Every year about 2.2 Lakh new patients of End Stage Renal Disease (ESRD) get added in India resulting in additional demand for 3.4 Crore dialysis every year. With approximately 4950 dialysis centres, largely in the private sector in India, the demand is less than half met with existing infrastructure. Since every Dialysis has an additional expenditure tag of about Rs.2000, it results in a monthly expenditure for patients to the tune of Rs.3-4 Lakhs annually. Besides, most families have to undertake frequent trips, and often over long distances to access dialysis services incurring heavy travel costs and loss of wages for the patient and family members accompanying the patient. This therefore leads to financial catastrophe for practically all families with such patients. With substantial gain in quality of life and extension of progression free survival for patients, families continue to stretch financially to make large out of pocket spends. It has been felt that both in terms of provision of this important life saving procedure and also for reducing impoverishment on account of out of pocket expenditure for patients, a Dialysis program is required. Hon’ble Prime Minister, in his address after the presentation by Secretaries Group on Health and Education, desired that a mechanism should be worked out to provide improved access to dialysis services. Accordingly, MoHFW with support from the National Health Systems Resource Centre (NHSRC) studied relevant models on Dialysis services being practiced under PPP mode. These included models of West Bengal, Kerala, Karnataka, Mumbai and Delhi NCR. Further, a consultation with experts in this field, experts from AIIMS & PGIMER as well as private service providers was held in the Ministry of Health & Family Welfare on the 16th Feb 2016 to discuss the modalities of envisaged program. Draft RFP and Service Level Agreement for the Dialysis in the PPP mode in the district hospitals were prepared and were shared with the states and valuable feedback was received. The Dialysis Program under Public Private Partnership was formally announced in the Union Budget 2016-17 by the Hon’ble Finance Minister.

Pradhan Mantry National Dialysis Programme (PMNDP)

The detailed Dialysis programme in state of Goa is as follow:

Dialysis units has been outsource on the basis of MOU made between Director of Health Services and Dr. R. Vankatesh providing dialysis services in Hospicio Hospital, Margao from 22nd September 2007 and Apex Kidney Care Private Limited from 22nd November 2017.

Number and names of districts in which the contract for dialysis services has been signed as follows:

1. Apex Kidney Care Private Limited :-

North Goa:- Asilo Hospital Mapusa(Operational Machine 11), CHC Valpoi(Operational Machine 4). Total Operational Machines 15 

South Goa:- SDH Ponda(Operational Machine 3) , PHC Balli(Operational Machine 3) , PHC Navelim  (Operational Machine 5). Total Operational Machines 11.

1. Dr. R. Vankatesh providing dialysis services

South Goa:- CHC Canacona (Operational Machine 9) , Hospicio Hospital Margao (Operational Machine 23) ,Total Operational Machines 32.

• Goa Medical College Operational Machine 10.
•  

REPORTS

Monthly PMNDP Report March 2019

Monthly PMNDP Report April 2019

INFORMATION REGARDING DIALYSIS SERVICES

From 1st March, 2018 to 31st March, 2018

Under State/Other Support

INFORMATION REGARDING DIALYSIS SERVICES

From 1st April, 2019 to 30th April, 2019

Under State/Other Support

Online Portal

Dialysis Monitoring

Finance 

1. Rate per dialysis cycle Rs. 996/- per cycle for Apex Kidney Care Pvt Ltd. + 3% annual increment.
2. Rate per dialysis cycle Dr. Vankatesh Rs. 1253.20 + 12% of  540 annual increment.

ROP 2019-20 approved Rs. 259.20 Crores

In order to expand comprehensive primary care to improve community access, Sub Centres/ Primary Health Centre have been strengthened as Health and Wellness Centres (H&WCs) The H&WC provides Preventive, Promotive, Rehabilitative and Curative care for RMNCH+A, Communicable diseases, Non-communicable diseases, Ophthalmology, ENT, Dental, Mental, Geriatric care, Palliative care, treatment for acute simple medical conditions and emergency & trauma services.

CPHC – ESSENTIAL PACKAGE OF SERVICES

1. Care in Pregnancy and Child-birth.
2. Neonatal and Infant Health Care Services
3. Childhood and Adolescent Health Care Services.
4. Family Planning, Contraceptive Services  and other Reproductive Health Care Services
5. Management of  Communicable Diseases: National Health Programmes
6. General Out-patient Care for Acute Simple Illnesses and Minor Ailments
7. Screening, Prevention, Control and Management of Non-communicable Diseases
8. Care for Common Ophthalmic and ENT Problems
9. Basic Oral Health Care 
10. Elderly and Palliative Health Care Services
11. Emergency Medical Services including Burns and Trauma
12. Screening and Basic Management of Mental Health Ailments

Currently, there are 9 existing Health & Wellness Centres which are operational.

1. RMD Thana
2. RMD Keri
3. RMD Diwar,
4. UHC Mapusa 
5. RMD Guleli 
6. RMD Agonda 
7. RMD Neturlim 
8. RMD Usgao 
9. RMD Sada.

As per the directives from Ministry of Health & Family Welfare, all the 24 PHCs, 31 RMDs, 5 CHCs, 4 UHCs including RMH Mandur and UHC St. Cruz have been converted to Health & Wellness Centres.

Hands on Training have been conducted for the implementation of MO-PHC portal for NCDs : MBBS MOs – 49, AYUSH MOs – 29, Staff Nurses – 49, Pharmacists – 44, ANMs – 80, DEOs – 18, IEC Officer/Ext educator – 21 have been trained.

At present, 15 Tablets are being used by ANMs for NCD Screening (application) for Population Enumeration & CBAC. Additional Tablets procurement is under way.

NCD Camps

NCD Camp is outreach programmes conducted monthly under each Health Facility. ANMs screen the population for the risk factors and presence of Non communicable diseases like Anaemia, Hypertension, Diabetes Mellitus, Oral Cancer, Breast Cancer, COPDs, Cervical Cancer. Focus of action is on health promotion, early diagnosis, prompt initiation of treatment as well as complication screening and referral.

The following activities are conducted in NCD camps

1. ANMs perform manual examination for Breast Lump & accordingly patients are referred to District hospital for further Management. 
2. Gynaecologist does the Gynaecological examination followed by -Pap smear examination of all female more than 30 years. The Pap Smears slides are then sent to District Hospital Laboratories for reporting.
3. Dental Surgeon conduct oral examination for any oral lesions like ulcers, leukoplakia & refer to Goa Dental College.
4. Blood Pressures are checked & Patient with BP above 140/90 mm Hg are referred for treatment.
5. Random Blood Sugars are checked by Glucometer, RBSL above 140gm/dl are referred for treatment.
6. Hemoglobin detection is done by Hemocue meter. Hb below 11 for females & below 12 for males are referred for treatment.

• Total Patients screened for Anemia 18739 & suspected 5906 

• Total Diabetes screened / Suspected  19826/ 4784
• Total Hypertension  screened/Suspected  19808/ 2311
• Total COPD screened /Suspected  19551/ 38
• Total Ca Breast screened /Suspected  22386/ 22/2
• Total Ca Cervix screened /Suspected/Confirmed 6999/72/2
• Total Oral Cancer screened /Suspected  1179/ 11

         Till Mar 2019 is 594 NCD Camps have been conducted.

• 2 cases of Oral Cancers detected & are treated at GDC.
• 2 cases of Breast Cancer & Cervical Cancer detected & are Treated for the same.

MEGA MEDICAL CAMP

Mega Medical Camps are mass screening of population of all age groups including both males and females in collaboration with Goa Medical College and Goa Dental College, Bambolim – Goa, NGO, Mukta Optician & Super Speciality Hospital like Narayana Hrudralaya Bangalore, KLE Hospital Belguem, and HCG Bangalore (Oncology).

 Consultants/Senior Residents/Junior Residents from GMC along with the doctors from Directorate of Health Services and services of Mobile Dental Van are utilised along with the resident doctots of Goa Dental College to screen the patients in various communicable and non communicable disease.

During these camps the multiple Health Services are provided for the patients such as Gynaecology OPD, Medicine OPD, Paediatrics OPD, Surgery OPD, ENT OPD, Ophthalmology OPD, Orthopaedic OPD, Dental OPD along with super speciality services. 

These Mega Medical Camps are conducted with the help of our Medical team and local governing bodies such as schools, local panchayat, etc.Every Mega Medical camp approximately screens 500 to 1000 patients, 

• 25 Mega Medical Camps are held across Goa till Mar 2019.
• Total No. of patients referred from camps is 3,568. 
• Total No. Patients Screened are 14,750.
• Patients referred from camp are treated on Priority Basis at GMC & GDC

Training status

Hands on training for HWCs

• Training done for Population enumeration & CBAC form – NCD

Training on HWC Portal

Population Enumeration

Total population is 15.42 Lakhs.

 Total 30+ Population is 5.2 Lakhs.

Total population enumerated is 3.2 Lakhs.

RMD Usgao

RMD Keri

RMD Diwar

RMD Agonda

National Mental Health Programme

It is estimated that 6-7 % of population suffers from mental disorders. One in four families is likely to have at least one member with a behavioural or mental disorder (WHO 2001). These families not only provide physical and emotional support, but also bear the negative impact of stigma and discrimination. Most of them (>90%) remain un-treated. Poor awareness about symptoms of mental illness, myths & stigma related to it, lack of knowledge on the treatment availability & potential benefits of seeking treatment are important causes for the high treatment gap. The Government of India has launched the National Mental Health Programme (NMHP) in 1982, with the following objectives: 

1. To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population; 
2. To encourage the application of mental health knowledge in general healthcare and in social development; and 
3. To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community. 

District Mental Health Programme

• Regular Psychiatric OPD are conducted at both District Hospitals.
• Camps are conducted by District Mental Health Team at Schools.
• Patients are also counselled at both the District Hospitals.  
• Medical Officers and RBSK Doctors are trained for prevention, early detection  and referral of  common mental health illnesses at IPHB, Bambolim – Goa.
• IEC Activities are conducted at District Hospital, Sub – District Hospital, Urban Health Centres, Community Health Centres, Primary Health Centres.

Training on Mental Health

• Training on” Basic Counselling Skills “held on 29th May 2018 at Urban Health Centre Margao Goa.
• Training for Primary School Teachers held on 24th July 2018

Mental Health HR

Mental Finance

Financial Allocations

Financial Status

B Part Expenditure 

Health Facilities in Goa

1. Tertiary Level- Goa Medical College & Hospital.

1. Health facilities under Directorate of Health Services

4 new non Bedded PHC Added 

1. PHC Porvorim
2. PHC Mayem
3. PHC Chimbel
4. PHC Navelim 

1. Other Hospitals in Goa

• ESI Hospital Margao
• MPT Hospital , Mormugao 
• Military Hospital , Panjim

1. Private Hospitals

• Manipal Hospital
• Apollo Hospital
• Vision Hospital, Mapusa
• Galaxy Hospital, Mapusa
• Grace Hospital, Margao
• Healthway Hospital, Old Goa
• Royal Hospital, Margao

Facility Based

Trauma Care Facilities

• Level 1- Goa Medical College & Hospital
• Level 2-Private Hospitals (DDSSY Scheme)
• Level 3- North & South Goa District Hospitals /Sub District Hospitals , Community Health Centre /Primary Health Centre.
• ECC: Setting up of Emergency Care Centres (ECC) are unique to State of Goa. The ECC  in the first phase have been launched in the existing Health facilities such as CHC Canacona, CHC Sanquelim, UHC Panaji,PHC Sanguem, PHC Aldona, CHC Pernem, RMD Keri, RMD Thane ,PHC Dharbandora & CHC Valpoi is equipped with Ventilators, Defibrillators, Suction Apparatus, Nebulizers, Medications and Splints for stabilizing and transfer of patients in well equipped advance life saving ambulances.  
• Presently 10 are launched & planning to launch in other health facilities.
• Emergency Care Centers are in a position to handle any kind of emergency at any given point of time with the help of the trained expert manpower and state of the art equipment and medications.
• The Emergency Medical Services/ Casualty Services are strengthened and rendered 24×7 in 15 Primary Health Centres and 4 Community Health Centres. Besides 10 Non Bedded Primary Health Centres have been rendering Trauma Care Services during the day time. It is ensured that Trauma Care Services are available all along the National Highways in the State.
• As regard to equipment, these health centres have being strengthened with equipments and consumable for diagnostic and management purpose.

ICU facilities in Goa (Govt. & Private)

• Goa Medical College  & Hospital, Bambolim Goa.
• Manipal Hospital, Dona Paula
• Vision Multispecialty Hospital, Mapusa Goa.
• Galaxy Hospital, Mapusa Goa.
• Healthway Hospital, Old Goa.
• Campal clinic, Campal Panaji.
• Royal Hospital, Margao.
• Horizon Hospital, Margao.
• SMRC Hospital, Vasco.
• Grace Hospital, Margao. 

Blood Bank Facilities in Goa (Govt. & Private)

• Goa Medical College & Hospital, Bambolim Goa.
• Hospicio Hospital, Margao.
• Asilo Hospital,(North District Hospital), Mapusa Goa.
• Manipal Hospital, Dona Paula Goa.
• Apollo Hospital, Margao.

Radiological Mapping

Changing Diabetes Barometer -Goa Program – Backgrounder

Executive Summary

Non-Communicable Diseases – A Silent Killer

• Today non-communicable diseases NCD’s (Cardiovascular disease, Chronic Respiratory Disease, Cancers & Diabetes) are a silent killer. 
• Government of India has a strong commitment to address NCDs
• We believe that timely detection and treatment can help people with diabetes and other NCDs lead a healthy, complication free life.

Goa has a high prevalence of diabetes at 10.3% vs a national average of 8.8% and that is why we are committed to reduce the burden in Goa

We have been working on this since 2008 under the Changing Diabetes® Barometer (CDB) programme and achieved some milestones 

• Reached out to > 3 Lakh people with awareness programmes
• > 100 patient camps conducted and 32,000 people tested for diabetes 
• Trained >600 doctors & nurses, 1,200 Anganwadi workers 
• Goa was the first state in India to launch a “diabetes registry” and > 7,000 people with diabetes were registered 

The current government in Goa, wants to renew focus on NCDs starting by focusing on diabetes 

We would like to systematically work on improving care in Goa through a 2 -phase project

Phase 1: Make sure that everyone gets better access to care for diabetes and related complications in all our government hospitals

1. • All government medical centers will provide high standard of care through trained doctors and nurses 
   • Treatment of medicines to ensure better quality of life will be provided for free at all these centers
   • The government will ensure there is high awareness on improving diagnosis and will build an online registry to monitor progress on the services provided
   • For this the government will tie-up with multiple private partners and support this endeavour 

Phase 2: Other NCDs like hypertension, Cancer and respiratory diseases will be under similar focus based on our learning in Phase 1

Current Health Care Scenario in Goa

• 1. Public health expenditure in Goa is almost four times the national average
  2. Goa’s infant mortality rate is among the lowest in India
  3. 94% of women in the state participate in household decisions 
  4. 96.9% of all births take place in hospitals as against the national average of 79%

Insights on NCDs status in India

1. 1. NCDs contribute to around 5.87 million deaths that account for 60% of all deaths in India. 
   2. 1 in 4 Indians is at risk of dying from a NCD before they reach the age of 70
   3. There are over 72 million people with diabetes in India. In 2017 about 21% of the total global deaths related to diabetes happened in India
   4. In 2017 about 21% (~1 million) of the total global deaths related to diabetes happened in India. 
   5. Between 2012-30, diabetes treatment in India will cost ~ INR 10 trillion.

Learning from the earlier Goa initiative: 

1. The program helped to have a mean estimated HbA1c value reduce from 7.18% (estimated from FBS) to 6.2% in people who were part of the diabetes registry. 
2. The project also helped avert 17,600 probable cases of micro vascular complications (Eye, Kidney and Nerve diseases) in the Goa population.

There is strong evidence that early detection and treatment of type2 diabetes has a positive impact on disease progression, leading to fewer complications and increased life expectancy for people with diabetes. In fact, early detection of diabetes and pre-diabetes is cost-effective because it enables timely treatment which can delay and hinder complications as well as increase life expectancy.

To address the diabetes challenge, a comprehensive and integrated plan of action based on the existing knowledge of cost-effective and reliable solutions, led by government in partnership with private entities, coupled with vigorous efforts to update awareness about the disease, can help in achieving success against diabetes.

Changing Diabetes Barometer – 2018 – 20 

The Changing Diabetes Barometer(CDB) is a Novo Nordisk Education Foundation initiative that works as a quality monitoring system for diabetes management to measure the gains made in the fight against diabetes focusing on quality of care and patient outcomes.

The Goa CDB program include:

1. 1. The launch of 15 Community Diabetes Centers
   2. Free treatment for all Goans with diabetes 
   3. In –depth training based on latest international curriculum for government doctors and health workers
   4. At- home counselling for people with diabetes by dedicated diabetes educators
   5. Launch of digital diabetes registry to track patient progress.

The ultimate, aim of the program is to give the people of Goa the best care through the best trained healthcare professionals, best treatment and best follow-up, working towards a healthy & progressive Goa

• The Government of Goa is committed to delivery of quality healthcare services for all citizen of the state. The re-launch of the Changing Diabetes Barometer programme will provide comprehensive diabetes care to over 3 lakhs people with diabetes in Goa. Under the programme, the Government of Goa will set up 15 Community Diabetes Centers; provide free anti- diabetic medicines; home visits from ANMS and diabetes counsellors and distribute relevant diabetes education literature at all government hospital and Primary Healthcare Centre.
• There will also be a roll out of a state-wide diabetes testing program for all adults over the age of 30 years for early diagnosis of diabetes. These steps are bound to reduce the disease burden in the state and change the health profile of the citizens of the state.

Overall CDB Goa – Project Plan 

ACT Framework for implementing changing diabetes initiatives in India

ACT for changing diabetes in India is a unique initiative. Novo Nordisk Education Foundation (NNEF) is partnering with state Governments to increase Awareness, build Capacity and elevate Treatment across India. Till now, NNEF has partnered with seven state governments and initiated changing diabetes® activities under PPP framework.

• • Awareness & Advocacy: Shift policy focus from curative to preventive care using the ‘community oriented, and community based’ to ensure healthy lives and promote well-being for all at all ages.
    • Conducted mass awareness programs in PAN India and reached more than 48 million people
    • Successfully conducted FIVE Changing Diabetes® policy meetings with 190 Government stakeholders and submitted roadmap for diabetes management.  
  • Capacity Building: Train health care professionals at primary, secondary and tertiary levels on integrated diabetes management.
    • ~1,239 Government doctors and paramedics were trained on basic and advanced diabetes management under LEAD program. All LEAD training programs have been accredited by local Medical Councils.
  • Treatment: Create patient friendly healthcare ecosystem for diabetes management, including primary, secondary and tertiary preventive strategies. 

• Currently 103 Community Diabetes Centres are established in Government healthcare units and nearly 0.1 million people with diabetes were getting benefited from these units.

About Novo Nordisk Education Foundation

• Novo Nordisk Education Foundation (NNEF) is a non-profit organisation established in the year 1997 with the purpose of increasing diabetes awareness and education. 
• NNEF aims to provide comprehensive education & awareness on diabetes and other healthcare issues by bridging the knowledge gap. 

Mission: Enhancing healthcare by facilitating awareness and education.

• As per our mission we collaborate with key stakeholders and like-minded partners on key initiatives to bring about awareness and education to tackle the burden of diabetes. 

Focus:

• Increasing awareness by educating people with diabetes (PwD), doctors, diabetes educators, paramedics and public in general can help to control the epidemic of diabetes. 
• The main challenge is to reduce the human and financial costs through early diagnosis and effective management and to prevent new cases of diabetes2.

Purpose and objectives:

The foundation hopes to improve healthcare, particularly diabetes care by facilitating:

• Diabetes awareness and patient empowerment programs 
• Diabetes education 
• Diabetes detection drives and formation of diabetes registries 
• Diabetes care standardization and up-gradation 
• Diabetes research

Training

1. LEAD Workshops for Primary Care Physicians

1st CDB Program Review Meeting held at DHS on 08-Feb-2019

2nd CDB Progress Review Meeting held at DHS on 24-Apr-2019

Inaugration of Community Diabetes Centre in Curchorem

Inaugration of Community Diabetes Centre in Sankhali

Inaugration of Community Diabetes Care Centre in Valpoi

Inaugration of Community Diabetes Care Centre in Canacona

Cancer Registry

The Goa Cancer Registry, which was launched in 2009, is a State-Government initiative to build a database of all cancer cases in the state. The aim of this registry is to document the different cancers prevalent in the state. It also gives an insight into epidemiology of various cancers in terms of age, sex and geographic distribution. Presently, all government health centres are reporting cancer cases along with few private centres. The cancer registry can provide useful trends in cancer prevalence. Challenges in building a robust database include reporting rates and coverage from private hospitals.

A consolidated report of Goa Cancer Registry will be made available on this website soon.

Cancer IEC

• World Cancer Day (4 February 2019)  & National Cancer Awareness Day (November 7 2018)

Cancer is one of the major health concerns today, both in Goa and across the world. In India, there are approximately 38 lakh cases of cancer. Every year, about 15.2 lakh new cases are added while mortality remains at approximately 7-8 lakh per annum.

The activity of awareness generation and screening has to be an ongoing activity. However, in the light of National Cancer Day (November 7 2018) & World Cancer Day (4 February 2019)  celebration, as per circular issued by the Secretary (NHM), all health centres were directed to conduct intensified cancer screening activities in the field. In addition to this, cancer screening activities were also conducted during this campaign. Cancers of public health significance were focused upon, i.e. breast cervical, & oral cancers among others.

Local bodies like panchayats and self-help groups were also involved in these activities.

Research studies under Cancer registry

• Epidemiology & trends of of breast, cervical and oral cancers in Goa, India.

Health promotion through behaviour change with involvement of community, civil society, community based organizations, media etc. Opportunistic screening at all levels in the health care delivery system from sub-centre and above for early detection of diabetes, hypertension and common cancers. Outreach camps are also envisaged. To prevent and control chronic Non-Communicable diseases, especially Cancer, Diabetes, CVDs and Stroke. To build capacity at various levels of health care for prevention, early diagnosis, treatment, IEC/BCC, operational research and rehabilitation. To support for diagnosis and cost effective treatment at primary, secondary and tertiary levels of health care. To support for development of database of NCDs through Surveillance System and to monitor NCD morbidity and mortality and risk factors.

NPCDCS IEC

• Diabetes Awareness Month (November 2018) and World Diabetes Day (November 14) Celebration.

Diabetes Awareness Month (November 2018) and World Diabetes Day (November 14) was observed across all health facilities. The theme for WDD 2018 was ‘Family and Diabetes’.

Useful resources for planning & conducting WDD activities, infographics, toolkits, posters and other educational material were shared with all health centres along with funds to carry out the activities. On this occasion, 2 of the following competitions were organized at all health centres:

• Elocution Competition

• Topic: ‘I can win against diabetes’ (‘Haanv diabetesak harvu shakta’)
• Participants: Diabetes patients from respective PHCs

• Poster making competition 

• Topic: Healthy lifestyle for preventing diabetes.
• Participants: Students from schools/ higher secondary/college

• Skit

• By PHC staff  on the theme: ‘Role of Family in Diabetes Prevention & Management’.

In addition to these competitions, all health centres were asked to conduct Health Education on relevant issues covering various aspects of diabetes prevention, management, complication screening, insulin injection technique, medication adherence, lifestyle changes, dealing with depression in diabetes, role of family, etc. has to be carried out in this program.

Hospicio Hospital, Margao also conducted screening of hospital staff for diabetes and hypertension and organized a walk for diabetes awareness.