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UTTAR PRADESH
26 January 2015
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DEVELOPING
countries and regions
all over the world struggle with getting
healthcare policy right: being too soft
can lead to costs that are high and
unmanageable; being too hard can lead to
genuine suffering amongst the people who
need help most.
Uttar Pradesh (UP) has taken a double-
headed approach to solving its present and
future healthcare issues by improving the
standard of healthcare offered to residents
throughout towns and villages and also
investing simultaneously in healthcare
education to prepare a greater supply of
medical professionals in the future.
As with much of the developing
world, nutrition is one of the first essential
healthcare issues that needs to be addressed.
For this reason the UP Government
launched the ‘State Nutrition Mission’ in
November 2014 to address the problem
of malnutrition in children head on. The
target of the initiative is to make the state
malnutrition-free and give a lasting gift of
a healthy life to the children of the state.
On a broader scale, under the leadership
of the Chief Minister (CM) Akhilesh Yadav
and his team, hospital admission fees have
recently been waived for all patients while
free treatment and diagnostic tests have
been extended to below the poverty line
cardholders. In-patients in UP’s hospitals
are now given medicine for five days rather
than three days while patients undergoing
treatments of a longer duration are now
given medicine for 15 days free of charge.
Looking towards medical education,
the present Government has added 500 seats
for medical students in the state and new
medical colleges have been inaugurated in
Kannauj, Azamgarh and Jalaun districts,
resulting in an increase of 300 seats under
the Bachelor of Medicine and Bachelor
of Surgery courses. A further 100 seats
each are proposed under the first phase in
Jaunpur, Chandauli and Banda districts.
These initiatives are being augmented
by the addition of 13 postgraduate seats
in the Rural Institute of Medical Sciences
in Safai, Etawah, 11 postgraduate seats to
the medical college in Gorakhpur, and five
postgraduate seats to the medical college
in Jhansi.
The Government also has plans to
establish new medical institutes in the
state and a cancer institute in Lucknow
district is being planned as a high profile
initiative. Naturally, these initiatives are a
serious drain on the public coffers, but are
indicative of the high importance being
placed on the future of healthcare services
in the state by the Government.
A further development sees a medical
complex known as Medanta-Awadh
being developed in an area of 12 acres in
Lucknow by Dr. Naresh Trehan to offer
comprehensive advanced healthcare.
This 1,000-bed specialty hospital will be
equipped with facilities that include 30
operating theatres, a 300-bed intensive
care unit, an Unani medical centre focused
on a form of traditional medicine, an
Ayurvedic medical centre, a research and
development centre, a healthcare business
process outsourcing (BPO), offices of multi
national healthcare and drug companies,
ancillary and supportive services and
residential premises.
Slightly lower profile initiatives
include the setting up of new medical
colleges in Budaun, Jaunpur and Chandauli
districts while the state’s first postgraduate
super specialty paediatric hospital and
educational institute is planned for Noida.
The Minister for Medical & Health,
Family Welfare, Women and Child
Welfare for UP, Ahmad Hasan, lays much
of the credit for the robust development
of the healthcare sector at the feet of the
CM. “Our state has improved in every
front on the healthcare aspect and we are
working harder to improve even more in
all aspects of healthcare delivery. The CM
governs under difficult and challenging
circumstances and despite this he has
increased the confidence of the poor in UP
for healthcare.”
He added, “One of the first things that
was in his manifesto concerned giving
poor people access to free medicine.
The previous Government only gave
medications free to for a period of three
days whereas this administration extended
that to five days. If people live in rural
areas, then the hospitals have been given
enough funding to give them medicine for
15 days. Twenty per cent of the hospital
budget was allocated towards that.”
The cost of this initiative earmarked
for the supply of medicine alone is about
$50 million per year. Another advance
seen as part of this initiative is that the list
of essential medicines that can be given to
hospitals has been revised and updated and
now includes a total of 431 medicines.
“To make sure that hospitals don’t run
out of medicine, the CM has launched an
IT solution that monitors the availability of
medicine in each district hospital, online.
The software also monitors if the supplier
has dispatched the order for medicine, when
he receives it and also when the suppliers
receive payments. These reforms have
been initiated already in a new state-wide
drug procurement and inventory system,”
says Arvind Kumar, Prinicpal Secretary
Medical, Health, and Family Department.
In order to avoid the problems caused
by the supply of counterfeit medicine sold
at bargain basement prices, the purchasing
process is transparent and open to tender.
“Any pharmaceutical company anywhere
in the world can come in and tender for the
supply of these drugs and they will get the
contract as long as their cost is the lowest,”
says Kumar.
Differentpartsofthestatehavedifferent
medical requirements although some
communicable diseases like tuberculosis
are quite common throughout the state. As
the general level of affluence slowly rises in
UP, incidences of cardiovascular diseases
are increasing but more generally doctors
have to deal with illnesses such as common
fever and diabetes. Some localised areas
suffer acutely from cases of Japanese
encephalitis and encephalitis syndrome.
The state’s largesse does not end at
free medicine. “The Government has also
given free X-rays and free blood testing
for everyone and this is unique in India.
There used to be a bed rental fee of 35
rupees ($0.55) in the hospitals and this
administration has done away with that
so that a bed is now free,” says Kumar.
“But one of the major achievements of
this administration is the health services
working with the private sector to provide
ambulance services. This administration
has introduced around 1,000 new
ambulances into the system.” This is
a crucial development in a state that is
overwhelming rural.
The introduction of a centralised
call centre via a 108 telephone number
means that anyone can call for free and
be picked up within 20 minutes from any
urban area. In rural areas the response time
is 30 minutes and there is no charge for
transportation, treatment or diagnostics.
This ambulance fleet looks after about
250,000 patients every month and now
represents one of the biggest ambulance
services operating anywhere in India today.
“There have also been big strides in
bringing down the maternal mortality rate
and the infant mortality rate. Mothers and
babies have a dedicated fleet of ambulances
that can be accessed via a 102 telephone
number,” says Kumar. This initiative is
supplemented in hospitals with free food
for pregnant women. “This is a key step
in enhancing institutional deliveries rather
than home deliveries and this has helped
reduce mortality rates,” added Kumar, hint-
ing at the drive to have women choose to
deliver their baby in the sterile environment
of a hospital rather than at home where san-
itation levels are variable at best.
Inevitably,
with
more
people
demanding access to better health services,
the demand for new doctors and support
staff becomes more of a problem. There has
been an increase of about 10 million visits
in outpatients departments over recent
years. “Human resources is a challenge
for us,” comments Kumar. “We need more
specialists. Over the past three months
we have been able to attract 1,800 new
doctors into the public sector. This has been
achieved by linking pay scales to length of
service rather than to positions available.”
The instance of non-communicable
diseases is increasing in UP with cancer
and diabetes on the rise. These illnesses are
difficult to handle in the primary healthcare
sector and as a result the tertiary healthcare
sector needs to be expanded to meet the
demand. “The Government of UP is giving
10 acres of land free of cost in Lucknow
so that public–private partnerships (PPP)
can set up super specialities in at least two
disciplines: one has to be cardiovascular
and other discipline the PPP partner
can choose. Within three years the PPP
partner would have to have set up a 500-
bed hospital and reach 1,000 beds within
12 years. And at least 50 per cent of the
beds will have to be charged at controlled,
central Government rates,” says Kumar.
There is a recognition that the
Government does not have the bandwidth
to do it all itself. It needs expert advice
and guidance from professionals. This is
an area where overseas companies with
good track records are most sought after.
But commercial input is not restricted to
hospitals and clinics alone. “The other
project that we are running on the PPP
model is in the ambulance services. We
purchase the ambulances and we open the
sector up to private participants to run the
fleet, to bring in HR and operate them on
a monthly fixed cost basis. “There is also
an opportunity for setting up nephrology
centres. Kidney problems are becoming
more prevalent and there is a growing need
for dialysis centres,” says Hasan.
As time goes on the opportunities for
lucrative partnerships that will help the
health of the people of the state are likely to
grow rather than diminish. The population
of UP is huge and growing and with it will
grow the demand for high quality medical
services. Quite rapidly the demands will
shift from dealing with third world illnesses
to developed world ailments. For investors,
healthcare in UP has the potential to be a
world of unlimited opportunity.
Medical
UP’s
Utt
ar Pradesh has a huge and growing medical bill. This
could spell opportunity for the world’s leading health
organisations as they move in to make a both a difference
and a profit at the same time.
Kathryn Freeman reports
THE
state of Uttar Pradesh (UP) has long
been established as one of the educational
hubs of India. Its rich history of education
and learning dates back to before the
British settled in India. On the arrival of the
British came the concept of an elaborate
school and college educational system that
was subsequently carried forward by India
and the state Government authorities post
independence.
Today, the green shoots of the new
educational age are almost everywhere in
UP as the state seeks to educate and train
its young hopefuls for the opportunities
of tomorrow. An Indian Information
Technology Institute (IIIT) is earmarked
for a 50-acre site on Chair-Ganjaria farm
in Lucknow as part of a collaborative joint
venture between the UP Government,
the federal Government of India and UP
Electronics. With the foundation stone
being laid in October 2014 the facility will
have 120 seats in year one, 180 seats in
year two and 300 seats in year three.
In addition to this, 19,760 seats have
been added within the Industrial Training
Institutes (ITIs) in 2013-14, thus providing
more opportunities of employment to UP’s
youth. ITI institutes specialise in teaching
hands-on skills to young people depending
on the trade that they want to enter. These
can range from electrical, mechanical and
services to retail, hospitality and health.
Four engineering colleges have been set up
in Ambedkarnagar, Azamgarh, Banda and
Bijnor with a collective capacity of 300 and
a further three engineering colleges will
be established by 2016-17 in Sonbhadra,
Mainpuri and Kannauj thus creating
another 150 seats each.
These colleges are being supplemented
with eight new polytechnics in the
Government sector and 50 in the private
sector catering to the needs of around
14,000 students. Two new Government
universities have also been established in
the state while 42 new Government degree
colleges have been established in the last
two years.
Minister of Vocational Education &
Skilled Development, Abishek Mishra,
a former professor of IIM-Ahmedabad,
says, “We realised that the level of training
and level of skill in our population was
extremely low; only about 2 per cent of
the population had any formal training.
We looked at other countries such as the
UK, Germany and Japan where the level
of skilled training given to the manpower
was about 60 to 70 per cent, so almost
everybody had some form of training.
“What our Chief Minister (CM)
did then was look at this and review the
funding allocation received from both the
state, and the main Government. He then
made the decision to restructure the way
our departments do things by pooling all
funds into one pot. It was a structuring
innovation – one department would look
after all the training. Which is how the
Uttar Pradesh Skill Development mission
was created. We were the first state in the
country to do this and the Government of
India is now doing something similar, a
year after we first created it.”
Mishra added: “This is a big country
with huge human resources. It is a
demographic dividend so we want to train
them and get the best out of them. Research
suggests that there is a skills manpower
gap of nearly 50 million globally so if we
can train our people we can fill some of
that gap. They need to be given the
right kind of skills for industry.”
The methodology of the state education
system has changed to reflect the new
demands of the marketplace. Bhuvnesh
Kumar, Secretary, Vocational Education
& Skill Development for the Government
of UP says, “In the past we used to give
people general training but this is no longer
enough. We had to skew it to offer specific
skills, which is what we do now. We did this
by talking to industry and asking themwhat
sorts of skills they wanted to see in workers
and we met that demand.” This gives some
sense of the collaborative nature of what
the state Government is trying to pull off
by working closely with the private sector.
It is the private sector that will benefit most
from this kind of advance.
“We know what sorts of roles there are
to be filled from plumbers to electricians to
security guards,” says Kumar.
Sector Skills Councils define what
skills are needed and the state educational
and training apparatus tries to match the
demand. Sector Skills Councils are not
Government bodies but private enterprises
headed by industry leaders and HR
professionals. They define the job skills,
skills levels and curriculum that need to
be taught and then the state provides the
training.
How does the Government go about
attracting candidates to take advantage
of this matching service? “We advertised
broadly and told people that we were
building these training institutes and asked
interested people to contact us. This was
done by the state itself and funded by the
state Government under the Uttar Pradesh
Skill Development mission banner. We got
4.6 million registrations on that website
from people indicating their willingness
to come and join the programme and be
trained and then find a job,” says Kumar.
“They have the freedom to choose the
sector that interests them most.”
The Government knows that its best
chance of rolling out this kind of initiative
successfully lies in engaging with the best
suppliers to achieve the best outcomes. “We
have engaged 85 training companies to do
the work for us, paid for by both the state
and national Government. The training
companies are allocated to geographical
areas,” says Kumar. And in order to keep
them on their toes, “Training companies are
only paid when 60 per cent of the intake for
a year is in full employment. They are also
subjected to tests to make sure that they are
delivering a quality product all the time.”
This is a relatively new initiative
that started in June 2013 with training
commencing in February 2014. Since then
more than 100,000 people have been trained
through the three or four centres operating
in every district. Over 20,000 assessments
have been done thus far and approximately
9,000 workers have qualified with 2,000
having found full time employment. It
looks like a very promising start.
“This was one of the CM’s initiatives,”
says Kumar. “This is very close to his heart
and he has inspected some of the centres
for himself and spoken to the trainees. He
personally thinks that this can be a game
changer for UP and can turn the state
around. Our target over the next few years
is to have 1 million people trained and 60
per cent absorbed into the workforce.”
To date the state Government has
signed a number of memorandums of
understanding (MoU) with reputed private
companies to provide vocational training
and employment to those enrolled with the
ITTs and polytechnics. The Government
had signed such flexi-MoUs with some
companies earlier as well, who have gone
on to commit not only to train several
thousands of the state youth, but also
provide employment to most of these
candidates after successful completion of
their modules.
At a grassroots level the UP
Government has often been lambasted
for poor literacy rates among females and
children but to change this the Government
has been working alongside voluntary
organisations, such as the likes of UNICEF,
and making radical reforms in the
educational system itself. These initiatives
have resulted in an 11.4 per cent rise in
literacy rates. According to the last census
report published in 2011, the literacy rate
in the state was 69.72 per cent, a noticeable
improvement when compared to the
literacy rate of 56.27 per cent recorded in
2001 during the previous census.
It is easy to understand why there
has been a rise, at the other end of the
spectrum, as the free education being
offered to children between the ages of
six and 14 is believed to be key. After the
age of 14, youngsters are being offered
a comprehensive programme of skills
development to help them find jobs. In
all it is believed that this should lead to
over 2.3 million young people in the age
group of 14 to 35 years receiving training
for three years.
In December of 2014 CM Akhilesh
Yadav told reporters that he was
keen to see uniformity in the education
system in UP, “We want everyone to get
qualitative education. If basic, secondary
and higher education is improved, the
results of our future will be very different...
it will change the face of our state and
our nation.”
mission
Uttar Pradesh has a population of 200 million with 65 per cent under the age of 35. If the
young generation is given access to a quality education, it will create a formidable talent
bench and a modern workforce that is to be reckoned with.
George Mitchell reports
UP shines spotlight
on youth education
Abishek Mishra, Minister of
Vocational Education & Skilled
Development
The International Oncology Centre is a world class cancer care centre in
Noida, Uttar Pradesh
Photo courtesy: Soumitra Ghosh
Ahmad Hasan, Minister for Medical
& Health, Family Welfare, Women
and Child Welfare
Our state
has improved in
every front on
the healthcare
aspect.