Dr. Anuradha Katyal, Kavita Jha

As per the World Health Organization, approximately 360 million people worldwide have disabling hearing loss. Of these, 35 percent are children. In the Indian subcontinent, approximately 63 million people suffer from severe to profound hearing loss. This means that about 22 million children in India suffer from this condition. The current prevalence of childhood hearing loss is 3:1000 live births.[1]

Deafness among children is associated with social withdrawal and poor academic achievement. It tends to have a lasting psychological impact into adulthood. Policymakers started to comprehend the gravity of the situation, as they started to roll out large scale health insurance programs. Several requests to cover young children (below six years) under the schemesby provision of cochlear implants, started to emerge. The treatment is associated with high costs of the implant, ranging anywhere between INR 500,000 to 1,000,000. The surgery costs are also high at about INR 100,000.[2][3]

Currently, in the public sector, Cochlear Implants are covered underthree main programs. The inclusion of Cochlear Implants in states and centrally sponsored health insurance schemes (GSHIS) first gained momentum around the early 2010s. Schemes like Aarogyasri of the erstwhile Andhra Pradesh, Chief Minister’s Comprehensive Program Tamil Nadu, Aarogya Karnataka (previous Vajpayee Aarogyasri) and even the Centre’s Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana have a package for cochlear implant in children.

In addition to this, the Assistance to Disabled Persons for Purchase or Fitting of Aids (ADIP) Scheme under the aegis of the Ministry of Social Justice and Empowerment also provides cover to children with hearing impairment. The aim of this scheme is to treat hearing disability in poor children by providing Cochlear implants for diagnosed hearing disability. There is a  ceiling of INR 6 lakh per unit.[4]Currently under this scheme, there are about 130 empanelled centres(both public and private) in ten states. Lastly, several states have either partnered with private sector hospitals or have strengthened their public ENT hospitals to provide surgeries under the Rashtriya Bal SwasthyaKaryakram (RBSK).

The inclusion of cochlear implants in government sponsored health insurance schemesseems like an example of a win-win situation for both the public and the private sector healthcare. It assures a volume of patients to the private sector players. For the public sector, coverage is assured to parents who cannot afford the high cost of the treatment. It assures goodwill and helps policymakers gain political mileage. Yet, the challenge does not end with providing the treatment. Children need long termhabilitationpost the treatment. This adds to the distress of the parents and often compels them to relocate to cities for their children. In addition, there is a dire need for early identification of hearing impairment since these children need to be treated under the age of six years.

In Tamil Nadu, quality assured satellite habilitation centres have been set up to ensure the care is given to the children beyond surgery.¹Similarly, in Nagpur, the Orange City Hospital & Research Institute has partnered with RBSK to serve the entire Vidarbha region to ensure early diagnosis ad mobilization of the children who need care.

There are many ways in which the private sector can play a significant role in this area.

Community Level- Habilitation:  The private sector can team up with NGOs and local partners for post surgery habilitation of the children, since long term care is essential for them. Tamil Nadu has set up quality assured satellite centres in partnership with NGOs. It eliminates the need for frequent travel or even relocation to cities for habilitation services.

Primary Healthcare- Identification: Early identification through the PHCs where private sector players enable setting up of guidelines and train the PHC staff. The Nagpur city RSBK program works closely with a private hospital for the entire Vidarbha region. It covers the four D’s namely defect at birth, deficiencies, diseases and development delays including disability.

Hospital level– Treatment and guideline setting: Several schemes have empaneled private players to provide care under various programs. Most government insurance schemes provide free of cost implants and surgeries to the beneficiaries. The Ministry of Social Justice Scheme also provides partial to full benefits based on the socio-economic status of the beneficiaries.

Efforts such as above, need to be integrated and scaled up to the entire country. A cochlear implant is an example of how even a costly procedure with the right approach and intersectoral and inter-departmental collaboration can be made available to the poorest of the poor. Several other care pathways can be set up in a similar manner for diseases like cancer, mental health, cardiovascular care, and dialysis, for which patients need care on a long-term basis. The private sector can play a significant role in not just providing tertiary care but also as an enabler for post-surgery habilitation, early identification, setting up treatment protocols, training the RBSK staff, and setting up gateway mechanisms for screening. The economic benefits of providing care to a young child to become a healthy and productive citizen fetch social dividends for several years to come. Health is not an opportunity cost rather an opportune investment for the future of the country.

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[1] https://pubmed.ncbi.nlm.nih.gov/29697411/

[2] https://www.thehansindia.com/posts/index/Telangana/2018-01-15/Govt-includes-cochlear-implant-surgery-in-Aarogyasri/352106

[3] https://timesofindia.indiatimes.com/business/india-business/cost-of-cochlear-implant-operation-may-go-down-to-rs-1-lakh/articleshow/51568005.cms

[4]According to the provisions of the ADIP Scheme, the income ceiling for the beneficiaries is ₹ 15,000 per month for 100% concession and ₹ 15001 to ₹ 20,000 per month for 50% concession.