Express Healthcare (Vol.10, No.1) January, 2016

VOL.10 NO.1 PAGES 72

www.expresshealthcare.in JANUARY 2016, `50

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CONTENTS MARKET Vol 10. No 1, JANUARY 2016 JOSE PETER

Chairman of the Board Viveck Goenka Sr Vice President-BPD

Neil Viegas Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bengaluru Assistant Editor Neelam M Kachhap

INDIAN HEALTHCARE: THE STORY SO FAR Experts opine on how the Indian healthcare industry has evolved in the last decade and half

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EXPRESS HEALTHCARE LAUNCHES UNICORNNEXT, A MOVEMENT TO DRIVE INNOVATION IN HEALTHCARE

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PD HINDUJA HOSPITAL HOSTS HEALTHCARE CONFERENCE

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TISS HOSTS CLAIRVOYANCE 2015

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AHPI TO HOST CONCLAVE ON ‘AFFORDABLE AND SAFE HEALTH FOR ALL’

N SANTHANAM

DR VIMAL ARORA

AMOL NAIKAWADI

DR BISHNU PANIGRAHI

DESIGN DR BS AJAIKUMAR

National Art Director

P M BHUJANG

Bivash Barua Asst. Art Director Pravin Temble Senior Graphic Designer Rushikesh Konka Artist Vivek Chitrakar, Rakesh Sharma Photo Editor

Experts opine on how the Indian healthcare industry has evolved in the last decade and half | P39

Sandeep Patil MARKETING Regional Heads

INTERVIEWS

Prabhas Jha - North Dr Raghu Pillai - South Harit Mohanty - East & West Marketing Team Douglas Menezes

P20: TYLER BRYSON General Manager, Marketing & Operations, Microsoft India

G.M. Khaja Ali Ambuj Kumar E.Mujahid Arun J Ajanta Sengupta

P22: VIJAI SHANKAR RAJA CEO, Helyxon Healthcare Solutions

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PRODUCTION General Manager B R Tipnis Manager Bhadresh Valia

P24: AAKASH SHAH Director – Sales, International and India Market, eClinicalWorks

Scheduling & Coordination Ashish Anchan CIRCULATION

P26: RAHUL SATHE Head of Surgical Innovation

Circulation Team Mohan Varadkar Express Healthcare® Regd.with RNI no. MAHENG/2007/22045,Postal Regd. No. MCS/162/2016 – 18,Printed for the proprietors, The Indian Express (P) Ltd. by Ms. Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021.

(Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021) *Responsible for selection of newsunder the PRB Act.Copyright © 2016 The Indian Express (P) Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

EDITOR’S NOTE

A not so ‘sweet sixteen’?

I

f last year’s anniversary issue celebrated the rise and rise of India's leading corporate hospital groups and profiled the next generation, this year’s focus is more somber. The Express Healthcare team brainstormed and came up with 16 areas which have seen varying pace of changes.

For instance, it was eight long years from the launch of the polio eradication programme that the WHO certified India as polio free. Other infectious diseases still plague us (no pun intended). The pulse polio campaign identified some of the bottlenecks in the public health delivery system which were systematically ironed and will no doubt accelerate the roll out of new additions to the national immunisation programme.

Similarly, we have succeeded in reducing maternal and child mortality rates. We have taken baby steps towards awareness on organ donation as well as setting up the infrastructure to transport donated organs, which is a challenge considering our congested cities. Age old ayurveda is being mainstreamed while the government is striving to increase the coverage of its subsidised medicine stores. India's experience with polio eradication is now being used in other polio-endemic countries.

But we cannot rest on our laurels. As Amitabh Bachchan, the face of India's Polio Eradication Campaign and now UNICEF's ambassador for the hepatitis B campaign, put it, let's not take another eight years to tackle other diseases like diphtheria, whooping cough, tetanus, polio, tuberculosis and measles which are all part of the government's child immunisation initiative, Mission Indradhanush. What will it take to achieve this target by 2020?

2015 saw two successful IPOs in the healthcare sector, with the Dr Lal PathLabs' IPO over subscribed 33 times, and the Narayana Hrudayalaya (NH) IPO which was oversubscribed 8.63 times.

Most IPOs across sectors were exit routes for private equity investors and market punters predict that 2016 will see another wave of such PE-exit led healthcare. HealthCare Global Enterprises is slated to IPO in the first quarter, Thyrocare Technologies filed its draft IPO papers on December 31, while Aster DM Healthcare is also eyeing this route.

IPOs market observers point out that the healthcare sector saw some of the highest success rates, an indication of investor interest in a segment still under-represented on the bourses.

In stark contrast, public healthcare remains neglected. Which is why, we at Express Healthcare decided to create a forum, Healthcare Sabha, which will focus on how India's public healthcare infrastructure can be raised to the next level, with

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As Amitabh Bachchan put it,let’s not take another eight years to tackle other diseases

the right inputs from policy makers, both global and national of course, as well as the private sector.

Do check out our newly launched website dedicated to this conclave: http://healthcaresabha.financialexpress.com.

Healthcare Sabha is set to be a meeting place for thought leaders in public health policy and delivery to discuss ways to make healthcare more inclusive. We believe that 2016 will see a new purpose to not just announce new health initiatives but also oversee that these initiatives actually deliver on the stated mission goals.

Of course, not all of this urgency is altruistic. If the Modi government hopes to be re-elected to a second term, it will have to show progress on its electoral promise of providing universal health assurance.

Thus health policy experts are optimistic that it will be forced to get its act together in 2016.

The National Health Mission has also sent operational guidelines to state governments for the implementation of its free diagnostics services initiative as well as mobile medical units. The latter initiative is geared towards increasing accessibility, while the former is a good step towards reducing out of pocket expenditure on diagnostics.

It is not just the party at the centre that will have to perform. Healthcare finally seems to have caught the attention of political parties across the canvas.

For instance, our December issue featured the plans of the Telangana government to create healthcare infrastructure in the newly formed state.

But some experts caution that we cannot expect one scheme or policy to plug all the gaps. Even universal health assurance has its naysayers, who point out that one reason why the IPOs of healthcare and diagnostics chains have done well is that the private sector is gearing up to capture a share of such government-sponsored health insurance schemes. It is obvious that such schemes will have to be outcome driven, and not service driven. Which means that service providers will have to prove benefits of the treatment recommended.

The short-term fix might be to use the expertise present in the private sector to meet the health burden on the public healthcare sector. But, the long time and tougher purpose should be to bring this expertise level to the public sector as well. Tata Memorial Hospital is one example of such a centre of excellence, and as it nears its 75th year celebrations in February, we hope it will inspire the same level of excellence in the public healthcare sector.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

LETTERS LOVED THE CONCEPT

QUOTE UNQUOTE

T

hank you for having us at UnicornNext! We loved the concept, and are hoping that you’ll have even more successful series of events moving forward.

Nidhi Saxena Founder & CEO, Zoctr

A GREAT JOB

T

hanks for inviting me. You guys did a great job.

Keep up the good work.

DECEMBER 2015

Dr Aniruddha Malpani Angel Investor

A GREAT LEARNING PLATFORM

T

hanks for giving us this platform. We had great learnings. Do keep us in the loop for the next event as well.

Vishal Mishra Creator of eye stick navigation system

(Feedback on UnicornNext, an Express Healthcare initiative. Read pages 10-13 to know more about it)

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Important: Whilst care is taken prior to acceptance of advertising copy, it is not possible to verify its contents. The Indian Express (P) Ltd., cannot be held responsible for such contents, nor for any loss or damages incurred as a result of transactions with companies, associations or individuals advertising in its newspapers or publications. We therefore recommend that readers make necessary inquiries before sending any monies or entering into any agreements with advertisers or otherwise acting on an advertisement in any manner whatsoever.

EXPRESS HEALTHCARE

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January 2016

MARKET POST EVENT

Express Healthcare launches UnicornNext, a movement to drive innovation in healthcare Healthcare innovators, entrepreneurs and investors come together on a common platform to pave the way for affordable and efficient solutions to improve healthcare delivery in India EXPRESS HEALTHCARE, a leading publication from The Indian Express Group, flagged off its first edition of UnicornNext, an initiative to drive innovation in healthcare and offer a platform for healthcare innovators, startups and investors to come together and network under one roof. It was held on December 11, 2015, at Express Towers, Nariman Point, Mumbai from 5:30 to 8:30 pm.

The event kicked off with

Viveka Roychowdhury

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January 2016

Chayan Chatterjee

a video clip of 19-year-old Harsh Songra, founder of Mychild App, who shared the highlights of his entrepreneurial story. His start-up story went viral when Sheryl Sandberg, COO, Facebook, blogged about his app,

which is being supported by Facebook under its FBStart programme.

Welcoming the audience, Viveka Roychowdhury, Editor, Express Healthcare expanded on the concept of UnicornNext. She said, “In the past two years, we’ve seen some start-ups growing into $1 billion Unicorns, while others going bust into Unicorpses. Tech companies are laying off staff even while VC funding is flowing into tech IPOs. UNICORN

Vipin Pathak

NEXT is our quest to identify and encourage the next Unicorns, the start ups most likely to make it to the growing billion dollar club.”

The next speaker was Vipin Pathak, CEO & CoFounder, Care24, a start-up which focuses on home healthcare. He spoke on the ‘Art of the Start’ and gave valuable insights on the aspects to be taken under consideration while launching a start-up. His advice was to choose to solve one prob-

lem of healthcare and be passionate about it.

Chayan Chatterjee, CoFounder & COO, Lattice Innovations, and India Partner, CamTech, spoke on ‘Hack-a-thons: Learnings for the real world’ and their relevance in the world of business. He gave a simple formula to build and sustain

INNOVATORS

start-ups, “Choose a problem-based approach, identify a minimum viable product, measure market risk and adopt market policy for sustainable growth.”

The next part of the event involved the healthcare innovators presenting their creations and explaining their application in today’s

healthcare scenario.

The first innovator was Soham Ganatra, a student from Somaiya College of Engineering. He and his team have developed a chair which would help in offering a certain amount of mobility to paralytic patients as it operates on brainwaves and blinks. Next speaker, Dr Tina

Dennis, from the Institute of Science presented her research on marine drugs which may prove to be very beneficial in treating noncommunicable diseases.

The next presenter was Vishal Mishra, Founder of Platform X. His invention was an Eye Stick, a technologically advanced but very

Vishal Mishra

A spirit of

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Breas has been motivated by the desire to improve patients’ lives and help clinicians since 1991, when the company started up in Gothenburg. From humble beginnings, it has grown into a significant player in bi-level and Home and Hospital mechanical ventilation across Europe.

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EXPRESS HEALTHCARE

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January 2016

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Dr Tina Dennis

MARKET MENTORS

Dr Aniruddha Malpani

Guests networking at UnicornNext

Madhukar Sinha

easy-to-use navigation system for the visually impaired. Rohan Sunder, another student from Somaiya College of Engineering, also presented his innovation — a gait analysis test which would be of help in physiotherapy.

The last healthcare innovator was Viraj Ranade, who alongwith his team has developed Ashioto, a digital footmat which is ideal for hospitals premises as it makes a note of the footfalls. Thus, it helps keep a track of when to clean the premises and aids in maintaining hygiene.

The next part of the event comprised mentors sharing their valuable insights with these budding talents. They lauded the innovators and took the stage to guide them on how to scale up their innovations and make them commercially viable.

The first mentor was Dr Aniruddha Malpani, an angel investor with stakes in several healthcare start-ups such as Plus91 — a health tech venture, PEAS — a health-

Dev Raman

Apoorva Patni

Nidhi Saxena

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January 2016

care information company etc. He stressed that there are three things to be considered in healthcare, i.e. human capital raised by healthcare entrepreneurs and innovators, financial capital provided by investors such as himself and lastly, social capital, referring to the impact created by the ventures.

The next mentor was Madhukar Sinha, Partner at India Quotient, a leading VC fund which has invested in healthcare start-ups such as Care24, Curofy, etc. His advice to attract funding was to identify a pain point, build a team that’s aligned with the objectives of the business and have a clear strategy to resolve the problem and achieve their goals.

Apoorva Patni, Director, Currae Healthcare, a chain of hospitals from the Patni Group, emphasised on the need for an effective pitch to attract investors. He said, “Take exclusive responsibility in anchoring important data points to draw investors’ attention.”

Dev Raman, Partner, Triton Investment Advisors, a renowned investment management firm was the next mentor. His advice was, “Idea is the first thing of a business.

Once that is in place, you need to worry about why will customers pay you.” He advised that the customers should be the focus, if one has a sound strategy in place, the investors would be definitely interested.

Last, but definitely not the least, was Nidhi Saxena, Founder & CEO, Zoctr Health.

“Start-up is not an option, it is a religion,” she said. She also advised the start-ups to focus on five things i.e. making an impact on the lives of millions, scaling up the business

to reach out to a wide audience, ensuring that the business is commercially sustainable, leveraging technology to further progress, constantly innovating to stay ahead of the competition and get returns for your investors.

Some of the other esteemed guests present at the event were Vikram Vora, CEO, MyDentist; Dr Suresh Saravdekar, Medical Consultant (Pharma and Medical devices), MCGM; Rajesh Pednekar, Mentor and Investor, Start-ups & Innovative Ventures; Dr Ashwin Bonde, Parag Vora and CA Gokul Indani, Co Founders, Pulsewell; Amey Belorkar, Assistant VP, SIDBi Venture Capital; and Bharat

Bhardwaj, Founder & Chairman, TopDoctorsOnline.

The last part of the evening was a networking session wherein innovators and entrepreneurs got a chance to directly interact with the investors and share their ideas and inventions. The speakers and guests alike were all praise for the event and opined that it was a great platform to encourage healthcare innovation and a positive step towards helping create a sound ecosystem for the growth of healthcare start-ups.

Express Healthcare would be conducting its next edition of UnicornNext shortly. Watch this space to know more about it.

EXPRESS HEALTHCARE

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January 2016

MARKET POST EVENT

PD Hinduja Hospital hosts conference on ‘Redefining healthcare: Value based delivery’ The conference brought together an interdisciplinary group of professionals working in the field of healthcare management PD Hinduja Hospital & Medical Research Center recently hosted its third national conference on the theme, Redefining healthcare: Value based delivery”. It was held on December 4-5, 2015 at the Conference Hall of PD Hinduja Hospital & MRC (Hinduja Hospital). This conference brought together an interdisciplinary group of professionals working in the field of healthcare management.

Joy Chakraborty, Organizing Chairman of the conference and COO of Hinduja Hospital gave the opening remarks and set the tone for the event.

The conference saw more than 50 key opinion leaders from the industry and academicians share their knowledge, views and experiences with the delagates. The conference aimed to capture a 360o view of valuebased delivery in the healthcare system.

The first session of the conference focused on the topic of ‘Developing Hospitals for Gen-Next’. The panel of speakers included Dr Vivek Desai, MD, Hosmac India; Gaurav Chopra, MD, HKS India; and Dr Yash Paul Bhatia, MD, Astron Hospitals & Healthcare Consultants, India. It was chaired by Maj Gen Naresh Vij, Director – Projects, Hinduja Hospital. The panelists discussed how infrastructure planning can help better patient experience and achieve value-based healthcare delivery.

The session was followed by the inauguration of the event

by Usha Raheja, Board Member & Trustee; Gautam Khanna, CEO; and Joy Chakraborty. Dr Deepak Sawant, Minister of Public Health & Family Welfare, Gov-

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ernment of Maharashtra was the Chief Guest of the event.

Addressing the attendees, Dr Sawant said, “More hospitals and other players in the healthcare sector should come forward to share, discuss and come up with suggestions to provide more focused healthcare services. Forums like these are welcome as they set the stage for private and public players to work in synergy for the benefits of the patients.”

The second session of Day 1 focussed on delivering right

and appropriate healthcare.

The session was chaired by Dr Sanjay Agarwala, Director Professional Surgery, Chief of Surgery and Head-Orthopedics & Traumatology, Hinduja Hospital. The speakers were Dr Gayatri V Mahindroo, Director, NABH and QCI; Dr Anupam Sibal, Group MD, Sr Pediatric Gastroenterologist & Hepatologist, Apollo Hospitals Group; Dr Parag Rindani, AVP & Head Wockhardt Hospitals, South Mumbai; and Chitranjan Chatterjee, Faculty

member in Corporate Strategy & Policy, IIM Bangalore.

The next session was on improving patient experience and achieving patient-centric care. The session speakers were Dr Harish Pillai, CEOAster Medcity & Cluster Head Kerala Aster DM Healthcare; Muralidharan Nair, Partner – Consulting Practice, Ernst & Young; and Bejon Kumar Misra, International Consumer Policy Expert, and Founder Trustee, Consumer Online Foundation.

Chakraborty

also elaborated with examples on how patient experience has been given importance in his organisation.

The fourth session was on ‘Enhancing quality and safety in healthcare: A mandate or choice?’ was a very interesting session that brought together all the key quality experts of the Indian healthcare industry for presentation of their perspective. Speakers of this session were Dr Prabhu Vinayagam, MD-Asia Pacific Office Singapore, JCI; Dr Mahindroo and Dr Ravindra Karanjekar, Group CEO, Jupiter Hospital. It was chaired

by Dr FD Dastur, Consultant Physician & Director - Medical Education & Hospital Quality, PD Hinduja Hospital & Research Centre.

KPMG, one of the three Knowledge Partners of the conference also released a Point of View (POV) paper titled ‘Next generation care: Helping create value-based healthcare organizations’. It was released by Utkarsh Palnitkar, Partner Head of Advisory, Head –Life Sciences, KPMG India and

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MARKET Usha Raheja. The paper proposed three amendments in the current thought process to transform the state of affairs in healthcare - first, mapping the outcomes of care that matter most to patients, rather than process outcomes which is of importance to the providers; secondly, integrating quality measurement to proper cost measurement; and finally, leveraging patient as data source and other forms of existing data, instead of capturing new information, to help design the future strategy.

This was followed by Palnitkar’s session on ‘Value Based Care Delivery: A Blue Print for Change.’

Information technology was the focus for the next session.

Titled ‘Harnessing the power of information technology’, it put forth opinions, experiences and offerings of the IT industry in delivering value-based care.

The speakers were Shailesh Mallya, AVP – Information Management , Lauren Information Technologies; Jeyaseelan Jeyaraj, Asia Pacific Director – Health Sciences Global Business Unit, Oracle Corporation; and Niranjan Ramakrishnan, CIO-IT, Sir Ganga Ram Hospital, Delhi. The session was chaired by Mahesh Shinde, Director IT – Hinduja Hospital.

The last session of the day was dedicated to customer’s voice which has lot of importance in terms of customer experience and the relationship between the provider and the customers. Titled, ‘New paradigm of healthcare delivery – Voice of customer’, it was chaired by Phalakshi Manjrekar, Director-Nursing, Hinduja Hospital. The speakers were N Santhanam, CEO – Breach Candy Hospital and Dr Anuradha Sovani, Professor & Head, Department of Psychology, SNDT Women’s University, Mumbai.

The second day of the conference began with a session on ‘Healthcare Service Delivery: Excellence, Uniqueness and Outcomes’. It brought to light the efforts made by health institutions to provide superior quality outcomes and distinguish themselves as a good healthcare provider. The session was chaired by Rana Mehta, Partner & Leader

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Healthcare – PWC. Dr Shubnum Singh, CE - Max Institute of Health Education & Research and Dr Ravi Shankar Singh, Zonal Director – Paras Hospitals in this session.

PwC, another Knowledge Partner, also released a white paper at the conference. Titled, ‘Enterprise performance management in hospital’, it highlighted the importance of enterprise performance management (EPM) in overcoming the various challenges the hospital face in providing better outcomes.

The next session was delivered by sponsors and partners.

Col (Dr) Ashok Kaushik, Professor – Dean IIHMR – Student and Academic Affairs. He gave an overview about IIHMR and the hospital industry.

Harshad Kheur from Cisco spoke about his company’s offerings and how they help in delivering value-based healthcare in the current healthcare scenario.

‘Building Human Competencies: Leveraging Human Assets’, was the subsequent topic under discussion. It was chaired by Dr Rajiv Yeravdekar, Dean of Faculty of Health & Biomedical Sciences – Symbiosis International University. Rajiv Kapoor, EVPChief People Officer, Fortis Healthcare; Swami Swaminathan, Chairman – Manipal Health Enterprises; Ashish Jain, CEO – Health Sectors

Skills Council and MS Venkatesh, Sr Director HR – Hinduja Hospital were the speakers. They spoke on how human capital is important and how to motivate, empower and retain human competencies.

The first key note speaker for Day 2 was Dr Girdhar J Gyani, Director General -AHPI. Dr Gyani addressed the attendees on ‘Adding value in healthcare delivery’.

‘Moving to value-based competition: Improving health insurance and access’ was the next session. It focussed on the insurance sector and the steps that it has taken towards achieving the theme of the conference. The session was chaired by Gautam Khanna.

Speakers were Annaswamy Vaidheesh, VP , South Asia & MD ; India-GSK Pharmaceuticals and Bhargav Dasgupta, MD & CEO, ICICI Lombard General Insurance Company.

The next topic discussed was ‘Healthcare: Competing on values and outcomes’. Dr Sujit Chatterjee, CEO, Dr LH Hiranandani Hospital, presented examples of how working with various partners of healthcare delivery helps an organisation to deliver better values and outcomes. Pavan Chaudhary, MD, Vygon was the chairperson for the session.

AB Ravi, Editor, CNBC TV18 anchored a CEO Forum on solutions to redefine valuebased healthcare and the

future of the Indian healthcare sector. The panel for this session included Khanna; Prashant Jhaveri, President Strategy -Medi Assist; Dr Sudhir Naik, President-Association of Medical Consultants Mumbai and Director, Sree Guru Hospital and Oyster Hospital; Sushobhan Dasgupta, MD, J&J Medical India, President of the Governing Council of the Healthcare Federation of India – NATHEALTH, and Chairman, FICCI Medical Devices Forum & Chair – Finance, Healthcare Sector Skills Council; and Dr Gyani, Director General, Association of Healthcare Providers India -AHPI. The panelists highlighted the issues and challenges of the current healthcare system.

Sanjit ‘Bunker’ Roy, Founder & Director, Barefoot College and Meagan Fallone, CEO, Barefoot College International were key note speakers.

Fallone presented on the activities of Barefoot College for the Tilonia village and its residents in Rajasthan. She showcased how they have made the small village self-sufficient and the village’s progress.

The session by Roy was a case study of how a highly educated person from going back to Tilonia and his struggles to tackle the complexities in making the villagers self-sufficient. He demonstrated how innovation and adoption of available resources helped im-

prove healthcare delivery for the villagers.

Knowledge Partner, IMS Health also presented a research paper on ‘The new frontiers in Healthcare Delivery and Innovation’. The paper was released by Amit Mookim, Country Principal South Asia, IMS Consulting Group and Chakraborty. The paper addresses the basic challenges of accessibility and affordability to ensure healthcare for all.

The conference concluded with a session on ‘Innovation – Shaping future of healthcare.’

It was chaired by Mookim. The speakers were Dasgupta, VT Bharadwaj, MD, Sequoia Capital; Probir Das, MD, Terumo India; and Dr Deepa Joshi, Director-Ultrasound, GE Healthcare, South Asia. They spoke on how innovation has been taking place in their respective organisations for better healthcare delivery and shaping the health industry.

Thus, over the course of two days, the speakers discussed many thought provoking issues and suggested possible solutions that would redefine the country’s healthcare system.

The day ended with the three attendees winning a tablet each in a lucky draw.

Juhi Bhandari, Asst Director Administration, Hinduja Hospital & Organizing Secretary of the conference gave a valedictory address and closed the two-day conference.

W &

ishing You a Safe, Healthy, Ansell Protected 2016

WRITE TO medical@jkansell.in TO GET YOUR FREE COPY OF HAND MUDRA CALENDAR 2016

MARKET

TISS hosts Clairvoyance 2015 Industry veterans discuss the concept of sustainability in healthcare at the two-day conference CLAIRVOYANCE, the annual signature event of the School of Health Systems Studies, Tata Institute of Social Sciences (TISS), recently organised a two-day conference on the concept of sustainability in healthcare.

Several veterans and experts from the healthcare sector spoke on various subthemes of the conference. The inaugural address was given by the Chief Guest, K Sujatha Rao, Former Union Secretary with Ministry of Health and Family Welfare. She took the delegates through the successful journey of National AIDS Control Organisation (NACO) and emphasised on the need for continuous efforts to sustain the achievements made so far.

The conference was attended by delegates from leading institutes across the country such as JIPMER, CMC Vellore, Goa Institute of Management, IIHMR Jaipur, KEM, Nair Hopital, Amrita Institute of Medical Sciences and Research Center etc.

Abhay Bang, Director, SEARCH spoke on ‘AarogyaSwaraj - Sustainable Health at the micro-level’ and Prof Gautam Sen, Founder and Chairman, Healthspring gave a speech on the need and vision for primary care in the country.

Prof R Ramakumar, Dean, School of Development Studies talked about ‘Sustainable Development and Food Security and Nutrition’ and Dr Nobhojit Roy, Surgeon and Public Health Specialist spoke about ‘environmental determinants of health and water supply and sanitation.’ He also said that achieving health is not just focussing on the Goal 3 of 17 Sustainable Development Goals (SDGs) but it is also about addressing the other SDGs that indirectly have an impact on the health of the individual and the community as a whole.

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A session was also held on ‘Stakeholders’ Onus — Taking Action Together,’ which was moderated by Prof T Sundaram. The panelists were Dr Amit Sengupta, Associate Global Coordinator, People’s Health Movement; Dr Indranil Mukhopadhay from Public Health Foundation of India; Dr Kaushik Sen, CEO and Co Founder, Healthspring; and Dr Salima Bhatia, Senior Consultant, Maternal Health Division, MoHFW. They discussed their roles towards sustainable health and healthcare systems.

The second day’s first session was on ‘360o Innovations: Revolutionising sustainable care in hospitals’. The session speakers were Dr A Lingaiah, Director – Medical Services, Yashoda Hospitals; Dr MI Sahadulla, Chairman and MD, KIMS Healthcare Group and Neeraj Garg, CEO, Apollo Health and Lifestyle.

Dr Lingaiah said, “Administration is the backbone of the hospital.” He talked about financial sustainability and about Yashoda Hospitals’ move

to go for day-care surgeries.

Dr Sahadulla talked about innovation in IT, highlighted the need for India to catch up in healthcare delivery, quality and accreditation in reducing costs, patient-centric care, medical travel etc. Neeraj Garg gave examples of disruptive business innovations, and spoke on innovation and reinvention in ambulatory care in India.

The next session for the day was on tertiary care reach strategy. The panelists were Dr Prem Nair, Medical Director, Amrita Institute of Medical Sciences; Dr Rakesh Verma, Group Head Training and Organisational Development, Narayana Hrudayalaya Hospital and Mohini Daljeet Singh, CEO, Max India Foundation.

Singh gave insights about Max Foundation’s CSR initiatives.

She said that CSR must be a fast track parallel solution. It should be a mix of healthcare awareness through immunisation, talks and screening videos.

The conference also looked into ‘Home grown models: India’s answers to sustainability’.

The speakers were Dr Raman Kataria, Co-Founder and Secretary, Jan Swasthya Sahyog and Garima Gupta Kapila, COO, Swasth Foundation.

The last session was chaired

by Prof Shalini Bharat. The speakers were Frederika Saksena, UNFPA representative; Priyanka Saksena, Technical Officer, WHO and Dr Amit Sengupta, Associate Global Coordinator, People’s Health Movement. They all highlighted the role of these global institutions in the journey towards sustainability.

The conference also had three exclusive contests for student delegates. Poster presentations were also held.

The event concluded with an address by Prof S Parasuraman, Director, TISS. The conference was well received by all the attendees.

MARKET I N T E R V I E W

‘We do design cloud solutions for hospitals as per their requirements’ Microsoft, in a bid to leverage the opportunities within the healthcare sector in India, has been developing customised solutions for various leading hospital chains.

Raelene Kambli catches up with Tyler Bryson, General Manager, Marketing & Operations, Microsoft India to know more about the solutions the company has been offering to healthcare providers in India, its strategy to deal with challenges in the Indian market and the growth areas in the healthcare IT vertical What kind of solutions do you offer in the healthcare space?

Our Microsoft Azure Marketplace offer many solutions to healthcare providers. This is an online market for buying and selling finished Software as a Service (SaaS) applications and premium datasets. The Microsoft Azure Marketplace helps connect companies seeking innovative cloud-based solutions with partners who have developed solutions that are ready to use. Our vision here is that over time companies should find our solutions very apt. For example, just like mobile applications or chat shores are available for information transfer, the same concept would be applicable to the cloud. So, in healthcare, people can log on to our Azure market place, type healthcare and get specific information on the various Azure-based cloud solutions.

Do you design tailored cloud-based solutions for the Indian market?

Yes. We do design cloud solutions for hospitals as per their requirements. Hospitals tell us their requirement and we design solutions that suits their environment better. This helps them to increase efficiency and also reach out to their customers in an appropriate manner.

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So, what kind of challenges do you face while designing solutions for hospitals that are tapping rural markets?

In the rural markets, access is a huge challenge. Getting information to the right medical practitioner at the right time is also a challenge.

Connectivity can be another big challenge in these areas.

How do you resolve these problems?

In healthcare there are many white spaces. Utilising them is one way to overcome these challenges. The other way is to design solutions that are easily useable and cloud helps you do that. When you are trying to communicate information, you do not know the strength of the end device. Hence, you need to have a cloud which is smart enough to encode the information successfully at any kind of connectivity. So, you see, the intelligence of the cloud will make accessibility possible of the right device to the right person.

Tell us about the LV Prasad Eye Institute case.

LV Prasad Eye Institute (LVPEI), in collaboration with Microsoft, is working on a model for data analytics that is set to revolutionise the healthcare sector. As per the collaboration, Microsoft and LPVEI is developing the demographic eyecare

integrating clinical data, all the way from the doorstep of patients to the boardrooms to gain insights and further, plan for delivery of healthcare services. The data will be seamlessly synced along the LVPEI pyramid when the patient is referred, enabling the clinician to have access to the right information in a temporal sequence.

If the cost of capturing medical information, storing it and then analysing it is brought down, then we will see tremendous new scenarios profile of the country. The institute is using Microsoft Azure and Power BI in the project. It is using Power BI for actionable insights on operational, business

and clinical areas as well as machine learning for clinical excellence and support in decision making. Their ‘Doorstep to Boardroom’ initiative is aimed at

In your opinion, what is the scope for Internet of Things (IOT) in healthcare? How do you see it scaling up?

I think the scope for IOT in healthcare is immense.

Hospitals have medical equipment and test equipment that are technologically advanced and can be connected to the Internet. The cost of capturing information from medical devices and equipment has been very high, if this cost of capturing the information, storing it and then analysing it is brought down, then we will see tremendous new scenarios.

Which other area do you see scope within the healthcare vertical?

I see huge scope for wearables in the Indian healthcare market.

Not just in hospitals, but also wearables to maintain personal health. raelene.kambli@expressindia.com

MARKET I N T E R V I E W

‘Our future products will find a place in the pockets of each individual’ Helyxon Healthcare Solutions has recently launched a compact fever monitoring system.

M Neelam Kachhap speakes to Vijai Shankar Raja, CEO, Helyxon Healthcare Solutions to find out about the technology and wearable devices market in India

What is the market for wearable devices in India?

Wearable devices market in India is in its stone age right now. The market can be categorised into three segments, Healthcare, wellness and fitness. The market size touched Rs 25 crores in 2014. The market is expected to jump multifold year-on-year, to a few hundred crores in 2015 and grow to more than Rs 1,000 crores in 2016.

How are smart sensors changing the way healthcare is delivered in India?

Smart sensors are those which can communicate the readings directly to the distant database over wireless network. That way the readings are directly computable and hence more reliable.

Advent of nanotechnology and ICT have created a new field called Internet of Things (IoT). These smart sensors are going to measure and continuously monitor various parameters in our body, be it chemical, electrical, temperature, etc. All these can be measured and interpreted to predict certain forthcoming changes in the health status of the patient.

Decades of investment negligence in India by policymakers have left Indian healthcare scenario just a little better than the African countries. Even our neigh-

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bouring countries like Sri Lanka and Bangladesh have better healthcare indices.

Building the infrastructure to take healthcare to the next level through conventional way is time consuming and going to need a huge investment. If we are smart, we can use smart devices to instantly scale up the system.

The new age IoT devices have the ability to work with smartphones. People have smartphones in their hand.

Network has become pervasive. There is no need for a common man to learn afresh to use a new device. Everyone has a smartphone which he/she knows how to use and they are doing it already.

While doctors are crowded in urban areas, patients are waiting eternally in the rural for a doctor’s visit. There is a clear failure of infrastructure here. We need the right platform to bridge this gap. We need right solutions for both patient and doctor to measure the parameters anywhere, anytime.

Using Internet, telemedicine is able to provide the remote doctor consultations for the patient who live in remote northeast state in hilly areas. Healthcare solutions are being developed for remote monitoring of the patient as simple as core body temperature to very complicated situation like diagnosing/doing surgery remotely

using robots.

Currently, we are focussed on establishing the business in Chennai, then in other major cities.

Before the fiscal year end we want to be available across the country

How is your product different from the existing temperature monitors available in India?

Today, there are hundreds of models of thermometer available in the market, but all measure the body temperature in that instant like capturing an act using a still camera. But what we really need is continuous monitoring like a video camera so that we don’t miss the events happening in between. This unique solution will help baby to sleep better, mothers to shed their anxiety, doctors get to see the fever trend, hospitals can bring in better efficiency of nurse usage, to name a few.

This product will replace all the mercury thermometers and digital thermometers.

Every household and hospital beds will eventually need a Fever Watch instead of a regular thermometer.

What are the price differentiators as compared to other products available?

There are mercury thermometers, digital thermometers, IR thermometers, continuous patient monitoring device and as such to measure the body temperature.

The existing continuous monitoring devices are usable only by trained professionals and it costs not less than

Rs 40,000 to Rs 50,000. Our product costs just Rs 4,999.

The IR thermometer which displays only instant temperature costs between Rs 2,000 to Rs 4,000 which is also not very accurate as many times it measures only the skin temperature and not the body temperature, which is very much influenced by the environmental conditions.

Other low cost thermometers cost few hundred rupees which are banned to be used as they use mercury which is harmful to use.

What are your plans for this product in the next financial year?

Currently, we are focussed on establishing the business in Chennai, then in other major cities. Before the fiscal year end we want to be available across the country. Next year we will be coming out with several other products which will make quality healthcare delivery affordable for anyone, anytime and anywhere.

Could you talk about your product pipeline?

Our future products will find place in the pockets of each individual, in each household and at every street corner/industry/office/villages. We will be using various technologies to make quality healthcare delivery affordable and reachable to the last citizen in the country. mneelam.kachhap@expressindia.com

MARKET PRE EVENT

AHPI to host conclave on ‘Affordable and Safe Health for All’ The event is expected to be attended by 400+ delegates from major hospitals in India and neighbouring countries

MONITORS VENTILATORS SPIROMETRY ECG DEFIBRILLATORS

ASSOCIATION OF Healthcare Providers (AHPI) is organising its 3rd annual conclave on February 13-14, 2016 at Hotel Lalit, Mumbai.

The conclave’s theme is 'Affordable and Safe Health for All’.

The event is expected to be attended by 400+ delegates from all major hospitals in the country and even from the neighbouring SAARC countries. The conclave will have sessions wherein the role of the stakeholders i.e. IT, equipment manufacturers and the pharma industry in improving safety and affordability will be discussed.

A white paper, bringing out the burning issues in sustainability of the healthcare industry, will also be released at the event. Reportedly, AHPI is engaging a renowned management consulting company to undertake a study to be released on the days of the conclave. This study would be presented to the Government of India. This initiative by AHPI seeks to create a roadmap for the stakeholders of the healthcare industry.

Reportedly, the Governor of Maharashtra would be the Chief Guest during the award ceremony which would be hosted over a gala dinner at the venue.

Express Healthcare is the media partner for the conclave.

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MARKET I N T E R V I E W

‘Our investment in India is to transform healthcare delivery using state-of-the-art technology’ eClinicalWorks, a US-based healthcare IT solutions provider recently announced a $30 million investment to further digital healthcare in Asia, specifically India and other countries in the region. Aakash Shah, Director – Sales, International and India Market, eClinicalWorks shares more details of this investment, the company's offerings for India, their strategy for the Indian market and more, in an interaction with Lakshmipriya Nair

Tell us about eClinicalWorks’ offering for the Indian market? How has it been customised to suit the Indian market? eClinicalWorks has built a successful cloud-based technology infrastructure that has positively impacted care in the US. As we expand in India, we plan to replicate this foundation and value proposition here. eClinicalWorks is offering its entire suite of products available, including a web-based, unified Hospital Management Information System (HMIS) system, its flagship cloud-based electronic patient medical records solution for physicians and primary care clinics, population health and patient engagement tools that are currently used by more

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than 1,15,000 doctors. mHealth and telehealth solutions are part of the patient engagement suite. All products and solutions of eClinical Works are customised to the locally-prevailing NABH and JCI standards with functionality being further updated to meet the operational requirements of Indian healthcare organisations.

What are its USPs? How is it different for its counterparts?

The biggest differentiator for eClinicalWorks is the extensive functionality that has been built into its solutions at an affordable price. For years, we have rolled out technologies to the healthcare industry which has solidified our position as a

The biggest differentiator for eClinical Works is the extensive functionality that has been built into its solutions at an affordable price

true thought leader. Now these path-breaking technologies are being brought into the Indian market under one integrated, cloud-based platform. eClinicalWorks is the only one which can provide 360 degree services with seamless integration to all the different components involved in delivery of healthcare in India, including the patient community. For example, hospitals can electronically manage their different departments (OPD, IPD, OT, Billing, Lab/Radiology, stores, pharmacy, etc.) under one umbrella without requiring any paper records. At the same time, clinicians can truly access pertinent patient information anytime, anywhere and deliver services through a telehealth

MARKET platform to remote patients.

Patients can also be directed towards a mobile app that will enable them to view and manage their medical records. Until this point, receiving all these benefits at an affordable cost has been unheard of in the Indian healthcare market.

You are planning to invest in the Indian market. What all would it entail? What are the focus areas?

This investment will lay a technology foundation for healthcare organisations to help meet their goals, with a major focus towards building a robust and secure cloud infrastructure for customers in Asia, especially those in India. This infrastructure will be replicated in all the key geographical locations of India to provide a fast, reliable and consistent service to across the country. Apart from this, we will strengthen our workforce to provide world-class service to our Indian customers.

How have you raised these funds? eClinicalWorks is a completely private and independent organisation, with no outside investors and zero debt. This gives us the flexibility to invest in areas where we see great potential benefits, using our existing funds. eClinicalWorks revenues this year is expected to cross $400 million. We have had 60 profitable quarters. We are a private, independent and a very entrepreneurial company.

We have been investing in R&D and new market strategies over the last 15 years. Our investment in India is to transform healthcare delivery using stateof-the-art technology.

What are the opportunities and challenges that India offers in the healthcare IT space?

With the recent Digital India initiative as well as the smartphone boom during the past few years, India stands at an interesting juncture where the healthcare sector is lagging behind other areas in terms of technology adoption. This is exactly where we see opportunity.

With the average age of people in India being 26, a large portion of the population is tech savvy and demanding smart

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services from the healthcare providers and, at the same time, physicians are looking for better technologies to provide more informed decisions for patients at the point of care.

Though there are challenges in terms of the existing Internet infrastructure and processes still mandating a lot of paperwork from healthcare insti-

eClinicalWorks revenues this year is expected to cross $400 million

tutes, we see a change coming through in the next two to five years with the Bharatnet project establishing optic fibre pipeline throughout India and the health department working towards a policy to define electronic patient records for Indian users.

What is your strategy to

penetrate the Indian market and leverage the opportunities?

Our strategy for India is simple – to provide a technology at the point of care (for hospitals, clinics, diagnostic centres) which is smarter, faster and more convenient at an affordable cost. lakshmipriya.nair@expressindia.com

MARKET I N T E R V I E W

The Ekano concept envisions how surgical care can be transformed across the entire surgical care continuum Cambridge Consultants have developed a new surgical system which seeks to provide low cost treatment to underserved patients. Known as the Ekano concept, it is aimed at laparoscopic surgeons in mid-tier and rural hospitals in countries such as India and China.

Rahul Sathe, Head of Surgical Innovation, divulges more details about the product, its benefits in the Indian healthcare scenario and the strategy to market it in India, in an interview with Lakshmipriya Nair

How did the concept of EKANO evolve? How will it serve the Indian market?

How different is the Indian market from other developed markets?

The surgical device industry is looking to emerging markets to drive significant growth and transform patient care, specifically developing tailored products for mid-tier markets. However, delivering new innovative projects requires a deep understanding of unmet needs of key stakeholders in surgical care, from patients and surgeons to nurses and hospital executives, as well as understanding challenges of infrastructure, work-flow, and equipment in hospitals and their operating theaters. Hence, our teams conducted ethnographic research in Indian hospitals to identify unmet needs and innovation opportunities, inter-

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viewing surgeons and hospital executives, and observing procedures in operating theatres. Focusing on unmet needs in laparoscopy, our team embarked on concept development, going from concept generation workshops in our Surgical Innovation Center (our own in-house operating room) to early prototype of the Ekano system in four months.

How will it enhance healthcare delivery, especially in the Indian context?

The Ekano concept envisions how surgical care can be transformed across the entire surgical care continuum. For example, its portability and low total cost of ownership allows surgeons to own the system and travel with it from hospital to hospital, thereby improving patient access to quality surgi-

healthcare players?

We are currently exploring potential partnerships with multinational surgical device companies to see how we can help transform surgery in emerging markets. At low production volumes we think this concept could be roughly one-fourth of the cost compared with conventional laparoscopy systems, achieved by making product trade-offs based on unmet needs of surgeons, patients, and hospitals in India.

We are exploring potential partnerships with MNCs for surgical devices to see how we can help transform surgery in emerging markets

cal care in rural areas. It also envisions using a Wi-Fi hotspot as a 'localised electronic medical records' system - this allows surgeons to send preoperative images (i.e CT or MRI) to the system and display them so the surgical team and nurses can plan their procedure as a team. Intraoperatively, we envision the system having good quality visualisation of tissue to enable surgeons to operate efficiently, and also use interchangeable tool tips to maximise functionality.

How do you plan to market it in India? How cost-effective would it be? Any tie-ups in the offing with other

Are you developing any more such products, specifically for India?

Cambridge Consultants is a global company that develops breakthrough products and technology for clients worldwide. We are a development partner for the world's top multinational companies, as well as early-stage dynamic start-up companies. As an example of our global footprint, we have been a development partner for Indian pharma companies, such as Sun Pharmaceuticals, helping to design, develop, and commercialise novel drug delivery devices.

We are also scaling our activities in India, Singapore and Japan to expand our service to clients and markets in Asia. lakshmipriya.nair@expressindia.com

EVENT BRIEF JANUARY - MARCH 2016 21

69TH ANNUAL IRIA CONFERENCE 2016, BHUBANESWAR

11

MEDICAL FAIR INDIA 2016

69TH ANNUAL IRIA CONFERENCE 2016, BHUBANESWAR Date: January 21-24, 2016 Venue: Hotel Swosti Premium, Bhubaneshwar Summary: Organised by the IRIA Odisha State chapter, the 69th Annual conference of IRIA will comprise scientific deliberations with intelligentsia from across the country and abroad to share their work and experience in various sub-specialities of radiology. The theme for this year's event is – Redefining Radiologist- A True Clinician.

Contact Organizing Comittee JK Diagnostics, N 5 / 98, IRC Village, Nayapalli, Bhubaneswar – 751015.

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Organiser: Messe Düsseldorf GmbH Contact Messe Düsseldorf GmbH Ph: +91 (0) 11 4855 0061 E-mail: BhardwajL@mdindia.com Website: www.messeduesseldorf.com

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cover )

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(

FOCUS:MILESTONES IN

H E A LT H C A R E

AUGMENTING HEALTH INDICES

T

he last 16 years have been eventful for India, dotted with significant achievements and failures.

The recently released United Nations Development Programme’s Human Development Report highlights that India’s gross national income has more than doubled over the last 15 years, from $2,522 (PPP) to $5,497 between 2000 and 2014.

This period also registered better human development outcomes; it went from 0.462 to 0.609 between 2000 and 2014.

There have been noteworthy improvements in health indicators such as life expectancy, infant mortality rate (IMR), maternal mortality rate (MMR) etc as well due to increasing penetration of healthcare services across the country, extensive health

campaigns, sanitation drives, increase in the number of government and private hospitals in India, improved immunisation, growing literacy etc. Initiatives such as Janani Shishu Suraksha Karyakarm, Janani Suraksha Yojana, Reproductive, Maternal, New born, Child and Adolescent Health Services; and national programmes to curb incidences of diseases such as polio, HIV, TB, leprosy etc have also played pivotal roles in improving India's health indicators. Malnutrition in children, another serious concern in India, is also being addressed at a rapid rate than ever before, as evidenced by the findings of India Health Report: Nutrition 2015, also released by PHFI recently. As per the report, the rate of decline in child undernutrition has grown exponentially between 2006 and 2014. It reveals that stunting

rates for children under five reduced from 48 per cent to 39 per cent, resulting in less stunted and wasted children.

Yet, a huge disparity in the availability of healthcare resources continue to exist in India. The rural-urban divide is considerable when it comes to healthcare access.

This is clearly reflected in the health indicators as well.

While fairly-developed states like Kerala, Maharashtra and Tamil Nadu have brought down their IMR, TFR and MMR rates to achieve the MDG goals of 4 and 5, states like Assam, Jharkhand etc continue to grapple with these issues even today.

Thus, the need of the hour is to scale up public health services, increase the number of trained health professionals and augment public healthcare spending to ensure adequate healthcare coverage.

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cover ) CRACKDOWN ON CORRUPTION

orruption, a social evil in India, has not spared the healthcare sector. Recently, several articles in various national and international publications have highlighted this issue. For instance, the British Medical Journal (BMJ) ran a series of stories on corruption in healthcare, with special focus on India. It revealed that the kickback policy is rampant within the healthcare sector in India. The National Public Radio in the US also aired a news in March this year about Dr Kunal Saha, an Indian doctor who won a case of medical negligence that resulted in his wife's death and was given a compensation of Rs 11.41 crores.

The story was about the prolonged legal battle he had to fight over 15 years before India’s apex court finally gave him the compensation. Dr Kunal's story was an eye opener about the kind of fraudulent activities happening in some wellknown medical institutes in India. Satyamev Jayate, a popular television show hosted by renowned actor Aamir Khan, also turned the spotlight on the various malpractices in India’s healthcare sector. A recent Bollywood movie 'Gabbar is Back’ was also based on the corrupt practices within Indian hospitals.

A story covered by Express Healthcare also

C

unearthed that several parents whose children have given the medical entrance exam in 2015 were receiving text messages by agents who claimed to represent various medical colleges in and around Mumbai. One of the parents shared the snapshots of these messages with Express Healthcare correspondent. As per these messages, colleges had quoted capitation fees that range anywhere between Rs 30-50 lakhs.

Moreover, these parents also informed that they receive calls with claims that they can hold seats in government as well as private medical colleges. It was also revealed that agents quote around Rs 5 crores for a post graduate seat in Navi Mumbai’s premium medical college.

The government has taken some measures to curb corruption in healthcare. In a bid to prevent the practice of kickbacks, the government has introduced stringent rules under the Uniform Code of Pharmaceuticals Marketing Ethics (UCPMP) which make it extremely difficult for pharma companies to provide any freebees to medical practitioners. Yet, corruption, a deepseated evil in our society will not be rooted out with few random measures. More concerted efforts and policies would be needed to bring it under control.

IMPROVED IMMUNISATION

rior to 1990s, India was a breeding ground for several communicable diseases. Epidemics such as poliomyelitis, diphtheria, haemophilus influenza type B, tuberculosis, pertussis, measles and hepatitis B cost several lives. Polio in the 70s left around 50,000 children crippled every year. TB, HIV and hepatitis had a devastating effect on the economy during the 80s. India’s Universal Immunization Programme (UIP), launched in 1985, sought to bring these diseases under control and better health indices. The programme consists of vaccination against seven diseasestuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles and Hepatitis B. India’s Universal Immunization Programme is one of the largest public health interventions in the country with an extensive vaccine delivery system. It comprises over 27000 vaccine storage units in 35 states across the country. 80 per cent of vaccination takes place in the outreach sessions, held in thousands each year in more than six lakh villages and other urban belts.

This programme has steadily improved public health in India. In fact, India was declared as polio-free in 2014, a major milestone in the country’s public health scenario.

Best practices and lessons learned from India's initiative are being applied by polioendemic countries like Nigeria, Afghanistan and Pakistan. The programme now serves as a model for health programmes globally - a case study which demonstrates that it is possible to

P

achieve ambitious health goals through high vaccination coverage, even in areas with weak health systems.

This year, the government also introduced the pentavalent vaccine which will provide protection to infants from five life-threatening ailments. Moreover, Mission Indradhanush launched in 2014 also seeks to strengthen immunsation coverage in India as it aims to cover all those children who are partially vaccinated or unvaccinated. This initiative has a special focus on 201 high focus districts. Of these, 82 districts are in just four states of UP, Bihar, Madhya Pradesh and Rajasthan.

Moreover, 297 will be targeted for the second phase. These districts account for nearly 50 per cent of the total partially vaccinated or unvaccinated children in the country.

Mission Indradhanush also provides protection against seven life-threatening diseases.

In addition, vaccination against Japanese Encephalitis and Haemophilus influenza type B will be provided in select districts of the country. Vaccination against tetanus will also be provided to pregnant women.

These measures have helped improve immunisation coverage to a great extent.

Between 2009-2013, it has increased from 61 to 65 per cent. The programme is being expanded and implemented at full throttle to achieve the target of full coverage by 2020. It seeks to accelerate the process of immunisation by covering five per cent and more children every year.

Thus, India has come a long way in immunisation but has to traverse far before achieving its targets.

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ENHANCING SAFETY IN HEALTHCARE

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ealthcare workers are constantly exposed to several safety and health hazards such as needlestick injuries, latex allergy, bloodborne pathogens, potential chemical and drug exposures, laser hazards, radioactive material and Xray hazards, waste anaesthetic gas exposures, workplace violence, and stress. Protecting healthcare workers from the many risks they are subjected to is a big challenge for Indian hospitals.

In the last few years, rising incidences of needle stick injuries, transmission of HINI influenza virus to healthcare workers while treating patients, terror attacks on hospitals, growing mob attacks on doctors in public hospitals, the life and death of Aruna Shanbhag, a victim of assault and rape at Mumbai's KEM hospital drew attention to the urgent need for measures to asssure safety and security of healthcare workers in India.

These incidences became a point of debate on several occasions, making it imperative to take stock of the current situa-

tion and implement measures to ensure healthcare workers’ safety. Today, most hospitals in India have set up departments and grievance cells that look after surveillance and monitoring of infection rates, needle stick injuries, safety incidents, etc.

Indian hospitals have also introduced training programmes for their employees on several topics related to hygiene, safety, security and overall well being.

Some of them consist of sessions on how to deliver care and handle blood samples of patients suffering from HIV, hepatitis B and C, and many other blood borne infections. Hospitals are also conducting vaccination programmes for their hospital staff.

Apart from this, Indian hospitals are focussing on HR policies that offer better working environment and security to their employees.

For instance, the implementation of the Sexual Harassment Act at Workplace offers a certain measure of protection to women healthcare employees.

Yet, much more needs to be done in this arena to improve the working conditions for health workers in India, in the coming years.

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cover ) BOOSTING ACCESS TO MEDICINES

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EMPHASIS ON ACCREDITATION

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espite being called the pharmacy of becomes a critical issue. To combat this probthe developing nations, over 65 per lem, the Jan Aushadhi scheme was initiated by cent of India's population did not the government in 2008. The aim was to achieve have access to essential medicines till three objectives: make generic medicines availthe government renewed its focus on able in the market; encourage doctors in governprocurement and distribution of medicines. ment hospitals to prescribe generic medicines; Experts report that during the mid-1980s, and lastly, reduce out-of-pocket expenses for approximately a third of the medicines prepatients. Although 150 more such stores were scribed during hospitalisation in public healthopened subsequently over the years, 85 are care facilities were supplied for free; however, working currently. Under the programme, 319 during 2004, the mean availability declined essential drugs were identified to be supplied sharply to approximately nine per cent. For outthrough these stores, but only 85 drugs belongpatient care, free medicine supply declined ing to 11 therapeutic groups could be sold due to from 18 per cent to about five per several reasons. The Bureau of cent over the same period. There Pharma Public Sector AS ON were reports of significant variaUndertakings of India has been tions in the availability and stock- DECEMBER 10, designated as the nodal agency outs of essential medicines 2015, THERE for running the programme. The among different states in India. programme, however, did not Several factors have influ- WERE 112 JAN make much progress as expected enced the supply and use of essen- AUSHADHI even after seven years of its tial medicines in the public health- STORES launch on account of the half care system. Poor and incomplete hearted approach of the main stocking of essential medicines OPERATIONAL stakeholders. because of inadequate budgetary IN INDIA. THE As on December 10, 2015, support is one of the main reathere were 112 Jan Aushadhi GOVERNMENT sons. Other factors are poor supstores operational in the country. ply chain management leading to IS TRYING TO The government is trying to start frequent stock-outs; prevailing START 200 NEW 200 new Jan Aushadhi stores by prescription practices leading to the end of the current financial inessential and costlier prescrip- JAN AUSHADHI year across the country. With the tions for medicines from outside STORES BY THE government’s plan to expand the the public healthcare system; and END OF THE number of drugs under the proa lack of confidence in the quality gramme to 504, including the 85 of medicines supplied through the CURRENT available now so that more drugs public healthcare system. In addi- FINANCIAL YEAR required for treating lifestyle distion, while availability may not be eases could be covered, the Jan ACROSS THE a significant barrier in the private Aushadhi scheme has received a sector, affordability often COUNTRY fresh lease of life.

uality standards for hospitals and other medical facilities improve the structure and process of care, with a good body of evidence showing that accreditation programmes improve clinical outcomes. In India, the healthcare sector is unstructured, both in terms of infrastructural capability and availability of medical personnel. There is a vast difference in the quality of rural and urban healthcare, and the services provided by private and public healthcare systems are accompanied by a significant difference in cost. Against this backdrop, accreditation appears as a favourable option to standardise care.

Experts believe voluntary accreditation of nursing homes and hospitals began in the 1930s in India with some refinement to standards being set in 1952. However, there was renewed demand for accreditation in the 1990s and recently, there has been a dramatic

increase in stakeholder interest due to growing awareness of rights, media coverage, greater consumer (patient) involvement, increasing costs of care and medical tourism.

National Accreditation Board for Hospitals & Healthcare Providers (NABH), a constituent board of the Quality Council of India, has been set up to establish and operate an accreditation programme for healthcare organisations. The board sets benchmarks for the progress of the healthcare industry.

Further, the accreditation standards released

by NABH are, in turn, accredited by International Society for Quality in Healthcare (ISQua). NABH has accredited about 320 Indian hospitals in India till date. Several hospitals in India have also gone for Joint Commission International (JCI) accreditation.

Thus, we have come a long way from the time when accreditation was a term that patients had rarely heard about.

BETTERING TREATMENT OUTCOMES WITH ORGAN DONATION

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ccessibilty of medicines, advancements in medical technology, growing health research, organ donation, improvement in the quality of care, enhanced health indices etc have led to better treatment outcomes in India. In fact, organ donation is playing a major role in saving a lot of lives. Cadaver transplants is also gaining acceptance in the community, especially in Tamil Nadu. In 2008, the state government put together systems and procedures to introduce the Cadaver Transplant Programme (CTP).

The majority of organ donations in India are by living related donors, often involving considerable risk. Deceased donation following brain death can bridge the huge gap between the requirement and availability of organs in India. It is estimated that there is a need for more than 1, 75,000 kidneys, 100,000 livers, 50,000 hearts, and 20,000 lungs in a year. A robust organ

donatio programme could give many terminally ill patients a fresh lease of life. The government should support the programme by providing better storage and transportation facilities.

In the last two years, donations resulted in 1150 solid organs like kidney, liver, heart, lung, pancreas and intestine being retrieved.

One of the major reasons for this success is the improved transport facility called ‘green corridor’. The first green corridor was initiated in Chennai to transport an organ from one hospital to another within the city itself. However, in September 2014, a heart was transported from Bengaluru to Chennai in two hours with the help of different stakeholders. Following this, many cities understood the value of green corridor and similar feats was achieved in Mumbai where the donor organ came from Pune, Delhi-Gurgaon and even Indore.

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cover ) FORTIFYING LEGISLATIONS

STREAMLINING AYUSH

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egislations play a vital role in improving public health. They assist in creating public health agencies, defines their roles and provides authority to ensure quality health services. However, given the multi-faceted and fragmented nature of the Indian healthcare industry, challenges in regulating the sector is immense. Yet, several important policies and laws have been drafted and brought into effect in the last two decades. A few notable mentions would be: The Clinical Establishments (Registration and Regulation) Act, 2010: It was enacted by the Central Government to ensure registration and regulation of all clinical establishments in India and assure minimum standards of facilities and services provided by them. The Act is applicable to all kinds of clinical establishments from the public and private sectors, of all recognised systems of medicine including single doctor clinics. It sought to standardise healthcare services to an extent.

PC-PNDT Act 2003: The Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 (PNDT), was amended in 2003 to The Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition Of Sex Selection) Act (PCPNDT Act). This move was to prevent the use of technology in sex selection and reduce female foeticide and was more stringent than its predecessor.

The Cigarettes and Other Tobacco Products Act (COTPA) 2003: This Act was

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passed to curb tobacco consumption, a leading cause for rising incidences of cancer and several other non-communicable diseases. It consisted of three important provisions: + Prohibition on smoking in indoor public places. + Ban on advertisement of tobacco products at all venues, with a few exceptions. + Prohibition on tobacco sales within 100 yards of schools to prevent children below 18 years from getting access to such products.

Drugs and Cosmetics Act: It sought to create regulatory provisions for import, manufacture, sale, distribution and export of medical devices and for regulating conduct of clinical trials in India. It also comprises provisions for setting up of a Central Drugs Authority (CDA) for regulation of drugs and cosmetics. Several recent reforms also sought to improve safety and efficacy of clinical trials in India. An Expert Committee set up by Central Drugs Standard Control Organisation (CDSCO) has formulated a good clinical practice (GCP) guideline for generation of clinical data on drugs.

Several other crucial bills such as the proposed Assisted Reproductive Technology (ART) Bill, Mental Health Bill etc are also under consideration. Yet, as it is often the case in India, despite the good intent we fail to implement laws effectively. A lot needs to be done under the this area to ensure more effective legislations to regulate healthcare in India.

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2,827 ayurvedic, 252 unani, 264 siddha and 216 homeopathic centres operating across the country.

Among them, ayurveda practitioners’ number stands at 3.99 lakhs, while homeopathy practitioners amount to 2.8 lakhs. There are 47,683 unani, 8,173 siddha and 1,764 naturopathy practitioners registered in the country. The minister also informed that there are 25,492 AYUSH dispensaries in the country.

Currently, the government is planning to create a special cadre of AYUSH practitioners and paramedics for village postings to tide over the shortage of doctors in rural India. Sources in the Health Ministry say that the Medical Council of India (MCI) and the Indian Medical Association (IMA) are both being consulted on the proposal and have been asked to come up with modalities. The move legally permits practitioners of the Indian systems of medicine or AYUSH to practice allopathy by getting the required permissions from the MCI, the medical education regulator. The proposal envisages development of training modules in integrated medicine for AYUSH practitioners and paramedics who can then be posted in villages to enable treatment access to the rural population. A good move indeed, if implemented effectively. This strategy can help in increasing access to healthcare in the hinterlands of India. However, there is a need for policies and laws which will ensure quality and standardised care by the AYUSH practitioners.

he Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy, abbreviated as AYUSH, has been integrated into the Indian national healthcare delivery system to strengthen public health in rural India. The department was created in March 1995 as the Department of Indian Systems of Medicine and Homoeopathy (ISM&H) under the Ministry of Health. AYUSH received its current name in March 2003.

In 2005, the Indian government launched the National Rural Health Mission (NRHM) to improve healthcare delivery in the rural areas of the country, in which AYUSH was integrated as an important strategy. This was done with the objective of offering more treatment options to people as well as a strategy to overcome the shortage of doctors working in the government health facilities. However, the planning and implementation of AYUSH differs across various states, depending upon the existing level of development of AYUSH services in the state. It became a full-fledged ministry in November 2014 after the Narendra Modi-led government came to power.

According to Minister of State (Independent Charge) for AYUSH, Shripad Yesso Naik, in April 2015, the country had 7.37 lakh practitioners of alternative medicine streams registered with them and over 3,600 AYUSH hospitals—including

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STRENGTHENING COMMUNITY HEALTH

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introduced by the National Rural Health Mission (NRHM) in 2005, are the key cadre in India’s community health programme that seeks to improve maternal and child health. The ASHAs have played three major roles: they function as a ‘link worker’, between the underserved population and the health service centres, secondly they are also trained and provided with a kit that comprises condoms, oral contraceptive pills, delivery kits and simple life saving drugs. They are also ‘health activists’ who create awareness on health and mobilise the community towards health planning.

The Khoj programme by the Voluntary Health Association of India (VHAI) is another project which has effectively used community health workers to enhance the knowledge and practice of community members on health, nutrition, water and sanitation.

The Comprehensive Rural Health Project, Jamkhed (CRHP) is another endeavour which works towards the betterment of the rural poor and marginalised. They also mobilised and strengthened communities through a primary community-based healthcare (Jamkhed Model).

Recognised by the WHO and UNICEF, CRHP has been introduced to 178 countries across the globe.

Reportedly, it has also trained over 22,000 local and 2,700 international representatives from NGOs, governments and healthcare professionals in the CRHP approach. Thus, community health has got an impetus in the last two decades.

INCREASED INSURANCE COVERAGE

n India, most of the health expenditure is out-of-pocket. The amount of money individuals spend on medical treatment come to around Rs three lakh crores annually in India, of which only Rs 20,000 crores are through insurance cover.

The rest Rs 2.8 lakh crore is spent on medical treatment, particularly by the poor and lower middle class through out-of-pocket expenditure.

Health insurance, in the form of healthcare financing (Mediclaim), was introduced in India during the 1980s. Through the years, health insurance in India has increased with both private and public companies offering various packages. Although one thing remains the same in India’s health insurance scenario, it is limited to in-patient hospitalisation, outpatient services are not payable under health policies in India.

The World Bank suggests that more than 550 million Indians now have some form of health insurance coverage, representing nearly ten-fold increase over the number a

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decade back.

The Rashtriya Swasthya Bima Yojana (RSBY), a centrally sponsored health insurance scheme, has been one of the most successful ones. Launched in 2007, it provides coverage to the population below the poverty line. The health insurance cover provided to the poor in Tamil Nadu has also been vastly successful. It has not only helped the poor get treatment but also helped the government to earn money through the insurance claim. The Tamil Nadu government’s popular health card scheme that provided insurance up to Rs two lakhs per family or individual has helped the General Hospital in Chennai alone earn Rs 18 crores last year by way of insurance claims for treatment of poor people covered under the scheme. At present, the RSBY is being implemented in 19 states/ UTs through the insurance mode. Total 3, 68, 36,005 beneficiary families have been covered under the RSBY Scheme.

Yet, medical insurance in India is yet to take off fully and several measures are needed to improve and expand insurance coverage.

he role of community health workers (CHWs) is pivotal to countries like India, which has witnessed phenomenal successes in various fields, yet continues to grapple with several challenges when it comes to healthcare. A WHO Study Group defines them as members of the communities where they work, selected by the communities, answerable to the communities for their activities, supported by the health system but not necessarily a part of its organisation, with shorter training than professional workers.

Either paid or voluntary workers, CHWs in India are part of government or national programmes, and have contributed significantly to have help reduce health inequity, one of the biggest hurdles that emerging economies continue to face.

They have helped revitalise primary healthcare and improve community participation in the attempts to achieve targets such as ‘Millenium Development Goals’. CHWs interact with families to improve their health and nutrition and facilitate access to treatment. Through their efforts, India has managed to increase outreach of health services, enhance patient adherence to treatment regimens and provide better health education to the masses. The support and supervision of the community worker is indispensable to the success of community health programmes.

Accredited Social Health Activists (ASHAs),

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cover ) ENHANCING NATIONALHEALTH PROGRAMMES Societies and select Municipal Corporations.

Concerted efforts through this programme ensured significant reduction in the number of HIV infections across the country. As per National AIDS Control Organisation data, India demonstrated an overall reduction of 57 percent in estimated annual new HIV infections (among adult population) from 0.274 million in 2000 to 0.116 million in 2011, and the estimated number of people living with HIV was 2.08 million in 2011.

National Programme for Prevention and Control of NCDs: The NPCDCS’ objective is to integrate the non-communicable diseases (NCDs) interventions in the NRHM framework in abid to optimise scarce resources and make provisions to ensure long term sustainability of these interventions. The NCD cell implements and supervises activities connected to health promotion, early diagnosis, treatment and referral, thereby facilitating partnership with labs for early diagnosis in the private sector. It also seeks to create and sustain a fortified monitoring and evaluation system for public health through convergence with the ongoing interventions of National Rural Health Mission (NRHM), National Tobacco Control Programme (NTCP) and National Programme for Health Care of Elderly (NPHCE).

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ational health programmes, launched by the Government of India, have been playing crucial roles in tackling several serious health concerns, communicable and noncommunicable diseases, over the last two decades. They have helped handle increasing disease burdens of emerging and re-emerging diseases such as drug-resistant TB, malaria, AIDS and leprosy with considerable success. Some of them saw accelerated progress in the last two decades and have helped improve the healthcare facilities to the underserved.

Some leading national health programmes are as follows: Pulse polio programme: Introduced in 1995, it aimed to immunise children in the age group of 0-5 years by administering polio drops during national and sub-national immunisation rounds (in high risk areas) every year. Celebrities like Amitabh Bachchan were roped in to educate the masses about immunisaton against polio. Through extensive campaigning and public awareness ads, the cases of polio reduced drastically. The last polio case in the country was reported from Howrah district of West Bengal on 13 January, 2011. Thereafter, no polio case has been reported in the country.

WHO declared India polio-free last year, a major

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achievement.

The Revised National Tuberculosis Control Programme: It was initiated with the objective of ensuring access to quality diagnosis and care for all TB patients. Several notable activities were implemented under this programme in 2012 to improve its efficacy. These included notification of TB; case-based, web-based recording and reporting system (NIKSHAY); standards of TB care in India; Composite indicator for monitoring programme performance; scaling up of the programmatic management of drug resistant TB services etc.

NIKSHAY, the web based reporting for TB programme has enabled capture and transfer of individual patient data from the remotest health centres of the country.

National AIDS Control Programme: Launched by the National AIDS Control Organization, Ministry of Health and Family Welfare from December, 1999, it encouraged and enabled the states to take the onus of responding to the epidemic and promoted growing partnerships between government, NGOs and the civil society. The AIDS - II project of the National AIDS Control Programme also includes a scheme with 100 per cent financial assistance from the central government to state AIDS Control

Mission Indradhanush: Launched by the Ministry of Health and Family Welfare (MOHFW) in 2014, Mission Indradhanush’s objective is to ensure full immunisation of all children under the age of two years as well as pregnant women against seven preventable diseases namely: + Diphtheria + Pertussis (Whooping Cough) + Tetanus + Tuberculosis + Polio + Hepatitis B + Measles Recently, the vaccines for Japanese Encephalitis (JE) and Haemophilus influenzae type B (HIB) are also being provided in selected states, under this programme.

The way foward These programmes have significantly contributed to the betterment of public health in India and ensure health access to the rural and remote parts of the country. However, there are several gaps that need to be plugged to improve and optimise their impact. Challenges to be tackled include inadequate funds or delay in releasing them, lack of coordination between the stakeholders, insufficient capacity of well-trained, motivated health workers etc.

It is of utmost importance to address these challenges and thereby enhance the impact of such programmes as it would help India achieve the goal of ‘Health for All’.

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LAUNCHING THE NATIONAL HEALTH MISSION

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5 years back, India's healthcare system suffered from several systemic deficiencies.

These included lack of a holistic approach, absence of linkages with collateral health determinants, gross shortage of infrastructure and human resources, lack of community ownership and accountability, non-integration of vertical disease control programmess, nonresponsiveness and lack of financial resources. On April 12, 2005, the Government of India launched a major welfare initiative, the National Rural Health Mission (NRHM) in 18 states (including eight Empowered Action Group (EAG) states, the North-Eastem states, Jammu & Kashmir as well as Himachal Pradesh) with weak public health indicators and infrastructure.

Eventually, it was extended across the entire country.

The Mission aimed at making the public health delivery system fully functional and accountable to the community, human resources management, community involvement, decentralisation, rigorous monitoring and evaluation against standards, convergence of health and related programmes form village level upwards, innovations and flexible financing and also interventions for improving the health indicators.

One of the success stories being attributed to NRHM is a huge increase in institutional deliveries.

ASHAs (around 7.5 lakhs in number) at the grassroot level have mobilised women from valuable community to come to institutions (the number of beneficiaries under JSY had increased from seven lakhs in 20052006 to over 86 lakhs in 2008-2009).

However, it is critical to ensure that there is corresponding increase in inputs available at the facilities, so that health outcomes for mother and

baby are ensured. There definitely have been gains as shown by statistics - infant mortality rate has come down to 53/1000 live births, maternal mortality rate has come down to 254/1000 live births and total fertility rate is now 2.7.

In the year 2013, the UPA government, as part of the 12th five year plan, extended the provision of the this mission to the urban poor as well and launched the National Health Mission that included the NHRM and National Urban Health Mission (NUHM). Under the NHM, efforts were taken to consolidate the gains and build on the successes of the NHRM to provide accessible, affordable and quality universal healthcare, both preventive and curative, which would include all aspects of a clearly defined set of healthcare entitlements including preventive, primary and secondary health services.

As reducing maternal and child mortality are the foremost goals of the National Health Mission it has significantly fostered plans for child health in a decentralised manner upto district level. Steady progress in curbing child deaths has been achieved. India’s under five mortality rate declined from 126 per 1,000 live births in 1990 to 49 per 1,000 live births in 2013.

In 2014, Mission Indradhanush was launched under the NHM to fill the gaps in immunisation. Further on, the ministry has called for the participation and partnership of the private sector in providing accessible, affordable and cost effective healthcare services in the country to complement the efforts of the NHM. It is one of the major initiatives undertaken by the Indian government. However, to ensure its success, it is vital to ensure transparency in its implementation.

RENEWED FOCUS ON SANITATION

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anitation and healthcare very closely interlinked. Hence, in a bid to improve public health in India, several sanitation programmes have been introduced in the country over the years. Central Rural Sanitation Programme, started in 1986, was one of independent India’s initial efforts to provide safe sanitation in rural areas. It focussed on providing subsidies to construct sanitation facilities.

Later, it was restructured and renamed as the Nirmal Bharat Abhiyan. The scheme's revised

target was to achieve total sanitation by 2022. Its goal was not only universal toilet coverage by 2022, but also improving health and providing privacy and dignity to women, with the overall goal of improving the quality of life among the rural population.

Sanitation again came into the limelight when in 2014, Narendra Modi, the Prime Minister of India launched the Swachh Bharat Mission. Nearly 95 lakh toilets have been constructed in the rural areas during the first year of the Swachh Bharat Mission.

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cover ) ADVENTOF TECHNOLOGY

echnology has changed the way we lead our lives, be it the way we shop communicate, work or the way we travel. In the last two decades, advent of technology has also been transforming healthcare delivery. Whether, it is patient interaction, treatment, diagnostics or research, technological innovations have given medical providers new tools to look at the disease and treat the patients more effectively.

Information technology has made patient care more efficient and safer. The Internet has changed everything and its effect is evident on healthcare. From sharing knowledge to bringing doctors and patients closer, the Internet is impacting healthcare in a big way.

While electronic health records (EHR) have already created big strides in the centralisation and efficiency of patient information, it can also be used as a data and population health tool for the future. Mobile health is freeing healthcare devices of wires and cords and enabling physicians and patients alike to check on healthcare processes on-the-go.

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Telemedicine and remote monitoring tools have changed the way healthcare is delivered in India. It has also aided in addressing the industry’s two biggest problems: accessibility and lack of manpower. Several telemedicine centres in smaller towns are connecting patients to specialists in metro cities.

Genomic sequencing has turned the healthcare industry upside down. Personalised medicine is no longer a dream and is being practised in India. With the rapid development in next generation sequencing techniques we are now able to detect defective genes that can be targeted for therapeutic response.

However, the most unmistakable way technology has changed healthcare is by providing new machines, medicines, and treatments that save lives and improve the chance of recovery for billions.

From robotic surgical tools to radio-surgery techniques, and sophisticated imaging techniques to digital microscopes, technology has penetrated every aspect of healthcare delivery.

LOWERING DRUG PRICES

espite being a leading exporter of pharma products, India faces a serious crunch when it comes to ensuring access to medicines to its own populace. The majority of the Indian population pays for their healthcare expenses from their own pockets.

Reportedly, medications and health services comprise 60 – 90 per cent of this expenditure. Hence, the government over the past two decades has undertaken several measures to regulate the drug market in India and ensure quality and affordability alongwith availability of medicines.

Setting up the National Pharmaceutical Pricing Authority (NPPA), in 1997, under the Ministry of Chemicals and Fertilizers was a major step to make medicines more affordable to its population.

The Pharmaceutical Policy 2002 also furthered the cause of ensuring quality drugs at reasonable prices, encouraging indigenous production of medicines for cost-effectiveness, curbing trade barriers and giving an impetus to in-house R&D efforts of domestic pharma players.

In 2003, the Mashelkar Committee conducted a comprehensive study on the growing presence of spurious and sub-standard drugs in the country and recommended several stringent measures at Central and state levels. The Commitee’s efforts brought to light that the country had only 17 quality-testing laboratories, of which only seven laboratories were fully functional. This highlighted the need for more effective measures to improve the quality of drugs.

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The National Pharmaceuticals Policy 2006, also recommended several steps to increase the number of bulk drugs under regulation, regulate trade margins and establish a new framework for drug price negotiations to make drugs more affordable.

In May 2013, the NPPA was authorised by the Ministry of Chemical and Fertilizers (Department of Pharmaceuticals) to regulate the availability and pricing of all the drugs mentioned in National List of Essential Medicines (NLEM), 2011. This led to a dramatic reduction in the prices of 348 essential medicines and the public could avail them at low cost.

An year later, in May 2014, a Drug Price Control Order (DPCO) authorised the NPPA to control prices 108 life-saving drugs that were not mentioned in the NLEM originally.

This move also led to significant reduction of several life-saving drugs for diseases such as cancer, HIV/AIDS, tuberculosis, cardiovascular diseases, diabetes, etc. However, in September 2014, the Department of Pharmaceuticals, Ministry of Chemical and Fertilizers, Government of India issued a notification by which 108 drugs under price control policy were withdrawn with immediate effect.

Thus, several measures have been taken from time to time to improve the availability of quality drugs, yet the verdict on their impact remains mixed. Several times, these steps for drug regulation have come under scrutiny and criticism. The need of the hour is to revamp the system and put better measures in place for further progress.

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JOSE PETER

INDIAN HEALTHCARE: THE STORY SO FAR Experts opine on how the Indian healthcare industry has evolved in the last decade and half

N SANTHANAM

DR VIMAL ARORA

AMOL NAIKAWADI

DR BISHNU PANIGRAHI

DR BS AJAIKUMAR

P M BHUJANG

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cover ) ALTERNATIVE THERAPIES NEED GREATER RECOGNITION AND ENCOURAGEMENT

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journalist asked the Police Commissioner of Delhi how is he going to enforce the odd-even car numbers on alternate days to combat pollution in National Capital Region since he does not have adequate force to watch every street. Smart response from the top cop was every citizen would participate and join the police in this mission! True, creating awareness against pollution is job half done. Healthcare is no exception and we have seen this in the past decades. Take the example of our country, which is considered the diabetic capital of the world. How the strong awareness created to have early detection and change

in life style has almost taken away the sting of this once considered dreadful disease. People have now realised they can lead normal life despite being diabetic.

The other major challenge that has been cracked is in the area of diagnosis. Earlier doctors had to do trial and error to rule out possibilities. Technological explosion has enabled the medical world to pin point not only the disease type but also facilitate targeted therapy. It has resulted in early treatment and lesser side effects.

On the surgery front the buzzword has become non-invasive and minimal access. Open surgeries are history. Minimum blood loss, shorter hospitalisa-

tion days and quicker resumption of routines are now possible, thanks to robotics.

Moreover, the focus has shifted from illness to wellness.

Annual check ups are becoming a part of life. Today, genetic studies give early warnings for change in life style!

Given the lesser number of hospital beds (one bed for every 350 in the US, 85 in Japan and 1050 in India) home care, be it palliative or otherwise, is gaining importance.

On the technology front, electronic communication has brought about sea changes. Tele radiology/medicine is a boon to rural people. Online medicine is reducing not only the sole dependence on distribution chan-

nel but also cost per se! Web casting and mobile apps let rural doctors get their Continuous Medical Education from opinion leaders living in urban cities.

But the challenge remains on how do we democratise healthcare. With 70 per cent of the population in rural areas, major happenings of the last decade are still to penetrate these areas.

Non-availability of qualified medical professionals (0.7 doctors and 1.5 nurses per 1000) and high cost of medicare are the burning problems, which need to be urgently addressed.

Commendable initiatives taken in eye and cardiac care by private doctors make one believe that several other initiatives are in the realm of reality.

N SANTHANAM CEO, Breach Candy Hospital

However, the government has a major role to play. Private – public initiatives have to mushroom. Make in India movement has to find a deep-rooted place in manufacturing low cost medical equipment and devices. Locally made cardiac stents have paved the way. All that is required now is a greater push.

Alternative therapies need greater recognition and encouragement.

Lets hope the coming decade squarely addresses all the above and make India an all-inclusive healthier nation!

THERE HAS BEEN ATREMENDOUS IMPROVEMENT IN THE QUALITY OF HEALTHCARE SERVICES IN INDIA

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ver the years, India has seen tremendous improvements in its healthcare sector.

Some of them are as follows:

Accreditation The standard of healthcare services in terms of cost, diagnostic procedures and therapeutic procedures may differ between various providers.

Over the last few decades, there has been a tremendous improvement in the quality of

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healthcare services in India.

This is illustrated by the significant improvement in health indicators such as life expectancy at birth, infant mortality rates, maternal mortality rate, etc., over this period. Standardisation of protocols through accreditation could be an effective step for eliminating disparity in the quality of healthcare services being offered. Accreditation offers advantages of higher efficiency, accountability and governance.

The National

The Transplantation of Human Organs (Amendment) Bill, 2009

gal dealings. This Amendment Bill provides for the regulation of the transplantation of human tissue along with the transplantation of organs. The amended bill regulates removal, storage and transplantation of human organs and seeks to strengthen provisions to curb commercial trade in human organs while facilitating organ transplantation for needy patients.

It is meant to streamline the process of organ transplantation and curb instances of ille-

Aruna Shanbaug judgement

Accreditation Board for Hospitals and Healthcare Organisations (NABH) is a branch of Quality Council of India set up with the cooperation of Ministry of Health and Family Welfare. The first set of NABH standards for hospital accreditation were released in 2005.

DR BISHNU PANIGRAHI Group Head, Medical Operations, Fortis Healthcare In a path breaking judgement, the Supreme Court of India allowed ‘passive euthanasia’ or withdrawal of life support to patients in permanent vegetative state (PVS). Simultaneously, it rejected outright active euthanasia or administration of lethal substances to end life. The court refused mercy killing for Aruna Shanbaug who lay in a

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FOCUS:MILESTONES IN

vegetative state for 37 years. It did set tough guidelines for passive euthanasia ensuring its implementation under a court monitored mechanism.

Medical tourism India has emerged as one of the top three destinations for medical tourism in Asia.

Within Asia, India, Thailand and Singapore are the three countries that receive maximum medical tourists owing to low cost of treatment, quality healthcare infrastructure, and availability of highly-skilled doctors. Estimates suggest that India's medical tourism market is expected to more

H E A LT H C A R E

Yeshasvini Co-operative Healthcare Insurance

to the co-operative farmers of Karnataka. It was designed for the farming community to undergo hospitalisation when required at a medical centre of their choice.

Yeshasvini Cooperative Farmers HealthCare Scheme (Yeshasvini Scheme) was introduced by the state government

This particular healthcare model involves: ❖A small monetary contribu-

than double in size from $3 billion at present to around $8 billion by 2020.

tion ❖Minimised administrative costs ❖Successfully ‘packaged’ hospital prices at pre-agreed, reasonable levels.

Presently, Yeshasvini is one of the largest self funded healthcare scheme in the country.

THERE IS A GROWING CONSCIOUSNESS ABOUT HEALTH RELATED ISSUES AMONG PEOPLE

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ndia has taken some landmark initiatives over the years to better its healthcare system. On April 12, 2005, the Ministry of Health and Family Welfare launched the National Rural Health Mission (NRHM) to address the problems of healthcare in rural areas. Under the mission, healthcare funding had increased from Rs 27,700 crores in 2004-05 to Rs 39,000 crores in 2005-06 (from 0.95 per cent of GDP to 1.05 per cent). At the national level, infant mortality rate reduced to 30/1000 live birth and maternal mortality ratio reduced to 100/100,000. Malaria mortality reduction rate 50 per cent up to 2010, additional 10 per cent by 2012. Leprosy prevalence rate reduced from 1.8/10,000 in 2005 to less than 1/10,000 thereafter. In the same year, the tuberculosis DOTS programme maintained an 85 per cent cure rate.

In 2006, the government announced to build new AIIMS or AIIMS like institutions in Jodhpur, Patna, Raipur, Bhopal, Rishikesh and

Bhubaneswar to bring down the cost of treatment.

Since 2006–15, 16 new AIIMS and AIIMS like institutions, were announced in the Union Budget, however, the construction for 2006 AIIMS like institutions started in 2009 and 2010 with 60 per cent of work completed. In Bhopal AIIMS, the cost of construction is said to have doubled from its 2009 estimate of Rs 682 crore. The main challenges for these institutions are shortage of doctors, nurses and trained staff. Most institutes are outsourcing nursing staff to external agencies, for instance. AIIMS Raipur has only 64 faculty members for the 24 non-clinical and clinical departments out of the required 41. There is no doubt that these facilities are required to create better health outcomes. Currently the need is to strengthen the primary and secondary care network.

Apart from this, the National Programme for Prevention and Control of Diabetes, CVD and Stroke (NPDCS) was launched in January 2008. The

objective of the pilot phase was risk reduction for prevention of NCDs (Diabetes, CVD and Stroke) and early diagnosis and appropriate management of diabetes, cardiovascular diseases and stroke.

The impact was great as there awareness was generated on healthy lifestyle, health promotion at school, community and work places and decrease in the incidence of non–communicable diseases.

A tax benefit of Rs 5000 was implemented on preventive healthcare check-ups. In the Union Budget, the Government of India announced tax benefits by widening the scope of Section 80D (IT Act). A complete tax waiver was given on payment made on account of preventive health check-up of upto Rs 5000 within the overall deduction of Rs 15,000 available with respect to premium paid towards a health insurance policy for self, spouse and children. A similar deduction is available for investments on policy for parents.

There is a growing consciousness about health re-

lated issues among people, giving a boost to preventive health check-ups in hospitals.

Annual health check-ups, which were largely the privilege of corporate executives, are now being sought after by the middle class as well. Most hospitals routinely cater to walk-in patients that avail tailor-made packages for all age groups.

We have observed a rise in the number of people who have come for check ups, especially from the corporate sectors/working population.

There has been an average increase of 15-17 per cent in increase of check ups till now.

Relative to treatment procedures, preventive health interventions are cost-effective, both from the prospective of health service payers and public funded health systems.

Early diagnosis and prevention of disease and its symptoms reduce burden on inpatient/outpatient care, ambulatory services, medications and rehabilitation.

In October 2015, a new ayurvedic medicine for type-II

AMOL NAIKAWADI Joint Managing Director Indus Health Plus

diabetes, BGR-34, was launched. The Lucknow-based Council of Scientific and Industrial Research (CSIR) laboratories prepared new and effective Ayurveda drug made from four plant extracts to treat diabetes. The drug, introduced in tablet form, may cost Rs 500 for 100 tablets. If taken for a longer period, it may also reduce dependence on insulin. The tests carried on animals and related scientific study found it to be safe and effective with clinical trials showing 67 per cent success.

The development of 'BGR34' will help to eradicate diabetes in India, which is also known. as the 'Diabetes Capital.' It is an innovation for the masses developed within the resources available with the institutions and has the potential to cut through the market.

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cover ) INCREASED AWARENESS ABOUT IMPORTANCE OF QUALITY IN HEALTHCARE IS AWELCOME DEVELOPMENT

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he last 15 years of the new millennium have been both exciting and challenging for the healthcare sector in India. There have been great strides in medical equipment technology. The diagnostic armamentarium has become very accurate, fast and less painful. Similarly, automated highly sensitive laboratories are providing fast and accurate results for the clinicians to make early diagnosis.

There is equally impressive progress in the therapeutic areas. Cardiac angioplasties, Carotid block removals, minimal access surgeries, most accurate and blood less robotic surgical procedures are some examples. There are also advances in radiotherapy, chemotherapy in cancer patients and heart, lung and pan-

creas, transplants in addition to kidney and liver transplants.

The real fascinating development is in healthcare IT sector. It has revolutionised the delivery of healthcare. Use of computers and transmission of prescription through them have not only reduced the waiting period but errors are also minimised. The real time information about the patients to the doctors and nurses on their smart phones and tabs has made it possible for the doctors to constantly monitor the patients’ health status and to give timely advice even when he is away from the patient.

Telemedicine is another remarkable progress. The patients in remote areas can seek expert advise from far off places.

It is satisfying to note that several communicable and in-

fectious diseases are controlled and some like polio and guinea worm infections have almost been eradicated. However, some diseases like dengue and malaria have shown a disturbing trend. There is increasing focus on infection control and environmental hygiene. But unfortunately antibiotic abuse has resulted in many organisms becoming resistant to antibiotics and appearance of superbugs, which are a great threat. Similarly cases of drug resistant tuberculosis poses a real challenge. Maternal and infant mortality rates have come down, though our country still lags behind in comparison with developed countries.

Similarly, high pollution in large cities is causing many serious illnesses.

Lifestyle diseases like diabetics, cancer have consider-

ably increased. It is observed that 50 per cent of the hospital beds are occupied by illnesses related to life style diseases.

Increased awareness about importance of quality in healthcare is a welcome development. Several hospitals are seeking accreditation from NABH, NABL and JCI. However, a large number of hospitals do not focus on quality. The major deficiency being poor documentation sketchy training of the staff and inadequate infrastructure.

The shortage of trained doctors, nurses and technicians is another major challenge which needs to be addressed immediately.

Some of the healthcare legislations like Drugs and Cosmetic Act, especially in relation to blood banking, biomedical waste rules, PCPNDT, Clinical

PM BHUJANG President, Association of Hospitals Establishment Act and Human Transplant Act have played effective role in improving the standards. However, implementation of PCPNDT to some ridiculous level, and some objectionable provisions in Clinical Establishment Act need to be addressed immediately.

Health insurance is another that needs attention. There are several drawbacks in the present system and the sector needs to mature.

Optimism for the future of health care is well founded where the entire population will have a healthier life. For that, all stakeholders especially the government should take appropriate measures.

ADVANCED TECHNIQUES IN DENTAL SERVICES ARE COMING TO INDIA

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any states are appointing dental surgeons as the DME. Many universities are appointing dental surgeons as vice chancellors. The army is elevating the rank of Dental Dir Gen to Lt Gen, equal to director of medical services.

All-India level entrance exam for the PG, equalisation of pay amongst medical and dental

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professionals. Some of the achievements include advancements in dental services.

Implants have become the most predictable prognosis rehabilitation tool and nano materials are the latest restorative materials. Digital radiography provides adjunct to all dental treatment, at the same time reduces radiation hazard. CBCT allows dentist to plan and execute

most rehab procedures with accuracy.

Less than adequate sterilisation protocols are followed by most practitioners in India which is a drawback to the image of the healthcare sector.

Also, there is a rise in improper display of educational degrees and limited options for advanced studies in dentistry.

One can see a lack of awareness amongst the public re-

garding specialities of dentistry.

Nevertheless some policy changes have certainly benefitted the sector. Formulation of Oral Health Care Policy by the government and inclusion of oral diseases in the main list have helped in improving dental services in India. Dental Council of India (DCI) banning the opening of new colleges without the medical college is

LT GEN (DR) VIMAL ARORA (RETD) Chief Clinical Officer, Clove Dental

an eye opener for defaulters.

Also, opening of imports in dental fields is another development in this field.

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H E A LT H C A R E

CREATING HEALTHCARE ‘AFFORDABILITY’THROUGH FINANCIAL INCLUSION IS SLOWLYTAKING OFF

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ndia is home to 1.2 billion people with a $2 trillion economy and a $100 billion healthcare industry. However, when it comes to healthcare, there are major challenges. Only 17 per cent of the population has some form of health insurance. A recent study

has shown that 95 per cent of even those who are insured do not have adequate insurance. Of the healthcare spend of five per cent of the GDP, public spend is only one per cent of the GDP, leaving 75 per cent to be spend out of pocket by private individuals, resulting in 40 million peo-

ple falling off into poverty every year, due to the burden of out of the pocket medical spent.

Healthcare expenses have emerged as the number one reason for people falling off into poverty. Public spent on healthcare must rise to 2.5 per cent of the GDP if it has to make any

dent on healthcare’s contribution to poverty.

In this bleak scenario, a welcome trend is emerging. Creating healthcare 'Affordability' through financial inclusion is slowly taking off. NBFCs and main line banks have started offering EMI options to patients to

JOSE PETER CEO, Arogya Finance meet hospitalisation expenses, benefitting those with good credit history or those with corporate jobs.

MEDICAL BREAKTHROUGHS THAT HAVE CHANGED THE WAY MEDICINE IS PRACTISED IN INDIA

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ersonalised medicine is the major breakthrough in cancer care. With the rapid development in next generation sequencing techniques we are now able to detect defective genes that can be targeted for therapeutic response. Our ability to predict responses to chemotherapeutic drugs and targeted treatment agents using ex vivo platforms is truly revolutionary as it will improve response rates and avoid unnecessary toxic and expensive treatment. With the integration of genomics and the ability to predict re-

sponses to therapy for any individual we can now deliver a truly effective personalised treatment designed around the specific person as we know that no two tumours and no two individuals are the same.

In terms of technological development, focused technology like radio surgery is another major breakthrough.

Additionally, analytics is another breakthrough, where analysing patients’ profiles on a massive way will help us get better outcomes.

Some of the progressive devices that we have developed include:

Aum voice prosthesis

X Pointer

The device helps throat cancer patients whose voice box is removed to speak again.

We have named it Aum voice prosthesis, signifying the first sound for a patient who regains his voice to communicate again after he loses his voice box. The Western makes cost upto Rs 35,000. The Aum voice prosthesis is designed to reach out to the Indian patients, especially for the needy, at Rs 50. This prosthesis is unique in the aspect, that it combines uncompromised quality and good functionality.

We have filed patents for this.

A new surgical landmark in neck dissection to help identify and preserve the spinal accessory nerve during modified neck dissections.

Intex Technique for dissection of carotid body tumours This technique helps conserve time by dealing with more vital branch - internal carotid artery in the initial steps itself, defines the need to involve the vascular surgeon in the initial stages and plan and pre-empt interventions early in surgical steps.

Lastly, in the area of preven-

DR BS AJAIKUMAR Chairman and CEO – Healthcare Global Enterprises

tive oncology, we have taken a major step to assist and participate with government towards tobacco control. Gutkha ban was one such significant landmark decision. In addition, HCG has played an active role in implantation of COTPA Act for tobacco control at the grass route level and participating in government committee to advance the role of cancer prevention.

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HEALTHCARE TRENDS EXPERT SPEAK

Access to medicines: India’s strides since independence Leena Menghaney, Regional Head, MSF Access Campaign, South Asia, in this article, explores milestones in policies that have had an impact on the production, supply and availability of affordable medicines from 1947 to the present day

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ndia’s journey in healthcare began with immense challenges – high rates of mortality due to malaria, TB, small pox, leprosy, malnutrition and infections, added to which were the highest drug prices in the world for the first generation of antibiotics and essential medicines.

Following independence, the drug supply situation in India was primarily dominated by what were then known as transnational corporations (TNCs) which imported a limited range of medicines. Drug prices were high and ungoverned, and profiteering was rampant. Local production by domestic companies like Chemical, Industrial and Pharmaceutical Laboratories (known as Cipla today) were blocked by the patent law which India had inherited as part of its colonial legacy.

Policy reforms However, innovative policy and legal reforms over two decades (1955 – 1975) resulted in India becoming a pioneer among developing countries in promoting indigenous manufacturing and technological capability in pharma products.

This benefited millions of patients in developing countries by providing a source of affordable generic medicines.

As a first crucial step, the Indian government in 1957 appointed a parliamentary committee under the chairmanship of Justice Raja Gopal Ayyangar, which led to path

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LEENA MENGHANEY Regional Head, MSF Access Campaign, South Asia

processes to boost API manufacturing. This enabled generic manufacturers to develop lowcost generic formulations of new medicines. By early 1990s the impact of technology transfer was evident- not only generic drugs were being produced from scratch but were far more affordable. In 1993, the price of an anti-ulcer drug ranitidine – in India was 16.58 times lower than the price at which Glaxo sold it in the UK.

Signing TRIPS agreement breaking amendments to the Intellectual Property (IP) system, disallowing product patents (monopolies) on food and pharma products as well as limiting process patents to seven years. The amended Patent Act 1970, based on the recommendation of the Ayyangar Committee, stated that its objective was to foster the development of an indigenous Indian pharma industry and to guarantee that the Indian public had access to low-cost drugs.

To accelerate the production of medicines domestically, the government set up the public sector units to manufacture new drugs with the aim to

build and strengthen domestic capacity in pharma products.

The production units were much needed for the production of drugs like penicillin.

Indian manufacturers were still struggling to develop and manufacture active pharmaceutical ingredients (APIs) – the raw material - that determines the cost and efficiency of production. The 1974 Hathi Committee Report on Drugs and Pharmaceuticals gave a fillip to API production in the country by recommending that the import of bulk drugs by domestic manufacturers be discouraged; and mandating TNCs selling formulations in India to start manufacturing

the API in India within three years.

Emergence of public R&D labs Simultaneously, public research and development (R&D) laboratories were also set up in India. Of particular importance are the National Chemical Laboratory, Pune; the Central Drug Research Institute, Lucknow; and Regional Research Laboratory (later renamed as Indian Institute of Chemical Technology), Hyderabad. Between mid1970s and late 1980s, the scientists and organic chemists from these institutes developed efficient, cost-effective

Early 1990s also witnessed India’s initial but strong opposition to the inclusion of IP within the ambit of trade negotiations in the World Trade Organisation (WTO).

The weakening of India’s negotiations was one major contributing factor that led to the Trade Related Aspects of Intellectual Property Rights (TRIPS) agreement. Finally as a member of WTO and having signed the TRIPS agreement in 1994, India was mandated to change its pharma patent system by 2005.

Ironically, in the decade between signing the TRIPS Continued on page 46

EXPERT SPEAK

Health insurance in 2016: Will the consumer be king?

Munish Daga, CEO, Remedinet recommends using the mobile phone as a medium to improve health insurance coverage in the coming year

KEEPING THE current government’s Universal Health Assurance Mission (UHAM) in mind, a solution that promotes universal healthcare will have to use technology in a way that is simple and robust, as well as scalable. The focus needs to be on a solution that aims to bring the consumers - the beneficiaries into the loop and enables them with the ability to use as well as monitor their health policy with minimum hassles and maximum transparency. More importantly, this solution should be able to make a scheme such as UHAM accessible to every single citizen of the country. And, that is the prediction for healthcare insurance, not just for 2016 but also for the foreseeable future.

Considering that mobile phone users in India are nearly one billion and counting, it is already the medium of choice to deliver health insurance. Thus, there is no doubt that a simple hand held device, on a strong technology backbone has the potential to make healthcare insurance delivery simple, affordable and accessible for all. Mobile devices have already proved their mettle across other segments. While shopping, booking tickets and transferring money is possible with a few taps on the screen, why not subscribe to and utilise health insurance using a mobile phone?

In healthcare insurance, the most misguided, misinformed, and left-out member is the consumer or the policyholder. Right from mis-selling of policies to meet sales targets and falling

prey to inessential medical tests, to having claims rejected at the end, the consumer is a victim of vested interests at various stages. By giving the consumer access to his/her policy on the mobile phone where he/she will be able to understand and utilise the policy as simply as making an ebanking transfer or even like chatting on WhatsApp, it will put tremendous power in the consumers’ hand. Not only will it curb malpractices, but also empower the consumer with knowledge and awareness.

How will the consumer be king in 2016?

For pre-empted medical treatment at a hospital, if the consumer is able to initiate his own

MUNISH DAGA CEO, Remedinet

pre-authorisation sitting at home, before he/she is admitted to the hospital; then, not only will the hospital be well prepared for the patient’s arrival but the payer too can verify and approve the initial claim made (pre-authorisation). This would require the consumer to upload relevant documents (only once) and send the policy details using the mobile application to the doctor, who will add the treatment details through his mobile

phone and send it to the payer.

The application will also ensure that alerts and notifications are sent at every stage to all parties involved. It not only ensures a hassle-free experience that does-away with form filling at arrival but also ensures that the consumer is kept in the loop of all information exchange.

In this manner, if there are any queries raised, if the consumer has uploaded incomplete documents, or any other iteration, everyone in the loop is informed through chat-like alerts for immediate action.

What will this lead to?

With a platform such as a mobile application allowing data to be entered and exchanged in electronic formats, where all

partners involved communicate in real time, a standard method of processing claims will emerge. The patient will enter and share his/her information, the doctor will add medical information, the TPA desk at the hospital will add insurance claims related information and send it to the payer. The payer will respond and approve accordingly. The mobile application can very well support translation of data into suitable languages for respective partners, for example; coded data for payers.

Thus, when information goes back and forth between the hospital and payer, there will be no paper exchange and conversion of data involved which might break the cycle of information exchange.

What will be the impact?

At the end, when the patient is discharged, all data related to the hospitalisation and treatment will be available in a structured electronic format – rich data. Data scientists can crack this data to identify trends such as number of instances of a particular disease in a particular area at a particular time of the year. They can identify trends such as the most common diseases that either gender group is affected by and much more. With analytical data, research and development wings can identify and work on preventive measures for the most commonly occurring health problems and diseases.

Can the government make use of mobile solutions in

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HEALTHCARE TRENDS 2016?

Currently, the governmentlaunched health insurance schemes have not performed as per expectations owing to various reasons such as inadequate spending, lack of trust, inadequate coordination and communication between various subsidiaries, etc. For a scheme such as UHAM to function on a large scale and serve 1.2 billion people, standardised delivery, transparency, accessibility, affordability of healthcare services is vital.

If SMS features can be used to inform beneficiaries about health insurance schemes, eligibility, subscription, and util-

A device as simple to use and maintain as a mobile phone has the capacity to scale healthcare insurance delivery to make it accessible for a billion people, an absolute need of the hour isation, it will make healthcare insurance simple and a part of every mobile phone user’s life.

In a similar manner, when the beneficiary arrives at a healthcare facility, he/she need only send an SMS alert regarding his/her policy information to

avail of the treatment. Also, the patient can receive policy utilisation details such as access to information regarding the insurance amount and how the scheme is used in a particular time frame (depending on the policy guidelines) at all times.

Here too, structured electronic data will help the government tremendously to identify health-related trends in specific geographical areas where preventive action can be taken accordingly.

Once a platform and technol-

ogy is established, it can be used for other educational and developmental purposes such as informing citizens about epidemics, precautionary measu res, etc.

Just like radio has reached the rural-most areas and has become a medium of choice for many, especially in the rural parts, mobile applications can be used as a tool to inform and educate. A device as simple to use and maintain as a mobile phone has the capacity to scale healthcare insurance delivery to make it accessible for a billion people, an absolute need of the hour.

Continued from page 44

Access to medicines... agreement and the deadline to implement it, generic production from India was recognised for its critical role in the supply of affordable medicines in the developing world, especially for newer drugs such as antiretrovirals (ARVs) needed in the treatment of HIV. For example, the cost of first generation HIV treatment dropped from over $10,000 per patient per year in 2000 to $350 by 2001- thanks to generic competition from companies like Cipla. In addition, Indian manufacturers developed generic fixed-dose combinations that dramatically simplified AIDS treatment in resource-limited settings, including India. By 2005, India established itself as the global power house of generic drug production and supply.

Amending the patent law Unfortunately, in 2005, India had to amend its patent law to become compliant with its obligations under WTO. In the midst of civil society protests and international media attention, the Indian Parliament approved and passed amendments to Patents Act on March 23, 2005. The Indian Patents Act

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Ironically, in the decade between signing the TRIPS agreement and the deadline to implement it, generic production from India was recognised for its critical role in the supply of affordable medicines in the developing world

of 1970 was thus amended to grant pharma product patents – something the country had not done since 1970.

The 2005 patent law not only put some serious constraints on generic competition but also had some potentially important features such as strict patentability criteria to prevent ever-greening; the right for anyone to object to a patent before it is granted; and compulsory licensing. The following decade is interspersed with several examples which affected access to affordable medicines, both negatively as well as positively. For instance in 2006, Roche proudly announced it was "becoming the first pharma company in India to receive a product patent under the new patent regime".

The patent granted was on peginterferon alfa-2a (Pegasys), a hepatitis C drug, priced at the time at over Rs. 18,000 per injection.

At the same time, in the decade since product patenting system was introduced in the country, India’s patent offices and Intellectual Property Appellate Board have strictly examined and rejected several secondary (evergreening) patent claims over

salts, polymorphs, dosages, fixed dose combinations and child formulations of known HIV, Hepatitis, TB and cancer medicines.

Among them was the Swiss pharma company Novartis, which lost a seven-year battle to claim a patent on a new form of an existing cancer medicine. The Supreme Court ruled that claims on a new form of a known substance did not meet the patentability requirement under the Indian patent law. The impact: price busting generic competition.

The cost of the generic version of imatinib in India is $790 per patient per year compared to the patented version which is marketed by Novartis at $106,322 per patient per year in the US. Unfortunately, almost a decade after the first product patent was granted, India is drying up as a source of affordable versions of newer and future medicines. Patenting new medicines in India could mean that Indian manufacturers will no longer be able to automatically produce cheaper versions of newer medicines.

Such newer drugs are crucial, for example, to treat TB, cancer and other critical diseases.

But, only one compulsory

license by the Patent Controller has been granted to increase competition. The move brought the price of the patented liver and kidney cancer drug down from over Rs 280,000 per month to Rs 8,800 per month; a price reduction of 97 per cent.

Granting a patent in India will have a chilling effect for a number of years on generic manufacturing and supply. A patented cancer drug lapatinib costs Rs 445 a tablet. Newly developed drugs against DRTB, Bedaquiline and Delamanid are under patent and thus highly priced or unavailable.

Need for a new IP policy Amidst rising drug prices and increasing US pressure to enforce the intellectual property of its pharma companies, India is now reviewing and drafting a new national IP policy, which will determine the future of generic competition and supply of medicines from India.

Prime Minister Modi now faces a challenge: future access to essential medicines for millions of people will depend on the new Indian government’s policies and the kind of patent system it endorses.

HEALTHCARE TRENDS I N T E R V I E W

‘Healthcare and pharma sectors should work in sync with each other’ Dr Suresh Saravdekar, Medical Consultant (procurement for Pharmaceutical and Medical devices) Municipal Corporation of Greater Mumbai, in a tête-à-tête with Raelene Kambli, points out that India needs a single healthcare policy to resolve its concerns revolving around affordability, accessibility and quality

Doctor, you have worked with some of the well-known public hospitals in Maharashtra. Can you tell us about your observations on the quality of medical devices used at these hospitals?

Medical devices are mainly classified into three categories.

The first is high-end medical equipment such as MRI, CT scanners, X-ray machines, cath lab equipment etc. The second category is OT equipment and surgical instruments and the third is devices such as catheters, IV sets etc.

Before 2005, manufacturers of medical devices enjoyed free import duty. However, in 2005, it came to light that some material, devices and stents were brought to JJ Hospital for clinical trials without prior permission and import licenses for those products. Consequently, the FDA seized those medical devices and stopped all clinical trials at the hospital. This case highlighted the need for regulation in this area and the government released the first circular in 2005 stating compulsory import license for medical devices.

Under this circular, only four to five medical and surgical devices such as catheters and IV sets would get free import license but they required a Form 10 issued by The Central Drug Standards and Control Organization (CDSCO).

Currently, at government hospitals, medical devices used are of good quality. Especially, when it comes to radiology and OT equipment. Moreover, there are only few MNC companies that manufacture these

high-end products which is why there is less choice as well. In the second category of medical devices like stents, heart valves etc., till 2010 the market was dominated by multinationals such as Medtronics, Abbott, Boston Scientific, and some more. But now there are some Indian manufacturers of stents as well. However, doctors still prescribe stents made by multinationals, even at government hospitals, as the indigenous ones do not have US FDA approvals.

What is your opinion regarding the quality of medicines?

Where medicines are concerned, I would like to cite examples from the Parliamentary report published in 2012 on the functioning of the CDSCO. The examples highlight how drugs are being brought into India without conducting clinical trials. This is happening because in India, we have two FDAs, one handled by the central government that takes care of making policies and the state FDA that provides licenses to drugs. Which is why there are so many loopholes. For example, say a drug that is declared sub-standard in Maharashtra is sold in Kerala and other states where they get easy approval. The worst part is that there is no proper data available on these subjects.

So, do you think India requires centralised control for drug licensing?

Yes. I completely agree that India requires centralised and more co-ordinated control

Medical education for doctors should also cover areas of pharmacy so that they have a better understanding of drug quality, licensing policies and the laws around it

where a high level of transparency is maintained. In 2012, the Parliamentary report did call for centralised control and the same was repeated in 2013 as well but no work has been done in this area.

I feel the main reason for no improvement in this area is because our healthcare, drug and medical device policies are very pro-industry and not prohealth. This is the reason why pharma policies are put under the Ministry of Chemical and fertilizers while the healthcare delivery segment falls under the Ministry of Health and Family Welfare. In contrast to this, world over, economies have healthcare and pharma industry work in tandem with each other and are covered under one standardised health system. But here in India, pharma and healthcare sectors have no co-relation. They function on parallel tracks.

Recently, Union Minister for Chemicals and Fertilisers, Ananth Kumar announced that the government will establish a separate ministry for pharma and medical devices sector in the next one year. What is your opinion on this move?

I don't think this move will help to improve our current system.

I feel that this dual policy system only disrupts the co-ordination between the sectors.

Healthcare and pharma sectors should work in sync with each other. Instead of making a separate ministry for pharma and medical devices, these two industries should be covered

under the Ministry of Health.

What is your opinion about the drug procurement process in hospitals? How can it be utilised to provide quality services?

The problem with drug procurement agencies within both the government and private hospitals is that this responsibility is given to doctors who are not well versed with laws and implications of the licenses. So, there is a need to educate these procurement agencies within hospitals.

Moreover, there is a need to also introduce filters in the drug procurement process within hospitals just like the system which has been introduced in Maharashtra. We have made WHO certification compulsory for companies. If they do not comply with these norms, their drugs will be rejected at once. This helps us ensure quality supply of medicines to our patients.

Public hospitals characteristically train future physicians. What measures can be incorporated into training programmes by public hospitals to improve the quality of services provided by the physicians?

Training is the best solution in this regard. Also, our medical education for doctors should also cover areas of pharmacy so that they have a better understanding of drug quality, licensing policies and the laws around it. raelene.kambli@expressindia.com

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HEALTHCARE TRENDS EXPERT SPEAK

Technology for better health and wellness Mandanna Dilip, Program Management, Sales & Marketing, ABOVE Solutions elaborates how technology has transformed healthcare delivery

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ommunications, businesses, education, science, travel are some of the many facets of everyday life that technology has transformed. Today, without technology (for most of us) the only thing we can have is the air we breathe, which in a few years probably will also be produced using technology.

80 per cent of our basic needs involves technology.

For the longest time, technology and health were associated together only in hospitals and clinics. For a layman, to be able to monitor his heart rate, ECG, diabetes, etc. in the comfort of his home was but a dream. Visiting a hospital for such basic clinical measures will soon become passé, considering the wide variety of wearable medical devices available for this very purpose. Continuous monitoring is now possible remotely with reports being shared with family members across seas. For instance, insulin shots can be taken after blood sugar levels have been measured via a device and fluctuating patient heart rates once recorded can be instantly mailed to the consulting family physician for review. All this clearly highlights the manner in which technology has given us a heads up on how to take better care of ourselves amidst growing stress, lack of movement, and pollution.

Studies or research elucidate some basic points that we need to keep in mind in order to live a healthy life. Much has come from the old school of

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thought (Ayurveda for example) supported by recent studies in science, regarding the importance of sleep, nutrition, stress (heart rate), and exercise in maintaining a healthy lifestyle.

All these can be monitored on a daily basis and with 85-90 per cent accuracy. This ensures that our health is taken care of with the added advantage of reduced medical bills.

While technology exists to help us improvise our health and wellness, the key is to be able to take complete advantage of this solution, and focus on how we should get and stay healthy. ◗ Adapt and learn how to create and live in a healthy environment It could be at our home, at work, or on the road. Long hours of sitting, watching television, constant usage of gadgets reduce the blood flow and cause shallow breaths. The solution is rather simple. At work, get a desk which leaves you no choice

While technology exists to help us improvise our health and wellness, the key is to be able to take complete advantage of this solution but to stand, instead of taking the car to work - ride a bicycle, skip watching television soaps and step out to get some fresh air. All of these are of course in today’s time easier said than done, but is it really that impossible? Making an effort to keep moving, watching what you eat

and drink, calming yourself down during a high stress situation. Simple steps and the battle is half won. Just being aware of yourself in a certain environment can lead you to become healthier. ◗ It’s only going to get more digitised tomorrow Each data point collected from varied healthcare devices can become the very foundation of analysing different aspects of your health, right from reading and understanding what is normal and what is not.

■ Monitoring your health data is gradually moving from devices to ‘smart garments’; clothes with technology woven in to measure and interact with your body and provide real time feedback by continuously connecting with your surrounding and communicating any change to the digital world.

■ Smart pill bottles send real time alerts by glowing, beeping, sharing mails/text messages as a reminder to ensure that

patients take medicine at the right time every day without any manual intervention. ◗ Take advantage of technology With devices which can monitor our sleep, heart rate, number of calories consumed and burnt, kilometres walked in a day technology is providing us with an opportunity to understand ourselves better and see how best we can monitor our health.

Constant reminders, motivational music playlists that change with your mood, seeking help from communities are some of the ways for us to improve our lifestyle and try to stay off medicines as much as we can.

Healthcare tomorrow will involve more remote doctor-patient interactions, cost effective medical solutions available across varied ailments, emergencies avoided with patients being informed beforehand of possible issues such as a heart attack basis the data collected remotely by hospitals.

However, technology can be a double-edged sword. Excessive use of phones, computers which emit radiations, blue light which causes variation in your sleep pattern and increases stress levels or affects your appetite.

One of the many tricks is to use technology judiciously and not make ourselves entirely dependent on it. Rightly said

by Dr Harry Greenspun, ‘Just because I have a fitness app on my phone doesn’t make me an athlete.’ Technology can only let us know if something is not going right, making it right is still our prerogative.

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LIFE PEOPLE

Dr Henk Bekedam takes charge as WHO Representative to India Before joining WHO, Dr Bekedam was seconded to governments in Zambia and Malawi DR HENK Bekedam, a senior WHO public health specialist with 29 years’ experience has taken charge as the WHO Representative to India. He is a Dutch national and a medical doctor by training.

He has worked for 19 years with the WHO as Representative in China and Egypt, Director of Health Sector Development in the WHO Western Pacific Region Office in Manila and as team leader of the health sector reform project in Cambodia. Before joining WHO, Dr Bekedam was seconded to governments in Zambia and Malawi.

Speaking of his new role, Dr Bekedam said, “It is a privilege to be in India. I am looking forward to building upon and further strengthening the excellent partnership that WHO has with the Ministry of Health & Family Welfare and with other stakeholders.”

“WHO India will continue to strive towards further strengthening health and equity in the country, as India takes major steps towards Universal Health Coverage,” he added.

Dr Bekedam’s work in Asia included supporting the Chinese government to success-

fully contain the SARS outbreak in 2003. This was one of his most impactful work as it not only led to a substantial increase in investment in public health, but also paved the way for universal health coverage in

China.

“A similar outcome was seen in Egypt, where we assisted the national government to define a new vision of universal health coverage in response to the Constitution

adopted in 2014, which gave more attention to health and education,” he added.

Dr Bekedam and the country office team also provided sound technical advice to the Egyptian government for an effective response to the largest outbreak of avian flu in humans and containing viral hepatitis C, including the expansion of the treatment programme. In addition, along with his team, he worked closely with the government to maintain the country’s poliofree status.

Other areas of Dr Bekedam’s strong expertise include, health system strengthening, Universal Health Coverage health sector reforms, food safety, AIDS, tuberculosis, tobacco control and chronic diseases.

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TRADE & TRENDS

KMCH Coimbatore sets up Chennai flood relief camp Sends a team of doctors, nurses and pharmacists to help people affected by the floods

MEDICAL NEEDS of the people arise in two ways; 1) In the form of immediate or intra event damages like cuts, bruise and fractures due to hit by moving heavy and sharp objects, 2) local epidemics caused air borne infections (large number of people are accommodated in relief areas), water borne diseases due to contamination of drinking water sources with unclean and sewage water. It can lead to increasing cases of ailments like leptospirosis as people are likely to come in contac t with infected rats’ urine through the sludge.

Recently, Chennai experienced a major calamity in the form of massive flooding due to heavy rains recently. Hence, Kovai Medical Center and Hospital (KMCH) Coimbatore, to serve the health needs of the community in Chennai, sent a team of 52, consisting of 23 doctors, 23 nurses, four pharmacists and two assistants.

The team, under the leadership of Dr VGanesh and Somasundaram, started from Coimbatore on December 7, 2015 and initiated their work on December 8, 2015. The relief efforts by the KMCH team continued for a period of five days, post which they returned to the station on December 13, 2015.

During their stay at Chennai, the team held medical camps at Kotturpuram Police Quarters, Kotturpuram Slum Board,

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Relief work at KMCH camps in Chennai

Jafferkhanpet, MGR Nagar, Nesapakkam, Cholai Pallam and Kannamapet. These areas are situated on the banks of the Adayar River. The victims in these areas were locked on the second floor of their houses during the flood as the floodwater entered the first two levels of the buildings. The team witnessed that the people in the area had lost their clothes, medicines, medical history, documents, money, food stores and other belongings. The people were walking bare foot as they were frightened of slipping in the sludge while walking. This was an additional

health risk as it increased the chances of contracting diseases such as leptospirosis and other fungal, bacterial and protozoal infections.

Dr Nalla G Palaniswami, Chairman, KMCH Hospitals, equipped the relief team with medicines worth Rs 15 lakhs.

The medicines ranged from antipyretic, antiallergic, antifungal, antibiotic, antidiarrhoeal, ulcer protective, hypoglycemic agents, suture materials, dressing materials and tetanus toxoid vaccines.

The team received additional support from the health ministry in the form of medicines

such as antifungals to reach to a wider population. The camps were located very close, i.e. 50 to 100 feet from the bank of the Adayar river. This made it possible for the team to reach the most needy people. Reportedly, the KMCH team served 5127 people in the mentioned areas during their five-day stay. A team member, speaking

on the experience, said that he was very moved on seeing the plight of the affected people in the area. He said that his team was glad that they were able to offer highest level of care with the minimum resources they had. He also informed that the team receive a memento with the image of Mother Teresa on it.

TRADE & TRENDS

Trivitron patents NeoMass AAAC kit for newborn screening to detect 50 inborn disorders First kit in the world to offer the broadest panel

TRIVITRON HEALTHCARE has launched NeoMass AAAC Kit (CE Approved) for expanded panel of newborn screening in India. This is the first kit in the global market that can detect up to 50 disorders that a newborn baby might be born with or without any immediate symptoms or visible manifestations, making it the broadest available panel of biomarkers. The launch of NeoMass AAAC Kit makes Trivitron a complete solution provider for NBS with modular systems, automated systems and kits for core panel screening and Tandem MS/MS and NeoMass AAAC kit for expanded panel screening. Dr Ralph Fingerhut, Director Swiss Newborn Screening Laboratory University Children’s Hospital,

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Zurich and Nitin Sawant, Sr VP, Trivitron Healthcare announced the launch of NeoMass AAAC Kit patented by Trivitron in India and shared insights about newborn screening, its causes, global and Indian scenario, importance, facts and figures etc.

The event was focused on creating awareness among target audience about newborn screening and its alarming need to make it mandatory in India too like other countries. The testing process involves pricking the heel of a newborn baby to collect a few drops of blood on a filter paper within 72 hours of birth and test for detection of life threatening disorders. The launch of NeoMass AAAC kit would lead to screening of inborn metabolic disorders based on a technology called tandem mass spectrometry which allows fast and accurate determination of metabolic disorders.

The newly patented NeoMass AAAC kit uses tandem mass spectrometry technology.

Dr Ralph Fingerhut, Swiss Newborn Screening Laboratory

(L-R) Dr Ralph Fingerhut, Director Swiss Newborn Screening Laboratory University Children’s Hospital, Zurich and Nitin Sawant, Sr VP, Trivitron Healthcare at the launch of NeoMass AAAC Kit

University Children’s Hospital said, “Newborn screening is mandatory in other parts of the world and has been enormously successful. The heel pricked blood can be used to detect deadly genetic disorders in newborns and can provide better life for infants. We hope globally accepted newborn screening sees some more light in India.”

Dr GSK Velu, Chairman and Managing Director, Trivitron Group of Companies said, “Trivitron Healthcare is one of the largest provider for newborn

screening solutions in the world and our new patented NeoMass AAAC kit is the first kit in the world to detect up to 50 disorders. Trivitron Healthcare is always at the forefront of developing affordable technologies for Indian market.

The recently patented methodology makes it possible to detect deficiencies of all the six enzymes involved in the urea cycle metabolic pathway. The urea cycle is a metabolic pathway occurring in the liver and kidney and aberrant functions

of the urea cycle enzymes lead to the buildup of ammonia, a product of protein metabolism.

If not treated the outcome is very serious with symptoms ranging from vomiting and increasing lethargy to respiratory distress and even coma and death. Additionally NeoMass AAAC enables an easy and reliable detection of type I tyrosinemia, a serious disease causing dermatologic and neuro developmental problems due to accumulation of tyrosine within the liver and kidney.

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