There is no budget cut for health. We have money, states don’t have a plan: J P Nadda

Union Health Minister J P Nadda rejects reports of rise in prices of essential drugs, and says the government plans a “holistic approach” to cut tobacco use

ABANTIKA GHOSH: The first announcement by the Health Ministry after your government came to power was the National Health Assurance Mission. Are you still sticking to the original definition of the scheme or is it being revised?

When we talk about the National Health Assurance Mission, we won’t only just stick to it but we are also very clear that we are going to provide it. The health assurance programme means provision of good health facilities, preventive and promotive, by the state governments. And the Union government should see to it that the gaps left are taken care of. So as far as the mother, child, reproductive health care is concerned, that has been taken care of. Everything is given free and we are now developing a life cycle approach.

As far as drugs are concerned, approximately Rs 3,000 crore per year is being given to states. And as for the component of drugs, other than cancer, tuberculosis and the national health programme, around Rs 800 crore has been kept for medicines. There are 300 to 400 categories, so that part has also been taken care of. Also, Rs 109 crore has been sanctioned for diagnostics. All this has been given on the primary level, secondary level, thankfully on the tertiary level too, to some extent. There was also some confusion that health assurance is health insurance. It’s not that. Health assurance means ensuring that a person gets good health facilities. To take care of the gaps, there are two ways. One is that we increase our expenditure, and see that it is taken care of. Other way is that on case-to-case basis we can give them relief. The third way of doing this is that, whatever gaps we can’t fill, are substituted with insurance.

ABANTIKA GHOSH: We recently shifted to the daily regimen in tuberculosis. What was the reason for that?

We have shifted to the daily regimen for technical reasons, but what we have done is a call-for-action programme. In tuberculosis now, the area of concern are MDR (multi-drug resistant) patients, and for that we need a door-to-door survey. The Ministry of Health and Family Welfare has undertaken the responsibility of conducting the door-to-door survey. Grassroot-level surveys are on and as far as daily regimen is concerned, it’s purely for technical reasons.

COOMI KAPOOR: By opening AIIMS centres all over the country, aren’t you diluting the brand, though the Delhi centre is unable to cope with the numbers?

It is because of bad planning. Bad planning in the sense that the pressure on AIIMS is because if a patient in Madhubani district of Bihar develops cancer, he does not stop in Patna. He comes to Delhi. Now there is no public health facility of that level near Madhubani. So, somewhere Patna is lacking. We are trying to see to it that the confidence level and the facility level both are there in Patna too. Once that is there, AIIMS’s standard will be maintained everywhere and the rush will also come down. If you see, the number of patients from Chhattisgarh coming to AIIMS in Delhi has reduced because the Raipur wing has started operating in the state. We have to take care that the standards are not diluted. That’s why people of AIIMS (Delhi) will set up other AIIMS centres. People who have gone and established Jodhpur AIIMS or Bhubaneswar AIIMS or Raipur AIIMS are all from AIIMS (Delhi). So, the standards have been maintained.

ABANTIKA GHOSH: The Rajasthan High Court recently asked the Central government to implement bigger tobacco warnings. What do you plan to do there?

As of now we haven’t got the notice from the Rajasthan High Court but certainly we will take care of whatever the notice says. We are holding discussions to reduce consumption of tobacco, to reduce occurrence of cancer. It is our commitment. I do not want to go in for cosmetic changes, it is a holistic approach. And for that, we have to go into the details. It can be done by faculty members, who have been doing it for years together. We are committed to a holistic approach as well as pictorial warnings. We have to respect Parliament also.

We have just constituted a syllabus for children because I always say ‘catch them young’. Maximum tobacco is sold near schools. It’s a fact. Children experiment there. If the child is sensitised at that point of time with pictorial warnings, that’s where it is needed.

APURVA: In the last few years, there has been a debate about radiation from mobile towers. But we don’t have a real picture on what the problem is.

At this point of time, I don’t have any information about this. But this is a very important area of concern, and if there is such a concern, we will be taking care of it. The ICMR (Indian Council for Medical Research) must be doing something.

ABANTIKA GHOSH: The stroke programme (Tele-stroke programme) in Himachal Pradesh is pathbreaking. Do you plan to replicate it at the national level?

We are trying to examine whether we can go forward with the programme at an all-India level or not. But if it’s possible, we will certainly do it. From 32 per cent, the budget from the Centre to states has increased to 42 per cent. There must be rightful utilisation of this budget.

What we have done is we’ve told all states to replicate this and whatever is needed, we will take care of it.

SHALINI NAIR: There have been reports of the cost of essential drugs such as for cancer, tuberculosis etc going up. What is the Centre doing to counter such criticism?

But these reports are wrong. In fact, the prices are decreasing. What had happened is that the western countries wanted an oversight of the Indian pharmaceutical industry and the Indian pharmaceutical industry has done tremendous work not only in India, but even in the African countries. We saw to it that there was no oversight of India and other countries as well, and we have tried to align drug policies in such a manner that prices do not increase. If there is need for any other intervention, we will do that too. As far as pricing by pharmaceutical industries is concerned, we are in close coordination with them to see to it that prices of drugs don’t increase, but decrease.

UNNI RAJEN SHANKER: We recently did a series on the situation in government hospitals in Delhi. The kind of work hours that the doctors are told to put in, endless shifts, no facilities. Then, there are private hospitals looking to attract talent from the government sector. How do you tackle a situation like this?

I am very clear about it. The first thing is that I want the doctors to be substituted at the primary (health centre) level; others should also be involved there. Until the pressure doesn’t reduce there, these areas will not have the condition for doctors to work. Right now, there is a shortage of doctors and wherever they go, as a result of the shortage, they have to work overtime. Patient rush is also there because primary and tertiary care hasn’t been given attention. When we strengthen this system — it wasn’t taken care of earlier and now we are doing it through the NHM (National Health Mission) — then the number of people will decrease and the doctor strength will increase, their condition will improve and they will be able to perform better.

COOMI KAPOOR: Why has the Aam Aadmi Party linked your name to the removal of Sanjiv Chaturvedi as chief vigilance officer from AIIMS?

I would not like to say anything about why they have done it. Frankly speaking, the issue was brought to me as an MP. Itna hi hai, isse zyaada humara kuchch hai nahin (That’s all there is to it). That is why I closed this chapter, because I didn’t want to get into these types of interactions…altercations…that’s not what I want. He is an officer and whatever opinion was given to me, I had forwarded it. Nothing more than that.

COOMI KAPOOR: Some laboratories have come out with stringent proformas against Maggi, whereas in England, tests have shown there’s nothing wrong with the noodles. Do you think there was something wrong with our labs or are the foreign labs wrong?

This case is now in the Bombay High Court so I would not like to go into the details. Two or three brands were in the market without permission, and the rest withdrew on their own, without reason. Our circular said that you may withdraw because they (these products) are unsafe. This is the only difference. We do not want to discourage (brands), but things need to improve. We told some brands to withdraw because they were unsafe according to our laboratories.

UNNI RAJEN SHANKER: This is not Maggi specific, but Food Processing Minister Harsimrat Kaur Badal has said that “a fear situation is being created by this action.. (with brands withdrawing products)”.

We had a discussion with them. Actually everybody is representing the concerns of their ministry and I take their concerns into view. But, at the same time, standards have to be maintained, so we are maintaining our balance. I had a talk with Harsimratji, with our officers, which will continue.

SARAH HAFEEZ: When will the draft national health policy be finalised? Also, are we doing anything to subsidise rates of branded medicines?

For branded drugs in private hospitals, we are coming with a regulatory mechanism. We are also taking help from the Digital India programme, because we are trying to bring the scheme. With digitalisation, we will be able to see to it which patient had what problem and what was the prescription given to him. Here we will will also take care of the drug aspect. As far as the health policy is concerned, there are some 5,000 suggestions and we are working on it. Within a month or two we will be clear with it, and by the year end, we will be coming up with the health policy.

ABANTIKA GHOSH: Do you plan to put a cap on the prices of drugs, diagnostics, surgeries etc?

Not cap, but of course, we would like to regulate it. What happens when you put a cap is that a patient may not get access to more facilities, beyond the cap. But there is a mechanism which needs to be developed.

RAJ KAMAL JHA: Since 1992, parallel with economic reforms, there has been no big government success story in health. More and more people turn to the private sector for treatment in cities and towns. How do you see this playing out?

There are two things here. As far as public health care goes, there have been many success stories in AIIMS Delhi. But there is a difference in attitude. When such things happen in the private sector there is a lot of talk about it, but when it comes to AIIMS, people feel such success stories always happen here. As for public-private partnership, we are open to it. We are having discussions with people who are leaders in private health care, we have asked them to develop a concept paper on their ideas, develop a model as to how they intend to go forward. But there is one thing that we need to keep in mind here —what is the profit angle? Because there is a large difference in the thinking of the private companies and government.

AJAY SHANKAR: There are so few nursing schools in India when there are so many young women or men who could work in the sector.

Yes, that is also another sector we can work in. There are more than 100 categories other than nursing and paramedics in health sector. Even stretcher carriers need skills, the ones we have now take patients as if they are carrying a load. So, we have signed an MoU for 37 categories. This will also help in employment while improving health facilities.

APURVA: You said there needs to be a targeted, more focused approach to stabilise population. Could you elaborate on that..?

I asked states to strategise. We have been able to stabilise (population) in 24 states, six are left, but they are major states like Uttar Pradesh, Bihar, Rajasthan, parts of Uttarakhand also. Our approach is very clear, we will have to go about it in mission mode. Like if figures in 205 districts improve, then the country’s indicators also improve. The same is true for family planning as well.

ABANTIKA GHOSH: The Prime Minister has backed a lot of causes, like Swachh Bharat, Beti Bachao, Beti Padhao. Will he do it for population control as well?

We will first develop a good programme, and then accordingly we will ask him. The plan needs to be ready. So far there have just been discussions. Once we are ready with the plan we can request him.

APURVA: There are elections coming up in several states. Do you see the AAP as a force in these states?

I find the Bharatiya Janata Party to be a force, and see it coming on top.

APURVA: Air pollution in Delhi has reached extremely high levels. If you look at the NCR, the pollution levels are astronomically high. This is a health issue too. Is the government taking any steps in this regard?

We are working with the Ministry of Environment. Actually it is an inter-sectoral approach. First we need to look at sensitisation and then we need to improve the regulatory mechanism, which cannot be done by just one ministry. So, we are collaborating with the Ministry of Environment. They have some very good suggestions.

AMITABH SINHA: There has been no increase in the health budget for three years. You have planned such big projects, where will the money come from?

There is no problem of money, there is no budget cut. We have already increased the budget from 32 per cent to 42 per cent. What has this extra 10 per cent been given for? Health is a state subject. This extra 10 per cent is not for paying salaries but to improve health programmes. The money has reached them, but nobody is talking about it. I have just travelled to the Northeast, I don’t remember the exact percentage, but a large chunk of money has not been spent. I sent a letter to Himachal Pradesh asking them about their plan.

Programme implementation plans can’t be made in air, they need a lot of work. We have enough money, there is still money. But there needs to be expenditure too. There is no question of cut in the budget.

AVISHEK G DASTIDAR: Do you think your government is constantly battling the perception that it has been high on promises and low on delivery?

No, we are high on delivery. The first stage of delivery is the programme, policies etc. For the implementation stage, we have laid the foundations in everything. Things have been pathbreaking in terms of policies. Changes have to be broad… we have taken so many initiatives, we are trying to develop a mechanism that we see to it that we go forward. Like in public health, we have taken it for granted that only 65 per cent of people have been immunised. To reach the target of 90 per cent, we need to take special steps and go into mission mode. Regulatory mechanism needs to be strengthened, that has also been decided, all this has been done in a year. Regulatory mechanism for drugs and for food… a good project has been developed. We now need the sanctions and we will proceed rapidly.

So we have laid the foundation for things, and that is why we say “saal ek shuruat anek”. The work has begun.