Cancer Patients in the Country
As informed by Indian Council of Medical Research, the estimated incidence of cancer patients in the country for the year 2016 is 1451417. As reported by ICMR as per “Consolidated Report on Hospital Based Cancer Registry: 2012-14”, it is estimated that approximately 17% patients report when the disease has spread throughout the body which is the end stage of disease There have been different opinions among experts regarding declaring cancer as a notifiable disease. The Government of India does not propose to declare Cancer as a notifiable disease. The National Cancer Registry Programme is already implemented by National Centre for Disease Informatics and Research (NCDIR), Bengaluru, under the aegis of Indian Council of Medical Research. The data made available is sufficient for the programme and policy related to Cancer prevention and control in the country. Central Government supplements the efforts of the State Government for improving healthcare including prevention, diagnosis and treatment of Cancer. The objectives of National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) being implemented under National Health Mission (NHM) for interventions upto district level include awareness generation for Cancer prevention, screening, early detection and referral to an appropriate level institution for treatment. The focus is on three types of cancer namely breast, cervical and oral cancer. Operational guidelines for implementing population wide screening of common cancer viz. breast, cervical and oral cancer have been issued to the State Governments. The guidelines include screening for the risk factors of cancer among common Non-Communicable Diseases (NCDs). Such screening will also spread awareness on the risk factors of common NCDs including cancer. The Government of India is implementing “Tertiary Care Cancer Centre” Scheme to assist to establish/set up State Cancer Institutes (SCI) and Tertiary Care Cancer Centres (TCCC) in different parts of the country. Oncology in its various aspects has focus in case of new AIIMS and many upgraded institutions under Pradhan Mantri Swasthya Suraksha Yojna (PMSSY). Setting up of National Cancer Institute at Jhajjar (Haryana) and 2nd campus of Chittranjan National Cancer Institute, Kolkata has also been approved. All these will enhance the capacity for prevention and treatment of cancer in the country.
The Minister of State (Health and Family Welfare), Smt Anupriya Patel stated this in a written reply in the Rajya Sabha here today.
Cancer Treatment for Economically Weaker Section
The cost of treatment of Cancer depends on various factors including, inter alia, the stage of diagnosis, type and site of cancer, type of treatment etc. The treatment of Cancer in many of State and Centre Government institutions is free for BPL patients and subsidized for others. The Central Government supplements the efforts of the State Governments to prevent and control cancer. Some of the steps taken by Central Government are as follows: (i) Implementation of National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) upto district hospital level. Further, the guidelines for population level screening of common cancer viz. Cervix, Breast and Oral have been released to the State Governments for implementation. (ii) To enhance the facilities for tertiary care of cancer, the Central Government is implementing a Tertiary Care Cancer Centre Scheme to support the setting up of State Cancer Institutes (SCI) and Tertiary Care Cancer Centres (TCCC) in different parts of the country. 13 TCCCs and 11 SCIs are approved till date. (iii) Supporting Cancer care under new AIIMS and State Government Medical Colleges being upgraded under Pradhan Mantri Swasthya Suraksha Yojna (PMSSY). (iv) Setting up of 2nd campus of Chittaranjan National Cancer Institute, Kolkata and setting up of National Cancer Institute (NCI), Jhajjar as part of second campus of AIIMS, New Delhi has been approved. (v) The Government is providing financial assistance to patients living below poverty line for life threatening diseases under the schemes such as Rashtriya Arogya Nidhi (RAN), Health Minister’s Cancer Patient Fund (HMCPF), State Illness Assistance Fund (SIAF) and Health Minister’s Discretionary Grant (HMDG). (vi) Affordable Medicines and Reliable Implants for Treatment (AMRIT) outlets have been opened at 41 Institutions/Hospitals with an objective to make available Cancer and Cardiovascular Diseases drugs and implants at discounted prices to the patients. Jan Aushadhi stores are set up by Department of Pharmaceuticals to provide generic drugs at affordable prices. (vii) The list of medicines specified in the National List of Essential Medicines (NLEM) which are included in the First Schedule of Drug Pricing Control Order (DPCO), 2013 also contain drugs used for the treatment of Cancer for which ceiling prices have been fixed. The Minister of State (Health and Family Welfare), Smt Anupriya Patel stated this in a written reply in the Rajya Sabha here today.
MRI Scanning Facilities for BPL Families
As per the provisions of Indian Medical Council Act, 1956, the Ministry receives applications for starting new Medical Colleges and forwards them to the Medical Council of India (MCI) for making recommendations. The MCI after making necessary scrutiny/assessment of the Colleges makes recommendations to the Central Government. In case MCI sends recommendation for disapproval, the Ministry grants an opportunity to the applicant colleges before taking a decision. The last date for sending recommendations by MCI is 30.04.17 and for issuing permission by the Central Government is 31.05.17 for the academic year 2017-18. The applications received for the year 2017-18 are at different stages of processing. The Minister of State (Health and Family Welfare), Sh Faggan Singh Kulaste stated this in a written reply in the Rajya Sabha here today.
Health Insurance for all
As per World Health Organization (WHO), Out of Pocket expenditure as percentage of total expenditure on health in India was 62% in 2014. India ranked 182 out of 192 countries in terms of Out of Pocket expenditure as percentage of total health expenditure. Presently Ministry of Health and Family Welfare is implementing Rashtriya Swasthya Bima Yojana (RSBY), a centrally sponsored health insurance scheme which covers BPL families (a unit of five) and 11 other defined categories namely Building & Other Construction Workers, licensed Railway porters, Street Vendors, MGNREGA workers (who have worked for more than fifteen days during preceding financial year), Beedi workers, Domestic workers, Sanitation Workers, Mine Workers, Rickshaw pullers, Rag pickers and Auto/Taxi drivers, who are enrolled under RSBY. They are entitled for cashless health insurance coverage of Rs.30,000/- per annum per family. Senior Citizen’s Health Insurance Scheme (SCHIS) for Senior Citizens of age 60 years and above, belonging to above said categories has also been implemented w.e.f. 01.04.2016 on top of RSBY. The health coverage is upto Rs. 30,000/- per annum per senior citizen for treatment packages, over and above RSBY entitlement. The Minister of State (Health and Family Welfare), Smt Anupriya Patel stated this in a written reply in the Rajya Sabha here today.
Legal Framework for E-Pharmacy Business
In view of the concerns raised on the sale of drugs over internet, the Drugs Consultative Committee (DCC) in its 48th meeting held on 24th July, 2015, constituted a sub-committee to examine the issue of sale of drugs on internet. The Sub-Committee, in its report, has inter alia recommended:-
- Creation of a National Portal to act as the nodal platform for transacting and monitoring online sale of drugs.
- Necessity of evolving a mechanism to register e-pharmacies.
- Geographical restrictions for operation of e-pharmacies.
- Mechanism for verification of authenticity through a link to the National Portal.
- Existing licensees carrying out retail sale of drugs would also be able to register on the National Portal for carrying out online sale of drugs.
- As certain categories of drugs viz. the Narcotic and Psychotropic drugs, tranquilizers, habit forming drugs and Schedule X drugs that are prone to being abused or misused to be excluded from sale through e-pharmacies.
- Amendment of Drugs & Cosmetics Rules, 1945 for effective monitoring and proper enforcement of the Drugs & Cosmetics Act, 1940 for achieving its aims and objectives. Any sale of medicine in the country continues to be regulated as per provisions of the Drugs and Cosmetics Rules, 1945 as amended from time to time. In terms of the provisions of the said Rules, drugs specified in Schedules H, H1 and X cannot be sold except on, and in accordance with the prescription of a Registered Medical Practitioner from a licensed premises. Therefore, any sale of such drugs other than from a licensed premise is not in conformity with these rules. Further, other requirements such as noting the name and address of seller and date on which medicines are dispensed can also not be met in many cases.
Currently, e-pharmacies which do not meet the requirements of Drugs and Cosmetics Rules, 1945 including those relating to sale from a licensed premises and maintaining necessary records, are not permitted.The Minister of State (Health and Family Welfare), Sh Faggan Singh Kulaste stated this in a written reply in the Rajya Sabha here today.
Decline in Healthcare Expenditure
A statement showing public health expenditure on health as percentage of GDP in India vis-à-vis select developed/developing countries for 2012, is given below:
Statement showing Public expenditure on health as percentage of Gross Domestic Product (GDP) in respect of some select developing/ developed countries.
S/No. Name of Country Public expenditure on health as percentage of GDP – 2012
1 Bangladesh 1.12 2 China 3.02 3 India 1.16 4 Indonesia 1.19 5 Kuwait 2.15 6 Malaysia 2.21 7 Oman 2.17 8 Pakistan 1.03 9 Peru 2.86 10 Sri Lanka 1.21 11 Thailand 3.58 12 United Kingdom 7.81 13 United States of America 7.99 14 Russian Federation 3.32 15 Spain 6.67
Source: World Health Statistics 2015 published by World Health Organization
As per Economic Survey 2016-17 brought out by Ministry of Finance, expenditure by Government (Central and State Governments combined) on health as percentage of Gross Domestic Product (GDP) for last three years and current year is as under:
(i) 2013-14 – 1.2 %
(ii) 2014-15 – 1.1%
(iii) 2015-16 – 1.3% (RE)
(iv) 2016-17 – 1.4 % (BE)
The Draft National Health Policy 2015 envisages raising public health expenditure progressively to 2.5% of the GDP.
Public health and hospitals is a state subject. However under NHM, Government provides technical and financial support to states to strengthen their healthcare system.National Health Mission (NHM) implementation framework seeks to achieve health goals through strengthening state health systems, facility based service delivery, expanding the outreach services, strengthening community The processes, addressing social determinants of health, providing social protection against cost of care through provision of free drugs, diagnostics, diet and transport; and building a robust health management information system.To ensure proper utilization of funds and to provide health care facilities to all the citizens of the country, the Government has taken several steps including, inter-alia :Organizing periodical review meetings/Joint Monitoring Missions, conducting external surveys, undertaking Common Review Missions (CRM) on annual basis, conducting monthly concurrent audit and annual audit of the State/District Health Societies, Performance Audit by CAG, Mid-Term Appraisal by Planning Commission (Now NITI Aayog) etc.The Minister of State (Health and Family Welfare), Smt Anupriya Patel stated this in a written reply in the Rajya Sabha here today.