In a wide-ranging interview, Dr Vijay Satbir Singh, Additional Chief Secretary, Health, Government of Maharashtra, talks about various health initiatives of the state like the upcoming new Vision 2030 document on health, a new nutrition policy and a partnership with the software giant Microsoft to boost IT in the state in an exclusive interaction with Prathiba Raju
How do you plan to achieve the dream of having an Arogya Maharashtra?
Our vision of Arogya Maharashtra is to provide affordable, accessible and quality healthcare to the people of the state, with a special focus on women and children, along with the people living in tribal areas. We are working to get the appropriate policies and suitable amendments in place.
With rising cost of healthcare, do you think the amount allotted can cover the expenditure of all health schemes? Besides, what are the reasons for the reduction in health budgets?
Well, this is a problem most of the states are facing. The revenues allotted to the state governments keep on changing and there are many reasons for it. For example, this year in Maharashtra, we had registered a shortfall in our revenue, particularly related to excise, property transactions were below the expectations. Whenever an income of the state fluctuates, it leaves an impact on the allocation of funds to various sectors like health and education. At times, the state also has some unexpected expenditures which has its impact on the money made available for each sector. For the 2017-18 financial year, the budget allocated for public health is Rs 8195. 18 crores, including an expenditure of Rs 4051.61 crores for the schemes and rest is the committed expenditure, which comprises expenses like salary and other commitments.
What was the reason for the nutrition schemes budget being lowered than what was allotted in the last budget?
The Government of Maharashtra has always given top priority to issues and schemes related to nutrition, which is related to children and women. There are many schemes run by the government out of its own budget and the central government also contribute to some of these. Whenever there is dearth of funds for a particular scheme, we make it available by re-appropriation of funds or by getting money from the unspent fund from any other department. Apart from funds, we are coming out with Maharashtra Nutrition Policy, which is at its final stage of shaping up and it will be implemented by the end of June. The policy will have many unique features, which will be implemented for the first time in the state.
For example, we will have a scheme where kitchen gardens will be implemented in educational institutions, anganwadis and primary schools. Besides, supplementation of food with micro nutrients will be taken forward in a major way across the state. However, one should know that when it comes to eradicating malnutrition, it is not just the public health department’s responsibility, but it needs more synergy of all the stakeholders like NGOs and the private sector. Even within the government, the other departments, be it water and sanitation, rural and urban development, should work in tandem.
Nearly 40 per cent of posts for specialists such as paediatricians, gynaecologists, nutritionists, obstetricians and ophthalmologists are vacant in the state. What steps are being taken to fill the posts?
The scarcity of doctor-patient ratio is not just in Maharashtra, but it is prevalent pan-India. There is a huge difference in the availability of doctors in urban and rural areas. Many specialists also join private hospitals instead of government hospitals. Most of the doctors, nurses, paramedics prefer urban areas, particularly the specialists.
We run several programmes to bridge this gap. We pay more incentives to the doctors who serve in rural and tribal areas, at least 15 per cent high entitlements. Apart from that, in postgraduate courses, we give reservation for the doctors who are in service. Many doctors who join the government service is because of the reservation they get. After completing PG courses, specialists do not want to serve rural areas. They are reluctant about the skills they acquire that are underutilised. Hence, we execute a bond with the students who study in the government-run medical colleges, so that either they have to complete conditions written in the bond or they have to pay money. Several measures are taken to tackle the mismatch of the doctor-patient ratio. The state government is also running tele-medicine consulting services for a year now in five district-level hospitals where government-run medical colleges and hospitals’ specialists are connected. We are also trying to connect the telemedicine centres with the nine central prisons in the state, so that the prisoners are not often taken out of the prison premises.
How will the plan to digitally connect 29,000 gram panchayats be implemented? What are the steps taken to boost e-health in the state?
The tribal Harisal village in remote Melghat district is being transformed into a digital village. People are given services of tele-consultation to connect with the doctors. We are also going to sign a Memorandum of Understanding (MoU) with Microsoft very soon as they will provide us with IT-enabled solutions and initiatives.
Microsoft will also be helping us in a big way to connect with the service providers as well as to get feedback from the people about the quality of the services provided by the government. We are working on the MoU and the IT giant has also been given varied options where they can provide their expertise.
The state has seen Infant Mortaity Rate (IMR) and Maternal Mortality Rate (MMR) falling to 25 from 36, and 87 from 130, respectively. What further steps are being taken to lower these rates further?
Maharashtra ranks third in the country when it comes to the infant mortality rate (IMR). Our Maternal Mortality Ratio (MMR) level is better than almost all the other states, except Kerala. We are working on a vision document exclusively for the health department what we aim to achieve by 2020 and 2030. The idea of the vision document came from the adoption of Sustainable Development Goals (SDG) by the UN after the Millennium Development Goals (MDG). SDG has the largest number of indicators on health. We are working out a vision document similar to it and adding more guidelines which is relevant to Maharashtra’s health parameters. This will give a clear cut road-map of what our government intends to achieve in the health sector viz to improve life expectancy, malnutrition, NCD, and TB control.
Can you share the details on the diagnostic service which HLL would provide to Maharashtra Hospital?
HLL Lifecare Ltd (HLL), a Mini Ratna PSU of the Union Ministry of Health and Family Welfare (MoH&FW), has signed an agreement with the Maharashtra government. HLL will establish around 100 Hindlabs in the 33 districts, particularly at the level of the Primary Health Centres (PHC). They will implement the project within a period of 90 days and commence the lab services to the general public. The project will be monitored on a real-time basis by IT-enabled systems which would track the details of patients’ samples collected from the collection centre to the lab for testing and reporting. Anybody who requires any diagnostic test can approach these centres and conduct their test for free, as the expense will be borne by the state government. If HLL is able to implement it properly, this initiative will be a huge success.
Apart from it, we find the concept of Amrit outlets by HLL and Jan Aushadhi Kendras (JAK) by Bureau of Pharma PSUs of India (BPPI) highly beneficial as both these outlets help the common man to substantially reduce the out-of-the-pocket expenditures by purchasing medicines. We have few JAK outlets in the state and we are also in the process of discussion to bring in more Amrit and JAK outlets across Maharashtra. At the same time, the government hospitals are also providing affordable medicines.
How encouraging is Government of Maharashtra when it comes to PPP model in healthcare?
The Government of Maharashtra has always been encouraging the PPP model in healthcare. We welcome any initiative which involves PPP model of finance in health services. We have Mahatma Jyotiba Phule Jeevandayeeni Yojana, which covers 1,100 ailments, hip and knee replacement, sickle cell and anaemia treatment. Benefits under this scheme has been increased from Rs 2 lakh and Rs 3 lakh in case of kidney transplantation. The state government invests Rs 1000 crore. We find it difficult to run these schemes at the same time we want to continue the scheme as it provides immense benefits to the public. If private players can help us to run the scheme, it will be a huge benefit for the common man.