Sickle Cell Anemia Control Program (SCACP)
Commissionerate of Health, Medical Services and Medical Education

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Sickle Cell Anemia (SCA) is a hereditary anemia and is predominantly seen amongst various tribal populations of India. This is due to inherited abnormal hemoglobin (Hb) gene producing Hb-S (Hb-Sickle). India has tribal community of about 180 million out of which 18 million people may have sickle cell trait and 1.4 million sickle cell disease patients. Adding to it, estimated 5,200 live births with Sickle cell disease (SCD) is recorded every year. SCD is a major public health problem in India however country does not have any health program at national level to address it. Although in different states of India various agencies, mostly Non-Governmental Organizations (NGOs), are working on short term, small scale projects in segregated areas but without proper documentation or regular follow up. According to Indian Council of Medical Research (ICMR) survey amongst the primitive tribes of south of Gujarat, viz; Kolcha, Kotwadia & Kathodi; 20% of Sickle Cell Disease children die before the age of 2 years, 30 % of Sickle Cell Disease children die before they reach adulthood (14 years) and the remaining 70 % die by the age of 50. Prevalence of Sickle Cell gene is as high as 5% to 34% in various scheduled tribes who are socio-economically weak and are medically underserved. Dhodia, Dubla, Kukna, Gavit, Chaudhary, Halpati, Varli, Kokni, Kathodi, Kolcha, Kotwadia etc. are among the major tribes having Sickle Cell problem in Gujarat. Gujarat has 8.9 million tribal populations and is expected to have at least 900,000 Sickle Cell Trait and 70,000 Sickle Cell Disease patients. Also more that 50% of the world Sickle gene carriers are in India. As SCD is genetic in nature, the numbers of diseased people are bound to rise, in absence of suitable interventions. As symptomatology of Sickle Cell Anemia is very similar to any other anemia, Sickle Cell Anemia patients are frequently misdiagnosed and mistreated. Though SCA is not a common iron deficiency (nutritional) anemia, Sickle Cell Disease patients are often mistreated with iron therapy. Due to excessive break down of red blood cell in this condition they show symptoms of hemolytic jaundice which is again misdiagnosed and treated as infective hepatitis. Also joint pains of SCA patient’s gets treated as arthritis. SCA patient’s murmurs due to anemia are wrongly treated as rheumatic fever. Owing to these similar symptoms with other common diseases, diagnosis of Sickle Cell Anemia is usually possible only at a stage when a patient complains of severe complication. It is also noteworthy that sickle-cell disease is incurable. Very few tribals are fortunate enough to be diagnosed as Sickle Cell Disease and are financially capable of taking regular life time medicine and crisis management which is strategy to deal with the disease and focuses on prevention and early diagnosis to ensure effective management of the disease and ward off sickle cell crisis situation. In recent past the field of genetic hemoglobinopathies has generated immense interest in national and international researchers and academia resulting in publications of plenty of research papers, articles in international scientific journals & discussions in conferences on Sickle Cell Anemia. But benefits of such researches were yet to trickle down to the person suffering from illness.

B. Strategic Approach

 2. What was the solution?
Looking into the gravity of SCA problem, in year 2006 Department of Health and Family Welfare, Government of Gujarat initiated pilot Sickle Cell Anemia Control Program (SCACP) in five tribal districts of the state viz; Surat, Navsari, Dang, Tapi and Valsad. In year 2008 the program was extended to remaining seven tribal districts viz; Bharuch, Narmada, Vadodara, Godhra, Dahod, Sabarkantha, Banaskantha; thus covering all 12 tribal districts of Gujarat. Sickle Cell Anemia Control Program of Gujarat, just like any other disease control program consists of three-fold approach: 1. Early screening of patients 2. Administering of treatment and 3. Counseling for managing the disease and preventing sickle cell births. SCACP holistically offers complete range of services by aiming at early diagnosis of the disease through New Born Screening (NBS) and Antenatal Screening, followed by treatment and counseling of Sickle Cell Disease patients including prevention by marriage counseling and prenatal diagnosis. Experience worldwide suggests that prevention of Sickle Cell Anemia and other hemoglobinopathies requires empowering of community to take informed decision. To facilitate such empowerment, creation of all required facilities is of utmost importance. The Government of Gujarat has developed all required facilities for Premarital Screening, Antenatal Diagnosis and even Newborn Screening for Sickle Cell Anemia. The screening under this program covers all -from new born to old age people - in a life cycle approach, the main target group for screening are adolescents, antenatal women and new born. As prevention is the only way to check further progression of disease in community, marriages between two sickle gene carriers (either sickle cell trait or sickle cell disease) have to be discouraged. Diagnosing the sickle cell gene in adolescence, creating awareness regarding disease and marriage counseling is the mainstay of the program. Gujarat Sickle Cell Anemia Control Society (registered under society registration act 21 of 1860) is formed in year 2011 with the goals to have no child birth with Sickle Cell Disease by 2020. Society has facilitated coordination of various stakeholders, Government Departments and agencies working in these fields to improve the health status and quality of life of Sickle Cell Anemia patients and prevention of death from Sickle Cell Crisis. The main objectives of program are to bring in all the activities by different departments and NGOs in Gujarat for prevention and control of Sickle cell disease under one umbrella. SCACP is based on Public-Private Partnership (PPP) model wherein the Government of Gujarat works in partnership with NGO’s/ Private Agencies for screening. The tribal people that the program caters to are given free of cost screening and treatment. This also includes counseling facilities to Sickle Cell Disease patients and their relatives. In 2012, Gujarat Sickle Cell Anemia Control Society outsourced district wise screening work among interested, qualified and competent agencies by competitive two bid process. Screening has been started since August 2012 by trained and dedicated staff at doorstep of tribal people.

 3. How did the initiative solve the problem and improve people’s lives?
The Sickle Cell Anemia Control Program adopts multipronged holistic approach to address sickle-cell anemia problem in the state. The approach involves: Complete screening: Screening of individuals for knowing their sickle status is an important prerequisite to decide actual disease burden in the society which forms the basis for policy actions. As Government health agencies are entrusted with implementation of many National Health programs along with preventive, promotive and curative care of community. In spite of best efforts, only 0.4 million population was screened per year before year 2012, at this pace it would have taken another decade or more to screen entire tribal population of the state. After outsourcing screening activity to competent and technically proficient private agencies working in health sector, more than 2 million populations has been screened in one year and the target will be achieved before Year 2015. Ensuring early diagnosis and free of cost treatment: This is ensured through New Born Screening, Prenatal Diagnosis, Antenatal screening and Adolescent screening. Free of cost Prophylactic pneumococcal vaccine and Tab. Folic acid is given to all SCD patients. Follow up of patients at their door step: Regular follow up camps for SCD patients are conducted at sub-district (Block) level. Web based application facilitates in managing huge data and online tracing of SCD patients. Build in component of Information Education and Communication (IEC)/Behavior Change Communication (BCC) and Counseling: It aims at better care of patients and prevention of birth with incapacitating SCD in community. Premarital / adolescent and marriage counseling is important activity to discourage the marriages between two sicklers and thereby preventing the spread of Sickle Cell Disease in next generation. This life cycle approach is the unique feature of the program. Co-ordination: Intersectoral coordination between various government sectors and involvement of dedicated NGOs for awareness and adoption of healthy lifestyle in tribal community and to bring awareness among the community, doctors, politicians, etc. have been crucial in making available the treatment at the doorstep of socioeconomically & medically underserved tribal population.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The elements of program mainly aim to early screening of tribal community, proper counseling, preventive measure and administering treatment. Screening activity has been outsourced among seven agencies to cover the entire population in next three year. The screening is done at the field level by trained and qualified staff. Initially, in 2006, 78 Government and NGO Institutions were involved and now it is extended to 419 centers in all over 12 tribal districts involved in Comprehensive care of SCD patients. HPLC based Hb Variant system for quantitative estimation of different hemoglobin has increased from 2 to 9 in number. HPLC based Variant-NBS system for New Born Screening for SCA from heel prick is now available and the count as of today stands at 6. There is a new addition of one Molecular Lab for prenatal diagnosis and Genetic Counseling Center. As this disease is more prevalent in unreached, underserved tribal population, inter departmental co-ordination was necessary to address issues like illiteracy, taboos, poverty, lack of awareness, poor accessibility, poor infrastructure, etc . Different departments like Tribal Development, Education, Information, Finance, Youth & Culture departments, etc were provoked to resolve the concerned issues. Also, Gujarat Sickle Cell Anemia Control Society was formed for better & effective implementation in 2011. The program framework was made in such a way that persons of all age group from new born to old age are covered. Government of Gujarat has adopted policy of screening of adolescents. So we can diagnose the sickle cell gene in pre marriage age and advise them on whom they should marry. Antenatal mothers in the tribal area are screened for SCA at “Mamta Divas”- a special immunization day in village. If mother is found positive for sickle gene, her husband is also screened. If husband and wife both found positive for sickle gene, they are advised for pre-natal diagnosis. If fetus is found to have sickle cell disease, legal MTP is advised. If not possible, MTP is not advised, fetus is delivered and new born screening is done. Five HPLC machines have been installed in five hospitals of tribal area. Thus SCACP covers the whole life cycle which is unique to the program. Training is a key element of any health program. All the field staff including female health worker, multipurpose health worker and ASHA (Accredited Social Health Activist) had been trained. Medical and Paramedical staff were given training regarding management of SCD patient. Counselors were trained to provide SCD patient care & support with regular follow up. All SCD patients are put in to the comprehensive care system and have been regularly supplied basic medications like Folic Acid, Pain Killers, IV fluids, antibiotics etc. are provided at PHCs, CHCs and at higher referral centers. Many of these patients with severe disease were put on Hydroxyurea therapy. Prophylactic Pneumococcal vaccine is given to SCD patients. Sickle Cell Trait – gene carriers are being provided counseling about their status and were also provided marriage counseling. Community health centers are equipped with advanced instruments, facility of blood bank or blood storage units. At Government Medical College, Surat advanced stem cell unit is being developed for treatment of SCD patients.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Sickle Cell Anemia Control Programme was started in 2006 by Health & Family Welfare Department, Gujarat and implemented in most affected five tribal districts and extended to remaining tribal districts in 2008. The program was started as GO-NGOs (Government Organization – Non Government Organization) partnership with Valsad Raktadan Kendra, Valsad, working in the field of Sickle Cell Anemia. Since 2008 Indian Red Cross Society has also become a partner in this program and helps in screening in 7 tribal districts. Commissioner (Health) is overall head of this program, while Additional Director (Health) is technical in-charge for this program and Deputy Director (Epidemic) is a state nodal officer of this Program. Chief District Health officers are responsible for implementation of program. All the activities of Sickle Cell Anemia Control Program are supervised and monitored through District Epidemic Medical Officer, who is the district nodal officer for SCACP. Gujarat Sickle Cell Anemia Control Society (registered under society registration act 21 of 1860) was formed in year 2011 under chairmanship of Hon'ble Health Minister and co-chairmanship of Hon'ble Tribal Development Minister. Other secretaries from different department like Tribal Development Department, Finance Department, Panchayat Department, Rural Development Department, Yuth and Cultural Department and all other stakeholders from different branch of Health department. Gujarat Sickle Cell Anemia Control Society has outsourced district wise screening work among interested, qualified and competent agencies. The details of agencies are as follows. 1. Schamka Technology Pvt. Ltd., Ahmedabad 2. Valsad Raktadan Kendra, Valsad 3. Indian Red Cross Society, Ahmedabad 4. Religare Technology Pvt. Ltd., Noida 5. Indu Health & Research Foundation, Vadodara 6. Kruise Pathline Lab Pvt. Ltd., Ahmedabad 7. Raman Developers, Ahmedabad
 6. How was the strategy implemented and what resources were mobilized?
The diagnosis of SCA is done by simple blood test known as Sickling test on RBCs. Hb electrophoresis / HPLC (High Performance Liquid Chromatography) technique finds out whether the person is Sickle Cell Trait (heterozygous) or Sickle Cell Disease (homozygous). DTT test is very simple test, which can be done at field level by any health worker after training and very cost effective. Initially before outsourcing the screening, one DTT test was cost about INR 45 to INR 50 and after outsourcing the screening one DTT test costs about INR 33/-only. HPLC is done for confirmation of disease but it is costly test but it is highly specific and HPLC test requires the expertise of pathology. Before outsourcing one HPLC test was cost about INR 160 to IN R175 but after outsourcing one test costs about INR 144/-only. An advanced HPLC machine is required which costs for about Rs 5 million. Five HPLC machines have been procured and installed at district hospital in tribal districts. Before 2012, all the activities of screening ware done by government staff and staff of Valsad Raktadan Kendra, Valsad and Indian Red cross Society. After August 2012, screening activities are being done by staff of outsourcing agencies. Different activities of program are done by government health staff, mainly Doctors, Paramedical staff, Field health workers and ASHA workers. To achieve the goals of program effectively, additional 180 counselors and 12 Program assistants are appointed in districts. All the medical and paramedical staff has been trained for Sickle Cell Anemia. Refresher training is being given regularly. Members of VHSNC committee, PRI members and private doctors are also oriented about Sickle Cell Anemia, which creates awareness in community. A technical module has been developed and circulated to all stakeholders especially in PHI, where most of patients are treated. Sickle Cell Anemia is a major public health problem of socioeconomically backward tribal people, so more funds are required. Main financial source of this program is the government budget. State government provides health department about INR 50 million per financial year. Tribal development Department also makes provision of about INR 10 million per financial year for prevention and control of this disease. National Rural Health Mission of central government also provide additional fund for human resources, drugs, IEC, screening etc. In the year 2013-14, INR 10.23 million has been sanctioned.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Since starting of program in 2006, about 0.4 million populations were screened per year, but after outsourcing the screening activity in 2012 more than 2 million populations have been screened in one year, which help in understanding actual burden of this disease. Till date more than 5 million people have been screened and more than 20,000 Sickle Cell Disease patients are identified. These all patients are getting free of treatment, regular counseling, vaccination, and referral services at their doorstep. Now due to available facilities in this program, the common tribal people are most benefited. Today they get regular free medicine at their door step, crisis are managed at CHCs, Civil Hospitals and at Medical collages and hence reduction in crisis. Better and persistent health care has reduced morbidity & mortality due to this disease and the economic loss to this community is also decreased. Before initiation of program only research papers on Sickle Cell Anemia were published in Journals & Conferences but fruits of this Research had not been reached to the needy person. The Fruits of the program have reached to the door step of under-served– The Tribal People. The many of the medical practitioners were not aware of sickle phenomena existing among local public. Most of Sickle Cell Disease patients were misdiagnosed and mistreated. But now awareness among medical practitioners due to various activities involving medical persons has increased dramatically in respect to Diagnosis & Treatment. Marriage counseling, Antenatal screening and prenatal diagnosis are being advised by medical doctors. This program has set up an example for many states grappling with this problem. This successful model has a scope of replication in other states under NRHM. The other state like Chhattisgarh having the largest tribal population has adopted some policy from this program. The program has the potential of being taken up as a national program. The state health department has suggested the Ministry of Health & Family Welfare, Government of India to launch a National Sickle Cell Anemia Control Program.

 8. What were the most successful outputs and why was the initiative effective?
The Sickle Cell Anemia Control Program is supervised and monitored at state level, district level and Block level regularly. Additional Director (Health) is technical in-charge for this program. Deputy Director (Epidemic), state nodal officer of this program is responsible for implementation of this program in state. Chief District Health officer is at district level. All the activities of Sickle Cell Anemia Control Program are supervised and monitored by District Epidemic Medical Officer (EMO), who is the district nodal officer for Sickle Cell Anemia Control Program. At district level, EMO supervises the activities and collect the data from PHC level through Block health office. Medical Officer at PHC look after the activity in his area done by agency and report to district office monthly. ASHA helps in mobilizing the beneficiary for screening, for its work, she gets INR 1/- per test. District officers supervise the screening done at village level. Liaison Officers from state as well as district supervise the activities. Work done is monitored and reviewed by district officer in monthly meeting and reports to state office. Review is also taken up by DD Epidemic in EMO review meeting. Screening done at field level is cross checked by district health authority blindly. 2% of DTT negative and 5% of positive samples are cross checked and doubted samples are sent to Government Medical College Surat for confirmation. All the agencies have to submit the certificate from Sarpanch (Village head) after completion of screening in village for satisfactory work.

 9. What were the main obstacles encountered and how were they overcome?
Sickle Cell Anemia is major public health problem of tribal population. These people are socioeconomically backward with low literacy rate. These people believe too much in superstitious. They don’t accept any newer scientific method of treatment and allopathic drugs easily. Therefore it is very difficult to implement the program in this community. Most of these people reside in remote and forest area, at which infrastructure, man power, etc. are not easily available. Migration is major obstacle in regular follow up of SCD patient. Early registration of ANC and regular follow up is not practice in tribal people. So ANC screening cannot be done at proper time. Health problem of tribal people are on the top priority of health department. Looking into magnitude of this problem in tribal people, Government has started separate program for prevention and control of Sickle Cell Anemia, so it can be focused specially. SCACP has started as Go-NGO partnership program, because the knowledge and experience of the NGO, particularly working in this field and area can be utilized. Program aims not only to screening and treatment of disease but to counseling also. So awareness is created regarding disease and the further transmission of gene can be prevented to next generation. Gujarat Sickle Cell Anemia Control Society is formed in year 2011 to integrate all the activities done by different departments and NGOs in Gujarat for prevention and control of disease under one umbrella. All the funds for this disease are utilized through the society. Treatment centers in tribal area are equipped with instruments, drugs, etc. This tribal people trusts very much on their local elected members. So the elected members of village, Block and districts are involved and informed regarding disease and control program, which help in creating awareness, acceptance of different treatment modality and truth about disease.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Very few tribal were fortunate enough to be diagnosed as Sickle Cell Disease and financially capable of taking regular life time medicine and crisis management. Now due to available facilities in this program, the Common Tribal People from remotest area of state are most benefited. Today they get regular free medicine at their door step, Crisis are managed at CHCs, Civil Hospitals and at Medical collages and hence marked reduction in crisis. The Medical Practitioners were not aware of sickle phenomena existing among local public. Most of Sickle Disease patients were misdiagnosed and mistreated. Increased awareness among medical Practitioners has helped early diagnosis & prompt correct treatment of the illness thereby reducing morbidity and mortality and burden of disease in the society. Better and persistent health care has reduced frequency of crisis which will help in reducing morbidity & mortality with improvement of overall life expectancy and quality of life of tribal people. The Fruits of the Program have reached to the door step of under-served– The Tribal People which is glaringly reflected in Case Study of poor tribal child, named Divyesh Patel. 14 year old child living at Barumad village in Dharampur Block of Valsad district named Divyesh Patel is a known patient of Sickle Cell Disease. His mother is Sickle Cell Trait, while his father’s sickle status is unknown as he died few years back; the cause for his death is unknown. Divyesh has one younger sister of years who is also suffering from Sickle Cell Disease. Divyesh had recurrent bouts of severe pain in abdomen or chest. It was on many occasions accompanied with breathlessness. When rushed to nearby health facilities and then to another facility further away from his village it was mentioned that his condition can improve only if blood is transfused to him which was very difficult to obtain in absence of relatives who are willing to donate their blood as a replacement. There were occasions where he needed blood on every 2nd or 3rd day. His spleen was enlarged as he had been received about 150 blood transfusions. Because of multiple blood transfusions, matched blood was not available even at District level hospital and special cross matched blood with different antibodies had to be brought from regional level blood banks at Surat city, further 150 Km away. He was suffering from infection very often and was lagging behind in his study due to oft-repeated illnesses. This was aggravated 5-7 times in a year resulting in life threatening condition called “Sickle cell crisis”. Once the SCACP got implemented, Divyesh got registered as a Sickle Cell Disease patient at “Valsad Raktadan Kendra, Valsad” an NGO partner of Government of Gujarat under Sickle Cell Anemia Control Program. He was given free of cost drugs and was regularly followed up for supportive treatment. Free of cost Splenectomy in February 2012 supported with all necessary medicines and vaccines under program reduced his miseries to great extent. Now, today Divyesh lives the normal life as other children do. He can do all the things himself and he can play. After operation he didn’t required blood transfusion even a single time. His bouts of infections and associated illnesses also reduced greatly. Thus care and support under SCACP changed life and future of poor tribal child belonged to downtrodden section of society. Govt. of Gujarat has signed MOU with GIOSTAR, USA based company for creating stem cell treatment facilities at Govt. Medical College, Surat. Stem cell transplantation will bring a hope of survival for all Sickle cell disease patients in Gujarat. Tremendous awareness has been seen amongst tribal people of Gujarat by way of their participation in program, thereby reducing morbidity and mortality due to this genetic disorder.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Sickle Cell Anemia Control Program initiated for tribal population of Gujarat to reduce the death from Sickle Cell Crisis and improve the health status of SCD patients. This is a successful model of a GO-NGO, Public- Private Partnership program where government infrastructure and NGO’s dedication and faith of local society in them has played a major role. Continued sensitization of people in this area increases the awareness about disease. This increases the demand for benefit of program by community. The program consists the training of private doctors, village leaders through Gram Sanjivani Samity (VHSNC), social activists also. Continuous counseling session in village and school are done by trained and dedicated counselors, some of them are from tribal community and having SCA. This program helps in early diagnosis through – New Born Screening, Prenatal Diagnosis, Antenatal Screening, Adolescent, Mass Screening and Marriage Counseling. A guideline for treatment of this patient have been developed which will be very helpful to doctors serving in this area. All the health centers and district hospitals are equipped with treatment facility and trained manpower. These all features make this program sustainable. Government of Gujarat is always dedicated for this genetic disease which is almost uncured at present. Government of Gujarat is also keen to establish an advanced treatment facility for the management of Sickle Cell Anemia. The fund for this program comes from State Government budget regularly. Additional financial support also comes from Government of India under National Rural Health Mission. Although lot has been done in state of Gujarat and elsewhere in different part of country but still lot needs to be done to completely address this problem. As Sickle Cell Anemia is seen in other tribal belt of the country and a vast number of tribal people are affected by this disease it is urgently required that a National Program for Sickle Cell Anemia to be started by Government of India. Sickle Cell Anemia Control Program of Gujarat has provided a successful model which can be replicated in other states of country and program may be taken up as National Health Program.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Equity: Economically and socially marginalized group /sections of the society such as tribal in Gujarat state needs specially designed health services and additional resources in terms of budgetary allocations and motivated trained personnel to take care of special health care needs and hereditary disorders such as Sickle Cell Anemia. Now due to available facilities in this program, the Common Tribal People are most benefited. Addressing accessibility: Geographically difficult terrain coupled with illiteracy and economic impoverishment adversely affects accessibility to already inadequate Health care delivery system in such areas. Unless special measures are initiated to reach to the doorstep of such unserved-underserved population, overall health parameters in such communities shall remain despairingly low compare to other communities in other parts of same state. Intersectoral coordination-IEC : This type of program reduces the hardship and arresting productivity loss of tribal community. Before, the program was launched, even if Sickle cell disease was diagnosed, it was believed that as this is a genetic disease, there is no cure & nothing more is to done except for providing symptomatic treatment. But due to IEC in campaign modes and continuous Medical Education ( CMEs) with medical and paramedical fraternity, health care seeking behavior and Diagnosis, treatment of the disease. Marriage counseling, Antenatal Screening and Prenatal Diagnosis are being advised by medical doctors. Public Private Partnership: This program is an ideal example of public private partnership. The wide infrastructure and manpower of Government sector are useful, while the experience of NGOs in the field and faith of community in them can make any program successful. Active involvements of NGOs help in creating awareness as well as community participation in program. Focusing health issue: This is one of the flagship programs of the Government of Gujarat. The programmatic approach instead of project approach gives the wider reach and focus view. Gujarat Sickle Cell Anemia Control Society formed under chairmanship of Hon’ble Health Minister and Co-chair by Hon’ble Tribal development Minister shows the commitment at highest level in the government. The Gujarat Sickle Cell Anemia Control Society aims to complete the screening of whole tribal population by year 2015. Identifying the actual burden of such disease will further facilitate acquiring necessary inputs and garnishing support from other sectors to achieve the goals of program in time bound manner. Gujarat Sickle Cell Anemia Control Society further aims to widen the scope of screening to non-tribal districts of the state also.

Contact Information

Institution Name:   Commissionerate of Health, Medical Services and Medical Education
Institution Type:   Government Agency  
Contact Person:   Prem Kumar Taneja
Title:   Commissioner Health, Medical Services & Education  
Telephone/ Fax:   079-23253271 / 079-23256430
Institution's / Project's Website:  
Address:   Commissionerate of Health & Family Welfare Department, Block No.5/1, Dr. Jivaraj Mehta Bhawan, Sector 10
Postal Code:   380020
City:   Gandhinagar
State/Province:   Gujarat

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