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National Free Diagnostics Initiative

The National Free Diagnostics Initiative offers essential diagnostic services free of cost to improve healthcare quality and access, reducing out-of-pocket expenses. The initiative includes pathology and radiology services at various healthcare levels. Financial support is provided for setting up infrastructure, quality assurance, and outsourcing services. Guidelines and implementation status for free pathology services, teleradiology, and CT scan services are outlined.

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National Free Diagnostics Initiative

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  1. National Free Diagnostics Initiative

  2. Free Diagnostics • Maintenance

  3. National Free Diagnostics Initiative

  4. The free diagnostics service initiative has been rolled out under NHM, in order to leverage existing institutional structures that are already in place The key objectives of this scheme are to: Ensure the availability of minimum set of diagnostics free cost appropriate to level of care Reduce high OOPE incurred for diagnostics Improve over all quality of healthcare & availability of comprehensive healthcare in Public health facilities A set of free essential diagnostics service at each level has been identified which are being provided free of cost in an assured mode

  5. Diagnostic services includes free pathology & radiological services & it ensures all high volume and low cost tests not requiring highly skilled expertise preferably be undertaken within public health facilities. However high cost, technologically demanding and low frequency diagnostic tests to be outsourced as a way of gap filling, with adequate check and balances Under this initiative, 7 pathological tests are made available at SCs, 19 tests at PHCs, 39 tests at CHC including(radiological tests-Xray & USG) & 56 tests (includingX-ray, USG & CT) at DH level and equivalent Under free pathological services, there is a provision of outsourcing of testing of samples which are high cost low volume tests For radiological investigations, identifications of technological pathways & setting for capturing, transmission and reporting of tests that could be digitised, are attempted where in-house expertise is not available

  6. Financial support is provided to all States/UTs under National Health Mission for: Setting up required infrastructures, institutional mechanisms, HR & equipments Supply of reagents, consumables and establishing procedures for outsourcing of services in PPP-mode Quality assurance for all diagnostic services including calibration

  7. Free Pathology services • Free Diagnostic Initiative is intended to provide a set of essential diagnostics at various levels of care so that providers are able to make rational decisions regarding treatment and patients benefit by getting their tests conducted within the facility free of cost • FDI guidelines are intended as a roadmap to assist states to roll out this initiative. However, the fundamental objective is to reduce financial stress, particularly on the poor, and those who use the public health system

  8. Status of Free Pathology Services • FDI-Lab - Has been implemented in total 31 States/ UTs ( 9 States in PPP mode Andhra Pradesh, Assam, Delhi, Maharashtra, Meghalaya, Uttar Pradesh, Odisha, Jharkhand, Manipur ) • Inhouse mode - 22 States/UTs. (A&N Island, Bihar, Chandigarh, Chhattisgarh, D&N Haveli, Daman & Diu, Goa, Gujarat, Haryana, Himachal Pradesh, Karnataka, Kerala, Lakshadweep, Madhya Pradesh, Puducherry, Punjab, Rajasthan, Sikkim, Tamil Nadu, Telangana, West Bengal, Jammu & Kashmir) • The tender to outsourcing is in progress in 2 States. ( Tripura, Arunachal Pradesh )

  9. Teleradiology • For radiology investigations, guidelines support identification of technological pathways and setting up of systems for capturing, transmission and reporting of tests that could be digitized. • This is attempted where in house expertise is not available. This facilitates capturing of images at public facilities and transfer images to specialists in public or private sector for diagnosis through IT based solutions and electronic reporting.

  10. Teleradiology Or

  11. Status of Teleradiology Serivces • FDI- Teleradiology - Has been implemented in total States 10. ( 10 States in PPP mode Andhra Pradesh, Meghalaya, Rajasthan, Tripura, West Bengal, Assam, Odisha , Uttarakhand, Uttar Pradesh, Himachal Pradesh) • The tender to outsourcing is in progress in 5 States. (Arunachal Pradesh, D&N Haveli, Daman & Diu, Manipur, Chhattisgarh )

  12. CT Scan Services • Eligible Districts having population more than 7.5 Lakhs • CT Scan services to be supported by Government of India under PPP mode • 16 slice machine is recommended for non-cardiac cases at District Hospital level • Service provider responsible for the turnkey project including the installation of the machine till reporting of scans

  13. Status of CT Scan Services • FDI CT scan - Has been implemented in total 24 States. ( 13 States in PPP mode Andhra Pradesh, Himachal Pradesh, Jharkhand, Karnataka, Punjab, Rajasthan, Tripura, Uttar Pradesh, West Bengal, Assam, Delhi, Odisha, Madhya Pradesh ) • Inhousemode of 11 states. ( A&N island, Goa, Gujarat, Haryana, Kerala, Puducherry, Sikkim, Tamil Nadu, Telangana, Daman & Diu, Lakshadweep ) • The tender to outsourcing is in progress in 1 State. (Chhattisgarh)

  14. Technical Specification of Medical Devices to support Procurement at state • In states there is a significant need for counselling regarding minimum specifications and requirements that should be considered before starting a process of purchase of medical devices. • In this regard the division has formulated technical specifications of 168 medical devices as per IPHS guidelines. • Technical Specification of another 301 equipment are under draft stage and review by MoHFW

  15. Technical Specifications

  16. Biomedical Equipment Maintenance Program • For technology intensive programs like Laboratory, Radiology, SNCU, ICUs and Operation Theaters, it is necessary to have fully functional equipment • Earlier dysfunctional rate was 30% to 63% for equipment inventory across various states and was a concern • Under NHM, Comprehensive maintenance of all equipment across DHs, CHCs, and PHCs was proposed and an exclusive program was launched under PPP given that equipment maintenance is a specialized skill requiring immediate availability of biomedical engineers and spare parts • Under the program design, Service Provider is to provide toll free number for equipment fault registration, spare parts, engineering HR and provide an upkeep time of 95% for DHs, 90% for CHCs and 80% for PHCs • Service provider to be selected after due tendering process • Within four months of the start of the program, the service provider would be responsible for repairing all currently dysfunctional equipment

  17. Status of BMMP • 1. BMMP - Has been implemented in total 25 States (20 States in PPP mode in the state of Andhra Pradesh, Arunachal Pradesh, Assam, Chhattisgarh, Jharkhand, Kerala, Madhya Pradesh, Maharashtra, Meghalaya, Mizoram, Nagaland, Puducherry, Punjab, Sikkim, Telangana, Tripura, Himachal Pradesh, Rajasthan, Uttar Pradesh, West Bengal ) • Inhouse mode of 5 States. ( D&N Haveli, Daman & Diu, Delhi, Lakshadweep, Tamil Nadu ) • The tender to outsourcing is in progress in 7 States. ( Goa, Haryana, Jammu & Kashmir, Karnataka, Uttarakhand, Odisha, Manipur )

  18. Radiation Safety • Medical use of x-rays for diagnosis and treatment has proven to be beneficial to society at large. Diagnostic Radiology includes various modalities of medical imaging by using X-rays. However, unsafe use of x-ray radiation has health risks associated with it and hence it is required that proper care is exercised throughout the life cycle of the equipment • In order to reinforce and support states in complying with AERB safety model Request For Proposal (RFP) has been developed. It’s estimated that to meet all the safety regulations within AERB framework, an average Rs. 2.00 to 3.00 lakhs is required per facility • NHM guidelines was relased in February 2018 and so far states of Tripura and Uttar Pradesh have rolled out the program

  19. Radiation Safety

  20. Thank You

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