Alok Kumar, IAS, Mission Director-National Health Mission, Uttar Pradesh
Availability of high-quality diagnostic tests is essential to enable doctors to make rational decisions regarding treatment. Drastic planning has been done to uplift these facilities in Uttar Pradesh in 2017-18.
Serious efforts are being made to provide good-quality medical care, free of cost, to the patients coming to government health facilities in Uttar Pradesh. All medicines are being provided free of cost. Basic tests and investigations are also available in district-level hospitals and CHCs. But facilities of high-end pathology tests, CT scan, MRI, hemodialysis, etc., are available in a few hospitals only. Initiating such services in all hospitals is difficult, due to problems faced in procurement of equipment, their maintenance, and non-availability of specialists and skilled manpower (radiologists, nephrologists, pathologists, lab technicians, etc.). As a result, these facilities are not available to a large number of patients. This leads to high out-of-pocket expenditure. Hence, it is essential to address this issue so that even the poor patients have access to these investigations, as also to ensure that doctors in public health facilities are able to make rational decisions regarding treatment.
In the year 2016-17, with the support of Government of India funds, it was planned to make these services available through service providers, on PPP mode. Specifications and tender documents were prepared and tenders were floated to select reputed and quality service providers, who can provide these services at competitive prices.
For most of these services, a good number of firms from all over India participated and offered very competitive rates. Consequently, service providers have been selected and work has been awarded to the selected bidders. All the firms selected for CT scan, dialysis, and pathological tests have good experience of providing similar services in other states/countries.
Free Diagnostic Services
With the support from World Bank/UPHSSP, Free Diagnostic Services were launched on December 3, 2015 in 40 hospitals. It was extended to 10 more hospitals by September, 2016. The scheme has benefitted a large number of patients in terms of all services in the hospital itself without any cost, saving transportation time and wage-earning time. On an average, out-of-pocket expenditure saved is 651 per patient. In addition, free diagnostic services under NHM/DGMH will also start in 95 district hospitals and 822 community health centers from February/March 2017 for which tender process has been completed.
CT Scan Services
CT scan services are being outsourced in two different modes. In category I, space will be provided in the hospital premises, while the equipment, specialists/manpower, operationalization, and reporting will be the responsibility of the service provider. In category II, those hospitals have been included, where CT scan machines are being procured by the state government, and manpower, operationalization, and reporting will be the responsibility of the service provider.
For dialysis services, units have already been established in 18 divisional-level district hospitals by the Director General, Medical and Health, UP, with support from UPHSSP, a World Bank supported scheme. It is already functional in one district Azamgarh, where 169 dialysis processes have been carried out within a week. National Health Mission had invited for establishing dialysis units in 18 more district hospitals. Tender process has been completed and dialysis units will be established soon. Each of these units will initially have six beds, which may be extended to ten later. On each bed, dialysis service may be provided to two patients daily. Based on the experiences of these units and patient turnover, decision will be taken on establishing dialysis units in remaining 39 districts.
To provide specialized quality services to pregnant women and newborns coming from distant areas, under NHM program, DGMH is carrying out construction of MCH wings. In above context, 50 units 100-bedded MCH wings in district women hospitals, 12 units 50-bedded, and 78 units 30-bedded in community health centers are being constructed and being made functional under DGMH. It will lead to total increase of 7940 beds. This initiative will be beneficial for public at large.
It is also being planned to start the services of tele-radiology to connect the X-ray units of CHCs/PHCs with radiologists to compensate for the shortage of radiologists, while radiologists' opinion will be available, for better diagnosis and treatment.