Clamping down

Home ministry blocks foreign funds for NGO that supported health ministry's anti-tobacco drive

The Public Health Foundation of India had been working on government programmes since 2010.

The Ministry of Home Affairs has barred the Public Health Foundation of India from receiving foreign funding by revoking its registration under the Foreign Contributions (Regulation) Act. The ministry cited the organisation’s lobbying against tobacco use as one of the reasons for the move. However, as the foundation’s officials have pointed out, it has been working with the Ministry of Health and Family Welfare on anti-tobacco programmes since 2010.

The Public Health Foundation of India is a public-private initiative established to provide technical support to the health ministry on a range of issues concerning public health, including tobacco control. The foundation has worked on several research projects and organised training workshops for health workers on how to counter tobacco consumption. It took on many of these initiatives at the ministry’s request.

In July 2015, experts from the foundation were asked to present evidence before a Parliamentary Committee on Subordinate Legislation that was reviewing pictorial health warnings on tobacco packets.

Health activists working on tobacco control have said that the home ministry’s position is appalling. “We have to interact with the government on any issue related to social development, not just tobacco control,” said Sanjay Seth from Voice of Tobacco Victims, a campaign that is putting tobacco victims at the forefront of the tobacco control movement in India. “How can they officially raise [anti-tobacco lobbying] as an issue?”

Other reasons cited by the home ministry’s for cancelling the foundation’s licence include alleged violations in the use of funds for HIV/AIDS projects, remittances to foreign countries from its Foreign Contribution Regulation Act account and failure to declare all its bank accounts to the government.

In October, the government cancelled the Foreign Contribution Regulation Act licence of the Institute of Public Health in Bengaluru and Voluntary Health Association of Assam, both which have done considerable work on tobacco control. However, the reasons for their licences being cancelled were not specifically stated.

Tobacco is one of the leading causes of cancer and non-communicable diseases around the world. Every year 9.8 lakh people in India die of a tobacco-caused disease. Research done by the Public Health Foundation of India under the directives of the government estimates that the health costs attributable to tobacco use in the year 2011 for people between the ages of 35 and 69 amounted to Rs 1,04,500 crores.

“Tobacco control activity is not a criminal activity,” said Dr Pankaj Chaturvedi, cancer surgeon at Tata Memorial Hospital. “We are furthering the cause of government of India and augmenting the National Tobacco Control Programme.”

Health ministry not consulted

The home ministry does not seem to have consulted the health ministry before barring the foundation’s foreign funding. Three health ministry officials told Scroll.in that they had not been informed about the order and only learned about it only from newspaper articles. They said they were surprised by the home ministry’s decision.

The health ministry runs the National Tobacco Control Programme to enforce the Cigarettes and Other Tobacco Products Act and spread awareness about the harms of tobacco. The government has allocated a budget of about Rs 40 lakhs per state and Rs 47 lakhs for each of the 400 districts under the programme this financial year.

“Our stance is very clear on tobacco control,” said Dr Arun Panda, additional secretary with the health ministry, who said that the ministry will continue its work to curb tobacco consumption.

Only last year, the government made encouraging moves to curb tobacco use in the country when it mandated that pictorial warnings must cover 85% of boxes containing tobacco products, as against 40% previously. This means that after Nepal and Vanuatu, India has some of the largest pictorial warnings on tobacco packets in the world.

In November, India hosted the seventh Conference of Parties of the Framework Convention on Tobacco Control, which takes decisions necessary to promote effective tobacco control implementation. The convention encourages countries to take measures such as outlawing smoking in public and restricting advertising and sponsorship of tobacco products. Health Minister JP Nadda made a commitment at the inaugural speech of the conference to continue efforts to regulate the use of tobacco products in the country.

However, even as the conference was underway, advertisements appeared on hoarding and even on the backs of autorickshaws alleging that anti-tobacco activists has “hidden agendas” that hurt the interests of tobacco farmers and paan wallahs.

Campaign against anti-tobacco movements portraying a tobacco farmer. Photo credit: Shoaib Daniyal.
Campaign against anti-tobacco movements portraying a tobacco farmer. Photo credit: Shoaib Daniyal.

The action against the Public Health Foundation of India comes at a time when anti-tobacco movements in India are showing some signs of success. The National Family Health Survey showed that the percentage of men and women who use tobacco has dropped in the past decade. In 2005-’06, 57% of men used tobacco, which has dipped to 44.5% in 2015-’16. In 2005-’06, 10.8% of women used tobacco which has dipped to 6.8% in 2015-’16.

Most organisations in India that work on tobacco control rely on foreign funds with much of their money coming from the Bloomberg Initiative to Reduce Tobacco Use, which funds anti-tobacco programmes around the world. The home ministry’s crackdown on the Public Health Foundation of India has alarmed many activists working with these organisation. Seth of Voice of Tobacco Victims said that the home ministry’s move blatantly favours the tobacco industry. A faculty member of the Institute of Public Health alleged that might have been targeted because they were working effectively against tobacco control.

Claimed cancer surgeon Chaturvedi: “This move is conspiracy of the tobacco lobby to malign non-governmental organisations working on tobacco control.”

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.