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Pradhan Mantri National Dialysis Programme

This topic provides information about the Pradhan Mantri National Dialysis Programme.

The Pradhan Mantri National Dialysis Programme was rolled out in 2016 as part of the National Health Mission(NHM) for provision of free dialysis services to the poor. The Guidelines for Pradhan Mantri National Dialysis Programme envisage provision of dialysis services under NHM in PPP (Public Private Partnership) mode.

Rationale

Every year about 2.2 Lakh new patients of End Stage Renal Disease (ESRD) get added in India resulting in additional demand for 3.4 Crore dialysis every year. With approximately 4950 dialysis centres, largely in the private sector in India, the demand is less than half met with existing infrastructure. Since every Dialysis has an additional expenditure tag of about Rs.2000, it results in a monthly expenditure for patients to the tune of Rs.3-4 Lakhs annually. Besides, most families have to undertake frequent trips, and often over long distances to access dialysis services incurring heavy travel costs and loss of wages for the patient and family members accompanying the patient. This therefore leads to financial catastrophe for practically all families with such patients. With substantial gain in quality of life and extension of progression free survival for patients, families continue to stretch financially to make large out of pocket spends. It has been felt that both in terms of provision of this important life saving procedure and also for reducing impoverishment on account of out of pocket expenditure for patients, a Dialysis program is required.

Solution Strategy

There are two main types of dialysis, which are hemodialysis and peritoneal dialysis.

  1. Hemodialysis (HD, commonly known as blood dialysis): In HD, the blood is filtered through a machine that acts like an artificial kidney and is returned back into the body. HD needs to be performed in a designated dialysis centre. It is usually needed about 3 times per week, with each episode taking about 3-4 hours.
  2. Peritoneal dialysis (PD, commonly known as water dialysis): In PD, the blood is cleaned without being removed from the body. The abdomen sac (lining) acts as a natural filter. A solution (mainly made up of salts and sugars) is injected into the abdomen that encourages filtration such that the waste is transferred from the blood to the solution. There are 2 types of PD - continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). CAPD needs to be done 3 to 5 times every day, but does not require a machine. APD uses an automated cycler machine to perform 3 to 5 exchanges during the night while the patient is asleep.

Close medical supervision is not required for most PD cases, thus making it a feasible option for patients who may want to undergo dialysis in the home setting. Each treatment option has its advantages and disadvantages, which vary with the condition of the patient and presence of underlying diseases. It is therefore important for every patient with ESRD to discuss various treatment options in detail with his doctor before starting treatment.

The majority of patients in India receive renal replacement therapy in hemodialysis center. The number of patients on Hemodialysis and the number of hospital based and free standing units is steadily growing. A dialysis unit delivers patient care, and has specific requirements of treated water, electricity, medical gases and waste disposal. It additionally requires accommodating all the workers involved in patient care, allow emergency procedures, permit adequate hygiene and maintenance of specialized equipment. The design and layout of a unit must take into account all the above features in order to function smoothly and prevent development of complications. Proper planning of a dialysis unit is therefore essential.

Public Private Partnership for Hemodialysis services

As per the guidelines, the private partner is to provide medical human resource, dialysis machine along with Reverse Osmosis (RO) water plant infrastructure, dialyzer and consumables, while the space, power, and water supply within District Hospitals is to be provided by the State Government.

Financial support

Currently, under NHM 100 % of the service procedure fees for patients from below poverty line (BPL) economic group is covered. However, non BPL patients would have the benefit of accessing the services close to the community at the district hospitals at same rates as paid by the Government for the BPL patient.

While there exist health schemes such as Rashtriya Swasthya Bima Yojana (RSBY) funded by Govt. of India which cover hemodialysis procedure, it is evident that due to high cost and recurring sessions required over the life time, the total cost for providing dialysis cannot be adequately covered. However, for BPL families registered under RSBY, the cost of dialysis care shall be catered through RSBY funding upto its maximum coverage. The additional resources required would be provided to the state under the National Health Mission.

Source : Operational Guidelines for Dialysis Programme

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Girish Sep 11, 2018 10:57 AM

Sir,

Dialysis patients are increasing in the country and so every state and central government must take decision to make necessary scheems and policies to provide free dialysis for Bpl patients.

Dr.Ravi Jul 18, 2018 12:23 AM

What is the amount being paid by government to the private partners in PPP model for each dialysis in Karnataka?

Abhimanyu Mishra Jul 12, 2018 11:36 AM

This facility should be applicable in Bihar, currently dialysis center are running in 17 district hospital of Bihar under PPP mode,
patients have to pay INR 1617 per dialysis that is too costly, government should aware in this matter

Suraj Sharma Jun 30, 2018 02:42 AM

It must free for everyone . because no one can spend 40 thousands for dialysis per month. At least it is free for them who earn less than 75 thousand per month.

Jyoti Jun 24, 2018 09:19 PM

Dear Sir
This facility should be provided for each and every senior citizen who are not able to earn themselves and are dependent on their children.Because in today's life no one is ready to pay for their parents treatment. So parents lyf is becoming hell. Kindly think upon
Seeking for your cooperation for my father.
India's daughter

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