is therefore the need of an hour that the concerned authorities should seriously think about an increased public healthcare financing as well as a private health insurance framework.

Reduce usage of tobacco and alcohol – The consumption of tobacco and alcohol are among the leading risk factors responsible for premature mortality worldwide. In India, 270 million adults consume tobacco, and about 17.5% of the young persons in the age group of 13 to 15 currently consume tobacco in one form or the other. It is also estimated that 1 million die every year in India due to smoking. These statistics compel us to look at some of the risk factors in our context.

Treat NCDs as a whole – There is a crucial need to have specialized teams for NCDs as the focus is on managing and treating the patient, and not just a single disease condition. The effective use of health teams and medications is one of the main components of effective care management. The major benefit behind having multi-disciplinary health professional teams is that it would enable optimization of outcomes from all interventions and ensure continuity of care. The effective and efficient management of NCDs require a shift in the traditional health approach. With a sudden change in lifestyle and demographics, it is important to adopt new approaches and services to treat NCDs.

Formulate new healthcare policy – There is an imperative need to formulate new healthcare policy, especially looking at the current scenario where India is witnessing huge disease burden, resulting in substantial economic and productive loss. The first health policy was made in 1983 with a revision in 2002. Since the last revision lots of new diseases have emerged, and at the same time the new technologies that have become the cutting edge and the way to go in the future.

Affordable access to essential medicines – The cost of treating NCDs has doubled from 1998 to 2005 particularly in urban households. The high cost of medicines and long duration of treatment poses a significant financial burden for low income groups. Access to essential drugs remains a major challenge and it is one area that we need to focus at. It is therefore the need of an hour to improve availability and affordability of essential medicines in the market as it would lower the healthcare expenditure especially for low-income families.

Multi-sectoral approach to address NCDs – It has been highlighted that the lack of privatization of NCDs in the whole healthcare gamut is a major setback as the government is struggling to provide more than 1.2% of GDP on health. The situation looks scarier when we look at an estimate that US$6.3 trillion is likely to be spent on NCD management in the period between 2012 and 2030. Therefore it is important that apart from the government’s contribution in the disease management, the private sector should also come up with innovative approaches like disease-specific insurance products, health campaigns and other technological advancements to address this growing burden of NCDs.

Monitor progress on timely basis – NCDs have a huge disease burden and different programs are required at the regional, state and national level. The regular monitoring and evaluation are the key components behind ensuring success of any program. It is important that one should take into account different aspects including preparing list of indicators, establishing sustainable systems for surveillance, collecting baseline assessment of the indicators, setting targets and time frames for each indicator, and establishing external review mechanisms to achieve fruitful results. The whole process requires coordinated efforts especially when you are targeting such a huge area of NCDs.

Use of traditional methods – We need to start looking at innovative things that can be incorporated in our day-to-day life to help manage NCDs effectively. Studies have shown that traditional approaches including yoga and meditation can be used instead of pulmonary rehabilitation in COPD patients. It has been found that there is really no difference in terms of the improvement in lung function parameters. Yoga is equally effective as compared to the standard pulmonary rehabilitation program which requires a lot of investment. And at the same time the patient acceptability is much higher for the yoga program as compared to the pulmonary rehab program.

Use of popular mediums to raise awareness – It is a well known fact that awareness and prevention is one of the major components to tackle NCDs. On the similar lines, a very interesting idea emerged during the discussion is to use religious leaders to raise awareness by organizing preaching camps as people listen and follow them. These religious leaders can be used to propagate general messages like how to modify lifestyle, how to follow a balanced diet. Also, the use of electronic media in raising awareness about health and health education was also discussed during the meetings.

Strong need for Universal Health Insurance – Universal Health Insurance and Non-Communicable Diseases (NCDs) are among the top priorities of the current government. The continuously increasing rate of death, disability and illness from NCDs in India clearly indicates that there are lots of gaps in our health system, making it incompetent to address the epidemic. The Universal Health Insurance can be seen as the only realistic path that can prove beneficial in closing the NCD services gap, arguably resulting in doing more for NCDs than for any other health area. Under this scheme, a package of health services can be defined that will be covered by health insurance.

Set-up patient groups – The idea of setting up patient groups is one of the key valuable points that emerged in the multi-stakeholder discussions. These patient groups can be educated and trained by the doctors, and these groups can further share their knowledge in different towns and villages without much hesitation. These patient groups can conduct a meeting once in 15 days or a month and can advise people suffering from NCDs on what to do and what not. This would enable NCDs patients to be on the right track and take the correct approach in managing or eliminating the disease.

NCDs prevention programs at workplaces – Employees spend majority of their day’s time at workplaces, so it is best to introduce behavior change at workplaces itself. It is a good idea to have gym and physical education training session mandatory for all employees. Apart from this, companies can conduct medical check-up camps for their employees once in a month. Additionally, the use of stairs and adoption of healthier eating practices can be promoted. This will not only help the employees but also the companies as these initiatives would create awareness, thus resulting in lesser medical leaves and enhanced productivity.

Government to make health promotion policies – Right eating habit is one of the most effective interventions to combat the growing public health epidemic. By adopting these habits, one can drastically lower the occurrence of chronic disease such as heart attack, diabetes, stroke and cancer. It is well said that fast food takes the people faster to the grave. So the government should work towards formulating health promotion policies which will make it more convenient for people to follow healthier options, and make the changes we desire out of them for NCD prevention and control and also help them sustain those changes.

m-Health – In the current scenario, a major challenge for every sector is to look out for cost-effective solutions and the health sector is no different. With the mobile technology becoming so economical, it can be termed as the best buy for NCDs. The use of this cost-effective technology would help in strengthening health system through the efficient use of mobile technologies and communication channels. This would also empower citizens by offering enhanced access to information relevant to address their health needs arising out of NCDs.

Inclusion of private practitioners – Private practitioners have a greater role in any healthcare deliveries. There is a belief that many of the national health policies have failed or not taken up because they have avoided the private sector. The private sector needs to be equally involved whenever a discussion or a decision on any national health policy is taking place. The private sector can play a significant role by augmenting public services with additional patient education, and at the same time can be used to raise public awareness about the causes of NCDs and treatments available.

Multi-stakeholder partnership to manage NCDs – With the rising incidence of NCDs in India, it is the responsibility of different stakeholder groups to find scalable, feasible and effective interventions to prevent their onset. The disease burden of NCDs is so high that no one single player working in silo can successfully deal with the challenges associated with it. The relevant stakeholders should put forward solutions to NCDs along with the outline required to make these solutions work.

Promote patients’ involvement – Healthcare advocates have been long advocating for a need to involve patients in the design and delivery of strategies to prevent and manage NCDs. So far, there is hardly any involvement of patients in health policy and initiatives despite the fact that people suffering with chronic conditions know what best can be done to improve their situation. Their involvement can help ensure healthcare services are developed to make the most efficient and appropriate use of limited resources.

Training in latest medical technologies – Medical technology is the key to develop an efficient and competent healthcare system. In the present scenario, majority of technology interventions are surgical. With a scarcity of doctors and paramedics in the country, it is important to provide training related to latest medical technologies in the tertiary and the secondary care centers. Whether the training consists of a treatment behavior of a particular disease or implanting a stent or inserting pacemakers, it can prove life saving under particular circumstances.

Promote awareness through all perspectives – Awareness and early diagnosis are the primary and the most important aspect in managing the growing burden of NCDs. All public health experts are of a same opinion that majority of NCDs cases can be avoided if people have the right knowledge and awareness about the chronic disease. So, it is the responsibility of the government, community and corporate to contribute in the health initiative by promoting awareness at their respective levels.

Care and support at each step – As earlier mentioned, awareness is a major aspect of NCDs management, but it is only the first step. It is important that we should provide care and support at each step to the patients. Providing adequate facilities for diagnosis and treatment and then prescribing medications is the general code of conduct, but what matter the most is setting up a mechanism where people are encouraged to adhere to the medications. Disseminating voice messages or preparing an electronic medical record system are some of the technology-based interventions that can come handy to deliver this care.

Focus on multidimensional approaches – We need to really have an ecosystem approach to healthcare, whether it is communicable or non- communicable diseases. It is the lack of awareness, screening, diagnosis, training, financing and efficient referral system that collectively denies access to healthcare. Unfortunately, the media focuses on one dimension which we all know very well about, but we really need to look at the multidimensional approaches. We have to strengthen our primary and secondary care level by identifying all the barriers to care, thus developing a whole care continuum model.

Provide essential drugs at affordable cost – Access to essential drugs is a major challenge in India, especially for NCDs patients whose duration of treatment is long and expenses are high. If the government directly procures some of the essential medicines and provide it at subsidized cost, it can result in reducing intermediary expenses for patients especially from low-income families.

Adopt right approach for communication – As mentioned several times in the past that awareness holds the prime importance in the whole framework of NCDs. To make people aware about the chronic disease and its outcome, one must adopt the right approach to reach to the maximum people. The city population can be covered through WhatsApp or SMS, while for the rural population, whatever board is kept in the hospital they read. This is the basic reason why rural population is more aware about Dengue and Ebola than NCDs.

Conclusion and Way Forward

On a broader parameter, there are three areas that really need to be worked on:

  • Surveillance & Policy
  • Strengthening of Healthcare Systems
  • Healthcare Financing

However, Innovation and Entrepreneurship will be the overarching theme which will run along all the three tracks. This would result in the implementation of a focused approach towards creating a sustainable healthcare environment in addressing the growing burden of NCDs in India.

The burden of NCDs is continuously rising in India, making this chronic disease a leading cause of death. The risk level has increased significantly due to the lack of prevention and awareness, absence of national health policy related to NCDs, and poor healthcare financing and infrastructure. It is therefore important to develop NCDs prevention and control program involving multiple stakeholders and innovative approach. There are already several successful interventions at different levels that can be replicated throughout the country to achieve the desired outcome. With a comprehensive policy-level response and improvement in health systems, India can successfully address the serious issue of NCDs and can present a roadmap for others to follow.

There is an imperative need to have a competent public health system, coupled with innovative strategies, technology-based initiatives and an efficient use of the existing resources. A multi stakeholder approach is the need of an hour where different stakeholders have their specific roles, and their experience and expertise can be utilized to set clear goals and objectives along with a roadmap to accomplish them.

The existing government of Prime Minister Narendra Modi has also emphasized on achieving a holistic healthcare system in its agenda. The government is presently working towards formulating a new Health Policy and National Health Assurance Mission, along with promoting traditional health methods and opening AIIMS like institutions in all states.

The PFCD, through its multi-stakeholder discussions and expert consultation meetings, is aiming to create an ideal platform where prominent policy makers, public health experts and industry professionals work in collaboration to suggest a comprehensive approach that can be instrumental in addressing NCDs and providing accessible and affordable healthcare to all.

INNOVATIVE MODELS OF HEALTHCARE FINANCING

FOR A HEALTHIER INDIA 

CONSULTATION PAPER

Jointly released by the Partnership to Fight Chronic Disease (PFCD) and Strategic Partners Group (SPAG Asia)

May 2015

Context

According to the World Health Organisation (WHO), non-communicable diseases (NCDs) are the biggest global killers accounting for 38 million deaths every year, with a whopping 28 million in low and middle-income countries alone. In India, nearly 5.8 million people die from heart and lung diseases, stroke, cancer and diabetes. In other words, 1 in 4 Indians risks dying from an NCD before they reach the age of 70 . NCDs have emerged as the leading cause of death in India — ahead of injuries as well as communicable, maternal, prenatal, and nutritional conditions. Further, NCDs account for about 40 per cent of all hospital stays and roughly 35 per cent of all recorded outpatient visits . NCDs not only affect health, but also productivity and economic growth. The probability of death during the most productive years (ages 30-70) from one of the four main NCDs is a staggering 26 per cent .

Heart and vascular diseases, common cancers, chronic lung disease, diabetes, mental illness and injuries are the major NCDs prevalent in India, causing mainly due to alcohol and tobacco use, unhealthy diet, physical inactivity and psychosocial stress. It is important to change the ongoing scenario as India has too much at stake.

Need for Healthcare Financing

NCDs add to India’s already substantial health burden from infectious diseases and injuries. NCDs are costly in terms of both human suffering and economics. According to WHO World Health Statistics 2012, 39 million Indians are pushed to poverty because of ill health every year . The report also claimed that nearly 60 per cent of total health expenditure in India was paid by the common man from his own pocket in 2009. Also, about 47 per cent and 31 per cent of hospital admissions in rural and urban India were financed by loans and sale of assets. Therefore, it is important to increase accessibility if one is looking to transform India’s healthcare sector.

Challenges

  • Less than 15 per cent of India’s population presently has any kind of health-care cover, be it community insurance, employers’ expenditure, social insurance etc
  • Only around 2.2 per cent of the population is covered under private health insurance, of which rural health insurance penetration is less than 10 per cent
  • At the current rate of growth, only 50 per cent of India’s population would have health insurance coverage by 2033
  • According to the World Bank, 85.9 per cent of the total private expenditure on health was out-of-pocket in 2013
  • 45 per cent of the population travel more than 100 kms to access a higher level of care
  • Some 700 million Indians in villages and non-urban areas don’t have access to healthcare facilities because around 80 per cent of the specialists and medical facilities are located in urban areas

India lacks a comprehensive system of health care financing which would pool financial risk through insurance and help to share the cost burdens. For most developing economies, no one public health insurance solution, such as a single national insurance program, can effectively cover the entire population given the significant fiscal resources required to run such programs.

Past public insurance initiatives of the Government of India have seen policy premiums priced as low as Rs1 per day and Rs5 or Rs10 per month. While such schemes have been welcomed, they have nonetheless faced key implementation barriers, such as lack of qualified healthcare service providers and a lack of proper understanding of the concept of health insurance.

The private sector can help to relieve the pressure on the public system. Private coverage can also substitute or supplement public cover age depending on income and other factors. More choices of private health insurance can also expand the choice of hospitals and coverage of services beyond basic services to include medicines and outpatient care. In India, a segmented approach utilizing both public and private health insurance is the most likely answer to the challenges of risk pooling and healthcare financing.

Global evidence on health spending shows that unless a country spends at least 5-6 per cent of its GDP on health and the major part of it is from government expenditure, basic healthcare needs are seldom met. The government spending on healthcare in India is only 1.86 per cent of GDP, which is about 4 per cent of total government expenditure, and less than 30 per cent of total health spending.

Having an efficient healthcare financing system is one of the key drivers as it will ensure that all people have access to needed health services – prevention, promotion, treatment and rehabilitation – without facing financial burden.

Roundtable Discussion on Healthcare Financing

The Partnership to Fight Chronic Disease (PFCD) organized four high-level panel discussions titled “Facing Our Future: Countering Non-Communicable Diseases in India through Investments in Innovation” in New Delhi, Mumbai, Chennai and Ahmedabad respectively in 2014. The discussions served as the platform to highlight the growing burden of NCDs along with the role of different stakeholders in fighting this epidemic. These discussions brought together over 40 prominent experts and opinion leaders from all related fields including policy, medical, academic, research, pharmaceutical, medical technology and patient groups.

Based on the four multi-stakeholder discussions, three key tracks emerged:

  • Surveillance and Policy
  • Strengthening of Healthcare Systems
  • Healthcare Financing

The PFCD recently held a focused discussion on Healthcare Financing titled “Innovative Models of Healthcare Financing for a Healthier India”, with participation from state and national-level policy makers, insurance specialists, economists, medical fraternity, academicians and others. The primary objective of the focused discussion was to understand gaps and challenges in regard to healthcare financing, apart from discussing other aspects and the way forward.

Key observations, recommendations and intervention areas emerged during the discussion are:

Implementation of Universal Health Coverage (UHC) – The continuously increasing rate of death, disability and illness from NCDs in India clearly indicates that there are lots of gaps in our health system, making it incompetent to address the epidemic. The UHC can be seen as the only realistic path that can prove beneficial in closing the NCD services gap. Strong implementation of this plan will place India on the same path to progress that around 50 countries around the world have achieved in health outcomes.

Multi-payer multi-model approach – Keeping in mind a huge disparity in terms of income, employment and geography in India, a multi-payer multi-model approach would be best suited since a one-size-fits-all model won’t work well in health insurance. The needs of different population segments can be covered under the approach.

Government needs to increase healthcare spending – India presently spends only about 4 per cent of its GDP on healthcare, while 10 years ago it was 4.4 per cent. The spending is declining just at the time when we actually need more investments in dealing with the issue. This scenario needs to be changed as global evidence on health spending shows that unless a country spends at least 5-6 per cent of its GDP on health, basic healthcare needs are hard to meet.

Who is going to pay for what and how much – The out-of-pocket expenses needs to be targeted immediately. According to a report by the World Bank, 85.9 per cent of the total private expenditure in India on health was out-of-pocket in 2013. These expenses lead to poverty, resulting in increased economic burden. Therefore, it is important that such financing schemes are developed where government and health insurance companies contribute in the healthcare expenditure of a common man, be it preventive care, out-patient care, hospitalization and post-hospitalization support. These schemes should clearly define what percentage and kinds of expenses will be paid by insurance schemes, ultimately resulting in reducing the financial burden on patients.

Scale-up innovative healthcare financing schemes – The government has initiated several healthcare financing schemes in the past both at the national and state level which have low premiums and high-value services. These schemes, including Rashtriya Swasthya Bima Yojna and Janani Suraksha Yojana, have seen success at certain level but cannot be scaled up due to key implementation barriers. Therefore, it is important that such schemes should be implemented effectively and provided both at urban and rural level so that majority of population can be covered.

Disease-specific insurance schemes – Health insurance policies always have a scope for improvement and one such step towards advancement is the idea of bringing disease-specific health insurance policies for individuals suffering from chronic diseases. These policies become all more important as the chronic diseases require life-long care, medication and support services. This would enable patients to take cover for their specific disease under the scheme apart from regular ones.

Outpatient coverage – The current healthcare insurance policies are majorly focused on in-patient care and hospitalization, generally the most expensive aspect of healthcare. The coverage is provided to patients who are hospitalized and undergoing medical treatment. However, the recommended approach is to include preventive check-ups and out-patient services in the insurance policies so that more people are encouraged to undergo screening and diagnosis, thereby reducing the chances of hospitalization.

People in unorganized sectors needs to be included for coverage – The National Commission for Enterprises in the Unorganized Sector has reported that nearly 52 per cent of unorganized workers in India are engaged in agriculture and allied sector and they constitute more than 90 per cent of the labour workforce. These people also contribute 50 per cent to the country’s GDP. Therefore, it becomes utmost important to target people in the unorganized sectors and develop healthcare policies that addresses the plight of this poverty-stricken and downtrodden class of India.

Adopt patient-centric approach – India’s diverse population has limited purchasing power overall. Penetrating this for broader healthcare coverage requires innovative insurance products at multiple price points. But innovation in the current Indian health insurance market needs to evolve considerably, with health insurers building their portfolios with multi-level, differentiated long-term products. Public and private sector players have already shown the way by introducing innovative insurance products with premiums as low as Re1 per day and Rs10 per month, catering to community as well as individual insurance needs. Such low-priced products can play a significant role in ensuring higher healthcare access and better health for all sections of Indian society.

Switch from patient cure to preventive care – Patient cure policies should be revised to include preventive care policies. Preventive healthcare could ultimately lower the cost of health services for those with chronic disease and subsequently reduce the cost of insurance operations, including a reduction in claims. Ignoring preventive care only means that the chances of disease progression and complications requiring hospitalization are inevitably higher.

Use CSR to strengthen healthcare system – According to a recently released report by the World Economic Forum and the Harvard School of Public Health, India stands to lose $4.58 trillion due to non-communicable diseases and mental disorders by 2030. Addressing this health burden should be the central agenda. The Corporate Social Responsibility (CSR) is one such component that can be used to strengthen awareness and education as well as develop models to encourage prevention and early care.

Affordable access to essential medicines – Access to essential drugs is a major challenge in India, especially for NCDs patients whose conditions are typically managed through the use of basic medicines. It therefore becomes important to improve the availability and affordability of essential medicines in the market as it would help avoid hospitalizations and out-of-pocket expenses.

Way Forward

NCDs have huge socio-economic implications. They disproportionately affect the poor, leading to loss of household income from unhealthy behaviours, poor physical capacity and loss of wages. Due to long-term treatment costs and high out-of-pocket expenses, NCDs can result in catastrophic health expenditures and impoverishment.

To address issues related to NCDs, the PFCD is working towards drafting a National Blueprint, involving multiple stakeholders including policy makers, intended towards developing policies and programmes to reduce the burden of NCDs within the regional socioeconomic, cultural, political and health system contexts.

PFCD has identified three tracks basis the five high-impact regional consultations in New Delhi, Mumbai, Chennai and Ahmedabad since the beginning of 2014:

  • Surveillance & Policy
  • Strengthening of Healthcare Systems
  • Healthcare Financing

The objective of the National Blueprint is to present a result-oriented action plan to effectively facilitate state governments and healthcare implementers with best practices and preventive measures to adopt innovative programmes for prevention and control of the growing burden of NCDs in India. Through a collective and effective implementation of the recommendations made under the over-arching three key tracks between 2016 and 2020, the country can achieve the goals set by the World Health Organization for 2025 for the prevention and control of NCDs.

List of Participants

  • Damodar Bachani

Deputy Commissioner (NCD), Ministry of Health & Family Welfare

  • Bahubali Nagaonkar

Assistant Director, Rajiv Gandhi Jeevandayee Arogya Yojana, Maharashtra

  • Amit Mookim

Country Principal South Asia, IMS Consulting Group

  • Ashoke Bhattacharjya

Executive Director, Global Health Systems and Innovation Policy at Johnson & Johnson

  • Kailash Shelke

Chief Underwriter, Max Bupa Health Insurance

  • Nitin K Gupta

Assistant Vice-President, Claims operations at Apollo Munich Health Insurance

  • Amit Jaiswal

Deputy Director Alternate Sales and Health, PNB MetLife India Insurance

  • Shubhankar Rudra

President, National Insurance Company Officers’ Association

  • Suneela Garg

Director Professor Community Medicine, Maulana Azad Medical College

  • Usha Shrivastava

Head, National Diabetes Obesity and Cholesterol Foundation

  • Selvaraju

Secretary, Indian Health Economics & Policy Association

  • Gaurav Arya

Director, Health Economics and Health Policy, Cohort Analysts

  • Sandeep Sharma

Senior Research Associate, Public Health Foundation of India

  • Vishal Gandhi

Founder and CEO, BIORx Venture Advisors

  • Bejon Mishra

Founder, Partnership for Safe Medicines India

List of Speakers

New Delhi

• Lov Verma (I.A.S)
Secretary, Ministry of Health and Family Welfare, Government of India

• Dr. Jagdish Prasad
Director General Health Services, Department of Health and Family Welfare, Government of India

• Prof.(Dr.) K. Srinath Reddy
President, Public Health Foundation of India

• Dr.Prabhakaran Dorairaj
Executive Director, Center for Chronic Disease Control (CCDC)

• Dr. Anand Krishnan
Professor, Centre for Community Medicine, AIIMS

• Dr. Prashant Mathur
Scientist ‘E’, Division of Non-communicable Diseases, ICMR

• Dr. Shridhar Dwivedi
Dean/Principal, Professor of Medicine/Preventive Cardiology
HIMSR & HAH-Centenary Hospital, Jamia Hamdard

• Dr.Randeep Guleria
Professor and Head, Department of Pulmonary Medicine and Sleep Disorders
AIIMS

• Dr. Usha Srivastava
Director, Centre for Public Health, National Diabetes, Obesity and Cholesterol Foundation (N-DOC)
Head, Public Health Diabetes Foundation (India)

• Siddhartha Prakash
Global Expert in Health Access, Innovation and Partnerships, Medtronic

• Dr. Ratna Devi
Chief Executive Officer, DakshamA Health and Education

• Prabhat Sinha
Programme Manager, NCD Partnership, Eli Lilly and Company

Mumbai

• Sujata Saunik (I.A.S)
Principal Secretary, Public Health Department, Government of Maharashtra

• Prof. (Dr.) S.V. Madhu
President Elect, Research Society for the Study of Diabetes in India
Professor and Head, Department of Medicine and Endocrinology, University College of Medical Sciences, University of Delhi

• Dr. Daksha Y Shah
Deputy Executive Health Officer (NCD), Public Health Department, Municipal Corporation of Greater Mumbai (MCGM)

• Dr. Jayesh Lele
Secretary, Maharashtra Chapter, Indian Medical Association

• Dr. Rajendra A. Badwe
Director, Tata Memorial Hospital

• Dr. Geeta Bharadwaj
Head, Healthy Workplace Initiative, Arogya World

• Dr. Manish Verma
Director Medical Affairs (Internal Medicine, Cardio, Hospitals), Sanofi India

• Yukti Bhargava
Senior Manager – Reimbursements and Health Economics, Medtronic

• Prabhat Sinha
Programme Manager, NCD Partnership, Eli Lilly and Company

• Dr. Ratna Devi
Chief Executive Officer, DakshamA Health and Education

Chennai

• Dr. K. Kolandaswamy
Director of Public Health and Preventive Medicine, Health and Family Welfare Department, Government of Tamil Nadu

• Prof. (Dr.) A Ramachandran
President, India Diabetes Research Foundation

• Dr. Sailesh Mohan
Senior Research Scientist & Adjunct Associate Professor, Public Health Foundation of India

• Dr. M. Balasubramanian
Tamil Nadu, State President, Indian Medical Association

• Dr. A. Muruganathan
Adjunct Professor, The Tamil Nadu Dr MGR Medical University
Dean Elect – Indian College of Physicians (ICP): 2015-2016

• Dr. Meenakshi Sundaram
Dean, Stanley Medical College
• Dr. Praveen Devarsetty
Senior Research Fellow (Research and Development), The George Institute India

• R. Ananthakrishnan
Director, Cancer Aid Society

• Siddhartha Prakash
Director, Corporate Affairs, Medtronic

• Dr. Gaurav Arya
Associate Director, Public Health and Policy, Eli Lilly and Company

• Bala Aryan
Arogya World

• Dr. Selvarajan G
Professor of ENT, Madras Medical College

• Dr. Ratna Devi
Chief Executive Officer, DakshamA Health and Education

Ahmedabad

• Dr. Jaydip R. Oza
State Programme Officer, State NCD Cell, Government of Gujarat

• Prof. (Dr.) Dileep Mavalankar
Director, Indian Institute of Public Health

• Dr. Rakesh Vyas
Director, Gujarat Cancer and Research Institute

• Dr. Ratna Devi
Chief Executive Officer, DakshamA Health and Education

• Dr. Pankaj M. Shah
Senior Medical Oncologist

• Dr. Daksha Y. Shah
Deputy Executive Health Officer (NCD), Public Health Department, Municipal Corporation of Greater Mumbai (MCGM)

• Dr. Geeta Bharadwaj
Head, Healthy Workplace Initiative, Arogya World

• Dr. Pankaj Shah
Founder and President, Sanjivani Health and Relief Committee

• Piyush Gupta
Principal Secretary, Cancer Aid Society

• Dr. Bharati Dalal
Professor of Pathology, Gujarat Cancer Society Medical College

• Dr. Gaurav Arya
Associate Director, Public Health and Policy, Eli Lilly and Company

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