Free medicines for all from October

June 24, 2012

Manmohan_MedicineNew Delhi, June 24: India's ambitious policy to provide free medicines to all patients attending a government health facility across the country will be rolled out from October.

Strongly backed by Prime Minister Manmohan Singh himself, the free-medicines-for-all scheme — being referred to as the "real game changer" — has received its first financial allocation of Rs 100 crore from the Planning Commission for 2012-13.

The entire programme, however, is estimated to cost Rs 28,560 crore over the 12th five year plan.

At present, the public sector provides healthcare to 22% of the country's population.

The ministry estimates that this will increase to 52% by 2017 once medicines are provided for free from 1.6 lakh sub-centres, 23,000 primary health centres, 5,000 community health centres and 640 district hospitals.

The ministry has sent the National List of Essential Medicines, 2011, (348 drugs which includes anti-AIDS, analgesics, anti-ulcers, anti psychotic, sedatives, anesthetic agents, lipid lowering agents, steroids and anti platelet drugs) to all the states to use as reference.

The states, however, have been asked to create their own Essential Drugs List (EDL), keeping in mind the diseases that worst affect them. Around 75% of the funds under the scheme will be borne by the Centre, while the rest will be the state's responsibility.

Around 5% of the district funds will be allowed to be used to purchase drugs outside the EDL. The Cabinet has approved the setting up of a Central Procurement Agency (CPA) for bulk procurement of drugs.

The PMO has asked the ministry to set up the CPA as early as possible. At present, 78% of the entire health expenditure in India is from out of pocket (OOP). Purchasing drugs alone accounts for 72% of this OOP expenditure.

Additional secretary in the ministry L C Goyal said a scientific committee will have to draw up the EDL list for the states.

They have also been asked to devise standard treatment protocols in order to avoid unnecessary and irrational treatments.

Goyal said, "The states will procure drugs directly from manufacturer or importer through an open tender. Companies applying for the tenders will have to have GMP compliance certificate, a no conviction certificate and should have a specified annual turnover. The drugs must carry a not-for-sale label printed on the packaging."

He added, "We plan to roll out the game changing programme from October."

Goyal said a district-level state-of-the-art warehouse will have to be set up by states to store the drugs and a passport driven system will move the medicines to district hospitals, CHCs and PHCs will then send the drugs to the sub centres.

He added, "It is being made mandatory for all doctors in the public sector to prescribe generic drugs and salt names and not brands. Action will be taken against doctors found prescribing brands."

Tamil Nadu has been providing free medicines in its public health centres for the past 15 years, while Rajasthan introduced it last October. Both these states have a corporation that runs the show with complete functional autonomy.

A Planning Commission panel had said drug prices have shot up by 40% between 1996 and 2006. It said that during the same period the price of controlled drugs rose by 0.02%, while those in the EDL increased by 15%. The price of drugs that were neither under price control, nor under the EDL grew by 137%.

The Commission says 39 million Indians are pushed to poverty because of ill health every year. Around 30% in rural India didn't go for any treatment for financial constraints in 2004. In urban areas, 20% of ailments were untreated for financial problems the same year. About 47% and 31% of hospital admissions in rural and urban India, respectively, were financed by loans and sale of assets.

States have cut down on spending to purchase drugs, adding to aam aadmi's woes. A study by the Public Health Foundation of India recently found that while India's per capita OOP expenditure to pay for healthcare costs has gone up from Rs 41.83 in 2005 to Rs 68.63 in 2010, the per capita spending on drugs increased from 29.77% to 46.86% during the same period, while hospitalization costs went up from 11.20% to 22.47%.

Outpatient expenditure also increased from 30.63% to 46.16%. Catastrophic spending, or percentage of households spending more than 10% of their overall income on healthcare, is nearly 15% in states that have insurance in place as against 11% in states that lack such policies.

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Agencies
June 6,2020

United Nations, Jun 6: The coronavirus disease has not "exploded" in India, but the risk of that happening remains as the country moves towards unlocking its nationwide lockdown that was imposed in March to contain the Covid-19, according to a top WHO expert.

WHO Health Emergencies Programme Executive Director Michael Ryan on Friday said the doubling time of the coronavirus cases in India is about three weeks at this stage.

“So the direction of travel of the epidemic is not exponential but it is still growing,” he said, adding that the impact of the pandemic is different in different parts of India and varies between urban and rural settings.

“In South Asia, not just in India but in Bangladesh and...in Pakistan, other countries in South Asia, with large dense populations, the disease has not exploded. But there is always the risk of that happening,” Ryan said in Geneva.

He stressed that as the disease generates and creates a foothold in communities, it can accelerate at any time as has been seen in a number of settings.

Ryan noted that measures taken in India such as the nationwide lockdown have had an impact in slowing transmission but the risk of an increase in cases looms as the country opens up.

“The measures taken in India certainly had an impact in dampening transmission and as India, as in other large countries, open up and as people begin to move again, there's always a risk of the disease bouncing back up,” he said.

He added that there are specific issues in India regarding the large amount of migration, the dense populations in the urban environment and the fact that many workers have no choice but to go to work every day.

India went past Italy to become the sixth worst-hit nation by the COVID-19 pandemic.

India saw a record single-day jump of 9,887 coronavirus cases and 294 deaths on Saturday, pushing the nationwide infection tally to 2,36,657 and the death toll to 6,642, according to the health ministry.

The lockdown in India, was first clamped on March 25 and spanned for 21 days, while the second phase of the curbs began on April 15 and stretched for 19 days till May 3. The third phase of the lockdown was in effect for 14 days and ended on May 17. The fourth phase ended on May 31.

The country had registered 512 coronavirus infection cases till March 24.

The nation-wide lockdown in containment zones will continue till June 30 in India but extensive relaxations in a phased manner from June 8 are listed in the Union home ministry's fresh guidelines on tackling the Covid-19 pandemic issued last week.

WHO Chief Scientist Soumya Swaminathan said the over 200,000 current coronavirus cases in India, a country of over 1.3 billion people, "look big but for a country of this size, it's still modest.”

She stressed that it is important for India to keep track of the growth rate, the doubling time of the virus and to make sure that that number doesn't get worse.

She said that India is a “heterogeneous and huge country” with very densely populated cities and much lower density in some rural areas and varying health systems in different states and these offer challenges to the control of Covid-19.

Swaminathan added that as the lockdown and restrictions are lifted, it must be ensured that all precautions are taken by people.

“We've been making this point repeatedly that really if you want behaviour change at a large level, people need to understand the rationale for asking them to do certain things (such as) wearing masks,” she said.

In many urban areas in India, it's impossible to maintain physical distancing, she said adding that it then becomes very important for people to wear appropriate face coverings when they are out, in office settings, in public transport and educational institutions.

“As some states are thinking about opening, every institution, organisation, industry and sector needs to think about what are the measures that need to be put in place before you can allow a functioning and it may never be back to normal.”

She said that in many professions working from home can be encouraged but in several jobs, people have to go to work and in such cases measures must be put in place that allow people to protect themselves and others.

“I think communication and behaviour change is a very large part of this whole exercise,” she added.

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Agencies
June 11,2020

New Delhi, Jun 11: India on Thursday rejected a US government report that voiced concerns over alleged attacks and discrimination against religious and ethnic minorities in the country.

"Our principled position remains that we see no locus standi for a foreign entity to pronounce on the state of our citizens' constitutionally protected rights," Spokesperson in the Ministry of External Affairs Anurag Srivastava said.

He was replying to a question on the report at an online media briefing.

Mandated by the US Congress, the '2019 International Religious Freedom Report' that documents major instances of violation of religious freedom across the world was released by Secretary of State Mike Pompeo on Wednesday.

"India's vibrant democratic traditions and practices are evident to the world. The people and government of India are proud of our country's democratic traditions," the spokesperson said.

"We have a robust public discourse in India and constitutionally mandated institutions that guarantee protection of religious freedom and rule of law," he added.

The India section of the report said that US government officials underscored the importance of respecting religious freedom and promoting tolerance and mutual respect throughout the year with the ruling and opposition parties, civil society and religious freedom activists, and religious leaders belonging to various faith communities.

The report referred to the revocation of the special status of Jammu and Kashmir last August and the passage of the Citizenship Amendment Act (CAA) in Parliament in December as major highlights for India last year.

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News Network
February 9,2020

Mumbai, Feb 9: Given the slow progress on the ongoing Rs 38,000-crore capacity expansion at the four largest metro airports, and also the surging traffic, the snaky queues will continue at least till 2023, warns a report.

The four largest airports -- New Delhi, Mumbai, Bengaluru and Hyderabad -- handle more than half of the traffic and are operating at 130 per cent of their installed capacity. These airports are under a record Rs 38,000-crore capex but the capacity will not come up before end-2023, says a Crisil report.

“With the dip in traffic growth largely behind, we expect congestion at the top four airports of New Delhi, Mumbai, Bengaluru and Hyderabad, which handle more than half of the load, to continue till about FY23,” says the report.

Already these airports are operating at over 130 percent of installed capacity, and the ongoing healthy traffic growth this operating rate is expected to rise further in the next 12 months.

“Operationalising of capacities in the following two fiscals will bring down utilisation levels albeit still high at over 90 per cent by fiscal 2023 and that is despite an unprecedented Rs 38,000 crore capex being undertaken by the operators of these airports over five fiscals 2020-24,” says the report.

Despite this unprecedented capex that is debt-funded, ratings are likely to be stable given the strong cash flows expected due to healthy traffic growth, low project risks associated with the capex and improving regulatory environment, notes the report.

“Capacity at these four airports will increase a cumulative 65 per cent to 228 million annually (from 138 million now) by fiscal 2023. However, traffic is expected to grow strong at up to 10 per cent per annum over the same period. Since additional capacities will become operational in phases only by fiscal 2023, high passenger growth will add to congestion till then,” warn the report.

High utilisation will ride on pent-up demand (accumulated in 2019 as traffic was impacted with the grounding of Jet Airways) and one-off issues with new aircraft of certain airlines.

Further impetus will also come from improving connectivity to lower-tier cities and reducing fare difference between air and rail. Increasing footfalls at airports provide a leg-up to non-aero streams such as advertising, rentals, food and beverage and parking, which comprise around half of the revenue of airports already.

These are expected to grow strongly at over 10-12 per cent, also supported by higher monetisation avenue coming along with current capex. The other half of revenue (aero revenue) is an entitlement approved by the regulator, providing a pre-determined, fixed return over the asset base and a pass-through of costs.

Aero revenue is also expected to get a bump up during fiscals 2022-24, when a new tariff order for airports is likely. Overall aggregate cash flows are likely to double by fiscal 2024 and provide a healthy cushion against servicing of debt contracted for capex, the report concludes.

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