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Prof. Mala Rao Administrative Staff College of India

Development of Guidelines for a Comprehensive Birth Management System The NICE Perspective 3rd May 2011. Prof. Mala Rao Administrative Staff College of India. Healthcare expenditure Total per capita in US dollars. Total per capita expenditure(us$). http://www.infoplease.com/ipa/A0934556.html.

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Prof. Mala Rao Administrative Staff College of India

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  1. Development of Guidelines for a Comprehensive Birth Management SystemThe NICE Perspective3rd May 2011 Prof. Mala Rao Administrative Staff College of India

  2. HealthcareexpenditureTotal per capita in US dollars • Total per capita expenditure(us$) http://www.infoplease.com/ipa/A0934556.html

  3. Uses of Scientific Guidelines Provide recommendations for treatment and care Are used to develop standards to assess clinical practice Are used in education and training Help patients to make informed decisions Improve communication between patients and health professionals

  4. NICE’s primary guidance Designed to promote good health and prevent ill health Produced by the people affected by their work- professionals, patients and public Based on the best evidence Transparent in its development, reliable, independent and based on rigorous development process Good value for money, weighing up the cost and benefits of the treatment

  5. A population perspective • “The classical purpose of a clinical guideline is to create decision rules which maximize the likelihood that the PATIENT will emerge from the process with the best achievable level of health • But NICE’s purpose is broader. It wants decision rules created which maximizes the chances that the ENTIRE POPULATION will emerge from the process with the best achievable health” -Alan Williams, OHE 2004

  6. Does India need NICE guidelines? “While we pontificate on whether a NICE approach to Indian healthcare is appealing, one must be cognizant of the reality that with each passing second of the time in a country without universal healthcare or allocative decision-making, those not fortunate enough to have access to basic healthcare shockingly die from inexpensively preventable or treatable conditions” National Medical Journal of India, Vol 23, 1, 2010

  7. Supporting the Rural Health Mission • Launched in 2005 to “provide affordable quality health services to even the poorest households in the remotest rural regions” 2nd Common review mission report, December 2008 • One of the largest public health experiments in the world… • A unique opportunity to drive the development of Indian best clinical practice guidelines and quality and performance standards to achieve: Safety; Quality; Equity; Efficiency; Access

  8. Andhra Pradesh: IIPH/NICE • Raising awareness and capacity building • NICE/IIPH training and policy workshop in Hyderabad in Aug 2009 to discuss the role of clinical guidelines as a means of improving equity, efficiency and quality • Selection of a high priority topic • Maternal deaths in India account for 25% of deaths worldwide • 50% caused by anemia of the mother and post-partum hemorrhage, both preventable • Identifying and engaging key stakeholders • Obstetricians, policymakers, managers, epidemiologists, midwives, public health doctors, lay members, major hospital providers • AP state government support and buy-in at the highest level

  9. Andhra Pradesh: IIPH/NICE (cont) • Using NICE guidelines on perinatal care as a starting point for adapting to local setting (public/rural) • Use local epidemiological and cost data • Look for India specific trials • Take account of practicalities of implementation -e.g. drugs requiring refrigeration, transport times blood transfusion • Parallel technical capacity building through FMR/ASCI/GoAP/GoM/CIPS collaboration • Funding being sought by ASCI and the Foundation for Medical Research (Mumbai) • Can catalyze partnerships with other states (e.g. Kerala, Orissa, Maharashtra, Assam)

  10. Towards an Indian “NICE” model: efficiency, effectiveness, accountability • Produce evidence-based guidelines to • Inform discussions on a basic package • Reduce variation in access and provision • Improve provider accountability; quality and perception of quality • Improve safety and affordability • Strengthen stakeholders engagement process (e.g. citizens’ juries/rogi kalyan samitis) and public consultation

  11. Towards an Indian “NICE” model: efficiency, effectiveness, accountability • Help incorporate efficiency and value for money considerations • Conflict of interest policies for all those involved in decision making • Build lasting local capacity in technical/methodological and process skills • Develop a systematic approach, spanning prevention and treatment.

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