DR. RASHEED HASAN KHAN PASSES AWAY

Urooj Bhatti,Hira Qaisar &Dr. Gulrayz Ahmed

Dr. Rasheed Hasan Khan passed away on April 30th 2016. A truly remarkable man of high integrity. Dr. Rasheed Hasan Khan was graduate of Dow Medical College and was President of National Student Federation (NSF) Pakistan. He left an indelible mark on generations of NSF workers. Although our organization and movement had shrunk considerably after various strives and repression, Dr. Sahab (as he was universally called) served as a beacon towards ideological unity. His clarity of thought, grasp of progressive ideology and principles made him stand out among stalwarts of leftist movement in Pakistan. Today all foes and friends will agree that Pakistani leftist movement lost a star. He passed away like the men he represented. Poor but dignified. Rest in peace Saathi! You will be sorely missed.

National Health Forum has provided an initial grant for a comprehensive Urdu nursing text book. This book will first of its kind in Urdu language that will be used in Nursing schools of Pakistan. References are taken from English text books and tailored towards the needs and requirements in Pakistan. NHF is thankful to Nursing Council of Pakistan for their help in taking interest in the publication of this text book. We are thankful to Mr. Salami who edited this text book. We hope that editing will be finished in June and the book will be marketed in late summer or early fall of 2016. After Urdu-English Medical Dictionary and Urdu-English Medical terminology books, this nursing book will be the third in line for NHF. These books are available at discounted and subsidized prices or free to certain nursing and midwifery students.

Dr. Iftikhar Yusuf and his United Kingdom team started a charity hospital in Kashmir that provides inpatient and outpatient care in different specialties. Arrangements to provide telemedicine is underway so as to make the hospital a training center for local health care providers. Initially the hospital will carry 40 beds with two functional operating rooms, medical laboratory and fully equipped radiology department.

Dow Medical College Student run organization Serve Our Civil Hospital (SOCH), which mainly deals with promoting better hygienic condition in Civil Hospital. President of SOCH Urooj Bhatti, Immediate Past President Hira Qaisar and one of Mentor Dr. Gulrayz Ahmed has announced that fund raising will be done to help do the forth HIGH DEPENDENCY UNIT (HDU) for Gynecology Ward 1. The goal will be to have a unit where acute patient can be kept and treated. SOCH has been successful in these endeavors and the total cost of this project will be 5 laks to SOCH, CHK administrators has promised to match 40 of additional cost. Estimate of running cost to SOCH will be about 2.5laks rupees per year. SOCH is most successful organization at present in Dow Medical College Karachi.

National Health Forum in conjunction with Dow Graduates Association of North America launched a 10 week pilot research program for medical students. The program was launched in March 2016 and 26 students were admitted in the first batch. This project is 80% funded by National Health Forum and 20% will come from fee paid by students. Ms. Sadaf Ahmed, a well known researcher, who has taught at many institutions like Indus Hospital and Agha Khan Hospital, will be conducting the research program.

The aim of this research program is to teach students the basics of research and help them apply different tools of research. At the end of course the students would be able to design a study and do a feasibility and validity of their presented project. The goal of NHF is to provide similar classes in all major medical colleges of Pakistan.

www.nhfus.org • Volume IX Number 2, June 2016Editor-in-Chief: Tanveer Imam

FIRST NURSING TEXT BOOK IN URDU

DR. IFTIKHAR YUSUF TO VISIT USA AND LAUNCH FUND RAISING FOR

HOSPITAL IN KASHMIR

SOCH TO SPONSOR HIGH DEPENDENCY UNIT IN GYNAE WARD AT CHK

RESEARCH ELECTIVE FOR MEDICAL STUDENTS

By: Tanveer M. Imam, M.D.EDITOR-IN-CHIEFTanveer Imam

EDITORAmin GaditMasood Moeen

PUBLICATION COMMITTEEIffat Shah-IbrahimRaheel R. KhanMujeeb-ur RehmanMuslim JamiJunaid SyedAsif MoinuddinMansoor AbidiRizwan JabirWamique Yusuf Naseem Shekhani

ARTICLE SUBMISSIONWe encourage every reader to send articles throughout the year on healthcare issues in Pakistan and the US. Articles can be emailed as text or in MS Word format to shekhani1@gmail.com. The Editor reserves the right to edit content of all articles that are submitted.

FOR ADVERTISEMENTS For advertisement rates, submission and schedule please email shekhani1@gmail.com

DISCLAIMERHealth Beat, the NHF newsletter, is a bi-monthly newsletter and provides health information to its readers. The views expressed are those of authors and do notnecessarily represent the official position of either the editor or the editorial board.

NATIONAL HEALTH FORUM

2325 Dougherty Ferry Rd, #203St. Louis, MO 63122JUNE 2016 ISSUE

IN REMEMBRANCE...

On April 30th, 2016, Dr. Rasheed Hassan Khan passed away peacefully in his sleep. He was a graduate of Dow Medical College, Karachi and an iconic student leader of his times. He was a charismatic man of

extraordinary intelligence and gallantry. His genius, sincerity and down-to-earth persona left an ineffaceable impression on generations of students.

He was committed to his ideas of struggle for an egalitarian society and practiced what he preached. In spite of being one of the top students in his class, he chose to practice general medicine serving one of the poor localities of the metropolis. He earned just enough to sustain an extremely simple life style and devoted his time in advancing proletarian politics. He shunned careerism specially career politics.

He was the figurehead of a galvanized student movement that took the military dictatorship of General Ayub Khan by its horns. He was instrumental in inviting Zulfiqar Ali Bhutto, the future Prime Minister of Pakistan, to Dow Medical College to preside over a pro-democracy student convention. Rasheed Hassan Khan later bore the brunt of the military regime when he was arrested in 1970 for protesting the ban on students union.

His image catapulted among the students during his days of incarceration and summary military trial when the junta failed to break the ‘doctor’s” resolve. When he was brought to Dow Medical College in a police van with armed guards, to appear in his final year exam, the assembled crowd of protesting students raised slogans against the dictatorship and demanded release of their colleague. The accompanying Inspector of Police buckled under pressure and allowed Rasheed to have tea in the canteen with fellow students, who treated him like a rock star.

But, rock star he was not, he was a people’s man with deep abhorrence for individualism. Common students and people in general identified with him. He was their man, representing and struggling for their cause. He became even more revered when he refused to sell his loyalty for the common man at the hands of the Bhutto government who renegade at their promise for basic democracy for workers. Warrants for his arrest on frivolous charges were

issued forcing Dr. Rasheed Hassan Khan to go underground for a number of years. He chose to live among a handful of colleagues organizing people’s democracy over offers of ministry and life of luxury.

Foes called him eccentric and outdated, friends held him in awe but none denied his abundance of knowledge, his unyielding resolve, his articulate thoughts and his charismatic personality. He remained committed to his principles till his last breath and never took away his faith from the masses. He practiced medicine for almost 30 years and eventually retired from his practice in 2010. He devoted the last years of his life in reading and writing on politics. He ran an active blog with a wide readership. His book encompassing his editorial collection titled “To Change the World” was published in 2015.

Rasheed Hassan Khan’s legacy is a life lived for one purpose alone, empowerment of people. He struggled for the basic rights of people. Free health care, education, employment and liberty from exploitation. He never considered dispensation of health care as charity. He believed that this was a basic right of every citizen. He also believed that it was incumbent upon government and state to provide its citizens with affordable and accessible health care. His teaching will live in the hearts and minds of people for generations. Rulers, ministers, military generals and career-oriented bureaucrats will come and go leaving no mark behind. But I am sure when history of student movement and democracy in Pakistan will be written, Dr. Rasheed Hassan Khan’s name will be mentioned in the same context as the Cubans remember Jose Marti!

With a very heavy heart we pay homage and final salute to a great friend and teacher. Rest in peace dear comrade!

EDITORIAL

TORT REFORMS:Is There Any Hope?

By: Mohammad Ahmed Aziz, MD, MS, MBA

Medical malpractice is not an easy subject to address, as the impact seems to cover almost all spectrums of the economy. As every physician knows, our tort system is

broken. Medical malpractice affects both patients and physicians severely. Malpractice suits have produced widespread disillusionment among physicians concerning care of patients, the legal system, and medicine as a profession. Thus, it is crucial to examine the effects of medical malpractice claims against all stakeholders.

Does the present medical malpractice system improve medical care? Some researchers suggest that the fear of malpractice does not improve medical care; rather, it forces doctors to take a more defensive approach. Physicians in the United States have long believed that they must practice defensive medicine to diminish litigation risk. Defensive medicine is commonly defined as the ordering of treatments, tests and procedures primarily to help protect the physician from liability rather than to substantially further the patient’s diagnosis or treatment. Fear of frivolous lawsuits may be so pervasive that it has changed what is considered an acceptable diagnostic approach. The overuse of tests and procedures because of defensive medicine is estimated to cost $46 billion annually in the United States, but these costs have been measured only indirectly.

Does the present medical malpractice system make patients safer? To answer this question let’s look at some statistics: of all hospitalization about 3-4% result in injury due to medical care and only about 1% of all hospitalization is due to substandard care. Only 2% of injuries from substandard care result in actual claims. That means that 98% of the injuries due to substandard care never result in claims. So, one way the malpractice system fails patients is by bringing far too few cases to light. This is a concern for people who have been legitimately harmed by the substandard care and shows that the malpractice system is f lawed. Does the present medical malpractice system protect doctors? Medical malpractice insurance premiums have a great impact on a physician’s career. Doctors pay high malpractice insurance premiums to practice medicine and may make alterations in their practices. Majority of the malpractice cases brought about have no merit. An estimated 61% – 66% of all claims made are withdrawn, dropped or dismissed. Malpractice claims are expensive to defend and can cost about $ 27,000 each. Defending many claims that get withdrawn, dropped or dismissed actually cost more each year than defending the few that go on trial. Moreover, legal action can result in other costs, including mental distress, lost time from work, and a damaged reputation. Medical malpractice lawsuits can impose more than just a financial burden upon physicians. Numerous surveys show that even doctors in “low-risk” specialties stand a good chance of being sued at least once over the course of their careers. It’s of little

comfort to doctors that two thirds of claims are dropped or dismissed, and that physicians prevail 90% of the time in cases that go to trial. There is significant research showing that coping with a medical malpractice suit can weigh heavily on a physician emotionally as well as physically.

So is putting caps on the malpractice the answer? Not really. Florida passed a version of tort reform and insurance companies had to pay out less in indemnity payment and saw their profits soar to 4300% from 2003 to 2010. The insurance companies did not pass the savings to doctors who continue to see their malpractice premiums remain sky high. If doctors don’t see change in their premiums, they won’t stop practicing defensive medicine and the whole concept falls apart. Is there a possible solution? The current system of compensating patients for medical errors is not working and is leading to profound disillusionment among those in the medical profession. Various solutions have been suggested over the years, only to fade away. But now, a promising new system for patient compensation in cases of medical error is being proposed in two states: Georgia and Florida. It makes sense for doctors and patients alike, and for our healthcare system as a whole.

If enacted, this system can put an end to malpractice litigation in those states and could serve as a template for other states to follow suit, replacing the current medical tort system with an administrative system for redress. The patient, via a patient advocate, would appeal to the system to investigate an injury. The full record would be reviewed by a rotating panel of relevant medical experts. If the panel agreed that the injury was avoidable, the case would be referred to a compensation committee to make payment.

The patient would not need a lawyer, although he or she could have one to ensure that due process was followed. Physicians would not need malpractice insurance because they could not be sued. Instead, they would pay an annual contribution to administer to the program—rates, that would be significantly below the current market rate for professional liability premiums. Whether the Patients’ Compensation System is constitutional is beyond the scope of this article, but experts who have reviewed the proposed law firmly believe it passes constitutional muster.

ABOUT THE AUTHOR; Dr. Mohammad A. Aziz is a graduate of Dow Medical College, Karachi Pakistan and practices Pulmonary/Critical Care in Long Island NY and have extensive experience on the subject Tort Reforms.

POLIO-FREE PAKISTAN:One Last PushOp-ed for The News International, PakistanMarch 29, 2016

“Not since the eradication of smallpox in 1980 has the world had a chance to wipe out an incurable, but preventable, human disease, “ says Dr Hamid Jafari, former director of the World Health Organization’s Global Polio Eradication Department.

Each year of delay in stopping the wild poliovirus, transmitted person to person through contact with infected human faeces, costs the global community a billion dollars. That’s what it takes to maintain the immunization programme that must be sustained as long as even one case of polio is detected.

Pakistan and Afghanistan remain the only two countries where the wild poliovirus is endemic, i.e., never stopped transmitting. This year, Afghanistan has detected one polio case and Pakistan six so far. Both countries are still hoping to interrupt transmission, working towards that goal, and tantalizingly close to becoming polio-free. If no wild poliovirus case is detected for 12 months, there is a good chance the transmission has been interrupted – something that is confirmed once a country has been polio-free for two years.

Once Pakistan and Afghanistan reach this goal, it would pave the way for the world to be polio-free, eliminating the risk of children becoming cripples or, in rare cases, dying.

Consider the progress made since polio vaccines were developed in the 1950s. Polio crippled about 35,000 children a year in the 1940s and 1950s in the United States alone. By 1979, the USA was polio-free. Worldwide, polio declined from 350,000 cases in 1988 to 74 in 2015.

On March 27, 2016, the WHO-designated South East Asia region was certified polio-free for two years. Nigeria stopped the spread of polio in 2014. If it remains polio-free by July 2016, the entire continent of Africa will have been polio free for two years.

In 2012, India was declared polio-free – a country that had appeared to have no hope of emerging from its polio-endemic status given the size of its population and large pockets of vulnerable populations. For five years India carried out an aggressive, sustained and innovative programme. The National Polio Surveillance Project, 2007 to 2012, was headed by Dr Hamid Jafari, assigned by the World Health Organization as the main technical advisor to the Indian government.

Dr Jafari, whom I’ve known since he was a medical student in Karachi, supervised a staff of over 2,300 and supported the efforts

of the government, Rotarians and other partners to ensure that polio vaccines to 172 million children each year. As in Afghanistan and Pakistan, they were mostly from migrant families or lived in remote or hard-to-access areas.

Dr Jafari’s multi-faceted, research-based and “tight net” strategic approach ensured that vaccinators reached the most vulnerable, particularly in areas with poor sanitation and high rates of diarrhoea. This involved targeting high-risk areas like flood-hit districts and migrant and mobile populations for vaccination campaigns and routine immunizations. Mobile vaccination teams used motorcycles and boats, and even waded through water to reach children. They administered vaccines at bus stops and on trains and went house-to-house to routinely register new-born babies and ensure they were vaccinated.

India’s last known polio case, discovered on 13 January 2011, was 18-month old Rukhsar Khatoon in West Bengal.

“I never met Rukhsar, but I’ve seen lots of photos,” says Dr Jafari. “She was a mild case and has largely recovered.”

Why should Pakistani or Afghan children remain the only ones in the world at risk of being crippled with polio? In both countries, the polio is now only found in pockets, mostly conflicted areas and communities of displaced people and mobile populations. And it’s not the communities that resist vaccinations – fewer than one percent of parents refuse.

The question is how to reach the vulnerable areas. We must examine which children are not getting vaccinated and why, says Dr Jafari. Why are children from areas around Peshawar, Gadaap, or Quetta being missed?

“This requires a continuous probing in a way that doesn’t get people defensive but focuses on the barriers that must be overcome. The key is to involve and empower the affected communities and engage people in their own language and on their terms,” says Dr Jafari. There is no shortage of dedicated teams and community leaders in Pakistan. Plus, in 2015, the government made important structural changes to enable health workers to reach every child through the National Emergency Action Plan (NEAP).

By: Beena Sarwar

but will also enhance the potential for building peace..”

The argument that Pakistan can’t eradicate polio unless Afghanistan does, because of the porous borders, is a false narrative, he says. Both countries export polio to each other but Pakistan as the larger, more complex country, has to be the major driver.

“Polio will disappear much faster from Afghanistan once Pakistan ends it,” he predicts. If Afghans are bringing it in, Pakistan can stop it from further spread by vaccinating all children.

Pakistan is not the world’s poorest, most conflicted or fragile state. Pakistanis have shown tremendous resilience and determination in overcoming all kinds of odds. This too, is a fight that we can win. We must win. It just needs one last push.

ABOUT THE AUTHOR: The writer is a freelance journalist, editor and filmmaker from Pakistan based in Cambridge, MA.Website: www.beenasarwar.com. She tweets @beenasarwar

Brief bio: Beena Sarwar is an award-winning and widely published journalist, editor and documentary filmmaker with extensive media and social media experience. She has worked in senior positions at various news outlets in Pakistan and contributes news and commentary to media outlets around the world. She has taught journalism at Harvard Summer School and at Brown University and will teach a journalism seminar at Princeton University this year. She has held honorary positions and served on the boards of several media and non-profit organizations. She has an undergraduate degree from Brown University and a Masters in Television Documentary  from  Goldsmiths College University of London. She is also the recipient of several international fellowships including at the Nieman Foundation, Harvard University and the Carr Center for Human Rights Policy at Harvard Kennedy School. 

The NEAP places the responsibility for the vaccination campaign at all levels of administration, each accountable to the other -- polio eradication committees, task forces and

steering committees at union council, district, divisional and provincial levels, further linked to provincial task forces, the Prime Minister’s Focus Group on Polio Eradication and National Task Force on Polio Eradication.

Pakistanis can no longer blame ‘the government for inaction’. The onus now lies on the regularity of the coordination committees’ meetings and their determination in identifying and closing the gaps, whether transport, security, or salaries.

“A lot depends on the vaccinators, how they are being trained and treated and how are they working and communicating,” says Dr Jafari, “and the level of follow up with the command and control, emergency and accountability structures.”

Since these structures were implemented, Pakistan has seen a dramatic decrease in polio – 80 % in 12 months, from 306 reported cases in 2014, to 54 in 2015. No small feat for a country beleaguered by so many other issues.

The odds are not worse than those in India or Nigeria. Yes, there is an insurgency - but not all militants oppose polio vaccinations. Taliban leader Mullah Omar actually issued a letter in 2010 endorsing the polio vaccination campaign. Afghan Taliban allow polio vaccination campaigns to take place, observing a truce during campaign days.

Looking ahead, we need a paradigm shift, says Hamid Jafari. “We have to find ways to get women educated and children vaccinated even where there is fighting and long running conflicts. Important lessons are being learned in the fight against polio in Pakistan. These lessons could guide strategies that may not only maintain delivery of essential services to the most vulnerable populations rather than waiting for the conflict to end,

ACCOUNTABILITY IN VA DISABILITY COMPENSATION“When Exposure to Agent Orange goes Unaddressed”

What is ‘Agent -Orange’? Agent Orange is the name given to a specific blend of tactical herbicides, used by the US military in the jungles of Vietnam from 1961 to 1971,

during the Vietnam conflict and Korean Demilitarized Zone. Agent Orange and other herbicides were used by the US military to remove leaves from trees which provided cover for the enemy forces. During this process more than three million veterans were serving in Southeast Asia although, it is unknown the number of Vietnam-Era veterans who were actually exposed to these herbicides. Still today, more than four decades later (40 years), health related problems have been ‘presumed’ as contributable factors that are a direct result to exposure to Agent Orange. Although medical exams and treatment are readily available for veterans exposed to Agent Orange, more than often, requests for disability compensation are repeatedly ignored, often refuted and disassociated with Agent Orange by the Veterans Administration (VA) in resistance to deny medical compensation for physical damages caused to veterans for proven-diagnosed conditions associated with exposure to Agent Orange. Disability compensation is a tax free monetary benefit paid to veterans who have been diagnosed with service connected medical disability. Veteran’s compensation claims are repeatedly denied, even upon decisions of Appeals. Veterans who have been found to have served during the above noted time frame, alleging exposure, are still fighting for VA to assume accountability and responsibility for their actions by providing a full range of health care protection to include compensation for veterans service connected injury and it’s possible life threatening disability.

VA has determined a veteran eligible for exposure to Agent Orange or other herbicides if they meet the following criteria’s: 1) if they served in Vietnam anytime between January 9, 1962 and May 7, 1975, including brief visits ashore or service aboard a ship that operated on the inland waterways of Vietnam, 2) If they served in or near the Korean demilitarized zone anytime between April 1, 1968 and August 31, 1971. VA reiterates that in determining eligibility only the two requirements noted above must be met, veterans do not have to show ‘exposure’ to be eligible for disability compensation . However, there must be competent medical evidence of a current disability, there must be medical evidence of an actual connection between herbicide exposure and the current disability to include the above noted eligibility requirements to receive disability compensation from the VA.

Studies attribute the blending of these chemicals, Agent Orange and its dioxin contaminants, as a contributor to cancers, high blood pressure, skin legions, liver damage, loss of sex drive, sensitivity to light, sore joints, birth defects, numbing or tingling in the extremities, bladder

cancer, chronic obstructive pulmonary disease (COPD)-respiratory disease and other health effects in humans who were exposed to these chemicals. VA offers an Agent Orange Registry healthcare exam specifically to determine diseases associated with the exposure to Agent Orange. Diagnosis identifies links with the diseases and medical conditions among veterans possibly who were presumably exposed to Agent Orange, but yet even with an acknowledged diagnosis of possible exposure, compensation by the VA often goes unrecognized and ‘denied’ for years on end despite VA’s recognition that the problem exists.

Veteran’s who have met the above, eligibility requirements, still argue more than 4 decades later that their submitted claims for compensation have been ignored. Veterans are now resorting to the media to help bring attention to their claims and to get their claims processed more expediently and resolved. Fox 2 News reported on February 29, 2016 ‘Veteran wins benefits after Fox 2 Agent Orange report’. It reported, ‘a military veteran suspected to have been exposed to Agent Orange feared the VA would deny him benefits, waiting for him to die’ and noted ‘one week after our Fox Files investigation about vets denied benefits for exposure to Agent Orange, Bill Casto received a 27 page letter with a surprising acknowledgement’: “It says VA memorandum, herbicide exposure conceded dated February 5, 2016’. The veteran reported that he’d filed his claim in 2009 and VA is now “admitting now that I was exposed to herbicide” (2016).

The concern remains, when will the VA assume full responsibility by both providing full medical care and full ‘due’ compensation for physical damages caused, from their decision to blend herbicides-Agent Orange to eliminate one problem, that created many other health related problems. It’s time to assume full responsibility, do the right thing and take care of our veterans who took care of us during the most critical time of war.

http://m.military.com

For an incomplete list of locations and dates where dioxin (Agent Orange and other agents) was used, consult the links on the VA web page online at http://www.publichealth.va.gov/exposures/agentorange/militaryexposure.asp

ABOUT THE AUTHOR: Patricia Wilson works with VA system for last 27 years in benefits department and this article is written by Ms. Wilson for Health Beat. June 2016 issue.

By: Patricia Wilson

The recent debate on health care reform has occurred mostly at the national level. The Affordable Care Act, or ACA, was a momentous change for the U.S. health care system. So far, 20 million people have

gained health insurance coverage due to the ACA—a historic reduction in the number of uninsured people in the United States.

The ACA also contained several tools designed to control health care costs. It created the Center for Medicare & Medicaid Innovation, or CMMI, which is authorized to test new payment and delivery methods in order to lower costs and improve quality for individuals who receive benefits from Medicare; Medicaid; or the Children’s Health Insurance Program, or CHIP. CMMI is currently testing and evaluating many different models, including accountable care organizations, bundled payments for hip and knee replacements, and primary care medical homes. The ACA also reduced Medicare payments to Medicare Advantage plans; to hospitals with poor quality measures; and to medical providers, which has had a spillover effect on private insurance.

Partly due to the ACA, health care cost spending growth has slowed in recent years. Before 2014, there were five years of historically low growth, and 2011 was the first time in a decade that spending on health care grew slower than the U.S. economy. Health care costs are still projected to grow faster than the overall economy, however, and health care spending already puts tremendous pressure on state and federal budgets and limits spending on other important services. More needs to be done to sustain this slowdown in growth.

The current political environment makes it unlikely that reforms to control system wide health care costs will be achieved at the federal level in the near future. States, however, are well-positioned to take the lead on implementing cost control and quality improvement reforms. Indeed, many states are already innovating and seeing positive results.

There are several advantages to implementing reforms at the state level. State-level reforms can be tailored to work best for each state, depending on the structure of its insurance markets, the size of the state, and its demographics. States also have considerable authority over the regulation of health insurance and the provision

of health care within their borders. States control their own insurance markets: They run their Medicaid and CHIP programs and state employee plans, and certain states run the exchanges for individual health insurance. States also control the rate review process, scope-of-practice regulations, physician licensing, antitrust laws, and provider and insurer regulations. Lastly, states and governors have considerable convening power to bring together diverse stakeholders, making reform efforts more politically feasible.

The innovations that some states are implementing to reduce costs while maintaining or improving quality can and should be replicated by other states. This report lays out a comprehensive summary of options, as outlined in the following table, that states can choose from to improve the quality and sustainability of their health care systems. Generally, these options relate to implementing new payment models, increasing accountability and transparency, collecting more data, increasing the use of high-value services and practices, and removing barriers to effective practices.

We have included examples from some of the most pioneering states and other examples where states are instituting similar reforms, as well as details from these states’ experiences and their strategies to make the reforms successful. These examples are not an exhaustive list of all the states that may be undertaking these reforms. Other ideas and strategies have not been used before. Importantly, these reforms are not mutually exclusive; in fact, states should adopt as many as possible.

All of these reform options would help states slow the growth of health care costs, improve the quality of their health care systems, and protect their residents.

Zeke Emanuel is a Senior Fellow at the Center for American Progress. Joshua Sharfstein is associate dean for public health practice and training and a faculty member in health policy and management at the Johns Hopkins Bloomberg School of Public Health. Topher Spiro is the Vice President for Health Policy at the Center. Meghan O’Toole is the Policy Analyst for the Health Policy team at the Center. Article taken from Center of American Progress website.

State Options to Control Health Care Costs and Improve Quality

By: Zeke Emanuel, Joshua harfstein, Topher Spiro, Meghan O’Toole

NONPROFIT ORGU.S. POSTAGE

PAIDST. LOUIS, MO

PERMIT #PI 1694

NATIONAL HEALTH FORUM2325 Dougherty Ferry Rd, #203St. Louis, MO 63122

Girls studying in pile of Garbage

IFMCH has taken upon itself in establishing a 150 bed,a state-of-the-art hospital in Thatta District.

This hospital will also cater to several adjoining small towns and nearby villages in Sindh. Combined with an OPD and in-house patient treatments, it will be pivotal in providing training of doctors and other paramedical staff including midwives. Furthermore, the trained staff will conduct awareness sessions among the local women folks on pregnancy and other birth issues.

The hospital will be built in 5 phases and the project is expected to complete in 5 years with an estimated cost of 610 million rupees. When finished, the hospital will be able to offer free maternity services, antenatal and post-natal care, gynaecological services, neonatal intensive care, neonatal medical & surgical services and child psychiatric services. This is considerably a large project requiring commitment, finances and strong will to serve the weak, under privileged, and socially outcast uneducated masses.

ABOUT THE AUTHOR: Dr. Saleemullah Khan is a Graduate of Dow Medical College and works as consultant in United Kingdom. Dr. Kahn is Chair of International Foundation for Mother and Child Health.

A Project by NHF

AIMS AND OBJECTIVESTo Set Up Delivery Units For

• Traditional Birth Attendants• Lady Health Workers• Midwives

These units will be set up either within or adjacent to their premises so that it will enable the care provider to provide prompt care, to conduct delivery in safe and clean environment. They will also be able to manage obstetrical emergencies and in need of patient transfer for initial stabilization of patient and transfer to appropriate hospital.

The delivery units will be funded by the I.F.M.C.HIt will include:

• Construction of the unit 20ft by 20 ft structure • Delivery room 9ft by 12ft ( delivery bed , instruments)• Toilet facilities 9ft by 8 ft• Reception/clinic area 11 by 20 ft aprox. Pre requisite• Access to public and private transportation• Providers will be taught Obstetrics emergencies

Lady health workers will be given adequate training for: • Antenatal care • Management of labor• Management of obstetrical emergencies• Post Natal Care • Breast feeding • Vaccination of the new born • Maintain records of patients• Follow up on all patients

There will be random follow up visits to check and maintain the quality of care The boarding lodging and transportation will be funded by the I.F.M.C.H.

Hospital in Mirpur Sakro-Thatta, Pakistan By: Dr. Saleemullah Khan

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