Recent policy development around dementia in India

Meera Pattabiraman, Chair of Alzheimer’s Disease and Related Disorders Society of India (ARDSI), writes about ARDSI’s successful engagements with the Ministry of Health and Family Welfare in India, a country where over 5 million people live with dementia.

Alzheimer’s & Related Disorders Society of India (ARDSI) has been diligently following up with the Ministry of Health and Family Welfare since we submitted the Dementia India Strategy Report to the then Health Minister, Sri. J P Nadda, last September.

As we have a new Health Minister, it became imperative that we bring to his attention the mandate of the WHO’s Global Action Plan calling for all countries to develop their own national dementia plans.

On 6 December 2019, ARDSI Vice Chairperson Dr Radha Murthy and I met with the new Health Minister, Dr Harsh Vardhan. We briefed him about the importance of a national dementia plan for India, to which he assured us that his administration is looking into the matter.

At the meeting, a letter from ADI’s Chief Executive Paola Barbarino was also presented to Dr Harsh Vardhan. The letter contained assuring support from ADI, as well as a request for dementia to be addressed at the G20 summit when India assumes Presidency in 2022.

We also had fruitful discussions with key officials in the Ministry of Health and Family Welfare to pursue our cause of seeking a country specific plan as part of public policy and advocacy measures. Narendhar Ramasamy, ARDSI’s Executive Director, also took part in these meetings.

During these discussions, we were happy to learn that dementia could be included immediately under the District Mental Health Programme as part of the Project Implementation Plan (PIP). We were advised to advocate with the Mission Directors and State Programme Officers of the National Health Mission (NHM) in each state to include dementia awareness, diagnosis and care under each of their Project Implementation Plans as a part of targeted intervention.

Dr Radha Murthy, Vice Chair of ARDSI (right) and Meera Pattabiraman, Chair of ARDSI (centre), handing over the request for a national dementia plan to India’s Health Minister, Dr Harsh Vardhan.

The officials also informed us that each district in India (totalling 732) has a budget allocated for each District Mental Health Programme. In addition, there are special provisions under two subdivisions, Public Private Partnership and Innovation, where dementia services like setting up memory clinics and linking the follow up through telemedicine from Health and Wellness Centres, Primary Health Centres, Community Health Centres, and Tertiary care facilities are possible.

The proposals for such services under these action areas in the PIP will be considered by the Ministry of Health and Family Welfare in Delhi.

This information has been shared with all 24 ARDSI Chapters, as well as with the names of State Programme Officers in each state. Though the cut off time for sending the PIPs ended in December 2019, there will be opportunity for a supplementary submission by mid-March.  

We at the national office have already written to the Mission Directors in 15 states. We will be working closely with Chapters to ensure that proposals with recommendations from the state governments for dementia awareness, diagnosis and care are sent from as many Chapters as possible. The only state where memory clinics have already been started under the existing central government schemes is the Western state of Maharashtra.

I see this as an excellent starting point to get the central government of India to implement schemes for dementia without any new policies or additional budget being allocated. The officials in the Central Ministry are very positive about including dementia in their health priorities.

According to existing rules, the proposals have to come from the various states in their PIPs as part of the National Health Mission, in order for them to be accepted. Since health is considered a state subject, the central government will not take the initiative for setting up such services; however, budget allocation will be made to the states whose proposals are considered favourably.

There is also a clear need to have separate state programmes and policies, like the successful Kerala State Initiative on Dementia, which entails awareness, diagnosis, care services and dementia friendly initiatives. The present national programmes under the Ministry of Health and Family Welfare, which provide health care for the elderly, mental health programmes, palliative care and programmes under non-communicable diseases, needs to be combined with the programmes for older persons under the Ministry of Social Justice and Empowerment in order for there to be a comprehensive programme for dementia management and care. These national programmes will have to be complemented by state projects in order to effectively benefit persons with dementia and their families across India.

In the end, what was most heart-warming after all of the meetings with the officials in Delhi, was their conviction that national programmes were essential and that ARDSI and the state governments should join hands in setting up special programmes and services to address the needs of persons with dementia. We are hoping for a lot of action on dementia in 2020 at both the state and national level.

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