India

The impact of collaboration

iDSI has built strong and fruitful collaborative partnerships with government, clinical and academic partners in India through State and Union level, since 2009. Together we have supported India’s ambitious move towards Universal Health Coverage for its 1.3bn population, through strengthening evidence-based decision making in health.

iDSI has:

  • Provided technical, operational and strategic support to HTAIn, India’s first national Health Technology Assessment (HTA) agency since its inception
  • Delivered a comprehensive capacity building program over two years to engage in cost-effectiveness analysis for the HTAIN and its network of technical collaborators
  • Supported the development of key methodological and technical resources, including the HTAIn reference case and the first National Costing Database
  • Supported the development of 12 Standard Treatment Guidelines and quality standards, and the first standardised methods manual for guideline adaption in India

iDSI initially provided technical assistance to improve Maternal and Child Health at the State level, then in the development of Standard Treatment Guidelines (STGs) at the federal level. iDSI is presently the primary partner assisting the Ministry of Health and Family Welfare in their efforts to institutionalise the first national body mandated to undertake HTA, building human and organisational capacity in the generation, synthesis and uptake of HTA evidence across Indian States including within Ayushman Bharat and State-level health insurance schemes. This will lead to more transparent, equitable, and cost-effective health policies across India.

“The Standard Treatment Guidelines are a very welcome initiative, which will enhance access and improve quality of care for many conditions of public health importance in India… a transparent, rigorous and collective approach was evolved and adopted in the development of these guidelines.” Prof Anurag Bhargava, MD, MSc, Yenepoya Medical College, Karnataka, India

Supporting the HTAIn, a made-in-India Health Technology Assessment agency

Since 2013, iDSI has worked closely with the Department of Health Research under the Ministry of Health and Family Welfare to conceptualise how HTA could enhance value for money in health investment and to realise this vision. The evidence-to-policy ecosystem in India has changed immensely and continues to evolve. iDSI continues to work closely with the Ministry of Health and Family Welfare to build capacity in health economics and HTA for the recently established HTAIn team and their network of technical partners across the country. For instance, iDSI is collaborating with the Post Graduate Institute of Medical Education and Research to undertake important academic projects commissioned by the Department of Health Research, including the development of the Country’s first National Costing database, which will be utilised to inform HTA studies and set fair reimbursement rates under new health insurance schemes. iDSI is also providing support to the Indian Council of Medical Research (ICMR) to teach scientists to enhance evidence to policy translation and improve uptake of its research into policy decisions across the country.

Impact

 The first HTA to be produced by HTAIn with the support of iDSI, intraocular lens for cataract surgery, has already been utilised to inform package inclusion and reimbursement under Ayushman Bharat (Pradhan Mantri Jan Arogya Yojana – PMJAY), the country’s largest health insurance scheme for 500 million Indian citizens – demonstrating rapid and meaningful uptake of HTA evidence into the system and setting a strong precedent for evidence-informed priority setting in India.

HTA is now recognised in all National Health Policy Strategy documents and the Government has dedicated significant domestic funding towards HTA-related activity, including funding for over 30 full-time staff members dedicated to HTA in the Central HTAIn Secretariat and six Regional Resource Hubs.

Developing Standard Treatment Guidelines (STGs) to enhance the provision and increase of access to cost-effective, high-quality care

iDSI worked with the National Health Systems Resource Centre to develop 12 high priority evidence-informed STGs; and a common methods manual for the development of future STGs to improve and standardise clinical management of high burden diseases. The STGs were also used to incentivise provider payment towards the most cost-effective health interventions.

Impact 

Modelling estimates found that successful implementation of just one guideline (hypertension screening) could prevent up to 966 cardiac events and provide cost savings of US$1.23m for each public health centre. Extrapolating this across all 28,863 Public Health Centres in India, under the assumption that only 10% of these benefits could be replicable elsewhere, this could lead to potential cost savings totalling US$3.55bn and the prevention of a total of 2.79 million cardiac events.

Improving care quality to save mothers’ lives in Kerala

iDSI was requested by the Government of Kerala to lead the development and support implementation of two clinical quality standards (measurable indicators derived from evidence-based guidelines) to improve quality of care for and reduce deaths due to postpartum haemorrhage and prenatal hypertension. These were the leading causes of maternal mortality in Kerala.

The evidence-informed quality standards were developed in collaboration with the Kerala Federation of Obstetricians and Gynaecologists and derived from World Health Organization, UK and Indian maternal care guidelines.

Impact

The quality standards now form the basis of all midwifery emergency training across Kerala. Implementing two quality standards in all facilities in Kerala, where approximately 500,000 babies are born every year, could result in between 23 and 91 mothers’ lives saved each year through improved prevention and management of post-partum haemorrhage and hypertension in pregnancy.

Implementing these standards is projected to reduce the maternal mortality ratio (MMR) in Kerala by 25%, to around 50 deaths per 100,000, far lower than the national average for India of 130 per 100,000. Since implementing the quality standards, MMR has dropped from 61 (2011-13) to 46 (2014-2016), of which this project has been referenced in national press, as having a “significant difference in delivery care practices”.

Improving foot care for diabetic patients in Mumbai

India is home to 69 million people with type-2 diabetes. Every year 100,000 amputations are carried out in India due to diabetes-related conditions, but 80% of these could be avoided if regular foot examinations were carried out. Starting in 2013, iDSI worked with India’s Ministry of Health & Family Welfare to design and develop Quality Standards that could be used to improve diabetic foot care in India. The diabetic foot QS were piloted at a primary health centre attached to the Bhabha Atomic Research Centre (BARC) in 2017.

The team looked at current practice for diabetic feet: physicians, general surgeons and podiatrists all manage patients with diabetic feet, however their responsibilities or management protocols are not clearly defined and foot assessment is not part of routine practice. The team also identified gaps in training and data collection. iDSI guided the BARC diabetes team on: evidence-based efficient ways to run the diabetic foot care clinic as an elective service; data input and patient consent, including providing additional training from UK-based diabetologists on how best to check diabetic feet.

Impact

Between April-October 2017 93% of diabetes patients (842 people) who attended one of the primary health centres of the BARC had their feet examined once by physicians that had received the training. If all primary health centres in India were to implement the QS to the same high level, this could help to prevent as many as 74,400 amputations per year.

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