Telangana Making Big Strides in Healthcare Delivery- eHealth Magazine February 2019

THE PREMIER MONTHLY MAGAZINE ON THE ENTERPRISE OF HEALTHCARE IN ASIA & THE MIDDLE EAST VOLUME 14 / ISSUE 02 / FEBRUARY 2019 / ` 200 / US $20 / ISSN 0973-8959

COVER STORY

Telangana

SPECIAL FEATURE

Municipal Corporation of Greater Mumbai Leveraging Technology to Boost Healthcare Delivery System

RAJENDRA NIMJE Director General, Centre for Good Governance

NITIN MADAN KULKARNI

Principal Secretary, Department of Health & Family Welfare, Government of Jharkhand

Making Big Strides in Healthcare Delivery SPECIAL INTERVIEWS

DR ANURADHA MEDOJU Senior Regional Director, Andhra Pradesh and Telangana, Ministry of Health & Family Welfare, Government of India

I A KUNDAN

Additional Municipal Commissioner Western Suburbs, Municipal Corporation of Greater Mumbai

JVN SUBRAMANYAM Mission Director, National Health Mission, Department of Health & Family Welfare, Government of Assam

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FEBRUARY 2019 | VOLUME 14 | ISSUE 02

COVER STORY

Telangana

Making Big Strides in Healthcare Delivery POLICYMAKER’S PERSPECTIVE

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INDUSTRY PERSPECTIVE 28 Hitech Diagnostic Offering Affordable Quality Services and Superior TAT for Three Decades

Dr Anuradha Medoju

Senior Regional Director for Health for Andhra Pradesh and Telangana, MoHFW, Government of India and Chief of International Health Airport Organisation under Government of India (AP&TS)

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I A Kundan

Additional Municipal Commissioner Western Suburbs, Municipal Corporation of Greater Mumbai

CANCER CARE PERSPECTIVE 32 Dr Manjiri M Bakre

CEO & Founder OncoStem Diagnostics Pvt Ltd

33 Dr Rama Vaghmare

MD Radiation Onocolgy (NIMS)

22 Rajendra Nimje

Director General, Centre for Good Governance (CGG)

38 Dr Nitin Madan Kulkarni

Principal Secretary, Department of Health & Family Welfare, Government of Jharkhand

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J V N Subramanyam, IAS !

Mission Director, NHM, Department of Health & Family Welfare, Government of Assam

SPECIAL FEATURE

MCGM Leveraging Technology to Boost Healthcare Delivery System

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Editorial Demystifying Healthcare Delivery Models of Telangana and Mumbai With technological innovations opening a big scope to reinvent traditional systems in nearly every sector, healthcare delivery is perhaps a key area among all. Some States that are steadily evolving their healthcare sector and becoming torch bearers for rest of the nation are – Telangana and Maharashtra.

India’s youngest state of Telangana evokes interest of any observer for the way it is steadily boosting its healthcare delivery model, making it accessible and affordable as well for people of all strata of life. Our cover story “Telangana – Making Giant Strides in Healthcare Delivery” thus justifiably explores how this State under the leadership of K. Chandrasekhar Rao is evolving as an exemplary place in terms of coming up with effective schemes worth embracing at the national level for all.

The State is driven by the vision of developing a ‘Healthy Telangana’ through an effective and ideal Healthcare Model.

With a mission to ensure -- ‘Good Health for All’ -- Telangana is fast emerging as a leader in the country by implementing various first-of-its-kind and effective healthcare initiatives.

In this light, we have organised the ‘Elets Healthcare Innovations Summit’ in Hyderabad, with the Ministry of Health & Family Welfare, Government of India as our host partner.

The conclave will be followed by ‘Urban Healthcare Summit’ in Mumbai being organised by Municipal Corporation of Greater Mumbai, to highlight and deliberate upon the finest practices being followed by it.

Through our Special Feature “Municipal Corporation of Greater Mumbai Leveraging Technology to Boost Healthcare Delivery System”, we have tried to explore and analyse how a city like Mumbai is providing healthcare to its huge populace along with a floating population, numbering in lakhs. The healthcare model evolved over the years by the MCGM inspired us to explore it in terms of its set up and sustainability model that caters all in the city.

We have also featured a range of interviews including that of policymakers Rajendra Nimje, Director General, Centre for Good Governance (CGG); Dr Nitin Madan Kulkarni, Principal Secretary, Department of Health & Family Welfare, Government of Jharkhand; Dr Anuradha Medoju, Senior Regional Director, Andhra Pradesh and Telangana, MoHFW, Government of India; I A Kundan, Additional Municipal Commissioner, Western Suburbs, Municipal Corporation of Greater Mumbai; and J V N Subramanyam, Mission Director, National Health Mission, Department of Health & Family Welfare, Government of Assam.

With cancer emerging as a big threat, the magazine also carries industry perspective of Dr Manjiri M Bakre, CEO & Founder, OncoStem Diagnostics Pvt Ltd and Dr Rama Vaghmare, MD, Radiation Onocolgy (NIMS) on the disease. Besides, a special write up on Hitech Diagnostic, which is ensuring quality and affordable pathology services for three decades.

With such a bouquet of articles, interviews and features, we hope this latest issue will evoke an invaluable feedback of our esteemed readers.

Dr Ravi Gupta Founder Publisher and CEO, Elets Technomedia Pvt Ltd & Editor-in-Chief eHEALTH Magazine ravi.gupta@elets.in

COVER STORY

Telangana

Making Big Strides in Healthcare Delivery

Telangana, the youngest State of India which came into existence barely in 2014, is drawing much attention due to its various futuristic schemes that are winning accolades from far and wide. Little is known about how this State is building a consolidated healthcare ecosystem for all, writes Sudheer Goutham of Elets News Network (ENN).

K Chandrasekhar Rao Telangana Chief Minister

T

he State is driven by the vision of developing a ‘Healthy Telangana’ through an effective and ideal Healthcare Model.

With a mission to ensure -- ‘Good Health for All’ -- Telangana is fast emerging as a leader in the country by implementing various first-of-its-kind and effective healthcare initiatives.

While announcing a health programme in the State, Chief Minister K Chandrashekar Rao recently said, “Health profile of entire Telangana state through health check-up of every citizen of the State, starting from the Governor to the last man will be created.”

“Irrespective of the income, caste, creed or religion, every citizen of the

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State can avail the annual holistic health check-up,” he added.

Telangana State has rolled out some of the finest healthcare programmes that are being appreciated and adapted by the governments across the country, while some of them are even being included in the National Health Mission Programmes.

While underlining the Telangana Government’s work and plans in the area of healthcare, Dr S K Joshi, Chief Secretary of the State, asserted, “It’s the aim of the Telangana Government to take improved healthcare delivery to every household in an affordable manner. In this wake, Telangana Government has taken a slew of measures to boost healthcare delivery system.”

“Our Aarogyasri, Kanti Velugu and ‘KCR Kit’ are the examples of our commitment. In this regard many more initiatives are in the offing,” Dr

Dr S K Joshi Chief Secretary of Telangana

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Joshi added.

After the formation of the Telangana State on June 2, 2014, the new government invented, revamped and introduced innovative healthcare programmes.

Simultaneously, standalone health schemes have been also launched in the form of T-Diagnostics, T-Dialysis, KCR Kits and direct cash benefit scheme for pregnant women, Basthi Dawakhanas.

The Government has allocated huge funds for the infrastructure, drawing patients to state-run health institutions.

KCR KITS AND AMMA ODI To improve the health of newborn child and mother, the Telangana Government launched two welfare programmes -KCR Kits and Amma Odi with financial assistance. The flagship scheme was launched on June 2, 2017 by the Chief Minister and simultaneously by his team across the State. The government earmarked Rs 605 crores in 2017 Budget.

While launching the KCR Kit programme, the then Telangana State Health Minister Dr C Laxma Reddy said, “A healthy State can be achieved starting from the better healthcare and medical facilities of the newborns and KCR Kits is part of the plan.”

The programme provides financial and medical assistance to women

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the service is based in Hyderabad and functions daily between 8 AM to 8 PM for entire year. By 2018-end another 200 vehicles were to be added to the existing strength of 241.

Telangana Chief Minister distributing KCR kits

undergoing delivery of the child at any government hospital in the State. The programme aims to reduce the Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR). The Aadharbased Mother and Child Tracking System (MCTS) software is used by healthcare workers to track women at every stage of pregnancy.

KCR KIT Following the delivery, the mother is provided with a KCR Kit. It consists of 16 items including clothes, quality baby soaps, baby oil, baby powder, mosquito nets, toys, napkins, and diapers. These are necessary to keep newborn babies (neonates) warm and hygienic and sufficient for three months.

AMMA ODI Amma Odi provides transport facility for pregnant women before and after delivery across the State. The scheme was launched by Chief Minister K Chandrashekhar Rao in January 2018, after the success of KCR Kit. To avails this, all one requires is dial “102”.

Under the scheme, any pregnant woman can use Free 102 Service Van to visit the hospital and be dropped off at no cost. It can be used any number of times as necessary. After the delivery, the mother along with the newborn are dropped at their home after being discharged from the hospital.

Presently, there are 241 multi-utility vehicles, GPS-tracked, with capacity for 10 patients. Each district is allotted 6-8 vehicles. The call center to avail

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FINANCIAL ASSISTANCE In this, the mother will be provided with financial assistance of Rs 12,000 (Rs 13,000 for a girl child) to compensate for the loss of work during the pregnancy and postnatal period. This amount will be provided in installment with the last two installments paid after child vaccination. The money is sent as direct cash transfer to individual Aaadhaarlined accounts of pregnant women in the State.

ELIGIBILITY The scheme is available for women who give birth at Government hospitals, for a maximum of two deliveries.

So far, the KCR Kits and Direct Cash Benefit scheme have achieved a unique landmark of touching lives of over 10 lakh pregnant women in the State.

The scheme has continued to attract expecting mothers to its fold, with cumulative registrations since its launch in June, 2017 reaching a record 11,42,582 women out of which 10,00,343 are pregnant women, while the remaining 1,42,221 have already delivered.

The Direct Cash Benefit, which is part of the KCR Kits scheme, too has benefitted close to one lakh women in the State. In fact, this year between January and October, the authorities have released a whopping Rs 243.12 crore to the beneficiaries at four different stages of pregnancy to women.

Public health experts and senior paediatricians pointed out that since its inception, the KCR Kits and Direct Cash Transfer scheme have become the centre piece initiatives solely aimed at saving mothers and infants, in addition to drawing them back to State-run healthcare institutions for deliveries.

INCREASE IN INSTITUTIONAL DELIVERIES Conservative estimates from persons familiar with KCR Kits scheme in Telangana acknowledge that institutional deliveries in districts now have increased by at least 40 percent, while in urban centres, it hovers between 20 percent and 35 percent.

Needless to say, the drastic jump in admissions has stretched State-run healthcare institutions.

Dr Naga Mani, Superintendent, Petlaburj Maternity Hospital, in a news article stated, “We are seeing a huge jump in admissions of pregnant women in districts. In fact, there are instances wherein private maternity clinics in districts were shut down simply because of the rise in demand for government hospitals.”

“We are trying our best to provide quality service,” Dr Mani added.

Authorities said that the longterm impact of KCR Kits scheme will be quite significant in reducing the Infant and Maternal Mortality Rates (IMR and MMR).

Since its launch, the scheme has seen a total expenditure of close to Rs 350 crore and the amount spent to procure the mother and baby kits, that are the integral part, was close to Rs. 50 crore.

KANTI VELUGU Another flagship healthcare programme launched by the Telangana State Government that stood out is Kanti Velgu – which is about free eye screening for all citizens.

Under ‘Kanti Velugu’, the entire population of 3.7 crore are provided free eye care. The authorities are not only conducting eye screening but also providing free medicines, spectacles and arranging for free surgeries, if required.

The government expects that four lakh surgeries will be performed across the state. Under what is claimed to be the first such programme taken up anywhere in the world, the government plans to distribute 40 lakh spectacles.

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COVER STORY

Telangana Health Minister C Laxma Reddy (second from right) during inauguration of Telangana Diagnostics Central Hub

ENT SCREENING ON THE LINES OF KANTI VELUGU The Government is also geared up to roll out free ENT screenings on the line of Kanti Velugu, “The government will constitute ENT and dental teams across the State to screen people for problems related to ear, nose, throat and dental on the lines of Kanti Velugu eye screening camps. Both the schemes will be implemented one after another soon.

We will prepare health profile of every Citizens of the State including his/her blood group,” said the Telangana Chief Minister.

PREVENTIVE MEASURES OR EARLY DETECTION All the citizens of Telangana will be given unique Identification cards where they can also have their routine annual check-ups.

The routine health check-up includes screening for cardiac, kidney and neuro issues. It is being planned in all districts of the State. This scheme is aimed at prevention or early detection of such chronic diseases or health complications for the underprivileged.

While the citizens of rural areas and urban slums would benefit from

Telangana CM attending eye checkup programme

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the schemes, any citizens can avail the benefit of the scheme.

While the data obtained from the massive holistic health screening will be used to come up with more effective healthcare model in the State.

AROGYASRI HEALTH INSURANCE -THE WAY AHEAD While the widely celebrated Central Government Universal Health Insurance Scheme - Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY), was being adapted by majority of the state government, The Telangana Government chose not to adapt it.

Citing the reason for not adopting the Ayshman Bharat Scheme in the state, K. Chandrashekar Rao, Telangana Chief Minister, said, “ Our State Arogyasri Health Insurance is much superior than Ayushman Bharat.”

With continuous improvements and ease of execution along with supplementary health schemes puts Aarogyasri way ahead REVAMPED AAROGYASRI Today’s Aarogyasri in Telangana is highly evolved and developed than the earlier scheme during the united AP. New MoUs with better terms were signed with individual corporate hospitals in Hyderabad.

The insurance scheme that initially covered only 7-8 lakh families now covers 80 lakh. Alongside, the state-run health institutions too started recording a jump in outpatient and inpatient

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inflows, unlike earlier.

Presently, Aarogyasri Healthcare Trust is implementing three schemes.

The first scheme is Aarogyasri Special Treatment Scheme which aims to offer special treatment to the below poverty level families.

Under this scheme, both private and public hospitals are empanelled under Aarogyasri Healthcare Trust.

This scheme can be availed by poor patients having white ration card supplied by the Civil Supplies Department as a proof. Whenever a patient, carrying a white ration card, visits a hospital, private or government, the Aarogyamithras as a functionary will register that patient’s details.

Post-examination in the hospital, the patient will be provided inpatient or outpatient treatment according to their needs.

The hospital will raise preauthorisation on the patients note and will be sent to the trust. Once the pre-authorisation is approved, the hospital will perform the treatment on the patients.

Post-treatment, they will raise a claim through an online model. After submitting the claim details, the trust will conduct the investigation and approval procedure. Once approved, the payment will be transferred online.

Approximately 2 crore people are the beneficiary under this programme.

The Telangana government also introduced exclusive schemes like Employee Health Insurance Scheme for State government employees, Journalists Health Scheme, health cover for employees of Singareni

Women undergoing health checkup under Basti Dawakhana Scheme

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and support for Central government employees through CGHS, ESI and CM Relief Fund.

HEALTHCARE AT CITIZENS’ DOORSTEP -- BASTI DAWAKHANA Bringing the healthcare facilities at the doorstep, Telangana government has set up Basti Dawakhana (Neighborhood Clinic) in the city.

The Greater Hyderabad Municipal Corporation has set up diagnostic centres in 28 Basti Dawakhanas. The corporation has established 17 Basthi Dawakhanas of which three have diagnostic centres.

The diagnostic centres will conduct 108 tests including 53 in association with the Institute of Preventive Medicine (IPM).

As part of the initiative, a central hub has been set up at the IPM and eight mini hubs have been set up in different parts of the city with equipment to take X-rays, ECG, ultrasound and CT scans.

The State government, already launched 40 dialysis centres across the State, and had come up with the Telangana Diagnostics Central Hub to provide better medical facilities to the needy.

A total of 500 Basti Dawakhana will be established as per the plan of the state government.

INCREASED TRUST ON THE GOVERNMENT HEALTHCARE SYSTEM While launching the above facilities in the Hyderabad, the then Telangana Municipal Administration and Urban Development Minister KT Rama Rao observed, “There is an increased trust on the government system and Government hospitals due to various pro-active initiatives taken up by the state government.”

“Normal deliveries have increased against cesarean deliveries. Even the high-end and complicated surgeries including Kidney, Liver transplantations that used to take place majorly in the private or corporate hospitals are being

Girl Students receving sanitary kits from Government

done Government Hospitals,” he added.

GIRLS’ HEALTH AND HYGIENE In a first of its kind in the country, the Telangana government launched a programme for health and hygiene of girls. It started distributing Balika Aarogya Raksha (Health and Hygiene) kits to about 6 lakh girl students studying in governmentrun educational institutions across Telangana.

The kit will contain 13 products including Patanjali bathing soap, detergent soap, toothbrush, Dabur coconut hair oil, shampoo, toothpaste, Eyetex facial powder, sanitary napkins, tongue cleaner, comb, sticker ‘bindi’s, nylon ribbons and hairbands.

The kits will be distributed to girls aged between 12 and 18 studying in government, general residential educational institutions, Kasturba Gandhi Balika Vidyalayas, Model Schools and aided schools. Besides, handwash will be provided to both girls and boys studying in government educational institutions.

TELANGANA PROFILE Capital City : Hyderabad Area :112,077 Sq. Kms. Districts : 33 Households : 83.04 Lakhs Population : 350.04 Lakhs

Conclusively saying, the manner in which the KCR Government appears to be also using all possible dimensions to reach out and build an affordable and accessible healthcare model, it only showcases the State Government’s commitment to cater its over 3.64 crore citizens for years to come.

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MCGM Leveraging Technology to Boost Healthcare Delivery System Having over 12 million people as residents besides a floating population of about 6 million people, India’s biggest metropolitan city Mumbai has quite a lot on its platter to cope up, especially in terms of healthcare. The onus to manage it lies on the Municipal Corporation of Greater Mumbai (MCGM), Sandeep Datta and Harshal Yashwant Desai of Elets News Network (ENN) explore the Herculean endeavour.

MUMBAI AT A GLANCE Described commonly as India’s financial capital, Mumbai has a large commercial and trading base. It hosts corporate offices of industries, multinational companies and headquarters of key financial institutions.

The city is divided into 24 administrative divisions (wards) with a population of 8-10 lakh each.

The Mumbai island city plus the Mumbai suburban district comprise what is now called as Greater Mumbai.

It is under the administration of the Municipal Corporation of Greater Mumbai (MCGM).

MCGM AND THE HEALTH DEPARTMENT Among the notable departments of

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Municipal Corporation of Greater Mumbai is the Health Department.

It not only provides basic healthcare facilities but also manages other aspects related to preventive and social or community medicine.

The city follows the three-tier system of healthcare. At the primarylevel of healthcare, it provides maternity and child care, family planning, control of communicable diseases, immunisation and services for non-communicable diseases through a network of 208 primary health posts, 175 dispensaries and 28 maternity homes in addition to outreach health services.

At the secondary-level, specialised health services are provided through 17 peripheral hospitals and five specialty hospitals. Tertiary care is provided

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through four medical colleges. The total annual outpatient department load in peripheral hospitals is 57 lakhs.

THE GAMUT OF CHALLENGES Some prominent challenges in healthcare service delivery at all levels include rising population, migration, undernutrition, poor housing, overcrowding and increasing risk factors of non-communicable diseases (NCDs) like obesity, eating habits, smoking and drinking and physical inactivity.

In the light of challenges and increasing demand, there are gaps in healthcare delivery. Hence, the MCGM in recent years embraced new innovations to provide healthcare, for example, in providing extra beds.

MCGM has been consistently

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MCGM HEALTH BUDGET Municipal Commissioner of Municipal Corporation of Greater Mumbai Ajoy Mehta recently presented the budget for 2019-20, while giving due attention to improve healthcare delivery within its hospitals and institutions.

MCGM has allocated Rs 4,151.14 cr for new hospitals and upgradation of equipment. The budget for health department has been increased by over 13 percent. Besides provision for major hospitals, the corporation will spend on basic infrastructure and equipment. There is a separate provision for building construction of proposed Hinduhriday Samrat Balasaheb Thackeray Medical College and repairing Nair hospital.

According to Mehta, budget primarily focuses on the health of Mumbaikars. The health budget has been increased by Rs 400 crores as compared to last year to Rs 4,151 crores for the health sector in the city. The corporation is very much focussed on improving its peripheral hospitals with newer upgradation to convert them into super specialty hospitals so that the pressure on major civic run hospitals is reduced.

making efforts to strengthen and revamp the three-tier system and public health infrastructure including preventive healthcare system.

MCGM’S LANDSCAPE OF INITIATIVES PPP POLICY FOR STRENGTHENING PATIENT SERVICES Public-private partnerships (PPPs)

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can be viewed as an effective way to expand access to higher-quality health services by leveraging capital, managerial capacity, and know-how from the private sector.

There is a constant need to bring together the private health sectors such as medical colleges, hospitals, industrial/corporate hospitals, nursing homes, NGOs and practicing doctors/ specialists for the success of public health programmes.

MCGM has a PPP policy revised in 2018 under which these premises are being utilised for provision of services such as maternal and child services and also other specialty services to the citizens.

STRENGTHENING OF PRIMARY AND SECONDARY HEALTHCARE SERVICES STRENGTHENING DIAGNOSTIC SERVICES THROUGH “AAPLI CHIKITSA” In major hospitals, 50% of the patient load is due to diagnostics (e.g. KEM hospital sees 3,000; 50% of total patients) referrals for diagnostics on everyday basis.

Therefore, Aapli chikitsa, an innovative solution to provide “free pathological diagnostic services” to patients at the peripheral level is being introduced.

Under the initiative, the laboratory services will be outsourced in 16 municipal peripheral hospitals, five Specialty Hospitals, 28 Maternity Homes and 175 Dispensaries on public private partnership basis.

PROVIDING FREE CANCER SERVICES THROUGH PPP India reports over 1.5 million new cancer cases annually, that’s about 100 cases per 1,00,000 people as compared to 300 in the US. According to data collated by the Indian Cancer Society, the Mumbai Cancer Registry recorded 13,564 cases in 2014 compared with the 12,090 in 2010.

Screening of cancer becomes an utmost prevalent public health action, for the purpose MCGM partnered with Cancer Patients Aid Association (CPAA) in 1998 to undertake early screening of breast cancer through mammography.

MCGM under the PPP policy allotted Naigaon Maternity hospital to the Cancer Patients Aid Association (CPAA), who runs the centre with the help of corporation and donor funds.

This was a true model of public private NGO partnership.

PROVIDING COMPREHENSIVE THALASSEMIA CARE, PAEDIATRIC HEMATOLOGY, ONCOLOGY AND BONE MARROW TRANSPLANT SERVICES FREE TO PATIENTS Considering the need of an intervention in this area, MCGM established the “Comprehensive Thalassemia Care, Paediatric Hematology-Oncology & BMT Centre” in 2017 with expertise from LTM Sion Hospital as a satellite centre.

The centre is well-equipped with all major facilities such as indoor facility, ICU, day-care chemotherapy unit, bone marrow transplantation unit, day care transfusion unit, prenatal diagnosis and operation theatre for bone marrow transplantation procedures.

Laboratory services are also available with all basic investigations; ultrasonography, electrocardiogram and 2D echocardiography machines, audiometry, apheresis machine, an ophthalmology unit with slit lamp and fundoscopy and the blood irradiator.

The centre also provides diagnostic procedures such as bone marrow aspiration, biopsy, lymph node and other tissue biopsy.

STRENGTHENING CT SCAN AND MRI DIAGNOSTICS SERVICES IN PERIPHERAL HOSPITALS The contracting mechanism was adopted and the services were started on PPP model wherein the PP partner

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brings in the equipment, staff and maintains the services throughout in the MCGM premises.

MCGM patients receive services at MCGM rates whereas the PP partner can also take private patients on paid basis.

BOOSTING INTENSIVE CARE SERVICES IN PERIPHERAL HOSPITALS The shortage of ICU beds combined with an insufficient number of trained professionals pose challenges to the delivery of effective critical care services across the city.

MCGM is set to share 180 intensive Care Unit (ICU) beds under publicprivate partnership (PPP) to cater to ICU patients because there is dearth of intensivists in peripheral hospital.

A contracting mechanism was adopted on the basis of per bed per day rates (Rs. 2,200 per bed/day) and intensivists were appointed to provide round the clock services in ICU. At any given time, one post graduate intensivist and other with M.B.B.S. qualification and five years ICU experience.

STRENGTHENING DIALYSIS SERVICES AT PERIPHERAL LEVEL MCGM evolved a model wherein nongovernmental organisation (NGO) backed by charitable dialysis units,

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either in an established hospital or as free standing units, were set up.

Mumbai has 112 dialysis centres, of which 12 are housed in MCGM and rest of them are in private sector.

As per the model, the NGO enters into a public-private partnership with the MCGM which provides space for the unit in MCGM hospital or the permission is obtained under Reservation Accommodation policy and the NGO runs the charitable dialysis unit by installing all equipment.

INCREASING THE BED CAPACITY THROUGH CHARITABLE TRUST HOSPITALS A total of 1,762 beds are being made available for weaker and needy patients in 77 hospitals.

As part of the process, the economic status of patient is verified

by MSW of hospital and is referred to the charitable hospital; thus, reducing the out-of-pocket expenditure of patients.

Bed, RMO services, nursing care, food, linen, water, electricity, routine diagnostics and housekeeping services are non-billable and to be provided free to weaker and indigent patients by charitable hospitals.

STRENGTHENING OF MATERNAL

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CARE IN MATERNITY HOMES THROUGH SPECIALISTS MCGM evolved a model where casebased approach has been adopted. A panel of anesthetics, sinologist, and paediatrician has been created.

Case-based payment has been fixed for managing each patient which makes it easy to make these specialists available at every centre.

• 28 anesthetics, 28 sonologists, 7 pediatricians, and 4 gynecologists have been appointed on the panel for specialized services • Out of 28 maternity homes, five maternity homes are identified zone-wise as sentinel centers as first referral unit with services of sentinel neonate care unit A MODEL OF PRIVATE SECTOR ENGAGEMENT IN TUBERCULOSIS Tuberculosis (TB) is one of the top ten most common causes of death worldwide.

In 2013, a comprehensive strategic plan “Mumbai Mission for TB Control” was formulated by MCGM in response to the growing concern over the spread of TB and increasing incidence of drug-resistant TB in the city. As a part of this mission, private sector involvement was an important strategy in order to improve quality of diagnosis, treatment and patient care at all levels of private sector.

The project was implemented in 2015 through a donor agency and was later transitioned to private provider support agency (PPSA) in the year 2018 to be fully implemented by MCGM (Mumbai District TB control society).

PROVISION OF GENERIC MEDICINES THROUGH PRADHAN MANTRI BHARTIYA JANAUSHADHI KENDRA Following the need assessment, it was decided that MCGM shall be making arrangements to build up an area for setting up of Pradhan Mantri Bhartiya Janaushadhi Kendra (PMBJK) under PPP Model.

The said premises shall be handed

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over to the service provider for a period of five years on care taker basis.

In the initial phase, three hospitals were shortlisted to begin the services and later on the services are to be expanded to other peripheral hospitals as well.

STANDARDISATION OF HEALTHCARE INFRASTRUCTURE With the growing disparity and no standard protocol available for standardisation of infrastructure for peripheral hospitals, it has been proposed to give uniform aesthetic look to all the peripheral hospitals which will include both exteriors and interiors of hospitals.

As part of the standardisation process, the internal arrangement in the wards, OPDs and casualty should be as per the Airborne Infection Control (AIC) norms.

PRIMARY PREVENTION FOR COMMUNICABLE AND NONCOMMUNICABLE DISEASES SOCIAL CAMPAIGN FOR DENGUE CONTROL USING MASS AWARENESS IN MUMBAI The existing strategies adopted by MCGM for dengue control involve work place interventions, contact tracing, and various interventions in non-slum areas and involvement of housing societies along with massive awareness campaigns.

• Representatives from PLAN International (India chapter) and health officials conducted a series of meetings to undertake a pilot project in five of high risk wards of MCGM • Based on the available data at epidemiology cell, five high risk wards were identified for this pilot project • A total of 100 volunteers (20 for each ward) were trained by PLAN’s insecticide department regarding common domestic, peri-domestic breeding sites, how to identify the larvae, adult mosquito etc. for the

door to door awareness activities PROVISION OF COUNSELLING SERVICES TO BEAT DIABETES (NCD CONTROL) Non-communicable diseases (NCDs) are a growing concern worldwide and as per Indian Council of Medical Research, prevalence of diabetes in Mumbai is 10% and that of prediabetes is 15%.

• The pilot project was initially started in 28 dispensaries and as a next step these services are now being expanded to 72 dispensaries from 1st December 2018 for a period of six months • A joint initiative of MCGM & Indian Dietetic Association (IDA) which was initially implemented in four select ward dispensaries to test the efficiency & efficacy of this model • As part of the intervention, patients who need counseling are referred to dietitians appointed by IDA. Patient is then provided lifestyle solutions on individual basis and is followed up on weekly basis STOP DIABETES BLINDNESS -- A STRATEGY TO PREVENT DIABETES MELLITUS RELATED BLINDNESS Diabetes is a lifelong disease and has immense long term effects where it affects other organs like the eyes, kidney, and nerves along with other essential body organs. The retina of diabetic patients gets affected over course of disease which may lead to blindness.

PROCESS OF IMPLEMENTATION • A joint initiative of MCGM & Aditya Jyot Foundation for Twinkling Little Eyes (AJFTLE) • Initially, the intervention was implemented at 47 MCGM dispensaries in select dispensaries Since the beginning of the programme in August 2018, 629 diabetic patients were screened for ophthalmic

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examination in 14 dispensaries, of which 56 showed cataract (8.9%), 50 showed retinopathy changes (7.9%) and other ailments were seen in 34 patients (5.4%).

STRENGTHENING AIRBORNE INFECTION CONTROL PRACTICES IN HEALTHCARE INSTITUTIONS An AIC Unit (AICU) model was established by Municipal District TB control Society in collaboration with U.S Centers for Disease Control and Prevention (CDC) and SHARE India in 2016, which is one of the unique initiatives in India.

It provides technical and operational guidance on environmental controls to reduce the risk of transmission of airborne pathogens for example Tuberculosis.

STRENGTHENING OF TERTIARY HEALTHCARE SERVICES PROVIDING TELEMEDICINE SERVICES AT PERIPHERAL HOSPITALS Telemedicine essentially combines state-of-the-art electronics, ICT and associated applications in the field of healthcare delivery and also helps in providing education to patients and healthcare professionals.

MCGM recognised that the use of telemedicine can greatly aid in dealing with the shortage of healthcare staff and improving the penetration of healthcare infrastructure and resources in underserved healthcare facilities.

MGGM is in the process of setting up telemedicine facility wherein 16 peripheral hospitals (patient node) will be connected with four major hospitals (specialist node) through outsourcing mechanism.

The services will also include real time screening with portable integrated medical devices, examination camera and store and forward image automation software, digital stethoscope to improve utilisation of healthcare services.

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ACCORDING TO THE WORLD BANK, INDIA HAS AROUND 10 HOSPITAL BEDS PER 10,000 PEOPLE WHILE THE GLOBAL AVERAGE IS 30 BEDS PER 10,000 PEOPLE. ADDITIONALLY, WHILE THERE IS EXPECTED TO BE ONE ICU BED PER 10 HOSPITAL BEDS, MUMBAI NUMBERS DO NOT STACK UP TO BEING EVEN CLOSE TO THE NORM.

INNOVATIONS IN FACILITY MANAGEMENT Health Management Information Systems (HMIS), one of the six building blocks essential for health

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system strengthening, is a data collection system specifically designed to support planning, management, and decision-making in health facilities and organisations.

MCGM does not have a single online platform to store electronic version of patient files.

HMIS will help store patient’s information in digitised form at one place making patient records particularly patient history easily and readily available at all levels.

PROCESS OF IMPLEMENTATION The HMIS is in process and will be rolled out in a phase-wise manner.

Some of the major features of HMIS in process include patient management, data generation and a special feature to convert speech to text for data entry into OPD sheets.

The connectivity providers will be MTNL & TATA and the scope covers four major hospitals, five specialty hospitals, 18 peripheral hospitals, 28 maternity homes, 161 dispensaries, 183 health posts.

The scope covers 34 modules under; patient registration / admission, OPD, IPD, emergency, administrative, allied services, diagnostic & investigation.

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‘Skill Centres for Health Awareness on Anvil in Telangana, Andhra’

To raise public health awareness, we have plans to launch several skill centres across Hyderabad. Two centres for Telangana and three for Andhra Pradesh have been sanctioned. To implement the best learnt practices, demo critical health management programme is also being run, says Dr Anuradha Medoju, Senior Regional Director, Andhra Pradesh and Telangana, MoHFW, Government of India, and Chief of International Health Airport Organisation under Government of India (AP&TS), in conversation with Sudheer Goutham of Elets News Network (ENN).

Q

What new tech-driven initiatives and innovations have been implemented by the Ministry of Health and Family Welfare (MoHFW)?

In Telangana, the MoHFW is soon going to launch a navigation-based health initiative. Like petrol pumps, now all health establishments in Telangana will be visible on the Google Maps. With this application, patients and their relatives would be able to locate the nearby hospital easily.

In addition, we have sub-centred two medical colleges. We have provided them the required financial aid. Besides, we will monitor the progress and implementation of the programmes, identify the lapses and find their relevant solutions.

The ministry is also going to introduce several new projects and district health centres.

In our country, we can overcome the existing lack of knowledge about healthcare by ensuring quality education in medical colleges. We have plans to launch several skill centres across Hyderabad. As of now, we have sanctioned two centres

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for Telangana and three centres for Andhra Pradesh.

In a bid to implement the best learnt practices, we are also running demo critical health management programme.

In future, many medical colleges are in the wish list. Through various innovations and initiatives, we are trying to spread the message across and inspire more and more people and States to replicate these ideas.

We are also spreading the word through media.

Q

How would you describe the recent accomplishments on the healthcare landscape?

Of the all best practices, “Aasara Pension”, a pension scheme of the Government of Telangana, has been the most appreciated one. It is a welfare scheme which offers pension to the elderly people, widows, Goud community, elephantiasis patients, AIDS afflicted people, physically disabled, and Beedi workers.

Till March 2018, the scheme had benefitted about 42 lakh people.

After the initiation by the District Collector with the report

Dr Anuradha Medoju

Senior Regional Director for Health for Andhra Pradesh and Telangana, MoHFW, Government of India and Chief of International Health Airport Organisation under Government of India (AP&TS)

of Regional Offices of Health and Family Welfare (RoH & FW), Hyderabad a thorough survey has taken a proper shape. In Khammam division, in a population of 7,70,196, a total of 3,243 cases have been noticed.

In Kalluru Division, in a population of 2,48,129, a total of 73 cases have been detected, in 6 PHCs, Microfilaria Survey has also

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Khammam District – A Case study

Q

What is the state of maternal healthcare across Telangana?

To improve the level of maternal health, we are undertaking a lot of measures across the State.

Recently, around 18 maternal deaths were reported within a week.

Suggestions have been given

THE MINISTRY IS TAKING A LOT OF MEASURES ACROSS THE STATE TO IMPROVE THE LEVEL OF MATERNAL HEALTH.

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Telangana has 31 districts in comparison to the 10 erstwhile districts. Khammam District is one of them, having a population of 14,01,639. Of this, the urban population is 10,84,81. The district is spread over a geographical area of 4,361 square kilometres.

In the district, particularly urban areas are affected by Lymphatic Filariasis. Khammam is located on the border of Nalgonda district which has more number of Lymphatic Filariasis cases. The major constraint of the National Filaria Control Programme (NFCP) unit at Khammam is that it could not cover the vast majority of the population at risk, residing in rural areas. The strategy demanded detection of parasite carriers by night blood survey, which is less sensitive, expensive, time consuming and poorly accepted by community.

There are a total of 3,335 Filaria cases in Khammam. Out of the 22 Primary Health Centres (PHCs), 21 are affected in 392 villages. The community-wise affected cases can be classified as Scheduled Castes (SCs) 771, Scheduled Tribes (STs) 241, Backward Castes (BCs) 1,426 and Other Backward Castes 448.

It shows that more BCs are affected. Of the 21 affected PHCs, 18 are urban and 3 are rural. Proper survey, initiation and representation have not taken place earlier that’s why the incidence had not come to light.

been conducted at eight places in which out of 4,020 micro slides, 49 asymptomatic cases have been identified randomly by the local staff.

To keep a check on Lymphatic Filariasis, we have launched an incentive programme for ASHA (Accredited Social Health Activist) workers. If the ASHA worker identifies any case of Lymposis, she is to get Rs 200. Not just in the high endemic areas of Lyme disease (caused by the bacteria Borrelia burgdorferi sensu lato) but in the low endemic areas also.

There is a need to use latest technologies in the health sector for reaching out to the underserved.

Every State across the country should also adapt the best practices learnt from each other.

pertaining to the overcrowded specialty centres which ultimately give rise to infections causing deaths. There is a need to follow a proper referral system. It is a general tendency that patients visit the specialty centres without visiting the available secondary level institution.

We have now refurbished our all secondary level centres. All the 24 health centres have been converted into community health centres.

Also, a message has been circulated all around that speciality centres should be used only for critical deliveries.

Q

Tell us about Airport Health Organisation in Andhra Pradesh and Telangana.

The health measures undertaken across all the airports in Andhra Pradesh and Telangana under supervised by me. At Airport Health Organisation, we take care of all concerns pertaining to international health such as regular check-ups and screenings against outbreak of Ebola Virus, Swine-Flu, Chika, Yellow fever etc.

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MCGM Taking Giant Leap to Enhance Patient Care We have of around 1.12 crore OPDs and 72 lakh Hospital Inpatient Department (IPD) load on MCGM-run hospitals…We aim to decongest the crowd, reducing patient load from major hospitals, says I A Kundan, Additional Municipal Commissioner, Western Suburbs, Municipal Corporation of Greater Mumbai, in conversation with Harshal Yashwant Desai of Elets News Network (ENN).

Q

The Municipal Corporation of Greater Mumbai (MCGM) has a huge responsibility to cater to people with comprehensive healthcare facility. How do you look at MGGM’s health department significance?

The Mumbai Municipal Corporation runs four major medical colleges and hospitals, five speciality hospitals, 16 peripheral hospitals, 28 maternity homes, 175 dispensaries, and 208 health posts. We have more than 17,000 employees working in our health department.

Out of 40,000 hospitals beds in Mumbai, MCGM hospitals provide about 12,000. MCGM’s share is 30 percent of the total bed strength of the city with a population of over 12 million. We aim to decongest the crowd or reduce patient load from major hospitals. The corporation has taken a slew of measures to improve healthcare deliverables across peripheral and primary hospitals.

So, the Health Department of the MCGM not only provides basic health care facilities to citizens but also focuses on other aspects related to preventive care.

Q

What interventions have been made by the MCGM of late to improve healthcare infrastructure in the city?

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I A Kundan, Additional Municipal Commissioner

Western Suburbs, Municipal Corporation of Greater Mumbai

The total Hospital Outpatient care (OPD) load on major MCGM-run hospitals on annual basis is 57 lakh.

OPD load on peripheral hospitals is 60 lakhs. We have a total of around 1.12 crore OPD and 72 lakh Hospital Inpatient care (IPD) load on MCGM run hospitals.

Taking into account patients’ loads on major hospitals and burden of communicable and non-communicable diseases, MCGM has huge responsibility and accountability to cater people with quality patient care.

Our primary focus is not just to reduce the load from the hospitals but

to strengthen the healthcare delivery system in the manner where primary, secondary and tertiary health centres will be robust enough to provide accessible, quality healthcare facility to residents of the city in their vicinity.

Q

What initiatives have been undertaken with regard to biomedical equipment management?

Medical equipment are critical to save a person’s life or perform any procedure. And, the use of medical devices is an increasingly important element of a healthcare professional’s role.

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Q

Please brief us on how operations at primary hospitals have been streamlined.

We have started various diagnostics centres, and also set up diagnostics in dispensaries. It is game-changing initiatives as poor people will now get the facility of around 101 basic investigations and 38 advanced investigation free of cost at these dispensaries. People above the Below Poverty Line (BPL) line can avail the facility at minimum cost.

This will lead to not just reduction in out-of-pocket expenditure, better care, but also decongest secondary and tertiary hospitals by at least 35-40 percent.

We went ahead with development of hospitals with three-pronged strategy where we emphasized on services, infrastructure and Human Resource (HR) aspect. We at MCGM have looked into very holistic manner of strengthening of healthcare delivery mechanism. Not even a single peripheral hospital remained untouched from infrastructural development i.e., renovation and restoration. Major hospitals have undergone lots of infrastructural strengthening and we have developed a concept of hub system whereby most of the peripheral hospitals were linked to certain major hospitals to avoid unnecessary congestion.

Also, we developed the superspecialisation in peripheral hospital in such a way that people living in near vicinity will have access of all kinds of specialisation and superspecialisation facility and they don’t

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need to travel far off places.

In terms of HR, we have made lots of efforts to fill in vacant posts i.e., post of nurses were filled up which improved patient to nurse ratio to ideal level.

Q

You have also undertaken innovations in Facility Management. Please elaborate.

We believe it is of utmost priorities to maintain clean environment in all areas of the hospital, and to ensure this we need enough manpower – which at times becomes difficult due to growing patient load. In order to address this concern, an innovative contracting mechanism was established wherein instead of outsourcing manpower, actual per square feet area was given for housekeeping services. By doing so, the intervention focused on the ultimate goal of cleanliness instead of getting into the complex mechanism of hiring people for housekeeping.

THE PRIMARY FOCUS IS NOT JUST TO REDUCE THE LOAD FROM THE HOSPITALS BUT TO STRENGTHEN THE HEALTHCARE DELIVERY SYSTEM IN A MANNER WHERE PRIMARY, SECONDARY AND TERTIARY HEALTH CENTRES WILL BE ROBUST ENOUGH TO PROVIDE ACCESSIBLE, QUALITY HEALTHCARE FACILITY TO RESIDENTS.

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An agency was allotted to map and maintain the biomedical equipment available at all MCGM hospitals including medical colleges, peripheral hospitals and maternity homes. The service agency is responsible to analyze and report medical equipment inventory and map the entire equipment inventory in all health facilities.

Q

How is MCGM ensuring digitisation of patients’ records?

Soon, we will have, Health Management Information Systems (HMIS), an innovative application which will help store patients’ information in digitised form at one place making patient records, particularly, the patient history, easily and readily available at all levels. Some of the major features of HMIS in process include patient management, data generation and a special feature to convert speech to text for data entry into OPD sheets.

Q

MCGM has done remarkable work by implementing Public Private Partnership model.

Isn’t it?

Yes. We have collaborated a lot with private players to improve healthcare delivery. For an example, in peripheral hospitals, 171 ICU beds were not functioning optimally.

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With private participation, we outsourced those beds at a certain fix nominal rate which not only improved condition of these beds but referrals to other major hospitals also came down.

To make maternity hospitals fully functional, we made empanelment of private practitioners, anaesthetists, paediatricians, and also created 33 additional posts of post-graduate medical officers which included 20 obstetricians and gynaecologists. We have also empanelled neonatologists so as to ensure better services in maternity homes. With this, urban poor will have very close access to these basic requirements. We provide free drug, diagnostics and treatment facility for non-communicable diseases including cancer at MCGMrun hospitals.

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CGG – Bolstering Telangana Healthcare Delivery System

The Telangana Government is determined to revamp the public health sector, enabling quality and equitable healthcare services for people at large. The Centre for Good Governance (CGG) with its immense experience in e-Governance solutions, is geared up to implement some of the path-breaking projects such as Hospital Management System and Patients Electronic Health Records in the State, writes Elets News Network (ENN).

CENTRE FOR GOOD GOVERNANCE – MAKING A DIFFERENCE WITH E-GOVERNANCE AND IT SOLUTIONS e-Governance in healthcare sector provides solutions such as sanction of licenses for healthcare infrastructure (hospitals, diagnostic centres and medical colleges), Hospital Information System (HIS), maintenance of electronic medical records of patients, monitoring of vital statistics like birth and death rates. Delivery of healthcare services through concepts like telemedicine/medical informatics, computerised prescriptions, quality assurance tools, finance related modules, image capture, storage and transmission tools and tools for doctor-patient communication are also available. These applications of information and communication technologies are spread across the whole gamut of functions from the doctor to the hospital manager, nurses, data processing specialists, social security of administrators and the most important of all – the “patients”.

In India, lack of hospitals/beds, low patient-doctor ratio, increasing incidence of lifestyle related diseases, increasing susceptibility to infectious

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diseases, high prices of medicines, insufficient health insurance - these are some of the annotations which come to mind with the mention of healthcare status in India. Rajendra Nimje, Director General (DG), Centre for Good Governance (CGG), however, firmly believes that effective implementation of e-Governance related applications can resolve most of these problems. He also adds, that e-Governance can also effectively tackle red-tapism and delays that currently exist in the public sector hospitals, across the country.

SMALL IDEAS BIG IMPACT THEORY Rajendra Nimje turned his belief into reality by making innovative use of technology to directly and proactively help people through “Small ideas – Large impact” solutions. Way back in 2000, when the IT sector was still at the nascent stage, he started a revolution in the area of e-governance and critical contributions in the healthcare sector include, • e-Immunisation solution was conceived for a population of around 2.5 million, of Khammam district, through a centralised

Rajendra Nimje

Director General, Centre for Good Governance (CGG)

database which contained the immunisation history and schedule of each child. The project focused on increasing immunisation coverage by increased health worker productivity; focused target of each child; ensuring parents are better informed during each stage of immunisation programme; and allowing effective monitoring at every level of the immunisation programme hierarchy.

• Health Call Center is a noteworthy

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sanitation across Telangana. CGG’s contribution in this mega campaign in conjunction with Digital India project has been development of a real time information system with a web application integrated with mobile app and GIS. Within the Healthcare – Human Resource domain (most important health system input), recently, CGG developed a Mobile App for Supervisory Staff at PHC for Commissioner of Health & Family Welfare,GoTS.CGG was also engaged in the recruitment of vacancies of civil assistant surgeons and dental assistant surgeons (for Director of Medical Education, GoTS) and staff nurses under the control of ​the ​ Director of Public Health and Family Welfare, GoTS. CGG – PLAYING A VITAL ROLE IN GOVERNANCE CGG provides strategic consultancy, knowledge & research, change management, capacity building related support to various Ministries, State Departments and international multi-lateral agencies such as World Bank, UNICEF, UNDP, and GIZ etc.

Under this arena, some of CGG’s projects worth mentioning include Rapid Assessment of Nutrition Rehabilitation Centers (NRCs) in Telangana for UNICEF; Situation analysis for ‘Poshan Abhiyaan’

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CGG PROVIDES STRATEGIC CONSULTANCY, KNOWLEDGE & RESEARCH, CHANGE MANAGEMENT, CAPACITY BUILDING RELATED SUPPORT TO VARIOUS MINISTRIES, STATE DEPARTMENTS AND INTERNATIONAL MULTILATERAL AGENCIES SUCH AS WORLD BANK, UNICEF, UNDP, AND GIZ ETC.

POLICYMAKER’S PERSPECTIVE

effort and has set an example for other projects in its approach towards piloting a project, as well as its rolling out and sustenance. This is a 24-hour hotline for resolving medical emergencies and for providing a single point of contact for mobilising the considerable medical facilities and ambulances that the district government possesses. The highlight of the call centre is an intelligent software system. It helps capture complete details of each call, such as incident location, time and caller identity based on the incoming phone number, and automatically suggests the nearest available medical facility, ambulances, and doctors. This programme was operationalised in a record time of three months, with a project cost of only Rs 7 lakh.

Apart from receiving several appreciation and awards for his exemplary contribution in the e-governance sector, Nimje has been felicitated twice with National e-Governance awards for e-Immunization” and “Health Call Centre” projects Nimje has been a frontrunner in the adoption of e-Governance in the country and is one of the first few techno-bureaucrats in the country who is embracing new technologies and the digital revolution such as Blockchain, Internet of Things (IoT) and Artificial Intelligence (AI), to act as the next wave of growth drivers. Under his leadership in CGG, its e-Governance division is involved with GHMC in the healthcare related solutions such as 1) digitisation of birth and death certificates and 2) adoption of new methodologies to curb mosquito menace (to prevent malaria/dengue), through a “Mosquito App”.

GoTS launched the Swachh Telangana Mission with a goal of achieving “open defecation free cities” by 2019, with the vision of ensuring hygiene, waste management and

(Nutritional Programme) in Telangana; Preparation of Andhra Pradesh Health Sector Strategy (Unified AP); Study of Procurement & Pharmacy Management Reforms in AYUSH Dept, GoAP; A study on the Human Resource Management Practices, Institutional Environment, Performance & Parallel Systems in India’s Public Health Sector, World Bank.

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POLICYMAKER’S PERSPECTIVE

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in one of the biggest achievements for CGG during the last couple of months, which is “ISO 9001:2015 Certification” and “CMMi level 3 Certification”. This is also reflected in the organizations exponential growth in the recent past.

Under his able guidance and leadership, CGG is associated with path breaking assignments such as Telangana 2024 – The First Decade Document, Design and Development The Telangana Government is determined to revamp the public health sector, of Good Governance Index for Govt. enabling quality and equitable healthcare services for people at large. The Centre for of India, Formulation of Telangana Good Governance (CGG) with its immense experience in e-Governance solutions, State Agriculture Policy, Farm Viability is geared up to implement some of the path-breaking projects such as Hospital Centric Interventions in Agriculture Management System and Health Patients Organization’s Electronic Health(WHO) Records health in the State, writes According to World system Elets News Network (ENN). and Allied Sectors Technical framework, there are six building blocks on which any health system support to Evaluation Resource works. Those are leadership and governance, healthcare financing, Group – UNICEF, Dashboard for CENTRE FOR GOOD GOVERNANCE diseases, high prices of medicines, health workforce, medical products and technologies, information and -MAKING A DIFFERENCE WITH insufficient health insurance - these Telangana State, Cabinet Resolutions research, and service delivery.

Neglect of which any one component may E-GOVERNANCE AN IT SOLUTIONS are some of the annotations Monitoring System; Computerization e-Governance in healthcare sector come to mind with the mention of lead to unintended consequences in the process of reforming a health provides solutions such as sanction of healthcare status in India. Rajendra of Telangana Legislature; Degree system.“Sound and reliableNimje, information” is(DG), the foundation of decisionlicenses for healthcare infrastructure Director General Online Services; Ease of Doing (hospitals, centres and health Centre for Good Governanceblocks.

(CGG), makingdiagnostic across all the system building medical colleges), Hospital Information however, firmly believes that effective Business; Electronic Payment and government of Telangana is determined to revamp the SystemThe (HIS),present maintenance of implementation of e-Governance Application System for Scholarships electronic records of patients, applications can resolvequality, most publicmedical health sector in therelated State to provide equitable health monitoring of vital statistics like of these problems. He also adds, that (ePASS); GHMC IT Services& Mobile care services to all its citizens, particularly the poor and underprivileged birth and death rates. Delivery of e-Governance can also effectively App; Hostel Monitoring System; healthcare serviceswith throughits concepts tackleexperience red-tapism and delays and CGG immense in that providing “e-Governance like telemedicine/medical informatics, currently exist in the public sector Land Regularization Management solutions” and “Knowledgehospitals, and Consulting” is gearingRajendra up to implement computerised prescriptions, quality across the country.

Nimje System; Legal Cases Monitoring Director General, Centre for Good some tools, of finance the path-breaking projects such as Hospital Management assurance related Governance (CGG) modules, image capture, storage SMALL IDEAS BIG IMPACT THEORY System; Online Paddy Procurement System and Patients Electronic Health Records, to put best use of and transmission tools and tools for Rajendra Nimje turned his belief into System; and State Online Beneficiary technology to enable of healthcare to allwhich in need. database contained the doctor-patient communication are the delivery reality by making innovative use ofservices Management & Monitoring System. immunisation history and schedule also available.

These applications of technology to directly and proactively These systems shall cover all key functionalities and administrative of each child. The project focused information and communication help people through “Small ideas – As mentioned earlier, he is one processes within the on increasing immunisation technologies are spread across the hospital.

Large impact” solutions. Way back in of the first few techno-bureaucrats coverage bybeyond increased health wholeNimje gamut of functions from the that2000, the IT to sectorthink was still at emphasises it’swhen time ofthehealthcare worker productivity; focused target doctor to the hospital manager, nurses, nascent stage, he started a revolution in the country who are embracing hospital andin the look ate-governance newer and models each child;health. ensuring parents are data processinginfrastructure specialists, social area of critical likeofdigital new technologies and the digital better during each stage security of administrators and the most contributions in the healthcare Digitisation of health records is a major task,sector especially ininformed the public of immunisation programme; andrevolution such as Block Chain, important of all – the “patients”. include, sector with its huge and complex database systems.

Blockchain allowing effective monitoring at In India, lack of hospitals/beds, • e-Immunisation solution was every levelcan of thehelp immunisation Internet of Things (IoT) and Artificial low patient-doctor ratio, increasing conceived for a population of applications being decentralized, distributed, and immutable programme hierarchy. incidence of lifestyle related diseases, around 2.5 million, of Khammam Intelligence (AI), to act as the next protect and safeguard data district, integrity (for critical drugs, blood, organs • Health Call Center is a noteworthy increasing susceptibility to infectious through a centralised wave of growth drivers. He has etc.) and hold an immense potential to transform the healthcare sector already forged partnerships with by minimising operational costs, make the space more transparent [ ehealth.eletsonline.com ] The Largest Portal on Healthcare Innovations in Asia and the Middle East FEBRUARY 2019 leading blockchain technology related and optimize healthcare processes. In addition, by putting all medical companies; signed MoUs, working licenses on a blockchain, fraudulent medical practitioners, druggists, ! on POCs and is actively engaged chemists can be prevented from practicing and selling drugs. in knowledge sharing in various conferences/workshops.

It is worth mentioning here that his governance, (which is the core CGG – THE JOURNEY SO FAR AND leadership, guidance and continuous mandate of CGG), drawing from his ENABLER’S ROLE motivation has been instrumental in core strengths to tackle organizational In Centre for Good Governance CGG being honoured with Digital challenges and his experience in public (CGG), as the Director General, India Award 2018, CSI Nihilent administration & governance. He has Rajendra Nimje has strengthened e-Governance Awards in 2017 & put together plans, processes, systems, the organisation and is continuously 2018 and Skoch Smart Governance people and infrastructure to scale up to guiding in promoting administrative Awards-2017. the next level. All these have resulted reforms and transformational

CGG – Bolstering Telangana Healthcare Delivery System

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the premier monthly magazine on the enterprise of healthcare in asia & the middle east volume 13 / issue 12 / DeCember 2018 / ` 100 / us $10 / issN 0973-8959

COVER STORY

IVF

An Innovation-Driven Blessing for the Childless

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Conference Report

VOLUME 14 | ISSUE 11 | DECEMBER 2018

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Industrial Revolution

4.0 IS INDIA READY FOR INDUSTRIAL REVOLUTION 4.0 IN

EDUCATION? Feature Is MBA Still A Sought After Course?

Conference Reports: School Leadership Summit, Indore & 2nd HE & HR Conclave, Jaipur, Rajasthan

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INDUSTRY PERSPECTIVE

‘Hyderabad – A Fertile Ground for Health-Tech Firms, Start-ups’

Hyderabad is making a big stride in providing an acclimatised environment to foster start-ups. With Genome Valley, pharma industries, and one of the largest incubators in the form of T-Hub, the city is fast growing as the hub of health-tech companies, says Jay Krishnan, former Chief Executive Officer, T-Hub, in conversation with Sudheer Goutham of Elets News Network (ENN).

Jay Krishnan

Former CEO, T-Hub

Q

What are the key reasons making Hyderabad a healthcare technology capital?

Hyderabad has got a great foundation for healthcare. It has got Genome Valley and majority of the pharma industries. It is the seed manufacturing capital of the world.

The Government of Telangana is also focusing on lots of research and innovations. In next two-three years, Hyderabad will see Med-Tech, life science, Bio-Tech and start-up to further proliferate. With the pace the city is making strides in healthcare space, it will soon become a HealthTech capital.

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Q

Q

Q

Q

How has T-Hub incubated and helped start-ups to be successful?

We started T-Hub in 2015. Over the years, we have realised that T-Hub is not only meant to focus on local start-ups, rather it must cater to the needs of the entire Indian start-up landscape. We are now one of the largest incubators in India. We also established a Corporate Innovation Accelerator that attracted over 100 start-ups not only from other parts of India but also across the world.

We also conducted multiple student exchange programmes with Israel, Australia and the US. Now, we have over 300 incubators, the majority of which are from Telangana.

What is the genesis behind T-Hub? The fundamental goal of T-Hub is to become the epicentre for start-ups in India and also be a common anchor point for all the start-ups in Telangana. In coming years, the incubation centre is likely to get bigger, as a new centre for T-Hub is under construction.

Moreover, with the new centre, the emphasis will be more on software, hardware and production labs. It’s going to be bigger and stronger. Our objective is to become the world’s largest incubator.

Can the city be called the start-up capital of India, as a lot of initiatives have been undertaken in Hyderabad to support start-ups?

As we want India to become the startup hub of the world, it is a must for every city to play its part to achieve this goal. Mumbai will become the fintech capital, Bengaluru will become the hub for different verticals, Delhi will become the market and e-commerce capital and Hyderabad will become the healthcare technology capital. The combination of these 10+ cities will attract talent from every corner of the world and all of it, when put together, will make India successful.

Venture capitalists play a major role in supporting startups financially. What is your perception?

For a start-up to become successful, it is necessary to have access to a pool of capital to convert its idea into a quality product. Once that comes in, the start-ups’ next focus should be on business development and pitching new customers. T-Hub incubates these start-ups and helps them sustain, grow and make a name for themselves in their respective markets.

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INDUSTRY PERSPECTIVE

Hitech Diagnostic

Offering Affordable Quality Services and Superior TAT for Three Decades

H

eadquartered in Chennai, Hitech Diagnostic Centre is a well-known pathology chain in South India with presence in six States across Tamil Nadu, Karnataka, Kerala, Telangana, Andhra Pradesh and Puducherry through 75-plus self-owned centres. It offers comprehensive end-toend test offerings in pathology services under one roof. Hitech has 1,300 plus test menu, ranging from routine screening tests to super specialised tests including highly impenetrable molecular & genetic Assays.

Started by a visionary promoter Dr SP Ganesan, Chairman and Medical Director in 1986, Hitech Diagnostic boasts of some impressive numbers. It has a network of 1,000 plus hospitals/

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FEBRUARY 2019

FACT SHEET Started in 1986 Present across six States 3 reference labs 75 plus centres 10 lakh plus patients attended every year Around 50 lakhs tests conducted every year 1,300 plus test menu One of the largest processing centre in South India: 8,000 samples / day capacity clinics and 5,000 plus consultants and physicians. It conducts nearly 50 lakh tests annua catering to 10 lakh plus patients. No wonder, it has one of the

largest processing centres in South India with around 8,000 samples / day capacity. “Superior Quality is our motto and our USP is offering quality service at affordable prices and superior TAT,�

Hitech Diagnostic claims proudly.

And, it has created enough brand equity to justify this tag too. Hitech today is a trusted name among doctors and patients alike resulting in strong recall value (it is evident from the fact that a substantial part of its revenues is derived from walk-ins). It is the first lab in India to achieve Six Sigma for biochemistry tests-based

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HITECH’S KEY DRIVERS: INDUSTRY PERSPECTIVE

Dr SP Ganesan (Chairman and Medical Director) • MBBS from Stanley Medical College, Chennai in 1980 and Diploma in Clinical Pathology from MMC in 1986 • Attended various national and international conferences related to Laboratory Medicine • Member of American Association for Clinical Chemistry (AACC), International Leptospira Society (ILS), Association for Molecular Pathology (AMP), Indian Medical association (IMA) and American Society of Gene Therapy • Delivered several lectures at IMA meetings, hospitals and Medical associations

Malini Parasuraman, Chief of Lab Services • M.Sc. in Biochemistry from Avinashilingam College, Coimbatore • Wide knowledge in Immunoassays, Endocrinology, Therapeutic Drug Monitoring, Autoimmune Disorders and many other disciplines • Wide experience both in manual assays and in operating various fully & semi automated instruments

on the UNITY programme. It has a NABL accredited processing centre --completely automated processing with output in sync with software with minimal manual intervention.

In addition, Hitech is a ISO9001:2000 certified laboratory and member of ILS, AACC, ASCP, IFCC, AMP, ICTDM & CT. Expansion plans are on the anvil too with more centres to start soon in Western India. The equipment are sourced from the best brands available globally. Hitech is making continuous investments in latest equipment like Next Generation Sequencing Equipment, Personal Genome Machine, New Born Screening, IHC and Tissue Processor among others.

For further details, please visit www.hitechlabsindia.com or reach out at +91 44 4291 9999

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POLICYMAKER’S PERSPECTIVE 30

MCGM – Making Healthcare Meaningful for All Strategically In dispensaries, we are also focusing on non-communicable diseases (NCDs) in addition to communicable diseases. Due to urban lifestyle, cases of NCDs are steadily rising. We have undertaken diabetes programmes since 2011. We have more than 72 dispensaries where monitoring is done, says Dr Padmaja Keskar, Executive Health Officer, Municipal Corporation of Greater Mumbai (MCGM), in conversation with Harshal Yashwant Desai of Elets News Network (ENN).

Q

As an executive health officer, give us an overview of primary job responsibilities assigned by the MCGM. Primary Healthcare in Mumbai city is one of the basic duties, and it is obligatory duty of Municipal Corporation as well. Under this, earlier, we had 175 dispensaries – recently 11 new PHCs have been added taking the total number to 186 dispensaries, located in different areas of Mumbai corporation. These dispensaries help us in providing quick OPD services to patients. If additional care is required, we refer them for secondary or tertiary care at peripheral or major hospitals of MCGM. Besides, we have 28 maternity homes. Here, antenatal checkups, delivery services and post-natal checkups are provided.

We also have 210 health posts which provide outreach services. All the immunisation, control of communicable diseases, and family welfare activities are undertaken at these health posts. These posts are very crucial for reaching out to communities.

Health posts are managed by

FEBRUARY 2019

one assistant medical officer, one public health nurse, auxiliary nurses and coordinators, and 20 CHVs (community health volunteers). They go door-to-door and consult and educate people on their health issues. They undertake field immunisation camps, family welfare camps and activities for communicable and non-communicable diseases.

Q

Do you also undertake and implement national programmes? Please brief us.

Yes. We undertake all the national programmes, like vector control programmes, leprosy, TB, HIV and immunisation. All these programmes are implemented by this department.

Then the execution of various acts including PC-PNDT act, MTP Act under which we give registration to all the imaging equipment and institutions which deals in such instrument we register all private nursing homes under Bombay Nursing Home Registration Act. We register all the vital events including birth and death. There are cemeteries in Mumbai -- municipal

Dr Padmaja Keskar

Executive Health Officer Municipal Corporation of Greater Mumbai (MCGM)

and private. Municipal cemeteries are maintained by us. MCGM is the first to start a PNG crematorium in the State.

Q

What recent initiatives have been undertaken by you in primary healthcare?

In dispensaries, now we are also focusing on non-communicable diseases in addition to communicable diseases. Due to urban lifestyle, cases of non-communicable diseases are

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• Coordinate with Health and Non Health Department for prevention and control of communicable diseases and outbreaks.

• Update the Higher Authority about the Disease Situation in Mumbai.

• Update the Media regarding Disease Situation Fortnightly/Weekly • Assists Training Cell, MCGM by providing resource person and resource materials for training and sensitisation of Medical, paramedical staff and Private Medical Practitioners

Q

What about measures to control Leptospirosis?

For leptospirosis, we have undertaken chemoprophylaxis, which has yielded very good results.

Chemoprophylaxis treatment is given to affected patients within 72 hours of infection which increases chance of survival of the patients. One of our major health problems is TB, an airborne disease. There are TB sensitive cases, drug resistant cases. We have GTB hospitals, which is 1,200-bedded hospital, where 200 beds are reserved for drug resistant cases. AIC (Airborne Infection Control) measures are being followed properly here.

Under PPSA, private practitioners are involved in our programmes and RNDCP programmes are going on under which we provide free

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POLICYMAKER’S PERSPECTIVE

increasing in a fast manner. We have undertaken diabetes programmes since 2011. We have more than 72 dispensaries where monitoring is done.

Patient list is maintained and dieticians are made available who visit once in a week to provide diet counselling. Minor investigations are being made available at dispensary-level.

For communicable diseases, there are programmes going on for preventive aspect. We do undertake mosquito abetment committee to prevent disease by reducing breeding sites. To control malaria and dengue, SOPs (standard operating procedures) were prepared. This has resulted in a steady decline in the number of such cases. We also have established EPID Cell which collects reports from private and government hospitals via emails. All the reports are analysed at EPID Cells and communicated to all the medical officers of health. Then they take invention at residential sites to prevent any disease from flaring up further.

Some of the major functions of EPID Cells are: • Collect, compile and analyse the data on various epidemic prone diseases for surveillance • Inform the local health authority for rapid response to prevent or control spread of diseases in the communities.

FOR HIV ALSO, WE ARE GETTING FREE TREATMENT AND INVESTIGATIONS FROM THE GOVERNMENT OF INDIA. THERE IS ENHANCED ADHERENCE COUNSELLING (EAC) PROGRAMME UNDER WHICH HIGH RISK PATIENTS ARE SEGREGATED.

medication, free diagnosis. We have tied-up with laboratories and NGOs for the same. Nutrition is given to drug resistant TB patients.

For HIV also, we are getting free treatment and investigations from the Government of India. There is Enhanced Adherence Counselling (EAC) programme under which high risk patients are segregated. 14 ART centres are established across Mumbai.

As per number of cases and types of cases, geo-prioritisation is adopted.

Mobile application has been developed also to cater such patients also.

Q

What are the challenges you face?

Health is not priority for Indian communities. They are least bothered about their health. We have to convince people to make them aware about TB, HIV and other issues and health problems. We have seen that public response for awareness campaign is also unsatisfactory. The Public Health Department is constantly working on addressing these challenges.

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CANCER CARE PERSPECTIVE

OncoStem Redefining Cancer Treatment

In the wake of rising cases of cancer recurrence across the country, OncoStem’s novel product has proved to be a big boon. CanAssist-Breast, is an innovative test to predict the risk of cancer recurrence in early-stage breast cancer patients, says Dr Manjiri M Bakre, CEO and Founder, OncoStem Diagnostics Pvt Ltd, in an interview with Sudheer Goutham of Elets News Network (ENN).

Dr Manjiri M Bakre

CEO & Founder OncoStem Diagnostics Pvt Ltd

Q

Give us an overview of your organisation.

OncoStem Diagnostics founded in 2011 is a Bengaluru based oncology Diagnostics Company funded by venture capitalist. Our goal is to develop innovative tests using robust technologies to improve cancer treatment planning. OncoStem Diagnostics’ CAP and ISO 15189/ NABL accredited laboratory, maintains international quality of work. We focus on developing tests for different types of cancers, including oral and ovarian.

Q

Shed some light on your flagship product CanAssist-Breast.

Can Assist-Breast, an innovative test which we have developed, validated and marketed in India, can predict risk of cancer recurrence in early-stage

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breast cancer patients. It’s useful for early-stage breast cancer patients with hormone receptor positive and Her2 receptor negative disease that constitute about 40-50 percent of total breast cancer patients. It is a cost-effective alternative to the Western tests.

Three out of four patients diagnosed with early-stage cancer may not benefit from chemotherapy. With our product, both doctors and patients get to know about the risk of cancer recurrence for a patient. This information along with other clinical parameters can be used to plan chemotherapy treatment. We help clinicians formulate personalised therapeutic programmes for their patients.

than 1300 Indian patients which gives it the edge over competing Western tests which are neither developed nor validated on Indian patients.

CanAssist-Breast is ISO 13485 accredited, and CE-IVD marked. Along with the existing pathology report, this test result can help in identifying the likelihood of the cancer returning post-surgery. It also provides an idea whether the patient will benefit from chemotherapy along with hormone therapy.

In Western countries, such tests are available but they are costly for our patients. We make available a similar test at a much lesser cost to the patients while keeping the quality intact.

Q

Q

What are the significant features of the product, how it provides an edge in the area of cancer care?

Routine tests can tell about the disease prognosis of patient based on expression of gold standard biomarkers.

While they are useful they don’t give information about in depth biology of tumour beyond presence of hormone receptors and proliferative capacity. The size of the tumour doesn’t determine whether it will come back or not.

Biology of the tumour is critical in predicting cancer recurrence. Can Assist-Breast looks into multiple cell signalling pathways and biomarkers involved in tumor recurrence other than proliferation. Additionally, it is developed and validated on more

What sort of collaboration are you aiming for in the Government and private sector?

We are looking at different segments for collaborations. Firstly, hospital collaborations for the purpose of developing additional tests in cancer care. Secondly, OncoStem aims to collaborate with nationwide distributors to market its product.

Finally, we also aim for collaborations with insurance companies, both private, third party and Government schemes such as Ayushman Bharat Yojana (PMJAY) which is an important insurance scheme rolled out recently by the government. If our test is adopted under PMJAYscheme, it can help our country to save around Rs 100 crore per year.

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Cancer is one of the leading causes of death worldwide. It often creates fear which comes out of ignorance and misconception. Comprehensive cancer care necessitates the integration of pscychosocial aspects of care into the overall assessment and management plan, says Dr Rama Vaghmare, MD, Radiation Onocolgy, (NIMS), in conversation with Elets News Network (ENN).

Q

What are the pscychosocial aspects involved in treating cancer patients? What are the best practices, challenges and trends?

Cancer is one of the leading causes of death worldwide. Cancer often creates fear which comes out of ignorance and misconception. Therefore it is important to deal with the patients’ pscychosocial response for diagnosis of cancer, loss of control, anger , guilt, fear of abandonment. These are all pscychiatric factors that need to be explored and attended to. Doctorpatient relationship should be central and it should encourage greater patient participation. Comprehensive cancer care necessitates the integration of pscychosocial aspects of care into the overall assessment and management plan.

Q

As a Radiation Oncologist, what is the approach taken towards treating cancer. How is technology coming as aid in this treatment?

Cancer treatment majorly is a

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multimodality treatment approach comprising surgery, chemotherapy and radiation therapy. There have been many advances in cancer care including targeted therapy, immunotherapy, gene therapy, adoptive cell transfer of which few are still in preliminary stages and also in the clinical trials. Radiation therapy specifically is a localised treatment which has come up with non-invasive and more conformal treatment approaches including intensity modulated radiation therapy, image guided radiation therapy, cyber knife, proton therapy. The aim is to eradicate the tumour cell and protecting the normal tissue simultaneously so as to avoid the treatment side effects to a major extent.

Q

What are the essential awareness and precautions to be taken by cancer patients before the diagnosis and after completion of treatment?

Cancer awareness includes helping people recognise the early signs and symptoms of cancer, thus enabling them to seek treatment at an early stage. To educate people about the key risk factors of cancer is important, since more than 30 percent of cancer cases would be prevented by modifying the lifestyle or avoiding risk factors.

After completion of cancer treatment, follow up care involves regular medical-check ups that include review of patients’ medical history

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CANCER CARE PERSPECTIVE

‘Awareness Key to Dispel Social Stigma Attached with Cancer’

Dr Rama Vaghmare

MD Radiation Onocolgy (NIMS)

and physical examination. This is important because it helps identify changes in health and also to check for recurrence or spread of the disease. It would also aid in prevention or early detection of other cancer.

Q

What essentially needs to be done for general awareness?

Even after completion of treatment there is social stigma and cultural inhibition and this may affect the post treatment pscychosocial functioning. So there is a need to educate patients and care givers and also create awareness towards dispelling this social stigma attached with cancer. Emphasising a more active participatory role for patients and a more patient tailored approach is needed.

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POLICYMAKER’S PERSPECTIVE

MCGM – Boosting Healthcare Model to Tackle Growing Demands Municipal Corporation of Greater Mumbai (MCGM) keeps working towards consolidating its healthcare centre. With its unique methodologies and procuring of the latest machineries and equipment the medical services of its four major medical colleges and hospitals have been improved, says Sunil Dhamne, Deputy Municipal Commissioner, Public Health Department, MCGM, in conversation with Harshal Yashwant Desai of Elets New Network (ENN).

Q

Looking at the mammoth task of catering to a huge population of metropolitan city like Mumbai in terms of healthcare, how would you define the significance of MCGM? MCGM indeed caters to a huge populace in this metropolitan city.

It has the responsibility to cater to the health delivery services to entire Mumbai city. As per Section 61 of M.M.C. Act, it is the obligatory duty of the Corporation to provide, establish, and maintain public hospitals and dispensaries and carrying out measures necessary for public medical relief (Sec.61 (gg)).

Q

What strategy is applied towards proper training of the staff at MCGM-run Hospitals?

Are there any special measures undertaken for it?

It is indeed a vital task. Continuous medical education is the requirement for renewal of the registration of doctors with Medical Council of India. Training is arranged by major hospitals and the experts in the fields are the resource persons for these trainings.

Q

How have medical services evolved over the years, especially in four major medical colleges and hospitals?

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Over the years it has been successful in catering to a wide range of public through its healthcare delivery system. Medical services of the four Major Medical Colleges and hospitals have been consistently improved by procuring the latest machineries and equipment. To mention a few -D.S.A., Cardiac Cath Lab, Ventilators, M.R.I. machines have been procured.

Q

Some of the states are witnessing Swine Flu cases.

How MCGM has geared up itself to combat the virus in a city frequented by such a floating population in lakhs?

Swine Flu is controlled by administering vacancies to high-risk patients and to the staff working with the Swine Flu patients. Robust I.E.C. is done. This has resulted in the decrease in the incidents of Swine Flu in Mumbai City.

Q

MCGM had plans to issue health cards to all patients in civic hospitals. Please tell us about it.

Health Cards will be issued to every patient. This will enable the patient as well as the doctors to track the medical history and all the reports, treatment given, across all the health facilities in the Mumbai once the H.M.I.S. Project is rolled fully.

Sunil Dhamne

Deputy Municipal Commissioner Public Health Department, MCGM

H.M.I.S. Project is being rolled out in four phases. Up till now, first phase is completed and second phase is being implemented.

Q

What are the major challenges the department faces while executing overall healthcare services within its hospitals?

The major challenge MCGM facilities have to face is the overcrowding in the hospitals, particularly during the monsoon. To ease out the patients load, mechanism to send the economically weaker and indigent patient to the Public Trust Hospitals is being worked out.

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Telangana State Drug Control Administration integrates complete Drug licensing System (ODLS) online, making it a 100 percent web-based licencing system.

Moreover, the TS iPASS ACT of the Telangana Government, a single window certification system for establishing the industries, has made the process industry and investment friendly.

T

he “Online Drugs Licensing System” (ODLS) has been initiated by the Government of Telangana as per the guidelines of the Department of Industrial Policy and Promotion (DIPP), Government of India, under the “Business Reform Action Plan 2017” for grant / renewal of license for retail, wholesale and manufacturing of drugs by Drugs Control Administration, Telangana State. The project of computerisation of Drug Control Administration (DCA) has been undertaken under the “Ease of Doing Business” initiative.

ODLS is a work-flow based Online Drugs Licensing System which allows online application submission, payment, verification, issue of license, tracking and monitoring etc.

For issue of manufacturing and sales licenses without the need for physical touch point for document submission and verification.

Services made online • Grant/Retention of Manufacture License (Formulations, Bulk Drugs,

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Cosmetics, Test Licenses etc.)

• Grant/Retention of Manufacturing Loan License • Grant/Retention of Repacking License • Grant/Retention of Sales License (Retail/Whole Sale).

• Grant/Retention of Approved Laboratories.

• Grant/Retention of Large Volume Parenterals (LVP), Vaccines & Sera.

• Grant/Renewal of Blood Bank licenses.

• Amendments in sale licenses.

On 30 June, 2017 C Laxma Reddy, Minister for Medical Health & Family Welfare launched online drugs licensing system portal of drugs control administration in presence of Rajeshwar Tiwari, the Principal Secretary, Medical Health & Family Welfare.

It is mandated that all applications for above mentioned services should be submitted online from 1st July, 2017. Online drugs licensing system drastically reduced the timeline for

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TELANGANA HEALTHCARE PERSPECTIVE

Online Drugs Licensing System: Telangana Shows the Way

getting licenses & the applicant can download signed license from online portal using their user credentials.

Services to be made online • Amendments in manufacturing & Blood bank licenses.

• Issue of certificates to be made online.

• WHO-GMP Certificate • Capacity Certificate • Licence validity Certificate • GMP Certificate • Capacity Certificate • Marketing Standing Certificate • Free Sale Certificate • Non Conviction Certificate • Manufacturing & Marketing Certificate • Performance Certificate • COPP for Product for country • Neutral Code Certificate • Issue & Renewal of NDPS licenses (both manufacturing & sales) Software development.

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ARTICLE

MCGM Waging War Against TB T

he National Strategic Plan (NSP) for tuberculosis (TB) has put forward the goal to end TB in India by 2025, five year ahead of the targets set by Sustainable Development Goals (SDGs). It is estimated that more than 50 percent of TB patients seek care from private sector in India, and hence, engaging private sector plays an importent role in elimination of Tuberculosis. To reach out to private sector patients, the ‘Universal access to TB care project’ (UATBC) was rolled out in Mumbai as a part of ‘Mumbai Mission for TB Control’, a comprehensive strategy of Municipal Corporation of Greater Mumbai (MCGM).

A project from September 2014 to December 2017, with support from Bill-Melinda Gates Foundation (BMGF) and PATH, was implemented by Mumbai District TB Control Society. It involved a systematic engagement of private doctors, laboratories and retail chemist for early diagnosis and treatment of TB by provision of free services of chest X-ray, GeneXpert testing, anti-TB drugs and Information & Communication Technology (ICT) enabled treatment adherence support. The engagement made it possible to detect more than 60,000 TB patients from private sector over three years. It also gave 78 percent success rates in all patients who were on treatment.

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To ensure the sustainability of the project, the donor supported project was transitioned to government supported Private Providers Support Agency (PPSA) with full integration in TB Programme of Mumbai.

Objectives: To sensitise the private sector in STCI (Standard of TB Care India) and to improve notifications of private sector patients by involving private healthcare providers and providing free referral, diagnosis and treatment services to private sector patients.

Intervention: All private sector engagement activities are now undertaken through the Innovative Scheme of PPSA, approved under National Urban Health Mission (NUHM) with support from Revised National TB Control Programme (RNTCP) Partnership Schemes.

PPSA is an interface agency to engage the private sector and functional since January 2018 in Mumbai. The complete package of TB services involving free services of chest X-ray for presumptive TB, Sputum /sample Transportation, GeneXpert testing from public sector, daily regimen (Government Fixed Dose Combination (FDC)) for drug sensitive patients along with ICT enabled treatment adherence monitoring through NIKSHAY (online platform for TB patient

Dr Daksha Shah

Joint Executive Health Officer & City TB Officer, Municipal Corporation of Greater Mumbai

management) and linking of drug resistant TB patients to public sector for free second line anti TB drugs under the national programme is being provided. These services are offered through ‘Hub & Spoke’ model of private sector engagement with the help of NGO- appointed staff to undertake all field activities related to private sector patients and providers. The District TB officers play an instrumental role in engaging private providers and undertake the responsibility of building relations, organising CMEs and further managing the overall programme, whereas a Public Private Mix Coordinator (PPMC) makes sure that the continuous flow of services is maintained with day-to-day

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ARTICLE

engagement with the provider.

Impact: The programme has been successful in delivering the following services with the help of the two NGOs who have been working as PPSA ; a) 285 formal providers; 1,694 informal providers; 385 hospital and nursing homes, 41 champion doctors, 177 CXR labs and 198 chemists have been linked with

PPSA; b) 30,000 CXR and 19,000 CBNAAT tests were given free to private sector patients; c) More than 3,000 doctors were sensitised; d) 11,500 drug sensitive TB patients diagnosed in private sector were initiated on government FDCs; e) 16,000 patients notified and provided with adherence counselling.

This intervention programme led by Municipal Corporation of

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Conclusion: Mumbai continues to provide quality free diagnostic and treatment services to private sector TB patients through PPSA. As a result, in 2018, the total TB Notification for Mumbai improved from 269/lakh in 2015 to 421/lakh in 2018.

Tapping private health sector for achieving universal access to TB care in India is achievable, although difficult and PPSA would further be enhancing the capacity to extend services to all private providers to reach out to all TB Patients in Mumbai as a step towards ‘TB Free Mumbai’.

Disclaimer: The writer is Dr Daksha Shah, Joint Executive Health Officer & City TB Officer, Municipal Corporation of Greater Mumbai. Views expressed are a personal opinion.

PPSA Model for Integration under NUHM and RNTCP

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Mumbai demonstrated a successful model which is now being adopted to scale up private sector engagements in many States of the country and has changed the way private sector is being approached by the Government for improving the TB care.

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‘Jharkhand Gearing Up for Better Healthcare Delivery Model’ In comparison to nearby States with Trust Model, Jharkhand is performing better on all parameters be it BIS pendency, hospital claim payment, claims generated, or portability numbers, says Dr Nitin Madan Kulkarni, Principal Secretary, Department of Health & Family Welfare, Government of Jharkhand, in conversation with Elets News Network (ENN).

Q

Tells us about the initiatives undertaken by the Government of Jharkhand to boost State healthcare delivery system.

Jharkhand is predominantly a rural and tribal society. We have 26 percent tribal population. Half of the areas are far-flung and hilly terrain. 15 districts are LWE (Left Wing Extremism) affected. Obviously, taking rural healthcare to people’s doorsteps is a big challenge. The State has taken many initiatives to improve the healthcare system of the State. Some of them are: • Free diagnostic and free radiological on PPP mode in all district hospitals • Free dialysis on PPP mode at district hospitals • 108 ambulance service to provide emergency services • 104 toll free service for health advice • Separate cadre for specialist doctor and recruitment through bidding system under NHM • All HSC and PHC are in the process of being converted into health and wellness centre. Till now we have converted 290 such centres to HWC

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• Telemedicine service for 100 PHC is ready to be rolled out • Running of CHC and HSC on PPP mode • Apart from that equipment maintenance by PPP mode, MMU service for rural area

Q

Ayushman Bharat scheme was launched from Jharkhand last year. How has the scheme benefitted poor and vulnerable people to avail secondary and tertiary care?

Since 23 September, 2018, a total of 60,051 claims have been accepted under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojna (AB-PMJAY) scheme, of which 18,338 beneficiaries were from the SECC category (as per centre scheme) and 41,712 from PDS card holders. Both these categories of families are from the poor and vulnerable sections of society.

As per the claims initiated under AB PMJAY Mukhya Mantri Swathya Bima Yojna (MSBY) in Jharkhand, till 22 January, 2019, the package type used by the beneficiaries is as under mentioned. More than 6,000 beneficiaries from the poor and vulnerable sections of the society

Dr Nitin Madan Kulkarni

Principal Secretary, Department of Health & Family Welfare, Government of Jharkhand

have used tertiary type of high value package treatment from this scheme: Type Secondary Secondary/ Tertiary Tertiary Grand Total

No. of such packages 33,380 1,542

Amounts blocked Rs 28,92,00,080 1, 64, 37,975

4,575 39,498

8, 31,93, 598 38, 88, 31,653

We have various success stories where poor people got their prolonged illness and surgeries done under the scheme.

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Q

Dr Nitin Madan Kulkarni inaugurating Day Care Centre for sickle cell disease

Q

Jharkhand has used hybrid model to implement Ayushman Bharat scheme. Shed some light on advantages of this insurance model.

The pricing of any risk from an insurance point of view would always be based on the amount of coverage being asked for. Since under the Ayushman Bharat, the insured sum of Rs 5 lakh for each family per annum has been fixed and hence going for absolute insurance model with Rs 5 lakh coverage would have been costly for the government. Our analysis and historical data taken from various other States have shown that number of claims for over Rs 1 lakh would not be more and hence we fixed the threshold limit for insurance to Rs 1 lakh and decided to settle directly all the claims beyond this limit.

Hence, the State government saved a lot in terms of premium. Out of the total about 60 thousand claims, till date there have been only 0.01% number of claims which exceeded one lakh. This itself proves that the model, which our State has opted, is better suited. With hybrid model we are able to utilise the experience and strength of the insurance company and

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simultaneously keep all the controls and monitoring with SHA (State Health Agency) to avoid any leakages.

However, we didn’t go with the complete trust model because of constraints in terms of manpower and experience in running such a mass scheme directly. Today, in comparison to nearby States with Trust Model we are performing better on all parameters; be it BIS pendency, hospital claim payment, claims generated, and portability numbers.

Q

Access to nutrition and medicine is a major issue among people residing in remote tribal districts. What steps have been taken to improve infrastructure in rural districts?

Undernutrition and malnutrition remain the most crucial challenge for the State. In spite of the best of efforts from the government, the figures are still daunting. Malnutrition treatment centres are functional throughout the State. We regularly conduct school health checkup programme, vit-A , Deworming, ORS rounds in the State.

Infrastructure and manpower are being upgraded to IPHS standards.

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Tell us about the Government’s strategy to contain Tuberculosis (TB) which is coming to fore as a major challenge.

Treatment of TB is provided free of cost to drug-sensitive as well as drug-resistant patients under RNTCP (Revised National TB Control Programme). The objective of the programme is to provide treatment at the earliest; to cut down the transmission chain. For this, in the State there is a network of around 340 DMCs, 36 CBNAAT Labs, one Intermediate Reference Lab at Ranchi and about 20,000 treatment providers. Emphasis is now to get TB patients notified from private doctors and chemists on priority. They are being sensitised regularly for the same.

For knowing the status of drug resistance, diagnosed TB patients are subjected to tests for drug resistance.

Now all districts can directly start treatment of drug resistant TB, as there are five nodal DRT centres and 19 District DRT centres in place.

TB patients are also being provided Rs 500 per month during entire period of treatment for nutritional support under Nikshay Poshan Yojna w.e.f 1.4.18.

For better engagement of community, TB forums are being formed in each district along with regular community meetings and patient - providers meetings.

Active case finding campaign was conducted in targetted vulnerable population and similar campaign with LCDC adopted in entire population of seven districts.

The State has signed MoU with Medanta to launch TB free Jharkhand with active cooperation from the PSU located in the State. We are trying our best to achieve the goal of TB free State by 2022.

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POLICYMAKER’S PERSPECTIVE

However, availability of trained manpower and reluctance of doctors to work in rural areas remain key issues.

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POLICYMAKER’S PERSPECTIVE

Assam Making Healthcare Accessible and Affordable Despite Challenges Assam is committed to reduce out-of-pocket expenditure and make healthcare affordable. Hence, the Chief Minister’s Free Diagnostics Services, a PPP model with HLL Lifecare Ltd was introduced. Till date over 2 million patients have availed free services, including high end investigations like CT scan, says J V N Subramanyam, IAS, Mission Director, NHM, Department of Health & Family Welfare, Government of Assam, in conversation with Elets News Network (ENN).

Q

How would you describe Assam’s healthcare delivery system in terms of quality, accessibility and affordability?

With about 3.4 crore population, Assam is poised in a unique context both demographically and topographically and is the largest State with 68.4% population of the country’s northeastern region. There are about 26 Scheduled Tribes and 22 Scheduled Castes. One must look at Assam’s healthcare delivery system in this context. In context of accessibility, quality of services and affordability, we need to look at various factors: Accessibility: Difficult geographical terrain with hard to reach riverine/ Char areas, tea garden areas, hilly and forest areas spread across the State are the major accessibility issues for healthcare delivery system in the State. a) Tea garden areas: About 20% of Assam’s population belongs to the tea growing communities. They are one of the most backward and exploited communities in Assam. Many studies revealed that Assam is facing a very high Maternal Mortality Ratio (MMR) among the districts with the

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high tea garden population, the MMR is very high. As per survey conducted by Regional Resource Centre for North Eastern States (RRC-NE), Ministry of Health & Family Welfare, Government of India, only 428 (57%) tea gardens have functional hospital out of total 758 tea gardens surveyed.

Similarly, only 324 (49.9%) have Medical Officer (Allopathic) out of total 649 tea garden hospitals and another 47(7%) running with Visiting Medical Officer. The study revealed poor status of health infrastructure, availability of doctor, nurses and paramedics and healthcare services in the tea garden areas. Proper implementation of Plantation Labour Act, 1951 in the large number of tea gardens in the state remains a challenge. b) Riverine areas: Around 10% of population of the State reside in the riverine/char areas where healthcare remains a critical challenge due to inadequate number of Health Infrastructure, doctors, nurses and paramedics. critical topographical condition is another challenge to reach these areas.

J V N Subramanyam, IAS

Mission Director, NHM, Department of Health & Family Welfare, Government of Assam

c) Hilly Areas: Accessibility is an issue with population density.

It is very low in Karbi Anglong and Dima Hasao hilly districts.

Availability of manpower is a huge issue in these areas. Due to hilly terrain and poor road connectivity referral transport system is inadequate in these areas. d) Border areas: The geographical location of the State itself is quite unique, sharing borders with seven States and countries like Bhutan

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Quality: Quality of healthcare service providers remains an issue with acute shortage of skilled healthcare service providers. a) Shortage of skilled healthcare service provider: Availability of

specialists in the State remains a challenge. Of the State’s 6 medical colleges, only 3 are offering post graduate courses. Only 50% of the PG seats are available to the State which needs to cater to both the public and the private sectors.

Shortage of MBBS Doctors, Staff Nurse and other paramedical staff is the major challenge in the health system. Rational posting of manpower is another challenge.

Affordability: 89.2% rural population of the State relies on public hospitals for all types of treatments, resulting high patient loads.

Q

Delivering healthcare services in north-east has always been a challenge due to difficult terrain and other issues. What measures have been taken by NHM, Assam?

To cover the hard to reach areas and areas where healthcare facility is inadequate, the Assam Government has deployed 130 Mobile Medical Units (MMUs) of which 80 are deployed in the tea garden areas. At present 414 tea gardens are covered by these MMUs every month.

MMUs are basically “hospital on

TO PROVIDE HEALTHCARE SERVICES IN THE RIVERINE AND CHAR AREAS, ONE OF ITS KIND BOAT CLINICS HAVE BEEN DEPLOYED WITH 15 BOAT CLINICS OPERATING ACROSS 13 DISTRICTS FROM 2008

POLICYMAKER’S PERSPECTIVE

and Bangladesh, and having 2276.3 km of inter-State and 529 km of international borders witnessed low coverage of health care services due to accessibility issues. e) Flood and erosion: Assam is a multi-hazard State and prone to floods, earthquakes, storms and landslides. Most of the Brahmaputra valley and Barak valley areas are prone to annual flooding with flash floods from Meghalaya/Bhutan/Arunachal causing havoc in the state year after year. Frequent change in the course of river Brahmaputra causes massive erosion which leads damage of health institutions also. f) Gap in Health Infrastructure: There is huge gap of health infrastructure as per population norms. Till last year, not a single facility was Indian Public Health Standards (IPHS) compliant.

wheel” manned with doctor, nurse, paramedical staff equipped with basic free diagnostic services and free medicines. More than 20.31 lakh patients have been treated in 47,020 camps organised by these MMUs from June 2017 to January 2019.

To provide healthcare services in the riverine and char areas, one-of-its kind Boat Clinics have been deployed with 15 Boat Clinics operating across 13 districts from 2008. These are basically “Floating Hospitals” manned with doctor, nurse, paramedical staff equipped with basic free diagnostic services and free medicines. A total 20,72,880 patients are treated in 27,959 camps organised by Boat Clinics.

Q

How PPP model, latest technology and mobile apps are being explored to improve delivery of services?

The 71st National Sample Survey by Ministry of Statistics and Programme Implementation Government of India had very interesting observations where the State has shown a sharp increase in utilisation of government institutions in the rural areas. The percentage of hospitalised treatments

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POLICYMAKER’S PERSPECTIVE 42

received from public sector hospitals varied from 19.2% (Maharashtra) to 89.2% (Assam) in the rural areas.

While other States have shown a high degree of reliance on private sector hospitals, Assam is building its own public health systems, nevertheless we have also PPP to fill the critical gaps in health systems.

The Mrityunjoy-108 Emergency Response Services is round-the-clock under PPP mode with GVK-EMRI since 2008 in Assam. This partnership has improved the access to emergency services particularly medical emergencies. With around 380 ambulances and 7 boat ambulances, the 108 services have served more than 35 lakh medical emergencies till date. Similarly, 316 number of 102 ambulances and 235 Adarani drop back vehicles transported more than 7.2 lakh patients and 14.93 lakh mothers.

The State is committed to reduce the out of pocket expenditure and make healthcare affordable. Hence, the Chief Minister’s Free Diagnostics Services, yet another PPP model with HLL Lifecare Ltd was introduced.

Till date over 2 million patients have availed free services, which includes high end investigations like CT scan. In partnership with Narayana

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Hrudayalaya, Bengaluru and Kolkata 6,288 children have been provided free heart surgeries. “Comprehensive” Cleft Care Centre- a state of the art Centre through PPP has been set up in Guwahati to work towards a ‘Cleft Free Assam’ under the name Mission Smile where 17,729 children received free surgeries.

State-run mobile medical units to provide comprehensive primary healthcare services along with diagnostics facilities in the state with 80 MMUs dedicated to tea garden areas which is again a PPP programme with through M/s Hindustan Latex Family Planning Promotion Trust (HLFPPT).

In addition to this, the NHM has entered public private partnership with 150 tea garden management and provides financial support for tea garden hospitals and with various charitable hospitals across the State.

The boat clinics providing essential health services in farthest riverine islands of Assam are exemplary PPP initiatives. Assam also has 104 Sarathi, a round-the-clock free of cost helpline and grievance redressal System in PPP mode.

The technology and the mobile applications have been extensively used for effective

implementation of flagship programs and intensive monitoring and supportive supervision of the health programmes.

The National Health Mission, Assam has won the Skotch Swasth Bharat Gold Award for implementation of ASHA Payment and Performance Monitoring System (APPMS), an IT tool for regular payment of ASHA Incentive through PFMS and analysis of ASHA programme.

The entire clinical data of sick newborns treated in public health facilities is available in SNCU online software used by policymakers like me to review the quality of newborn care in the State.

There is robust Human ResourceMIS System for comprehensive HR management. The village health and nutrition day (VHND) which is most critical program to deliver most of preventive and promotive services in the community is being monitored by VHND Monitoring System.

The Drugs availability status is being constantly monitored through Drugs Stock Monitoring System and it is also made available in the public domain to increase transparency in the system.

We also have online Inventory Management, Online Maternal and infant Death Reporting System. The entire system is being integrated with GIS based system.

NHM, Assam has also implemented robust HR-MIS system with provision of centralized payment of salaries of close to 21,000 NHM employees on last week of every month.

Assam is one among the few states in the country to use android mobile application for conducting district gap analysis using Indian Public Health standards with the support from UNICEF and the results are utilised for strengthening health infrastructure and service availability.

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R

ajiv Nath, the founder and forum coordinator of Association of Indian Medical Device Industry (AiMeD) and Joint Managing Director of Hindustan Syringes & Medical Devices Ltd, has been recently honoured for his exemplary contribution to global public healthcare sector.

He was conferred upon the ‘Award of Appreciation’ by Minister of State for Health & Family Welfare Ashwini Kumar Choubey recently at a ceremony, organised by Diaspora Foundation.

Nath was honoured for his valuable, remarkable and outstanding achievements in the field of healthcare and community services for affordable Medtech access and patients safety initiatives.

“I am pleasantly surprised and humbled to receive this award.It validates the contribution and efforts made by us at AIMED, HMD and AISNMA to better the healthcare sector in the country and internationally in areas of Injection Safety, Drug Delivery , Patients Safety & Affordable access,” said an elated Nath reacting to being appreciated in such a way.

“This recognition by the Indian

NRI Diaspora is an appreciation of the hard work and dedication we have made towards transforming the healthcare sector in India. I thank the teams of all three organisations who were always behind me, supporting my vision and working relentlessly to meet our common goal,” said Nath whose dynamic leadership to drive innovations and contributions in medical devices for healthcare has played an important role for the country to carve out a niche for itself on the global map.

Nath has demonstrated exceptional performances in setting up the agenda and roadmap for the future healthcare by putting up an exemplary entrepreneurial competency and leadership in the healthcare industry not only by his own manufacturing company Hindustan Syringes & Medical Devices Ltd but also for the entire MedTech industry segment to realise his vision to position India among the top five manufacturing global hubs of medical devices.

As the founder and forum coordinator of AiMeD, Nath has undertaken many initiatives for establishing a collaborative framework with various Government departments

The Award was collected by Pradeep Sarin & Manoj Tiwari from Ashwini Kumar Choubey, Minister of ! State for Health & Family Welfare at Ministry of Health, Government of India, in absence of Rajiv Nath on behalf of the Indian Diaspora Foundation

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AIMED PERSPECTIVE

AiMeD’s Rajiv Nath Honoured for Contribution to Global Public Healthcare

Rajiv Nath

Founder and forum coordinator of Association of Indian Medical Device Industry (AiMeD) and Joint Managing Director of Hindustan Syringes & Medical Devices Ltd

and media to bring to their attention issues affecting the industry and drawing investments in India as part of the endeavour to make the country a global manufacturing hub of medical devices – Make in India -- and a preferred manufacturing destination and the leading supplier of medical device worldwide.

Hindustan Syringes & Medical Devices Ltd is one of the largest manufacturers of disposable syringes in the world and the largest manufacturer for auto disable syringes.

AiMeD is an umbrella association of Indian manufacturers of medical devices, covering all types of medical devices including consumables, disposables, equipment, instruments, implants, electronics, and diagnostics.

Nath was recently appointed a member on Board of National Medical Devices Promotion Council by DIPP, established to boost the Indian Medical Devices sector and lead India to an export -driven market in the medical devices sector.

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TECHNOLOGY PERSPECTIVE

‘Technology Enabling People to Optimise Patient Care’

Technology has been instrumental in shaping the Indian healthcare industry.

Modern-day advancements and digital initiatives have transformed the healthcare sector, enabling people to avail better patient care, says Selva Kumar Devannam, Managing Director, Trimed Solutions Pvt Ltd, in an interview with Elets News Network (ENN).

Q

How will you summarise Indian healthcare in terms of opportunity and challenges?

Healthcare is becoming one of the largest sectors in India in terms of revenue, budget and employment.

The Indian healthcare sector is expected to touch $280 billion by 2020.

Rising income-level, greater health awareness, increased precedence of lifestyle diseases and improved access to insurance, are key contributors to growth. The sector is expected to generate 40 million jobs in India by 2030. One lakh jobs are expected to be created from Ayushman Bharat, the National Health Protection Scheme.

Q

Shed some light on healthcare Initiatives in 2018 Technology has been instrumental in shaping the Indian healthcare industry. Technological advancements and digital initiatives have transformed the healthcare sector enabling people to avail a better patient care.

In the present times, people are becoming more aware and cautious of their well-being with information and tools available at their disposal. One of the challenges is how to provide quality, accessible and affordable healthcare services to people at large. The answer

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is to improve, regulate and systemise the service delivery through adoption of technology and IT infrastructure.

The Government is making lots of concerted efforts to provide affordable healthcare facilities to poor population through programmes like free dialysis and diagnostics services, ePHC, teleradiology services, telemedicine and biomedical equipment maintenance services. These programmes are implemented through PPP mode. Various telemedicine projects have been launched under NHM enabling people in remote areas to get connected with expert doctor sitting in any tertiary hospitals in metro cities. Telemedicine has compensated the infrastructural gaps in healthcare delivery.

Q

Share with us your company’s business plan for 2019 The Government is aiming to develop India as a global healthcare hub. In a bid to encourage medical infrastructure in India, it has approved a budget support of Rs 85,271 crore for three years under the National Health Mission.

In order to develop a sustainable model, NHM is supporting States for Biomedical Equipment Maintenance Programme (BMMP).

Selva Kumar Devannam

Managing Director, Trimed Solutions Pvt Ltd

BMMP, one of the biggest medical equipment maintenance programmes globally, takes care of 7,56,750 equipment in 29,115 health facilities across the country, of which 30 percent were found dysfunctional across.

Trimed Solutions is part of this giant programme and involved in the BMMP services for over 1,00,000 equipment in six States of the country with business value of about Rs 50 crores a year. It has added an additional business value of about Rs 100 crores for coming years.

We take every challenge as an opportunity and develop a business

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Q

Tell us about implementation challenges in medical technology and remedial actions in this area.

India has a huge number of unemployed engineering graduates, even though it is hard to find skilled Biomedical Engineers (BME).

As per an estimate, there will be a requirement of about 6,000 skilled BMEs in five years. To fill the gap, it is necessary to focus upon skill development of these engineers and make them employable.

Being a private player, we are investing huge money to develop the skill for the engineers. We have designed a training course, in association with Osmania and IICBCSIR, which is certified by Health Sector Skill Council.

Our aim is to identify critical gaps in medical technology and support the healthcare providing authorities to standardise the system.

We have formulated national SPOs for providing biomedical equipment maintenance services in the country with the help of NHSRC (National Health System and Resource Center).

In addition, we have also designed a specific training programme for the

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WE TAKE EVERY CHALLENGE AS AN OPPORTUNITY AND DEVELOP A BUSINESS MODEL WHICH SUPPORTS THE HEALTHCARE PROVIDERS TO DELIVER THE SERVICES AT PAR WITH GLOBAL STANDARDS. OUR BUSINESS IS ESTIMATED TO GROW AT 100 PERCENT IN COMING YEARS.

fresh biomedical engineers which enable them to understand the roles and responsibilities in the healthcare system.

Our training programmes bridge the gap between manufacturing, maintenance and service delivery.

Q

Brief us about healthcare technologies and trends which will play a key role in augmenting healthcare delivery system in coming years.

There is no limit for technological innovations as they play a pivotal role to meet rising demands of humans.

In the next decades, one can expect that research will be in focus in the area of medical devices for restoring the functions of tissue through sophisticated implantable electronic devices.

In future, there maybe patients with more than one implantable electronic device and these devices will learn to communicate and adjust their performance to meet the requirement

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of the tissue functions.

Technology has enabled people to optimise their health and lifestyle through wearable devices such as smartwatches, activity trackers, fit bits, etc. Such devices which can monitor body vitals are helping people set goals, track and accomplish them.

Today, people have become increasingly health conscious due to unprecedented increase in lifestylediseases. Stress and mental health concerns have furthered encouraged consumers to be more connected with their overall health.

There has been a spike in the sales of body ideal measurement devices in recent times. Tools that allow people to measure their blood-pressure, oxygen level, diabetes or blood sugar levels at home are becoming more common. One-touch tests and other home-based health-monitoring devices have given people the choice to keep a track of these body ideals on a daily or weekly basis.

It further enables people to share these body vitals with doctors and receive real-time feedback through online platforms. Technology is replacing the human effort of keeping track of health.

The next area may be functional tissue engineering where tissue will be grown from biological material (stem cells). It will be placed into the body into the right position to restore the function of the newly implanted tissue.

Of course, there is still a lot to be learned on how to produce biological materials which have properties close to, or the same as human living tissue and can withstand the same forces and strain.

There are two major fields of intensive research which will improve the current results, neural interfaces and neuroscience. The need for neural interfaces fosters development of new biocompatible materials for neural prosthesis, especially among the nanomaterials and nanotechnology.

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TECHNOLOGY PERSPECTIVE

model which supports the healthcare providers to deliver services at par with global standards. Our business is estimated to grow at 100 percent in coming years.

Our technical team is having 200 years of combined experience. They are now involved in transforming the knowledge and experience to the young engineers through various training programmes in collaboration with universities like Osmania and CSIR- IICB. We are also maintaining a 24 X 7 call centre in all the States with real time dash board to give critical data information. All in our technical team are enabled with a self-designed mobile application to support the work flow and process.

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BUDGET: INDUSTRY PERSPECTIVE

Industry Lauds Government Vision of Healthy India In the wake of upcoming parliamentary elections, the Narendra Modi government presented the interim-budget instead of Full Budget. The budget, which purposefully avoided any major announcement due to propriety of the interim budget, highlighted role of healthcare infrastructure and its significance. Mukul Kumar Mishra of Elets News Network (ENN) looks at what response it evoked in the healthcare industry.

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resented by the then interim Finance Minister Piyush Goyal in the Lok Sabha on February 1, the Budget 2019-2020 emphasised on creating a strong healthcare delivery system in the country while enabling people of all strata to avail quality, accessible, and affordable healthcare.

The minister underlined, for instance, about a new AIIMS in Haryana and a Centre of Excellence for Artificial Intelligence, which would lay a strong foundation for a robust healthcare system to enhance patient care.

Goyal, who replaced Arun Jaitley as finance minister when he was recuperating from an ailment in the US, announced the vision of the Government to build a distress free, functional and comprehensive healthcare and wellness system by 2030.

During the budget presentation, Goyal said: The Ayushman Bharat scheme will be scaled up to benefit more number of people with better implementation mechanism.

HOW INDUSTRY VIEWED THE BUDGET? Industry players hailed the budget

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and lauded the Government’s efforts towards creating a healthy India.

According to NATHEALTH, Healthcare Federation of India, the Interim Budget 2019 appears to be a comprehensive, wide ranging and balanced, with many positives for the health sector.

“NATHEALTH welcomes the scaling up plans for the Ayushman Bharat Mission and the government’s focus on universal health coverage that improves India’s march towards a Swasthya Bharat,” said Siddhartha Bhattacharya, Secretary General, NATHEALTH. “However, we believe it has to be done collaboratively through value based scientific costing driving sustainable pricing supported by improved ecosystem efficiency gains.”

Dr Prathap C Reddy, Chairman, Apollo Hospitals Group, said, “A forward-thinking budget with a definitive vision to accelerate much greater progress and enhance wellbeing of Indians, the allocation of Rs 6,400 crores for Ayushman Bharat is a welcome.”

“Now it is paramount, that India ramps up its efforts to arrest the

upsurge of non-communicable diseases (NCDs), which are increasing like an epidemic.”

Nilesh Jain, Founding partner, Clinivantage Healthcare Technologies, said, “The thought of accessible and affordable medical healthcare treatment is taking center stage. Adoption of new technology, AI and transparency controls via deployment of unified cloud system will help speed the success story of Ayushman Bharat.”

Dr Aashish Chaudhry, MD, Aakash Healthcare Super Speciality Hospital said Interim Budget 2019 reaffirms the government’s commitment to improve healthcare systems in the country.

“The government has presented a positive Interim Budget for the sector.

Creating distress-free health delivery systems with necessary infrastructure for comprehensive wellness of the people would be a game-changer.

However, Comprehensive Wellness for a Healthy India needs bigger collaborations and all stakeholders including private providers need to participate proactively,” said Chaudhry.

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“It is laudable that the Finance Minister has outlined the government’s vision of a healthy India with ‘distress-free and comprehensive wellness system’. Envisioning a healthy India and taking a step towards it will have a far-reaching positive effect in the years to come on the country’s healthcare delivery system,” said Saurabh Arora, Founder & CEO, Lybrate.

According to Shanthini Arunthavanathan, Chief Financial Officer (CFO), Westminster Healthcare, Chennai, “The government’s vision towards having a distress free healthcare and a functional, comprehensive healthcare system by 2030 is praiseworthy.”

“The announcement regarding setting up of 22nd All India Institute of Medical Sciences (AIIMS) in Haryana is a welcome move towards enhancing advanced medical research in India, producing a greater number of qualified medical professionals and expanding opportunities for the aspiring medical students of the country,” Arunthavanathan added.

Dr Dharminder Nagar, MD, Paras Healthcare said: “It is great to know that under Ayushman Bharat around 10 lakh sick people have already received treatment and Rs 3,000 crore have been saved by poor families. Shri Piyush Goyal also stated his government’s intention of providing an “environment of health assurance” for all people.”

“The government can now introduce new strategies to make sure that all Indian citizens are covered under some kind of health insurance by launching new insurance initiatives for the middle classes and reducing the GST slab on insurance premium from the current 18 percent,” he added.

Dr Sudarshan Ballal, Chairman Manipal Hospitals, said, “The greatest challenge in Health care today is to focus on prevention of illness, primary care, creation of

Budget Allocation • Budget allocated Rs 61, 398.12 crore for healthcare sector • Health outlay in 2019-20 is highest in the last two financial years • Rs 6,400 crore earmarked for scaling-up AB-PMJAY • Rs 1350.01 cr for setting up Health and Wellness Centres under NRHM • The allocation for NHM was raised to Rs 31,745 cr from last budget’s allocation • The budgetary allocation for the AIIMS increased to Rs 3599.65 cr from Rs 3,298 cr in 2018-19 • Rashtriya Swasthya Bima Yojna (RSBY) saw an allocation of Rs 156 crore • Rs 2,500 crore earmarked to National AIDS and STD Control Programme • National Mental Health Programme saw an hike from Rs 5.50 cr to Rs 40 cr • Rs 2,000 cr was given for establishing new medical colleges

wellness rather than treat illness and provide Universal health care for the masses. The government in its efforts to achieve these goals has spent resources and efforts to make about 5 lakh villages defecation free as part of the Swachh Bharat mission will improve sanitation which will go a long way in preventing morbidity and mortality especially in children.”

Meena Ganesh, MD & CEO, Portea Medical, said, “the Interim budget is in favor of two sections: the common man seeking access to quality and affordable healthcare; and the organizations providing this.

Given the rising cost of healthcare, the reduction in prices of essential medicines, stents, and knee implants will come as a boon.”

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NEWS HIGHLIGHTS

Latest from Healthcare World Cardiac treatment among top 3 specialties with most claims under AB-PMJAY Cardiac treatment is among top three speciailties which has received the most number of claims under the Centre’s ambitious Ayushman Bharat –Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY). Other specialities are cancer and orthopeadic treatments.

AB-PMJAY, a health insurance programme, also touted as ‘Modicare’ was launched in September 2018.

Among the packages availed under the scheme, cardiac treatment — angioplasty and stents, used to treat blockages that cause heart disease, have been the most performed high-end medical procedure, according to data provided by the National Health Authority (NHA), the apex body implementing the scheme.

More than 10.8 lakh people have availed treatment under AB-PMJAY scheme so far. More than 14,756 hospitals, both private and government, have been empanelled for the scheme and 8,03,821 claims worth Rs 1,041.3 crore have been submitted, of which 6,24,300 claims worth Rs 808.2 crore have been approved as, according to available statistics.

Haryana: Patient care gets a big boost

Prime Minister Narendra Modi has inaugurated a series of projects in Haryana to do away with existing infrastructural barrier in the direction of making healthcare delivery accessible, affordable, and cost-efficient.

Modi inaugurated National Cancer Institute (NIC) at Badhsa in Jhajjar district and ESIC Medical College and Hospital in Faridabad recently. He also laid foundation stones for series of other projects including Shri Krishna Ayush University at Kurukshetra and National Institute of Ayurveda in Panchkula.

The state-of-the-art tertiary cancer care-cum-research institute, constructed on the AIIMS Jhajjar campus, will have facilities such as 700 beds, surgical oncology, radiation oncology, medical oncology, anaesthesia, palliative care and nuclear medicine, besides hostel rooms for doctors and attendants of cancer patients, an official communiqué stated.

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Rajasthan: Naveen Jain to be Secretary, Skill, Boiler Inspection & Medical & Health Services Ashok Gehlot-led Rajasthan Government recently carried out a major reshuffle of the State bureaucracy, moving 19 IAS officers to different departments.

Many of them were given additional charges along with present responsibilities.

Naveen Jain, former Mission Director, National Health Mission & Secretary, Medical & Health, is now Rajasthan’s new Secretary for Skill, Employment & Entrepreneurship, an official communiqué said on Thursday.

Jain, who is presently Commissioner of Labour & Employment department, will also now hold the post of Secretary, Boiler Inspection & Medical & Health Services (E.S.I).

Other officers who were transferred include Bhaskar A Sawant, Ashwini Bhagat, Hemant Gera, and Shuchi Sharma.

Jharkhand: Cabinet nod to 1,300 posts of doctors, nurses In a bid to improve healthcare delivery system of the State which is facing acute manpower crunch, the Jharkhand Cabinet recently sectioned around 1,300 posts of doctors and medical practitioners across medical colleges and hospitals.

A major chunk of the posts of doctors were sanctioned for PMCH in Dhanbad and MGM in Jamshedpur, informed State Health Minister Ramchandra Chandravanshi.

“For PMCH, a total of 513 doctors were sanctioned while for MGM, the cabinet approved the hiring of 713 doctors,” Chandravanshi was quoted as saying.

He also said that additional posts were sanctioned separately for the upcoming superspecialty wing of PMCH. “For that we created and sanctioned 77 new posts of doctors, mainly specialists for different wings,” he added.

“So we have created three new posts — additional directors of administration and finance and deputy director of finance at Rims. Rims director will solely be focussing on the health aspect while the administrative side will be dealt separately. It will ease some burden on doctors and allow them to focus on offering quality services,” Chandravanshi said.

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NEWS HIGHLIGHTS

Delhi Govt launches Bike Ambulance Service for medical emergency In a bid to provide quick emergency medical aid to people, the Delhi Government has started bike ambulance services in the national capital.

Delhi Chief Minister Arvind Kejriwal along with Health Minister Satyendra Jain recently launched a fleet of 16 bikes at the Delhi Secretariat.

“This is a big step in the health sector. Everybody knows that the Delhi government is doing good works in education and health sectors,” Kejriwal said.

Initially, the bike ambulance services has been started on pilot basis for people residing in East Delhi areas to ensure immediate health assistance which becomes a major issue when a four-wheeler ambulance travels through congested lanes in national capital. Known as First Responder Vehicles, these bike ambulances will be equipped with a portable oxygen cylinder, first aid kit, air splints as well as GPS and communication device.

Govt brings 8 new medical devices under regulatory framework In an endeavour to regulate quality of commonly used devices which play a crucial role in healthcare delivery, the Health Ministry has decided to bring eight new high-end medical devices including X-ray machines, MRI and CT scan equipment, and dialysis machines under the purview of Drugs and Cosmetics Act. The Union Ministry of Health and Family Welfare has notified these devices as ‘drugs’ with effect from April 1, 2020.

The list also includes defibrillators, PET equipment, and bone marrow cell separator.

“In pursuant of sub-clause (IV) of clause (b) of section 3 of the Drugs and Cosmetics Act of 1940, the central government after consultation with the drugs technical advisory board hereby specifies the following devices intended for use in human beings as drugs with effect from the first day of April 2020 namely — all implantable medical devices, CT scan equipment, MRI equipment, defibrillators, dialysis machine, PET equipment, X-ray machine and bone marrow cell separator,” a notification issued recently by the Health Ministry stated. This move is important for patient’s safety as with this notification, all implantable and diagnostic devices will come under the regulatory framework.

BMC budget focuses on healthcare infrastructure to improve patient care In a bid to provide quality, accessible, and affordable healthcare facilities to people at large, the Mumbai civic body has earmarked Rs 4,151 crore for health in its Rs 30,692-crore budget for 2019 -20.

The allocated fund will be spent to upgrade healthcare infrastructure to enhance patient care. The budget has allocated Rs 16.38 crore for ‘aapli chikitsa’ diagnostic service, facility through which patients can avail of 101 basic and 38 advanced tests.

They can avail these services at maternity and peripheral dispensaries. ‘Aapli chikitsa’, which will be available to general public soon, will cut down the crowd at major hospitals by 30-35%.

“Our analysis shows that 1,000 patients on an average are referred from maternity homes to tertiary hospitals every day. From peripheral hospitals, the daily referrals are sometimes as high as 17,000. From every single dispensary, there are a minimum of 10 referrals every day,” Municipal commissioner I A Kundan was quoted as saying.

“The patients will get their reports on SMS and emails,” she further said.

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49

CORPORATE UPDATE

Corporate Acquisitions/Appointments Ashutosh Raghuvanshi takes reins as CEO of Fortis healthcare Fortis healthcare has appointed Ashutosh Raghuvanshi new CEO of the company effective from March 18, 2019. Raghuvansh who has years of experience in healthcare sector, will be replacing Bhavdeep Singh as CEO. “Prior to joining Fortis, Dr Raghuvanshi was associated with the Narayana Hrudayalaya group for over 18 years.

He was the Group Chief Executive Officer since November 19, 2010, Managing Director since November 3, 2011 and also served as its Executive Vice Chairman,” Fortis Healthcare said in a statement.

“We are happy to welcome Dr Ashutosh Raghuvanshi as the newly appointed CEO of Fortis healthcare,” IHH Healthcare MD and CEO and Fortis Board Member Tan See Leng said.

Raghuvanshi is M.Ch in cardio thoracic surgery from Bombay Hospital Institute of Medical Sciences, MS (general surgery) and MBBS from Mahatma Gandhi Institute of Medical Sciences, Wardha, Nagpur University.

Narayana Hrudayalaya rejigs top posts; Viren Shetty takes reins as COO Hospital chain Narayana Hrudayalaya has appointed Emmanuel Rupert as new MD and Viren Shetty COO of the company. Earlier, the company announced that its Group CEO and Managing Director Ashutosh Raghuvanshi resigned from the post.

The company board has accepted the resignation of Raghuvanshi and appointed Emmanuel Rupert new MD & Group CEO, Narayana Hrudayalaya said in a regulatory filing. Rupert has been associated with the hospital chain since 2000 and has been part of the founding team at Narayana Hrudayalaya.

Shetty, an MBA from Stanford Business School, has been on the Board of the company in the capacity of an Executive Director, and has been Sr VP Strategy since 2012.

Dabur replaces Sunil Duggal with Mohit Malhotra as new CEO Mohit Malhotra has been appointed chief executive officer of Dabur India, an Ayurveda major. Malhotra, who will be taking charge from April 1, will replace Sunil Duggal, currently the longest serving CEO at the company.

“During the last few years, the Board of Directors of the company had undertaken a succession planning exercise to identify the successor to take over the responsibility from Sunil Duggal, who has been the Dabur India Ltd CEO since 2002. Duggal was entrusted with the responsibility of ensuring a smooth transition. As a result of this process, Mohit Malhotra was found to be suitable as a successor to Duggal. Therefore, on the recommendation of the Nomination and Remuneration Committee, the board today approved the appointment of Malhotra as the new Chief Executive Officer of Dabur India Ltd,” Dr Anand C Burman, chairman of Dabur India said.

48-year old Malhotra joined Dabur in 1994 as a management trainee after completing his MBA from Indian Institute of Foreign Trade, New Delhi. He handled key assignments in marketing and sales, besides being CEO of Dabur International, based out of Dubai, before taking charge as the CEO-India Business in his current position.

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Pharma major Dr Reddy’s appoints Shikha Sharma as additional director

Shikha Sharma, Axis Bank’s former MD and CEO, has been appointed independent additional director of Dr Reddy’s Laboratories.

An official release from Pharma major Dr Reddy’s Laboratories stated that Sharma was given reins as additional director for five years.

“Shikha Sanjaya Sharma has been appointed as an additional director, categorised as independent, on the Board of Dr Reddy’s Laboratories Ltd for a period of five years, effective January 31, 2019,” the company said in a filing to the BSE. Sharma, who has more than three decades of experience in the financial sector, was the Managing Director and CEO of Axis Bank from June 2009 up to December 2018

Vyome Therapeutics raises $22 mn funding led by Iron Pillar Vyome Therapeutics, a biopharmaceutical company has raised $22 million in a Series D round of funding led by Mumbai based investor Iron Pillar.

Existing investors including Perceptive Advisors, Romulus Capital and Kalaari Capital also participated in the latest round of funding, company said in a statement.

The company will use the fund to advance its lead molecule, VB 1953.

Prior to this round of funding, Vyome had raised $3.35 million in 2012, $8 million in 2014 and $14 million in 2016.

“The closing of Vyome’s Series D (round) comes at a transformational time for the company, as we prepare to initiate a phase 2b clinical trial with our lead candidate,” Venkateswarlu Nelabhotla, chief executive officer of Vyome Therapeutics was quoted as saying.

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