Transcript Action Plan India - Pain & Policy Studies Group

Action Plan India
Priya, Nandini, Shalini, Dr. Sudhir,
Rajesh, Raj, Frank, David
Patients across India receive
quality pain management,
including opioid analgesics
Problems identified
1.
Regulations of central and state governments do not support adequate
access to controlled pain medications.
2.
Lack of appropriate environment (attitudes, knowledge, skills, and
behaviors) amongst health care professionals, policy makers and
regulators
3.
Lack of access to competent health delivery centers for adequate,
effective pain relief
4.
Inadequate awareness of public about pain management and use of
opioids
1. Issues on Regulations
Problems
objective
Regulations of central and state
governments do not support adequate
access to controlled pain medications
Ensure alignment with U.N. Single
Convention
Facilitate RMIs* throughout the country
Develop system for reporting of
estimates and consumption statistics
1.1 Complex and non-uniform
regulations
Amend the NDPS Act
Frame new central rules for entire
country
1.2 No single central government
Form a consultative committee as per
agency with a mandate to ensure access section 6 of the NDPS Act
to controlled pain medications
1.3 Lack of awareness about “the
principle of balance” amongst policy
makers
Support implementation through
communication and educational
activities
1. Action Plan for Issues on Regulations
Action
Who
When
1.1. Amend the NDPS Act & Concerned ministries with
Frame new central rules for DOR as nodus
entire country
6 months after
governmental approval to
go through both houses
- Language, supportive
documents, SOPs
- Advocacy at state level
IPPF Fellow
Continued engagement with
the concerned govt.
agencies – until ACT/Rules
Passed
1.2 Form a consultative
committee as per section 6
of the NDPS Act
- Facilitate through
interactions with NAC,
ministries
- Identify members
- Frame rules for committe
NAC, PMO, MOF and MO
Health, PC advocates- to
help form
Continued engagement with
the concerned govt.
agencies
DO Revenue to frame rules
and notify the committee
IPPF Fellow – assist with
resource
1.Ensuring accurate reporting of estimates and consumption statistics
Action
Steps
3.1. Develop an online system for registration and return filing of
manufacturers/wholesalers to enable gathering of consumption
statistics as defined in the Single Convention
3.2. Give input on the importance of consumption statistics for monitoring
and research for 160 manufacturers/wholesalers.
- Identify the ideal format for the statistics (e.g. by RMI, state, etc.)
3.2.a Be alert for blockages in the system that lead to stock-outs and impact
patient care
3.3. Get manufacturers/wholesalers to register
Who has
A/R
3.1. Narcotics commissioner, CBN
3.2. Fellows and other experts
3.3. Narcotics commissioner, CBN
When
3.1. 1 year
3.2. 3-4 months
3.3 6 months after system is created
Assistance
3.1. MoF will sanction funds
3.2. IPPF fellows - Consultation from PPSG
3.3. N Commissioner - host workshops with manufacturers + PC experts
Outputs
Online system is in place, Accurate consumption statistics are available
1.3 Lack of awareness about “the principle of balance”
amongst policy makers
What
Communication and
educational activities to
sensitize policy makers /
regulators
Who
Centre - Health ministry
- Making a plan – 3 months
Dept. of Health and Family
- Approval of / consensus – 6
months
Welfare
- Implementation of plan – 1
State - Health secretory or his year
nominee
PC advocates – National PC
1. Development of strategy
2. Develop consensus plan
amongst key stake
holders
3. Mobilize resources
4. Implement the plan
When
bodies
IPPF Fellow
Problems identified
1.
Regulations of central and state governments do not support adequate
access to controlled pain medications.
2.
Lack of appropriate environment: (attitudes, knowledge, skills, and
behaviors) amongst health care professionals, policy makers and
regulators
3.
Lack of access to competent health delivery centers for adequate,
effective pain relief
4.
Inadequate awareness of public about pain management and use of
opioids
2. Lack of appropriate environment
Health care professionals
Capacity building
- doctors, administrators, ,
nurses, pharmacists
- government and private
sector
Who?
IPPF fellow, Stakeholders
H Secretory, DGHS
MCI, NCI, Pharmacy council
National organisations in Palliative
Care, ISSP
How?
Creation of manual
1. guidelines for pain assessment and management
2. SOPs for access to strong analgesics
3. Information regarding safe usage
Implement undergraduate teaching on pain
management
1. Faculty empowerment workshops [25 medical
colleges]
2. Conduct training program through identified
training centres – X number / year/ centre
3. Develop and implement discipline specific plans
and monitor outputs and outcomes
When?
Formation of key group – 3-6 months
Making a plan, consensus – 9 – 12 months
Implementation of plan 3-5 years
Healthcare professional training - continued
Problems identified
1.
Regulations of central and state governments do not support adequate
access to controlled pain medications.
2.
Lack of appropriate environment: (attitudes, knowledge, skills, and
behaviors) amongst health care professionals, policy makers and
regulators
3.
Lack of access to competent health delivery centers for adequate,
effective pain relief
4.
Inadequate awareness of public about pain management and use of
opioids
3. Lack of access - what?
Creating capacity and implementation of effective pain
management/services in
•
•
•
Government run HC providers - NPCDCS (primary, secondary and tertiary)
Private health care institutions
Facilitating new pain/palliative care centers through NGOs
Contents – addressing the 3 aspects of availability and accessibility
a)
Education of professionals & public awareness
b)
Opioid access and
c)
Implementation of pain policy by WHO method
3.Lack of access – How?
Government
1.
2.
3.
4.
Creation of Technical Resource
Group (TRG) in Ministry of
Health & FW for palliative care
Identification of training centers
in Delhi and in 10 other places
in India – government
Design training program in pain
management in palliative care
for doctors and nurses
Start dedicated pain /palliative
care services through 5 RCCs &
20 other hospitals including
medical college hospitals
Who?
1.
A national level Policy
Centre - Director General of Health
services
State - health Secretary
2.
3.
4.
Technical Resource Service
Group (TRG)
Palliative care organizations
(Pallium India, IAPC)
Identified palliative care
organizations
3.Lack of access – How?
Government
1.
2.
3.
4.
Creation of Technical Resource
Group (TRG) in Ministry of
Health & FW for palliative care
Identification of training centers
in Delhi and in 10 other places
in India – government
Design training program in pain
management in palliative care
for doctors and nurses
Start dedicated pain /palliative
care services through 5 RCCs &
20 other hospitals including
medical college hospitals
When?
1. 2 months
2. 4 months
3. 4 months
4. 8 months to 2 years and
ongoing
3.Improving access in Private sector
1.
2.
3.
4.
5.
6.
Explore ways of influencing accreditation process for
implementation of institutional pain policy as essential
requirement for hospitals
Approach major health insurance schemes to include palliative
care in their coverage
Advocacy through IMA & other major professional bodies
Sensitize Chains of hospitals
Promote Scholarships through government / foundations
Establish systems for appreciation( Centres for excellence )
Who – IPPF Fellows along with the MOH support and PC fraternity
When – sincere efforts ongoing - ??
Problems identified
1.
Regulations of central and state governments do not support adequate
access to controlled pain medications.
2.
Lack of appropriate environment: (attitudes, knowledge, skills, and
behaviors) amongst health care professionals, policy makers and
regulators
3.
Lack of access to competent health delivery centers for adequate,
effective pain relief
4.
Inadequate awareness of public about pain management and use of
opioids
4 . Inadequate awareness of public
What?
Who?
Campaign to increase
•Indian Association of
awareness and shifting
Palliative care.
attitudes of public about
•Indian Association of study
effective pain management
of pain.
including opioids
•Pallium India
•Disease interest group such
as Indian Cancer society
•Selected Media
personalities
•Selected healthcare NGO’s
When?
Assistance
• Finances for education and awareness
– NPCDCS funds, MoH
– WHO India
– Private foundations
• Policy
– Department of Narcotics control - amendments
– Lawyer’s Collective
• Policy implementation and educational activities
– Pallium India, IAPC
Expected outputs
• Amended NDPS Act
• New Model rules applicable uniformly
throughout India
• At least 2 RMIs per district
• All healthcare professionals learning and
executing effective pain management