Express Healthcare (Vol.10, No.7) July, 2016

VOL.10 NO 7 PAGES 64

www.expresshealthcare.in JULY 2016, `50

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CONTENTS Vol 10. No 7, JULY 2016

Chairman of the Board Viveck Goenka

ANTIBIOTICAPOCALYPSE

MARKET

Sr Vice President-BPD Neil Viegas

12

Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das

CII EASTERN REGION ORGANISES 4TH EVOLVING HEALTHCARE INVESTMENT LANDSCAPE IN KOLKATA

KNOWLEDGE

45

Bengaluru Assistant Editor Neelam M Kachhap

SOCIAL MARKETING AND INSULIN USE

Design National Design Editor Bivash Barua Asst. Art Director Pravin Temble Senior Graphic Designer Rushikesh Konka Senior Designer Rekha Bisht Artists Vivek Chitrakar, Rakesh Sharma

A spectre of untreated infectious diseases is looming large over humanity with the growing incidence of antibiotic resistance| P22

Photo Editor Sandeep Patil

INTERVIEWS

MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - West Kailash Purohit – South Debnarayan Dutta - East Marketing Team Ajanta Sengupta, Ambuj Kumar Arun J, Douglas Menezes E.Mujahid, Mathen Mathew Nirav Mistry PRODUCTION General Manager BR Tipnis Manager Bhadresh Valia Scheduling & Coordination Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar

P14: V RAJA

36: ANIL PHIRKE

Chairman and MD, Philips India

CMD, Meditek Engineers

P16: SN SATHU CEO, HITES

18: SUMIT AGARWAL CFO, Kids Clinic (Cloud Nine) P32: HIMANSHU JAIN MD&VP, Indian Sub-Continent, Sealed Air

44: SIR MALCOLM GRANT Chairman, NHS

P58: DR LOVELEEN KACKER CEO, Tech Mahindra Foundation

MEDICALL-2016 SPECIAL-PG-34-43

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

India’s action plan to tackle AMR

T

oo much of a good thing is generally bad for you. And in the case of antibiotics, could even kill you. The world over, decades of overuse and misuse of antibiotics has governments, doctors and drug researchers worried because our allies have turned traitors.

The situation is quite alarming. In 2010, India bagged the dubious distinction of being the world’s largest consumer of antibiotics for human health.

Thus in addition to being diabetes capital of the world, we will most probably top the charts in antimicrobial resistance (AMR) as well. In fact, we could soon be confronted with the situation where hospital acquired infections, which generally involved super bugs resistant to most antibiotics, could result in more deaths than disease itself, predicts Dr Ramakant Panda, Vice Chairman and Managing Director, Asian Heart Institute.

(Read our cover story in the July issue: Antibiotic Apocalypse, Page no 22-31) Getting AMR under control requires multipronged action. While the clinical and medical community has to resolve to prescribe less antibiotics, pharmacists/chemist shops have to stop selling them over the counter. Patients have to be counselled on the importance of finishing their dosage regimes and not resorting to self medication. Pharmaceutical companies have to stop the practice of incentivising the clinical fraternity to prescribe more antibiotics as well as zerodischarge facility across their supply chain. Beyond the medical and pharma sectors, governments are calling for the food and livestock industry to reduce the use of antibiotics in feedstock.

Besides, awareness drives in public and private hospitals, medical education needs to reflect the challenge of AMR. Including a section on AMR and antibiotic use, guidelines will automatically take care of the overuse/misuse of antimicrobials in the future. Old habits die hard and unless we act fast to sensitise the current generation of medical students to the need for rational antibiotic prescribing habits, patients too will keep dying.

Partnerships will have to be forged to tackle the AMR challenge. For instance, in a paper published on the Center for Disease Dynamics, Economics & Policy (CDDEP) website, titled, A role for private sector laboratories in public health surveillance of antimicrobial resistance, the authors point out how unlike developed countries, low- and middle-income countries (LMICs) lack the public health resources to track AMR. This is where the expanding private healthcare sector, both hospitals and test-

Old habits die hard and unless we act fast to sensitise the current generation of medical students to the need for rational antibiotic prescribing habits,patients too will keep dying

ing laboratories, can be leveraged to collect data.

For instance, the CDDEP’s ResistanceMap for India shows antibiotic resistance rates based on data from a large private laboratory network with, approximately 5700 collection points including private hospitals and community diagnostic labs in 26 states, aggregating more than 18,000 blood isolates between 2008 and 2014. This data can throw up country-wide AMR trends, which can be used to formulate policy guidelines as well as decide fund allocation.

Many medical device companies are experimenting with diagnostic tests to detect AMR and help clinicians detect as early as possible if the infection is viral or bacterial, and if the latter, whether there is drug resistance and if so, the level.

India has taken quite a few steps in its battle against AMR. The Jaipur Declaration, signed in September 2011 by health ministers of member states of WHO South-East Asian Region, recognised the seriousness of the problem, while the Chennai Declaration two years later, coinciding with the global initiatives to combat AMR, resolved that the country did not need a 'perfect antibiotic policy' but rather 'an implementable antibiotic policy'. In line with the Chennai Declaration, the ICMR initiated a programme on antibiotic stewardship, prevention of infection and control (ASPIC) to raise awareness and to train participants on antibiotic stewardship and infection control. Under this programme, 15 microbiologists, four pharmacologists and one physician were trained in 2012. ICMR then followed up with the launch of the Anti Microbial Resistance Surveillance and Research Network (AMRSN) across the country in 2013 with a mission to rationalise Antimicrobial Stewardship Programmes (AMSP) in India.

In February this year, the Ministry of Health & Family Welfare released the 64-page National Treatment Guidelines for Antimicrobial Use in Infectious Diseases. This is part of the Ministry's national programme for containment of AMR under the 12th Five year plan (2012-17). Appreciating the efforts of the National Centre for Disease Control to put together these guidelines, Dr Jagdish Prasad, Director General of Health Services, quoted estimates that 50 per cent or more of hospital antimicrobial use was inappropriate. Many hospitals have antibiotic use policies but are they implemented properly? Only time will tell.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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LETTERS QUOTE UNQUOTE

JUNE 2016

There is an urgent need to make training course contextual to country’s needs. Nursing courses can be blended with skill India training courses for countering the shortage of nursing staff.

WELL WRITTEN ARTICLE

JP Nadda Union Health Minister, India (Speaking at the inauguration of Indian Nursing Council Office Complex in New Delhi)

I

am impressed with the article titled ‘Breaking barriers to dialysis,’ which appeared in the June issue of Express Healthcare. I am certain that the article will help the dialysis industry get the much awaited and desired attention and eventually serve the cause.

Vikas Verma, Business Head – Avitum (Renal Division), BBraun India

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Board line: 0120-6651500.

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The MoU between Indian Council of Medical Research (ICMR) Council on Energy, Environment and Water (CEEW) will bring together synergies between the objective of ‘time to care’ as mandated in the National Health Mission (NHM) and clean energy as outlined under the National Solar Mission (NSM). The aim of the collaboration is to create resilient health systems in rural India, benefitting primarily women and children Dr Soumya Swaminathan Director General ICMR

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MARKET I N T E R V I E W

‘Cascading cost of sale virtually eliminates our profit margins in India’ Recently, Philips India held the 4th edition of Philips India Innovation Experience in Bengaluru. The healthcare company launched, innovative products like the children’s respiration monitor, Air Purifier Series 3000 and Air Purifier Series 6000, the fetal heart rate monitor, the dream series of sleeping aids, and the e-alert system at the event.

M Neelam Kachhap spoke to V Raja, Vice-Chairman and MD, Philips India, to find out how the medical device industry is struggling with profitability against the backdrop of rising incremental costs How do you see the medical device market in India?

I see that everything is pointing in the right direction.

Business is growing and is thriving. Everyday new and enhanced technology is coming into this space.

How has this industry changed in the past few years?

I have come back to the healthcare industry after about five years. What it was a few years back to what I see now, it is pretty much the same. A lot of emphasis is on newer advanced technologies.

Would you say that the Indian market is nearing saturation?

Interestingly, when I look at the growth in this market, it is now moving from bigger to smaller cities. Technology is being embraced there because the markets here are growing with more diagnostic centres and more hospitals are coming in. The other day, I was speaking to a group of hospital guys and they told me that their case load growth was coming down as compared to the disease area growth. For the same disease area, the growth was positive in tier-II cities. So people who were coming from peripheral areas to the main cities are today being treated in the same

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town. I see that the shift is clearly happening in tier II, III and IV towns. The good news is that in these tier II and tier III towns, I am happy to say hospitals and centres are not going for high-end technology.

They are going in for what makes appropriate sense.

So, I really see positive growth in those areas. I’m seeing good growth in the government sector where we have private public partnerships. Many years back what we started while at the helm of another healthcare MNC, I am seeing more and more activity there.

It is in the interest of the government, the patients and the providers because in many ways, it is the private players providing healthcare at government costs in government hospitals.

How much of your business comes from government segment?

I would say about 20-25 per cent. This includes PPP, direct selling indirect selling etc.

Tell us about your role at Philips Healthcare.

I head the healthtech business at Philips which consists of both healthcare and consumer health businesses. The idea is to seamlessly look at this whole business as one business and help people live

better lives. My mandate is primarily to see that the business grows at a faster rate make it profitable and also build a larger footprint in India. Last but not the least, I would see how I can export talent out of this country.

The cost of equipment we sell in the western world and in India is almost similar.

But the cascading cost of sale is high.

Cascading costs virtually eliminates our profit

Is the multimillion euro investment in India by Philips bearing fruit?

Investments made by Philips, whether at its manufacturing base in Pune or at Bengaluru centre or launch of fetal heart monitor etc, I genuinely believe that the company is willing to invest and it is a testimony to the fact that whatever the company has invested is paying rich dividends. Most of the products have something from Philips Innovation Campus (PIC) Bengaluru. We are a strong contingent if you look at the global place for us.

We conduct R&D activities for Indian as well as global products at our Chakan facility in Pune, which also happens to be our headquarter for R&D. India is a growing market but not a high profit market.

This is true for most MNCs in healthcare. From the growth point of view, we are doing well.

On the profitability front, there are more expectations from where we are today. There are miles to go on what we have

invested and what we expect.

Would you say that the medical device industry is struggling with profitability issues?

I think it will still be a struggle for all of us for the simple reason that incremental costs are high. You have to understand that the cost of equipment we sell in the western world and in India is almost similar. But the cascading cost of sale is high (importing from other location, customs duty etc).

Therefore, there is a difference in the money we make in the US or Europe and in India. This cascading cost virtually eliminates our profit.

Our consumers might say that the cost of a scan in India is 1/10th or 1/20th of the cost of scan in the western world. So, how will I breakeven unless the number of scans go up by 20 times than what is done in the western world. Besides for consumers, the funding cost is also high. So the entire economics is a challenge for us to increase our profitability.

Our profit margins are really low because of cascading costs and will remain through till the entire cost comes down. Duties and freight cost go down; hence, customer profitability has to goes up. So the entire value

A few years back when the government had not coined the term ‘Make in India,’ company like yours were already talking about reverse engineering. How has that developed?

It continues till today. I say more for Philips than others, we do make products not just for the local market but also for the global market. The trend will continue especially if we feel that the engineering capability exists; there is a local market that exists and it makes economic sense for us to make the product in this market. But the genesis of this will be more on whether the product has a large local market. I am not talking about a shear transfer of work or cost benefit. That era is gone.

See if ‘X’ product is made in the US and it has a large market potential in India in the next five years and today the cost of making the product is same or marginally lower, then we will say let us start making here for India first then build volume and export it out.

Because quality and engineering remains the same.

But, the local market needs to be addressed first. Today, people want to make factories closer to the market so that flexibility and ability to deal with the customers locally is much better.

So where will large companies invest in the coming years?

The investment will focus more on disease front. Investments in cardiology, oncology will continue. Besides, we have a huge population and growing number of children (we produce an Australia every year). So, I would say that products like ultrasound will see more investments. As more healthcare institutions come up, say for example hospitals, you will see more ICUs, OTs. I see the business grow for the next several years from India perspective.

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From the growth point of view, we are doing well. On the profitability front, there are more expectations from where we are today

What will Philips invest in the next five to 10 years?

The investment will not be product specific but will cater to specific disease landscape which we can address. And a disease can be addressed by different

technologies. Similarly, investments will be made in the respiratory segment, mother and child care etc.

However, technology will always be the differentiator of clinical products. mneelam.kachhap@expressindia.com

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chain is getting affected because of this and unless that challenge goes, I don’t see any improvement in profitability in the near term.

MARKET I N T E R V I E W

‘We are gearing up to become a Rs 10,000-crore company by 2020’ HLL Infra Tech Services (HITES) was recently nominated officially as the construction and executing agency of the Ministry of Health and Family Welfare, India. SN Sathu, CEO, HITES speaks on the role HITES intends to play in improving healthcare infrastructure in the country, its ongoing and forthcoming projects, its growth plans in the coming years and more, in an interview with Lakshmipriya Nair What would HITES’s role as the construction agency for the Health Ministry involve?

What services would it offer?

We will now serve as the Executing Agency of the Ministry in implementing various healthcare projects.

This includes setting up AIIMS-like institutions, building super speciality hospitals and upgradation of various government medical college institutions.

HITES will partner the Ministry in correcting regional imbalances in providing affordable and reliable tertiary healthcare services, and also to augment facilities for quality medical education in the country.

Besides infrastructure development, HITES will offer services including procurement consultancy, with experts helping the government procure a range of healthcare and hospital products, equipment and devices. HITES will also offer its expertise in the niche area of facility management, which covers a gamut of hard and soft services ranging from integrated building management and housekeeping to security and horticulture services.

How has HLL Lifecare, a contraceptives manufacturer, successfully diversified into an infrastructure development and procurement company?

HLL has traversed 50 eventful years to emerge as a wellrecognised global brand in the

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area of contraceptives, hospital products and healthcare services.

At the core of our business is a deep commitment to help address serious public health challenges. HLL intends, therefore, to be a total healthcare solutions provider supporting every aspect of public health delivery.

Our success with the production and marketing of contraceptives and medical products and devices also showed us that we could replicate this efficiency and quality-consciousness in other areas of healthcare delivery; which is the reason why our diversification and expansion efforts have been equally successful. HITES is one such example.

There are very few who can offer the level of expertise we do in specialised infrastructure development, procurement and management specifically for the healthcare sector.

What are the opportunities which are unique to healthcare in the infrastructure space?

HLL was established by the Indian government with the express purpose of bringing high-quality healthcare products and services to the public at affordable prices.

With HITES, HLL has forayed into a very niche and specialised area with enormous potential. Healthcare is expected to become a $280 billion industry by 2020.

The Government of India has given well-deserved

shift from hospital-centric care to person-centric care. They are advocating green, smart hospitals with technology inputs such as telemedicine, social media and apps in healthcare. Hospital designs are centered on pre-engineered construction, green building with Griha ratings, patient safety and barrier free access, infection control, telehealth remote access, hybrid HVAC solutions, HMIS, queue management etc.

For HITES, this scenario offers a sea of opportunities.

HITES will partner the Ministry in correcting regional imbalances in providing affordable and reliable tertiary healthcare priority to the health sector and is investing in a big way to boost services and delivery.

There is a huge impetus on building quality healthcare infrastructure, establishing centres of medical excellence, creating smart and sustainable hospitals, the list goes on.

Around the world, health experts are recommending a

How is HITES poised to leverage them?

HITES is India’s only total solutions provider in the specialised area of healthcare infrastructure — offering support from concept to commissioning. We are uniquely placed in the healthcare sector to offer comprehensive services; we design, build, procure, install and maintain both building and equipment.

HITES has a full-fledged design cell with proven expertise in healthcare infrastructure. We have a dedicated team of experienced and highly qualified professionals in varied fields including project and construction management, procurement, engineering, financial management, contract management and legal services.

HITES is also designated as a National Procurement Support Agency (NPSA). Our team undertakes consultancy

assignments including bid process management, procurement of goods, as well as project planning and monitoring.

HITES focuses on timely execution of projects.

Which are the healthcare infrastructure projects that HITES has undertaken?

Since its formation in 2014, HITES has taken up projects for clients include the Government of India, state governments, government departments, public sector undertakings, corporations and institutions.

HITES has been entrusted with the upgradation of 12 government medical college institutions across the country.

We are setting up super speciality centres at all these institutions as part of the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) at an outlay of Rs 960 crores.

We are also setting up 200-bedded mother & child hospitals for the UP government in Chitrakoot and Amethi.

The Central Drugs Standard Control Organisation (CDSCO) has appointed HITES as Project Management Consultant for setting up the CDSCO Laboratory in New Delhi, and Chennai JIPMER has appointed HITES as consultant for setting up JIPMER-II off-site campus at Karaikkal.

The UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, has engaged HITES for setting

MARKET up a 500-bedded cardiac hospital in the state.

HITES is also going global.

It has been appointed as Project Management Consultant for strengthening of the health system in the Republic of Guinea under line of credit funding by the Government of India.

The MoHFW has assigned HITES to undertake preinvestment activities for the proposed new AIIMS in Bathinda, Punjab.

We are doing facility management work at AIIMS Patna and JIPMER Puducherry.

Have you earmarked certain areas (geographically) to focus on? What are the major challenges in the healthcare infra space that HITES would address and mitigate?

Right now, HITES has a pan-India presence through its various projects. We have regional/sub regional offices in Noida/ NCR, Thiruvananthapuram, Mumbai, Bengaluru, Chennai and an office is planned in Guwahati to take care of the North East region.

Having our registered office in Thiruvananthapuram, we have a strong presence in Kerala. We are now mainly focusing on South, North and Central India.

As for the challenges, being a new entrant in the infrastructure space we have had to compete in the open market to tap opportunities.

Also, the entry of private players in the government sector has increased competition, but we have stepped up to this challenge by focusing on quality, reliability, cost-effectiveness and timely execution.

We also have a very strong accent on R&D and innovation.

For instance, we have developed prototype design models for mother & child hospitals in various bed ranges.

What are the growth plans of the company for the next three years? What is the roadmap to achieve them?

HITES is in the process of expanding its business in a big way under the main four verticals, viz. infrastructure

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development, procurement consultancy, facility management and bio-medical engineering.

We have registered a turnover of approximately Rs 20 crores during the last financial year. We currently have business worth approximately Rs 5,000 crores with us and we are gearing up

to become a Rs 10,000 crores company by 2020.

We are also offering a range of new value added services to our customers such as medical equipment maintenance, third party inspection, testing & calibration, specification portal, real estate (re-development of government lands), direct construction etc.

Our design wing is working on prototype models for various ranges of hospitals, so that the client can choose based on their requirement. We have a dedicated BD Team focussing on new business development.

In order to accomplish our long-term plans, we are in the process of strengthening our team. The HLL Management

Academy has been engaged for conducting manpower study at HITES. We are also setting up a oneof-its-kind EMI/EMC testing facility in NOIDA, for testing of medical equipment for compliance with the medical devices regulations of the Government of India. lakshmipriya.nair@expressindia.com

MARKET I N T E R V I E W

‘Cloud Nine to expand its business in Delhi NCR and Maharashtra’ Financial viability is extremely important for the survival of any hospital. Cloud Nine hospitals so far has been sailing smoothly. Sumit Agarwal , CFO, Kids Clinic (Cloud Nine) shares his strategy to attain financial stability for his hospital and also talks about the company’s expansion plans with Raelene Kambli

What according to you are the bigger issues that hospitals and health system CFOs experience today. How are these challenges going to affect their day-to-day routine and long-term planning?

Hospitals can be compared directly with the multi-retail environment from the service side whereby the emotion level is very high.

Further, given that it has the flavour of the multi-retail environment and high cash transaction, we need to have proper control in place before some unwanted stuff happens. Unlike products, you can bar code stuff.

However, in services it’s not possible and hence, we need to have the systems and control in place together with audits. Given that we are in the growth stage, entire cash flow management will be the biggest challenges coupled with the entire forecasting and budgeting exercise.

With your enormous experience in financial management, how do you solve these issues at your organisation?

Well, definitely technology helps to a great extent on tightening up the controls, continuous audit process to ensure the check and balance, make people accountable and responsible and also put the processes in place and be prepared for any set back if any.

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What role does technology play in solving these challenges? How have you utilised technology for automation of hospital processes and how has it helped?

At the early stage, we have realised that technology will make a difference to the entire business and will uplift the performance as well as the overall experience. For a growing company, cash flow matters a lot and we have decided to invest in the right pocket for technology and go light. Following the vision, we have first gone with the Electronic Health record (EHR ) system on the SAS model to set the foundation right. This helps us to go with the journey on the paper less environment and retrieve the entire clinical record as well.

Further, we have added Microsoft Dynamics CRM, Mobile App, Feedback system on the customer experience side and the journey is on.

We have also heard that you have transformed the way Cloud Nine handles imaging and printing with innovative pricing models.

Can you please elaborate on the same?

The major challenge which we were facing in the entire imaging and printing process was maintaining quality and this was worsening as the printers were getting older.

Further, over a period of time, we have added

sufficient printing volume.

We have gone ahead and upgraded the printer from small to network printers, moved from dedicated to shared solution which help for better maintenance and single point to check stuff.

We have approached Ricoh and they helped us in providing good printers on the OPEX model by paying per page printing rather than incurring the affront cost.

This helps the cash flow and business.

On the long run it is a very lucrative investment.

Unlike multi specialities, in single specialities, the investments ticket size reduces at least one-tenth time and hence makes it more attractive

Many investors have an opinion that investing in healthcare burns out their investments, since healthcare is a capital incentive sector. What's your opinion on the same?

Yes! However, on the long run it is a very lucrative investment. Well unlike multi specialities, in single specialities, the investments ticket size reduces at least one-tenth time and hence makes it more attractive. As a result, investors are showing more interest on target healthcare.

What is key to Cloud Nine’s finance accounting strategy?

We are a private limited company registered as per the Companies act. We follow IGAAP as per the ICAI and also soon going to adopt Ind AS. You have attracted many investors such as India

Value Fund Advisors (IVFA), Matrix Partners India and Sequoia India.

Can you share more update on the fund raised so far and how are you going to utilise it?

We are very fortunate that we have the panel of great investors and in December 2015, we have completed the Series C funding with IVFA with the Company valuation of Rs 1200 crores ( post money). Well the funds have been raised for future expansion. Typically, we will break even in 12 to 15 months time.

How do you project yourself different from your competitors, especially when it comes to dealing with vendors?

We treat vendors as business partners and provide a great level of respect. We believe in the strategy of having long lasting relationships and doesn’t believe in shortcuts.

Finally, tell us about your vision for Cloudnine hospitals and your expansion plans?

Our strategy is to have a strong foot in the cities we are already present and then venture out. We are present in Bengaluru, Gurgaon, Mumbai, Pune and Chennai.

Our next expansion is in the region of Delhi NCR and Maharashtra and we are preparing to launch 10 more facilities all over India. raelene.kambli@expressindia.com

MARKET POST EVENT

CII Eastern region organises 4 Evolving Healthcare Investment Landscape in Kolkata th

Highlights opportunities and challenges in private equity, venture capital, debt and angel funds in the healthcare sector in eastern India CONFEDERATION OF Indian Industry (CII) Eastern region recently organised the 4th Evolving Healthcare Investment Landscape in Kolkata.

The Evolving Healthcare Investment Landscape is a forum, which, since its inception has been instrumental in sensitising the scope of private equity (PE), venture capital (VC) and angel funding in the healthcare space in eastern India, particularly West Bengal.

The inaugural plenary was graced by Dr Shashi Panja, Minister of State, Health and Family Welfare, West Bengal. Dr Panja said that the stage is set for private investors. Mentioning how healthcare is accessible, affordable and sustainable in West Bengal like never before, she drew special attention to the child and woman social development sector and also urged CII to play the role of a facilitator.

Earlier, setting the tone of the conclave, Sanjay Prasad, Chairman, CII ER Healthcare Subcommittee, said, “The challenge is to provide entrepreneurs with the right intellectual capital so that they are able to proceed with funding abilities. This initiative by CII brings investors, end users, hospital chain owners,

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MARKET stand alone hospital owners and all kinds of healthcare providers under one roof which would translate into effective investment decisions.”

TV Narendran, Chairman, CII Eastern Region, described India as an evolving destination for investment. The demand for specialised quality healthcare services is driven not only by the swelling middle-class in big cities but also from tier-II and tier-III cities across the region. Narendran also spoke of CII’s initiatives such as conducting a model case study on the status of tuberculosis in Haryana, efforts to identify areas at the national level where the private sector could complement government efforts, and creation of the Healthcare Sector Skill Council.

CS Ghosh, MD and CEO, Bandhan Bank, said, “Organisations should also take up CSR activities that promote medical awareness among people. Infrastructure and indigenisation of medical devices need attention as well.” He also spoke about the need for tax exemption for small entrepreneurs to help their projects become viable.

Dr Rupali Basu, Vice Chairperson, CII West Bengal, stated, “Eastern region has witnessed more than Rs 450crore private equity investment in the healthcare domain. The requirement now is to try and connect them with relevant fund houses or advisory houses.”

Sean Sovak, MD, Light House Fund, spoke of making an impact in the healthcare sector which has promising domestic & export markets.

Also present was Kaushlendra Sinha, Regional Director, CII East and North East. The session concluded with a vote of thanks by Rupak Barua, group CEO, AMRI Hospitals.

The first plenary was all about diverse funding opportunities in healthcare. Moderator Dr Rana Mukherjee, MD, Mediplanners, commented that in 10 to 15 years from now, healthcare sector will undergo a sea change. Vamesh Chovatia, Partner, Healthcare Fund, Tata Capital Fund, highlighted key emerging themes like local production of medical equip-

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(L-R) Rupak Barua, Dr Rupali Basu, Sanjay Prasad, Dr Sashi Panja, TV Narendran, CS Ghosh, Sean Sovak and Kaushlendra Sinha, Regional Director, CII East and North East

(L-R) Sunil Thakur, Vamesh Chovatia, Dr Rana Mukherjee, Mahadevan Narayanamoni and Abhishek Kabra during plenary session I

(L-R) Dr Sabahat Azim, Vrinda Mathur, Mr Rakesh Goyal, Mr Sean Sovak, Mr Ayanabh Debgupta during plenary session II

(L-R) Raghav Kanoria, Samir Agarwal, Srikrishna Ramamoorthy and Rajesh Singhal during plenary session III

ment, e-pharmacy and digital healthcare system, telemedicine and analytics that would bridge the urban-rural divide.

Mahadevan Narayanamoni, Director, TPG Capital, said that upgradation of infrastructure is key to success.

Sunil Thakur, Director and COO, Quadria Capital, felt that with privatisation, Eastern India is soon turning into a pop-

ular destination for investors allowing cross-pollination of best practices in healthcare.

Abhishek Kabra, VP, Samara Capital, highlighted how corporatisation, consolidation and brand building are gathering pace. With molecular diagnostics, social media, mobile clinics and home-based healthcare services gaining momentum, there is a high investment appetite for innovative business models.

The second plenary covered the difficulties regional players face in accessing funds.

Recounting the experience of setting up a green-field project with private funding, Ayanabh Debgupta, Director, Medica Super Speciality Hospital, said using a diverse workforce leads to implementation of better practices, thus improving services.

According to Sean Sovak, MD, Light House Fund, it is the scalability factors with an accelerated growth path that investors look for. “People who have had a growth path in life are sometimes better suited in taking businesses forward,” said moderator Dr Sabahat Azim, Founder and CEO, Glocal Healthcare. Investors look for a credible business model and not necessarily B-school tags in budding entrepreneurs.

Rakesh Goyal, Director, investment banking, Yes Bank and Vrinda Mathur, Partner, Grant Thornton India, confirmed that investors’ interest in eastern India’s healthcare sector is growing rapidly.

The third plenary was about strategies healthcare units could adopt while utilising PE, VC, debt and impact utilisation funds. Moderator Samir Agarwal, MD, INDCAP, emphasised the need to invest in technology and brand visibility. Srikrishna Ramamoorthy, Partner, UNITUS Seed Fund felt that customers are ultimately, the best investors.

Raghav Kanoria, Co-founder, Calcutta Angels Network, stressed the importance of technology in today’s business scenario as one of the key factors for investment decisions.

According to him, since the quality of entrepreneurship in the east is good, the region will attract greater volume of investments soon.

EVENT BRIEF JULY - SEPTEMBER 2016 22

MEDICALL 2016

MEDICALL 2016 Date: July 22-24, 2016 Venue: Chennai Trade Center, Chennai Organiser: Medexpert Business Consultants Summary: Medicall is a leading hospitals needs and equipment exposition in India. It brings the latest, appropriate and affordable technologies, for the benefit of all hospitals including smaller hospitals, clinics, nursing homes and physicians setting up group practice.

Express Healthcare is the media

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IIMTC 2016

partner for the event. It will be organised by Medexpert Business Consultants, promoted by Dr Manivannan, Joint Managing Director, Kauvery Hospital.

The exposition will be attended by doctors – physicians and surgeons. hospitals owners and decision makers, dealers distributors and manufacturers of medical equipment, owners of diagnostic and other healthcare centres, medical directors, academicians, biomedical engineers, key policy makers from the governmental sectors, purchase managers, healthcare professionals and paramedical staff

and healthcare consultants.

Contact Medexpert Business Consultants 7th Floor, 199, Luz Chruch Road, Mylapore, Chennai - 600 004, Tamil Nadu, Email: info@medicall.in Website: www.medicall.in

IIMTC 2016 Date: September 3-4, 2016 Venue: Hyderabad Summary: The third edition of International India

Medical Tourism Congress (IIMTC 2016) is going to witness a significant representation from CIS countries, the Middle East, North African Nations, and many more. Several domestic as well as international players from the medical tourism industry has already confirmed their presence for the event, and the IIMTC 2016 will prove a benchmark journey to establish India as the foremost destination for patients around the world, seeking quality, affordable and satisfying medical care.

At IIMTC 2016, Indian healthcare providers will also showcase their sophisticated medical technologies and capabilities in other areas as well to draw more international patients. The event is expected to play a significant role to bolster the growth of the Indian medical tourism industry.

Contact CS Garg (Event Coordinator) Telephone: 011-43029887, 09718459379, 09721008996 Email: contact@iimtc.com Website: http://www.iimtc.com

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cover )

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(

F O C U S : H E A LT H C H A L L E N G E S

R

ANTIBIOTIC

APOCALYPSE A spectre of untreated infectious diseases is looming large over humanity with the growing incidence of antibiotic resistance

BY RAELENE KAMBLI

ising burden of antimicrobial resistance (AMR) also called antibiotic drug resistance has terrorised the world with fear of entering into a ‘post-antibiotic’ era. India, too is losing several lives to antibiotic resistance and the burden of which will soon impact, the nation if not tackled. Let’s understand how?

Twenty-year-old Swati (named changed), a medical student from Mumbai was diagnosed with neurotuberculosis one and a half years ago and was put on to first line anti TB drugs. During the course of her treatment, it was found that she showed no improvement and her health deteriorated further. A battery of medical investigations were conducted which revealed that she had developed Multidrug-Resistant Neurotuberculosis after which she was put onto second line TB drugs consisting of some combination drugs of Rifampin, Cycloserine, isoniazid and few others to treat the MDR TB. A month back, while attending her college lectures Swati felt dizzy and fainted.

She was immediately rushed to a hospital and was detected with diabetes ketoacidosis (a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones).

Currently, Swati is seeking treatment for diabetes from Dr Pradeep Gadge, Consultant Diabetologist, Gadge’s Diabetes Centre and is still on her second line MDR neuroTB drugs. Dr Gadge is of the opinion that Swati’s medical condition seems to be very delicate at this point of time and her diabetes is adding to her misery. He notifies saying, “Diabetes is a multi factorial

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cover ) disease where genetics, sedentary lifestyle and certain drugs are responsible for its manifestation. In Swati’s case we are contemplating that her genetics, coupled with the enormous mental stress faced by her deteriorating medical condition and the use of steroids which were a must in her treatment for neuro-TB all could have precipitated into developing diabetes at an early age.”

While speaking to Swati, she informed that in this entire process her family has spent around Rs 8-9 lakhs on hospitals bill, medical tests and medicines. Her father, who is a school teacher is finding it hard to raise the kind of money required for his daughter's growing medical expenses. Swati on the other hand, aspires to be a doctor, but her dwindling health seems to make this ambition a tall task. As per experts, treatment for TB usually takes around one year or so, but Swati had developed Multidrug-Resistant Neurotuberculosis and so her treatment time will be prolonged.

After speaking to Swati, what lingered in my mind for days together is not the mental stress that this girl is currently going through but rather fear of a financial crisis her father is soon going to face.

Such is the state of people suffering from antibiotic drug resistance world over.

Cure becoming the catalyst

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lakhs

Globally, around 700,000 people die each year from antibiotic drug-resistant infections.

A review commissioned headed by the UK Prime Minister David Cameron and chaired by economist, Jim O’Neill in 2015 warned that if the world fails to get to grips with the problem, an extra 10 million people a year will die by 2050. The review also notes that E. coli, malaria and tuberculosis are the biggest drivers of the study's results, with malaria resistance accounting for the most fatalities and E. coli accounting for

Globally, around

700,000

people die each year from antibiotic drug-resistant infections

Indians are likely to die each year due to antibiotic resistance by 2050, predicts WHO

the greatest economic cost.

Moreover, it appears that the genes responsible for spawning these so-called ‘super bugs’ are also spreading, and turning otherwise mild conditions such as throat infections into deadly killers.

Likewise, researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP) in September 2015 released data documenting alarming rates of bacteria resistant to last-resort antibiotics that can lead to lifethreatening infections across

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cover ) the world. The report states, “Though wealthy countries still use far more antibiotics per capita, high rates in the low- and middle-income countries where surveillance data is now available—such as India, Kenya, and Vietnam— sound a warning to the world.

For example, in India, 57 per cent of the infections caused

by Klebsiella pneumoniae, a dangerous superbug found in hospitals, were found to be resistant to one type of lastresort drug in 2014, up from 29 per cent in 2008. For comparison, these drugs, known as carbapenems, are still effective against Klebsiella infections in 90 per cent of cases in the US and over 95 per cent of cases in most of Europe.”

Explaining how infectious bacteria develop resistance to certain drugs, Dr Dhruv Mamtora, Consultant Microbiology and Infection Control Officer, SL Raheja Fortis Hospital, Mahim states, “Spontaneous natural development of antimicrobial resistance in microorganisms present in the nature is a slow process.

However, the frequent and inappropriate use of a newly discovered antimicrobial drug leads to the development of altered mechanisms of the concerned microbes as a survival strategy. Such antibiotic selection pressure kills the susceptible microbes and helps in selective replication of drug resistant bacteria. These resistant bacteria already existed in the population along with the susceptible ones or susceptible bacteria acquired resistance during antimicrobial treatment. Ultimately, such resistant bacteria multiply abundantly and entirely replace the susceptible bacterial population. This results in treatment failure or ineffective management of such infected patients. Antimicrobial resistance has been observed and reported with practically all the newly discovered antimicrobial molecules till date. Antimicrobial resistance makes the treatment of patients difficult, costly and

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(PAHO, forthcoming). In India, 13 per cent of E. coli were resistant to carbapenems in 2013. For K. pneumoniae, 57 per cent were resistant in 2014 (CDDEP 2015b). ◗ Clostridium difficile infections are related to antibiotic use: bacteria are not affected by most antibiotics and therefore proliferate in the human intestine after most other bacteria are killed by antibiotics. C. difficile causes an estimated 14,000 deaths per year in the US (CDC 2013).

Warning signs on the global front

sometimes impossible.”

Dr Mamtora also provides us global data on certain antibiotic-resistant bacteria of highest concern. The data is as follows: ◗ Methicillin-resistant Staphylococcus aureus (MRSA) has declined in incidence in Europe, the US and Canada over the past eight years, to 18 per cent, 44 per cent and 16 per cent, respectively (EARS-Net 2014; CDDEP2015b; Public Health Agency of Canada 2015). It also has begun to decline in South Africa (to 28 per cent), where antibiotic stewardship is taking hold (Kariuki and Dougan 2014; CDDEP 2015b). In sub-Saharan Africa,India, Latin America, and Australia, it is still rising (AGAR 2013; CDDEP 2015b), recorded at 47 per cent in India in 2014, and 90 per cent in Latin American hospitals in 2013 (PAHO,forthcoming). ◗Escherichia coli (E. coli) and related bacteria have become resistant to newer third-generation cephalosporins, indicating that they are difficultto-treat extended-spectrum betalactamase (ESBL) producers. In 2013, in 17 of 22 European countries, 85 to 100 per cent of E. coli isolates

were ESBL positive (EARSNet 2014). In 2009 and 2010, 28 per cent of all Enterobacteriaceae (the E. coli family) from urinary tract infections in 11 countries in Asia were ESBL producers, and resistance to third- and fourth-generation cephalosporins ranged from 26 to 50 per cent (Lu et al.

2012). In Latin America in 2014 resistance in Klebsiella pneumoniae ranged from 19 per cent in Peru to 87 per cent in Bolivia (PAHO, forthcoming). In sub-Saharan Africa, median prevalence of resistance to third-generation cephalo sporins ranged up to 47 per cent (Leopold et al.

2014). ◗ Carbapenem-resistant Enterobacteriaceae (CRE) are resistant even to last-resort carbapenems. In Europe, five countries reported increases in 2013, starting from low levels of less than 10 per cent (EARS-Net 2014). In US hospitals, 11 per cent of K. pneumoniae and two per cent of E. coli were resistant to carbapenems in 2012 (CDC 2013).

In Latin America in 2013, resistance of K. pneumonia to carbapenems ranged from full susceptibility in the Dominican Republic to 28 per cent resistant in Guatemala

Reports likes these and many other documented facts have revealed the growing economic burden of antibiotic resistance. Experts around the world have been constantly warning for years of an 'antibiotic apocalypse'. Alexander Fleming, the British microbiologist who discovered penicillin in 1929 had also warned the world that misuse of the drug could result in selection for resistant bacteria.

In an 1945 interview with the The New York Times he said, “The time may come when penicillin can be bought by anyone in the shops. There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant."

Fleming's prophecy is legitimate. Within 10 years of the discovery of penicillin, the drug also developed resistance in some people. Nevertheless, the problem did not seem to be of such great magnitude then. It is only in the last few decades that the alarming rise in deaths caused by infections, which are a result of antibiotic resistance and discoveries of new resistant bacterias, have turned the spotlight on this frightening issue. Indeed, experts fear that this apocalypse would send medicine back to the dark ages. With this in mind, World Health Organization Director-General Margaret Chan in a public statement has pointed out that

once antibiotics stop working, hip replacements, organ transplants, cancer chemotherapy and care of preterm infants will be far more difficult or even too dangerous to undertake. In fact, Sir Malcolm Grant, Chairman, NHS- UK, who had recently visited Mumbai on a trade mission spoke to Express Healthcare on the urgent need to address the issue of growing antimicrobial resistance. During this meeting, he mentioned about the Longitude Prize which is a challenge with a £10 million prize fund to help solve the problem of global antibiotic resistance.

He went on to say that the challenge is to create a costeffective, accurate, rapid and easy-to-use test for bacterial infections that will allow health professionals worldwide to administer the right antibiotics at the right time.

However, he pointed out that

The time may come when penicillin can be bought by anyone in the shops.There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.

In an 1945 interview with the The New York Times Alexander Fleming, the British microbiologist

(

F O C U S : H E A LT H C H A L L E N G E S

DR SOUMYA SWAMINATHAN, Director General, Indian Council of Medical Research, Government of India

TWO MAJOR CONCERNING FACTORS THAT HAVE CONTRIBUTED TO THE RISE OF ANTIBIOTIC RESISTANCE IN INDIA ARE OVERUSE AND MISUSE OF ANTIBIOTICS inspite of these efforts, a break through in this regard is currently far beyond sight.

(Read his detailed interview on Pg 44 of this issue) This is a stark reality, that antibiotics which were once called the saviour from many deadly infections have become one of the biggest threats to the world, especially emerging countries such as India. So what’s the scenario in India? Is India braced to battle this apocalypse?

Indian scenario Several studies conducted by global research organisations point out that countries such as India are an epicentre to such antibiotic resistance. Indian researchers and infection control specialists also continue to raise alarm over rising burden of such resistance within the country. “We are facing an extremely grave situation in India, especially as the health sector is one of the neglected sectors in our country and we still have infectious diseases as the major chunk of the illness. On one hand we have a high load of drug resistant cases but at the same time the mediation for the same are extremely expensive and most of the patient require long hospital stay, especially in ICUs. In our country, the number of ICU beds is grossly inadequate. This also increases the burden in the hospital and increases the risk of further spread of drug resistant bugs,” discloses, Dr Anita Mathew, Consultant Physician & Infectious Disease Specialist, Fortis Hospital, Mumbai.

Dr KK Aggarwal, Honorary Secretary General, Indian Medical Association and President, Heart Care Foundation of India provide statistics that puts India on a high

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cover ) DR ANITA MATHEW, Consultant Physician & Infectious Disease Specialist, Fortis Hospital, Mumbai

IN INDIA, THE NUMBER OF ICU BEDS IS GROSSLY INADEQUATE. THIS ALSO INCREASES THE BURDEN IN THE HOSPITAL AND INCREASES THE RISK OF FURTHER SPREAD OF DRUG RESISTANT BUGS risk zone. He pointed out that in 2010, India was the largest consumer of antibiotics for human health globally followed by China and the US. Between 2000 and 2010, consumption of antibiotic drugs globally increased by 36 per cent. BRICS countries, i.e., Brazil, Russia, India, China, and South Africa accounted for 76 per cent of overall increase. Referring to the WHO’s global report on antimicrobial resistance released in 2014, he informed that there were an estimated 450 000 new MDR-TB cases in 2012, about half of which were reported from India, China and the Russian Federation. Moreover, a recent report published by WHO predicts that antibiotic resistance may cause rise in death of Indians to 20 lakhs per year by 2050.

Dr Ramakanta Panda, Vice Chairman & Managing Director, Asian Heart Institute, Mumbai adds saying, “Meta analyses of the drug susceptibility results of various laboratories in India reveal an increasing trend of development of resistance to commonly used antimicrobials in pathogens like Salmonella, Shigella, Vibrio cholerae, Staphylococcus aureus, Neisseria gonorrhoeae, N. meningitidis, Klebsiella, e.coli, Pseudomonas , Mycobacterium tuberculosis, HIV, plasmodium and others.”

Moreover, an article published in the Open Magazine last October, reported on how India's excessive antibiotic usage was now leading to a powerful never-before-seen mutation within bacteria. The article pointed out that NDM-1 (New Delhi Metallo-beta-lactamase-1) a bacteria gene discovered first in India and later in countries such as the US, the

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Data Integration The governm ent's existing egovernance platform can be utilised to fulfill this purpose

Use various diagnostics tools Stressing on right diagnostics will lead to more patients receiving the right antibiotic to treat their infection, and fewer antibiotics would be prescribed unnecessarily

Create an AMR innovation fund An concerted efforts can be made to create an innovation fund to tackle AMR, where the government and the private sector and both chip in.This fund can be utilised for research activities and to create awareness campaigns.

FIVE WAYS TO FIGHTTHE ANTIBIOTIC APOCALYPSE Invest in human resource

Investing in more drug development Pharma companies should consciously re-examine their existing antibiotics portfolios.They need to test whether changing their existing doses or combination of drugs with other antimicrobials could slow down the spread of drug resistance and treat ‘resistant infections’more effectively

It is crucial to train the next generation of medical practitioners.These professionals will need to find novel approaches and therapies for microbial diseases, whilst maintaining a connected and global outlook.

UK, Canada, Japan and China had taken away several lives.

Agreeing that countries such as India could be breeding grounds for such resistant bacterias, so, what are the determining factors for this problem?

GOOD MANUFACTURING PRACTICES FOR PHARMA INDUSTRY

The root cause

❖ Introduce new production techniques and implement

According to a study published in 2015 by Professor Ramanan Laxminarayan, Vice-President for Research and Policy, Public Health Foundation of India and late Professor Ranjit Roy Chaudhury, Ex-chairman of the National Committee for formulating the policy and guidelines in drugs and clinical trials in India, the concurrence of factors such as poor

strict quality controls along the production and supply chain ❖ Treat wastewater from the antibiotic production in dedicated Waste Water Treatment Plants (WWTPs) before it leaves the production site to municipal plants ❖ Limit discharges and emissions of active pharmaceutical ingredients (APIs) into the rivers, local lakes and drainage systems ❖ Renew efforts to develop medicines to fight emerging antibiotic-resistant bacteria, joining hands with the government to make the effort worth the investment

public health infrastructure, rising incomes, a high burden of disease, and cheap, unregulated sales of antibiotics has created ideal conditions for a rapid rise in resistant infections in India.

Dr Soumya Swaminathan, Director General, Indian Council of Medical Research, Government of India, pointed out two major related factors that have contributed to the rise of antibiotic resistance within the country. One is the inappropriate use of antibiotics which are freely available over-the-counter and secondly, the fact that doctors prescribe these antibiotics without understanding the implications of each of these drugs. Therefore there is a lot of overuse and misuse of antibiotics in India.

Dr Panda expounds further, “In India, very effective antibiotics have also been failing to give desired results as bacteria have become resistant to them. As doctors prescribe antibiotics for regular infections that would heal themselves anyway cause bacteria to mutate and develop resistance. The result is a potentially nightmarish proliferation of antibiotic resistant super bugs. The issue of getting infections in hospitals is not new. However, the spread of these infections from the 'hospital environment' to the patient is very high. Also, increasing is the severity of these infections.

Doctors have observed that the bacteria are becoming more resistant, making it harder to treat these infections. Hospitals in India have a high burden of infections in their ICUs and wards, many of which are resistant to antibiotic treatment says a recent report by the Global Antibiotic Resistance

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F O C U S : H E A LT H C H A L L E N G E S

DR RAMAKANTA PANDA, Vice Chairman & Managing Director, Asian Heart Institute

THE ISSUE OF GETTING INFECTIONS IN HOSPITALS IS NOT NEW. HOWEVER, THE SPREAD OF THESE INFECTIONS FROM THE 'HOSPITAL ENVIRONMENT' TO THE PATIENT IS VERY HIGH Partnership (GARP)-India Working Group and the Center for Disease Dynamics, Economics & Policy (CDDEP). It won’t be an exaggeration to say that in the next few years, deadlier hospital acquired infections will kill more people than diseases itself. Other problems such as self-medication by patients, unrestricted over-the-counter (OTC) sale of antibiotics and unauthorised use of antibiotics by quacks etc., are all contributing to antimicrobial resistance.”

Dr Panda is meticulous in identifying the root cause of this problem. All the same, Anurag Roy, Business Unit Director, Asia Pacific, Middle East and Africa, DSM Sinochem Pharmaceuticals brings in a new perspective to this issue. Time and again we have referred to the inappropriate use of antibiotics and lack of infection controls within hospitals that lead to growing resistant bacteria, but we have missed out an important aspect – good manufacturing practices among pharma companies and the responsible management of the entire supply chain.

Roy says, “Producing antibiotics creates loads of waste in the form of water, air and solids. If these waste streams are not managed and disposed responsibly, the pollutants they contain end up in our environment. These create an increasingly growing breeding ground for bacteria to develop resistance. Thousands of tonnes of antibiotics are produced every year in India and China, and there are numerous factories that do not use proper waste management and treatment systems. They dump untreated effluents into water streams, lakes and rivers in and around their fac-

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Forr enquiries Fo enquiries contact contact : sales@schillerindia.com

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cover ) tories and plants. They have either no dedicated waste treatment systems or don’t want to invest in these as these are cost-intensive. Some of the manufacturers have it but don’t want to use it as it involves additional resources.

The result is that sometimes a single water source gets a huge load of harmful effluents from multiple manufacturing plants posing a grave danger to the environment and disturb the entire eco-system of the habitat.”

Furthermore, Dr Swaminathan raises another concern. She mentions, “ Antibiotics are been mixed with animal and poultry feeds.

This is potentially dangerous as these antibiotics find their way through water and soil and lead to drug resistance within the environmental bacteria, in the bargain transferring drug resistance to humans”.

Well, it's time we take some responsible actions. India has quite a few efforts taken by both government and private healthcare players in this direction so far such as, research conducted by some pharma companies on new drugs to fight resistance, research on infection control mechanisms by healthcare institutes like AIIMS, formulations of AMR policy by government bodies etc. However, are these efforts effective to bring about a change? Or the road map to achieve success in this sphere still looks gloomy?

Efforts to tide over During our investigation, experts have conveyed that there is a serious lack of data integration when it comes to AMR in India. This is quite detrimental to the progress of any initiative taken in this regard.

Dr Swaminathan agrees that there is no serious compilation of data on this subject. Moreover, she said that the ICMR is now taking proactive steps to address this health concern in India.

She said, “Four hospitals in India cur-

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Percentage of carbapenem-resistant Klebsiella pneumoniae, by country (most recent year, 2011–2014) Source: CDDEP 2015

Spread of New Delhi metallo-beta-lactamase-1: first detection Source:CDDEP 2015

During our investigation, experts have conveyed that there is a serious lack of data integration when it comes to AMR in India.This is quiet detrimental to the progress of any initiative taken in this regard rently have the surveillance programme conducted- AIIMS, PGI Chandigarh, JIPMER- Pondicherry and CMC Vellore which will help to understand the resistance pattern of these bacteria. This will soon be increased to 10 major hospitals in India which will give us an idea on the system and protocols that will curtail resistance. One of the lessons we have learnt so

far is that we really need to act on framing and implementing strict infection control policies within every hospital in India. We are also coming up with an antibiotic stewardship programme that will consist of SOPs and manual for infection control within hospitals and the terms on which antibiotics can be used within hospitals.”

One more potential area of

concern is the availability of many irrational combination drugs. She further stated, “Although the government has banned around 350 odd combination drugs, some of these irrational combination drugs had the tendency to develop resistant bacteria which is why these drugs had to be banned. More so, I suggest that pharma companies should market their combina-

tion drugs more responsibly, especially when they are marketing these drugs to the doctors. It is very important to explain the causes and effects of each of the drug’s components to the practitioners so that they make an informed decision while prescribing these drugs to their patients .”

On this suggestion, Roy recommends some good manufacturing practices to his colleagues from the pharma industry. They are as follows: ◗ Introduce new production techniques and implement strict quality controls along the production and supply chain ◗ Treat wastewater from the antibiotic production in dedicated Waste Water Treatment Plants (WWTPs) before it leaves the production site to municipal plants ◗ Limit discharges and emissions of active pharmaceutical ingredients (APIs) into the rivers, local lakes and drainage systems ◗ Renew efforts to develop medicines to fight emerging antibiotic-resistant bacteria, joining hands with the government to make the effort worth the investment Having said that, we cannot deny efforts taken by the government lately. Ban on certain irrational combination of drugs, stricter marketing codes for pharma companies, setting up of surveillance units within hospitals will set a clear road map ahead. But all these efforts will make no change without public initiative. This calls for a need to create public awareness on this issue. In this regard, an impressive effort taken by the government recently is the 'Medicines with the Red Line'-to spread awareness about irrational use of antibiotics. According to this campaign, packs of certain medicines will soon carry a 'red line' differentiating them from other drugs.

The move is aimed at discouraging unnecessary prescription and over-the-counter sale of antibiotics causing drug resistance for several

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F O C U S : H E A LT H C H A L L E N G E S

critical diseases including TB, malaria, urinary tract infection and even HIV.

Lastly...

We will have to move ahead with the never say die attitude and come up with more effective measures. Here are five ways by which India can leap frog in our efforts to fight the antibiotic apocalypse.

Data integration:Appropriate data is a valuable asset in solving any healthcare concern. Stakeholders involved in large healthcare initiatives usually face problems when trying to incorporate data from multiple sources in order to craft a usable set of action plans. Effective tools and strategies for data integra-

Ban on certain irrational combination of drugs, stricter marketing codes for pharma companies, setting up of surveillance units within hospitals will set a clear road map ahead tion will solve this issue and in turn help in coming with a clear road map. The government's existing e-governance platform can be utilised to fulfill this purpose.

Create an AMR innovation fund: In an era where India is projected to be as an innovation hub, an concerted efforts can be made to create an innovation fund to tackle AMR, where the government and

the private sector can both chip in. This fund can be utilised for research activities and to create awareness campaigns. The other way is to create this fund by using Corporate Social Responsibility (CSR) as an financing option. Many corporates do invest in R&D as part of their CSR activity, a fund can be created by leveraging such opportunities.

Investing in more drug development: Pharma companies should consciously re-examine their existing antibiotics portfolios. They need to test whether changing their existing doses or combination of drugs with other antimicrobials could slow down the spread of drug resistance and treat ‘resistant infections’ more effectively.

Use various diagnostics tools: Stressing on right diagnostics will lead to more patients receiving the right antibiotic to treat their infection, and fewer antibiotics would be prescribed unnecessarily.

Invest in human resource: It is crucial to train the next generation of medical practitioners, scientists, microbiologists, pharmacologists, medicinal chemists and biochemists, as well as economists, social scientists among others. These professionals will need to find novel approaches and therapies for microbial diseases, whilst maintaining a connected and global outlook. raelene.kambli@expressindia.com

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STRATEGY I N T E R V I E W

‘The recent re-branding effort highlights the integral role sustainability plays in the Sealed Air identity’ Sealed Air’s Diversey Care as part of its Corporate Social Responsibility(CSR) has recently launched an access to soap programme in partnership with Doctors for You, a humanitarian organisation. Himanshu Jain, MD&VP, Indian Sub-Continent, Sealed Air, explains the strategy behind the programme and impact achieved so far in an interview with Raelene Kambli

How important it is for corporates to invest in healthcare through the CSR activities?

Corporate Social Responsibility (CSR) is a concept that has many different meanings and definitions. The way it is understood and implemented differs greatly for each company and for each country.

Companies have their duty towards the society and CSR helps in bridging the gap between society and corporate world. CSR will help the healthcare sector to participate in social issues that could serve to improve their images and enhance the stakeholder.

The healthcare industry deals with a variety of challenges. Right from labour shortage, costly technological advancements, implementation of international quality standards, etc., makes this industry one of the most operationally difficult sectors.

Hospitals have to work harder than other industries to win and retain that trust while coping with the operational challenges.

India carries 20 per cent of the world’s disease burden, according to data from the

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World Health Organization (WHO). About 75 per cent of deaths globally are caused by communicable diseases, of which India accounts for 17 per cent.

CSR funds are therfore being used to encourage innovation in healthcare processes and medical devices to deliver healthcare in a portable, convenient and cost-effective way.

Investment in healthcare is an asset to the country and companies should seriously consider investing in healthcare.

Explain to us the rational behind your Soap for Hope campaign and how have you implemented this?

Millions of children and their families around the world live and work in slums, in dire poverty, with very little or no access to soap. Hand-washing with soap is among the most effective and inexpensive ways to prevent diarrhoeal and respiratory diseases in the developing countries, where millions of children per year suffer from diseases that could have been prevented with proper hand-washing.

Soap for Hope is based on a simple process that requires no running water or electricity. Once the used

Investment in healthcare is an asset to the country and companies should seriously consider investing in healthcare

soap are collected from hotels, Sealed Air, through an NGO, teaches the local people to recycle/process soap using an innovative cold-press method with simple but uniquely customised equipment. The entire process takes less than 10 minutes and once the used soap is recycled into fresh bars of soap, the soap will be distributed to communities which lack access to soap or sanitation. UNICEF facts show that hand washing with soap can reduce the incidence of acute respiratory infections (ARI’s) by around 23 per cent. Hand washing can be a critical measure in controlling pandemic outbreaks of respiratory infections. Several studies carried out during the 2006 outbreak of severe acute respiratory syndrome (SARS) suggest that washing hands frequently can cut the spread of the respiratory virus by 55 per cent. Hand washing with soap has been cited as one of the most costeffective interventions to prevent diarrhoeal related deaths.

Sealed Air’s Soap for Hope, is a soap-recycling programme. This innovative programme has been pioneered by Sealed Air to

recycle used hotel soaps into fresh soap for distribution in local communities. The programme's objective is three-fold: to save lives by promoting a cleaner and healthier environment through proper hand-washing with soap; to provide a means of livelihood for local communities through learning a new skill; and to help hotels reduce waste by recycling used or discarded soap.

Is your campaign a shared value-business model approach?

Yes! Soap for Hope initiative is an integrated systematic shared value business model approach by Sealed Air Corporation. A typical 400room hotel generates 3.5 metric tonnes of solid soap waste per year. Hand-washing with soap is among the most effective and inexpensive ways to prevent diarrhoeal and respiratory diseases in developing regions. Soap for Hope, addresses waste reduction and hygiene enhancement at the same time, while also generating livelihoods for local communities. Thus, this programme creates Shared Value for communities through engagement with

hotel partners. Furthermore, the programme also demonstrates the massive potential for hotels to deliver shared value through its lowcost and sustainable model.

Hotels benefit by supporting their own communities while achieving their sustainability goals and finding an ideal use for soap that is otherwise discarded, all at a minimal cost.

What are the outcomes so far? ◗ Access to soap for those who need it, thereby reducing the chances of serious illnesses for the community, especially young children. ◗ Create livelihood opportunities by enabling families to earn a small living by making soap. ◗ Hotels have a meaningful way to recycle soap and hotel staff can be involved in the project, making a positive difference to the hotel and in the community.

Do you have any more shared value programmes under your CSR activity?

Other programmes of Sealed Air which create shared value are United Nations World Food Programme Partnership: Sealed Air's vision is to create a better way of life, and so we have partnered with the United Nations World Food Programme and WFP USA on disaster relief by not only making monetary donations, but by using our footprint, product portfolio and customer relationships to bring potable water and shelter to affected areas.

Alliance for Water Stewardship: Sealed Air was one of the first businesses to help the Alliance for Water Stewardship develop an international standard for responsible water management. The Beta version of the standard was launched in March 2013, and after five years of work, the Alliance for Water Stewardship’s International Water Stewardship Standard was released in April 2014.

Soap for Hope has been officially launched in India on May 27, 2016 and the company aims to take this project to other cities across India.The company has received the Asian CSR award for this initiative.We intend to reach out to more communities and create an impactful living by touching thousands of lives by the end of this year and thus create this as a movement rather than a one-off initiative

World Wildlife Fund: A member of the World Wildlife Fund’s Climate Savers Programme in (2008) - Sealed Air’s Diversey Care was honoured for fulfilling a 10year commitment to reduce CO2 emissions. By the end of 2013, it had reduced absolute CO2 emissions by over 48 per cent from 2003 levels. Sealed Air is also a founding member of the WWF Global Water Roundtable to establish water use standards and address clean water issues (2009).

Porter Prize for creating distinctive value: Sealed Air India received the award from the Institute for Competitiveness for creating new market spaces, segments and solutions that redefined markets. The award recognises the role of strategy in the creation of unique and valuable positions that cannot be easily imitated by the competitors.

Sealed Air Among Top Companies on CDP’s 2014 & 2015 Global 500 Climate Change Report: The company’s efforts to reduce greenhouse gas emissions and mitigate the risks of potential climate change were recognised by the CDP, the world’s only global environmental disclosure system. According to CDP S&P 500 Climate Change Report 2014, which presents new analysis linking S&P 500 industry leaders with financial out performance, Sealed Air, was one of the 63 companies on S&P 500 to

achieve a position in CDP’s S&P 500 Climate Disclosure Leadership Index (CDLI).

Do you think that this approach can lead a company toward sustainability in the long run?

Our goal is to be the leader in protecting the important, what you eat and drink, where you go and the products you ship. Sealed Air Corporation creates a world that feels, tastes and works better. In 2015, the company generated revenue of approximately $7.0 billion by helping its customers achieve their sustainability goals in the face of today's biggest social and environmental challenges. Sustainability is an integral part of our business practices, innovative solutions and values. Sustainability is at the core of all what we do. The recent rebranding effort highlights the integral role of sustainability which Sealed Air plays. The three sides of the Trillian, our new logo, symbolises the values we bring to bear on behalf of our customers — sustainability, performance and cost competitiveness.

Who is your NGO Partner?

Why did you choose to partner with this NGO? Doctors for You (DFY) is our NGO partner in the Soap for Hope Initiative. DFY is a pan India humanitarian organisation with

international presence and is working in various disaster hit zones since the last seven years. DFY focuses on providing medical care to the vulnerable communities during crisis and non-crisis situation, emergency medical aid to people affected by natural disaster, conflicts and epidemics. They are also committed to reducing disaster risk to human society by delivering trainings and capacity development in emergency preparedness and response.

DFY team operates with vulnerable communities across India. Distributing soaps in these areas will help increase the effectiveness of immunisation programmes, and also make people aware about hand washing.

What is the impact of your campaign and within your organisation?

Soap for Hope was first launched in Cambodia in 2013. Since then, it has been implemented in multiple Asian countries and expanded beyond the region.

Soap for Hope’s most recent launch was in Vietnam which was a resounding success with participation from 11 hotels. Soap for Hope is now in 17 cities across 11 countries including Indonesia, Thailand, Philippines, Malaysia, China, the United Arab Emirates, Kenya and South Africa. Currently, 120 hotels are supporting the programme and more than

160,000 beneficiaries gain free access to soap every year.

Recycling used hotel soap is not a new idea; however, the costs are usually high due to collection, shipment, a centralised reprocessing plant and redistribution.

Through an innovative but simple cold-press method that is easy to operate, Soap for Hope decentralises and brings the initiative to communities that are located near partner hotels.

It has been officially launched in India on May 27, 2016 and the company aims to take this project to other cities across India. The company has received the Asian CSR award for this initiative. We intend to reach out to more communities and create an impactful living by touching thousands of lives by the end of this year and thus create this as a movement rather than a oneoff initiative.

How involved are your employees in this CSR activity?

CSR for Sealed Air India is not about donating money, but making a difference in the lives of the people we encounter. Our employees are very much involved in 'giving', even before we had an organised CSR committee.

Every time, any calamity happens, we rise to the occasion fully; whether by donating a month's salary, or collection of clothes, books etc. or participating enthusiastically in blood donation drives etc. It is a practice at Sealed Air, without an exception. We now have a CSR committee headed by senior management team, and with various employees as members. The CSR committee is tasked with implementing the CSR programme at the ground level, and given the past few month's experience, the committee is on course to implement our CSR plans fully. raelene.kambli@expressindia.com

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MEDICALL 2016

15 edition of Medicall to be held in Chennai th

Medicall will serve as a paltform to share expertise with the fellow medical fraternity

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he 15th edition of MEDICALL, reportedly India’s largest B2B medical exposition, will be held at Chennai Trade Centre in Chennai from July 22-24, 2016. Express Healthcare is the media partner for the event. It will be organised

by Medexpert Business Consultants, promoted by Dr Manivannan, Joint Managing Director, Kauvery Hospital, a-1000 bedded hospital in South India. This hospital was started 11 years back with 30 beds by young professionals with limited knowledge about hospital industry.

They faced many hurdles in the course of their growth. Medicall was born with the idea to share their expertise with the fellow medical fraternity.

Sundararajan-Project Director is assisted by a dedicated team of professionals who have vast experience in the industry.

Since MEDICALL is being organised by people who have been in this field for many years, the content and the quality of the visitors are expected to be better than any other previously held event.

The exposition will be attended by doctors – physicians and surgeons. hospitals owners and decision makers, dealers distributors and manufacturers of medical equipment, owners of diagnostic and other healthcare centres, medical directors, academicians, biomedical engineers, key policy makers from the governmental sectors, purchase managers, healthcare professionals and paramedical staff and healthcare consultants.

Exhibitors profile include building automation and facility management, consumables, electrical and lighting solutions, endoscopy equipment, healthcare consultants, healthcare IT

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Exhibitor zone

solutions, hospital beds, furniture and floorings, housekeeping solutions, HVAC and Medical Gas, implants, laboratory equipment, laundry equipment, life support systems, mannequins and teaching equipment, medical disposables, OT & ICU equipment, patient monitoring systems, physiotherapy and orthopaedics, radiology equipment, recycling and hospital waste management, refurbished equipment, rehabilitation products, sterilisers, surgical instruments, telemedicine, wound care products.

A series of seminars will be held during the exposition. They are 'Hospitals – Build it Faster, Cheaper & Better', 'How to Reduce Cost and Increase Profitability', 'Innovations in Medical Industry-Learn from Innovators', 'Digital Hospital – Business Analytics in Hospital | Cost Effective IT Infrastructure | Mobile Apps |Software Licensing & IT Audit' and 'Patient Satisfaction', 'Easy Capital – Funding a Hospital', 'Failure of Hospitals – Reasons, Lessons & Mitigation

of Risks, 'Future of Indian Clinical Diagnostics & Imaging Industry', 'Workshop for OT Nurses.'

Rise over the years 2006: The first Medicall exhibition was introduced as a small medical equipment expo and was hosted at Chennai. It was very well received by the industry and there were more than 100 exhibitors and 3000 visitors.

2007: Medicall 2007 was bigger and better than its first edition. There were more exhibitors and visitors at the event.

2008: The third edition of Medicall attracted 5,400 visitors from across the country. Apart from hospital owners, hospital administrators, and people from other segments like dealers, architects, hospital consultancy, nurses, and biomedical engineers, exhibitors dealing with hospital flooring, lighting, energy saving equipment, storage solutions, ambulance fabricators, etc., also participated for the first time in this show.

2009: With more than 5700

visitors attending Medicall 2009, the expo bridged the gap between the buyers and users and managed to bring them together on one single platform. In this three-day expo, more than 250 exhibitors from all over India and China displayed their latest equipment. Medicall became a pan-India event than just a regional expo in Chennai.

2010: Availability of unique products, choice of products, international exhibitors were the USPs of Medicall 2010. It was bigger and more incisive in terms of content and participation.International participation increased and over 400 exhibitors from China, Germany, Taiwan, England and India displayed their latest medical equipment. It grew to become India’s largest and Asia’s third largest medical equipment expo.

2011: Around 7500 visitors from India and other countries like Sri Lanka, Nigeria, Nepal, and Taiwan visited the three day show. The Healthcare Innovation Awards, instituted for first

time in this edition of Medicall, attracted several applications from across the country. More than 430 exhibitors from India, Germany, China, Taiwan, Korea, Japan and Iran participated in the show and displayed A-Z requirement of hospitals.

2012: Medicall 2012 was again a year to remember with huge participation from healthcare industry experts and professionals as well as several new and innovative segments like fashion show on hospital garments and “Hospital Property Mela”. Over 500 companies exhibited at Medicall. It also saw an increase in exhibit space.

Representatives from Germany, China, Taiwan, South Korea, Pakistan, Malaysia and more participated in Medicall events that year.

2013: With 530 exhibitors and more than 10500 visitors, Medicall 2013 grew in terms of quality and quantity. BrainStormMedicall conferences attracted more than 850 delegates with eight parallel thematic healthcare conferences.

2014: Medicall 2014 involved approximately 630 companies from across the globe who participated in the exhibition. Most of the exhibitors substantially increased the size of their stall and showcased more products during the three-day exhibition. It was a true bazaar for hospital equipment and supplies, ranging from surgical gloves to the most sophisticated medical equipment used worldwide.

2015: Over 600 exhibitors from more than 20 countries and professional visitors exceeding 11,000. The international pavilions included Bavaria, Germany, China, Taiwan, Malaysia, South Korea, Portugal, Italy, UK, US, Indonesia, and Nigeria

Sometimes I’m blunt.

But never pointless.

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The Indian Express.

For the Indian Intelligent.

#IndianIntelligent

MEDICALL 2016 I N T E R V I E W

‘There are tremendous growth opportunities in Indian healthcare industry’ Meditek Engineers, an ISO 9001:2008 and ISO 13485 certified company, engaged in the business of manufacturing and marketing full range of medical beds and furniture. Anil Phirke, CMD, Meditek Engineers, talks about its future growth prospects to Express Healthcare What role did Meditek Engineers play in the field of hospital beds and other ancillary products? Throw some light on your company’s growth story?

We at Meditek Engineers are steady and comfortable in hospital beds and furniture market since the last 27 years.

It is all because of respect and trust by our clients and vice versa. The success of our company is due to the following factors. They are, customer comes first, best services through out sale and after sales, continouse R&D, innovative sales and marketing strategies.

What market opportunities

and trends do you witness in the Indian healthcare industry? How do you plan to tap it and what is your current market share?

Yes, there are tremendous growth opportunities in Indian healthcare industry.

Seeing the current market trends, there are two types of opportunities. They are volume based (beds and other furniture) and specific beds and furniture opportunities.

Our continuous effort is to cater to both the opportunities. Our performance in the market for so many years has given significant business to Meditek Engineers.

relationship works for us. The approach of customer comes first. It gives us the benefit of being different in the market.

Many companies are entering into hospital furniture market space. Who according to you are your competitors?

How would you differentiate yourself from them?

We don’t believe in compitition. Client

Going ahead, what are your expansion plans? What strategies have been chalked to meet the expansion plans?

We have aggressive growth plans. There are plans to penetrate various demographics in the national and international market. We recently visited Kenya and South Africa for getting international exposure. At the same time, we are working on sales and marketing strategies to cover the Indian market.

Meditek has received

industry recognitions. Can you take us through some of your past and recent achievements?

For us achievement basically comes when customers appreciate our products and services. For all these years, we have counted this as achievement. We have recently received the Best Hospital Furniture Manufacturer Award in Goa. Are there any new initiatives being undertaking by Meditek Engineers?

We have undertaken a lot of R&D activities to cater to the specific requirements of hospitals. A lot of new things are in the offing.

JKAnsell excels in leveraging technology in customer engagement JK Ansell develops an exclusive conference delegate mobile app on android and iOS mobile app

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K Ansell, an Indian counterpart of Ansell Australia has been honoured as most enterprising company for ‘Leveraging Technology in Customer Engagement.’ Business World had created a property - DigiPharmaX to recognise the efforts taken by PHARMA industry in exploring the accessible digital technology. In total 18 awards spread across multiple categories were recently given away at DigipharmaX in Mumbai. The ceremony was at-

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tended by eminent personalities of industry including renowned policy maker Rajendra Pratap Gupta as the chief guest.

JK Ansell, the pioneer in medical glove technologies, developed an exclusive conference delegate mobile app on android and iOS mobile app.

This app enhances the way a medical or surgical conference is attended and provided an engaged experience for organisers, faculties and and most importantly delegates.

MEDICALL 2016

Sysmex Partec: Excellence in flow cytometry Amardeep Gupta, Business Manager, Partec, Sysmex India gives an overview on how Sysmex Partec provides excellent automated cell analysis tools with higher precision and more affordability than ever before

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ore than 45 years of ‘Flow Experience’ characterises the pioneering leadership of Partec.

Almost 60 patents in the field of cell analysis impressively demonstrate the commitment of Partec to push the stages of technological innovation with further development of sophisticated and cutting-edge flow cytometry instrumentation.

Partec was established in 1967 and in 1968-69 brought to the market, the Impulsecytophotometer ICP 11, the first fluorescence-based and commercial flow cytometer (FCM).

This analysis method was later renamed in 1978. Continued scientific research and development resulted in today’s advanced generation of high precision instruments and procedures for cell analysis.

Today, in addition to most advanced FCM instruments, Sysmex Partec provides complete solutions for many cell analysis applications, covering reagents, protocols, accessories, application support, training and service.

Sysmex Partec is the newly formed collaboration between Partec, a worldwide leading pioneer, developer and manufacturer of flow cytometry systems and Sysmex Corporation, a leading international supplier of in vitro diagnostic products. Sysmex Partec products are used in a wide range of applications in healthcare. The company is recognised as a global leader in essential healthcare by widely providing

Amardeep Gupta, Business Manager, Partec, Sysmex India

robust and affordable hi-tech diagnostic solutions to resource poor markets.

With its new partnership, Sysmex Partec is now available in more than 150 countries worldwide. By combining the latest scientific and biotechnological knowledge into clever and cost-effective solutions, based on easily applied analysis procedures and instru-

ments, Sysmex Partec can provide excellent automated cell analysis tools with higher precision and more affordability than ever before.

The Sysmex Partec product portfolio can be generally characterised by the combination of groundbreaking all-in-one design with outstanding ergonomics, while featuring optimal performance. In addition to the

CUBE 6 instrument, this portfolio also includes the CUBE 8 flow cytometer, a red dot design award winner for 2012 and an iF design award winner for 2013Flow cytometry has evolved today to become the key method for precise and rapid cell analysis. With continuous innovation, Sysmex Partec now makes available flow cytometers, reagents and new, dedicated applications

that are easier to use and more affordable than ever before.

Sysmex Partec will continue to expand the broad range of applications, which can be perfectly covered with Sysmex Partec Flow Cytometry technology by dedicated instruments for human healthcare, microbiology, industrial applications, food quality control, plant and animal research, etc.

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MEDICALL 2016

Modi Medicare introduces MEDMAMMO: An independent FFDM mammography workstation Med Mammo is a mammography diagnostic workstation which combines ease of use and high performance features.

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edecom’s Med Mammo is enhancing reading and image management for diagnostic mammography. Breast imaging and women’s health clinics will benefit from Medecom’s fifteen years of radiology and image workflow experience.

With Medecom’s Med Mammo breast imaging workstation, one can include reading of tomosynthesis images and other multi-modality radiology examinations in the regular mammography reading workflow. This significantly increases efficiency as the need to move to a dedicated modality workstation is eliminated.

Med Mammo is among the first digital mammography solutions to offer support for import and review of the tomosynthesis DICOM format.

Each imaging study is automatically associated with the correspo nding modality imaging functions such as, measureme nts, stitching, MIP/MPR and modality display protocols

Multimodality with relevant prior matching Users benefit from Med Mammo’s multi-modality support to pre-fetch clinically relevant priors including ultrasound, MRI and tomosynthesis, to be displayed side-by-side with the mammograms.

Each imaging study is automatically associated with the corresponding modality imaging functions such as, measurements, stitching, MIP/MPR and modality display protocols. This ensures that they are hung with the precise tools according to ra-

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diologists’ preferences for optimal viewing and diagnosis.

Mammography studies from multiple vendors are automatically scaled and aligned to ensure optimal side by side comparison. Medecom has improved this critical element of digital mammography reading, to make it possible to view and

report on all forms of breast imaging (MRI, ultrasound, digital breast tomosynthesis and X-ray) from any vendor on a single client interface.

A complete digital mammography solution In order for you to take full diagnostic advantage of the to-

mosynthesis format you need to ensure the support of tomosynthesis images throughout the digital mammography workflow. This requires modules that complement legacy radiology systems to ensure compatibility or extend functionality offered by the new tomosynthesis format.

Medecom provides tomosynthesis support throughout a vendor neutral, digital mammography, product line.

Medecom's digital mammography modules include storage, reporting, printing, CD/DVD archive and Electronic Image Exchange.

Compliant with the regulatory requirements and standards in many countries, Med Mammo is a true alternative to any manufacturer’s workstations.

Contact Jigish B Modi Ph: 2506 5664, 98670 01110, Email: modimedicare@gmail.com Skype: modi.medicare

MEDICALL 2016

Myrian XL Onco: A leading solution for oncology follow-up Myrian XL-Onco was developed and validated jointly with leading French experts

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he unique solution for multi modality oncology follow-up, Myrian XLOnco is the culmination of eight years of development of the Myrian platform.

Dedicated to oncology follow-up, it manages the sequencing of tasks essential for the management of the cancer patients with elevated efficiency and in strict compliance with the international RECIST rules, consensually established

by European, Canadian and American authorities.

The Cheson protocol whose parameters can be set by the user is also available.

Myrian XL-Onco was developed and validated jointly with leading French experts.

It makes Intrasense a world

leader in oncology follow-up software applied to medical imaging.

It is intended for routine clinical practices of hospitals treating cancer patients as well as for pharmaceutical companies and CROs in the framework of phase I, II and II clinical trails to evaluate anti-cancer therapies.

of a patient's cancer by comparing the latest examination to prior results. This follow-up involves key steps managed by the software that considerably simplifies the radiologist's work.

First rate partners The best specialised cancer teams contributed to the de-

velopment of this module.

They are: ◗ Curie Institute (Paris, France) ◗ Pitie-Salpetriere (AP-HP – Paris Public Hospitals Authority) (Paris, France) ◗ Hopital Europeen Georges Pompidou (AP-HP – Paris Public Hospitals Authority) (Paris, France)

◗ Civil Hospices of Lyon (HCL) (Lyons, France) ◗ Montpellier University Hospital (Montpellier, France) Contact Jigesh B Modi Phone: 25065664, 9867001110 Email: modimedicare@gmail.com Skype: modi.medicare

Original technologies Automated retrieval of prior exams, dedicated clinical workflow obeying RECIST rules, automatic 3D registrations of examinations in elastic mode, automated production of reports and graphs.

Applications It is used to follow the course

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MEDICALL 2016

Innovative CR 10-X EPS from Agfa Healthcare It has been designed to flexibly fit the real financial flows of healthcare facilities of any size

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oo often, high infrastructure, equipment and service costs plus a slow return on investment are preventing healthcare providers from adopting advanced technologies such as digital imaging. Now, Agfa HealthCare has developed a new product combining technology with finance that lets even facilities with a low volume of imaging benefit from the higher quality images, increased productivity and smoother, more efficient workflow that computed radiography (CR) provides.

EPS – Easy Payment Scheme – has been designed to flexibly fit the real financial flows of healthcare facilities of any size, so you can adopt a brand-new CR 10-X system right away. You pay as you go, with a fixed down-payment followed by equal and regular installments, keeping your upfront capital investment low and your cost management easy. There is no need for a bank loan or complex paper works.

A full digital package With EPS, you get a full digital package up-front, including: ◗ A brand-new CR 10-X EPS digitizer: an affordable CR solution that makes no compromises on image quality, offering a convenient and fast workflow ◗ A new NX workstation: the radiographer's image identification and quality control tool, with an intuitive user interface

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◗ MUSICA image processing software: Agfa HealthCare’s ‘gold standard’ intelligent, automatic and body-part independent image processing, with superior contrast detail ◗ New CR MD1.0 general imaging plates and cassettes ◗ A new DRYSTAR 5302 imager: tabletop, two online trays that can support any of the five media sizes, direct

digital imager designed for a decentralised workflow ◗ Three years of comprehensive warranty that takes care of the system against unexpected service costs And paying the installments is easy, through the web-based interactive portal.

Each payment ensures your use of the system through to the next installment date.

CR 10-X digitizer ◗ Affordable and efficient CR solution offering high image quality ◗ Intelligent MUSICA image processing ◗ Convenient and fast workflow ◗ Robust yet easy to install and maintain ◗ Fits in small spaces and is suited for mobile applications

◗ Smart image plate handling that reduces wear and tear Contact the nearest Agfa HealthCare office to know more about stepping into digital imaging, with EPS 402, 4th Floor, Nitco Biz Park, Plot No. C/19, Road No. 16, Wagle Industrial Estate, Thane (West) - 400604, India Tel: +91 22 40642900 / 29 Email: sales.india@agfa.com

MEDICALL 2016

KMCH observes ‘World No Tobacco Day’ The awareness programme aimed to draw public attention to spread message of harmful effects of tobacco use as well as its passive effects to others

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ovai Medical Center and Hospital (KMCH), a multi-speciality hospital in Coimbatore recently launched a 'Let’s say No to Tobacco -signature campaign' to observe ‘World No Tobacco Day.’ The awareness programme aimed to draw public attention to spread the message of harmful effects of tobacco use as well as its passive effects to others.

'World No Tobacco Day' is an UN initiative to bring in awareness and encourage people across the globe to reduce or completely stop the tobacco consumption in any form.

Understanding the importance, KMCH launched a 'Let’s say No to Tobacco signature campaign,' which aimed to draw public attention to spread the message of harmful effects of tobacco use as well as its passive effects to others.

KMCH for the first time organised this unique signature campaign in four different locations in the city on the same day.

They were Coimbatore international airport, Coimbatore railway junction, Ghandhipuram bus station and Comprehensive Cancer Center, KMCH. The signature campaign was held at 7 am, 8 am, 10 am and 12 noon respectively. The chief guest was Archana Patanik, District Collector, Lakshmi, Deputy Commissioner of Police (Law & Order), Dr Somasundaram, Deputy Director Health Services, Chinnaraju, Station Master (Coimbatore Railway station), Dr V Kumaran, Dean – KMCH and Dr AN Murugan, Medical Director, KMCH. Dr Nalla G Palaniswami, Chairman, KMCH, Dr Arun N Palaniswami, Director, KMCH also took part in the event.

This multi-location based signature campaign was an absolute success in terms of

reach. A large number of doctors from KMCH, Government Medical College, airport staff, railway staff, other senior police officials also participated in the

campaign. Close to 10,000 people pledged their signature against the use of tobacco in any form. As part of the campaign, the KMCH marketing

team distributed 25,000 tobacco awareness pamphlets across Coimbatore city.

Dr Palaniswami mentioned that these kind of repeated

awareness campaign can play a significant role in eliminating the use of tobacco and thanked the officials for their active participation.

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MEDICALL 2016

Patient centricity in healthcare Dr J Sivakumaran, COO, KMCH, Coimbatore elaborates on the benefits of patient centered care

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n the healthcare environment often patients and their families/friends are excluded from the decision making process. This results in leaving the patients in dark as how to manage the problems and get cured from the disease. Advancement in medical sciences and various newer technologies also distanced doctors from patients.

A transition is needed by changing patients from a passive recipient of care to an active decision making member.

The active involvement of patients and families is very important especially when there are different options available for curing a disease. When therapy is needed for early detection of breast cancer or prostate cancer or taking steps for lowering lipid profile in preventing heart diseases, the involvement of patients and acceptance of the treatment plan is very essential to yield better results. This will lead to better understanding of the risks by the patients and less conflicts with the service providers. The side effects and complications expected from each options need to be explained to the patients. The patients’ preferences and priorities need to be understood to choose a suitable option.

What is patient centric care?

Patient centred care is not disease centered, technology centered, physician centred, hospital centred or area centred.

It provides health services from the patient point of view instead of hospital point of view. Patients will be made as part of the decision making process where more than one

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option is available. It is an art of running business with positive experience of the patients in mind. From a mere service provider's role, the realisation of feeling part of patient’s life is the patient-centric approach.

There are changing needs of patients from time to time. The process should be in a position to take care of them. It is the responsiveness to individual preferences, needs and values of patients in all clinical decisions. Many studies have shown that the patient-centric care improves the satisfaction of patients, quality of care and clinical outcomes along with reduced costs for healthcare. It does not mean a fixed set of guidelines but it is a flexible practice which will benefit patients and service providers with enhanced safety and quality. This approach is likely to reduce the anxiety and depression, while indirectly build trust and confidence on the doctors. Patient-centric approach: It is an approach in which doctors

Dr J.Sivakumaran COO, KMCH, Coimbatore

engage patients in a two way communication. The patients and families need to be helped for participating in clinical decisions. This will bring the doctor closer to the patient and develop bonding. Doctors need to give personalised care and customised drug therapy.

When more than one doctor is taking care of a patient, there should be a coordinated

effort to obtain patient satisfaction. Doctors need to consider patient’s level of literacy on health, understanding level and need to provide information suitably. With insufficient information from the Internet, many patients get confused about their health conditions and panics. It is the responsibility of the service provider to make the patient understand the real status by sharing the correct information and make the patient part of the decision making process. Patient-centric approach is a state of shared information, shared deliberation and shared mind.

Patient-centred approach does not end only with doctors. The security staff and the top management also have a role to play. If a patient-centred approach is to be made successful, three basic elements are needed. They are the patient, family who are interested in participating in the decision making process and professionally qualified healthcare provider who is willing to share information and educate the patient about his health condition and care

plan. A well-established infrastructure which can coordinate and integrate the patient-centred system is needed for successfully implementation. The latest IT tools can play a major role in implementing the system. Patientcentric approach needs to be present from top to bottom of the organisation. The organisation leader is the person responsible to initiate the approach. It may not be successful, if implemented partially. Every member of the organisation needs to understand the importance of the approach and need to follow in their best way. This culture should be present across the organisation.

Challenges In this competitive and tightly scheduled environment, it is doubtful whether doctors can spend much time with the patients to make them part of the decision making process.

The acceptance and understanding level of patients to take up the essential role in the process needs to be looked into. The level of emotional support that can be extended to understand patients’ values and preferences is a challenge.

Due to improper understanding of the various options given by the doctors, when something goes wrong, the patient or attendants can seek a legal assistance for getting relief. Training the members of the organisation right from the house keepers to the top managerial staff is a big challenge. The volume of training needed for various categories of the hospital employees and the rate of attrition that the industry facing is another challenge.

MEDICALL 2016

ROSSMAX - Just a heartbeat away The company is committed to the Indian sub continent and it works hand in hand with the needs of society for a healthy India and adjoining region

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ossmax, a leader in the global healthcare market, is committed to developing and supplying premium products and solutions with supreme technologies on a top quality level.

Rossmax's business fields are prevention, monitoring, therapy. Its product and service portfolio consists of healthcare products in the field of fitness, obesity, hypertension, respiratory care, fever management, hot and pain therapy, wound healing as well as sleep disorder.

The products are distributed in more than 50 countries and are clinically validated and approved based on latest quality standards. With the only fully integrated factory in the industry, the company prides itself as having world class manufacturing capabilities and end-to-end

process controls. From pioneering research and product development to highly efficient manufacturing, shipping and logistics, its operational excellence is a crucial key to the success.

International certification Internal and local validations as well as proofs from well recognised institutions (such as BHS - British Hypertension Society, ESH - European Society of Hypertension) confirm the accuracy, safety, stability, reliability and high performance of the entire product range. The Rossmax blood pressure monitors can be fully recommended for an application in the pregnant population too. Since 1988, Rossmax is committed to strive for the best technologies in each business field. Providing value for

the customer’s specific need is the key driver in inventing patented solutions.

Rossmax does not compromise on fulfilling the highest quality standards and proofing the results through outstanding clinical validations. The formal healthcare system has become increasingly stressed. Patients discharged from hospitals and

Ashish Zutshi Director-India Subcontinent Region of Rossmax International

other healthcare facilities still need care. As a consequence, both laypeople and professional caregivers are making use of a wide variety of technologies, some of them quite complex, in non-institutional settings to manage their own health, assist

others with healthcare, or receive assistance with health management. These technologies provide support not only for care related to acute and chronic medical conditions but also for disease prevention and lifestyle choices.

At Rossmax constant up gradation of features is a continuous process says Ashish Zutshi, Director, India Subcontinent Region, Rossmax International.

Sales being the first step but not the last. We try to provide excellent after sales service and are committed to build a long-term relationship with entire business channels. Rossmax follows a dynamic global after sales service policy. The company is committed to the Indian sub continent and it works hand in hand with the needs of society for a healthy India and adjoining region.

IndiaMediCart: Online medical equipment store The website provides benefit to a range of customers, such as end users or bulk suppliers, hospitals, doctors and patients

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n the era of online purchase, everyone wants to buy from a reliable source, which not only help save time and money. Congenial to all, there is a well known name in the online store space for medical equipment and accessories, www.indiamedicart.com.

IndiaMediCart is an online portal introduced by Sukhmani Enterprises Delhi. The website provides benefit to a range of customers, such as end users or bulk suppliers, hospitals, doctors and patients.

The portal has different sign up and login methods for

seller, customers, bulk buyers and retailers. It also offers different deals for bulk buyers, discount offers for new and retails customers. Apart from this, there are beneficial deals for hospitals and seller portal for sellers. As a result, it attracts a wide range of consumers to this website.

Benefits for hospitals: Hospitals face the challenge to manage purchase of equipment and accessories. Purchasing through the website helps to easily accomplished under one roof. Customers can compare the price, brands, benefits, service, war-

ranty and support from ICU bed to ICU equipment, OT table to OT accessories, small mask to high-end life saving and diagnosing equipment, like ventilator, defibrillator, anaesthesia work station, ECG/CTG machines, TMT, patient monitor and other equipment, which is easily available and can be compare with ease and comfort.

Benefit for individuals/doctors: Individuals who are unable to spare time to reach the store, or search helpful or life saving equipment for their patients can easily choose product from a range of big and

small brands. They can also avail discounts provided by the website time to time.

Benefit for dealers: www.indiamedicart.com offers various categories and products for bulk buyers and wholesale dealers. Even there is a different login portal for dealers.

Products available on website Equipment: OT and ICU equipment like, patient monitor, defibrillator, ECG Machine, Fetal Monitor & Doppler, ventilator, Bi-Pap, C-Pap, Oxygen concentrator, anaesthesia ma-

chine, blood and infusion warmer, pulse oximeter, TMT. Accessories: Reusable and disposable SPO2 sensors, ECG Patient cable and lead wire, medical oxygen sensors, reuseable and disposable respiratory tubing, reuseable and disposable full face/Nasal Mask, ECG/ EEG/EMG Electrodes, medical batteries, Xenon Lamps, ETC02 Sample line, NIBP Cuffs, IBP cable and transducer, ECG/TMT Papers Etc. Furniture: ICU Beds, OT Tables, OT Lights, Scoop, Spine and auto loader stretcher and related products.

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KNOWLEDGE I N T E R V I E W

‘We recognise that India and UK have things to learn from each other’ Sir Malcolm Grant, Chairman, NHS recently visited India on a UK healthcare trade mission.

Raelene Kambli met him to understand the lesson that India can learn for the NHS model of healthcare and what Sir Grant would offer India as part of the his trade mission Give us an overview of UK healthcare system and what lesson India can learn for it?

In 2014, the US-based Commonwealth Fund ranked the UK’s National Health Service (NHS) as the leading health system in the world for the use of innovative solutions to deliver the highest quality care. And this care is available to all our citizens free at the point of delivery and paid for from general taxation. The UK has developed some of the most innovative healthcare services and systems in the world over the past 70 years, supported by academia and innovative commercial healthcare companies.

The UK has expertise to support every aspect of healthcare systems and services. The UK creates breadth and depth of expertise that no other country can match. The UK offers one of the best clinical services in the world spreading across the whole spectrum of primary and community, medical, surgical and mental health services. The UK’s healthcare education and training is one of the best in the world. The UK is in the forefront of transforming healthcare services using digital solutions such as telecare and telehealth, mhealth using mobile technology and e-health using the analysis of large datasets in the UK. Now, as the emergence and adoption of new services and technologies in India reach record levels within health and care as well as the country begins its creation of 100 smart cities, we are delighted to bring

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to India NHS hospitals and healthcare services as well as the companies that work with the NHS to show what can be achieved by working with smart services and systems.

What should India do to increase health insurance penetration?

Private health insurance is a comparatively small part of the market in the UK. But what makes our insurance companies work are ease of access to trusted services, careful attention to costing and pricing and an emphasis on supporting subscribers to stay healthy. If state insurance is to increase, this will need an increase in funds for government services.

What is your opinion on India's GDP spending on healthcare?

I am amazed by what has been achieved in government services with only around one per cent of GDP being spent on these services. Clearly, this investment will need to increase if the vision of universal healthcare is to be achieved. The risk of an uncoordinated development of private series is that it will not run as efficiently as it could and the five per cent spent on outof-pocket and private healthcare will not be enough to meet the needs even of those who can afford private healthcare.

Among the emerging economies, where do you see India's healthcare system?

India has much of the

infrastructure and workforce to provide an excellent system of primary, secondary and tertiary care. Some of your best states have better healthcare than many in the region. But it will need investment of time, resources and training to bring all states to the level of the best and then to bring it to the level of developed economies such as the UK. What are the reforms that the Indian healthcare system urgently requires?

This is something for India to decide. But the UK stands ready to work with you on improving the infrastructure, developing effective clinical and health promotion services, training the future workforce, using smart technology to improve services and running systems to ensure the quality of care is increased.

What opportunities do you

see in India?

There are opportunities for the NHS and UK healthcare related companies to work with Indian companies and governments based on the UK’s long experience in providing a comprehensive healthcare system. This has already been shown by the major Indo-UK Institutes of Health programme where a private Indian company has partnered with Kings College Hospital to create NHS standard clinical services and training institutes in several states around India.

We share much in terms of history, culture and the 50,000 doctors of Indian origin who help make the NHS a success.

The UK has expertise to share with India in creating smart healthcare: designing, creating and managing healthcare facilities, producing and running excellent clinical and health promoting services, training staff to the highest standards, underpinning this with efficient information systems that help patients and clinicians to manage the patients care and ensuring that the quality of services is maintained at the highest level Whilst this is a commercial offer, we recognise that both countries have things to learn from each other.

What is your purpose to visit India?

I am delighted to bring representatives of the UK system to show what can be achieved by working with smart services and systems.

Our delegation consists of leading NHS hospital and

healthcare trusts and select pioneering British companies whose innovative solutions are delivering results across health and care economies both in the UK and around the world. We want to put PM Modi’s comment about the UK and India being an unbeatable combination into practice. This means securing commercially viable deals between the UK and Indian companies and governments.

I am also meeting ministers and senior government officials and some of the leading lights in Indian healthcare such as Dr Prathap Reddy and Dr Devi Shetty to understand how best we can partner with the Indian healthcare sector.

What are your learnings from India?

I am impressed by the high level of skills and services provided by the leading private healthcare companies in India.

The NHS can learn from some of their efficient methods of providing treatment to large numbers of patients. At the same time, I can see just how much we could help improve many of India’s services if we can promote collaboration between the two countries.

What kind of alliance would you like to offer India?

I am looking for commercial opportunities for UK organisations to be joint venturers or suppliers to the Indian market. But I am also keen to promote research and clinical practice collaborations. raelene.kambli@expressindia.com

INSIGHT

Social marketing and insulin use Dr Sanjay Kalra – Consultant Endocrinologist, Bharti Hospital Karnal & Vice President, South Asian Federation of Endocrine Societies emphasises on the use of social marketing tools to improve use of insulin therapy DATA FROM across the world reflects the increasing prevalence of type II diabetes mellitus, making it clear that diabetes will remain endemic to almost all human societies for 1 generations to come . However, it cannot be denied that our capability to fight the disease has also seen advancement. Our understanding of the pathophysiology has increased, as has the variety of drugs available to counteract this pathology 2.

Advances in monitoring technology, drug development and delivery device have meant that safe and effective pharmacotherapy is now available for the vast majority of people with diabetes.

Hard hitting ground reality Sadly, the better understanding of the pathophysiology has not translated into visible improvement in outcomes evident from the unacceptably low number of persons who are diagnosed in time, treated in time, and who achieve appropriate therapeutic goals. Taking ‘the rule of halves’ as a guide, perhaps just one out of eight individuals with diabetes achieves HbA1c targets3.

Unhealthy behaviour, attitude or practices are the basic barriers to good glucose control.

Relatively less emphasis is laid on pharmacological management and its relationship to behaviour or attitudes. This is surprising, as it is well-documented that lifestyle modification alone does not suffice, and that the majority of people with diabetes will need drug therapy including insulin at some time4.

Clinical inertia related to prescription and acceptance of appropriate modern pharmacotherapy is well documented in

diabetes literature. This is especially true for injectable therapy, specifically insulin5. Delayed initiation or intensification of insulin is also associated with higher long-term medical costs, and a greater economic burden on society6.

insulin manufacturers. It must be noted, however, that ‘classic’ social marketing campaigns have promoted pharma interventions (oral contraceptives, vaccines, oral rehydration solution, nicotine substitutes) and for profit products (condoms, helmets) without facing such criticism. Insulin use, therefore, can be promoted as a part of social marketing.

Social reality The concept of social pharmacology is also well described7, and has been suggested to be a patient-centered, or personcentered framework as opposed to a drug-oriented one8. This science is extremely important for a chronic condition such as diabetes, which impacts virtually every aspect of social life, including food, exercise, and inter-personal relationships. It is not surprising that diabetes has been termed a family disease or a community illness9, and that the family is taken as an integral part in the fight against diabetes10. It can be assumed that the family or community should be targeted to ensure better healthcare seeking and accepting behaviour, including use of glucoselowering drugs, like insulin. This can be achieved by systematic and scientific social marketing.

Social marketing The term social marketing was coined by Kotler and Zaltman11, keeping ‘social good’ as a primary aim and not focusing on commercial or financial gains.

India has been a trailblazer in the use of marketing techniques in public health. The first documented use of modern marketing strategies to achieve social good is from Calcutta, where Chandy et al. proposed and implemented a national family planning programme, which encouraged the use of low cost good quality barrier contra-

SMART – An effective tool for the social marketing of insulin

ceptives, supporting it with an integrated consumer and retailer marketing campaign12.

Other countries, including both developed and developing nations, followed suit, with active government backing in many cases.

Social marketing of insulin As the final goal of social marketing is societal good (good glycemic control, and complication-free diabetes, in this case), timely use of insulin (which helps achieve this goal) can be considered an apt social marketing intervention.

Social marketing should be differentiated from routine marketing strategies meant to promote specific services and organisational aims13. For example, a sustained campaign to encourage timely insulin usage, without mentioning brand names or products, may be considered social marketing, while a drive to increase sales of a particular drug cannot be discussed under this umbrella.

Critics may disparage this argument, pointing to the ‘pharmaceutical’ nature of insulin, and the profit orientation of

A well designed tool, the Social Marketing Assessment and Response Tool (SMART), has been developed to help systematic study of various social marketing interventions in this regard14.

The SMART lists various steps involved in creating an effective social marketing intervention. It is ironic that while all required information and knowledge is available regarding timely insulin use, this has not been collected and utilised for purposes of social marketing so far.

The first step in crafting a social marketing strategy is preliminary planning14. In the case of insulin therapy, our problem of interest is lack of timely initiation and intensification.

This brings us to the next steps in SMART, which together are termed as formative research14. Formative research includes identification of the wants and needs of the target audience, and factors that influence its behaviour. If diabetes care is teamwork, so is insulin use. The healthcare professional, the person living with diabetes, the family, and the community at large, all play an important role in insulin use15.

This implies that social marketing campaigns must be aimed at all these stakeholders, viz,

DR SANJAY KALRA Consultant Endocrinologist, Bharti Hospital Karnal & Vice President, South Asian Federation of Endocrine Societies

healthcare professionals, persons living with diabetes, their families and their communities.

Channel analysis, the next step, involves identification of preferred communication methods used by the intended audience, with an assessment of their relative importance and influence14. Channels may include mass media, such as television, radio, print publications; online media, including internet, blogs and twitter accounts; and focused channels, like professional journals or patient support groups16.

Market analysis is an important step in planning a social marketing campaign14. This encompasses identification of partners, allies, competitors and 'foes' working in the same arena. Examples of partners and allies include organisations working for general health promotion, healthy lifestyle, healthy environment, early diagnosis of diabetes and its complications, and optimal glucose monitoring.

Competition may refer to schools of thought which promote the use of alternatives to insulin, such as quadruple oral combination therapy, even in persons with poorly controlled HbA1c. The term 'foe' may be used to describe players who defend and propagate unvalidated, unscientific approaches to the management of diabetes, viz, unproven alternative or complementary systems of medical care, which lack robust evidence-based support.

4Ps of marketing Once friends and foes are recognised, market analysis emphasises preparation of the right ‘marketing mix’ of 4Ps (product, price, place and promotion). It must be noted here that the price paid by an insulin-user (i.e.

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KNOWLEDGE consumer) is often intangible in nature, and must be given due weightage. The 4P marketing mix should be able to weigh the price against the perceived value of the product, and create a beneficial cost: benefit ratio for insulin use. While our product is straight forward (timely use of insulin), the intangible or non-financial price paid for insulin adoption must be explored in detail. This may include time spent in attending continuing medical education (CME), and time spent in counselling patients, for the healthcare professional17. For the patient, insulin use may imply loss of flexibility and freedom in lifestyle, and acceptance of intrusion into one’s preferred lifestyle18. The family may feel it has to pay a price by restricting social activities such as travel and leisure, or by changing dietary patterns19. The community or society, too, shares a part of the price as it meets its obligation of providing a diabetes-friendly environment20.

A complete formative analysis or research is followed by development which is a continuous activity, with ongoing evaluation, and frequent midstream correction or modification. Once the final product (strategies, tactics, methods) is ready, it is ready for implementation or activation. Implementation should be accompanied by monitoring, using various validated or pretested means of assessment. The 4Ps, as applied to insulin initiation and intensification, are listed below: Product: It refers to the idea/behaviour/service/tangible item i.e., insulin. Insulin use entails timely insulin initiation /intensification and it requires prescription, acceptance, adherence and persistence.

Price: In this case it indicates the psychological tangible price that has to be paid for product adoption. For the patient, insulin use may imply several fears - fear of injection, fear of hypoglycemia and weight gain, fear of inability to handle insulin administration or being able to monitor adverse events, fear of the reaction of the family, fear of social ostracisation. To counter this, marketing of the benefits of insulin needs to be done and patients or their family mem-

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bers need to be reassured that their fears are largely untrue.

Place: Place is where consumers are exposed to communication/receive product. For insulin use, all persons with diabetes, their family members, all healthcare settings and all healthcare portals/channels constitute place. While the place is the diabetes care setting, premarketing and post-marketing is universal.

Promotion: Means of communication that can deliver the message to target audience include mass media, person to person and community-based portals. Promotion requires multiple channels, focusing on multiple targets.

Boost for social marketing of diabetes The social marketing of diabetes care received a muchneeded and well deserved fillip, when the World Health Organization (WHO) and International Diabetes Federation declared November 14 as World Diabetes Day, to be celebrated globally.

This year, the WHO has helped the diabetes social marketing movement by choosing diabetes as its focus for World Health Day (7 April), with the theme ‘Beat Diabetes’.

For the past few years, Injection Technique Day has been celebrated on January 11, to commemorate the first insulin dose administered by Dr Ed Jeffery to Leonard Thompson in Toronto. The week from January 11 to 17 is observed as Injection Technique Week.

Various celebrities, such as Wasim Akram and Sachin Tendulkar have lent their voice to social marketing campaigns in the recent past. Most of these campaigns, however, are run by private firms and organisations.

This is in sharp contrast to social marketing policies for other public health issues, such as immunisation, sanitation and maternal health, where the government takes a proactive role in spreading awareness and encouraging healthy behaviours.

Public-private partnerships already exist in India, with regards to diabetes care, especially insulin usage. Examples include the Changing Diabetes Barometer (CDB), Changing Diabetes in Children (CDiC)

Working as a team, social marketers and diabetes care professionals should be able to achieve timelier acceptance and usage of insulin, thus allowing more persons with diabetes to benefit from advances in therapy

project, which are running successfully in many states of the country. The Public Health Foundation of India (PHFI) has tied up with state governments (such as Madhya Pradesh) to train public sector doctors in diabetes care. Their comprehensive programmes include detailed discussion on insulin therapy, and facilitate timely usage of this treatment modality.

Summary Such public-private partnerships should be strengthened, and a concerted, nationwide social marketing policy created to enhance insulin usage.

Awareness about the science and art of social marketing should be coupled with knowledge of the art and science of insulin use. Working as a team, social marketers and diabetes care professionals should be able to achieve timelier acceptance and usage of insulin, thus allowing more persons with diabetes to benefit from advances in therapy.

References 1. Kalra S, Kumar A, Jarhyan P,

Unnikrishnan AG. Endemic or epidemic? Measuring the endemicity index of diabetes. Indian J EndocrMetab 2015;19:5-7 2. DeFronzo RA. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009 Apr 1;58(4):773-95.

3. Hart JT. Rule of halves: implications of increasing diagnosis and reducing dropout for future workload and prescribing costs in primary care. Br J Gen Pract.

1992 Mar 1;42(356):116-9.

4. UK Prospective Diabetes Study Group. UK Prospective Diabetes Study 16: overview of 6 years' therapy of type II diabetes: a progressive disease. Diabetes. 1995 Nov 1;44(11):1249-58.

5. Anand Moses C R, Seshiah V, Sahay B K, Kumar A, Asirvatham A J, Balaji V, Kalra S, Akhtar S, Shetty R, Das A K. Baseline results indicate poor glycemic control and delay in initiation and optimization of insulin therapy: results from the improving management practices and clinical outcomes in type 2 diabetes study. Indian J EndocrMetab 2012;16, Suppl S2:432-3 6. Wangnoo SK, Maji D, Das AK, Rao P V, Moses A, Sethi B, Unnikrishnan AG, Kalra S, Balaji V, Bantwal G, Kesavadev J, Jain SM, Dharmalingam M. Barriers and solutions to diabetes management: An Indian perspective.

Indian J EndocrMetab 2013;17:594-601 7. Maiti R, Alloza JL. Social Pharmacology: Expanding horizons. Indian J Pharmacol 2014;46:246-50 8. Kalra S, Gupta Y. Social pharmacology and diabetes. Indian journal of pharmacology. 2014 Sep 1;46(5):564.

9. Fisher L, Chesla CA, Skaff MM, Gilliss C, Mullan JT, Bartz RJ, Kanter RA, Lutz CP. The family and disease management in Hispanic and EuropeanAmerican patients with type 2 diabetes. Diabetes Care. 2000 Mar 1;23(3):267-72.

10. Kalra S, John M, Baruah MP. The Indian family fights diabetes: Results from the second Diabetes Attitudes, Wishes and Needs (DAWN2) study. J Soc Health Diabetes 2014;2:3-5.

11. Kotler P, Zaltman G. Social marketing: an approach to planned social change. The Journal of Marketing. 1971 Jul 1:3-12.

12. Chandy, K.T., Balakrishman, T.R., Kantawalla, J.M., Mohan, K., Sen, N.P., Gupta, S.S. &Srivastva, S. (1965). Proposals for family planning promotion: A marketing plan. Studies in Family Planning;1(6):7-12.

13. Ling JC, Franklin BAK, Lindsteadt JF, Gearon SAN: Social marketing: its place in public health. Ann Rev Public Health 13:341–362, 1992 14. Neiger BL, Thackeray R: Application of the SMART Model in two successful social marketing projects. Am J Health Educ 33:291–293, 2002 15. Tandon N, Kalra S, Balhara YS, Baruah MP, Chadha M, Chandalia HB, Chowdhury S, Jothydev K, Kumar PK, MadhuS, Mithal A, Modi S, Pitale S, Sahay R, Shukla R, Sundaram A, Unnikrishnan AG, Wangnoo SK. Forum for Injection Technique (FIT), India: The Indian recommendations 2.0, for best practice in Insulin Injection Technique, 2015. Indian J EndocrMetab 2015;19:317-31 16. Thackeray R, Neiger BL. Use of social marketing to develop culturally innovative diabetes interventions. Diabetes Spectrum. 2003 Jan 1;16(1):15-20.

17. Holt RI, Nicolucci A, Kovacs Burns K, Escalante M, Forbes A, Hermanns N, Kalra S, MassiBenedetti M, Mayorov A, Menéndez-Torre E, Munro N. Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross-national comparisons on barriers and resources for optimal care—healthcare professional perspective. Diabetic Medicine. 2013 Jul 1;30(7):78998.

18. Kalra S, Gupta Y, Unnikrishnan AG. Flexibility in insulin prescription. Indian J EndocrMetab 2016;20:408-11 19. Kovacs Burns K, Nicolucci A, Holt RI, Willaing I, Hermanns N, Kalra S, Wens J, Pouwer F, Skovlund SE, Peyrot M. Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross-national benchmarking indicators for family members living with people with diabetes.

Diabetic Medicine. 2013 Jul 1;30(7):778-88.

20. Prasanna Kumar K M, Raghupathy P, Kalra S. Diabetes-friendly environments for children with diabetes. Indian J EndocrMetab 2015;19, Suppl S1:1-3

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OLYMPUS110HD- Prices 3 Times Less Then Your Current Digtal Films Product Features: The Medical Films Can Be Printed By High- Precision Color Printers, It Can Be Took When Printer Had Finished, Pure White For Material Surface, Clean For Image Details, Wear-resisting, Firm Image And Can Keep The Ink. Environmental-Friendly Layer, DO Not Cause Any Damage And Harmful Smell. Water-proof And Color-proof, The Denition Of Medical Films Is 10Times Higher Than The Paper Film. It Can Be Saved More Than 20 Years And Can Be Written By Pencil, Mark Pen-Ball Point Pen And Common Seal. Products Usage: Can Be Used In Medical Diagnosis And Medical Diagnosis Reports, Also Can Be Used In Medical Teaching

Blood / IV Fluid Warmer

The Parameters of the lm: 1. The highest resolution:≥ 9800dpi 2. The thickness of basement membrane:≥150μm 3. The thickness of the lm:≥190μm 4. The Maximum transmission density: ≥3.8D 5. The maximum reection density: ≥2.4D

Plasmatherm Blood Donor Chair

Specications Environmental Protection High Compatibility Easy To Preserve Easy To Use Color And Luster Is Gorgeous.

Blood Collection Monitor

Blood Bank Centrifuge

Biological Refrigerator

Platelet Incubator with Agitator

Benchtop Sealer

DEALER ENQUIRY SOLICITED A-3, NEW RAJINDER NAGAR, NEW DELHI-110060, INDIA TELE/FAX: +91-11-28741437, 28742510, 28742864, M. +91-9810270997 E-mail: tarun@atsequipments.com, info@atsequipments.com website: www.xrayglobal.com

Centrifuge Bucket Equalizer

Blood Bank Refrigerator

Biological Deep Freezer

REMI SALES & ENGINEERING LTD.

Remi House, 3rd Floor, 11, Cama Industrial Estate, Walbhat Road, Goregaon (East), Mumbai-400 063. India Tel: +91 22 4058 9888 / 2685 1998 Fax: +91 22 4058 9890 E-mail: sales@remilabworld.com l Website: www.remilabworld.com

USE COUPON CODE For accessories IMC10 For Equipment's IMC500

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High-accuracy surgical and endoscopic displays

The complexity of general and minimally invasive surgery places high demands on both the medical staff and the equipment used. Barco has designed a complete line of surgical and endoscopic displays, boom-mounted or trolley-mounted, from HD to 4K, that provide unsurpassed precision while meeting the specific image-guided surgery requirements in the digital operating room.

MDSC-8258 Slimline 58" Quad HD surgical display

MDSC-2242 42" full HD large-screen surgical display

MDSC-2226 26" full HD surgical display

Modi Medicare, 4/102, Deep Sunil, Garodia Nagar, Ghatkopar(E), Mumbai - 400 077 +91-22-2506 5664, +91-98670 01110

MDSC-2232 32" full HD surgical display

MDSC-2224 24" full HD surgical display

MDSC-8232 31" 4K UHD surgical display

E192HSA 19" surgical color LCD display

Barco - India A38, A B&C, Sector-64, 201301, Noida, UP, India Tel: +91 120 4020000 Mob: +91 99714 41118 Email: sales.in@barco.com

www.barco.com

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Semi & fully automatic urine analyzers

Semi & fully automatic coagulation analyzers

Accurine- 1600+1280

Ceveron Alpha

(segment & chemistry)

• Clotting • Turbidimetric • Chromogenic • Flurimetric

3 & 5 Part Hematology Analyzers

Thrombolyzer Compact X / XR / XRC / XRM

Semi & fully Automatic Chemistry Analyzers

Global 4500DR Auto Hematology Analyzers • 12 inch touch screen • Communication (4USB, COM, LIS) • Net Weight (Only 28kg) • Laser Light scatter and Cell Histochemistry method • Accurate blood dispense system • Original Reagent • Prediluted • Auto Sample for option

Critical Care Instruments

Blood Gas Analysers

Electrolyte analyzers

Compact Diagnostics (India) Pvt Ltd

C-60, C-Block Community Centre, Janak Puri, New Delhi - 110058 Phone: +91-11-25510137, 25535945 / Fax : +91-11-25514066 / Moble : +91-9810126062/ 9717398596 E-mail : skchauhan@compacthealthcare.com / Website: www.compacthealthcare.com

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LIFE I N T E R V I E W

‘TMF Academy is blessed with well qualified and experienced professionals who have great exposure in field of healthcare sector’ Tech Mahindra Foundation, the CSR arm of TechMahindra recently launched the Tech Mahindra SMART Academy for Healthcare. Dr Loveleen Kacker, CEO, Tech Mahindra Foundation, shares more details about the initiative, its curriculum, objectives and more, with Lakshmipriya Nair Why has Tech Mahindra earmarked healthcare sector for this initiative?

One of the major challenges in the Indian health sector as on date is the non-availability of trained allied health professionals. In fact, there is a shortage of over 14 lakh such professionals. The Tech Mahindra CSR initiative intends to bridge some of this gap.

What would be the focus area for the training programmes?

What would they comprise?

The focus would be to evolve a well-designed and delivered training programme which would create a pool of allied health professionals. The training would comprise classroom lectures, laboratory exposure, internship in hospitals as well as seminars/workshops

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conducted by experienced faculty.

skill trainer. The foundation has also appointed an independent medical advisor to audit the curriculum.

How are these modules/curriculum designed? What are the parameters under consideration?

The conceptual framework of module/curriculum has been designed as per Health Sector Skill Council benchmark- a part of National Skill Development Council. The modules are designed as per the benchmark of National Occupational Standards (NOS).

Have any healthcare providers/practitioners played a role in drafting the curriculum?

Yes, Tech Mahindra Foundation (TMF) has on board experienced professionals to draft the

Where would these training sessions be held? Is it a panIndia initiative?

This TMF Smart Academy for Healthcare is located at Harijan Sevak Sangh, Gandhi Ashram, GTB Nagar. It is the only one as of now.

curriculum. TMF Academy is blessed with well qualified and experienced professionals who have great exposure in the field of healthcare sector.

This team consists of a Dean Academics, nurse tutors, technician and IT trainer/soft

How can the interested candidates apply for these courses?

As of now the Tech Mahindra Smart Academy mobilisers are sensitising the environment/ local population about the presence of the Academy and the courses offered.

Interested candidates may visit the Academy take a simple aptitude test, show

their credentials and seek admission.

What does Tech Mahindra envisage through these courses?

The focus will be to give priority to students from lowincome families. They are being charged a miniscule (20 percent) of the sum being currently charged by other institutes offering similar courses. A six months course fee including tuition fees, uniform, books and certification is pegged at Rs 8600 only. There is also an option of scholarship/ subsidy on this sum for very needy students. If the Smart Academy for Healthcare creates a pool of professionals, it will in a small way, surely improve the healthcare scenario in the country. lakshmipriya.nair@expressindia.com

LIFE AWARDS

Nari O Shishu Kalyan Kendra organises seminar to mark‘Menstrual Hygiene Day’in Kolkata Discussions were held on the challenges being faced by women and young girls in managing their menstrual cycles safely HOWRAH-BASED NGO, Nari O Shishu Kalyan Kendra in association with Nirman Foundation and CFAR (Centre For Advocacy and Research) recently organised a seminar to mark ‘Menstrual Hygiene Day’, which is observed on May 28.

‘Menstrual Hygiene Day’ (MH Day) serves as a neutral platform to bring together individuals, organisations, social businesses and the media to create a united and strong voice for women and girls around the world, helping to break the silence around menstrual hygiene management Inaugurating the seminar, Rahima Khatun, Secretary, Nari O Shishu Kalyan Kendra shared her experiences on the challenges being faced by

women and young girls in managing their menstrual cycles safely in our country.

Dr Parveen Banu, Asst Professor, National Medical College & Hospital, Kolkata explained, ‘Menstruation is just a

normal biological process in the life of a woman and a key sign of reproductive health, yet in many societies it is still treated as something negative, shameful or dirty. Besides due to lack of proper information

and continued silence about the physiological phenomenon at home and in schools, it results in very little knowledge about what is happening or going to happen in their bodies when they menstruate and how

it can be dealt with.” She stressed on to spread more awareness about the subject.

Dr Banu pointed out that it is disheartening to note that even in this 21st century women and girls have to face social stigmas and many become isolated from family, friends and their communities during the period of menstruation. They are even debarred to perform any religious rituals and not allowed to participate in social functions.

Nari O Shishu Kalyan Kendra recently received the ‘Express Public Health Award for the most effective healthcare NGO’ instituted by Express Healthcare.

EH News Bureau

PEOPLE

ePsyClinic appoints Rohit Shrivastava as CTO Shrivastava's cross-domain experience and expertise will give a tremendous boost to ePsyClinic's marketing and technical credibility EPSYCLINIC, THE online platform which provides the best of emotional and mental healthcare to clients, has appointed Rohit Shrivastava on board as Chief Technology Officer (CTO). ePsyClinic is looking forward to utilising his experience gathered over a period of more than 15 years working in various sectors such as healthcare, telecom, banking, security and eLearning to boost the technological

infrastructure and service optimisation of the company.

Shrivastava did his Bachelor’s Degree in Computer applications from Jiwaji University in Gwalior followed by an MBA in General Management from the University of Virginia. He has also worked with reputed names on industry standard software solutions with extensive knowledge on external regulatory authorities like TRAI/RBI in India and HIPAA

in the US. Commenting on his appointment, Shipra Dawar, CEO, ePsyClinic said, “Shrivastava completely fits in the dynamics of ePsyClinic with his technological acumen and deep understanding of EQ or emotional quotient. As CTO, we look forward to seeing Shrivastava’s cross-domain experience and expertise being utilised efficiently in this direction.”

Shrivastava said, “I have

had the privilege of working on multiple products in various domains over the duration of my professional experience. I will be hoping to bring the requisite impetus to raise ePsyClinic’s technological prowess.

The idea of bringing worldclass therapies, psychiatric, wellness and counselling services online to ensure the best of mental and emotional wellness and healthcare services is a novel concept in India.”

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LIFE BOOK SHELF

Health Care Reforms in India: Making Up for the Lost Decade The book offers insights on the challenges and opportunities to improve healthcare outcomes in India

H

ealth Care Reforms in India: Making Up for the Lost Decade is a book authored by Rajendra Pratap Gupta, a public health expert. It offers an in depth look at India’s healthcare system and documents the development of India’s healthcare sector in the last six decades. It offers insights on the challenges and and opportunities to improve healthcare outcomes in India.

Gupta states, “We need to define the problem of Indian healthcare, as it has become a ‘business’ and is not a profession anymore. India’s so called health care system is actually a healthcare market place, which is unregulated and corrupt.

Though everyone needs it, everyone hates it!”

Defining an ideal healthcare system, the author also says that we need a healthcare

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system which is: ◗ Pre–emptive ◗ Comprehensive ◗ Holistic ◗ Coordinated ◗ Accessible, and ◗ Outcome-driven accountable care He also recommends several measures to revamp the state of healthcare in the country like: ◗ It is time to look beyond the disease and illness-centred models of healthcare and also focus on age-related new paradigm of health. ◗ We need to empower the patients without their having to move outside their homes.

There is a huge scope for resorting to a model of care that is built on awareness, sensitisation and promotion of healthy habits rather than building a system that aims at and is driven by doctors, medicines

and hospitals.

Currently, the main focus of healthcare for NCDs in many low and middle-income countries is hospital-centred acute care. This is a very expensive approach that will not contribute to a significant reduction in the NCD burden. To ensure early detection and timely treatment, NCDs need to be integrated into primary healthcare. ◗ Ministry of Health and Family Welfare (MoHFW) should start a national and regional health quiz contest with attractive prizes. This will serve the purpose to attract and engage people towards health and to increase their knowledge as either passive listeners or active participants. ◗ ‘Pharmacists and nurses’ hold the key to better healthcare and this relationship must be leveraged for healthcare. It might be worth considering the frontal role of nurses and pharmacists as a gate keeper or health counsellors rather than a doctor. ◗ A family health kit for every household that includes the thermometer, glucose monitor, BP machine, weighing scale and OTC medicines can be provided by the government in a phased manner. This will be the first step in providing primary care for all. ◗ Innovate rural healthcare delivery in villages. It is time to have a programme – GP @ GP (general physician at gram panchayat) as a key deliverable for rural healthcare. ◗ India can look at taking a cue from the GPs practice system of the NHS, UK; where the GP form the foundation of NHS but

Book: Health Care Reforms in India: Making Up for the Lost Decades Author: Rajendra Pratap Gupta Publishers: Reed Elsevier India Pages: 456

they are contractors to NHS and are paid per capita annual payment. GPs do the role of gate keeper in the UK’s health system as over 90 per cent of all healthcare consultations and interactions are with the GPs. Empanelling of existing private practitioners in India will mean a huge saving on salaries (in CHCs and sub-centres, this is the major portion of the expense), infrastructural investments and terminal benefits that have to be offered to permanent staff of the government. ◗ Indigenous systems of medicine looks at the past to claim their position and modern medicine looks at future to claim its space and so, the future of indigenous system is limited. Indigenous systems have to become forward looking and most importantly, address the issue of outcome validation studies to

reclaim its space. ◗ All the officials must be trained in modern management techniques. All officials of the state and central administration, including the secretary and the minister, must spend between 10 per cent and 25 per cent of their time in remote areas of the country as ‘surprise’ visits. ◗ Also, it must be made compulsory for all healthcare providers – both, public and private, including stand-alone practitioners, to disclose their admissions, treatment charges and success rates. ◗ Medical education and training needs fundamental reforms.

Medical Council of India (MCI), Pharmacy Council of India (PCI) and Nursing Council of India (NCI) protects the turfs and interests of the professionals they represent but there is no one to take care or talk about the interests of the patients around which the health care system revolves. All these three bodies need to be merged into Health Council of India (HCI), with representation from the non-medical fraternity, patient groups and the public. ◗ There should be health guidelines for the population, base on age groups, stating the details of self-checks and physician routine checks that one must undertake every year. ◗ Healthcare should not be just process and treatment driven but outcome driven, with prognosis. Improved outcomes should not just underpin any intervention but also be the part of the entire continuum of care.

s

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