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26 January 2015


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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.


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.





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.




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


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


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


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.”


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


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