Action Plan India

Priya, Nandini, Shalini, Dr. Sudhir, Rajesh, Raj, Frank, David

Patients across India receive quality pain management, including opioid analgesics

Problems identified

1. Regulations of central and state governments do not support adequate

access to controlled pain medications.

2. Lack of appropriate environment (attitudes, knowledge, skills, and

behaviors) amongst health care professionals, policy makers and

regulators

3. Lack of access to competent health delivery centers for adequate,

effective pain relief

4. Inadequate awareness of public about pain management and use of

opioids

Problems objective

Regulations of central and state governments do not support adequate access to controlled pain medications

Ensure alignment with U.N. Single ConventionFacilitate RMIs* throughout the countryDevelop system for reporting of estimates and consumption statistics

1.1 Complex and non-uniform regulations

Amend the NDPS ActFrame new central rules for entire country

1.2 No single central government agency with a mandate to ensure access to controlled pain medications

Form a consultative committee as per section 6 of the NDPS Act

1.3 Lack of awareness about “the principle of balance” amongst policy makers

Support implementation through communication and educational activities

1. Issues on Regulations

1. Action Plan for Issues on RegulationsAction Who When

1.1. Amend the NDPS Act &Frame new central rules for entire country - Language, supportive documents, SOPs- Advocacy at state level

Concerned ministries with DOR as nodus

IPPF Fellow

6 months after governmental approval to go through both houses

Continued engagement with the concerned govt. agencies – until ACT/Rules Passed

1.2 Form a consultative committee as per section 6 of the NDPS Act-Facilitate through interactions with NAC, ministries-Identify members-Frame rules for committe

NAC, PMO, MOF and MO Health, PC advocates- to help form

DO Revenue to frame rules and notify the committee

IPPF Fellow – assist with resource

Continued engagement with the concerned govt. agencies

Action Steps

3.1. Develop an online system for registration and return filing of manufacturers/wholesalers to enable gathering of consumption statistics as defined in the Single Convention

3.2. Give input on the importance of consumption statistics for monitoring and research for 160 manufacturers/wholesalers.- Identify the ideal format for the statistics (e.g. by RMI, state, etc.)

3.2.a Be alert for blockages in the system that lead to stock-outs and impact patient care

3.3. Get manufacturers/wholesalers to register

Who has A/R

3.1. Narcotics commissioner, CBN3.2. Fellows and other experts3.3. Narcotics commissioner, CBN

When 3.1. 1 year 3.2. 3-4 months3.3 6 months after system is created

Assistance 3.1. MoF will sanction funds3.2. IPPF fellows - Consultation from PPSG3.3. N Commissioner - host workshops with manufacturers + PC experts

Outputs Online system is in place, Accurate consumption statistics are available

1.Ensuring accurate reporting of estimates and consumption statistics

1.3 Lack of awareness about “the principle of balance” amongst policy makers

What Who WhenCommunication and educational activities to sensitize policy makers / regulators

Centre - Health ministry

Dept. of Health and Family

Welfare

State - Health secretory or

his nominee

PC advocates – National PC

bodies

IPPF Fellow

- Making a plan – 3 months- Approval of / consensus – 6 months- Implementation of plan – 1 year

1. Development of strategy 2. Develop consensus plan

amongst key stake holders

3. Mobilize resources4. Implement the plan

Problems identified

1. Regulations of central and state governments do not support adequate

access to controlled pain medications.

2. Lack of appropriate environment: (attitudes, knowledge, skills, and

behaviors) amongst health care professionals, policy makers and

regulators

3. Lack of access to competent health delivery centers for adequate,

effective pain relief

4. Inadequate awareness of public about pain management and use of

opioids

2. Lack of appropriate environment

Health care professionals How?

Capacity building -doctors, administrators, ,

nurses, pharmacists

-government and private

sector

Creation of manual1. guidelines for pain assessment and management2. SOPs for access to strong analgesics3. Information regarding safe usageImplement undergraduate teaching on pain management 1.Faculty empowerment workshops [25 medical colleges] 2. Conduct training program through identified training centres – X number / year/ centre3. Develop and implement discipline specific plans and monitor outputs and outcomesWho?

IPPF fellow, Stakeholders H Secretory, DGHSMCI, NCI, Pharmacy councilNational organisations in Palliative Care, ISSP

When?Formation of key group – 3-6 months Making a plan, consensus – 9 – 12 monthsImplementation of plan 3-5 yearsHealthcare professional training - continued

Problems identified

1. Regulations of central and state governments do not support adequate

access to controlled pain medications.

2. Lack of appropriate environment: (attitudes, knowledge, skills, and

behaviors) amongst health care professionals, policy makers and

regulators

3. Lack of access to competent health delivery centers for adequate,

effective pain relief

4. Inadequate awareness of public about pain management and use of

opioids

3. Lack of access - what?

Creating capacity and implementation of effective pain management/services in • Government run HC providers - NPCDCS (primary, secondary and tertiary)• Private health care institutions• Facilitating new pain/palliative care centers through NGOs

Contents – addressing the 3 aspects of availability and accessibilitya) Education of professionals & public awarenessb) Opioid access andc) Implementation of pain policy by WHO method

3.Lack of access – How?

Government 1. Creation of Technical Resource

Group (TRG) in Ministry of Health & FW for palliative care

2. Identification of training centers in Delhi and in 10 other places in India – government

3. Design training program in pain management in palliative care for doctors and nurses

4. Start dedicated pain /palliative care services through 5 RCCs & 20 other hospitals including medical college hospitals

Who?1. A national level Policy

Centre - Director General of Health services State - health Secretary

2. Technical Resource Service Group (TRG)

3. Palliative care organizations (Pallium India, IAPC)

4. Identified palliative care organizations

3.Lack of access – How?

Government 1. Creation of Technical Resource

Group (TRG) in Ministry of Health & FW for palliative care

2. Identification of training centers in Delhi and in 10 other places in India – government

3. Design training program in pain management in palliative care for doctors and nurses

4. Start dedicated pain /palliative care services through 5 RCCs & 20 other hospitals including medical college hospitals

When?1. 2 months

2. 4 months

3. 4 months

4. 8 months to 2 years and ongoing

3.Improving access in Private sector1. Explore ways of influencing accreditation process for

implementation of institutional pain policy as essential requirement for hospitals

2. Approach major health insurance schemes to include palliative care in their coverage

3. Advocacy through IMA & other major professional bodies 4. Sensitize Chains of hospitals5. Promote Scholarships through government / foundations6. Establish systems for appreciation( Centres for excellence )

Who – IPPF Fellows along with the MOH support and PC fraternityWhen – sincere efforts ongoing - ??

Problems identified

1. Regulations of central and state governments do not support adequate

access to controlled pain medications.

2. Lack of appropriate environment: (attitudes, knowledge, skills, and

behaviors) amongst health care professionals, policy makers and

regulators

3. Lack of access to competent health delivery centers for adequate,

effective pain relief

4. Inadequate awareness of public about pain management and use of

opioids

4 . Inadequate awareness of public

What? Who? When?

Campaign to increase

awareness and shifting

attitudes of public about

effective pain management

including opioids

•Indian Association of

Palliative care.

•Indian Association of study

of pain.

•Pallium India

•Disease interest group such

as Indian Cancer society

•Selected Media

personalities

•Selected healthcare NGO’s

Assistance

• Finances for education and awareness– NPCDCS funds, MoH– WHO India– Private foundations

• Policy– Department of Narcotics control - amendments – Lawyer’s Collective

• Policy implementation and educational activities – Pallium India, IAPC

Expected outputs

• Amended NDPS Act• New Model rules applicable uniformly

throughout India• At least 2 RMIs per district• All healthcare professionals learning and

executing effective pain management