notes on sensitization workshop on recent initiatives

January 28, 2016 [NOTES ON 5 NEW INITIATIVES_NHM]

Notesfor the sensitization workshop on 5 new initiatives (29.01.2016) 1

Notes for Sensitization workshop on New Initiatives

NTR Vaidyapariksha-Free Laboratory Services

Objective

It has been established that 40% of out of pocket expenditure in OPDs and

up to 15% in IPDs is due to lack of diagnostics, leading to high levels of

dissatisfaction among health seekers.

It has also been realized that providing these diagnostic services would

drastically reduce the out of pocket expenditure of the poor.

Hence under NHM support, free diagnostics program has been initiated in

PPP mode.

Coverage

The free Diagnostics programme would be implemented in all 1186 PHCs,

192 CHCs, 31 Area Hospitals, and 8 District Hospitals.

However teaching hospitals would not come under this programme since

NHM does not support tertiary care hospitals.

Strategy

Under this programme the tests that are not currently done in the facilities

such as PHCs, CHCs, AHsand DHs would alone be outsourced.

The tests that are being done currently, would continue to be carried out

by the available Lab Technicians in those facilities.

Tests that are in high volumes and low cost will be performed within the

public facility by existing Lab Technicians.

High cost and low volume tests for which no equipment is available are

outsourced.

Only tests that are not currently provided in PHCs/CHCs &DHs, are

outsourced.

Hence this arrangement will not weaken the existing capacity available at

the public health facilities.

The tests so outsourced are not meant for general screening and those

tests would be prescribed to the patients who visit public health facilities.

The payment shall be made per sample, basis only regardless of the no of

tests performed with the same sample.

Test for diagnosing Haemoglobinopathies in tribal areas is included from

AH and above in the present package for the first time in the Country.

M/s. Medall Healthcare Pvt Ltd, is service provider for Laboratory Services



Details of the programme

The service provider (M/s. Medall Healthcare Pvt Ltd) would establish 80

labs across the state and out of which 39 labs will be high end labs

catering to the requirements of Area hospitals and District hospitals and 41

labs are low end labs to cater to the requirements of CHCs and PHCs.

The labs so established would be reachable within half an hour from the

public facility.

The service provider will provide all Clinical equipment, Application

software, Billing, Sample collection, Sample management, Laboratory

Equipment Management, Laboratory quality controletc along with a trained

manpower and supervisor for quality check.

31 Labs serving AH and DH were Inspectedby appropriate authorities to

ensure quality of services. The remaining Labs will also be inspected as

soon as they were established.

The reports generated from the facilities of the service provider would also

be cross checked for ensuring quality, in order to achieve this about 1% of

the sample collected every day would be sent for a third party check.

The service provider will provide trained phlebotomists during the working

hours for blood collections in all hospitals including PHCs(1186),

CHCs(192), AHs(31) and DHs(8).

A phlebotomist arranged by the Service Provider would be stationed in all

the public facilities and who collects the samples and sends the same to

the nearest laboratory.

The results reported shall be reported back to the public facility by using

both online with digital signature/email and also a hard copy to be handed

over personally by the service provider.

The service provider will be responsible for the safe transportation of the

samples to the processing centers.

The service provider would provide access to full MIS with analytics of top

10 diseases, complete pattern of diseases on a real time basis with drill

down reports upto Panchayat Level.

The service provider is also required to provide institution wise analytics

for PHCs, CHC, Area Hospital and District Hospitals.

Key performance Indicators

District level:

1. No of laboratory cases reported in three categories –PHCs; CHCs; AH

and DH



2. Turnaround time of reported laboratory cases in four categories –

PHCs;CHCs; AH and DH

3. Number of laboratory cases reported beyond turnaround time

4. Facility with the highest number of laboratory cases

5. Facility with lowest number of laboratory cases

6. Total Count of laboratory cases repeated within 7 days – FACILITY wise

7. Total count of ‘badly taken laboratory cases on which report could not be

given- FACILITY wise

8. Total count of ‘Critical Result’ reported in the laboratory cases facility wise

9. Normal and Abnormal results ratio (percentage value) for all three

categories –PHCs, CHCs, AH and DH- Facility wise

The service provider is responsible for the 7 tests in PHCs, 21 tests in

CHC’s and 41 tests in AH& DHs. Wherever Lab Technicians are not

available the service provider would conduct all the prescribed tests.

Type of Facility

No. Of Facilities

No of In house tests

Number of Tests out-sourced

DH 8 19 41

AH 31 19 41

CHC 192 16 21

PHC 1156 12 7

39 labs have been already established on priority basis to cater to the

Area hospitals and District hospitals where these services are ready for

launch.

Details of the in-house and Outsourced Tests:

A. List of laboratory tests at PHC (19)

S.No In house Tests at PHC

in the PHC

Tests Outsourced in PHC

1 Hb Estimation

2 MP slide method

3 ESR

4 Clotting time & Bleeding time

5 Blood group

6 Blood sugar

7 HIV Test

8 Sputum for AFB



9 Malaria Rapid Test

10 Urine Sugar & Albumin

11 Urine Pregnancy test

12 HBsAg

13 TLC

14 DLC

15 Platelet count

16 S. Bilirubin

17 Rapid Plasma Reagin (RPR)

18 Dengue Rapid test

19 Stool for ova and cyst

B. List of laboratory tests at CHC (40)

In house Tests in the CHC Tests outsourced in CHCs

Hematology

1 Hb

2 TLC

3 DLC

4 MP (Slide Method)

5 ESR

6 ABO – Rh

7 CBC

8 TRBC

9 Packed cell volume

10 Platelet Count by Cell Counter

11 Prothrombin time test and INR

Serology

1 HIV rapid test

2 Malaria rapid test

Urine

1. Urine Sugar and Albumin

2. Urine Microscopy

3 Urine complete by strip method



Clinical Pathology

1. Urine Pregnancy test

2 Stool for ova & cyst

Biochemistry

1. Blood Sugar

2 Blood Urea

3 S. Creatinine

4 S. Bilirubin (T)

5 S. Bilirubin (D)

6 SGOT

7 SGPT

8 S. Alkaline Phosphatise

9 S.T. Protein

10 S. Albumin

11 S.T. Cholesterol

12 S. Triglycerides

13 S.VLDL

14 S.HDL

15 S. Amylase

16 RPR Rapid test

17 Dengue rapid test

Microbiology

1. Sputum for AFB

Cardiology

1. ECG

C. List of laboratory tests at District / Area Hospitals(63)

In house Tests in AH/DH Tests outsourced in AH/DHs

Hematology

1. Hb Estimation

2. TLC

3. DLC

4 MP – Slide method

5. ESR

6. PFB

7. Blood group

8 CBC

9 Peripheral blood smear

10 Total Eosinophil count

11 Total red Blood cell count



12 Platelet count by cell counter

13 PCV

14 Coomb’s test – direct

15 Coomb’s test – indirect

16 Prothrombin time test and INR

Serology

1. RPR Rapid test

2. HIV Rapid test

3 Malaria Rapid Test

4. HBsAg(Rapid) Test

5 Dengue Rapid Test

6 Rheumatoid Factor

7 Anti streptolysin

8 S.CRP

Tests Mandated in the hospital

Haemoglobinopathy

Biochemistry and Immunoassay

1. Blood sugar

2. Serum creatinine

3. S. Bilirubin (T)

4 S. Bilirubin (D)

5. Blood Urea

6. SGOT

7. SGPT

8 S. Alkaline Phosphatase

9 S.Total Protein

10 S. Albumin

11 S. Calcium /Potassium / Sodium

12 Troponin - I / Troponin – T

13 S.LDH

14 S. Amylase

15 S. Uric Acid

16 S. Total Cholesterol

17 S. Triglycerides

18 S.VLDL

19 S.HDL

20 TSH

21 HbA1C



Clinical Pathology

1 Urine Pregnancy test

2 Stool for ova & cyst

3 Fluid (CSF, ascitic, pleural) cell

count & Biochemistry 4 Semen Analysis sperm count

Urine Analysis

1 Urine sugar and albumin

2 Urine microscopy

3 Urine complete by strip

Microbiology

1 Sputum for AFB

2 Blood Culture

3 Urine Culture

Pathology

1 Histopathology

2 Cytology

3 Bone marrow aspiration

Cardiology

1 ECG

Responsibility of Medical Officers of PHC / Superintendents or RMOs of

CHC,AH,DH:

To allow the M/s. Medall Healthcare Pvt Ltd, to start collecting samples by

the phlebotomist arranged by the Service Provider

Phlebotomist would be stationed in all the public facilities and who collects

the samples and sends the same to the nearest laboratory.

Test results will be sent back to the facility by mail and a signed hard copy

by the service provider.

To verify weather all results are coming within the TAT .

District management(DM&Hos/DCHS) shall monitor the services provided

by service provider at facilities and ensure quality services are delivered in

time.

Free Laboratory Services were launched by Hon’ble CM on 1stjanuary 2016 in

all DH and AHs.

Free Laboratory Services will be extended to all CHCs and PHCs from 21st to

31st January in phased manner .



NTR Vaidyapariksha - Tele Radiology & CT scan Services

Objective:

It has been observed in most of the hospitals though X-Ray Machines are

available they are not put to use either due to the absence of qualified

radiologists or dysfunctional equipment resulting in hardships to the patients.

In view of this, to obviate this chronic problem, it has been decided to extend

quality radiology services in 113 locations by providing access to the radiology

services within the facility thereby enabling the patients to minimise their Out

of Pocket expenditure.

Strategy:

The X-Ray Machines which are lying idle either because of non-availability of

Radiographer or qualified Radiologist or non-functioning of the existing

equipment due to various reasons, would be made operational through PPP

mode.

In addition to the existing X-ray machine either Computerised Radiography

unit or Image Digitiser would be arranged in the facility by the service provider

and the same will be established online connectivity with a remote hub where

expert radiologist is available for obtaining expert opinion there by all the

existing radiology equipment will be brought under use and also enables the

patients to get radiology services wetted by a qualified radiologist free of cost.

M/s. Krsna Diagnostics Pvt Ltd is the service provider for Tele radiology

Services.

Coverage:

This facility will be made available in CHCs, Area and District Hospitals across

the State of Andhra Pradesh totalling 113 locations.

Details of Programme:

Under this intervention, the service provider will provide Tele radiology

services through digitization of X-ray film, transmission of the data through

Licensed Software.

In the remote hub a qualified radiologist will do the study using FDA & CE

approved Tele-radiology platforms and detailed report with digital signature

will be sent back online to the institution.



X-Ray Image taken will be converted into a digital image either through

Computerized Radiography unit or a digitizer. The digitized image will then be

transmitted to a remote hub where qualified radiologist downloads the image

and reads the image. Detailed study with opinion of Radiologist will then be

sent back to the facility of origin online immediately.

This process enables the doctors to diagnose the actual ailment for better

treatment.

Report will be made available online and hard copy will be made available in

the institution where the sample is collected for the benefit of the patient.

This initiative will not only reduce out of pocket expenditure of the patient but

also saves time.

District management shall monitor the services provided by service provider

at facilities.

Tele radiology services in all 113 locations will be ready by 1st January2016.

Key Performance Indicators to Tele Radiology

1. Number of X-rays reported per District

2. No of X-rays reported in three categories – CHCs; AH and DH

3. Turnaround time of reported X-rays in three categories – CHCs; AH and

DH

4. Number of X-ray reported beyond turnaround time

5. District with the highest number of X-ray cases

6. District with lowest number of X-rays cases

7. Facility with highest number of X-rays

8. Facility with lowest number of X-rays

9. Total Count of X-rays repeated within 7 days – FACILITY wise and district

wise

10. Total count of ‘badly taken X-rays/inadequate exposure etc’ on which

report could not be given- district wise and FACILITY wise

11. Total count of ‘Critical Result’ reported in the X-ray- district wise

12. Total ratio (percentage) of Normal vs abnormal results district wise

13. Facilities with dysfunctional X-rays district wise

District level:

14. No of X-rays reported in three categories – CHCs; AH and DH

15. Turnaround time of reported X-rays in three categories – CHCs; AH and

DH

16. Number of X-ray reported beyond turnaround time

17. Facility with the highest number of X-ray cases

18. Facility with lowest number of X-rays

19. Total Count of X-rays repeated within 7 days – FACILITY wise



20. Total count of ‘badly taken X-rays/inadequate exposure etc’ on which

report could not be given- FACILITY wise

21. Total count of ‘Critical Result’ reported in the X-ray- facility wise

22. Total ratio (percentage) of Normal vs abnormal results facility wise

23. Facilities with dysfunctional X-rays district wise

Responsibility of Superintendents or RMOs of CHC,AH,DH:

To allow M/s. Krsna Diagnostics Pvt Ltd to start the services in all 113

locations

District management(DM&HOs/DCHS) shall monitor the services provided by

service provider at facilities and ensure quality services are delivered in time.

Free Tele Radiology Services were launched by Hon’ble CM on 1stjanuary 2016

CT SCAN SERVICES

Objectives:

Advanced Radiology services such as CT scan is required to be made

available to the patients at every District Hospital for accurate diagnosis of

certain health conditions.

Coverage

Currently out of eight District Hospitals CT is available only in four locations,

hence it is decided to extend CT facility in the remaining DHs: Tekkali in

SrikakulamDt, Cheerala in PrakasamDt, Proddutur in KadapaDt and Gudur in

Nellore Dt.

Strategy:

Providing the CT Scan Services under PPP mode at 4 District Hospitals

where CT Scans are currently not available.

M/s. Krsna Diagnostic Pvt Ltd is the service provider for CT scan Services

Programme Details:

Service provider will provide CT Scan Machines at all four locations along with

the interiors and other amenities including HT Power Connection and power

back up.



Qualified Radiologists and supporting staff will be positioned by the service

provider. All reports will be generated in the facility itself by availing the in-

house expertise provided by the Service provider.

CT scan services in Tekkali in SrikakulamDt,Prodduturin kadapaDt will be ready by

1st February 2016.

102 CALL CENTRE:

Objectives:

1. Ensuring the delivery of Comprehensive Services related to pregnant, postnatal women and Infants by creating awareness on various services they are entitled to receive freely from Government.

2. Handholding all the high risk pregnant women in availing every service from public health facility.

3. Reduction of Maternal and Infant deaths through continuous monitoring of Maternal & Child Health Services.

4. Improvement in quality of RCH services provided by the public health facilities 5. Demand generation on services and entitlements.

Strategy:

A centralised 24X7 Health Help Line dedicated for pregnant and postnatal women would be established for monitoring the Services provided to the Pregnant Women with special focus on High Risk Pregnant Women.

M/s. GVK EMRI is the service provider for 102 Services

Programme Details: The Service provider will establish call centre with 30 seater capacity housed with Para medial & Medical staff at a centralised location. He shall providing Medical Advice, Directory Services and ensuring the referral transport services are responsibilities of the service provider. Every Day 12600 Minutes of outbound calls will be made from the call centre by the Service provider for evaluating the services provided to pregnant and postnatal women. Four Pre-recorded Messages to pregnant women and 3 to the postnatal women for ensuring the ANC, PNC and Immunisation services, would be made. Maintenance of database and software for real time display of all the services provided by the Call Centre would be done. In addition the Service provider shall also Gauge the public perception on services provided by health department. 102 call center will be ready by 1st January, 2016.



Key Performance Indicators:

1. Number of Incoming Calls Received: a. Number of Incoming Calls answered with Medical Advice : b. Number of Incoming Calls answered with Advisory Services: c. Number of Incoming Calls answered with providing Transport Services: d. Number of Incoming calls answered for registering Grievance services:

2. Number of Pre recorded Messages sent Pregnant Women:

a. For ANC Checkups(3 times) b. For Birth Plan c. For Admission to Hospitals

3. Number of Pre recorded Messages sent post natal Women: a. CMs Message for Congratulating b. For Immunisation

4. Number of Out Bound Calls Made to Pregnant Women: a. For ANC Checkups b. For Birth Plan c. For Admission to Hospitals

5. Number of Outbound calls made to Postnatal women: a. For Post Delivery Status b. FP Method Utilisation c. Immunisation Schedule

Drop Back Services (ThalliBidda Express)

Objectives: Providing safe transport of postnatal women with infant by dedicated fleet of vehicles under 102 Services is the core objective. It is decided to ensure that every women delivered in Public Health Facility is dropped back home safely. Providing referral transport to the pregnant women is one of the vital interventions for keeping the IMR and MMR at minimum

Strategy: Out of the total 8.4 Lakh women estimated to deliver app.4.2 lakh women deliver in public health facilities during the current year. All the post-natal women delivered in Public health facilities will be dropped back home safely under this intervention through dedicated fleet of 278 vehicles

M/s. GVK EMRI is the service provider for 102 Services



Programme Details:

a. All the Postnatal Women who deliver in Government Hospital shall be provided with the Drop Back Services through dedicated vehicle.

b. Service Provider transports the Post Natal Women, Child and one attendant from Government Health Facility to Home. The Drop Back timing is between 8 AM to 6 PM.

c. Service Provider shall arrange the vehicle ready for pick up within 30 minutes from the receipt of call from the institution. Penalties will be imposed in case of non-attending the cases or non-attending within the time.

d. All the vehicles are fitted with GPS system for real time monitoring of movement of vehicles online.

e. Service Provider shall maintain database and software application for uploading all the details on real time basis and also movement of vehicles on real time basis.

Drop Back services will be ready by 1st January, 2016.

Key Performance Indicators for Drop Back Services:

1. Number of Post Natal women transported per day, per district: 2. Average number of post-natal women per vehicle ride per district and per

block 3. Number of postnatal women arranged with drop back services within 30

minutes from call: 4. Average time from Call to Pick up at the facility 5. Average time from pick up to drop 6. Average Distance travelled for drop back of postnatal women at home: 7. Total vehicle failures per vehicle per month

Bio Medical Equipment Maintenance

Objective:

Regular maintenance and upkeep is required for optimum functionality of the Medical

Equipment in the Public Health Facilities.

Currently Rs 480 crore worth of equipment is available in all the Public Health

Facilities and approximately 28% of equipment is dysfunctional either due to lack of

maintenance or for want of repairs. Optimum functionality can be achieved through



PPP Mode thereby delivering the quality health services to the needy.Hence it has

been decided to maintain all the Bio-Medical equipment through PPP mode.

Coverage

All the Bio-Medical equipment in all 1186 PHC, 192 CHCs, 31 Area Hospitals, 8

District Hospitals, 20 Teaching & allied hospitals and 11 Medical colleges would be

covered under this programme.

Strategy

All equipment registered would be geo-tagged, repaired, maintained and calibrated

on continuous basis by the PPP partner by positioning qualified bio medical service

engineers. And the process would be monitored through a dedicated round the clock

call centre. It is also mandated to ensure the AMCs already entered by other

agencies.

M/s. TBS India is the service provider for biomedical equipment maintenance

Details of the Programme:

It is the endeavour of the Government to provide health care services to all the

patients visiting Public Health Facilities. Government Health Institutions are equipped

sufficiently to serve the needs of the patients.Due to high dysfunctional rate of

existing equipment expected service delivery is affected adversely. Hence it is

decided to maintain all the equipment on real time basis through PPP.

Bio medical equipment maintenance includes:

Tagging of individual equipment with a Bar coded sticker is done and full details of equipment captured in a software resulting in detailed equipment inventory would be available online.

Repairs and replacement of spare parts.

Preventive maintenance of equipment

Calibration of equipment

Training for Medical & Paramedical staff on existing equipment and on new equipment for better utilization.

Chasing AMCs and Warranties whereever available

Agency will provide biomedical engineering HR and ensure an upkeep time of 95% for THs, DHs, 90% for CHCs and 80% for PHCs at any given point of time

Agency will provide a toll free number for equipment fault registration of equipment.

Agency will establish a Round the clock functional call center.

As and when new equipment is procured same would also come under maintenance.

Agency will place dedicated engineer at every Teaching hospital, Medical College & District hospitals and mobile teams for CHCs and PHCs.



Bio medical equipment maintenance services in all TH, DH and AH, will be ready by

1st January, 2016.

Key Performance Indicators

State Level:

1. Total number of equipment functional - per day; per week, per month: 2. Total Number of equipment Dysfunctional/ Open call - per day; per week,

per month: 3. Average turnaround time for closed calls - per day; per week, per month: 4. Total number of Preventive maintenances done per Quarter: 5. Calibrations of equipment done categories wise per quarter: 6. Count of Pending calls - per day, per week: 7. Total No of equipment in which spare parts were replaced- per week 8. District with the Highest Call received, dysfunctional rate, Dysfunctional

rate: 9. Average turnaround time per district for all facilities: 10. Total number of standby critical care equipment supplied per week: 11. No. of Dedicated and Shared Human Resource per district 12. No of training sessions of doctors/nurses per district per quarter

District level:

1. Total number of equipment functional - per day; per week, per month: 2. Total Number of equipment Dysfunctional/ Open call - per day; per week,

per month: 3. Average turnaround time for closed calls - per day; per week, per month: 4. Total number of Preventive maintenances done per Quarter: 5. Calibrations of equipment done categories wise per quarter: 6. Count of Pending calls - per day, per week: 7. Total No of equipment in which spare parts were replaced- per week 8. Total number of standby critical care equipment supplied per week: 9. No of training sessions of doctors/nurses per quarter