Many states in India have begun offering free dialysis to its citizens. Some are under the Central Government’s National Health Mission Free Dialysis Program Some schemes already existed before this program. Some of the schemes are flawed in their design and some are flawed in their execution. A few of these schemes are implemented very well.
It takes a lot of effort, knowledge, asking the right people for advice and most importantly, intent for a government to do things the right way. Not all schemes have got the details right. What constitutes a well-designed and well-implemented Dialysis provision scheme? I would list the following items as some of the important aspects to consider if genuinely good outcomes are desired:
- Providing thrice weekly dialysis. Some schemes offer only twice weekly sessions. World over, the minimum recommended dialysis frequency for dialysis patients on MHD is three times a week. Anything more is welcome. Anything less can be called half-baked at best
- Including ESAs, IV Iron and other medication like phosphate binders and blood pressure medication. Without this, it is very difficult to maintain good anemia management and effective management of co-mobidities like Mineral and Bone Disorders, Left Ventricular Hypertorphy etc.
- Including blood tests and other investigations. If this is not done, it is like shooting in the dark. How can clinical outcomes be managed if they are not even measured?
- Implementing a comprehensive Renal Replacement Therapy program by including Peritoneal Dialysis and importantly, Kidney Transplants under the purview of the scheme
- Having a comprehensive prevention program where governments target population segments that are considerd high-risk such as diabetics, hypertensives and implementing an effective program to manage such conditions to prevent or at least delay progression to kidney disease
These are only some of the aspects which must be included.
However, it is very difficult to expect a government who is not sure of whether they would be continuing for another term to think long-term and to be able to effectively come up with such an ideal program. After all, such as program would require a lot more funding, effort and infrastructure to be able to implement.
In these circumstances, should no program be implemented at all?
We have a saying in Gujarati that loosely translates to “It is better to have a blind uncle than no uncle at all.” In this context, it means that it is better to have a flawed program than no program at all.
Perfection is difficult to achieve at first. Implementing a flawed program and then continuously keep making changes to the program to include the above items in the program might be a better idea.
Rome, they say, wasn’t built in a day. Implementing a Free Dialysis Program in a country like India is arguably even more complicated. Let us take it one step at a time. Let us make one improvement at a time.