Discussion on 'Sustainable Dialysis Care Ecosystem in the North-East Region (NER)' held in Guwahati

STAFF REPORTER

GUWAHATI: Pradhan Mantri National Dialysis Program (PMNDP) was announced by the Ministry of Health & Family Welfare in 2016 under the National Health Mission (NHM). The PMNDP aims at strengthening District Hospitals by providing affordable dialysis services. The first phase of the program was envisaged for the setting up of haemodialysis centres across all the districts of the country.

Every year about 2.2 lakh new patients with the end-stage renal disease get added in India resulting in additional demand for 3.4 crore dialysis each year. As per a study in 2016, "Health of the Nation's States: India State-Level Disease Burden", NCDs accounted for nearly 61.8 per cent of the total deaths, while communicable, maternal, and nutritional diseases caused 27.5 per cent of deaths. However, the proportion of total disease burden for NCDs amongst the NER states ranged from 51.2% to 57.5% in 2016 as per the said report. Chronic kidney disease was one of the top 10 diseases causing Years of Life Lost (YLL).

The North-East Region (NER) traditionally suffers from a poor supply chain due to connectivity and transportation issues. Non-availability of a favourable dialysis ecosystem in the Northeast may be due to various factors like lack of Nephrologists, poor supply chain regarding equipment & consumables, lack of trained staff (dialysis technicians), poor after-sales service/spare availability etc.

In this regard, a brainstorming session at Guwahati with all stakeholders from Northeast states and private service providers engaged in the delivery of dialysis services in the country was undertaken. Vishal Chauhan, Joint Secretary (Policy), MoHFW, Government of India deliberated upon the different issues related to NER. He also emphasized that funding is not a problem; if there is a need for the fund for site preparation for the dialysis centres, the fund in the NHM pool can be utilized and also get eligible for further release of funds.

Vishal Chauhan further reiterated that the objective of the meeting is to develop a sustainable dialysis care ecosystem in the NER with the help of private service partners in the Public-private partnership model. States/UTs are supported by MoHFW under the National Health Mission for implementation of the Pradhan Mantri National Dialysis Programme (PMNDP) at all the District Hospitals. All BPL patients are getting free of cost dialysis services under PMNDP.

The availability of nephrologists and proximity to multi-speciality hospitals are other parameters to consider as Chronic Kidney Diseases (CKDs) patients are usually in a fragile state of health and the likelihood of any life-threatening emergency arising anytime needs to be addressed.

A huge opportunity exists in NER in providing reliable dialysis services for all and in ensuring better accessibility.

The number of dialysis patients is increasing as a greater number of dialysis centres are established in the State. Nearly 14,500 new patients with CKD had been registered in the different public Dialysis Centres in NER from April to October 2022 and 1.40 lakh dialysis sessions have been conducted in addition to the services availed at the private sector. A Central Registry will be of immense help.

Moving towards the Central Registry and for the maintenance of health records of patients, ABHA (Ayushman Bharat Health Account) number is a 14-digit number that will uniquely identify a patient in India's digital healthcare ecosystem. A portal for creating a state registry using ABHA IDs is already operational which offers visibility and portability for the dialysis patient to avail of dialysis free of cost in any district of the state in case a vacant slot is available. This concept of 'One State-one Dialysis' will eventually progress to 'One Nation-One Dialysis' in the country.

Assam, Sikkim and Tripura are expected for providing dialysis services in all the districts by 2022-23 but still lagging in the other five North Eastern States viz. Arunachal Pradesh, Manipur, Meghalaya, Mizoram, and Nagaland. At present nine district out of 25 in Arunachal Pradesh, 26 out of 33 districts in Assam, 9 out of 16 in Manipur, 3 out of 11 in Meghalaya, 4 out of 9 in Mizoram, 3 out of 12 in Nagaland, 3 out of 4 Sikkim and 7 out of 8 districts in Tripura PMNDP are available to cater dialysis services in the States. In the NER, the programme is being implemented in 72 Public Health facilities across 64 districts with the deployment of 400 machines as of October 2022.

Arunachal Pradesh and Assam have implemented the programme through Public Private Partnership and Tripura has implemented it in a mixed model, and the State of Manipur, Meghalaya, Nagaland, and Sikkim have implemented it in an In-house mode.

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