Meghalaya Hospitals too should take initiatives for empanelment under Modicare

Written by Meghalaya Times. Posted in Editorial

Thomas Lim
The National Health Agency (NHA) on July 4, 2018 called on Public and Private Hospitals to get empanelled under the Ayushman Bharat programme, popularly known as Modicare, with the motto of service to mankind to achieve universal health coverage. The objective of the project is to improve access for the most vulnerable, unreached sections of the population and holistically address healthcare by covering prevention, promotion and ambulatory care at primary, secondary and tertiary levels.
NHA and Ayushman Bharat CEO Indu Bhushan while calling upon the stakeholders to partner with the mission through the empanelment process initiated on July 4 to enhance the accessibility, also urged the healthcare service providers to join the revolution in spirit and deed. Bhushan also requested the governments of all states and Union Territories to help the Ayushman Bharat - National Health Protection Mission (AB-NHPM) in garnering the support of hospitals and healthcare providers across the country for the path-breaking mission.

Regarding the advantages of empanelment, Ayushman Bharat Deputy CEO Dinesh Arora clarified that the mission provides financial protection to 10.74 crore deprived rural families and identified occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data. It provides a cover for cashless hospitalization services of up to Rs 5 lakh per family per year.
However, facilities undertaking defined speciality packages will be required to satisfy additional requirements.  Specific criteria are outlined for cardiology and cardio-thoracic vascular services, cancer care, neurosurgery, burns, plastic and reconstructive surgery, neonatal/paediatric surgery, polytrauma, nephrology and urology surgery.
The State Health Agencies (SHA) will start empanelling private and public healthcare service providers and facilities through State Empanelment Committees (SEC). At the district and block level, workshops will be held to brief on empanelment criteria, packages, processes and queries.
Meghalaya does not have proper facilities especially the specific criteria mentioned and in most cases, patients are referred to outside, which further escalates the cost of treatment which many cannot afford.  It is also reported that the number of Indians suffering from chronic kidney ailments has doubled in the past 15 years, and at present 17 in every hundred citizens suffer from some form of kidney disease. The experts noted that several Indian population-based studies in the past estimated that some 150-230 persons are suffering from End-Stage Kidney Disease (ESKD) in every million people, and about 2,20,000-2,75,000 new patients need Renal Replacement Therapy (RRT) every year.
The exact burden of chronic kidney diseases in India is still undefined, but its approximate prevalence is said to be 800 per million people (pmp). Consultant for Nephrology at Max Super Specialty Hospital, Sudeep Singh Sachdev, elaborating on kidney problems in children said early detection is necessary for a healthy lifestyle in children to combat preventable kidney damage that may include acute kidney injury.
Sachdev further clarified that difficulty in gaining weight for the child and poor growth, frequent body aches, urination difficulty or longer time in urinating, swollen face, legs, ankles while getting up in the morning are few symptoms of kidney problems.
According to nephrologist of Ram Manohar Lohia Hospital, Piyush Rastogi, change in lifestyle is the major cause of the rising kidney disorders. Lesser fluid intake, smoking, excess intake of medicines and drugs and salt intake are the reasons contributing to the rising chronic kidney diseases, because too much of sodium can lead to hypertension, so cutting down on salt intake is better. About 1.5 to 2.3 grams daily is the prescribed amount of salt intake. Healthy fluid intake is necessary for children, especially water, to avoid kidney problems.
Besides medication, most doctors suggest dialysis for kidney problems. According to doctors, only 300-400 dialysis centres are currently available in India. With 1,500 nephrologists in metro cities treating kidney patients, more than 60 per cent of the patients do not receive any medical attention in time. Only four per cent of the patients get a donor.
The number of patients undergoing dialysis in India is also increasing by 10-15 per cent every year, which majorly includes children too. Not much importance is given to kidney disorders as it is still under-the-radar condition, informed Sudeep Singh Sachdev.
According to the Health Ministry, 2,000 new dialysis centres will be set up at district-level hospitals in the country within the next two years, underlining the gravity of the problem. In the Budget session 2016, central government has slashed down the cost of dialysis machine such that proper healthcare to Kidney patients can be given on time.
In Meghalaya, chronic kidney ailments too are increasing, most of the hospitals in the urban sector have installed dialysis units, while such services are yet to be extended in the rural sector. The small units set up in the urban hospitals are in the absence of the supervision of nephrologists and lack professional technicians to mend the machines. There is a sudden rise in demand for the dialysis and most hospitals are facing manpower deficiency. The process of dialysis is still very new for many patients here in the state.
As mentioned, due to shortage of nephrologists, and semi to untrained technicians, most of the chronic kidney ailment patients are rushing to Guwahati, double the number to Delhi and huge number to Vellore. Being a continuous treatment, many have to come back home to continue the treatment.
Other specialized doctors are suggesting home dialysis, as the hospital does not have nephrologists, and qualified dialysis technicians; the doctor will even provide the contact person and the company who will sell the machine to the needy for a commission.
In Meghalaya, very few can afford a kidney transplant, so they have become dependent on the dialysis process. While in the other states, organ transplant is as common as the dialysis unit. It was reported that after the Nepal earthquake, many survivors hit by poverty are selling their kidney for survival, while here in Meghalaya, sudden rise of missing cases is feared to be the handy work of the illegal organ trade to meet the ever increasing market outside, there are even suspicions that many doctors are involved in this racket.
As the process of dialysis is an expensive one, the state government should regulate the cost of treatment, such that even the economically weaker section of the society could avail dialysis which has now become a common modern need.
The Health Department should also conduct inspection if the dialysis units in hospitals are being operated by professionally trained technicians and not simply deputing some nurse to operate the machines under the supervision of doctors and not nephrologists. Such negligence of medication is a serious crime.
The Meghalaya Health Minister, should instruct the Directorate of Health Services to take advantage of the Modicare and instruct all the hospitals to initiate getting empanelled under the mission to make health care accessible for all sections of the society.


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