Utilization of Imprest Money by Hospitals



Utilization of Imprest Money by Hospitals


The details of the imprest money available during each of last 3 years and current yearin respect of Central Government hospitals in Delhi viz. Safdarjung Hospital (SH), Dr. RML Hospital (DRMLH), Smt. SuchetaKriplani Hospital (SSKH) and Kalawati Saran Children Hospital (KSCH) are given below:
(Amount in Rs.)
Name of the Hospital
SH
DRMLH
SSKH
KSCH
Imprest money available
80,000
11,500
3,000
2,000
The imprest amount is utilized for urgent administrative matters and not for procurement of life saving/essential medicines. Procurement of life saving/essential medicines, if required, is done from regular budget.



The details of year-wise net mortality rate of these hospitals are given below:


2011
2012
2013
2014
DRMLH
2.6
3.6
3.7
2.7*
SH
3.5
3.4
3.8
3.3#
SSKH
1.1
0.9
0.8
0.9#
KSCH
2.6
3.1
1.8
1.2*
* Upto October, 2014;      # Upto November, 2014

No death has occurred due to non-availability of imprest money or lack of life saving/essential medicines in these hospitals.

The Health Minister, Shri J P Nadda stated this in a written reply in the LokSabha here today.

***

Assistance by USA for Mothers and Newly Born Children

USA has agreed to provide assistance for strengthening health systems to address health needs of vulnerable populations, to achieve a broad set of intermediate results which contribute to the GOI’s national health programs, but not limited to the Reproductive and Child Health (RCH) programme and the National AIDS Control Programme. One of the components of the agreement is to provide assistance for expectant mothers and newly born children in India.

A Health Partnership Programme Agreement was signed between Government of India and USAID on 30th September, 2010 which will be implemented till 30th September, 2018. United States Agency for International Development (USAID) provides technical assistance to Government of India’s flagship health programmes to achieve population stabilization, integrate health services and nutrition to improve maternal newborn and child health including HIV/AIDS, Polio and TB. The total commitment is USD $256.67 million.

Government of India has designated USAID as a lead development partner for its Call to Action for Child Survival and Development Programme for 30 high Priority Districts spread across the six states of Jharkhand, Delhi, Himachal Pradesh, Haryana, Punjab and Uttarakhand.

One of the major objectives of the assistance is to strengthen health systems for RCH programme, whose main goals are to reduce MMR, IMR and TFR.

The Health Minister, Shri J P Nadda stated this in a written reply in the LokSabha here today.

***
Diagnosis of Thalassemia, Sickle Cell and Haemophilia

As per information received from Indian Council Medical Research (ICMR), it is estimated that around 10,000 to 12,000 children with Thalassemia major and 5000 to 7000 children will sickle cell anemia are born each year in the country.  However there is no state-wise central registry to give details on children born with thalassemia, sickle Cell disease and haemophilia.

As per information received from Indian Council Medical Research ICMR), the government run prenatal diagnosis centres for thalassemia and sickle cell anemia are as following:-

(i)                  National Institute of Immunohaematology, Mumbai.



(ii)                All India Institute of Medical Science (AIIMS), New Delhi.



(iii)                Postgraduate Institute of Medical Education and Research (PGI), Chandigarh.



(iv)               Sanjay Gandhi Postgraduate Institute of Medical Science (SGPGI), Lucknow.



(v)                Kolkata Medical College, Kolkata.



(vi)              Nail Ratan Sircar (NRS) Medical College Kolkata.


New centres are being established at Indira Gandhi Medical College Nagpur, Regional Medical Research Centre- Jabalpur and Regional Medical Research Centre – Dibrugarh.

The Government run prenatal diagnosis centres for hemophilia are at:-

(i)                National Institute of Immunohaematology , Mumbai

(ii)               PGI, Chandigarh


Health being a State subject, diagnosis and management of this disease is done by the States. However, under the National Health Mission, the Government of India supplements the efforts of State governments in providing health care services, including for establishing blood transfusion services.

Diagnosis and treatment facilities for these diseases is also available in Central Government Hospitals like Lady Harding Medical College and Smt. Sucheta Kripalani Hospital, Safdarjang Hospital, Dr Ram Manohar Lohia Hospital, New Delhi and Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry.

Ministry of Health and Family Welfare also gives financial assistance for treatment of life threatening diseases at different hospital under the Rashtriya Arogya Nidhi(RAN) and also the Health Minister’s discretionary grant. The categories of treatment to be provided from RAN fund include anti-haemophilic globulin, blood and blood products.

The National Blood Transfusion Council under National Aids Control Organization (NACO) has issued guidelines to all state/UTs administration that patients suffering from thalassemia, sickle cell and hemophilia should be provided blood free of cost.

There is no separate vertical program for genetic blood disorders. The Rashtriya Bal Swasthya Karyakarama (RBSK) launched under the National Health Mission (NHM), provides early detection and treatment of children suffering from genetic disorders including sickle cell anaemia, beta thalassemia etc. up to the age of 18 years. State Governments can submit proposals for prevention, awareness generation and treatment for blood disorders in their respective Programme Implementation Plans (PIPs) for consideration of assistance under NHM within their resource envelope.

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.
***

CGHS Wellness Centres

The cleaning work (housekeeping) has been outsourced in the CGHS due to vacant posts of Safaiwala. The outsourcing has been done pursuant to DoPT guidelines that no further recruitment to Group D posts would be done w.e.f. April 2010.

In view of the overcrowding in certain CGHS wellness centres elderly beneficiaries may have to wait to meet the doctors and collect medicines.

CGHS has already issued guidelines that elderly beneficiaries will be provided privileged access to medical facilities at the dispensaries in order to minimize the waiting time of the elderly patients.

The CGHS dispensary proposed at Najafgarh is yet to be handed over to CGHS by the Delhi Police authority who has constructed the building in the premises of the Police Training School, Jhadoda Kalan. This is a temporary accommodation for the CGHS wellness centre till a permanent premise is built in Najafgarh area.

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.
***

OncoNet Project for Cancer Treatment

Under OncoNet project, two telemedicine centres each were set up in the State/ UT of Karnataka, Puducherry, Tamil Nadu, Punjab and J&K. Funds of Rs.1.43 cr. were released on 5th March, 2008 by Ministry of Health & Family Welfare to National Informatics Centre Services Inc. (a Government of India Enterprise under NIC), Ministry of Communications & Information Technology for setting up and operation of OncoNet centres.  As per statement of Expenditure (SoE) dated 23th March, 2014, funds have been utilized. The Government has not undertaken any study to ascertain the effectiveness of the said project.


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. 489 NLEM medicines for which ceiling price have been notified under DPCO, 2013, includes 47 anti-cancer medicines.

The said therapies can have side effects. Hence, dosing, fractions etc. of treatment are to be decided by treating doctor in the larger interest of the patient.

Standard Treatment Guidelines have been made for oncology under the Clinical Establishment Act. The guidelines are placed on website, http://clinicalestablishments.nic.in /WriteReadData/329.pdf.

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.
***

Online Services for Patients

Pre-registration online service for Out Patient Department (OPD) has been started inAll India Institute of Medical Sciences (AIIMS), New Delhi.Under this service, patient is required to fill all demographic details in an online electronic form and issued a pre-registration number which is used at the time of registration. This service is basically a step towards easing out the registration process.

National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore has started online appointment system for patients who are coming for the first consultation in this Institute. The date and time of appointment is confirmed through SMS on their mobile phone.

Government of NCT of Delhi has already developed and implemented the software application for online registration of patients for OPDs in various specialties of hospitals of GNCT of Delhi to enable patients to print OPD registration cards on their own and directly go for OPD consultation, thereby reducing overcrowding at OPD registration counters.

As on date there is no proposal to extend such services to other central government hospitals.

The Health Minister, Shri J P Nadda stated this in a written reply in the LokSabha here today.
***

Cancer Care Facilities


As per data provided by National Cancer Registry Programme of Indian Council of Medical Research (ICMR), the estimated incidence, prevalence and mortality due to cancer in the country for the last three years is as under:


2011
2012
2013
Incidence
1028503
1057204
1086783
Prevalence
2819457
2820179
2934314
Mortality
452541
465169
478180

There is no recent data available on the survival rate of cancer patients.  As per data provided by ICMR, the survival rate is as under:

Table 1. Percentage Survival of Cases by Different Registries and Different Years (1990-1999)

Registry
Period of study
No. of sites
Cases
1 year
3 years
5 years
Bhopal
1991-1995
16
1863
62.3
35.6
27.9
Chennai
1990-1999
20
22598
55.3
34.0
27.4
Karunagapally
1993-2001
22
1601
59.3
34.3
25.4
Mumbai
1992-1999
28
46162
55.2
36.1
28.1
Pooled over all Registries
72224
55.5
35.4
27.8

(Source) Sankaranarayan R and Swaminathan R (2011): Cancer Survival in Africa, Asia, the Caribbean and Central America, IARC Scientific Publications No. 162

The increase in the number of cancer cases in the country may be attributed to larger number of ageing population, unhealthy life styles, use of tobacco and tobacco products, unhealthy diet, better diagnostic facilities etc.  The cancer survival rate is generally believed to depend upon among others, stage at diagnosis, stage of initiation of treatment, type and site of Cancer, correct and complete treatment.

Government of India has in the year 2013-14 approved a scheme for enhancing the tertiary care cancer facilities in the country. Under this scheme, Government of India will assist 20 State Cancer Institutes (SCI) and 50 Tertiary Care Cancer Centres (TCCC) in different parts of the country.

Guidelines of the Strengthening of Tertiary Care Cancer facilities scheme were circulated to the States in the month of January 2014 inviting detailed proposals as per guidelines. 37 proposals have been received from various States including Maharashtra. The State wise details of number of proposal received are given below:-

Proposals received from State/UT Governments as on 16.12.2014 under the scheme for ‘Strengthening of Tertiary Care Cancer facilities’

Sl. No.
State
TCCC
SCI
Total
1
Bihar
1
1
2
2
Delhi
1
0
1
3
Goa
1
0
1
4
Gujarat
0
1
1
5
Himachal Pradesh
1
0
1
6
Jammu and Kashmir
0
2
2
7
Karnataka
1
1
2
8
Kerala
1
1
2
9
Maharashtra
*
0
1
10
Madhya Pradesh
1
0
1
11
Manipur
1
0
1
12
Mizoram
1
0
1
13
Nagaland
1
0
1
14
Odisha
3
1
4
15
Punjab
2
1
3
16
Rajasthan
2
1
3
17
Tamil Nadu
0
1
1
18
Telangana
0
1
1
19
Tripura
0
1
1
20
Uttar Pradesh
2
0
2
21
Uttarakhand
1
1
2
22
West Bengal
3
0
3
TOTAL
24
13
37

SCI – State Cancer Institute, TCCC- Tertiary Care cancer Centre

*   The proposal from Government Medical College, Nagpur was received as State Cancer Institute whereas the Institute has been identified as Tertiary Care Cancer Institute.

Deficiencies in the proposals received from state governments have been identified such as non-availability of required manpower, Atomic Energy Regulatory Board’s clearance, non-submission of utilization certificate of earlier released grant-in-aid etc. Status of the proposals State wise are given below:-

Status of the Proposals for SCI/TCCC received from the State Governments

S No.
State/UT
Name of the Institutes
SCI/
TCCC
Remarks
1.
Kerala
Government Medical College, Kozhikode
TCCC
Integrated Finance Division (IFD) of Ministry of Health & FW has agreed for release of funds.
2.
Tripura
Cancer Hospital (RCC), Agartala
SCI
3.
Jammu &
Kashmir
Sher-i-Kashmir Institute of Medical Sciences, Srinagar
SCI
4.
Karnataka
Kidwai Memorial Institute of Oncology (RCC), Bangalore
SCI
5.
West Bengal
Government Medical College, Burdwan
TCCC
6.
Bihar
Indira Gandhi Institute of Medical Sciences (IGIMS), Sheikhpura, Patna
SCI
Standing Committee on Tertiary Cancer Care Programme has recommended the proposals subject to fulfilment of deficiencies including clearance from AERB, furnishing MoU, non-availability of required Manpower, non-submission of Utilization Certificate of earlier released  Grant-in-aid etc.
7.
Darbhanga Medical College-Darbhanga
TCCC
8.
Goa
Goa Medical College, Bambolim, Goa
TCCC
9.
Gujarat
Gujarat Cancer and Research Institute(GCRI), Ahmedabad
SCI
10.
Jammu & Kashmir
Government Medical College (GMC), Jammu


SCI
11.
Karnataka
Govt. Medical College, Mandya
TCCC
12.
Kerala
RCC, Thiruvananthapuram
SCI
13.
Manipur
Regional Institute Of Medical Sciences (RIMS), Imphal
TCCC
14.
Punjab
Government Medical College (GMC), Amritsar
SCI
15.
District Hospital, Hoshiarpur
TCCC
16.
Tamil Nadu
Cancer Institute, Adyar, Chennai
SCI
17.
Uttarakhand
Government Medical College (GMC), Haldwani
SCI
18.
West Bengal
Sagore Dutta Memorial Medical College and Hospital, Kolkata
TCCC
19.
Murshidabad Medical College & Hospitals, Murshidabad
TCCC
20.
Delhi
Lok Nayak Hospital (Maulana Azad Medical College)
TCCC
The deficiencies have been communicated to State Government/ Institution concerned.
21.
Himachal Pradesh
Indira Gandhi Medical College  (RCC), Shimla
TCCC
22.
Madhya Pradesh
Vidisha – District Hospital
TCCC
23.
Maharashtra
Govt. Medical College, Nagpur
TCCC
24.
Mizoram
Aizawl-Civil Hospital
TCCC
25.
Nagaland
District Hospital, Kohima
TCCC
26.
Odisha
Regional Cancer Centre,  Cuttack
SCI
27.
Burla Medical College (District Sambalpur)
TCCC
28.
M. K. C. G. Medical College Hospital, Berhampur
TCCC
29.
District Hospital, Bhawanipatna, District Kalahandi
TCCC
30.
Punjab
District Hospital, Fazilka
TCCC
31.
Rajasthan
RUHS College of Medical Sciences, Jaipur
SCI
32.
Bikaner- S P Medical College
TCCC
33.
Govt. Medical College/ District Hospital, Jhalawar
TCCC
34.
Telangana
Hyderabad-MNJ Institute of Oncology (RCC),
SCI
35.
Uttar Pradesh
Institute of Medical Sciences (BHU), Varanasi
TCCC
36.
Sanjay Gandhi Institute of Medical Sciences, Lucknow.
TCCC
37
Uttarakhand
Dehradun - Himalayan Institute of Medical Sciences
TCCC

SCI – State Cancer Institute, TCCC- Tertiary Care cancer Centre

Insofar as Maharashtra is concerned, one SCI in Mumbai and two TCCCs are envisaged. State Government has sent proposal of Govt. Medical College, Nagpur as State Cancer Institute (SCI) while the same was identified by this Ministry as a Tertiary Care Cancer Centre (TCCC).  The State Govt. has been requested to clarify this matter.

Two proposals have also been received from: (i) Mahatma Gandhi Institute of Medical Sciences (MGIMS), Wardha and (ii) Rashtrasant Tukdoji Maharaj Cancer Hospital run by Cancer Relief Society, Nagpur.  Both the proposals are received without the recommendation of the Government of Maharashtra.


The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.

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