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Dr. T Rajaiah, Deputy Chief Minister, Telangana Launches Policy Paper on Universal Coverage of End Stage Renal Disease: A Case for Peritoneal Dialysis (PD) First Policy, Prepared by Public Health Foundation of India

November 11, 2014 - Hyderabad, India

End-stage renal disease (ESRD) or Chronic kidney disease (CKD Stage 5) has become worldwide public health problem. The population of India exceeds one billion and ESRD burden will continue to rise. Recognising that renal care is an important aspect that needs to be covered urgently, the Public Health Foundation of India (PHFI) launched a policy brief on the role of Peritoneal Dialysis (PD) in management of ESRD, which will act as a blueprint for the inclusion of such services in universal health coverage in India. Launched by the Honourable Deputy Chief Minister of Telangana, Dr. T Rajaiah, the policy paper presents Peritoneal Dialysis as a treatment for ESRD in India thus balancing equity, cost effectiveness, value & affordability, which are the components of universal health coverage. Dr. T Rajaiah is also the Health Minister of Telangana state.

While addressing the gathering of nephrologists, Diabetologists, public health specialists, and the media, Dr. T Rajaiah emphasised that Chronic Kidney Disease (CKD) is a worldwide public health problem, both for the number of patients and cost of treatment involved. “Globally, CKD is the 12th cause of death and the 17th cause of disability, respectively. Early detecting of CKD by screening for kidney disease in high-risk patients, early referral to nephrologist, appropriate treatment of hypertension, Diabetes Mellitus and other risk factors, lifestyle modification with specific emphasis on reduction in salt intake, physical exercise, abstinence from smoking, will retard progression of kidney disease to an advanced stage. Telangana government is taking urgent steps for making a state program to control the epidemic of NCDs like hypertension, DM, chronic respiratory and CKD. This policy brief by PHFI, and methodology proposed is an excellent solution to highlight strategies for propelling policy and programme action using game-changing ideas to definitively address ESRD burden in India, making it affordable to all.”

The policy brief by PHFI provides the first estimate of ESRD incidence in a large population base, determines the contribution of Diabetes to ESRD, and provides a basis for health-care policy planning. The policy brief outlines a plan based on national and global evidence and case studies which would ensure that such coverage is presented in a comprehensive manner and includes both prevention and treatment while ensuring financial feasibility. The launch was further followed up by a panel discussion where eminent nephrologists exchanged views and perspectives in the light of the new evidence highlighted in the PHFI Policy Brief 'Universal Coverage of End Stage Renal Disease'.
Key findings:
  1. Strengthen measures to prevent End Stage Renal Disease (ESRD)
  2. Policy of using Peritoneal Dialysis (PD) first
  3. Financial incentives for PD first
  4. Cost containment measures namely Central Tendering & Bulk Purchases to be introduced for medicines & supplies
  5. PD to be introduced in district hospitals & other public health facilities
  6. Develop & create treatment partnerships with private facility with fixed prices on re-imbursement
  7. Task shifting through ASHA, Village Volunteers & Patient groups
  8. Renal disease registry to be set-up on resources & patient pro-files

In his address Dr. Kanav Kahol, Head - Division of Affordable Health Technologies, PHFI said, “Through this report we have made an attempt to provide a solution to the ever increasing burden of ESRD in India. A sustainable and mediated approach would be to train the ASHAs for PD for patients as a cost effective, time saving and more feasible model as compared to Haemodialysis. Leveraging the principles of task shifting, clinical evidence on safety and efficacy and rural access, PHFI proposes a policy of ‘Peritoneal Dialysis First’ (PD First) in India.”

ESRD patients require either a kidney transplant or dialysis to maintain life. The dialysis modalities include Haemodialysis (HD) and Peritoneal dialysis (PD). Without such treatment death is inevitable in days, weeks, or months. Global estimates show that dialysis expenditure accounts for nearly 25-70% of the household expenditure. Stage 5 CKD or ESRD is an issue of major concern in India also. Based on the current Indian population of 1.27 billion, even a conservative estimate of ESRD burden in India would suggest that about 3, 00,000 people develop ESRD every year. Out of these, only about 10% or less receives RRT.

Several factors influence dialysis modality selection, and they include: patient clinical needs and capability; healthcare system funding; provider reimbursement; physician incentives; dialysis clinic organization, capacity and expertise; physician and nursing knowledge, skills, attitudes and view of patient capability; and patient confidence, skill and/or support at home.

Considering the options used by other developing countries, India should implement a national policy to include HD as second line treatment for those clinically, socially and cognitively unsuitable for PD. The uptake of PD can be improved by incentivizing and community based payment schemes. Also the option of Public Private Partnership should be explored for the PD services delivery.

The Policy paper proposes a new model of PD in rural areas. Here clinicians and patients have the security blanket of a trained ASHA or frontline health worker in rural areas to provide supportive supervision and if necessary intervention and guidance by the clinician. This increases compliance and can provide superior results in terms of PD. PD facilities and infrastructure should be made available at district level hospitals and other public health facilities (primary and community health centres). As India strives to achieve universal health coverage, renal care is an important aspect that needs to be covered. PD as a treatment allows India to balance equity, cost effectiveness, value & affordability and is a suitable means of providing universal health coverage in renal care.
For more details on Policy Paper, please contact:

Division of Affordable Health Technologies, PHFI/

Photo caption: Dr. T Rajaiah, Deputy Chief Minister, Telangana launches policy paper on Universal Coverage of End Stage Renal Disease: A case for Peritoneal Dialysis (PD) First Policy, prepared by Public Health Foundation of India

Source: Business Wire India


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