CK Mishra, Additional Secretary & Mission Director (NRHM), Ministry of Health and Family Welfare, shares details about the National Health Mission, its objectives, ICT usage, benefits of telemedicine and more, in conversation with Anoop Verma
What are the key objectives of the National Health Mission?
The National Health Mission has been formed by merging NRHM and NUHM. The NRHM was essentially conceived to provide primary healthcare in rural areas, which did not have adequate coverage of healthcare services. Subsequently, we realised that there were pockets in urban areas too where the healthcare services were not available to the poorer sections of society, even though most towns and cities may have many big hospitals. So to cover the poorer sections of the urban population, we launched the National Urban Health Mission was created through a Union Cabinet decision on May1, 2013. In order to improve the efficiency, we have now merged the two missions into a single mission. Our goal is to increase access, provide services, improve infrastructure and provide more finances for better healthcare to various states.
At times the people who move from rural areas to the urban areas lack proper documentation for identification. What can be done to ensure that their medical data can be kept track of through a easy to access system of identification?
We are now planning to provide health cards to the beneficiaries of our schemes. Many states have already done it. Lot of work still needs to be done in the area of health cards, but this is the general direction in which we want to move. They will take some time to fructify, but this is the general direction in which we plan to move. The NUHM was specifically created to cater to the health needs of the migrant population that keeps moving to urban areas temporarily or on a permanent basis. The vision behind NHM is that no one in this country should be left without access to proper healthcare. Everyone should have equal access to modern medical-care. We intend to use Aadhaar as a platform for identification of the beneficiaries for our healthcare schemes. This is because we don’t want to be in situation that other states are where one application is not speaking to another application. Aadhaar will ensure inter-operability and unique ID for everyone.
If the records are kept in electronic format, they would be more easily accessible. Is there work being done on this aspect?
Many states are currently experimenting with keeping records online. Electronic health record will ensure that a person’s health records remain with him. The records can reside somewhere in the cloud, so that they can be accessed when he goes to another facility. For instance, I live in X city where I get a treatment done from some hospital. From here I move to town Y, where I go to another hospital. The hospital in town Y should be able to access my medical records, depending on my choice because confidentiality and privacy are the major issues. The ministry has already notified standards, and now within the system of the mission we are trying to develop the methods for facilitating exchange of medical data between hospitals while ensuring that the privacy related safeguards are adhered to. We are speaking to the states on this. The important point is that NHM is there to impose the ministry’s standards and guidelines from the top, its main function is to enable states to achieve the target of universal healthcare.
Are you satisfied with the level of ICT usage in the healthcare space?
If you look at the ICT implementations in the healthcare sector, I would say that we have done reasonably well. Our HMIS system is capable of capturing the facility level data. We have access to the PHCs in smaller towns around the country. We can communicate with the various PHCs through our HMIS. We have created the web based system called MCTS, which is the Mother & Child Tracking System, on which more than 14 crore mother and children registered. MCTS was introduced in 2010 to capture details such as name, address, mobile number, etc., of every pregnant woman and child up to five years of age and of health services provided to them. The scheme aims to ensure that every pregnant woman gets complete and quality antenatal and post natal care and every child receives the full range of immunisation services. The system is already in place, even though it is still learning as many of the states are having problems in fully implementing it. We are trying to resolve all these issues. My personal view is that the MCTS should start working well during the next year or year and a half.
The Kilkari Yojana has been started for mothers and children. What are the benefits of this scheme?
The health ministry has started Kilkari Yojana for mothers and infants. Under this scheme, mothers will be informed through an audio about how to look after infants, vaccinations, and other such information. For instance, if the mother is in the sixth month of her pregnancy, the system will send her a message that this is your sixth month and you need to undergo this medical test or treatment. These will be pre-recorded messages. A successful pilot has already been done on this project and we plan to roll it out this year.
What is your opinion on using telemedicine to provide healthcare services to people living in far-flung areas of our country?
Telemedicine is a very important system for providing healthcare to people living in remote areas, but unfortunately many of such areas also face the problem of poor connectivity. Unless the problem of connectivity is solved, we can’t make much progress in telemedicine. However, now we are launching telemedicine in a big way, particularly for specialised consultations. We have tied up with four medical colleges to facilitate the expansion of telemedicine in the country. In order to ensure that everyone in the country has speedy access to medical care, we are taking the “time to care approach,” which means that a citizen should not have to walk for more than 30 minutes for reaching a healthcare facility. Today it is stipulated that you need to have a healthcare sub-centre for a population of 5000, but if the terrain is rough, we allow additional sub-centres to come up in the same area.
What are the benefits of the Mission Indradhanush programme?
Mission Indradhanush, which depicts the seven colours of the rainbow, will cover all those children by 2020 who are either unvaccinated, or are partially vaccinated against seven vaccine preventable diseases which include diphtheria, whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B. The programme was launched on the Good Governance day. As of now we have identified 201 high focus districts in the country. These districts will be targeted by intensive efforts to improve the routine immunisation coverage.
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