some photographic evidence re my post on FPMS

Fair Price Medicine shops -innovative public policy interventions that worked in West Bengal

Health care expenditure is the largest budget component of family expenditure in our country as share of private expenditure to total expenditure is more than 80 percent. Public expenditure through budgeting in State and Central Govt. planning is still very low and covers expenditure on salaries, capital cost on health infrastructure and recurring expenditure on running health facilities. Expenditure on drugs, investigation and transport is generally paid by patients as Out of Pocket Expenses despite free drug supplies and efforts to provide investigation at subsidised rates in Public hospitals.

There have been several policy interventions by State to reduce OOPE including free and full time course of prescribed medicines in Public hospitals. Model of Fair Price Medicine Shops in West Bengal assures drugs and devices at affordable discount on MRP ranging from 37 percent to 77 percent on mandatory 142 essential and vital molecules in generic composition. There are 94 FPMS running in Public hospital premises where apart from 142 mandatory drugs, stents, orthopaedic devices, JSSK drugs and drugs from National list of Essential Medicines are sold at the same agreed discount rate.

1. FPMS model : Rented space in Public hospitals allotted through competitive bidding based on highest discount offered to sale mandatory and other drugs on generic prescription. Selection was done in a transparent open bidding by a committee of experts. Electricity charges and rent of space at market assessed rates are paid to the hospital on monthly basis. FPMS is free to keep stock beyond mandatory drug list provided the sale is done on fixed discount as agreed in bidding.

2. Monitoring system : all transactions of stock entry,  sale billing and stock out is effected through software developed by the department and all transactions are updated on department server on three hourly basis. There are systems in place to monitor new stock for validation of MRP not exceeding Drug Price Control Order 2013 price cap, no stock in except from manufacturer having General Manufacturing Permit (GMP) and rolling annual turn over above Rs 20 Crores and stock availability. Computer printed Bills are generated through software only where discount is prefixed and can't be modified by shop owner. Daily sale and discount value are captured in central server. There is monitoring and supervision committee at each FPMS comprising of hospital authorities and doctors to ensure that quality, stock and generic prescription based dispensing is done 24x7.

3. Statutory and Non Statutory Medical audit : Mandatory quality control samples are drawn by Director drug control for quality testing in addition to non statutory quality testing through NABL accredited laboratories. Out of 275 samples tested this year, quality of drugs was found standard and ok in 269 cases. This confirms high standards of quality in FPMS. State level teams make frequent visits to FPMS.

4. Generic prescription mandatory : State Government issued orders last year making it mandatory to write generic prescription by doctors. Ethical norms of Medical Councils mandates generic prescription for all doctors registered with them. Generic means name of chemical molecule with composition contains in the drug. For Cetrizine is chemical molecule, zyncet is branded product containing Cetrizine. Some products contain   combination of molecules. For example Mannitol injection containing Mannitol and Glycerin. Now, it has been decided that names of both the molecules to be written in generic formulation for combination drugs also. MRP of drugs depend on generic contents and cost of promotion, marketing strategy and local taxes. There is tendency to prescribe the brands of market leading drug companies where higher commissions/ profit margins are offered to doctors and retailers irrespective of MRP. Naturally, there is tendency to prescribe selective brands instead of generic formulations on the basis of offers. Consumer has to pay the MRP irrespective of actual consumer price as break up of margins to retailer and marketing promotions are never disclosed. Same generic drug consumer cost may vary from 100 percent to 500 percent, though efficacy of both the brands/ drugs containing same composition of generic molecules is the same. For example MRP of MERO brand of Meropenem injection is Rs 2251 whereas Moromonas brand Meropenem injection MRP is Rs 980 and that of leading brands is Rs 600 (approx). All three products are equally effective and contains the same generic molecules. Now, medical marketing promotions will push their brands influencing prescription and retailers margin but consumer has to pay the MRP. Imagine the retailer's price of MERO is Rs 400, that of Moromonas Rs 490 and leading brand is Rs 450. In open market consumer has to MRP but in FPMS consumer pays fixed discount, say 65 percent. So cost of drug will be less than Rs 400 for generic prescription based leading brand or Moromonas whichever the FPMS is selling. Since Meropenem is regulated by DPCO price cap, FPMS is not allowed to stock MERO having higher MRP than Price cap. There are numerous examples of such variations of prices.

Take the example of Mannitol injection. MRP is Rs 98, but branded product released by drug company contains Mannitol plus Glycerin molecules with MRP Rs 150. This does not come under price cap so can be sold at higher consumer price influencing prescription. To prevent such attempts, Orders being issued to make generic prescription mandatory for double combination molecules also.

FPMS model has successfully influenced the prescription and retailer's margins in favour of consumers and has also reduced the pharmaceutical market in favour of consumers. Private Medicine shops forced to sale drugs below MRP reducing retailers margins and of course promotional cost to compete with FPMS.

 5. Results : 94 FPMS are running in West Bengal and 22 more will come up in next three months. Sale of Rs 500 Cr happened thro

Visit to RSBY help desk counter at Diamond Harbour District hospital

RSBY in Government hospitals in West Bengal: There were only 25 Government hospitals under RSBY enlisted to extend cashless indoor treatment services till September 2013. Now, 747 hospitals are enlisted including 127 government hospitals. There are plans to cover all Hospitals up to Block by March 2015.
Rogi Sahayata Kendra, RSK with five Rogi Sahayaks in Government hospitals are very helpful to facilitate admission and free cashless treatment. Diamond Harbour hospital earns Rs 12 lakhs from Insurance Companies by doing RSBY in last 7 months. This amount is adequate enough to take care of RKS expenditure. Happy to interact with RSKs.
Total Rs 15 Crores earned by Government hospitals in last 7 months as against only Rs 2 Crores last year. Private hospitals earned Rs 150 Crores. Hope the proportionate share of Government hospitals is doubled by end of current financial year.

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Mobile Governance to alert bed in charge doctors -MR Bangur hospital shows the way

After successfully launching ePrescription and online admission in selected District hospitals in West Bengal, mobile governance tool has been launched by Swasthya Bhawan to issue sms alerts to specialist doctors about patient details as soon as new patient is admitted.  Server based online admission process has been linked to free sms gateway and system generated alerts are sent to doctor concerned.
This is improved and reliable way of alerting doctors instead of on call communication. There are plans to up scale the initiative.

RSBY in Government Hospitals in West Bengal : Sitai Block Hospital in Cooch Behar claimed Rs 20 lakhs from insurance in last 7 months and extended cashless treatments.

West Bengal started RSBY in Block hospitals after success in Secondary and Tertiary care hospitals. There has been manifold increase in income of Government hospitals from RSBY by providing cashless free indoor treatment supplementing the Rogi Kalyan Samities. With highest number of live smart cards 60 lakhs covering 212 lakhs individual, West Bengal is at the top in the country. 2.51 lakhs got free cashless treatment through network of 747 hospitals claiming Rs 168 Cr in last seven months out of which Rs 130 Cr is settled.
While secondary and Tertiary Hospitals are leading in performance in terms of volume of cases, small block primary hospital of Sitai in Cooch Behar shows the way to others by earning more than many district hospitals. Sitai covered 375 indoor patients under RSBY claiming Rs 20.4 lakhs from Insurance Company during February 2014 to October 2014. This is very good performance of Block level hospital and sets good trend as most of the cases are general medicine unlike surgeries in case of private nursing homes under the scheme. Team of Doctors and health personnel deserves appreciation.
This is great step to achieve self sufficiency to run hospital services without user charges and bed charges and strengthen the efforts of State Policy declared recently. Another hospital,  Haldibari Rural hospital earned Rs 11.18 lakhs from 381 cases during the same period.
While holding review workshops with Bdos and hospitals at CHINUSRAH on 14th November pleased to note that Jangipara Block hospital BMOH also performed quite well under RSBY. There are numerous examples of good performing Government hospitals showing path and good future of the scheme.

West Bengal proposes Additional Transport allowances to RSBY Card holders from remote and inaccesible areas and tertiary care facilties

RSBY scheme provides only Rs 100 per episode of hospitalisation to RSBY smart card holders. West Bengal allowed additional transport allowance of Rs 200 over and above Rs 100 to the RSBY patients getting admission in Government hospitals. After tremendous success of the intervention, proposal is under consideration to further enhance the additional transport allowances for patients from remote & inaccessible areas with difficult terrains like Sunderbans and for all the RSBY cardholders availing indoor services in Medical College & Teaching hospitals. Details follows.

West Bengal starts Online application for Clinical Establishment License and renewal for all Hospitals, nursing homes and diagnosis facilities in Districts

Online application receiving and processing of CE Licenses already started in Kolkata from 1st August 2014 and successfully functioning. System is very helpful to the private health care providers as all documents can be uploaded online and all the process of enquiry, inspection and issue of license are system generated time bound activities. Application is linked to sms and email gateways to keep the applicant updated instantly.
Now, this has been decided to roll out the online facility to all districts of West Bengal from 1st December 2014.
Details at www.wbhealth.gov.in under CE License Section.
There are plans to link online return of reports from health care providers through eFiling only thereby making good use of information.

RSBY supports free medical service delivery abolishing user charges in Secondary and Primary hospitals in West Bengal

RSBY in West Bengal updates

Unprecedented claim improvement in last 6.5 months. 2.20 lakhs patients for cashless surgical treatment worth Rs 145 Crores from April 2014 to October 25th 2014 through network of 745 hospitals spread throughout the state. After successfully starting RSBY in 120 Govt hospitals in last one year, covering all Medical College Hospitals and Secondary hospitals, it has now been decided to enlist all BPHC and Rural Hospitals in next one year. Some BPHCs enlisted last year are doing quite well like Haldibari earned Rs 6 lakhs in 6 months. This decision will provide easy access to healthcare in all blocks of the state.

 

Convergence of RSBY with hospital service supports yielded positive results in the State. RSBY now supports Rogi Sahayata Kendra set up in all Hospitals up to Sub division extending patient care help to patients at help desk counters. RSBY contributes substantially to the efforts of the State Government to provide free medical services and abolition of user charges in Primary and Secondary hospitals of the state as notified this week and all set to provide alternative financial support to Rogi Kalyan Samities of Hospitals. Experience of RSBY in Govt. Hospitals in last one year has been very encouraging. Now, implementation of RSBY in block level hospitals will certainly support Rogi Sahayak Kendra help counters.

 

Affordable and equitable access to healthcare will be a step to move towards Universal Assurance of Health Care to all. Thanks Team RSBY West Bengal for sincere efforts.

Abolition of user charges and bed charges in Primary and Secondary hospitals in West Bengal from today- remarkable decision

West Bengal Government issued orders today withdrawing the user charges for diagnostics, surgeries, therapeutic, hospital charges, treatment costs for drugs, pathology, imaging and bed charges including Cabin charges and CCU charges from all primary and secondary hospitals under Health & Family Welfare department. Abolition of user charges and bed charges is remarkable decision to achieve affordable, equitable access to health care to all and improve easy accessibility as system of paying beds, BPL identity/ income certificate etc are abolished making all services free. 

Copy of orders issued and sent to hospitals today can be downloaded from www.wbhealth.gov.in. Circular being issued to all hospitals to erase wall writings of user charges, bed charges and other charges and rewrite public messages as per new order.

For details

Read FB post 

https://m.facebook.com/story.php?story_fbid=779169025483774&id=364551790278835&ref=bookmark

RSBY to be started in all BPHCs, Rural Hospitals in West Bengal, to be supported by RSKs

After successfully launching RSBY in all Secondary hospitals, Health department of West Bengal today decided to provide RSBY services in all BPHCs and Rural Hospitals having more than 10 functional beds. More than 300 hospitals will be enlisted. 

The model of Rogi Kalyan Samity RSK at secondary hospitals have been very successful in all Government hospitals. Decision has been taken today to engage two Rogi Sahayaks in RSK at BPHC and RH out of administrative cost of RSBY. There are 5 Rogi Sahayaks in each Secondary Hospitals and 8 in each Medical College Hospitals extending their support at Patient Help Desk. 

Convergence of RSBY with hospital services will go a long way in the direction of health care support. 

RSBY in West Bengal covered 2.15 lakhs patients in last six months worth Rs 112 Crores settled by Insurance Companies to 727 enlisted hospitals. There were only 521 hospitals when Health Department took over the scheme and 206 hospitals added in one year that includes 120 Government HOSPITALS. Government hospital collected Rs 13 Crores in last six months and gradually increasing its share. 

West Bengal RSBY is committed to provide quality health care and increased claims.

DNB courses in six district hospitals of West Bengal : 36 seats out of 42 filled, courses started

In earlier blog post, we reported that 22 doctors has joined in six district hospitals in the first round of counselling and 2nd round of counselling is going on.

After second round of counselling, National Board of Examinations have published the list of 14 more candidates in six hospitals of West Bengal. Now, 36 seats have been filled. It is great news and satisfactory response to initiative of Health Department of West Bengal to start DNB courses at District Hospitals. You may read earlier posts about DNB at www.meenaonkar.blogspot.com.

 

Our teams from the department started interacting the doctor students at the hospitals and guiding them about the three years DNB courses.

 

Here is latest status of filling up of seats.

Name of DH/ Speciality	Anaesthesiology	General Medicine	General Surgery	Obstetrics & Gynaecology	Paediatrics	Total filled in DH	Percent seat filled
Asansol DH	1	2	2	1	1	7	100%
Purulia DH	0	2	2	1	0	5	71%
Krishnagar DH	1	1	1	1	1	5	71%
Barasat DH	1	2	2	1	1	7	100%
Howrah DH	1	1	2	1	1	6	86%
Chinsurah Imambara DH	1	2	2	1	0	6	86%
Total filled	5	10	11	6	4	36	86%
Total seats	6	12	12	6	6	42
Total vacant	1	2	1	0	2	6	14%
Break up vacant	OBC-A 1	OBC-A 1 and PWD 1	OBC-A 1		OBC-A 1 and PWD 1	Vacant : OBC-A4 PWD 2

DNB Courses in six District Hospitals of West Bengal starts - news item in Bartamanpatrika on 13th October 2014

  ,  
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  , :    ’          (   )    ,               ,                                   ,          ,   

     ,   ’        ,   ,   ,   ,   ,                               ,   ,   ,                 -      -             

     ,              ,                  ,                 ,                ,     ,                     ,            -          ,                           

DNB courses in six District Hospitals of Health & Family Welfare Department in West Bengal – big step in generating specialists and improvement of speciality services in Secondary Hospitals

1.     DNB in District Hospitals in West Bengal

In order to achieve the mission of the Health Department to provide affordable, quality health care services that are accessible to all round the clock, several Policy initiatives and interventions have been taken by State Government of West Bengal. Works of 34 super speciality hospitals from BRGF grants and another 6 from State Plan are have been planned and under construction and likely to be operational in next few years. Apart from this, 12 Mother & Child Hubs are planned for mother & child care specialities. 37 SNCUs and 18 CCUs have been made functional and there is plan to have one SNCU and one CCU/ HDU at each Sub divisional hospital in the State.

1.1   Health infrastructure being created needs trained manpower, particularly the specialist doctors, nursing personnel and technicians to utilise the facilities to full capacity. While, steps have been taken to increase postgraduate degree and diploma seats in medical colleges in last three years and absorption of passed out doctors in the Public Health Care through recruitment, there remains a large gap between demand and supply, particularly.

1.2   Multi Disciplinary Expert Group constituted by State Government recommended DNB courses in District Hospitals where CCUs, SNCUs and other speciality health care services are already functional and accordingly, six District Hospitals applied for accreditation to National Board of Examination in January 2014.

1.3   All these DHs got approval for 10 seats in each Hospital under Anaesthesiology, General Medicine, General Surgery, Obstetrics & Gynaecology and Paediatrics specialities. DNB students will be utilised to provide health care in these hospitals as resident doctors.

1.4   Junior Consultants with five years experience and senior consultants with eight years of experience in the specialisation field working in the District Hospital will be teaching faculty and guide to these DNB students. Medical College mentors have been tagged with each District Hospital for providing guidance regarding research, thesis and course curriculum.

1.5   Administrative arrangements and logistics for the DNB courses have already been created in all six hospitals.

1.6   In first round of the counselling, 22 out of 42 Primary seats have already been filled. This is very good response in the first year of accreditation by Government run Secondary hospitals. 

1.7   All arrangements for library, seminar hall, classrooms, faculty rooms, accommodation for DNB doctors and practical examinations have been made in record 8 months time on emergency basis. These hospitals can take the pride that their experienced doctors got the status of teaching consultants.

1.8   Details of seats approved and seats filled so far in six hospitals are given in tabular format below. MR Bangur DH is already running DNB courses. More seats will be filled after second round of counselling.

Name of DH/ Speciality	Anaesthesiology	General Medicine	General Surgery	Obstetrics & Gynaecology	Paediatrics	Total filled in DH	Percent seat filled
Asansol DH	0	1	1	1	1	4	57%
Purulia DH	0	1	1	0	0	2	29%
Krishnagar DH	0	1	1	1	0	3	43%
Barasat DH	1	1	1	1	1	5	71%
Howrah DH	1	0	2	1	1	5	71%
Chinsurah Imambara DH	1	1	1	0	0	3	43%
Total filled	3	5	7	4	3	22
Total seats	6	12	12	6	6	42
Total vacant	3	7	5	2	3	20
Break up vacant	SC 1, OBC-A 1 and ST 1	SC 4, OBC-A 1, OBC-B 1 and PWD 1	SC 1, OBC-A 2 and OBC-B 2	SC 2	SC 1, OBC-A 1 and PWD 1	Vacant : SC 9, OBC-A 5, OBC-B 3, ST 1 and PWD 2

 

2.      What is DNB :-

The Nomenclature of the degree awarded by the National Board of Examinations is called the “Diplomate of National Board”. The list of recognised qualifications awarded by the Board in various Broad and Super specialities as approved by the Government of India and included in the First Schedule of IMC Act 1956. 2.1   The Diplomate qualifications awarded by the National Board of Examinations have been equated with the postgraduate and post doctorate degrees awarded by other Indian Universities by the Government of India, Ministry of Health and Family Welfare; vide their notifications issued from time to time. 2.2   The holders of Board’s qualification awarded after an examination (DNB Final) are eligible to be considered for specialists post in any Hospital including training/teaching institution 2.3   The Board at present conducts postgraduate and postdoctoral examinations in 54 disciplines approved by the Board for the award of Diplomate of National Board. The Medical Council of India has laid down standards for post graduate examinations conducted by various medical colleges and affiliated to concerned universities and other institutions, yet the levels of proficiency and standards of evaluation vary considerably in these institutions. 2.4   The setting up of a National Body to conduct post graduate medical examination was intended to provide a common standard and mechanism of evaluation of minimum level of attainment of the objective for which post graduate courses were started in medical institutions.

3.     Some of the salient advantages and limitations of DNB courses are described below :-   a.      Easy of entry. This is the most common reason for someone to choose DNB degree programme. To enrol in MD/MS one need to clear tough nationwide entrance exam for Govt. Medical Colleges or pay expensive capitation fee at Private Medical Colleges. For enrolling in DNB programme one need to clear NBE common entrance test which is relatively easy compared to MD/MS exams followed by interview at the institution of choice. b.     Inexpensive - All one need to pay is the yearly fee stipulated by the NBE. Compared to the fees charged by private medical colleges it is a very small amount. c.      Those MBBS who missed opportunity to get admission in MS/ MD can get DNB course done and gets the same status. d.     Students of West Bengal pursuing DNB can get admission in the State, in districts as total seats in Private Facilities was very low forcing them to go outside the State.

4.     Summary:    West Bengal becomes the only State in India to run DNB courses in such large number at District Hospitals, utilising the expertise of the Specialists already working there. DNB course will not only provide additional doctors in DHs but also augment availability of specialists in the State. Initial response is very good in the first counselling and it is expected most of the seats except few reserve category will be filled up. This is big step to give opportunity to MBBS working in the State and augmentation of manpower for major initiatives by State Government.