Dr Harsh Vardhan began his second term as minister in the National Democratic Alliance – II government by cycling from home to the health and family welfare ministry in Nirman Bhavan to highlight the importance of physical activity for health and green transport for the environment. He had not even hopped off his bicycle when his staff informed him about a Nipah case being confirmed in Kerala, which was followed a week later by nationwide protests and strikes by doctors and health professionals after two junior doctors were assaulted at Nil Ratan Sircar Medical College in Kolkata. Dr Harsh Vardhan speaks to Sanchita Sharma on the firefighting his ministry has done over seven weeks and its plans for the next five years. Edited excerpts:
Your taking charge was immediately followed by one of India’s biggest doctors’ strikes. How can hospitals be made safer for doctors?
Doctors often work under stressful and difficult conditions and I strongly condemn assault against them. The violence in Kolkata that led to doctors’ strikes across the country gravely affected healthcare services. The health ministry has set up a 10-member committee on violence against doctors with representation from the ministry, Indian Medical Association (IMA), Federation of Resident Doctors Association, Medical Council of India, AIIMS, and the Union ministry of home affairs and the law department. The first meeting was on July 10th, during which the home and law ministries concurred on the need for a central legislation. It was decided to have the first draft of the proposed Act readied within a week.
I wrote to West Bengal chief minister Mamata Banerjee, urging her provide a secure working environment to doctors. I also requested all chief ministers to consider establishing specific state legislation or bring amendments in existing state legislative acts to ensure doctors and clinical establishments function without fear of violence.
What is the long-term solution to end violence against doctors?
Ensuring a safe environment for doctors and patients and involves multiple stakeholders. Apart from taking all possible preventive and deterrent measures, state governments need to investigate all cases of violence promptly and ensure that the criminals get prosecuted under the legal provisions available. The IMA’s draft act, called The Protection of Medical Service Persons and Medical Service Institutions (Prevention of Violence and Damage or Loss of Property) Act, 2017, which includes clauses on penalty and recovery in case of loss or damage to property, has now been shared with the states for their consideration.
Nipah was confirmed in Kerala the day you took charge even as Muzaffarpur was struggling to contain child deaths from acute encephalitis syndrome (AES). Kerala contained Nipah, but Bihar floundered. How can the Centre ensure containment and treatment protocols are followed across states?
You see, health is a state subject. The Integrated Disease Surveillance Programme (IDSP) does surveillance to quickly detect and respond to disease outbreaks, providing additional manpower, training rapid response teams to investigate outbreaks, strengthening laboratories, strengthening ICT equipment for data entry, analysis and data transfer, and providing funds for operationalisation.The Centre also supports states in implementing communicable disease programmes, such as National Vector Borne Disease Control Programme that covers six vector-borne diseases, including Japanese encephalitis and AES, which is of unknown etiology.
So, what is causing the AES deaths in Muzaffarpur?
AES describes a disease with symptoms of fever and altered consciousness and has a very complex etiology. Studies were done on the possible association with litchi toxins in Muzaffarpur during 2013-14, but no definitive evidence linking AES to litchi toxins was conclusively established.In the present outbreak, Indian Council of Medical Research (ICMR) has done research studies covering various aspects of the disease and I am hopeful we will arrive at substantial findings soon.
Soon after taking charge, you requested all states that haven’t joined the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to launch the scheme. Rajasthan has announced merging the state healthcare scheme with AB-PMJAY. Did you hear from Delhi, Telangana, Odisha or West Bengal?
The implementation of AB-PMJAY across the country is undoubtedly the top priority. The scheme is going to be rolled out in Rajasthan and Punjab very soon. As a follow-up action, CEO, National Health Agency (NHA), visited Odisha and the state is positive about implementing AB-PMJAY. The NHA is working on the convergence plan. I expect other states to get on board sooner than later.
How many people have been treated under AB-PMJAY? Which are the best and worst performing states?
The budget for Ayushman Bharat went up 154.87% this year. Under the health protection scheme, there have been 32,07,000 hospitalisations and 8.9 crore cards issued till July 12.It is difficult to rate states as there are different parameters for performance, such as access, quality etc. Some states that are doing better are Chhattisgarh, Maharashtra, Jammu & Kashmir, Daman and Diu, Gujarat, Kerala, Himachal Pradesh etc. The NHA continually monitors performance of all states on different parameters and issues guidelines to improve performance.
How is primary health care, which can treat 80-90% illnesses, being strengthened?
As you know, delivering Comprehensive Primary Health Care (CPHC) through health and wellness centres (HWCs) is a key component of Ayushman Bharat, which is the fulcrum programme being implemented to achieve the proposed goal of universal health care.Our vision is to transform 150,000 sub-health centres (SHC) and primary health centres into AB-HWCs in a phased manner. The target for 2018-19 was 15,000, and the cumulative target for 2019-20 is 40,000 and so on, till we achieve our goal by 2022. We are on track and have at least 19,000 operational AB-HWCs.
In addition to investments made through NHM and other programmes to strengthen PHCs/SHCs, central funds are being galvanised. An outlay of Rs 1,200 crore was made as central share for 2018-19, and another Rs 1,600 crore for FY 2019-20. Till now, approvals for more than 52,000 AB-HWCs have been provided to states/Union territories.
What about building human resources and technical capacity in resource-deficit regions?
Investments made by the Centre are intended to support creation of IT, upgradation of infrastructure, creating primary health care teams at sub-health centres, posting new cadre of non-physician health workers called community health officers, capacity building, and expanding the range of medicines and diagnostics so that HWC become the first port of call for primary health care.There is a provision of primary health care services related to maternal, newborn, child health and nutrition and some communicable diseases. AB-HWCs will also provide care for acute simple illnesses, screening, prevention and management of chronic diseases like hypertension, diabetes, mental health, and care for chronic communicable diseases like tuberculosis and leprosy, and elderly and palliative care. All these additions are, of course, incremental and the phasing will depend upon the states.
Artificial intelligence (AI) is also being in public health, such as setting up an imaging bio-bank of cancer-related radiology and pathology images of more than 20,000 profiles of cancer patients with focus on the major cancers prevalent in India. AI is also being used for early detection of diabetic retinopathy, which is a side effect of uncontrolled diabetes that can cause blindness.
As health minister, which steps will you prioritise to ensure clean air?
This is a subject that involves different ministries and cooperation from various stakeholders, including state governments. During my tenure in the ministry of environment, forests and climate change, we launched the National Clean Air Programme to reduce air pollution through various measures. Cooperation from all stakeholders was sought to lower vehicular emissions, stop stubble burning etc., which adds to air pollution.Under the health ministry, the NCDC (National Centre for Disease Control) is collecting data on acute respiratory illnesses reporting to Emergency departments of six central government hospitals in Delhi. The data is being analysed monthly to track how spikes in AQI (air quality index) is linked with increasing hospitalisations.
The ICMR is also conducting a study on ‘Health impact assessment in 20 most-polluted cities’ in the country to provide an invaluable link between air pollution and health problems.
What are your two biggest priorities as health minister?
Preventing all illnesses and ensuring the population has the tools to stay healthy is a priority. One of the key priorities is stopping tuberculosis, which claims more lives than any other infectious disease, by 2025.Moving towards universal health care for each and every citizen of India is the prime minister’s dream and we will work hard to make it a reality. The goal is to make India a global model for ‘Health for All’.