Action Plan India

1. Action Plan India Priya, Nandini, Shalini, Dr. Sudhir, Rajesh, Raj, Frank, David

2. Patients across India receive quality pain management, including opioid analgesics

3. Problems identified • Regulationsof central and state governments do not support adequate access to controlled pain medications. • Lack of appropriate environment (attitudes, knowledge, skills, and behaviors) amongst health care professionals, policy makers and regulators • Lack of access to competent health delivery centers for adequate, effective pain relief • Inadequate awareness of public about pain management and use of opioids

4. 1. Issues on Regulations

5. 1. Action Plan for Issues on Regulations

6. 1.Ensuring accurate reporting of estimates and consumption statistics

7. 1.3 Lack of awareness about “the principle of balance” amongst policy makers

8. Problems identified • Regulations of central and state governments do not support adequate access to controlled pain medications. • Lack of appropriate environment: (attitudes, knowledge, skills, and behaviors) amongst health care professionals, policy makers and regulators • Lack of access to competent health delivery centers for adequate, effective pain relief • Inadequate awareness of public about pain management and use of opioids

9. 2. Lack of appropriate environment Who? IPPF fellow, Stakeholders H Secretory, DGHS MCI, NCI, Pharmacy council National organisations in Palliative Care, ISSP When? Formation of key group – 3-6 months Making a plan, consensus – 9 – 12 months Implementation of plan 3-5 years Healthcare professional training - continued

10. Problems identified • Regulations of central and state governments do not support adequate access to controlled pain medications. • Lack of appropriate environment: (attitudes, knowledge, skills, and behaviors) amongst health care professionals, policy makers and regulators • Lack of access to competent health delivery centers for adequate, effective pain relief • Inadequate awareness of public about pain management and use of opioids

11. 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 accessibility • Education of professionals & public awareness • Opioid access and • Implementation of pain policy by WHO method

12. 3.Lack of access – How? Government Who? A national level Policy Centre - Director General of Health services State - health Secretary Technical Resource Service Group (TRG) Palliative care organizations (Pallium India, IAPC) Identified palliative care organizations • Creation of Technical Resource Group (TRG) in Ministry of Health & FW for palliative care • Identification of training centers in Delhi and in 10 other places in India – government • Design training program in pain management in palliative care for doctors and nurses • Start dedicated pain /palliative care services through 5 RCCs & 20 other hospitals including medical college hospitals

13. 3.Lack of access – How? Government When? 2 months 4 months 4 months 8 months to 2 years and ongoing • Creation of Technical Resource Group (TRG) in Ministry of Health & FW for palliative care • Identification of training centers in Delhi and in 10 other places in India – government • Design training program in pain management in palliative care for doctors and nurses • Start dedicated pain /palliative care services through 5 RCCs & 20 other hospitals including medical college hospitals

14. 3.Improving access in Private sector • Explore ways of influencing accreditation process for implementation of institutional pain policy as essential requirement for hospitals • Approach major health insurance schemes to include palliative care in their coverage • Advocacy through IMA & other major professional bodies • Sensitize Chains of hospitals • Promote Scholarships through government / foundations • Establish systems for appreciation( Centres for excellence ) Who – IPPF Fellows along with the MOH support and PC fraternity When – sincere efforts ongoing - ??

15. Problems identified • Regulations of central and state governments do not support adequate access to controlled pain medications. • Lack of appropriate environment: (attitudes, knowledge, skills, and behaviors) amongst health care professionals, policy makers and regulators • Lack of access to competent health delivery centers for adequate, effective pain relief • Inadequate awareness of public about pain management and use of opioids

16. 4 . Inadequate awareness of public

17. 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

18. 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