ACCESS Health India in collaboration with the State Agency for Comprehensive Health Insurance and Integrated Services (SACHIS) and Department of Health and Family Welfare, Government of Uttar Pradesh organized a stakeholder consultation to commemorate four years of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), on September 30, 2022. AB-PM-JAY is the world's largest health insurance scheme that provides hospitalization cover to the poor and vulnerable for secondary and tertiary care. ACCESS Health facilitated the participation and technical discussion with premier health institutions across the country, such as the National Health Authority, King George Medical University, Lucknow, Sawai Mansingh College, Jaipur, Institute of Rural Management-Anand, (IRMA) Karkinos Healthcare, Roche India Healthcare Institute, and Bill & Melinda Gates Foundation. The experts reviewed the findings of recently concluded AB-PM-JAY process evaluation for the period 2018-2021 by IRMA and Indian Institute of Technology- Madras. The deliberations identified the next generation of implementation strategies to empower beneficiaries, and strengthen the supply and administration. With the increasing prevalence of cancer in the state, technical experts deliberated on challenges faced by patients while seeking care. The deliberations advocated for greater allocation resources, strengthening capacities for awareness, early screening and diagnosis and building infrastructure to provide treatment.
Statement on Roe v. Wade Supreme Court decision
ACCESS Health International believes in the right to access high-quality healthcare for all people to live healthy and productive lives. Restricting access to safe and legal abortion services significantly jeopardizes a person’s physical and mental health. In the US, a 1973 court ruling Roe v. Wade made access to safe and legal abortion a constitutional right for all American women. That life-saving right has now been stripped. The decision to overturn Roe v. Wade will have a profoundly negative effect on women and their families in the US, and widespread public health consequences. Over decades, researchers have found that restrictive abortion laws do not result in fewer abortions. Instead, such laws will only serve to increase rates of unsafe abortions. Banning abortion in the U.S. will likely lead to a 21% increase in pregnancy-related deaths. US policy yields influence well beyond their geographic borders and overturning Roe v. Wade has obliterated decades of progress towards safe and accessible reproductive health services for women globally. Denying any person safe abortion care keeps people and families in poverty and creates barriers to the workplace and pursuing higher education.
ACCESS Health India attends Rockefeller Foundation Asia Partners Meeting
Dr. Krishna Reddy Nallamalla, Regional Director of South Asia and Dr. Uma Aysola, Director of Communications, Relations, and Partnerships at ACCESS Health India attended a Rockefeller Foundation Asia Partners Meeting in New Delhi on April 28. The Rockefeller Foundation has provided catalytic grant support to ACCESS Health International to launch the Global Learning Collaborative for Health Systems Resilience. During the meeting, participants had the opportunity to network, reflect on experiences working with the Foundation, and explore areas for further collaboration.
ACCESS Health Southeast Asia Releases New Fintech for Health Case Study
ACCESS Health Southeast Asia released a Fintech for Health case study about how embedded insurance can serve the healthcare needs of ready-made garment workers in Bangladesh. Employing over four million workers, the garment export industry receives much international attention concerning the wages and welfare of the workers. Access to quality healthcare services is also poor with little to no support given by employers. Workers experience high rates of obesity and non-communicable diseases and risk financial catastrophe when a healthcare incident occurs. Read the case study and the solutions it proposes to these challenges here.
ACCESS Health China launches 2022 Health Futures Scholarship and Fellowship Program
On May 13, 2022, ASK Health launched its Health Futures Scholarship and Fellowship Program with a virtual opening seminar. The seminar was attended by the 2022 fellows, past fellows and the entire ASK Health team. Fellows will have the opportunity to participate in ASK Health's ongoing research and consulting projects and network with industry leaders and academic experts throughout the program. The ASK Health team looks forward to working with these passionate and talented future healthcare leaders.
ACCESS Health China and Singapore Economic Development Board establish the China-Singapore/ASEAN Biomedical Industry Platform
ACCESS Health China initiative, ASK Health is collaborating with the Singapore Economic Development Board to jointly establish the China-Singapore/ASEAN Biomedical Industry Platform. The platform will assist Chinese pharmaceutical and MedTech companies looking to expand to the ASEAN market and the wider APAC market. In recent years, Chinese pharmaceutical and MedTech companies have become increasingly interested in expanding to the ASEAN market. As ASEAN's biotech hub, Singapore is well positioned to be an entry point and gateway for the Chinese biomedical companies to the ASEAN market.
ACCESS Health China Participates in the World Economic Forum Global Health and Healthcare Strategy Officers Meeting
On May 4, 2022, the World Economic Forum held a virtual Global Health and Healthcare Strategy Officers Meeting. Dr. Chang Liu, Regional Director of ACCESS Health China was invited to participate virtually and discuss the progress of China's health system reform. The meeting was a unique opportunity provided by the World Economic Forum for its partners to collaborate and discuss the future of the healthcare industry while considering the impact of rapidly changing socio-economic and geopolitical systems.
ACCESS Health Southeast Asia Presents at the Sustainable Development Goals Innovation Roadshow
ACCESS Health Southeast Asia, Senior Strategy Consultant Simeen Mirza spoke at the Sustainable Development Goals Innovation Roadshow 2022 on May 25 alongside partners at Amazon Web Services (AWS) and The Startup Buddy. Simeen highlighted key concepts in the whitepaper she co-authored “Overcoming Barriers to Cloud Adoption in Public Healthcare in the Asia Pacific,” explaining how the cloud can have a positive impact on reaching the Sustainable Development Goals when utilized in a healthcare setting.
Tackling the Growing Burden of Cancer in India
The burden of cancer is growing in India. According to the World Health Organization, cancer comprises almost 20 percent of the non-communicable disease burden, with over 1.1 million cases recorded in 2018. Breast cancer, which is one of the most common cancers in India, has an over 14 percent incidence rate (WHO), and one woman dies of cervical cancer every 8 minutes in India, according to a doctor's body attached to the National Institute for Cancer Prevention and Research (NICPR). Unfortunately, India's cancer crisis is compounded by the fact that a majority of the patients with cancer are diagnosed at the locally advanced stage (head and neck 66%; breast 57.0%, cervix uteri 60.0%; and stomach 50.8%, among others), as shown in this paper published in Pubmed, assessing the status and trends of cancer in India. What these figures consistently point at is the urgent need for strengthening and augmenting the existing diagnostic and treatment facilities, which are inadequate, often inaccessible and concentrated in urban centres and may also be financially not viable, especially for long term treatment and management for the economically weaker section of society. While government schemes such as the Pradhan Mantri Jan Arogya Yojana (PM-JAY) provide beneficiaries with free and cashless treatment for cancer, the lack of awareness and resulting delay in screening and testing contributes to poor prognosis. Travelling to hospitals, lack of day care and palliative care also add to the disease burden. This is also why the burden of care falls disproportionately on the tertiary care centres such as medical colleges and superspecialty hospitals. What then is the solution to this growing threat of cancer? Doctors, policy makers, and patients unanimously agree that bringing care closer to home will improve the indicators for cancer in India. "If preliminary cancer detection and care can be done at a primary or Community Health Centre or district hospital, with basic blood tests, an ultrasound or X rays, under the supervision of a medical oncologist, and chemotherapy drugs can be administered, a patient will receive care closer to home and is more likely to follow through the entire course of treatment," says Bengaluru based oncologist Dr Rajeev AG. It will also decrease the burden on tertiary care centres whose doctors can then focus on the terminal patients who need specialized therapy with specialized equipment. "Providing care closer to home also makes periodic monitoring easier, and reduces mortality and morbidity. If a patient has to travel long distances for care, they are likely to self-diagnose and stop or delay care," adds the oncologist. Issues such as travel time and expenses, loss of wages, vastly impact health seeking behaviour among patients belonging to the economically weaker sections. It is also a challenge policy makers designing schemes like the National Health Authority's PM-JAY have been trying to address when beneficiaries need to travel long distances for care. For now, the revised Health Benefit Packages 2022 include new procedures, high-end drugs & diagnostics and have introduced a differential pricing opportunity that acts as an incentive for specialized private and public providers. "Adherence to the Standard Treatment Guidelines set by the NHA is also expected to improve the quality of services," shared Dr Shankar Prinja, Executive Director, National Health Authority (NHA), while apprising Principals, Chief Medical Superintendents, and PM-JAY nodal officers of Medical Colleges who were attending a workshop by State Agency for Comprehensive Health and Integrated Services (SACHIS) which implements PM-JAY in Uttar Pradesh. While the scheme has brought cancer care and oncology services under its purview to prevent out-of-pocket-expenses of beneficiaries, access and logistics such as travelling long distances for care continue to be challenges. Currently, the cancer care scenario in Uttar Pradesh, like in other parts of the country, is very centralized and depends heavily on the tertiary care centers and super specialty institutions. Bringing cancer care closer to home In Assam a Distributed Model of Cancer Care is being championed by the Assam Cancer Care Foundation, to deliver affordable and quality care close to home. Under this model, a network of hospitals and medical colleges are categorized as apex tertiary care institutions and level 2 and 3 hospitals that provide diagnostics, and cancer day care services and palliative care at district hospitals.Supported by awareness for early screening and detection, this model envisions developing patient-centric institutions that overcome the challenges of accessibility and affordability by providing standardized care close to home. Dr NC Prajapati, Director General of the Directorate of Medical Education, government of Uttar Pradesh, agrees that linkages within hospitals-from primary health centres, district hospitals, referral centres and tertiary care hospitals-will strengthen the decentralized system of care and help patients receive the care they deserve without having to travel to apex hospitals. "If linkages are strong, and doctors at the referral centres can electronically consult specialists at tertiary care centres, and a patient’s medical history is made available to them online, the practitioner at referral centres can provide treatment and care," he says. These services could include initial screening, collecting and sending samples to labs, and initiating early treatment. While this requires upskilling and strengthening primary and secondary care centres and empowering the personnel, the existing Hospital Information Management System (HIMS) links Providers across the public health spectrum, and can trace patients across the Primary Health Centres (PHCs), Community Health Centres (CHCs), District Hospitals and Medical colleges, he adds. "Empowering this system is both doable, makes optimum utilization of advanced facilities for cancer care delivery, helps the patient and reduces the load on tertiary care centres and medical colleges," says the DME. One of the key mandates of DME is also to promote research and test interventions which improve quality of care for the patient, and identify global and national best practices. Roche India Healthcare Institute (RIHI), which undertakes research on patient pathways and service interventions for oncology and other therapeutic areas, has been working on numerous pilot programmes on distributed cancer screening and referrals. At Roche Access- a collaboration with Punjab State Government, they work on the […]
Strengthening Partnerships for Implementation of PM-JAY in Uttar Pradesh: Contribution of the Medical Colleges
On May 31, the State Agency for Comprehensive Health, and Integrated Services (SACHIS), the implementing agency for the Pradhan Mantri Jan Arogya Yojana (PM-JAY), the Department of Medical Education, and ACCESS Health came together to deliberate on increasing the participation of medical colleges in the government-sponsored health insurance scheme. The workshop was attended by the Additional Chief Secretary, Department of Health & Family Welfare, Principal Secretary, Department of Medical Education, Chief Executive Officer, SACHIS, Director General Medical Education and Chief Medical Superintendents, and the PM-JAY Nodal Officers of 51 public and private medical colleges. The participants deliberated to identify actionable steps for Medical Colleges which would improve access, experience, quality of care and reduced out-of -pocket-expenditure for patients who access care under PM-JAY. The state has a wide network of 51 empanelled medical colleges under PM-JAY, which provides an opportunity to increase the availability of tertiary and specialized care for the state including PM-JAY, which in the last three years has been limited. The scheme provides a prospect of additional financing for the public medical colleges which can help strengthen the teaching institutions in the state. The key takeaways for improving access at Medical Colleges under PM-JAY included pivotal need in screening beneficiaries of their eligibility status, (as patients are walk-in and may or not be enrolled) through strengthening of the PM-JAY desk and other approaches. Empaneled medical colleges such as King George Medical College and Tirthankara Mahaveer Hospital and Research Centre Moradabad highlighted that they screen all the in-patient cases for their eligibility status under PM-JAY, in all the wards and the departments which helps in reaching out the beneficiary. Ram Manohar Lohia hospital does community outreach through the Department of Community Medicine. Additional strategies included scheme orientation of all levels of staff in medical colleges, incentivizing the staff through the reimbursements, increasing accountability through coordination and monitoring support,which have shown success in the colleges. The implementation highlights that despite being a cashless scheme the patients incur out-of-pocket expenditure (OOPE). The majority of this expenditure is towards the purchase of medicines, diagnostics, consultation, and then some towards transportation and boarding. The discussion highlighted supply chain issues affecting the availability of medicines. For which use of E-pharmacies has emerged as one of the options, additional bulk purchasing to address supply-related gaps were discussed and suggested. Another cost of OOPE is transport, which is especially very high in cases where the patient is going to another state for treatment. In the last three years, more than 80,000 patients have gone out of the state for the services which are available within the state and in some cases within the districts and mostly for tertiary care. Thus, a key strategy to reduce OOPE will be to increase availability of services nearest to home and medical colleges will have a critical role. On improving experience and quality of care, the discussion emphasized on strengthening four elements of care- quality of doctors, nursing care, paramedic care, and coordination support to patients, and ability to give feedback. The case of SNMC Medical College Agra was presented, whereby supporting the medical colleges through monitoring, problem resolution, and capacity building the uptake of PM-JAY increased considerably along with improvement in correct and timely submission of the claims. The suggestion of developing Standard Operating Procedures towards building Adarsh Ayushman Kendra in Medical Colleges was made. Further, examples of how hospitals that are accredited and certified in addition to standardizing quality of care have also shown better claims management processes and systems. Additionally, training and being updated on the scheme developments are critical for which SACHIS can devise methods to keep the provider network engaged. Another element is continuity in post-hospitalization care when the patients get back home. The key vision of the Ayushman Bharat reforms is a continuum of care through gatekeeping, and forward and backward linkages. The implementation highlights at present that most patients are direct walk-in, therefore forward referrals from lower institutions may not be immediately possible, however, how can we initiate backward linkages to provide continuity of care through the Health & Wellness Centre. In this direction, SACHIS and ACCESS Health are working on an integrated application, which aims to establish bi-directional linkages for the patient. An important health systems issue highlighted by the Principal Secretary Medical Education was the urgent need to shift the thinking towards self-sustainability and innovation for the teaching institutions. PM-JAY for public colleges is an opportunity of additional financing, which along with other innovations and ideas could strengthen the institutions. He urged the medical colleges to introspect and identify actionables. A major issue voiced by the hospitals is the availability of cash flows due to time taken for claims settlement. A new funding proposal called the Green Channel was shared by SACHIS to encourage greater participation of empaneled hospitals. Under this hospital empaneled with PM-JAY for at least six months with no history of reported malpractice can receive 50 percent of the claim amount at the time of claim submission subject to no trigger for fraud. The partial payment will be released automatically through the system at the time of claim submission while the balance amount will follow the process of adjudication. The proposed idea was welcomed by the participants. The Medical Colleges also got an opportunity to understand in detail from Dr Shankar Prinja, the Executive Director National Health Authority, on the newly launched Health Benefit Package 2022. The revised HBP aims to bring more clarity in the nomenclatures of the different procedures earlier put under the unspecified packages. It now has new procedures for palliative care, high-end drugs, consumables, and diagnostics that have been unbundled from the per-bed day cost of medical packages, inclusion of daycare packages for mental health, more procedures as cross-specialty, standard specifications for implants. Additionally, prices include outpatient consultation and pre-diagnostic work-up within three days of the procedure, the cost of the procedure, hospitalization following the procedure, and the cost of drugs for 15-days following hospitalization. The introduction of a differential pricing based […]