Express Healthcare (Vol.11 No.3) March, 2017

Dia/02-2017/V1/DOM/ADV

CONTENTS Vol 11. No 3, MARCH, 2017

HEALTHCARE SABHA2017

MARKET

Chairman of the Board Viveck Goenka

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NATIONAL HEALTH CONCLAVE TO BE HELD IN NEW DELHI FROM MAY 25-26, 2017

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SATYA NADELLA, CEO MICROSOFT UNVEILS THE COMPANY’S FOCUS ON HEALTHCARE

Sr Vice President-BPD Neil Viegas Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das, Mansha Gagneja Delhi Prathiba Raju Design National Design Editor Bivash Barua Asst. Art Director Pravin Temble Senior Designer Rekha Bisht Graphics Designer Gauri Deorukhkar

Around 100 policy makers and public health professionals gathered together at the second edition of Healthcare Sabha 2017.The three-day conference saw public health experts deliberate on ways and means to create a blueprint to facilitate evidence-based policy making,augment excellence in healthcare delivery and eliminate barriers to equitable access.Moreover,public health champions in India were also honoured at the Express Public Health Awards held concurrently | P-12-43

Artists Vivek Chitrakar, Rakesh Sharma Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - West Kailash Purohit – South Debnarayan Dutta - East Marketing Team Ajanta Sengupta, Ambuj Kumar, Douglas Menezes, E.Mujahid, Mathen Mathew, Nirav Mistry, Rajesh Bhatkal PRODUCTION General Manager BR Tipnis Manager Bhadresh Valia Scheduling & Coordination Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar

SESSION SPEAKERS 16| DR JITENDAR SHARMA | Director and CEO, Andhra Pradesh Medtech Zone

KNOWLEDGE

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HEALTH VECTORS WINS DIGITAL HEALTH COMPETITION AT 2017 HITLAB INNOVATORS SUMMIT: INDIA

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SEMINAR ON ‘PRICE REGULATIONS HELD IN NEW DELHI

IT@HEALTHCARE

ARE BLOOD TRANSFUSIONS SAFE?

18| DR SURESH SARAVDEKAR | Director, The Rural Health & Education Centre, spoke on National List of Essential Medicines (NLEM)

20| Sunil Sharma |

Joint Secretary, Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), Ministry of Health & Family Welfare, Government of India

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21| Angshuman Sarkar | Principal Consultant, ThoughtWorks Technologies

21| Dr A Velumani |

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INHERITANCE PATTERNS

Promoter, Chairman, MD and CEO, Thyrocare

22| Dr Mohanasankar Sivaprakasam | Director, Healthcare Technologies Incubation Centre, IIT Madras

23| Prof MV Padma Srivastava | Department of Neurology, Neurosciences Centre, AIIMS, New Delhi

24| Ashish Jain | CEO, HSSC

STRATEGY

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FROM IDEA TO REALITY: THE FUNDING LANDSCAPE FOR HEALTHCARE INNOVATIONS IN INDIA

DIGITAL HEALTHCARE: A PARADIGM SHIFT FOR THE BETTER!

LIFE

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QUALITY HEALTHCARE FOR WOMEN

Express Healthcare® Regd. With RNI No.MAHENG/2007/22045. Postal Regd.No.MCS/162/2016-18. Printed and Published by Vaidehi Thakar on behalf of The Indian Express (P) Limited and Printed at The Indian Express Press, Plot No.EL-208, TTC Industrial Area, Mahape, Navi Mumbai-400710 and Published at 2nd floor, Express Towers, Nariman Point, Mumbai 400021. Editor: Viveka Roychowdhury.* (Editorial & Administrative Offices: Express Towers, 1st floor, Nariman Point, Mumbai 400021) * Responsible for selection of news under the PRB Act. Copyright © 2017. 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

Stents today, implants tomorrow?

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he Government of India had a very unique Valentine Day gift for Indian citizens, especially cardiac patients. On February 14, the regulatory pricing body, the National Pharmaceutical Pricing Authority (NPPA) slashed the rates of heart stents by about 380 per cent, by fixing the ceiling price of various categories. Bioresorbable Vascular Scaffold (BVS) and drug-eluting stents (DES) now have to be sold at `29,600 (post VAT and local taxes, the MRP works out to around `31,000, down from a pre-cap price of `1,21,000) and bare metal stents (BMS) `7,260 (approximately `7600 post VAT and taxes, down from `45,000).

Price monitoring of heart stents was on the cards for quite some time. Heart stents were included in the National List of Essential Medicines (NLEM) on July 19 last year, and then into Schedule I of the Drug Prices Control Order (DPCO), 2013 on December 21. And the government had to cap stent prices before the March 1 deadline imposed by the Delhi High Court, thanks to the persistent efforts of activist lawyer, Birender Sangwan over the past two years. What has shaken up industry was the drastic drop in price and the lack of a transition period. Which means that all stocked stents, bought at the previous rates, will have to be sold at the new ceiling prices.

There were apprehensions that hospitals would make up this price difference by increasing procedure costs, doctors' fees and forcing patients to stay longer. However, hospitals have been warned that these practices too are being closely monitored. But, will the NPPA really be able to go after the defaulters and recover the overcharged amount along with 15 per cent interest? The government seems to be relying on whistle blowers and alert patients, nudging them to post their complaints via two mobile apps, Pharma Jan Samadhan and Pharma Sahi Daam, started by the government when they reduced prices of medicines over the last year.

Insurance players seem to have sided with the government on this issue, obviously because it reduces their payouts. A note from Bajaj Allianz

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Will the medical devices segment go down the same path as the pharmaceutical sector?

General Insurance projects that a reduction in stent prices by 85 per cent could reduce total angioplasty procedure cost by around 25-30 per cent. Does the government have the manpower to enforce its diktat that stent prices will have to be mentioned separately in billing receipts?

Stent makers predictably countered the price caps, foretelling that the price cap would defeat the purpose of the Make in India initiative. But this argument was somewhat deflated when Gujarat-based Meril Lifesciences reportedly became the first Made in India BVS to get the regulatory nod in late February, though marketing approval is still awaited.

The price caps on stents has pitted hospitals and surgeons/doctors, against stent manufacturers, with the latter lobby alleging discrimination.

It is easier to put a price tag on a product than on the expertise of an individual doctor/surgeon so its anybody’s guess that this loophole will be still be used for some time.

Will the medical devices segment go down the same path as the pharmaceutical sector? The pharma sector is suffering from the impact of shrinking margins of medicines on the price control list. As companies cut corners to reduce price or exit these categories, consumers are forced to rely on products which might not be as safe as desired. Down the supply chain, manufacturers of the active ingredients in these medicines too have shut shop. Today, the country is dangerously dependent on countries like China for key ingredients, which often turn out to be of so poor quality that our exported finished products risk being rejected by importing authorities.

The NPPA is unlikely to stop at heart stents, given that it has already asked for pricing data on other medical devices, especially more expensive categories like orthopaedic implants. Predictably, just a fortnight after the cap on stent prices, Shanghai-based MicroPort Scientific Corporation announced the launch of their heart stents and joint implants in the country. It is high time that the government and med tech majors work together to find a middle path.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

FEEDBACK ON HEALTHCARE SABHA 2017 ENLIGHTENING

CONGRATULATIONS

EXCELLENT

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t the outset I would like to convey my congratulations for the very well organised second edition of Healthcare Sabha in Visakhapatam. The scientific deliberations and discussions against a picturesque backdrop of beach were truly stimulating. Thank you for inviting me to be part of the conclave

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hank you so much for inviting us to Healthcare Sabha-2017.

The overall programme and arrangements were excellent. It is very heartening to know that Indian Express group has taken the initiative to recognise performance in public facilities and programmes through Public Health Awards which is the need of the hour.

Prof AK Mohapatra Prof of Neurosurgery Chief, Neurosciences Centre and Dean, AIIMS

Dr DK Sharma Medical Superintendent All India Institute of Medical Sciences

Dayashankar Maurya Chairperson Healthcare Management, Chairperson International Relations, TA Pai Management Institute, Manipal

he conference was worth attending and educative. It was a multi-dimensional event with sessions which were educative and enlightening. It covered various aspects of public health including role of technology

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FEBRUARY 2017

Check out the online version of our magazine at

www.expresshealthcare.in

HEAD OFFICE Express HealthcareÂŽ MUMBAI Douglas Menezes The Indian Express (P) Ltd. Business Publication Division 2nd Floor, Express Tower, Nariman Point Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821580403 Email Id: douglas.menezes@expressindia.com Branch Offices NEW DELHI Gaurav Sobti The Indian Express (P) Ltd. Business Publication Division Express Building, B-1/B Sector 10 Noida 201 301 Dist.Gautam Budh nagar (U.P.) India.

Board line: 0120-6651500.

Winners of Express Public health Awards 2017 held concurrently with Healthcare Sabha 2017 at Visakhapatnam from February 9-11, 2017

Mobile: 91-9810843239 Fax: 0120-4367933 Email id: gaurav.sobti@expressindia.com CHENNAI Mathen Mathew The Indian Express (P) Ltd. Business Publication Division 8th Floor, East Wing, Sreyas Chamiers Towers New No 37/26 (Old No.23 & 24/26) Chamiers Road, Teynampet Chennai - 600 018 Mobile: +91 9840826366 Email id: mathen.mathew@expressindia.com BENGALURU Mathen Mathew The Indian Express (P) Ltd. Business Publication Division 502, 5th Floor, Devatha Plaza,

Residency road, Bangalore- 560025 Board line: 080- 49681100 Fax: 080- 22231925 Mobile: +91 9840826366 Email id: mathen.mathew@expressindia.com HYDERABAD E Mujahid The Indian Express (P) Ltd. Business Publication Division 6-3-885/7/B, Ground Floor, VV Mansion, Somaji Guda, Hyderabad – 500 082 Board line- 040- 66631457/ 23418673 Mobile: +91 9849039936 Fax: 040 23418675 Email Id: e.mujahid@expressindia.com

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AHMEDABAD Nirav Mistry The Indian Express (P) Ltd. 3rd Floor, Sambhav House, Near Judges Bunglows, Bodakdev, Ahmedabad - 380 015 Mobile: +91 9586424033 Email Id: nirav.mistry@expressindia.com

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

KOLKATA Ajanta Sengupta

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MARKET PRE EVENT

National Health Conclave to be held in NewDelhi from May25-26,2017 The conclave endeavours to be a national level think-tank for paving a road-map to address the issues related to NCDs

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he National Health Conclave will be held in New Delhi from May 25-26, 2017. The theme for this year’s event is ‘Chronic care: Innovation Opportunities and Challenges.’ The conclave endeavours to be a national level

think-tank for paving a roadmap to address the issues related to NCDs. It will be a platform for premier institutions and organisations to discuss and deliberate on various issues that affect the nation’s health scenario. The conclave will be an

ideal stage for health and nonhealth sectors to share and learn from experiences and imbibe best practices for health system strengthening.

The deliberations of the meet are expected to result in the formulation of strategies and rec-

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: Express Towers, 1st Floor Nariman Point, Mumbai-400 021 : MONTHLY : Ms. Vaidehi Thakar : Yes : Express Towers, 2nd Floor Nariman Point, Mumbai-400 021 : Ms. Vaidehi Thakar : Yes : Express Towers, 2nd Floor Nariman Point, Mumbai-400 021 : Ms.Viveka Roychowdhury : Yes : Express Towers, 1st Floor Nariman Point, Mumbai-400 021 : The Indian Express (P) Ltd 2nd floor, Express Towers, Nariman Point, Mumbai 400021 : Indian Express Holdings & Entp Private Limited 2nd Floor, Express Towers,Nariman Point, Mumbai 400021 : Mr. Viveck Goenka & Mr. Anant Goenka 2nd Floor, Express Towers, Nariman Point Mumbai 400021 : Mr. Shekhar Gupta & Mrs. Neelam Jolly C-6/53, Safdarjung Development Area New Delhi 110 016

I, VAIDEHI THAKAR., hereby declare that the particulars given above are true and to the best of my knowledge and belief.

Date : 1/3/2017

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sd/VAIDEHI THAKAR Publisher

The deliberations of the meet are expected to result in the formulation of strategies and recommendations that will help in policy development and implementation.The white paper drafted from the proceedings is expected to aide in synergising efforts of the public and private sectors in combatting NCD epidemic ommendations that will help in policy development and implementation. The white paper that will be drafted from the proceedings of the conclave is expected to aide in synergising efforts of the public and private sectors in combatting the NCD epidemic.

The conclave will bring stakeholders including government, research institutions, academia, industry, community and international agencies on one platform to find a lasting solution. While Public Health Foundation of India (PHFI) and Association of Healthcare Providers India (AHPI) remain the organising leads, the various stakeholders include Ministry of Health and Family Welfare, Ministry of AYUSH, Government of India, Director General Medical Services – Defense (DGMS), Department of Biotechnology, Ministry of Science and Technology, Government of India, National Board of Examination, National Health Systems Resource Centre, National Centre for Health

Informatics, Quality Council of India, Indian Space Research Organization, Public Health Foundation of India, Indian Council of Medical Research, Indian Institute of Management, Bangalore, Indian Institute of Technology, Madras, Christian Medical College, Vellore, National Law School of India University, Association of Healthcare Providers India, Association of National Board Accredited Institutions, Consortium of Accredited Healthcare Organizations, Association of Biotech Led Enterprise, Association of Indian Health Sciences Universities, Association of Indian Medical Device Industry, Disease Management Association of India, Organization of Pharmaceutical Producers of India, Healthcare Sector Skill Council, Indian Medical Association, Indian Pharmaceutical Association, British Medical Journal, India and Google.

Express Healthcare is the media partner for the event.

MARKET POST EVENT

Satya Nadella,CEO Microsoft unveils the company’s focus on healthcare Microsoft launches Skype Lite app, which can be well utilised in public health Raelene Kambli Mumbai ‘Digitisation is not just about innovation. It is about shifting gears to the whole new way of working and above all, it is about keeping your business ahead of the curve.' This was the message delivered at the recent held two-day tech-business convention-Future Decoded organised by Microsoft. The event was recently held in Mumbai.

The conclave attracted experts from various industries who deliverated on ways and means to transform their businesses using digital technologies such as cloud computing, artificial intellegences, IoT etc. The event also had a focussed Immersive Zones for invitees to engage with businesses who have digitally transformed their businesses. The convention focussed on three key aspects: ◗ Inspiring the digital business ◗ Designing the digital business ◗ Building the digital business During the two days, experts spoke on various technologies that can provide individual businesses, industries and the society a whole lot of benefits. Out of which digital transformation in healthcare was an important topic of discussion. Right from cloud computing, IoT to artificial intelligence, experts seemed to be gung ho about the idea of utilising these technologies to make healthcare delivery accessible to all and of high quality standards.

Microsoft who has been the organiser of this event also made a series of India-focussed announcements. Prior to this event, Satya Nadella, CEO, Microsoft, met with Prime Minister Narendra Modi and IT Min-

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Satya Nadella, CEO, Microsoft, in conversation with Devendra Fadnavis, Chief Minister, Maharashtra, at Future Decoded

Dr Sangeeta Reddy, Joint MD, Apollo Hospitals

ister Ravi Shankar Prasad, assuring the government of its initiatives in healthcare and education. Nadella also participated in a round table at NITI Aayog, tapping into cloud computing for good governance in the country.

During the event, Sangeeta Reddy, Joint MD, Apollo Hospitals spoke of how technology is redefining healthcare in India.

She began with quoting the latest NASSCOM report that speakes about digital technology to fuel India’s growth by 3X. Referring to the impact of digital technology in healthcare she pointed out, “Technology is influencing procedures in healthcare drastically.” Speaking about Apollo's vision to transform healthcare delivery in India she said, “We’re looking at healthcare access differently.

There is a paradigm shift in terms of healthcare delivery.

We’re moving from a sick-care model to a preventive care model. Moreover, the point of care is shifting from the hospital to the clinic and now even at home. Today its a known empowered ecosystem right from the doctors to nurses, to patients and even Asha workers.

With artificial intelligence and machine learning, we can scale at skill level to ensure better healthcare for everyone, even those in remote areas,” points out Reddy.

Referring to the importance of Big data in healthcare she went on to say that integrated healthcare delivery system is the need of the hour.

Nadella during his keynote address on day two of Future Decoded, spoke about Microsoft’s enterprise initiatives in India with a focus on cloudcomputing for enterprises and government organisations.

MARKET “Technology is everybody's business. It is shaping the private sector, the public sector and shaping every life. Our mission is to empower every person, every organisation on the planet to achieve more. It has a deep sense of meaning for us,” he expressed.

He also spoke about his vision to metamorphose the Indian healthcare arena. “We need to talk very eloquently of what is happening in healthcare because of technology,” he conveyed.

Sharing his experience he stated, “I had a chance to meet an entrepreneur who is reshaping healthcare. This entrepreneur is using data as a natural resource to reshape diagnostic capabilities.”

Explaining this further he said, “The fact that an health problem can be predicted in advance will reshape the cost curve of healthcare. Even monitoring diabetes in a real time manner can reshape healthcare.

And all that is possible with the help of technologies such as AI and cloud services. So, this entrepreneur has been able to utilise these services rich in data making it available for any hospital to deploy them. This is the kind of entreprenial spirit and energy that India has.”

Nadella also mentioned that the healthcare sector in India is therefore one of the sector that they would be closely watching and investing in. Further, he spoke of their partnership with Andhra Pradesh and Maharashtra government. Using Microsoft's Kaizala platform, the AP government has been able to empower the public and private sector. The platform has also facilitated governance in public health and provided access to healthcare services to many in the rural areas.

He also mentioned their partnership with players such as Apollo, Fortis and LV Prasad Eye Institute. Moreover, Nadella informed that through their partnership with the Government of Maharashtra they have touched 32 villages in the state and help track the IMR rate within the state.

Furtheron, Nadella announced a new Skype Lite app for the Indian market, which will be available only on Android for

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now. This app can be uitlised in healthcare as well.

On the sidelines of this event, Microsoft also organised a round table discussion on enhancing e-governance with the help of Kaizala. Government officials from the education sector, health sector, administration, municipal corporations were present. Rajendra Pratap Gupta, Advisor to the Union

Minister for Health & Family Welfare. Government of India who was also present for the discussion said, “We cannot undermine the role of technology in enhancing our work and create more efficiencies within our system. Certainly technologies can be an important tool to bring about good governance in healthcare.”

N Chandrababu Naidu

raelene.kambli@expressindia.com

MARKET POST EVENTS

Health Vectors wins digital health competition at 2017 HITLAB Innovators Summit: India 2017 HITLAB Innovators Summit: India was held in New Delhi THE 2017 HITLAB Innovators Summit: India, which was recently held in New Delhi, named the developers of myhealthvectors as the winner of 2017 HITLAB World Cup: India, a digital health tech challenge. The competition took place before medical technology thought leaders at the 2017 HITLAB Innovators Summit: India.

Health Vectors is revolutionising personal health management by collecting clinical and personal health data from individuals (via hospitals, insurance companies, and corporations) and providing them with hyper-personal, actionable insights using predictive analytics and machine learning. The company’s goal is to eradicate chronic diseases globally. Its personal health analytics engine also helps various stakeholders in the hospital, health insurance, and corporate sectors by providing deep insights into an indi-

vidual’s current and future health.

“It was truly a humbling experience winning the 2017 HITLAB World Cup: India and being part of a prestigious programme,” said Dr Subhasish Sircar, Founder and CEO, Health Vectors. “Health Vectors is now squarely focussed on explosive growth in hospitals, insurance companies, and corporate verticals. Recognition by, and collaboration with, HITLAB will go a long way toward establishing the key relationships globally that are essential for such growth.”

According to Devmalya Sarkar, Summit Director, HITLAB, organiser of the event, “The HITLAB World Cup: India enables highly creative healthcare technology entrepreneurs to showcase ideas with the highest probability of significant diffusion that will lead to healthcare transformation. The competition is the highlight of our HITLAB Innovators Sum-

(L-R) Devmalya Sarkar, Summit Director, HITLAB, Ron Lancaster, Director, Corporate Research, Boston Scientific, Sunil Thakur, Director & COO Quadria Capital, Dr Subhasish Sircar, Founder and CEO, Health Vectors, Frank Fries, Director of Information Technology and Product Management, HITLAB, Dr Pinak Shrikhande, Principal, Healthquad and Director, Critinext

mit: India, an event packed with engaging talks, panel discussions, and presentations on the latest evidence of high-growth health innovations.”

He continued, “We congratulate Health Vectors and all the finalists, who produced exceptional solutions to pressing health challenges. We are in-

spired by their dedication, and determined to advance their projects as well as others through HITLAB's extensive collaborative network.”

Health Vectors earned top honours by demonstrating the outstanding impact, innovation, feasibility, and business sustainability of its idea to

judges Dr Pinak Shrikhande, Principal, Healthquad and Director, Critinext; Sunil Thakur, Director and COO at Quadria Capital; Ron Lancaster, Director, Corporate Research at Boston Scientific; and Frank Fries, Director of Information Technology and Product Management at HITLAB.

Seminar on ‘Price Regulations: A360 Degree Overviewon its Impact on Availability& Accessibility’held in NewDelhi PHD Chamber with DoP organise the seminar PHD CHAMBER in association with Department of Pharmaceuticals, Ministry of Chemicals & Fertilizers, Government of India recently or-

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ganised a seminar on ‘Price Regulations: A 360 Degree Overview on its Impact on Availability & Accessibility’ in New Delhi.

Bhupendra Singh, Chairman, NPPA, Department of Pharmaceuticals, Ministry of Chemicals & Fertilizers, Government of India was the Chief Guest at the inaugural session of the seminar. He said, “No complaints about

MARKET shortage of stents even on my Whatsapp number which is public and I congratulate the industry for ensuring smooth supplies.�

Singh further said that a comprehensive health policy in conjunction with the pharma industry needs to be worked out in conjunction with the pharma industry and expressed that higher government spend on healthcare delivery is desirable but it itself cannot solve the problem of affordable healthcare for all.

He mentioned that NPPA also plays role in ensuring accessibility by rationalising the prices of the drugs in the market.

Anil Khaitan, Senior Vice President, PHD Chamber on this occasion said that IIM Ahmedabad has independently published a report highlighting that firms may exit a category under regulation due to low profit prospects and there was also a drop in R&D resulting in fewer new introductions of generic drugs and there has been reduced competitions since India expanded its list of priced-controlled medicines two years ago.

Khaitan added that many governments continue to intervene through some form of price regulations in the pharma market. While in the US, the pharma industry is highly unregulated, in Europe, the governments are actively involved in price regulation. The main argument in countries that favour price regulation is that neither the doctor nor the patients takes decisions based on the costs incurred. As these governments typically provide some form of universal healthcare, the government intervene in an attempt to reduce the healthcare expenses incurred. As a result of strict price regulations, pharma companies in the European Union attain lesser profits and stock returns, and invest lower R&D amounts compared to their US Counterparts as per Golec and Vernon 2010.

Nishant V Berlia, Chairman, Health Committee, PHD Chamber shared that the overall market share of

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priced-controlled medicines in India has been declining across therapies, falling from 78 per cent to 70 per cent between 2007 and 2015 and after the price control order was expanded two years ago, the sales volume of price controlled medicines had a compounded annual growth rate of five per cent compared

The Vision 2020 Document on medical devices was also handed over to Bhupendra Singh which was made by the chamber by getting all pharma and medical devices associations together

with eight per cent for the same drugs prior to being added to the list in 2013.

The chamber also gave a copy of the Vision 2020 Document on medical devices to Singh, which was made by the chamber by getting all pharma and medical devices associations together on a simple platform.

GLIMPSES OF THE EVENT...

Around 100 policy makers and public health professionals gathered together at the second edition of Healthcare Sabha 2017. The three-day conference saw public health experts deliberate on ways and means to create a blueprint to facilitate evidencebased policy making, augment excellence in healthcare delivery and eliminate barriers to equitable access. Moreover, public health champions in India were also honoured at the Express Public Health Awards held concurrently

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HEALTHCARE SABHA 2017 DAY 1 FEBRUARY 9, 2017 VIDEO MESSAGE

WELCOME ADDRESS

Ô JP Nadda |

Ô Viveka Roychowdhury |

Union health Minister, Ministry of Health & Family Welfare, GOI

Editor, Express Healthcare& Express Pharma

HEALTHCARE SABHA 2017 ◗ Inaugural ceremony ◗ Welcome Address by Viveka Roychoudhury ◗ Panel discussion: Tackling the talent crunch in public health: ✦ Dr Subhash Chandra Parija, Director,JIPMER, Puducherry; ✦ Dr Farhat Mantoo; Regional Coordinator HR, MSF, South Asia; ✦ Prof AK Mahapatra, Chief Neurosciences Centre,AIIMS Delhi; ✦ Madhumita Dobe, DirectorProfessor & Dean,All Indian Institute of Public Health, Kolkata ◗ Creating a sustainable financing system for India: Dr Jitendra Sharma, Director & CEO, Andhra Pradesh MedTech Zone ◗ "NLEM, procurement practices and patient safety : Joining the dots: Dr Suresh Saravdekar, Director,The Rural Health & Education Centre" ◗ One-on-one meetings

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am happy that the Indian Express Group’s Express Healthcare is organising this Healthcare Sabha focussing on public health. Public is not only about policies, it is about implementation of these policies and more importantly about taking on board the perspectives of all stakeholders, policy makers, state governments, doctors and patients in order to improve the nation's health indicators. It is in this light, I am pleased that the Indian Express group has The Ministry of launched Healthcare Health & Family Sabha to facilitate a Welfare is looking dialogue in public health.

The Ministry of Health & forward for the Family Welfare is looking outcome report forward for the outcome from Sabha report from Sabha.

he second edition of Healthcare Sabha 2017 started off with a welcome address by Viveka Roychowdhury, Editor, Express Healthcare & Express Pharma. She took the audience through the vision of the event and welcomed them to three days of knowledge sharing on various aspects of public health.

Referring to the allocations for healthcare in the Union Budget 2017, she stated, “ In many ways, the budget has been good to the healthcare sector. Allocation of funds was raised by 27 per cent. But inspite of this seemingly generous increase in allocation, the health sector's share of GDP has seen only a marginal increase from 0.26 per cent in 2016-17 to 0.30 per cent in 2017-18.

Since most of the increase comes from transfers to states and union territories, which comprise 55 per cent of the health budget, this reflects the central government's continued efforts to increase the role of the states in health, while reducing the role of the union Health ministry. And this is where Healthcare Sabha 2017 comes in.” Explaining the viWe hope that over sion she added, “Built around today and the next the vision to co-create a manitwo days,we will festo for a healthy India, we hope that over today and the discuss,debate next two days, we will discuss, and arrive at debate and arrive at recomrecommendations mendations towards this goal.”

PANEL DISCUSSION

Tackling talent crunch: Improving capacityand competence KEY HIGHLIGHTS:

Moderator: Dr Farhat Mantoo; Regional Coordinator HR, MSF, South Asia, Dr Madhumita Dobe, Director-Professor, All India Institute of Hygiene and Public Health, Kolkata, Govt of India, Dr Pravin Shingare, Director of Medical Education and Research, Govt of Maharashtra, Prof AK Mahapatra, Chief Neurosciences Centre, AIIMS Delhi, Sudeep Shrivastava, Director, Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), Ministry of Health & Family Welfare, Dr DK Sharma, Medical Superintendent, AIIMS- Delhi

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ndia’s public health sector is plagued by a huge manpower scarcity. In consonance with this dearth, the panel discussion on ‘Tackling Talent Crunch: Improving Care and Competence’ focussed on addressing the challenges such as inadequacy and under-utilisation of human resources, as well as discuss the way forward to improve manpower capacity and competence in public health.

Dr Farhat Mantoo, Regional Coordinator HR, MSF, South Asia, began the discussion by highlighting the severity of the issue. She referred to a WHO report that stated, ‘India is not a unique country when it comes to talent crunch. By the year 2035, there will be shortage of healthcare workers globally.’

From that perspective, she said that it is the right time to deliberate on that subject of talent crunch and raised her first question to Dr Madhumita Dobe, Director-Professor, All India Institute of Hygiene and Public Health, Kolkata, Govt of India, asking her to share her

perspective on this issue and what public health really means.

Dr Dobe while referring to the definition provided by CEA Winslow in 1920 said, “Public health is the science and art of preventing disease, prolonging life, and promoting physical health. That's where the crux of it lies. Public health just does not mean clinical cure, it is far beyond this. When we talk of issues related to talent crunch, resource allocation and compacity building we need to lay emphasis on this fact.”

The next question was posed to Dr Pravin Shingare, Director of Medical Education and Research, Govt of Maharashtra, on how can medical education play a role in instilling the values and virtues needed in a healthcare provider to practice in the public health domain?

Replying to the same, Dr Shingare informed that our current MBBS course does not produce specialised doctors.

He also brought to light the disparities in shortage of health workers within urban and rural areas. He said, “The shortage

of doctors is such that we have less than two per cent deficit in metro cities, less than 10 per cent in tier II cities and around 30-40 per cent deficit in the rural areas. In order to tackle this issue, we tried to increase the number of medical seats, incentivise their salaries as well as brought a compulsory rule to practice in rural areas for the starting years of their career, but these stop-gap measures did not work. We then came up with an idea to introduce a specialised course in public health by the state government, where we intend to train undergraduate doctors in public health. This strategy has helped us increase the number of doctors in Maharashtra.”

Chipping in, Dr Dobe raised two important points while training doctors for public health services. She said, “We need to ask ourselves whether we are giving competencebased skill training needed for public health professionals?

And these competencies a wish of the healthcare industry or is it based on job role needed to

serve the population of India? It is also important to introspect on who looks into the matter of framing these guidelines. Till date, it was the Medical Council of India (MCI) and the Indian Nursing Council but the time has come when we need to set up a public health council.

There is diversity of disciplines incorporated in public health today and so there is a need for a specialised agency to look after this aspect. Thirdly, public health requires certain distinctive competencies such as good communication skills, leadership, knowledge of finance etc.

In order to access, attract and retain talent in public health, we will need to restructure our entire promotional strategies, cadre system and so on.”

Prof AK Mahapatra, Chief Neurosciences Centre, AIIMS Delhi, gave a historical background to the increasing number of medical colleges, medical seats and post graduation seats in India. He also referred to an analysis published in the Careers360 magazine of June 2016 that examines the quality of

■ India has not given due regards to quality medical education and research ■ Need for innovation not only in terms of technology but also in our strategies ■ Need for specialised course in public health by the state government ■ Need for a public health council ■ Use digital technology to fill the gap ■ Need for mentorship plan for our AIIMS instiutes ■ Recruitment creteria should include communication skills and behavioural insights of candidates to work in public health

medical education provided at the colleges as well as the number of students passing out from these institutes. He highlighted that the number of medical colleges have increased over a period of time yet the standard of education provided has not advanced.

Dr Mahapatra quoted that there has been an increasing number of PG seats year-onyear and informed that despite an increasing number of seats for PG courses, the number of specialised doctors have declined.

Going forward, he went on to speak on the demand and supply gap and said that in the last 70 years, India has produced around six lakh doctors; however, good quality doctors produced are very few.

Another point Dr Mahapatra made was about the lack of good quality teachers in healthcare. She said that lack of good quality medical colleges, teachers and healthcare professionals has been the main reason for the talent crunch in public health. “ India

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HEALTHCARE SABHA 2017 DAY 1 FEBRUARY 9, 2017 has not given due regards to quality medical education and research,” he remarked.

Sudeep Shrivastava, Director, Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), Ministry of Health & Family Welfare, shared his views on the need to enhance infrastructure to attract talent in public health.

He spoke on the vision of PMSSY and also explained the government’s vision to set up two new AIIMS institute — one each in Jharkhand and Gujarat.

He informed that from their past experiences they have come to the realisation that there is a need for mentorship plan for AIIMS institutes that will be enabled to provide high standard education. It will include, good facilities for students, teachers that will also foster research. “This year, the

government has doubled the budget allocation for PMSSY. Our agenda is to complete the establishment of the target number of medical colleges and more importantly look after the human resource component to ensure that we recruit good quality teachers. We have instituted a selection committee for the same. Moreover, we are also upgrading the existing medical colleges by commencing a super-speciality block. The government has identified 72 government medical colleges for upgradation. So, developing infrastructure and HR components are the two areas that the government is focussing to resolve the talent crunch in public health,” he informed.

Dr DK Sharma, Medical Superintendent, AIIMS-Delhi touched upon the subject of ef-

Developing infrastructure and HR components are two areas that the government is focussing to resolve the talent crunch in public health fective recruitment process.

“While recruiting healthcare professionals for public health, we often go by their qualification and technical knowhow and ignore their communication skills and behavioural insights.”

Adding on Dr Dobe’s views

Sustainable health financing system D Ô Dr Jitendra Sharma |

Director and CEO, Andhra Pradesh Medtech Zone

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r Jitendra Sharma, Director and CEO, Andhra Pradesh Medtech Zone spoke on sustainable health financing systems and elaborated on how it touches various segments of the healthcare sector.

He began the session by categorising how India’s health financing system works in terms of providing health services, medicine, diagnostic services, health promotion and education as well as industrial promotion and medical equipment.

Dr Sharma cited an example of how the Andhra Pradesh Government has come up with a smart health financing system wherein the state having a simple budgeting strategy has managed to keep their net inflow higher than their net expenditure. He further provided details of the scheme saying, “In January this year, N Chandrababu Naidu, Chief Minister, AP, launched the Arogya Raksha scheme that encompasses all health financing schemes. The idea behind this is to offer medical insurance to those who were

on the need for public health council, Dr Sharma said that there is a need to design our recruitment process and retention policies around public health. “We are looking at healthcare as a sickness industry and not looking at health. To make India healthy, we need to advocate for promotion and prevention of diseases.”

Bringing back the point that India is not unique to problem of scarcity of healthcare professional, Dr Mantoo urged the panelists to provide sustainable solutions to address this issue.

Replying to this, Dr Dobe said that medical educationists need to chart a career path for public health professionals. This will ensure that public health has enough opportunities for people to grow.

These thought encouraged

the audience to raise more pertinent questions to this discussion. Some also provided measures that they adopted at their state level and institute. An interesting point that was raised by the audience was that digital technology can be a game changer in the management of human resources in public health. Technology will also help increasing efficiency of health workers and track their progress.

Sharing the learnings from this session, Dr Mantoo summed up saying, “Some Indian states have been very innovative in their solutions.

There is a need for innovation not only in terms of technology but also in our strategies. Rethink on our policies related to public health and use technology to fill the gap.”

not covered under any of the existing health schemes of the state government. To avail the benefits of Arogya Raksha, all one needs to do is pay `100 per month per head. The health insurance cover is offered up to `2 lakh and free treatment can be had for 1,044 listed health ailments in any of the 432 corporate hospitals and 80 government hospitals in the state.”

He also gave a rundown on the myriad financing programmes being implemented in different states and their impact. At the same time, he also cautioned the need for more streamlined processes such as third party audits of these programmes for better transparency and efficiency.

He also spoke on the need for an effective tender management system and how this will impact the good governance in healthcare. Additionally, he highlighted the AP government’s initiative in make Aadhar card, a single point identification number, to avail services under the public

health schemes from the state.

Dr Sharma further recalled the purpose of National Diagnostic scheme launched by the Union Ministry of Health and Family Welfare and spoke on its importance, urging the audience to leverage this scheme to provide quality diagnostic services to the public. He mentioned about the fair price shop for medicines under the Jan Aushadhi scheme. He spoke of the Swasthya Vidya Vahini Scheme, a health education launched by the AP government and said that initiative like these should be leveraged to promote their right health information to the public at large. Lastly, he spoke on the importance promoting the medtech industry in order to drive innovation in healthcare.

Key recommendations: ■

Need for an effective tender management system ■ Promote the medtech industry in order to drive innovation in healthcare

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NLEM,procurement practices and patient safety: Joining the dots D ÔDr Suresh Saravdekar |

r Suresh Saravdekar, Director, The Rural Health & Education Centre, spoke on National List of Essential Medicines (NLEM), procurement practices and patient safety. He began by saying that the Indian medicine market is flooded with more than one lakh drugs.

Referring to the same, he gave a historical background on the development of NLEM in India. Moving forward, he spoke about the role of NLEM in ensuring the availability of good quality drugs at affordable rates. He drew attention to the fact that there have been instances across the country where people have lost their lives due to poor quality of drugs or medicines. Further, he highlighted the missing links with medicine procurement system in public health that need to be connected in order to ensure good quality

Director, The Rural Health & Education Centre

There is a need for comprehensive guidelines for selection, procurement and for quality use of essential medicines in public health medicines reach the patients.

Dr Saravdekar also elaborated on bridging the differences between various generic medicines. Emphasising on the need to design a NLEM-based hospital formulary and state level procurement policy he said, “There is a need for com-

prehensive guidelines for selection, procurement and quality use of essential medicines in public health to have optimisation of funds, quality and of services provided to poor patients visiting these facilities.”

Additionally, he advised the audience to promote rational use of medicines.

Lastly, he urged the audience to change their mind from quality assumed to quality assured in terms of medicine procurement. Further on, Dr Saravdekar also conducted a workshop on the same subject to provide more clarity on it.

Key highlights: ■ Indian medicine market is flooded with more than one lakh drugs ■ Need for comprehensive guidelines for selection, procurement process ■ Promote rational use of medicines

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DAY 2 FEBRUARY 10, 2017 competence

HEALTHCARE SABHA 2017 AGENDA DAY 2 ◗ Keynote address Cornerstones of availability, affordability,reliability of public tertiary healthcare services and quality medical education in India ✦ Sunil Sharma,Joint Secretary,PMSSY,MoH &FW, GoI ◗ Envisioning India’s integrated health ecosystem ✦ Angshuman Sarkar, Principal Consultant, ThoughtWorks Technologies ◗ Transitioning from a PSU scientist to a corporate leader: Retaining the values of social good ✦ AVelumani,Founder,CEO and MD,Thyrocare ◗ Join the digital evolution ✦ Dilip Bhosale,Head Marketing,India and Pranav Shah,Head Business Development,ITIndia, Agfa Healthcare ◗ Bridging delivery gaps in Indian healthcare through affordable medtech development and deployment ✦ Dr Mohanasankar Sivaprakasam,Director, Healthcare Technologies Incubation Centre,IITMadras ◗ Delhi's ‘Code-Red’ programme: The need to scale up stroke care in India's public health facilities ✦ Prof MVPadma Srivastava, Department of Neurology, Neurosciences Centre,AIIMS, New Delhi ◗ Future of Imaging ✦ Sabu Jose,GM Government,OEM & Corporate Accounts - India Cluster,Carestream Health ◗ The single use dilemma ✦ Sumit Marwah,CEO & Director,Dispoline India ◗ Tackling talent crunch: Improving capacity and

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✦ Ashish Jain,CEO,HSSC ◗ Health sector governance and resource generation

✦ Prof Mukul Asher,Professorial Fellow,Lee Kuan School of Public Policy ◗ Dealing with NCDs

✦ Dr Damodar Bachani,Deputy Commissioner (NCD),MoH&FW,GoI ◗ Workshop on designing an NLEMbased hospital formulary in a public

health facility ✦ Suresh Saravdekar, Director,The Rural Health & Education Centre

HEALTHCARE SABHA 2017 DAY 2 FEBRUARY 10, 2017 KEYNOTE ADDRESS

Cornerstones of availability,affordability,reliabilityof public tertiaryhealthcare services and qualitymedical education in India Ô Sunil Sharma | Joint Secretary, Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), Ministry of Health & Family Welfare, Government of India

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unil Sharma, Joint Secretary, Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), Ministry of Health & Family Welfare, Government of India set the tone for the second day's sessions at Healthcare Sabha with a very informative keynote address. He appreciated Express Healthcare and The Indian Express Group for creating a platform like Healthcare Sabha to discuss on various challenges faced by the country’s public healthcare sector. He also iterated that availability, affordability and reliability are the corner-

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stones of any successful public health system. At the same time he also assured the audience that the healthcare poli-

cies in India seek to ensure these crucial factors for all its citizens by trying to reduce out-of-pocket spending, pro-

Realising that the cost of medicines constitute a large share of healthcare costs,the government is also looking at providing free medicines and diagnostics services at all public health facilities

vide healthcare financing through measures such as health insurance, and create health infrastructure.

Sharma also gave a detailed overview of the diverse measures introduced by the government to alleviate the challenges in public health and build a a robust system which would effectively serve all the citizens of the country.

He admitted that there is a need to increase our GDP spend on healthcare, however, he also pointed out that funds allotted to this sector has been steadily rising over the years. He cited the rise in NHM funds to elucidate his point.

He also spoke about plans to introduce a National Health Protection Scheme under which around eight crore families would be provided an insurance cover of ` one lakh for a good basket of IPD procedures. Similarly, each elderly person under this scheme will get an additional ` 30000 under this scheme. To be introduced soon, Sharma informed it would be the largest initiative of its kind till date at the national level.

Realising that the cost of medicines constitute a large share of healthcare costs, the government is also looking at providing free medicines and diagnostics services at all public health facilities, announced Sharma. He said that these 544 formulations are provided free of cost to the needy. He also recommended the need for a robust IT system to improve the drug dissemination process. He drew attention to initiatives like the Jan Aushadhi stores and AMRIT stores to bring down

out-of-pocket expenses. Highlighting that access to medicines finds mention even in the SDG goals, he informed that the government is making efforts to ensure affordability to healthcare in the country.

Stressing on the government's moves to enhance availability of healthcare, especially in terms of tertiary care, he spoke on the efforts underway to implement more medical colleges, revamping the district hospitals to provide more facilities to patients such as dialysis centres, cardiac care centres and oncology care centres. Sharma also drew attention that the government is also looking training allied healthcare professionals as well as and gave a rundown of various initiatives in this direction.

He also admitted that there are several chinks in our system that need to be ironed out to fortify it and make it more foolproof. He also addressed queries from the audience to give them more clarity on the government’s stance and commitment to improve healthcare scenario in the country.

KEY ANNOUNCEMENTS ■ 20 new AIIMS under PMSSY, 6 are already functional another 14 are underway ■ Upgradation of 72 medical colleges and 58 district hospitals ■ Launch of National Health Protection Scheme for expanding health cover ■ Creation of more seats for MBBS and PG courses ■ Total fund for PMSSY last year – 2400 crores, this year it is 4000 crores (an increase of 60 per cent)

Envisioning an integrated health ecosystem A Ô Angshuman Sarkar |

Principal Consultant, ThoughtWorks Technologies

ngshuman Sarkar, Principal Consultant, ThoughtWorks Technologies spoke on his organisation's role in strengthening public health systems through its products, citing the example of Bahmni – an open source solution which is being used in 17 countries including India, Bangladesh, Nepal and Bhutan. Sarkar elaborated on the other myriad projects undertaken by his organisation to strengthen the public health system as well.

In his session, Sarkar also drew attention towards the need for a connected health ecosystem to ensure quality, affordability and accessibility. He opined that this ecosystem can go a long way in eliminating the current flaws such as lack of correct data, incorrect priorities, lack of information about patients' needs and so on. For instance, he said that even today most of the efforts in the public

Open source platforms can play a pivotal role in ensuring better interoperability and thereby enhanced healthcare services health are directed towards reducing maternal and infant mortality and tackling communicable diseases while there is a clear shift in the disease burden towards non-communicable diseases. This growing threat remain largely unaddressed because the data is not being clearly assimilated and analysed.

He further clarified on the in-

teroperability issues and said that the patient needs to be at the core while designing solutions and open source platforms can play a pivotal role in ensuring better interoperability and thereby enhanced healthcare services. He rooted for the need of an effective health data repository and recommended several measures to create an integrated health ecosystem which included establishing digital health infrastructure, redefining governance structure, determining interoperability aspects and partnering with ongoing projects.

He ended his session by reminding the audience that as stakeholders or custodians of public health in India, it is a collective responsibility to safeguard the citizens' health and well being. This goal can be achieved only through a sound mechanism to ensure quality and equitable health services.

Transition from PSU research scientist to corporate leader I Ô Dr A Velumani |

Promoter, Chairman, MD and CEO, Thyrocare

n an inspiring session, Dr A Velumani, Founder, CEO and MD, Thyrocare, shared the story of his rise from a PSU scientist to a corporate leader, without losing the values of social good. He gave a stirring account of his glorious journey from a government employee at BARC to build a successful business.

Many of his success mantras like profit from volumes, making affordable care possible without compromising on quality, using technology to reach out to a large number of people etc carried valuable insights for public health professionals as well.

His inimitable style of speaking and interesting anecdotes kept the audience enthralled and entertained while offering significant les-

sons for success, and life in general. Citing his own struggles with poverty and other adversities, he asked the public health stakeholders to not get cowed down by challenges and look for out-of-the-box solutions to tackle them.

He also explained his volume-driven model of offering low-cost, high-quality diagnostics services with the help of people, technology and systems. If replicated, it could serve as a great model of services delivery for Indian healthcare which is currently plagued by concerns of affordability and accessibility.

At the same time, he also highlighted how essential it was to bring in operational efficiencies through people and technology to provide effective services, especially in a

sector like healthcare where lives of people are at stake.

His advice to turn adversities into opportunities, step out of your comfort zones, find courage to venture into new pathways of life etc, were well received by the audience. He also answered queries on how he handled various challenges in the course of building up his business .

Key highlights: ■ Look for out-of-the-box solutions to tackle public health problems ■ Volume-driven models are the way to go for public healthcare ■ Human resources and technology can play pivotal roles in ushering efficiency in public health

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Join the Digital Evolution Ô Dilip Bhosale| Head Marketing, India and Pranav Shah, Head Business Development, IT India, Agfa Healthcare

Ô Pranav Shah| Head Business Development, IT India, Agfa Healthcare

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ilip Bhosale, Head Marketing, India took the stage to give an overview of Agfa Healthcare's e-health and digital imaging solutions for public health facilities. He spoke on various advantages offered by these solutions to streamline the hospitals' processes and through a video presentation elaborated how his organisation can in hand hold public health facilities in their transformation from analog to digital. Bhosale assured that Agfa would be the

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ranav Shah, Head Business Development, IT India, Agfa Healthcare emphasised that healthcare is undergoing a paradigm shift from a hospital-based care to population-based care. He pointed out that the world is

right partner for hospitals in

their aim to provide integrated care, the need of the hour. He also spoke on how Agfa has also been instrumental in driving an era of digitalisation in India. He also divulged that his company is already partnering with various government institutions such as West Bengal Medical Services Corporation, Punjab Health Systems Corporation, Municipal Corporation of Greater Mumbai, Health Department of Haryana, etc. to bring about a digital transformation in public health.

moving towards more standardised care through collaborative and value-based models. Shah also explained that technologies such as digital health records, digital imaging solutions, clinical analytics tools are aiding

this metamorphosis. He asserted that digitalisation is the way forward and urged public healthcare fraternity to join digital revolution to attain the goal of Universal Health Coverage (UHC).

Agfa would be the right partner for hospitals in their aim to provide integrated care, the need of the hour

Bridging deliverygaps in healthcare through affordable medtech Ô Dr Mohanasankar Sivaprakasam | Director, Healthcare Technologies Incubation Centre, IIT Madras

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r Mohanasankar Sivaprakasam, Director, Healthcare Technologies Incubation Centre, IIT Madras, gave an overview on the medtech advancements in India and its role in rendering quality healthcare services. He also explained the needs and opportunity for med-tech to bridge the gaps in the Indian context. At the same time, he also gave a rundown on the problems hindering the growth of medtech sector such as over-dependence on imports, cost and skill barriers, limited India-centric innovation, lack of effective regulatory pathway etc. He also explained IIT Madras’ role to encourage innovation in the med-tech sector and help create a better entrepreneur eco-system to facilitate growth in this sector.

He spoke on various innovations being incubated at his organisation and emphasised that affordable innovations are the key to create a good public health system. He cited three examples of innovations incubated at IIT Madras to explain how affordable med-tech development and deployment can help bridge delivery gaps in the Indian healthcare system.

The three examples he gave were as follows: SN-IITM Mobile Eye Surgical Unit which helps to provide safe, sterile cataract surgery. It received the Health Ministry’s approval for pan-India operations in 2015 and since then it has completed over 4000 surgeries.

Indigenously manufactured Forus eye examination devices which helps to screen and diag-

nose ailments through computation.

Helyxon- Fever Watch, a wireless remote continuous monitoring system for neonates.

As part of its many advantageous features, it also helps to collect, store and disseminate data from home to the hospital set up and helps in ensuring better care to the newborns.

Dr Sivaprakasam pointed out that all these innovations are affordable and yet as they are created to address Indiaspecific issues, they have achieved considerable success.

He also opined that such innovations are the need to reform the public health system as well. Stating that medtech innovation in India is on a rise and it would continue to grow, he ended his session on a positive note.

The need to scale up stroke care in India's public health facilities S Ô Prof MV Padma Srivastava |

Department of Neurology, Neurosciences Centre, AIIMS, New Delhi

troke is not restricted to the old people, in fact almost one fourth of strokes happen in less than 40 years of age. Prof MV Padma Srivastava discussed different case scenarios that pointed out how time effective management is required to manage strokes. The time window frame should not exclude patients from thrombolysis within the first three hours.

This was recently extended to 4.5 hours so as to cover larger number of patients under the ambit of acute stroke care programme. She referred to the guidelines followed by Indian Academy of Neurosciences (IAN) which states that the only FDA approved treatment for acute ischemic stroke is a thrombolytic agent.

She elaborated on the paradigm shift occurring due to various interventions to improve stroke outcomes such as use of asprin with 48 hours, Hemicraniectomy, IV throm-

Health is our birth right,it should be available,accessible and affordable

bolysis within 4.5 hours and management of patients.

She further points out that as health is our birth right, it should be available, accessible and affordable. She said that if acute stroke treatment is brought into the CCU, infrastructure and cost will not be very high. It will only require bringing in training and SOPs in place.

She mentioned that there is a huge treatment gap which requires physicians to step in. To

bridge the gap, she further elaborate on the concept of telemedicine which will be available irrespective of social, economic and geographic barriers.

She gave an example of Himachal Pradesh where this programme was conducted.

They had collaborated with MoH&FW and brought together the district level CMOs and emergency personnels and trained them. Using the whatsapp-based module, they thrombolysed 176 patients at the district level.

Key recommendations: ■ Time effectiveness is required to manage the acute ischemic stroke ■ To bridge the huge treatment gap, physicians have to step in along with neurologists.

■ The concept of telemedicine should be conducted in other districts as it will help increase the availability, accessibility and affordability

Future of imaging Ô Sabu Jose | GM,- Government, OEM & Corporate Accounts- India Cluster, Carestream Health

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abu Jose, GM, Government, OEM & Corporate Accounts- India Cluster, Carestream Health, said that after working on digitalisation, Carestream plans to work towards bringing it to the ultimate beneficiaries, the patients.

He gave an overview of the company and a glimpse of their offerings which include laser printers, DR as well as the ultrasound for better patient care.

Acknowledging the dearth of resources, he explains the dire need for optimum utilisation of funds and manpower in the public health sector. Applying reverse engineering, they took feedback from the beneficiaries and have designed solutions to suit the patients.

He informed that many such

Carestream took feedback from patients to design solutions that suit them solutions have been introduced and cited three examples: Mobile universal/ field portable kit: The solution helps connect and use the DR detector with the existing mobile Xray system. It caters to hospitals as well as people working in extreme environments by taking DR to the field. It is an all-in-one

solution which is portable and is quick to set up. Its simple user interface requires minimum training and provides fast work flow, making it suitable in the Indian context.

DRX- Evolution transbay: During an emergency, this solution caters to patients by reducing the waiting period. It is designed to move around between two rooms, thereby optimising the resources.

Onsight 3D Extremity System: The solution enables a CT scan in the standing position. It allows accurate determination of the placement and orientation of the bones while under realistic load conditions. It also reduces patient radiation exposure thus providing better patient care.

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Single use dilemma Ô Sumit Marwah | CEO & Director, Dispoline India

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umit Marwah, CEO & Director, Dispoline India began his session by stating that health in India is provided by public health facilities and they play a more significant role that the private health sector. He opined that we would be able to create a healthy India only through strong public health system.

Then, he went on speak on the ‘Single use dilemma’ of products in healthcare. He addressed the issue in a very insightful manner and made an effective case for single use solutions. He pointed out that India continues to battle the threat of communicable diseases which gets magnified as a result of the country's huge population. He also said that lack of proper safety and hygiene compounds this problem.

Talent management in public health A Ô Ashish Jain | CEO, HSSC

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shish Jain, CEO, HSSC in the session, highlighted that amongst the challenges faced by the healthcare sector, the most critical is shortage of human resources.

While he appreciated the presence of para medical council in eight states, he indicated that there is still a huge gap between the demand and supply of skilled manpower. The establishment of Healthcare Sector Skill Council (HSSC) was to bridge this skill gap. He pointed out that HSSC is a unique initiative under the ambit of Ministry of Skill Development and Entrepreneurship constituted

by CII, NSDC, healthcare providers, pharmaceuticals and associations with both public and private sectors.

Government of India has

Cleaning and sterilisation procedures for instruments used in healthcare setups need to better and gave a rundown on the right way to go about doing them

Marwah also pointed out that reusable products need to be very carefully designed, manufactured and maintained. In India, we often come across inadequacy in

created a body which is a nonstatutory body to certify the healthcare workforce other than the doctors and nurses.

To improve capacity and competence, the qualifications are registered on National Qualification Register, National Occupational Standards are developed, which are rectified and validated across country by the employers, creating trans-national standards. He mentioned the importance of training, assessing and certifying these professionals.

“HSSC acts as bridge between the employers and seeks certified professionals through placement support and job aggregation. It also recognises existing professionals and certifies them through their recognition of prior learning

these areas. In such a situation, single use products, are safer and more effective alternatives. He emphasised that our cleaning and sterilisation procedures for instruments used in healthcare setups need to better and gave a rundown on the right way to go about doing them.

Listing down the benefits of single use products which include clean, sterile, reduced infection, faster reaction time etc., he also advised that single-use products should never be reused. He spoke on the essentiality of ensuring better safety and sterilisation of medical devices and instruments. He recommended that indigenously manufactured single use devices are the way forward for India and stated that India could be the new hub for affordable devices in the global market.

scheme. To connect these trained professionals with employers, Rozgar Melas are held.” He added that they are working with various state governments and have 300 plus training centres. An MoU has also been signed to include HSSC qualification in the NABH recruitment centres.

Key highlights: ■ National Qualification register set up to keep a track of qualifications thus improving capacity and competence ■ An MoU has also been signed to include HSSC qualification in the NABH recruitment centres ■ Rozgar Melas are held to connect the trained professionals with employers

Health sector governance and resource generation T Ô Prof Mukul Asher |

Professorial Fellow, Lee Kuan School of Public Policy

here is recognition of the need to increase stewardship and oversight of healthcare and pension programmes, improve coordination across different implementing agencies, and ensure that social protection programmes remain robust and sustainable, said Prof Mukul Asher, Professorial Fellow, Lee Kuan School of Public Policy in his address. Sharing his insights on health sector governance and resource generation, Prof Asher also highlighted how essential it is to have an effective framework for good governance and efficient management of resources.

Accentuating the importance of organisations in delivering healthcare and pension services, he advised that it was essential to ensure professionalism, training, and capacity of organisations and institutions as these would have significant impact on the outcomes of

these programmes.

He also elaborated on the various governance failures such as information asymmetry, moral hazard, adverse selection, etc across publicly financed and privately organised financed programmes. He was of the opinion that these failures can be overcome only with the aid of a range of policy tools, thereby making a strong case for active oversight and regulation of health programmes. Creating a system of counterweighing incentives and disincentives to shape their economic behaviour and recasting the generic model of health system were some of his other recommendations.

Moving on, Prof Asher gave on overview of the existing healthcare system in India and the delivery and financing models which are currently in practice. He also emphasised on the developing the right funding-financing mix as per the country's needs and opined

Addressing the burden of lifestyle diseases D Ô Dr Damodar Bachani |

Deputy Commissioner, NCD, MoH&FW

r Damodar Bachani, Deputy Commissioner, NCD, MoH&FW in this session informed, “Out of all the deaths occurring in India, 60 per cent are caused by NCDs which comprise cardiovascular disease, cancer, COPD and many others.” He elucidated on the different challenges faced by the healthcare sector and shared focus points to strengthen the public healthcare facilities to address NCDs. He pointed out that though NCD clinics are being set up at the district hospitals and the community health centres, lack of healthy attitude in people is a bigger challenge. The various other challenges include little allocation of budget toward

NCDs, financing and no reduction in the out of pocket expenses. He suggested measures like a multi-sectoral action plan be initiated to better the public health scenario. Contribution from the private sector and 20 plus ministries will help reform policies to curb risk factors leading to NCD’s.

He referred to the initiative led by NITI Aayog which constitutes four working group to engage existing private sectors, so they can contribute towards addressing NCDs. Dr Bachani added, “The government, health sector and the society should all join hands to curb the issue of lifestyle diseases.”

As most of these diseases are prevalent life long, more insur-

that public healthcare programmes must be designed not to pay for all healthcare expenditure but cover catastrophic expenditure, and some form of cost-sharing for minor episodes of illnesses. He pointed out that there is no society which can provide best health services all the time, hence management of existing resources is key.

Key recommendations ■ Governments need to reconcile conflicting goals of stakeholders through a concerted use of policy tools ■ Any social protection system should provide benefits with credibility and confidence to all stakeholders in society ■ Each health system should develop its own financing mix based on a combination of instruments like commercial insurance, social insurance, tax financed programmes etc.

ance plans such as Rashtra Swasthya Bima Yojana must also be designed to reduce the out of pocket expenses. He also proposed a two to three-tier financing system be drafted to fulfill the goal of healthcare for all.

Key recommendations ■ A multi-sectoral action plan should be initiated to better the public health scenario ■ Contribution from the private sector and 20 plus ministries will help reform policies to curb risk factors leading to NCD’s ■ A two to three-tier financing system be drafted to fulfill the goal of healthcare for all

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Workshop on NLEM-based hospital formularyin a public health facility

(L-R) Dr VK Shukla, Director, Institute of Medical Sciences, BHU; Dr Pravin Shingare, Director, Directorate of Medical Education and Research (DMER); Dr DK Sharma, Medical Superintendent, AIIMS; Dr Suresh Saravdekar, Director, The Rural Health & Education Centre; Dr AK Gupta, Medical Superindentendent, PGIMER, Chandigarh; Dr Om Prakash Upadhyay, Medical Superintendent, SS Hospital, Indian Medical Sciences-Banaras Hindu University (IMS- BHU)

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he workshop on NLEMbased hospital formulary in a public health facility, spearheaded by Dr Suresh Saravdekar, Director, The Rural Health & Education Centre, helped gain more understanding about the best practices in procurement that India can inculcate to improve its own drug quality standards. It started off with a presentation by Dr Saravdekar which clarified various aspects of the National List of Essential Medicines (NLEM) and its purview as well as objectives. Then, he went on to explain about monitoring and evaluation of procurement practices. He also gave a rundown on various challenges faced at the imple-

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mentation level. He also put forth his recommendations for improving the current processes in tendering and procurement to improve their efficacy.

Thus, he set the stage for a brief panel discussion which followed. His panelists were Dr Pravin Shingare, Director, Directorate of Medical Education and Research (DMER); Dr VK Shukla, Director, Institute of Medical Sciences, BHU; Dr DK Sharma, Medical Superintendent, AIIMS, Dr AK Gupta, Medical Superintendent, PGIMER, Chandigarh; Dr Om Prakash Upadhyay, Medical Superintendent, SS Hospital, Indian Medical Sciences-Banaras Hindu University (IMSBHU)

Dr Gupta, spoke on the challenges in ensuring best practices in procurement with

The panelists also rooted for constant upgradation of quality standards in medicines and urged implementation of GMP standards recommended by WHO to upgrade the quality of drugs

insights from his own experiences at PGIMER, Chandigarh. He also shared how these challenges were dealt with in his organisation in details. The difficulty in getting doctors to prescribe only generic drugs were one of the challenges he highlighted. Dr Shukla agreed with Dr Gupta's views and stated that the skewed way of providing financial incentives is also a serious problem. He further informed that it is high time we came up with standard guidelines to streamline the processes. Dr Shingare gave his account of handling existing challenges and the role WHO GMP guidelines are playing in making the tendering and contracting procedures simpler and more effica-

cious. Dr Sharma touched up on issues like the rational use of medicines, encouraging the quality and use of generic medicines, and testing procedures of medicines. Dr Upadhyay advocated better pricing regulations to deal with some these issues. He also reiterated that public health doctors must be mandated to prescribe generic medicines.

The panelists also rooted for constant upgradation of quality standards in medicines and urged implementation of GMP standards recommended

by WHO to upgrade the quality of drugs.

The delegates also got the opportunity to share their experiences in this sphere and exchange learnings.

DAY 3 FEBRUARY 11, 2017 KEYNOTE ADDRESS

HEALTHCARE SABHA 2017 AGENDA DAY 3 ◗ Keynote address Co-creating a manifesto for a healthy India: Role of an empowered patient ✦ Dr Bejon Misra, Founder PSM India Issues impacting healthcare industry in 2017 ✦ Vivek Tiwari, Director and CEO, Boston Ivy Healthcare Solutions Role of health insurance in creating a sustainable health financing system ✦ KB Vijay Srinivas, GM, National Insurance Corporation

Co-creating a manifesto for a healthyIndia: Role of an empowered patient Ô Bejon Misra | Founder, PSM India

Journey to a healthy India ✦ Bhudeb Chakravarti, Honorary President, Centre for Development of Excellence, Hyderabad Govt sponsored schemes: Meant for poor, but beyond their reach? ✦ Prof Dayashankar Maurya, Chairperson, Healthcare Management & International Relations,TA Pai Institute of Management ◗ Panel discussion Sustainable Health Financing Systems/Health Economics ✦ Moderator: Prof Dayashankar Maurya, Chairperson, Healthcare Management & International Relations,TA Pai Institute of Management ✦ Gajendra Kumar,Advisor, Ministry of Railways, Government of India; ✦ Dr RK Srivastava, Sr Advisor, Public health and innovation,Wadhwani Initiative for Sustainable Healthcare (WISH) Foundation; ✦ Dr Payal Laad, Assistant Professor of Community medicine, Public Health at Lokmanya Tilak Medical College and Hospital ◗ Presentation Regulatory practices in Gujarat to protect public health ✦ Dr HG Koshia, Commissioner, Food & Drugs Control Administration, Govt. of Gujarat Ensuring access to quality health services and essential medicines ✦ RP Khandelwal, Chairman, HLL Lifecare ◗ Panel discussion Good Governance in Public Health ✦ Moderator: Dr Pratheek Rathi, Special Executive Officer, ESI Scheme; ✦Panelists: Dr Atul Kharate, State TB Officer, Madhya Pradesh, GOI ✦ Dr Suleman Merchant, Dean, Lokmanya Tilak Medical College and Hospital; ✦ Dr Deepak Agarwal, IT Head, AIIMS, Delhi A brief glimpse into the future ✦ Dr Suleman, Merchant, Dean, Lokmanya Tilak Medical College and Hospital ◗ Panel discussion Access to quality services and medicines ✦ Moderator: Lokesh Sharma, Director, QuintilesIMS Institute India and Head of Government Solutions in India for QuintilesIMS Health ✦ Panelists:, Bejon Misra, Founder, Partnership for Safe Medicines (PSM) India, Healthy You Foundation, Cell For Consumer Education and Advocacy Society ✦ Dr M Prakasamma, Executive Director,ANSWERS (Academy for Nursing Studies and Women's Empowerment Research Studies) ✦ Dr RK Srivastava, Sr Advisor, Public health and innovation,WISH Foundation, Former Chairman, MCI and Former DGHS, Govt of India ◗ Express Public Health awards

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he third day of Healthcare Sabha 2017 began with a key note address by Bejon Misra, Founder, PSM India in which he highlighted the role of most important stakeholder in public heath — patients. He began by talking about the expectations of patients when they seek healthcare services.

He listed top 10 expectations of patients in India (standards, choice, information, accessibility, accountability, prompt redressal, safety, quality, nondiscriminatory and privacy) and elaborated on the significance of them. Misra emphasised on the need for policy makers and public health workers to design their health programmes keeping in mind these expectations. He said that it is pivotal to empower the patients to create a sustainable and good public health system.

He further said that the

healthcare sector is currently undergoing a huge churning.

There are opportunities galore and patients are anxiously waiting for new products that will enhance their health and lifestyle. In his presentation, he also mentioned the areas where patients spend on healthcare (viz. hospitals, pharmacy products, medical equipment, health insurance and diagnostics).

The renowned patient activist was also emphatic on ensuring highest quality in medicines and healthcare services in his session. Subsequently, he cautioned that the patient is slowly loosing faith in the public health system.

He drew attention to the role of private sector in public health. He informed that the investment in healthcare over the years has increased by 8x, yet addressing the healthcare needs of patients in India is a

huge challenge. He accentuated on the relevance of a comprehensive health financing system. He amplified on the draft National Health Assurance Mission and said that if implemented well, it can be a game changer for Indian healthcare.

Misra urged the audience to make a strong appeal to the government to increase its investment in health. He also urged the audience to relook and rationalise the pricing strategies of medicines and services in healthcare. “Quality healthcare is priceless, whereas absence of quality will cost life,” he avered.

Moreover, he critised the concept of price control saying that it kills creativity. “There needs to a be an environment of healthy competition,” he said.

Referring to the telecom sector he said that earlier a cost of one mobile phone call used to cost him ` 21 in the year 1995 in Delhi and he was charged even for incoming calls; however, due to the competitive nature of the sector, today a phone call cost him less than a rupee. Therefore he said that even in healthcare the government must encourage healthy competition.

Misra also engaged the audience in conversations on subjects related to quality of services and good governance.

He urged the audience to be fearless and work with the right attitude.

Key recommendations ■ Empower the patients to create a sustainable public health system ■ Role of the private sector vital to public health ■ Encourage healthy competition ■ Government needs to increase its investment in health ■ Be fearless and work with the right attitude

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Issues impacting healthcare industryin 2017 V Ô Vivek Tiwari |

Director & CEO, Medikabazaar

ivek Tiwari, Director & CEO, Medikabazaar began by speaking about the challenges he faced in terms of building a marketing engine for enabling medical institutions to gain operational efficiency. In his presentation, he highlighted the fact that India is home to around 17.5 per cent of the global population and accounts for 20 per cent of global disease burden, 27 per cent of neonatal deaths and 21 per cent of infant mortality.

“Despite this, India has a weak primary healthcare structure.

We are struggling with basic issues such as lack of sanitation and drainage,” he informed. Further, he spoke on regulatory issues that plague

Merger and collaborations for community care facilities,integrating new technologies in providing healthcare facilities can be helpful the sector such as price control on life saving drugs like stents, lack of health insurance penetrations within the country, inefficiencies in distribution of essential medicines and sup-

plies, growing cyber security concerns and rising medical costs due to lack of transparency of prices.

Presenting some solutions to these problems, Tiwari stated that merger and collaborations for community care facilities, integrating new technologies in providing healthcare facilities can be very helpful. “There is a need to adopt latest advancements to tackle various public health challenges faced by the country,” he opined. He further gave a rundown on various trends transforming healthcare in India. “Biosimilars and mobile apps are some technologies that will certainly shape the future of healthcare,” he added.

Role of insurance in creating sustainable health financing system K Ô KB Srinivas | GM, National Insurance Corporation

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B Srinivas, GM, National Insurance Corporation, gave a brief introduction to the company and spoke about its inception and growth. He reiterated the words of Dalai Lama who once said, ‘Man sacrifices his health to make money.

Then his sacrifices his money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; result being that he does not live in the present or the future.

He lives as if he is going to die and then dies having never really lived.’

Srinivas opined, “The Indian healthcare sector is only focussing on ailment care which is just smaller portion of the term healthcare. We should be focussing more on health and wellness rather than treating ailments.” He applauded the Express Healthcare team to begin the day with a Yoga session. He said that promoting healthy lifestyle with the help of Yoga and other holistic approaches to

We should be focussing more on health and wellness rather than treating ailments

health and wellness should be the way of life. He also thanked Prime Minister Narendra Modi for his efforts to promote Yoga.

Additionally, Srinivas gave a comparison of the health indicators between India and rest of the world as well as gave an overview of healthcare industry and the state of affairs within the sector.

He also elaborated on myriad ways to finance healthcare and cited interested financing

models in his session. Citing example from the Tamil Nadu model of financing for healthcare, he informed that the scheme has a system wherein a portion of healthcare insurance claim money is given to government hospitals in order to upgrade their infrastructure and other facilities. This strategy has been successful and has helped many district hospitals within the state.

Similarly, he put forward some interesting case studies from Germany, Italy, Cuba, Great Britain, Japan, France, Belgium, Switzerland, Spain, Taiwan and many more who have adopted different models for healthcare financing. He also explained the implications of models such as Bismarck, Beveridge and out-of-pocket model and compared it with the National Health Insurance model followed by India. Lastly, Srinivas explained the growth opportunities and insurance trends in healthcare in the coming years.

Journeyto a healthyIndia Ô Bhudeb Chakravarti | Honorary President, Centre for Development of Excellence, Client Principal, ThoughtWorks

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ealthcare and education should be integrated with the help of digitisation, informs Bhudeb Chakravarti, Honorary President, Centre for Development of Excellence, Client Principal, ThoughtWorks.

Education is an important factor which affects the social and economic development and has a profound impact on health too. Education helps to avail a lot of benefits at the individual level and community level.

Highlighting the need for a robust Primary Health Centre (PHC), Chakravarti said, “We provide consultancy services to various state governments at grass-root levels. Also, we are planning to initiate a healthcare wing as it requires a lot of attention and focus on PHCs, as these are the citizen’s primary contact with a health- providing entity.”

He also added that achieving positive health outcomes in today's healthcare environment requires variety of factors like

education and a combination of soft and hard skills.

“Healthcare at the primary level is not up to the mark. Most of the patients in towns and villages benefit from the ability to understand their health needs, follow or read instructions, advocate for themselves and their families, and communicate effectively with health providers.

Frontline health workers should be educated and given a mobile helpline, so that it could connect doctors and patients.

Besides, state governments should come with a module to improve the PHCs. State governments mostly concentrate on posting doctors to serve in villages rather than connecting them with patients.

Citing an example that community health workers could bring in a transformation in the villages, he said, “In Bahamani, Chhattisgarh, there is a cluster of 22 villages. The community health workers have formed a group of 35 ladies in the villages where training is provided on

delivery. They also provide a delivery kit which consists of three boxes; one each for pre-delivery, during delivery process and for post delivery. The kit has medicines, cloth required during labour, blade to cut the umbilical record, among other tools. The village has seen zero infant death in nine months.”

The critical care data should be collated with Aadhaar card, so that every person’s health can be easily accessed.

“The details of each citizen should be collected and collated in a village or town and each PHC should share this to the district hospitals and the same should be shared to the server at the state headquarter,” he added.

Summing up, Chakaravarti informed that education on health is crucial, and it should start from community level, tertiary care and in PHCs, as transformation in these areas will bring in awareness and it will improve health trajectory of a particular locality.

Govt sponsored schemes: Meant for poor,but beyond their reach?

P Ô Prof Dayashankar Maurya |

Chairperson, Healthcare Management & International Relations, TA Pai Institute of Management

rof Dayashankar Maurya, highlighted about the current spendings of Government Sponsored Health Insurance Schemes (GSHIS) which is around `2500 cr on various national and state-run schemes. These schemes have converted healthcare need into healthcare demand by bringing millions of consumers into the formal healthcare market which were beyond reach. The schemes have got the attention of healthcare sector and have provided additional resources.

Out of the total health insurance coverage, which is around 15-18 per cent, GSHIS holds 75 per cent of this share,

but as for the premiums they collect a total of 12 per cent.

He mentioned the status and the evolution of the government health insurance schemes. He pointed that major developments in the insurance industry have taken place in the last decade. He elaborated on different design modules available for GSHIS including schemes for various states.

Another focus point was, “Are these schemes reaching the intended beneficiaries.”

He explains that the lists include educated and politically connected people who are not below the poverty line whereas the ones who are under BPL are not included. He

also discussed about the schemes not meeting the health needs of the beneficiaries. Further, he opined that though there is an increase in utilisation and patient satisfaction is high, yet there has been no reduction in the out of pocket expenses. Also, the impact on the catastrophic expenditure is minimal.

The reason behind this are issues in institutional design, minimal monitoring and lack of managerial interventions.

He suggests a few measures to improve including improving design by having an institutional structure and capabilities; improvising the system and measuring progress; and reducing fragmentation.

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HEALTHCARE SABHA 2017 DAY 3 FEBRUARY 11, 2017 PANEL DISCUSSION

Sustainable Health Financing Systems

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he prerequisites for an ideal health financing system in India are improved health indicators, reduced burden of catastrophic expenditure and improved equity by applying some of the principles of the health economics. The discussion on Sustainable Health Financing Systems/Health Economics by Prof Dayashankar Maurya, Chairperson, Healthcare Management & International Relations, TA Pai Institute of Managementwith an eminent panel comprising, Gajendra Kumar, Advisor, Ministry of Railways, Government of India; Dr RK Srivastava, Sr Advisor, Public Health and Innovation, Wadhwani Initiative for Sustainable Healthcare (WISH) Foundation; and Dr Payal Laad, Assistant Professor of Community Medicine, Public Health at Lokmanya Tilak Medical College and Hospital revolved around analysing these aspects.

Prof Maurya highlighted India’s overall healthcare expenditure being 4.7 per cent of the GDP which is at par with many other countries, yet thehealthcare outcomes are far less. He elaborated on the role of financing mechanisms in determining incentives to players, providers as well as insurers.

“There are various factors that are currently impacting financia;l mechanisms such as shifting disease burden, rapid aging population, medical inflation rate along with technological growth which will increase cost of healthcare in the future thus making it difficult to create a sustainable healthcare system.

There is a need to make a shift from curative to preventive healthcare.”

He posed a question to Dr Srivastava on how India should move forward to deliver value

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From L-R: Dr Payal Laad, Assistant Professor of Community Medicine, Public Health at Lokmanya Tilak Medical College and Hospital;Dr RK Srivastava, Sr Advisor, Public Health and Innovation, Wadhwani Initiative for Sustainable Healthcare (WISH) Foundation; Gajendra Kumar, Advisor, Ministry of Railways, Government of India and Prof Dayashankar Maurya, Chairperson, Healthcare Management & International Relations, TA Pai Institute of Managementwith an eminent panel comprising

for health? He suggested to reserve a percentage of budget for preventive, curative and rehabilitative services. He expounded on healthcare expenditure distribution variables wherein the public sector holds around 1.14 per cent and invests largely in the primary care, whereas private sector invests mostly on secondary and tertiary. “The larger chunk requires primary health but minimum resources are allocated towards it, therefore the end users suffer. Increasing public health expenditure, empowering healthcare experts to improve planning will help better the healthcare scenario.”

Continuing with the discussion, Dr Laad referred to medical colleges being the think tank of the country yet they are not utilised to the fullest. She gives a few measures to be considered such as involving beneficiaries’ opinion in policy making, testing schemes on computer assisted epidemiological models, monitoring,

evaluating and revamping current processes. “As our age of survival is increasing, so is our age of retirement” she exclaimed. Further she raised an integral point for a need to delibrate on the budgetary allocation of continuum of care, hospices and palliative care.

Taking forward the discussion Dr Srivastava added that there is a requirement to change provider’s behaviour to produce an evidence-based,

There is a need to use different financing modes,perform experiments to add innovations and include technology to create an unfragmented system

rightly financed and cost effective system. He mentioned that there is an urgent need for faculty development programmes.

He suggested that the continuum of care should emerge by a robust financial evidence gathering mechanism.

He reflected upon how an integrated care system can be created through the utilisation of technology as healthcare service users can be linked through online records. He highlighted the importance of digitalisation, partnerships with start ups and devising new solutions with the help of technology.

The panel further discussed on the administrative integration which involves various ministries and their link with delivering value-based healthcare. Gajendra Kumar pointed out that preventive and promotional interventions is the need of the hour. He suggested that there needs to be a synergy among the public and the private healthcare providers.

Taking a few learnings from Bangladesh’s health financing system, Dr Srivastava explained that there is an organised consumer movement with a strong cooperative insurance system which the government promotes which can be adopted by India.

Dr Laad adds a few experiments which can be applied forcreating a sustainable financing model. She recommended for a communitybased health insurance wherein Mutual Health Organisations (MHO) are created and NGOs work towards the betterment of the community.

She mentioned about NHM’s Panchayati Raj Institutions have played a vital role and could me more acceptable.

Prof Maurya concluded the sessions with various learning such as a need to use different financing modes and performing experiments to add innovations. He added that including technology is essential to create an unfragmented system.

Regulatorypractices in Gujarat to protect public health “M Ô Dr HG Koshia | Commissioner, Food & Drugs Control Administration, Govt. of Gujarat

ay all beings be happy; may all beings be healthy; may all beings see beauty everywhere; may all beings be free from suffering,.” This inspiring sanskrit verse was quoted by Dr HG Koshia, FDCA Commissioner, Gujarat in his address. He said that this is the vision that the public health fraternity needs to have in order to make the nation healthy.

He also gave an overview of the pharma sector of Gujarat and said, “in terms of pharma output, around one-third of the country pharma products comes from our state. Gujarat caters to 28 per cent of the country's pharma exports. Moreover, Gujarat's pharma sector caters to 20 per cent of the global population,” he informed.

Koshia then spoke on the relevance of regulatory practices in ensuring value-based public healthcare delivery and

gave a rundown on the initiatives by the government to protect public health. He said that the role of the Food and Drug Control Administration is to ensure high standards of products such as medicines, medical devices, diagnostic labs, food products and cosmetics. In term of public health the FDA play an pivotal role in assuring the quality of medicines.

Elaborating on the regulatory practices impletmented in his state to ensure safe medicines for all, Koshia informed that they keep a watchful eye on the pharma sector, curb the circulation of spurious medicines floating in the market as well as punish offenders of law.

He also informed that Gujarat was the first state to get National Accreditation Board for Testing and Calibration Laboratories (NABL) accreditation for their FDA testing lab.

He also mentioned that their state has the highest surveillance rate when it comes to FDA inspections. Infact, in 2013-14 Gujarat was among the top states for conducting drug sample tests. Koshia said that they had achieved highest efficiency in their operations by utilising technology. He also gave examples of how they integrate mobile app in their operations. He said, “We maintain a transparent, accountable system and focus on providing immense information to the public at large in order to empower patients.”

Key takeaways ■ Gujarat caters to 28 per cent of the country's pharma exports ■ Gujarat's pharma sector caters to 20 per cent of the global population ■ There is a need to maintain a

transparent,accountable system and focus on providing information to the public

Ensuring access to qualityhealth services and medicines R Ô RP Khandelwal |

Chairman, HLL Lifecare

P Khandelwal, Chairman, HLL Lifecare, started off by outlining the current scenario of public health in India. He raised concerns on the rising out-ofpocket expenditure in healthcare and said that need of the hour is to come up solutions to provide, affordability medicines and services to all.

He also recommended the creation of a comprehensive care delivery system for India on a priority basis. He was also in favour of adopting technology to make our country's healthcare system smarter .

He then shared the story of HLL's growth trajectory from a condom manufacturer to a PSU involved in a range of activities. Today, its serv-

ices range from pharmacies to contraceptive manufacturing and diagnostic centres.

HLL not only provides affordable pharmacy products but also affordable services. As a government-owned organisation it has made a difference by providing drugs, diagnostic services , maternal care, opthalmalogy supplies and health promotions in terms of educating patients on various health issues and making them aware of the available government facilities.

Khandelwal also divulged HLL's future growth strategies. “Going forward, we will be bringing down the price of medical device and will be setting up 300 AMRIT stores to increase access to medicines. We will also be partner-

ing with the governments of Maharashtra and Assam to provide diagnostic services.

We see a huge opportunity in diagnostics and medicine distribution. We will be setting up a medtech park in Chennai for providing business opportunities to companies who wish to manufacture high quality devices and provide it at affordable rates,” he disclosed.

He also spoke about the Lifecare hospitals that focusses on providing dignified child delivery care for women living below poverty line.

Key announcements ■ Setting up 300 AMRIT stores to increase access to medicines ■ Setting up a meditech park in Chennai

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HEALTHCARE SABHA 2017 DAY 3 FEBRUARY 11, 2017 PANEL DISCUSSION

Ushering good governance in public health

(L-R) Dr Deepak Agrawal, IT Head, AIIMS, Delhi; Dr Atul Kharate, State TB Officer, Madhya Pradesh, GOI; Dr Prateek Rathi, Special Executive Officer, ESI Scheme, Department of Public Health, Maharashtra; Dr Suleiman Merchant, Dean, Lokmanya Tilak Medical College and Hospital, Mumbai

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he third day of Healthcare Sabha had three interesting panel discussions on topics of great relevance to creating a healthy India. One of them was a discussion on ‘Ushering good governance in public health’ wherein Dr Atul Kharate, State TB Officer, Madhya Pradesh, GoI; Dr Suleiman Merchant, Dean, Lokmanya Tilak Medical Col-

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lege and Hospital, Mumbai and Dr Deepak Agrawal, IT Head, AIIMS, Delhi, highlighted the need for development thinking, spending and action to ensure good governance in public health. Dr Prateek Rathi, Special Executive Officer, ESI Scheme, Department of Public Health, Maharashtra moderated the discussion.

Dr Rathi began the session

by setting the context with a brief snapshot on the current scenario as far as public health parameters are concerned. Referring to reduced IMR and MMR rates and eradication of diseases like polio, he said that the current healthcare system has had some amount of success but also admitted that we have not done so well in many other crucial areas. He cited

examples of Thailand, Bangladesh and Pakistan to point out that these developing nations have seen more success than India in certain areas of healthcare delivery.

He spoke on the rising burden of diseases and accented the need for better policies and strategies to tackle them. He drew attention to huge health iniquities faced by the country and reflected that these

are due to failures in governance. He rooted for the adoption of a more holistic approach towards healthcare delivery which can be possible only through good governance. In the course of his session, he raised several pertinent questions to the panelists on issues faced by the public health system in India.

Some of them were dealing with dilemmas like choosing

between equity and efficiency in healthcare delivery, setting the priorities and deciding on resource allocation; means to tackle information asymmetry and empower patients; charting a plan of action for the future, etc.

The panelists were unanimous in their opinion that technology is the answer to deal with a lot of problems in the public health sector.

Dr Merchant recommended the use of telemedicine, community medicine, big data analysis, and others as a measure to eliminate the quandary of choosing between accessibility and quality. He informed that BMC hospitals have tie-ups with Centres of Excellence to increase telereporting. He also gave examples of apps created by NGOs like Armaan to track maternal and child health. He strongly advocated

Data,if disseminated appropriately,can also empower the patients to make empowered decisions and educated choices with regards to their own healthITimplementation has streamlined the processes and encouraged efficiency which,in turn,gets passed on to the patients.ITadoption,right resource allocation, innovative solutions and best practices will create an efficient framework for public health the use of simple, basic, preventive measures to tackle issue in governance.

Dr Kharate highlighted how TB management has improved by leaps and bounds in his state with the implementation of new advance-

ment in diagnosis and better reporting of the disease. He also explained how technologies like GeneXpert have played a significant role in bettering TB management.

Dr Kharate is also a strong proponent of absolute com-

mitment and adherence to the healthcare policies in the country. He feels that failure in governance are the result of incorrect practices and lack of commitment towards implementing the right measures, to a great extent. He said that concerted efforts and allegiance are the means to usher good governance.

Dr Agrawal gave instances of how AIIMS Delhi has effectively used technology to get more data and improve treatment outcomes. He went on to describe various ways in which IT has improved processes and thereby outcomes in his organisation. He explains that IT implementation has streamlined their processes and encouraged efficiency which, in turn, gets passed on to the patients.

Thus, technology brings in evidence in healthcare delivery, a key aspect of good gov-

Abrief glimpse into the future of healthcare D Ô Dr Suleiman Merchant |

Dean, Lokmanya Tilak Medical College and Hospital

r Suleiman Merchant, Dean, Lokmanya Tilak Medical College and Hospital gave a glimpse of healthcare’s future and drew attention to the various advancements that are transforming healthcare. At the same time, he also advocated that simple measures can help prevent several health threats. He gave the example of TB management and pointed out Vitamin D supplements can help improve TB outcomes. He pointed out that flaws in our initial approach to disease management can lead to bigger menaces such as MDR TB. He stated that low-cost innovations and timely interventions are the way forward to improve public health.

Dr Suleiman also showed a video where a stroke patient is being treated using a minimal-invasive technology

where the blood clot in the brain is disintegrated rather than removed through surgery. He also informed that the procedure is being done in his hospital at affordable cost. He went on to describe various other new interventions adopted in his hospital and how patients can benefit from these techniques

ernance. Dr Agrawal also said that data, if disseminated appropriately, can also empower the patients to make empowered decisions and educated choices with regards to their own health.

Thus the experts recommended IT adoption, right resource allocation, innovative solutions and best practices to create an efficient framework for public health.

Key recommendations ■ Technology is the answer to deal with a lot of problems in the public health sector ■ Failure in governance are the result of incorrect practices and lack of commitment towards implementing the right measures ■ There is a need for a more holistic approach towards healthcare delivery which can be possible only through good governance

and technologies.

His session also highlighted newer areas like epignetics and its potential in transforming healthcare delivery. He urged the public health fraternity to wholehardheartedly adopt the advancements in science and technology to provide best quality care to the patients.

He played several videos to prove his points and catch the interest of the audience. He also cautioned that changing according to times is not a choice but a necessity.

Key recommendations

Flaws in our initial approach to disease management can lead to bigger menaces such as MDR TB

■ Timely measures will help nip problems in the bud and prevent them from becoming bigger dilemmas ■ Low cost innovations are the way forward to improve public health ■ Emerging areas like epigenetics can transform healthcare delivery

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HEALTHCARE SABHA 2017 DAY 3 FEBRUARY 11, 2017 PANEL DISCUSSION

Access to quality health services and essential services: The way ahead

(L-R) Lokesh Sharma, Director, QuintilesIMS Institute India and Head of Government Solutions in India for QuintilesIMS Health; Dr RK Srivastava, Sr Advisor, Public health and Innovation, WISH Foundation, Former Chairman, MCI and Former DGHS, Govt of India; Dr M Prakasamma, Executive Director, ANSWERS (Academy for Nursing Studies and Women’s Empowerment Research Studies) and Bejon Misra, Founder,Partnership for Safe Medicines (PSM) India, Healthy You Foundation,Cell For Consumer Education and Advocacy Society

O

ne of the most important element of a strong healthcare system is the availability, accessibility and reliability of essential medicines and services. This panel discussion intended to bring forth an essence of these key determinants of public health. The experts in this discussion recommended fortifying public healthcare and safeguarding the human touch, which is fast diminishing in a high-tech

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world.

The panelists for the session were Bejon Misra, Founder, Partnership for Safe Medicines (PSM) India, Healthy You Foundation, Cell For Consumer Education and Advocacy Society; Dr M Prakasamma, Executive Director, ANSWERS (Academy for Nursing Studies and Women’s Empowerment Research Studies) and Dr R K Srivastava, Sr Advisor, Public health and innovation, WISH

Foundation, Former Chairman, MCI and Former DGHS, Govt of India. The session was moderated by Lokesh Sharma, Director, QuintilesIMS and Head of Government Solutions in India for QuintilesIMS Health.

The panelists deliberated on the following aspects: ◗ Improving accessibility to the essential medicines, especially in rural areas ◗ Prioritisation of service delivery imperatives such as man-

power, infrastructure, medicines etc., given limited resources ◗ Does the new expanded version of RSBY play a significant role in improving access and quality care? ◗ Pragmatic models of private sector engagement Sharma started off the discussion and said, “India is on a critical juncture wherein on one side we have increased burden of non-communicable diseases and on the other we

are still fortifying our efforts to reduce the communicable diseases and curb IMR and MMR. In keeping with this fact and as we expand our health services, we need to focus on quality and ensure specific monitoring frameworks which are deployed by various stakeholders including governments, patient communities, payers and providers.

Taking the discussion forward, Sharma asked Dr Prakasamma to share her

views on the existing quality of health services in India. She said that India’s healthcare system is going through a crisis situation. “Our healthcare system is fragmented and we only focus on curing sick people. There is a need to move from a unipurpose approach to a multi-purpose approach to resolve India’s health concerns. Neither are our healthcare professionals are trained to give quality care in public health, nor our health programmes are of multi-purpose nature to provide a wide variety of health services,” she stated. Our health programmes are very uni-purpose in nature, therefore scaling up becomes an issue. She pointed out that around 1970s, the healthcare system did focus on wellness, however, over the years we have moved backwards away from the wellness model. “India needs a holistic approach to health,” she averred.

Dr Prakasamma also spoke on understanding the social determinants of public health.

She cited inferences from various existing healthcare programmes and pointed out their flaws. Similarly speaking about the draft national health policy and the draft National Health Assurance scheme, she mentioned that these initia-

tives also do not have a comprehensive primary healthcare approach. “Despite being part of the National Health Mission, I am sorry to say that our health programmes are not moving towards the direction to provide a comprehensive healthcare platform. My request to all of you to plea for wellness model in primary healthcare delivery,” she averred.

When asked about how schemes such as Jan Aushadhi can ensure quality essential medicines to all, Misra gave the entire backdrop of how the concept of essential medicines came into being. He also raised concerns on the mechanism to which the government bodies function in terms of scaling up healthcare-related projects.

He went on to say, “Govern-

ment does not have the mechanism to scale and reach out to those in need of these healthcare service. Therefore there is a need for public-privatepartnerships (PPP).”

Misra informed that earlier these Jan Aushadhi stores were made available at very few district hospitals and that state governments have vested interest in not allowing the scheme to expand its reach to other government hospitals, NGOs and other government healthcare centres. Nevertheless, the government has now come to the realisation that these stores need to be allowed to function at various areas.

“The solution is that there needs to be a all stakeholders partnership movement in order to break monopolies,” Misra strongly affirmed.

Focus should be given on quality and it needs to be ensured that specific monitoring frameworks are deployed by various stakeholders including governments,patient communities,payers and providers

Dr Srivastava spoke about the policy implications on such schemes. He suggested that we must have a good model for procurement, storage and timely distribution of essential medicines. Giving the example of the Government of Tamil Nadu’s model for provision of essential medicines scheme, he said that this model is time test and has been successful as it is professionally managed. He also mentioned that technology adopting in management of this system has been a key factor for its success.

Articulating on the learnings from this model, he said that the professional management built up in this system needs to be carried forward as well as the technology utilised needs to be upgraded from time to time.

He also spoke on the need for a systematic, corruption free procurement system for medicines.

Mishra chipped in and said that the industry is prone to discontent when the government brings in price control.

At the same time when the government encourages an open market for generic drugs, the patients become more empowered. He also confessed that after the origin of online pharmacies in India, the pharma sector has become

more competitive.

Misra put forth a contention for the need of a watchdog who is not a government agency and yet has an influential say in opinion building. He further insisted the media to take on the role of a watchdog of the healthcare system and provide an informed and un-biased opinion.

Coming strongly on the need to force on caregiving in public health, Dr Prakasamma stated that all stakeholders need to upscale their efforts in this direction.

She was also alarmed on the increasing number of C- section deliveries in the private sector, which needs to be addressed.

“We need to transcend beyond technology and gauge the future. We do need technology but we also have to consider the human factor in our caregiving.

We have to understand that more technology cannot ensure better quality service in public health. We need to have that discomfort within us to proactively work towards the betterment of the society.”

Moving forward, the panel also discussed on how private sector can play their part in fortifying public health. The audience also posed relevant questions engaging valuable discussion between the audiences and the panelists.

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HEALTHCARE SABHA 2017 DAY 3 FEBRUARY 11, 2017

Valedictoryaddress at Express Public Health Awards “T

he theme of Healthcare Sabha 2017Co-creating a manifesto for a healthy India’ is very timely as world over healthcare policy makers, professionals working in this sphere are focussing on population health and more importantly India with its several challenges need to direct its effort toward this aspect,” expressed Rajendra Pratap Gupta, Advisor, MoH&FW, Government of India during the valedictory speech at the event.

Gupta gave a rundown on the existing public health system of India and drew inference from the past experiences. He spoke that healthy living was an old Indian concept and how our Indian society has moved away from the same. “There is a continuous debate on whether the government needs to invest more on medical interventions or public health interventionsboth being of great evidence.

However, the overwhelming evidence says that the highest impact on longevity is public intervention v/s medical interventions compared to the cost. Lifestyle and preventive care have the highest impact on longevity,” he said.

Furtheron, Gupta shared examples of the US and the UK and how they have dealt with their public health problems as well as designed a strong healthcare system by focussing on addressing problems such as sanitation, hygiene and nutrition. Moreover, he said that these countries were able to sort their healthcare challenges by focussing on public health interventions.

He referred to the Indian Economic Survey of 2014 and said, “India needs a fundamental and a strategic shift in its thinking on how to spend on public health. But the ques-

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India needs a fundamental and a strategic shift in its thinking on how to spend on public health.

But the question arises where to spend in public health and answer is child health.If our children are healthy then we will have one half of the battle won against NCDs

tion arises where to spend in public health and answer is child health. If our children are healthy then we will have one half of the battle won against NCDs and then can we will be able to build a sustainable healthcare system.”

Gupta also spoke on various endeavours by the government to enhance health and well-being of its citizens.

He also gave several recom-

mendations to augment the current framework such as making pharmacists and nurses the cornerstones of the public health system and integrating AYUSH with mainstream medical practice by making it more evidencebased. He also lauded Express Healthcare for creating a platform like Healthcare Sabha to bring all policymakers under one roof.

POWER DISCUSSIONS

Power Packed discussions @ Healthcare Sabha 2017 Knowledge sharing galore on pivotal topics like procurement practices, strengthening primary healthcare and digitisation of medical imaging PROCURING IT RIGHT - Powered by GLENMARK

G

lenmark hosted a power breakfast focussed on creating a robust procurement management moderated by Dr Suresh Saravdekar, Director, The Rural Health & Education Centre.

Dr Prateek Rathi, Special Executive Officer at ESI Scheme, Department of Public Health, Maharashtra, Kimi Nagpal, Consultant NHRM, Government of Mizoram, Sanjay Dalvi, Director of Health Services, Goa; AG Prasad, Divisional Head, Institutional Sales & Marketing at Glenmark Pharmaceuticals etc were some of the delegates who attended the session.

Deliberations were made on challenges faced by procurement agencies to filter unscrupulous manufacturers and maintain a balance between quality and price. Suggestions were made to streamline the process and bring in transparency. The delegates discussed about various irregularities that mar the

country’s tendering and contracting processes in the procurement of medical supplies. Recommendations audits of companies to understand about their financial standing as a measure to avoid discrepancies in the long run. They also discussed on the urgent need to reform the procurement and distribution models existing in the public health sector to bring in widespread adoption of the generic medicines through initiatives like Jan Aushadhi and AMRIT stores.

These measures will go a long way in reducing healthcare costs, opined the attendees. They further discussed several solutions that can be implemented at different levels to eliminate the existing gaps.

They unanimously agreed that only through concerted efforts can the system be strengthened and made more effective.

EVOLVING TOWARDS DIGITAL MEDICAL IMAGING - Powered by AGFA

A

GFA Healthcare presented an hour-long discussion at Healthcare Sabha 2017 which focussed on how hospitals should move on from analog to digital medical imaging.

Giving the opening remarks, Mahendra Singh Jodha, Regional Sales Manager- North, informed that AGFA Healthcare is committed to the industry as it wants to improve delivery of patient care through technology investments and creating a culture of security. Jodha also mentioned that the Gujarat government is planning to set up CR systems in 200 different locations through the PPP model.

Dilip Bhosale, Regional Sales Manager (West), AGFA, briefed about different healthcare solutions offered by AGFA and its uses in government hospitals. He informed, “Gujarat Medical Service Corporation (GMSC) had installed small Computed Radiography (CR) system in remote places of the state with a minimal investment of `10 lakh.”

Dr MK Vadel, Professor and Head, Medical Superintendent at Government Medical College, Surat, said, “We have installed CR system in ten CSCs. The Surat Medical College is connected with seven villages and we get a daily report of 20 to 25 X-rays per day, which are of good quality. It can be implemented in other medical colleges as well.”

Playing a small video describing the future of radiology, Bhosale also shared details about the projects taken by AGFA in Mumbai, Punjab and West Bengal.

Speaking on how public health is witnessing a transition

from volume-based care to value-based care, Pranav Shah, Business Development, Healthcare IT, said, “When we look at public health at large, we are now finding ways and means to use technology at its best. There are multiple drivers of this change such as necessity of collaborative care and optimising service distribution. In certain departments like the laboratory system and radiology department, there is a need for digitisation to improve efficiency. Technology in the public health sector should have a unified single platform for better outcomes.”

Shah also said, “A single consolidated platform would help bring in clinical efficiency -- be it radiology department, surgical department or a cardiology department. An integrated platform can effectively exchange information within and outside the hospital and a time-saving IT solution would help. Eventually, AGFA is looking at one single patient record to be viewed with one single enterprise imaging solution.”

Giving the government’s view, Sudeep Srivastava, Director, PMSSY said, “Government is already working on an IT integration platform and it would be functional from this year, post which all government hospitals, medical colleges and institutes will share patient data. Subsequently, even the private sector willbe involved. To give a statutory status, NeHA (National eHealth Authority) will be formed. The gist of all this is that in public health there should be convergence and it is already taking place. ”

EMPOWERING PHCs Powered by BIOCON

I

n a session powered by Biocon, select delegates attended a freewheeling discussion on primary healthcare in India. Chaired by Biocon's representative, Rani Desai, Head-Strategy & Operations, the conversation revolved around ways to bring in a reformation in the primary healthcare segment and Biocon Foundation's efforts in this direction.

Desai gave a rundown to the participants about smart digital clinics called eLaj, a Biocon initiative through its CSR wing. She informed that it was the company's endeavour to enhance health access and demonstrate how efficiencies can be brought into this segment. She also informed that they have partnered with the Governments of Rajasthan and Karnataka to set up these clinics. Five PHCs are operational in Rajasthan while three are being operated out of Karnataka.

Then she opened the floor for any queries from the delegates which included prominent names such as Dr Navjot Khosa, Commissioner & MD, Kerala Medical Services Corporation; Dr Prateek Rathi, Special Executive Officer at ESI Scheme, Department of Public Health, Maharashtra, Zahoor Ahmad Wani, Director Finance, Health & Medical Education Department, Government of Jammu & Kashmir, etc.

The delegates posed several questions about the clinics' operational model, the challenges they encountered, strategies to make the initiative sustainable in the run and so on. The delegates also exchanged learnings of operating PHCs in their states and regions. The conversation also moved on to topics such as mobile health clinics and their efficacy, how to reduce errors in PHCs, and making PPPs viable and successful in healthcare.

Thus, it is was a very interesting session with opportunities galore to interact and learn from the each others' experiences.

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HEALTHCARE SABHA 2017 DAY 2 FEBRUARY 10, 2017 POWER BREAKFAST GLENMARK

POWER DISCUSSION AGFA

POWER DISCUSSION BIOCON

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HEALTHCARE SABHA 2017 DAY 3 FEBRUARY 11, 2017 AWARDS

HEALTHCARE SABHA2017

PAYS HOMAGE TO PUBLIC HEALTH CHAMPIONS Celebrates commitment to safeguard India’s health with Express Public Health Awards, in collaboration with Glenmark, Public Health Foundation of India and KPMG.

By Lakshmipriya Nair

E

xpress Public Health Awards, in its second edition, honoured state governments, public sector institutes, government hospitals and NGOs for their exemplary efforts to achieve UN’s Sustainable Development Goals (SDG) related to health.

Held concurrently with Healthcare Sabha 2017, at Novotel Visakhapatnam, it began with a welcome address by Viveka Roychowdhury, Editor, Express Healthcare. She explained that the awards were a tribute to public health champions for their commitment towards people’s welfare and good health in the face of diverse challenges like budgetary constraints, resource restraints and exacting timelines. She expressed her thanks to Glenmark, the Presenting Partner; Public Health Foundation of India, the Knowledge Partner and KPMG, the Process Partner.

She also introduced the eminent jury comprising Dr Srinath Reddy, Founder and President, PHFI and Chairperson of the Jury; Dr RK Srivastava, Sr Advisor, Public Health and Innovation, WISH Foundation, Delhi; and Bejon Misra, Founder, PSM India; Dr Sheetal Amte-Karajgi, CEO, Maharogi Sewa Samiti, Warora; Prof Yogesh Chawla, Immediate Past Director, PGIMER, Chandigarh; Prof Dr Bhabatosh Biswas, Vice Chancellor, Health University, West Bengal and Dr M Prakasamma, Executive Director, ANSWERS, Hyderabad. She also expressed her gratitude to all the jurists for their invaluable contribution in choosing the deserving winners.

In a Skype address, Dr Reddy stated that PHFI is very glad to partner with Express Healthcare in celebrating the game changers in India’s public health sector.

Rajendra Pratap Gupta, Advisor, MoH&FW, Government of India, in a Special Address, gave a rundown on the existing public health system of India and spoke on various endeavours by the government to enhance health and well-being of its citizens. He also gave several recommendations to augment the current framework such as making pharmacists and

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nurses the cornerstones of the public health system and integrating AYUSH with mainstream medical practice by making it more evidence-based. He also

lauded Express Healthcare for creating a platform like Healthcare Sabha to bring all policymakers under one roof.

Roychowdhury took the stage again to explain the methodology and the selection process of the winners, followed by the felicitation ceremony.

The winners were as follows: ✦ Express Public Health Award for Most Efficiently Run Health Programme by a State Government: Government of Madhya Pradesh won this award for their comprehensive TB programme run by the Directorate of Health Services. The programme’s objectives included improving notification and success rates for drug resistant TB, morbidity and mortality of HIV associated TB as well as outcomes of TB care in the private sector. ✦ Express Public Health Award for Most Efficiently Run Health Programme by a Government Institution: It went to National Institute of Mental Health and Neuro Sciences (NIMHANS) for their hub-and-spoke model across the country comprising community health professionals, NGOs, GPs, non-specialists and lay counsellors to provide quality services. ✦ Express Public Health Award for Innovation in Increasing Affordable Access by a State Government: The winner in this category was Government of Andhra Pradesh for their initiative to provide free drugs to all patients visiting government institutions in 13 districts and 17286 villages, in a transparent way, through online indenting, monitoring, consumption and auditing with E Aushadhi, a software developed by CDAC. ✦ Express Public Health Award for Most Effective Health Technology System by a State Government: Government of Himachal Pradesh bagged this award for their Himachal Pradesh Tele Health Services (HPTHS), a project run by SPO (e-health), Directorate of Health Services. It was given to laud the efforts of the state government, given the difficulties in providing telehealth services at high altitude regions and making specialist healthcare services including 24×7

MOST EFFICIENTLY RUN HEALTH PROGRAMME BY A STATE

MOST EFFICIENTLY RUN HEALTH PROGRAMME

BY A GOVERNMENT INSTITUTION

INNOVATION IN INCREASING AFFORDABLE ACCESS BY A STATE GOVERNMENT

GOVERNMENT OF MADHYA PRADESH

NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES (NIMHANS)

GOVERNMENT OFANDHRA PRADESH

MOST EFFECTIVE HEALTH TECHNOLOGY SYSTEM BY A STATE GOVERNMENT

MOST EFFECTIVE PUBLIC PRIVATE PARTNERSHIP

MOST EFFECTIVE HEALTHCARE NGO

GOVERNMENT OF HIMACHAL PRADESH

THE GOVERNMENT OF ANDHRA PRADESH

RURAL HEALTH CARE FOUNDATION, KOLKATA

BEST GOVERNMENT HOSPITAL WITH A MEDICAL COLLEGE

SPECIAL MENTION: BEST HOSPITAL WITH A MEDICAL COLLEGE

SPECIAL MENTION: BEST DISTRICT GOVERNMENT HOSPITAL

INDIRA GANDHI MEDICAL COLLEGE & HOSPITAL, SHIMLA, HIMACHAL PRADESH

SHREE KRISHNA HOSPITAL, HM PATEL CENTRE FOR MEDICAL CARE & EDUCATION

MAHARAJA DISTRICT HOSPITAL, VIZIANAGARAM, ANDHRA PRADESH

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HEALTHCARE SABHA 2017 DAY 3 FEBRUARY 11, 2017 emergency services available even in remote locations covered by the project: Kaza and Keylong in the districts of Lahaul and Spiti. ✦ Express Public Health Award for Most Effective Public Private Partnership: The Government of Andhra Pradesh received this award for their diagnostics project, NTR Vaidya Pariksha, which helped reduce out of pocket expenditure (OOPE) from 54 per cent to 17 per cent in one year, while allowing 46.5 lakh patients in one year to avail free diagnostic services. ✦ Express Public Health Award for Most Effective Healthcare NGO: Rural Health Care Foundation, Kolkata was the winner in this category for innovation in service delivery. Their work in primary health centres of seven districts of West Bengal was found to be scalable, sustainable and replicable. ✦ Express Public Health Award for Best Government Hospital with a Medical College: Indira Gandhi Medical College & Hospital, Shimla, Himachal Pradesh received the award in this category. The hospital provides treatment free of cost or at nominal subsidised rates and has been able to attract people from all over the state including distant tribal areas of Himachal Pradesh.

Four Special Mentions were also part of Express Public Health Awards. They comprised: ✦ Regional Institute of Medical Sciences

Winners and jurists of Express Public Health Awards

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Express Public Health Awards honoured state governments,public sector institutes,government hospitals and NGOs for their exemplary efforts to achieve UN’s Sustainable Development Goals (SDG) related to health.It was a tribute for their commitment towards people’s welfare and good health in the face of diverse challenges like budgetary constraints, resource restraints and exacting timelines Rehabilitation Hospital, Imphal, Manipur received a Special Mention as the Best Government Hospital (Non Metro Region) for rendering services in remote areas.

Ziqitza Healthcare Limited (ZHL) received a

Special Mention under the Most Effective PPP in Healthcare Infrastructure category for their ‘1298’ ambulance project and PPPs with various state governments to provide Emergency Medical Services (EMS).

Shree Krishna Hospital, HM Patel Centre for Medical Care & Education deserved a Special Mention as Best Hospital with a Medical College for their unique, physician-led governance structure standing on four pillars of quality; namely humane care, efficient care, rational care and affordable care.

Maharaja District Hospital, Vizianagaram, Andhra Pradesh, received a Special Mention as the Best District Government Hospital for innovative initiatives like the 24×7 emergency management for all referred cases, minimising further referrals to tertiary care hospitals and having a separate place for biomedical wastage with segregation rooms.

Rajendra Pratap Gupta; Jury members, Dr Prakasamma, Dr Srivastava and Bejon Misra; AG Prasad, Divisional Head, Institutional Sales & Marketing at Glenmark Pharmaceuticals and Viveka Roychowdhury gave away the awards to the winners.

The event ended with a vote of thanks to all the jury members, dignitaries and delegates for being a part of Healthcare Sabha 2017 and the Express Public Health Awards. lakshmipriya.nair@expressindia.com

KNOWLEDGE INSIGHT

Are blood transfusions safe?

The latest National Aids Control Organisation (NACO) report reveals a 10 per cent rise in the number of HIV cases through blood tranfusion in the past one year in India. Highlighting the risks associated with unsafe blood transfusions, Sumit Bagaria, CEO, Hemogenomics opines that the solution is ID-NAT (Individual Donor – Nucleic Acid Testing), an international standard blood screening test

W

e are aware that blood transfusions are required for surgery, trauma and loss of blood (accidents or other causes), some types of cancer, thalassemia etc. Most of us also believe that that blood obtained through a blood bank is 100 per cent safe and can be transfused to our near and dear ones. It is therefore a serious cause for concern that there is a rise of infections like HIV, Hepatitis B&C etc. being transfused through blood. The latest National Aids Control Organisation (NACO)released report in response to an RTI request reveal that 14,474 cases of HIV has been caused due to unsafe blood transfusion alone in India over the last seven years. Not just this, but observations from the report also reveals that there has been a 10 per cent rise in the number of HIV cases through blood transfusion over the last one year from 1,424 in 2014-15 to 1,559 in 2015-16. This shocking data brings to light the bitter truth that screened and tested blood available in blood banks might not be safe after all.

These are the number of cases which have been self reported by patients at NACO’s Integrated Counselling and Testing Centres (ICTC) spread across the country.

There are many cases which don’t even come to light and go unreported. Apart from HIV, other dreadful diseases such as Hepatitis B&C, malaria, dengue and syphilis can also pass through blood from an infected donor to a recipient.

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This increase in the reporting of the spread of infections through blood transfusions is an alarming situation.

Blood donation, no doubt is a noble act that should be encouraged. But, blood banks which collect blood from donors should be properly equipped to test each unit of donated blood and ensure that only safe blood is transfused to a patient. There are close to 2750 registered blood banks in India, which follow different screening techniques. The National Blood Policy says that every unit of blood that is donated at a blood bank should be thoroughly checked and tested to ensure that the blood does not contain any viruses or other infection. The last two decades have had significant up gradation of blood banks in India including licensing based on strict guidelines, screening/ testing of all collected units, quality systems etc.

Despite the testing and screening done at blood banks, every other day there are cases of people getting infected with HIV, HBV or HCV due to blood transfusion. This is mainly due to the testing method called ELISA (Serology) used in most blood banks that has some limitation to detect very early stages of infection in a donated blood unit.

So, if a person who is in an early stage infection of HIV or Hepatitis donates blood, there is a higher risk of ELISA test failing to detect the infection in that blood unit due to very low concentration of viruses or antibodies present in the blood unit. However, when

14,474

cases of HIV has been caused due to unsafe blood transfusion alone in India over the last seven years

10%

rise in the number of HIV cases through blood transfusion over the last one year from 1,424 in 2014-15 to 1,559 in 2015-16 (NACO) released report

that blood unit is transfused to a recipient, the viruses multiply in the recipient’s body thus infecting the person.

Blood is required by patients during emergencies and various health conditions.

While conditions like sickle cell anaemia and dengue require blood transfusions occasionally, Thalassemics and patients suffering from cancers like acute myeloid leukaemia and lymphoma require blood frequently. Emergency situations like surgeries and accidents require blood during times of blood loss. While there must be consistent effort in ensuring an adequate supply of blood units, making sure that patients get safe blood must be the top priority. There should be a multifaceted strategy to tackle this issue. Encouraging and motivating regular repeat voluntary blood donations, better screening and counselling methods at blood banks, haemovigilance etc. are some of the measures which can be implemented in order reduce the number of transfusion transmitted infections. With the rise of digitisation, technology as well can be incorporated to tackle this issue. What mobile phones did to our telecom sector, technology can do for safer transfusion.

App based systems focusing on demand and supply, geographic proximity of donor and blood bank, AADHAR-based tagging of donors etc. on one side to increase regular repeat voluntary donors, combined with the latest advances in screening and inactivation for viruses and other pathogens on the other, can almost end the

SUMIT BAGARIA CEO, Hemogenomics

chances of an infected sample being transfused.

One of the latest and most effective medical techniques used globally is the ID-NAT method of screening blood.IDNAT (Individual Donor – Nucleic Acid Testing) is an international standard blood screening test where scientific evidence has shown that it has caught many cases of HIV and Hepatitis B&C infections that were not detected by conventional Elisa tests. It is a method of testing blood that is more accurate and detects early stage thereby decreasing the possibility of transmission of infection via transfusion.

Ravi Reddy, who heads the South African National Blood Services (SANBS) and is the current President of International Society of Blood Transfusion (ISBT) states that IDNAT is the best screening technique that can be adopted to curb the spread of infections through blood transfusions. He has time and again emphasised that through implementation of ID NAT, South Africa was able to eradicate the spread of infections through blood transfusions.

His thoughts have been echoed by Dr TR Raina, Secretary General of the governing body of Indian Society for Blood Transfusion and Immunohaematology (ISBTI) who says that ID-NAT is the best technique to ensure blood safety in India.

This test which is mandatory in many countries continues to be an optional test in India. Most countries with known prevalence of HIV or hepatitis

KNOWLEDGE or TTIs now test each unit of blood individually for NAT. New Zealand, Australia, Egypt, Israel, South Africa, France, Denmark, Greece, Italy, and many countries do ID_NAT to keep their blood supply safe.

Almost all of Asia which has high rates of hepatitis B including Japan, South Korea, Thailand, Singapore, Hong Kong, UAE, Saudi Arabia, Indonesia, Malaysia have moved from pooled NAT to ID-NAT. even low prevalence countries use ID-NAT for Zika and in season for West Nile Virus.

Several progressive hospitals and blood banks in India also ensure that their blood supply is safer by screening

with ID-NAT technology.

These include AIIMS, Apollo, Fortis Hospitals including Escorts and FMRI, Medanta, Gangaram, RML, AFTC, Artemis, Jaypee, etc. in New Delhi/NCR; PGI Chandigarh; CMC Vellore; Hinduja, KDAH, HN etc. in Mumbai; SIMS and Global in Chennai; Amrita and Aster in Kochi; CMC and DMCH in Ludhiana, International and Marwari Hospital in Assam and many more. Also, Karnataka Government is the only state government in India which has made ID-NAT mandatory in all government hospitals and blood banks. Recently, Indian Medical Association (IMA) has urged all hospi-

tals in Kochi to adopt this technology to curb the spread of infections through blood. Also, Governor of Andhra Pradesh and Telangana States, ESL Narasimhan has suggested the new state body to introduce Nucleic Acid Testing (NAT) of blood donors for screening of HCV and HIV. Some other sites are pooling six samples, which while providing some cost benefits, may pick up some infections in the serological window period but may also miss some TTIs as experienced in Japan, Thailand, etc. Recent publications show, for example that Thailand is detecting over five times as many Hepatitis B infections

Apart from HIV,other dreadful diseases such as Hepatitis B&C, malaria,dengue and syphilis can also pass through blood from an infected donor to a recipient after moving to ID-NAT. Even after adopting various precautionary methods and latest screening practices, there still remain a few challenges. Shortage of blood arising due to lack of voluntary blood donation, lack of a centralised national blood transfusion body, policies, appropriate infrastructure, trained person-

nel, financial resources to support the running of a voluntary non-remunerated donor transfusion service, and old & emerging threats of transfusion-transmitted infection are a few challenges that come in the way of safe blood transfusion in India which have to addressed and looked into by the government.

360 degree approach to ‘stitchless -drainless’surgeries Dr Swapnil Zambre, HOD-Orthopaedics, Fortis Hospital Kalyan, talks about how stitchlessdrainless procedures are the future of orthopaedic surgeries A MAJORITY of joint replacements are currently being done using older techniques, requiring skin sutures and plastic tube (drain) in the knee after surgery, to drain the blood that accumulates after surgery. This has been shown to significantly slow down the patient’s recovery and affects joint motion in the long term.

The stitchless-drainless procedure is beneficial to patients which allows them rapid mobilisation of their operated joints immediately after surgery. There are no drains that need to be pulled out after 24 hours, neither are there any stitches to come out later, thus avoiding pain and apprehension associated with these procedures.

Patients are therefore able to walk on day one and climb stairs between day three and five, post-surgery. Apart from the avoided pain from removal of stitches, patients have reported better cosmetic scars and joint motion.

The technique has been combined with Cruciate Retaining Knee Implants in TKR

(Total Knee Replacement) thereby allowing a large number of patients to start sitting cross-legged at six weeks post-surgery, which is considered unachievable not so long ago. Patients who have had this procedure done are now happy and guiding others to get this procedure for comfort and safety.

The stitchless procedure not only serves as a cosmetic purpose but adds strength and protection to the incision.

The technique increases the strength of closure by more than 1.5 times that of a simple suture or clips. It adds a watertight seal to the incision immediately post-surgery thus creating an antimicrobial barrier preventing Surgical Site Infection(SSIs) of all types. This is important, since the advent of advanced aseptic techniques and laminar flow theatres vast majority of joint infections are due to bacteria that are native to the patient’s skin. So stitchless procedures are a step further in direction of eradicating infection from arthroplasties.

The technique uses plasticizers and initiators. Plasticizers increase flexibility and three dimensional strength for secure wound closure and patient comfort while initiator enables consistent setting time across various skin types and conditions. It also inhibits Gram Positive Bacteria (MRSA & MRSE) and Gram Negative Bacteria (E. Coli).

The technique is now used for total knee arthroplasty, minimally invasive TKR, total

hip arthoplasty, partial knee replacements and total and partial shoulder replacements. There are plans to rollout the procedure to a vast majority, if not all of elective orthopaedic procedures.

This will allow patients to also shower while bathing within few days of post-surgery and there is no need to take sutures or clips out.

The team of in-house physiotherapists at Fortis Hospital, Kalyan, have also noticed significant differ-

ences in recovery. Earlier, bending the operated knee, sitting at the edge of bed/chair, standing and walking were all very painful and terrifying for recovering patients at physiotherapy. The staples used for closing skin, caused pulling sensation on the incision, restricted joint mobility and generated tremendous pain. Sometimes there were chances of drains coming out, making patients more apprehensive and reluctant to undergo physiotherapy sessions which are vital after knee replacement surgery. Patients typically need a walker for a month or more and are unable to return to normal activities for a significant period of time.

The very first question the patients ask on post-op day one is “When will I be able to walk?” Nowadays, the answer is today. Patients are more cooperative due to less pain.

Their confidence level is boosted when they find themselves bending knees, maximally walking and climbing staircase with almost no pain within few days after surgery.

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KNOWLEDGE

INSIGHT

Inheritance patterns Dr V L Ramprasad, COO, MedGenome, gives an insight on ways to improve global health by decoding the information contained in an individual’s genome A FAMILY’S health history if recorded correctly through the years helps to understand how traits are passed on to their future generations. This set the pace for understanding the way familial characteristics are passed on from one generation to another is based on the patterns of inheritance discovered by an Austrian scientist and monk, Gregor Mendel. He is known as the father of modern genetics researched and discovered the essential patterns of inheritance during conducting experiments in the garden of the monastery he lived in. Mendel's studies of inheritance patterns in pea plants are a solid foundation for our current understanding of single-gene diseases in humans. Inheritance patterns describe how a disease is transmitted in families.

Through his research, Mendel inferred that human genes are present in pairs, one of each pair inherited from each parent. Some genes undergo changes which don’t impact their functioning but the changes known as mutations do influence the functioning of

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DR V L RAMPRASAD COO, MedGenome

does not apply to all cases.

Autosomal dominant (mutation) If a person has one copy of dominant mutation in each cell, the person gets affected by the disorder. At times, a person inherits mutant gene from her/his parent who is affected, e.g. Huntington's disease (a progressive neuro-degenerative disorder) caused by mutant huntingtin gene (HTT), then the person who inherits that mutant gene will develop the same disease. In this case, the presence of a single non-mutant or "wild-type" copy of the gene is not enough to prevent the disease. Individuals can inherit the mutant copy of the disease-associated gene from either an affected mother or an affected father.

This type of inherited disease occurs in every generation of a family but can also develop in individuals who have no family history of the same.

Autosomal recessive (mutation) the genes and may lead to disease. Such diseases are also called as Mendelian or monogenic diseases and they sometimes run in families. In the case of some families, members whose genes may experience a similar mutation don’t necessarily have to experience the same symptoms (recessive). However, in the case of some other families, members whose genes experience dissimilar mutations may inherit the same traits/disease (dominant). Pedigree analyses of large families with many affected individuals can be used to determine whether a disease-associated gene is located on an autosome or on a sex chromosome, and whether the related disease phenotype is dominant or recessive.

Different patterns of inheritance Diseases caused by mutations in a single gene are usually inherited through a simple process. This is dependent on the gene’s location and the understanding of whether one or two normal copies of the gene are necessary. Though majority of the single gene disorders are uncommon, they affect millions of people in the US. If a disease is caused by a mutated gene located on the X chromosome, it could be inherited in a dominant or a recessive manner. Single-gene disorders can be inherited via numerous methods like autosomal dominant, autosomal recessive, X-linked dominant and X-linked recessive though this

In the case of recessive genetic diseases, not every generation of a family gets affected. Because, autosomal recessive single-gene diseases occur only in individuals with two mutant alleles of the disease-associated gene. Remember, for any given gene, a person inherits one allele from his or her mother and one allele from his or her father.

Therefore, individuals with an autosomal recessive singlegene disease inherit one mutant allele of the disease-associated gene from each of their parents.

If both the parents have this type of a mutated gene, their children will definitely inherit the same. Thus, In pedigrees of families with multiple affected generations, autosomal recessive single-gene diseases often show a clear pattern in which the disease 'skips' one or more generations.

Example,

Phenylketonuria (PKU) associated with mutations in the gene that encodes the enzyme phenylalanine hydroxylase (PAH). Several other human diseases, including cystic fibrosis, sickle-cell anemia, and oculocutaneous albinism, also exhibit an autosomal recessive inheritance pattern.

X chromosome-linked recessive: Females carry two X chromosomes while males carry one X and one Y chromosome. This results in women carrying two copies of each X-linked gene but none of the Y-linked genes.

Men carry only one copy each of X-linked and Y-linked genes Therefore, females with an X chromosome-linked recessive disease inherit one copy of the mutant gene from an affected father and the second copy of the mutant gene from their mother, who is most often a carrier (heterozygous, having one copy of non-mutant allele) but who might be affected (homozygous, having two copies mutant allele). Males, on the other hand, have only one copy of the X chromosome, which they always receive from their mother. Therefore, males with an X chromosome-linked disease always receive the mutant copy of the gene from their mother. Moreover, because men don't have a second copy of the X chromosome to potentially "cancel out" the negative effects of X-linked mutations, they are far more likely than women to be affected by X chromosome-linked recessive diseases. Hence, single-gene diseases that involve genes found on these sex chromosomes have somewhat different inheritance patterns than those that involve genes found on a person's autosomes (nonsex chromosomes, chromosome 1 to 22). The blood-clotting disorder hemophilia A is one of several single-gene dis-

KNOWLEDGE

eases that exhibit an X chromosome-linked recessive pattern of inheritance, in which males having mutant copy of the factor VIII gene (F8) will always have haemophilia.

X chromosome-linked dominant: Families with an X chromosome-linked dominant disorder affect both males and females in every generation. In the case of X-linked inheritance, fathers pass the X chromosome to their daughters and Y chromosomes to their sons but mothers pass X-linked genes to both, their sons and daughters.

Thus, females with an X chromosome-linked dominant disease can inherit the mutant

gene from either an affected mother or an affected father, whereas males always inherit such diseases from an affected mother. Very few X chromosome-linked dominant diseases exist. For example dominant mutations in the phosphateregulating endopeptidase gene (PHEX), which resides on the X chromosome, are associated with X-linked dominant hypophosphatemic rickets.

Mitochondrial inheritance: The mitochondrion is an organelle that has its own DNA, often called as mitochondrial DNA (mtDNA). Mitochondria play essential roles in energy

Families with an Xchromosome-linked dominant disorder affect both males and females in every generation production and in various cellular processes such as metabolism and signal transduction. In humans, and most animals, although the sperm-derived pa-

ternal mitochondria enter the oocyte cytoplasm after fertilisation, their mtDNA is never transmitted to the offspring.

Thus, this pattern of mtDNA inheritance is well known as 'maternal inheritance.'

Why are some genetic conditions more common in particular ethnic groups?

People living in geographical territories inhabited by their forefathers are prone to develop genetic orders carried by their ancestors. If any of the genes passed on includes a mutation that causes disease, a distinct genetic disorder will be visible in such individuals. Sachs disease and sickle cell anemia are widespread amongst the ethnic

groups of Africa, European and the Mediterranean regions.

References https://www.ncbi.nlm.nih.gov/b ooks/NBK115561 https://ghr.nlm.nih.gov/primer/i nheritance/inheritancepatterns http://www.enotes.com/homework-help/what-role-dna-storage-expression-transmission702571 http://www.preservearticles.co m/2012032728968/what-is-theimportance-of-human-genomeproject.html https://ghr.nlm.nih.gov/primer/h gp/description http://www2.le.ac.uk/departments/genetics/vgec/schoolscolleges/topics/inheritancepatterns

I N T E R V I E W

Attrition rates are very high in PPP models In a conversation with Raelene Kambli, Sabu Jose, GM - Government, OEM & Corporate Accounts - India Cluster, Carestream Health, explains the challenges related to effective management of PPPs in healthcare How are public private partnerships designed in healthcare?

PPPs in healthcare are mostly designed in a way where the government’s role is such that it is involved in developing, financing and providing health infrastructure and services.

Whereas the private sector player provides medical equipment or operates the healthcare facility.

Given the backdrop that PPPs in healthcare don’t seem to be very successful.

What is your view on the same?

When we thought of PPPs last year, we realised that many companies are withdrawing from these models of partnership with the government.

States such as Gujarat, Madhya Pradesh are some states that withdrew from this model.

And that is when we decided to go very slow in terms of partnering with the government.

We also identified the reason

behind the failure of such models. It is not just the money involved but it is about the operations and especially managing the manpower deployed on such projects.

Do you think it is a lack of competency that is causing this problem?

It is not only about competencies. They find it very difficult to retain people. One of my associate shared his experience working in a PPP and said that his team found extremely difficult to find people who would work dedicated in these project. The attrition rates are very high in such models. Moreover, most of these PPPs are done with equipment players and these players are not good with talent enrollment and do not have those strategies to retain people.

So, what approach would you take in this regard?

In my view, we need to split

the component wherein the labour management should be dealt by the government.

But do you think that the government is equipped to hire and manage specialised technicians especially the ones who operate high-end radiology imaging system?

When a technician is hired by the government there is more responsibility involved.

Employees understand that they cannot just quit and that they are been monitored as well. When hired by a private player they do not show that commitment.

We have partnered with Kerala, Telangana, Maharashtra and Gujarat

Apart from this, what is your opinion on rising import duty for medical equipment?

Last year, the government introduced eight per cent tax on import duty and at the sametime they asked us to cut down on our price. If taxes are high, how will we be able to cut down on cost.

Which are the states that you have partnered so far?

We have partnered with Kerala, Telangana, Maharashtra and Gujarat.

And which state according to you offers a better business environment?

Telangana offers a better business environment. Apart from this, Kerala also offers a good business environment for us.

What is different in these states?

These states are different in their style of working as they always adapt what is new.

Do you think there should a governing body that will look after PPPs and liaison between the government and the private sector?

There are bodies such as HLL who are doing well but yes there should some sort of understanding between the two parties to make PPPs work. raelene.kambli@expressindia.com

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STRATEGY INSIGHT

From idea to reality: The funding landscape for healthcare innovations in India

DR SUCHITA MARKAN Asst GM, BCIL

DR YOGMAYA VERMA Technology Management Professional

Dr Suchita Markan,Asst GM, BCIL and Dr Yogmaya Verma,Technology Management Professional, in this article talk about how funding opportunities made available to healthcare enterprises promotes innovation-based technological inventions leading to development of new products, processes, infrastructure development, capacity building leading to economic growth and sustainability IT IS true that nothing is more powerful than an Idea whose time has come. But it is equally true that in today’s technologydriven world, the idea needs, inter alia, a lot of funds, so that it takes the shape of a socially useful innovative product.

Innovation is a key driver of sustainable and equitable economic growth for any country.

When it comes to healthcare sector, adequate funds are indispensible for progressing on the path of innovation. Funding opportunities made available to healthcare enterprises promotes innovation-based technological inventions leading to development of new products, processes, infrastructure development, capacity building leading to economic growth and sustainability. Today, India offers plethora of funding opportunities from government and private players for all the stages of technology development and commercialisation.

Whether it is a scientist conceptualising an invention with commercial potential or an industry developing a drug or vaccine which needs validation and scale-up, India offers ample funding opportunities to help them accelerate their inventions to the next level. The funding can be availed by students, researchers, entrepreneurs, start-ups and estab-

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lished companies alike.

To bridge the gap between academia and industry and to promote translational research, funding platforms are also being provided in publicprivate partnerships. By virtue of such partnerships, academia brings in rich experience and expertise of basic research and industry brings in its relevant expertise of technology validation, scale-up and marketing thus leading to accelerated technology development and commercialisation. This has led to development of numerous commercially viable technologies with societal relevance. International funding agencies such as Bill and Melinda Gates Foundation, Wellcome Trust, WHO, CEFIPRA, Indo-US Science and Technology Forum have also joined hands with the Indian government to fund high risk, globally relevant translational research in India.

Government of India is working actively to create an

enabling environment for healthcare enterprises and to attract foreign investments including simplifying regulations, infrastructure development and providing a stable and more predictable environment to enable industry to build sustainable and profitable manufacturing ventures.

This is encouraging private investors and venture capitalists to fund innovation-driven healthcare ventures.

Multinational organisations are in the league of Indian start-up supporters. SoftBank, a Japanese bank has invested $2 billion into Indian startups.

The Japanese firm had pledged the total investments at $10 billion. Google has also declared to launch a startup, based on the highest votes in which the top three startups will be allowed to join the next Google Launchpad Week, and the final winner could win an amount of $100,000 in Google cloud credits.

At this unique juncture of a very favourable pro-innovation environment, various funding initiatives by the government, international bodies and private entities can be utilised by academia and industry alike at various stages of technology development and commercialisation including ideation stage, validating proof-of-concept, technology validation, scale-up and commercialisation. In today’s global economy, as intellectual property (IP) is the key asset which provides exclusive commercialisation rights to the innovators/innovating enterprise, the funding opportunities which support IP protection and maintenance are also available. Utilisation of these funding opportunities will enable the current and future entrepreneurs and healthcare enterprises to grow, sustain and derive benefits as well as contribute to the economic development of the country.

Funding schemes for supporting innovative ideation and early stage R&D There are multitude of early stage seed grants offered by the Government of India for fostering innovative ideas by individuals, start-ups and small enterprises. These are aimed at promoting entrepreneurship in the young innovators who have an exciting idea but need funding support to validate their idea till proof-of concept stage. One of such scheme which is successfully being implemented by BIRAC, a Government of India enterprise is Biotech Ignition Grant (BIG). BIG offers itself as a unique grant-in-aid opportunity being provided by the government wherein an individual scientist or entrepreneur with no formal engagement with a company can also avail this funding and validate ones innovation. More than 100 projects have been supported through BIG scheme. Another

TABLE 1 FUNDING OPPORTUNITIES FOR INNOVATIVE IDEAS FOR PROOF OF CONCEPT Name of the Scheme

Eligible entity

Grant-in-aid/ Loan/others

Cap on Funding (in INR)

BIG

Individual, entrepreneurs, start-ups, incubates

Grants only

50 Lakhs

TePP

Individual, entrepreneurs, start- ups, incubates

Grants only

45 Lakhs (Varies for Each Phase)

GYTI-SHRISTI

Students, Grassroot innovators

Award

15 Lakhs

IIPME

Indian start-ups , entrepreneurs, Innovators

Grants and Loan

1 Crore (max)

PRISM

Innovators from various sectors

Grants only

Upto 50 Lakhs

STRATEGY

such scheme is BIRAC-SRISHTI Gandhian technology Innovation for supporting grass-root innovations budding at institutional level.

About 100 nascent ideas across the country are supported annually through this funding scheme. Table 1 summarises the key funding opportunities supporting innovative early stage technologies.

Funding opportunities for technology advancement, validation, scale-up and commercialisation Several funding schemes are focussed on funding advanced stage technologies.

These schemes are aimed at fostering innovations which have proof-of-concept but need further development, valida-

TABLE 2A

tion and regulatory approvals before these are ready for entering the market. SBIRI and BIPP are such schemes which extend funding support to high risk innovative research by industry and is provided to grantees in a public-private partnership (PPP) mode. Support is extended in the form of grant-in-aid, equity or soft loans, which varies with the type of funding scheme. Funding support by such schemes accelerates technology development and its validation.

Contract research Scheme (CRS) of BIRAC is also a PPP scheme for facilitating technology validation and translation by academia through industry partner. Table-2a and 2b summarise funding schemes by various government depart-

ments and agencies to foster technology development and commercialisation. Indian companies or partnership firms with majority stakes and functional R&D laboratory or incubated in an incubator/ biotech park with DSIR recognition and scientists/academicians are generally eligible for availing such grants. The Technology Development Board (TDB) is another organisation within the government framework with the sole objective of translating the fruits of indigenous research into commercial products or services. TDB provides assistance in the form of soft loan and/or equity fund under its Seed Support System Scheme.

International organisations such as BMGF, Wellcome

Funding opportunities for intellectual property protection

Trust, Indo-US S&T forum, CEFIPRA etc. also provide funding support to healthcare innovations. Most international schemes have priority areas for providing funding support and are aimed towards commercialisation of technologies for societal impact. Funding opportunities are also provided through collaboration and fund allocation

by Indian and foreign governments for promotion of joint activities that lead to innovation and techno-entrepreneurship through application of science and technology eg.

Indo-US Science and technology endowment fund financially supports promising joint US-India entrepreneurial initiatives through grant programme.

Due to lack of support mechanisms for patent protection, a large portion of innovations emanating from the Indian public institutes, in particular, from SMEs, have not made their way to the marketplace.

To step-up efforts and engage with India’s thriving biotech entrepreneurial ecosystem, several funding schemes are aimed to provide assistance for protection of IP for innovative technologies. IP protection and maintenance of innovative technologies is also supported as inherent component of the funding schemes supporting translational research as covered in Table 2. Table 3 summarises funding opportunities

FUNDING OPPORTUNITIES FOR TECHNOLOGY SCALE-UP/ VALIDATION / DE-RISKING FUNDS (NATIONAL)

Name of the Scheme

Eligible entity

Grant-in-aid/Loan /others

Cap on Funding (in INR)

SPARSH (BIRAC)

Biotechnology Indian start-ups, LLPs, Indian Innovators

Grant-in-aid

Up to Rs. 50 lakhs for a period up to 18 months

SBIRI(BIRAC)

Industry or Jointly by Industry and National R&D Organizations and Institutions: or Collaborative projects of common interest to the concerned sector/area proposed by a group of industries/users, national research organizations etc

Grant in aid as well as soft loans

50-80% of Project cost based on actual cost of projects. Rs. 50 lakhs as grant and eligible for interest free loan upto 50% of the amount for projects beyond Rs. 100 lakhs.

BIPP (BIRAC)

A single or consortia of Indian companies - Small, Medium or Large having DSIR recognized in-house R&D unit(s).

Grant-in-aid

50% of project cost

CRS (BIRAC)

Academia in partnership with DSIR recognized Company for validation of the technology

Grant in Aid

Up to100% of project cost

TDB Funding

Indian Companies alone or in collaboration with foreign companies

Soft loans (preferable model) Grant-in-Aid (in exceptional cases)

(up to 50% of project cost @5% simple interest per annum), equity participation (up to a maximum of 25% of the project cost)

TABLE 2B

FUNDING OPPORTUNITIES FOR TECHNOLOGY SCALE-UP/ VALIDATION / DE-RISKING FUNDS (INTERNATIONAL)

Name of the Scheme

Eligible entity

BMGF (Bill & Melinda Gates Foundation) IKP Students, Researchers, Faculty, Grand Challenges Exploration and SMEs, Non-profit organizations BIRAC Grand Challenges India

Grant-in-aid/ Soft Loan/others

Cap on Funding (in INR)

Priority areas

Grant in aid

INR 50 Lakh, INR 10 Lakh on successful completion , Opportunity for Phase II funding of up to USD 1 Million

Funding for theme areas only- Theme for 2017 is new medical devices, drug delivery systems, diagnostics and technology-enabled service models for health

A maximum of INR 150 lakhs per project

For joint R&D, scientist exchange programmes – for specific technology sectors

Grants size up to Rs. 2.50 crores

Medical devices and diagnostics, preventive health, ICT,Water, Agriculture, Education and Financial Inclusion

30 lakhs to one crore

Education,Water and Sanitation, Health,Agricultural sectors, Food security, Clean energy/climate change

Upto about Two Crores

Off-grid, clean energy technologies

GITA (Global Innovation and Technology Alliance Fund )-DST-CII-TDB

Indian and Canadian or UK registered Soft loans/grant to the Indian company Project Lead in partnership Applicant

USISTEF (United States–India Science & Technology Endowment Fund )

Bi national teams including Individuals/incorporated and nonincorporated companies

USAID-FICCI-TDB Millennium Alliance

Indian and French registered companies in partnership

PACE Fund (IUSSTF )

Rural energy services companies; rural distribution, Grant in Aid operations/maintenance technology implementers system integrators

Grant in aid

Grant in Aid

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STRATEGY TABLE 3.

FUNDING OPPORTUNITIES FOR INTELLECTUAL PROPERTY PROTECTION

Name of the Scheme

Eligible entity

Grant-in-aid/Loan/others

SIPP Start-up Intellectual Property Scheme)

Registered start-ups

Free of cost drafting and filing (official fee to be Not relevant borne by start-ups)

SIP-EIT (Support International Patent Protection in Electronics and IT )

Registered Indian micro, small and medium enterprises; enterprises engaged in manufacture or production of goods

Support will be limited to Rs.15 lakh or 50% of Reimbursement of expenses (on actual) to the total expenses incurred on filing each invention, applicant whichever is less

Patent Assistance Funding Scheme (BIRAC)

Indian public institutes, in particular, from SMEs As per provisions of the specific grant

For BIRAC Grantees

National Patent Protection Scheme (NRDC)

Financial assistance for patenting is given to individuals working in universities, laboratories, Free of cost filing MSMEs for protecting novel inventions.

Financial assistance to scientists and researchers for patent inventions (30 % of revenue share on commercialization of the technology)

Pfizer-IIT Delhi Innovation and IP Program(PIDIIP)

Indian Innovators and stat-up companies

Grant in aid

Upto 50 Lakhs for IP Protection

Grant in aid

Funding on grant of IP (Up to Rs. 25000/Indian patent andRs. 2.00 lakh for foreign patent and Rs. 1.00 lakh for Geographical Indications)

MSME

Registered Indian MSME

which specifically supports IP filing and prosecution. Patent Facilitation Cell of TIFAC (PFC-TIFAC), an enterprise under DST provides financial assistance to scientists and researchers working in universities, R&D institutions and laboratories and also to individuals in scientific and industrial fields for patenting their inventions which are proved to be workable, advantageous, useful and commercially viable. National Innovation Foundation (NIF) also provides financial support for IP to grassroots innovators.

Private/ Venture capital funding opportunities Another source of funding for driving innovations is risk capital. Risk capital is an option where the provider reduces the burden of risk of the entrepreneur and thereby bears some part of the overall risk involved in technology translation. Risk capital is an important instrument for not only start-ups and innovative / fast growing companies but is also critical to those companies looking at growth. Risk capital substitutes promoter’s contribution, thereby reducing the capital to be brought by the entrepreneurs. As per an annual report on Indian venture capital and private equity on startups released by IIT-Madras, only 8.3 per cent of startups are successful in getting funding. The percentage of funded companies globally is about 36 - 52 per

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cent, against the Indian startups which are about 5-11 per cent. For example, the Tata Capital Innovations Fund is a venture capital fund managed

by Tata Capital. The fund invests in the range of $2 million to $10 million in early stage companies offering technologybased solutions for Indian as well as global markets. The Fund’s investment philosophy is to back the right entrepreneurial spirit by identifying investments which have a potential to create new growth opportunities; increase efficiency; bring affordability and accessibility to the industry or change the way business is conducted. The government has also initiated a venture capital fund as public-private partnership to support entrepreneurships through innovative technologies such as the Bharat Innovation Fund, Micro Venture Innovation Fund (MVIF) and India Inclusive Innovation Fund. A list of key venture capital funding opportunities in India is provided in Table 4.

The Bharat Fund, a publicprivate-academia partnership has been set up by the Centre for Innovation Incubation and Entrepreneurship (CIIE) of IIM Ahmedabad. The fund aims to support and provide funding (grants, seed capital, venture capital) and business support to innovation-driven start-ups that solve real problems faced by the masses of India through technology-enabled and rapidly scalable solutions. This fund

primarily focuses on healthcare and life-sciences sustainability and digital technologies.

Micro Venture Innovation Fund (MVIF) is the first and unique micro-venture risk fund in the world, which provides funding to grassroot innovators under a single signature on a simple agreement of understanding, without any collateral or a guarantor. MVIF invests in risk areas with a probability of high failure, investing in those technologies and products for which either market does not exist or may be very limited. Apart from the financial returns, one of the key criteria for selection of a technology for MVIF support is social return or social value created for the benefit of society at large. India Inclusive Innovation Fund focusses on providing risk capital funding to enterprises that create and deliver technologies and solutions aimed at enhancing the quality of life at the bottom of the pyramid; and subject to ap-

Cap on Funding

plicable law work with other funds with objectives similar to its own. The fund supports investment at different stages of the enterprise development cycle – from early stages, through later phases of scaling-up of potentially successful solutions and business models.

Funding from angel investors Many prominent companies, including Google, Yahoo and Alibaba have come with funding support from angel investors.

Though, angel investors generally invest lesser amounts than venture capitalists, this alternative form of investing generally occurs in a company’s early stages of growth, with investors expecting upto 30 per cent equity. They prefer to take more risks in investment for higher returns. Some examples of popular angel investors in India are Indian Angel Network, Mumbai Angels, Hyderabad Angels etc.

Some of these active angel investors have invested in many

successful startups. Table 4 summarises the key VC and angel investors in India.

New funding initiatives A number of new initiatives to support innovation have come up in the past two years as part of the Make in India scheme.

These aim to support innovation and technology scale-up by various inclusive means such as funding, infrastructure support in the form of labs and incubators. These include the NIDHI, AIM, SETU, IMPRINT UAY etc. to name a few.

National Initiative for Developing and Harnessing Innovations (NIDHI) is an umbrella programme conceived and developed by the Innovation & Entrepreneurship division, Department of Science & Technology (DST), Government of India for nurturing ideas and innovations (knowledge-based and technology-driven) into successful startups. The programme would work in line with the national priorities and

STRATEGY TABLE 4.

KEY VENTURE CAPITAS AND ANGEL INVESTORS IN INDIAL

Scheme

Organization

Type of funding

TEX Fund

SIDBI Venture Capital Limited

Equity

India Opportunities Fund

SIDBI Venture Capital Limited

Equity

Setu Ventures

Setu Ventures

Equity

Venture Factory

i2india Ventures

Equity

Infuse Venture Fund

I3E Trust

Equity

Seed funding

Villgro Innovations Foundation

Other

BSE SME Platform

BSE Ltd

Equity

Centre for Innovation Incubation and Centre for Innovation Incubation and Entrepreneurship Entrepreneurship

Other

Support for International Patent Protection in E&IT

Department of Electronics and Information Technology

Other

Omnivore Capital Management Advisors Private Limited

Omnivore Capital Management Advisors Private Limited

Equity

Unitus Seed Fund

Unitus Seed Fund

Equity

TIFAC -SIDBI Revolving Fund for Technology Innovation

TIFAC - SIDBI

Debt

SAMRIDHI Fund

SIDBI Venture Capital Limited

Equity

Small Business Innovation Research Biotechnology Industry Research Assistance Council (BIRAC) Debt Initiative(SBIRI) Phase II Micro Venture Innovation Fund (MVIF)

National Innovation Foundation (NIF)

Debt

Seed Fund

ICICI Knowledge Park (IKP)

Other

Various financing schemes

National Bank for Agriculture and Rural Development

Debt

Omnivore Partners

Omnivore Partners

Equity

Bharat Innovation Fund

Centre for Innovation Incubation and Entrepreneurship

Equity

Amity Innovation Fund

Amity Capital Ventures

Equity

BIRAC-CEFIPRA Partnership

Biotechnology Industry Research Assistance Council (BIRAC) Equity

Global Innovation & Technology Alliance (GITA)

Global Innovation & Technology Alliance (GITA)

Other

NSTEDB Seed Fund

Entrepreneurship Development Center

Equity

TDB Seed Fund

Entrepreneurship Development Center

Equity

Various financing schemes

Department of Science and Technology, Govt. of India

Other

Seed Support System of NSTEDB, DST

IIT Kharagpur

Equity

NSTEDB and other Seed Support Scheme

SIDBI Innovation and Incubation Centre, IIT Kanpur

Other

Seed Support System of NSTEDB, DST

TBI - KIET Ghaziabad

Other

Seed Support System of NSTEDB, DST

KIITTechnology Business Incubator, Bhubaneshwar

Other

Seed Support System

Society for Innovation and Entrepreneurship SINE – IITB

Other

Utthishta Yekum Fund

Utthishta Management Advisors LLP

Equity

Angel Investment Network

Intellecap Impact Investment Network (I3N or I-cube-N)

Equity

VENTUREASTTENET FUND

Ventureast

Equity

goals and its focus would be to build an innovation-driven entrepreneurial ecosystem with an objective of socioeconomic development through wealth and job creation. NIDHI aims to nurture start-ups through scouting, supporting and scaling of innovations. There are eight components of NIDHI

that support each stage of the innovation cycle from idea to market. The first component of NIDHI is PRAYAS (Promotion and Acceleration of Young and Aspiring technology entrepreneurs) with funding support upto `10 lakh and the final components is the seed support system which provides upto one

crore to start-ups through technology business incubators.

Atal Innovation Mission (AIM) is an umbrella scheme which has two sub-components - i) Innovation; and ii) and SETU. The AIM focusses on inviting aspiring entrepreneurs to solve India’s contemporary

socio-economic problems via ‘grand challenges’ that offer substantial awards to incubate and scale up winning ideas.

Self-Employment and Talent Utilisation (SETU) scheme’s resources are devoted to strengthening incubators and setting up ‘tinkering labs’ where ideas can be shaped into prototypes before they are ripe for funding.

Uchhatar Aavishkar Yojana (UAY) is a scheme that would be applicable to the projects proposed by the Indian Institutes of Technologies initially.

The projects should have collaboration between the academia and industry, within or outside India.

trepreneurial culture amongst the students. Few amongst the ‘Job-Seekers’ would be converted to ‘Job-Generators’ through the entrepreneurial route.

The investment climate in India for supporting innovation-driven technologies is very supportive. To make various initiatives of the Government of India such as Make-in-India, Start-up-India, a successful reality, huge investments are being made by the government, international agencies and private partners alike. Department of Industrial Policy & Promotion (DIPP) has initiated a start-up fund of ` 10,000 crores. During 2016-17, DSIR has committed `27 crore, DeiTY `3 crores and BIRAC has earmarked `120 crores for the start-up and innovation industries. DST has also allotted `180 crores to promote innovation and entrepreneurship. BIRAC has identified the areas of Biopharma including vaccines, bio-agriculture, bio-industrial and bio-informatics for building the national biotechnology capabilities and has initiated several new awards to promote innovations such as SITARE (BIRACSRISTI GYTI Awards), BIRAC Hackathons, BIRAC Technology Day Award and BIRAC Innovator Awards.

New Generation Innovation and Entrepreneurship Development Centre (NewGen IEDC) is a programme launched by National Science and Technology Entrepreneurship Development Board (NSTEDB), DST. NewGen IEDC will aim to inculcate the spirit of innovation and entrepreneurship amongst the young S&T students, encourage and support start-up creation through guidance, mentorship and support.

The programme will be implemented in academic institutions. Students will be encouraged to take up innovative projects with possibility of commercialisation. NewGen IEDCs would also spread the message of entrepreneurship and create a culture of entrepreneurship in the Host Institution (HI). With faculty already trained in the nuances of entrepreneurship, the presence of NewGen IEDCs in HI would create a vibrant en-

References 1. Department of Science and technology-www.dst.gov.in 2. Department of Scientific and Industrial Research (DSIR)www.dsir.gov.in 3. Micro, Small and Medium Enterprises (MSME)msme.gov.in 4. NITI Aayog-http://niti.gov.in 5. Indo-US Science and Technology Forum (IUSSTF)www.iusstf.org 6. Biotechnology Industry Research Assistance Councilhttp://birac.nic.in 7. Department of Biotechnology - www.dbtindia.nic.in 8. Technology Development Board (TDB) -http://tdb.gov.in 9. The National Science & Technology Entrepreneurship Development Board (NSTEDB)www.nstedb.com 10. Venture Center- www.venturecenter.co.in 11. Start-up India- www.startupindia.gov.in

Impacting Research Innovation and Technology (IMPRINT) is a first-of-itskind Pan-IIT and IISc joint initiative to develop (a) New education policy, and (b) Roadmap for research to solve major engineering and technology challenges in selected domains needed by the country. The government has identified 10 themes under the IMPRINT scheme to promote innovations and DSIR has been identified to pursue innovations in the areas of manufacturing technology and water resources.

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IT@HEALTHCARE INSIGHT

Digital healthcare: A paradigm shift for the better!

AMIT MOOKIN TiE Mumbai Board Member & General Manager, South Asia Quintiles IMS

Amit Mookin, TiE Mumbai Board Member & General Manager, South Asia Quintiles IMS, elaborates on how companies are able to leverage the power of data to offer 360-degree perspective on health for its clients

I

ndia’s rising population, affluent lifestyles, and fast paced lives have all resulted in an increasing need for healthcare services. In the period from 2008-2020, India is expected to record a CAGR of 16.5 per cent in healthcare sector spends. The total industry size is expected to touch $160 billion by 2017 and $280 billion by 2020. That is too big an opportunity to ignore.

It is no surprise then that a lot of healthcare tech start-ups have been founded in India in the last few years. These startups have leveraged the power of technology and the ubiquity of the mobile devices to disrupt existing models and reach customers on-demand.

The digital healthcare startups either operate in B2C space and cater to all people who require healthcare services or operate in the B2B space and help healthcare companies, pharma companies, insurers etc.

The B2C digital healthcare companies Companies like Practo operate in this space and enable patients to discover doctors/ hospitals. People can use their web/ mobile devices to locate doctors or hospitals for their specific healthcare needs and book appointments from the comfortable confines of their home.

Then, there are start-ups which operate in the delivery of medicines to homes. Companies such as Netmeds enable you to check, buy and send

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medicines from any corner of the country in just a few clicks.

There is the home healthcare services segment as well.

Companies such as Portea operate in this space and provides hospital-quality healthcare at home. It provides doctors, nurses, and physiotherapists for home visits. These medical professionals pass rigorous hiring standards and background checks. Their medical knowledge verification is done by senior doctors.

The B2B digital healthcare companies Companies in this space mostly offer services to the corporate sector. Bengaluru-based Health Vectors offers technologybased medical screening and diagnostic services for corporate and retail clients. The company leverages the power of data to offer 360-degree perspective on health for its clients.

Another start-up that operates in this space in InstaHealth, now acquired by Practo. Instahealth provides cloud-based hospital information management system that helps hospitals to optimise productivity, streamline operations, and reduce inventory leakages.

The demand for start-ups in digital healthcare India currently has close to 65 million diabetics. This figure is expected to reach 87 million by 2030. With such alarming numbers, there is immense opportunity for on-demand medical services and accordingly, a need to disrupt existing models of providing healthcare services.

India-based Cooey Technologies has released India’s first IoT glucometer that wirelessly syncs data with a smartphone. The blood glucose levels are measured through a drop

of blood on a strip in the smart glucometer and data is automatically logged. This data then provides complete access to history, patterns, spikes and other data to track the progress of the patient. This data can be made available to doctors using WhatsApp, text message or e-mail. This allows the diabetics to lead an enormously convenient life and not worry about reading and recording daily sugar levels.

According to its founder, the start-up, through its app, will talk to the customer daily and remind them to drink water and exercise, and offer diabetes friendly food-options based on location.

New and interesting delivery models Mydentist has a network of over 110 clinics that provides patients with complete information about all dental treatments. Offering complete dental check-ups, X-rays and consultations, Mydentist strives to provide access to oral care to everyone in India through a robust technology backbone. The Mydentist clinic network allows patients to easily start a treatment at one clinic and continue it at any other clinic as all records are accessible online.

These start-ups are exciting and enable last mile reach but adoption of these models is not very easy. Doctors have years of experience operating with pen, paper and files, and adoption of these digital interfaces and delivery models would

mean that they must undergo a huge transformation of habits.

This calls for design thinking, and a more immersive and intuitive user interface and user experience on mobile and digital interfaces. This will enable medical professionals to easily adapt digital healthcare models. The mass adoption of such models would augment on-demand healthcare services, which is the need of the hour.

Recent developments and technology advancements Demonetisation: We are all privy to the demonetisation initiative by the Prime Minister of India (November 2016) to curb black money and ensure that money changes hands through proper and formal channels.

This development will create a huge impetus for healthcare, wherein a lot of transactions happen through cash. Most of us do not even follow practices such as asking for bills after availing a medical treatment or buying medicines from pharmacies.

With demonetisation, a lot of transactions will be through digital and cashless mechanisms, hence flowing through formal banking channels. This would give the Indian healthcare sector a huge fillip.

Big data and advanced analytics: The digital data generated while rendering healthcare services would be of great use for applying advanced analytics models and predicting things in advance. Healthcare can completely run on predic-

tive analytics. An example of that is predicting readmission rates. In the US, hospitals are compensated based on readmission rates. Hospitals are trying to use predictive analytics to minimise the readmission of patients and to ensure that treatment or surgical procedures are carried out in the best possible manner.

IBM’s Watson for Oncology is another interesting use case for data in healthcare. It is a cognitive computing platform that analyses data to provide information and insights regarding evidence-based treatment options for cancer. This enables oncologists to provide the most personalised and individualised healthcare to each cancer patient. In India, hospital chains such as Manipal and Apollo have already started using 'Watson for Oncology' to provide cancer patients with individualised healthcare.

IoT and Cloud: With the internet of things (IoT) and cloud computing becoming strong, doctors can track and monitor their patients any time. With applications, such as fitbit, all vital health parameters can be recorded, stored in cloud-based systems and accessed by doctors in real-time. While the data will help doctors to treat patients better, it will also enable insurers, and other healthcare providers to offer better and more personalised services by leveraging this data from each patient. Imagine having to pay lesser health insurance premium because you go for a jog every day; religiously.

That’s where we are headed.

Five years from now, India will have the largest pool of diabetics, more than most of the countries put together. It will lead to a very different way in which healthcare will be delivered in India. A mobile phone

Hospitals are trying to use predictive analytics to minimise the readmission of patients would become a virtual clinic or hospital and payments will be through cashless models.

Everything from ordering medicines to communicating with insurance will happen through the mobile phone.

Very soon, a model will emerge when you would not have to go to the clinic to avail healthcare services. There would be a virtual digital interface with the

doctors and medical professionals to enable you to avail the best possible treatment for your illness from home, or from anywhere in the world.

You can even pay for the services virtually using cashless mechanisms.

TiE as an accelerator of the growth of India’s healthcare sector Given the above developments and the unanimous appeal of digital services, TiE would help start-ups in the healthcare sector to take off and become significant companies in healthcare.

To do so, TiE has set up a special interest group (SIG) for healthcare. This group will focus on shaping and accelerating the growth of disruptive start-ups in Indian healthcare.

The SIG would comprise successful academicians, entrepreneurs, and experts from the

healthcare fraternity in India as well as the charter members on the TiE board with experience in healthcare. The SIG would advise, and guide entrepreneurs to pilot test their products, reiterate based on feedback and insights, and help launch a great product to mass audience.

TiE Angel network will help with the initial funding for entrepreneurs who have a great idea for healthcare in India but do not have the capital to start.

TiE will also facilitate a forum for networking among start-up founders. This would be an important platform as it would bring together entrepreneurs who are working towards solving challenges in Indian healthcare. This would foster more innovation and create an excellent and robust healthcare ecosystem in India – exactly what we are all striving for!

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POLICY OPINION

Industry reacts negatively to stent price capping by NPPA G

overnment of India recently issued a notification to fix ceiling prices of coronary stents to eventually bring down the cost of coronary stents, currently hiked by about 380 per cent.

It will deprive patients of latest tech advancements, say medical technology industry, associations

The story so far...

According to a recent data published by National Interventional Council (NIC), surgeries involving stent procedures have tripled over the last five years.

In the absence of proper regulatory framework, a patient undergoing such a procedure ends up paying anywhere between 10 to 1000 per cent more than the actual cost of stent, pushing the cost of medical procedure to around ` 200,000 – 250,000.

Nonetheless, recently the government has included all types of stents – drug-eluting stents (DES), bioresorbable vascular scaffold (BVS) and bare metal stents (BMS) in the National List of Essential Medicines (NLEM) and has fixed their ceiling prices at `29,600 for DES and BVS and `7,260 for BMS respectively. The cap on prices is with immediate effect.

It will lead to a reduction in stent prices by 85 per cent.

Reportedly, this move would directly result in the reduction of total procedure cost by around 25-30 per cent.

Ananth Kumar, Union Minister for Chemicals & Fertilizers and Parliamentary Affairs, asserted that the step is a major decisive action on the unethical margins charged at each stage in the supply chain of coronary stents. The Ministry of Health and Family Welfare had included Coronary Stents in the National List of Essential Medicines, 2015 (NLEM, 2015) on July 19, 2016 and the Ministry of Chemicals and Fertilizers incorporated Coronary Stents in

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ing ecosystem.”

AiMeD suggested that stent’s average price to hospitals should be the basis for arriving at a price band. It had also maintained that anything less than `40,000 – 50,000 for quality stents would be dampening and unfeasible commercially.

Detrimental to domestic manufacturers?

Schedule I of the Drug Prices Control Order (DPCO), 2013 on December 21, 2016.

However, the decision has not found favour with many in the stent industry. The critics believe that the move will not lead to the anticipated results, on the contrary it could have adverse effects.

A counterproductive move Himanshu Baid, Chairman, CII Medical Technology Division, opines that the move could be detrimental to patient safety, as it will limit accessibility to cutting-edge technologies in coronary stents for Indian patients, affecting treatment quality and growth in the medical tourism sector.

Baid said that despite extensive stakeholder consultations, including eminent cardiologists and industry, on variousmethodologies to potentially control stent prices, the

National Pharmaceutical Pricing Authority (NPPA) did not regard the suggestions offered in patient interest. Additionally, since this order is being enforced with immediate effect without provision of a transitory period, Indian stent industry is going to face enormous operational challenges in the coming times. He requested the NPPA to amend the order with a rational transition timeline.

Not a balanced decision Rajiv Nath, Forum Coordinator, AiMeD also states that the government cannot vacillate from one extreme to another – once giving a free run to all kinds of malpractices and then taking such measures which are neither feasible nor sound - even in the garb of welfare populism.

He said, “We have been demanding setting up of an expert body which really understands the medical device manufactur-

Gurmeet Chugh, MD, Translumina Therapeutics, said, “This MRP is detrimental for the domestic stent manufacturers and may kill this upcoming industry. We are sure that the price points taken for imports and manufacturing are erroneous. There is a huge spend in R&D to keep upgrading the technologies and such knee jerk pricing regulations shall ensure the survival of only fly by night operators. Morever, the requirement of all stocks in market to be sold at revised price is impractical and unreasonable.This move may appear populist but will ultimately kill the ecosystem as Indian manufacturers will keep manufacturing, only low-end technologies.”

Need for encouraging policies The Medical Technology Association of India (MtaI) also believes that a nascent sector like medical devices needs support with policies which would encourage technology innovation, clinical evidence and strong quality management systems to ensure best patient outcomes. Initiatives like ‘Make in India’ would lose on a major opportunity to generate highly skilled employment in absence of clear and rational policy framework. A knee-jerk policy framework without accounting for innovation will not only make India unviable to be a

global destination for medical device manufacturing but will also reduce India’s competitiveness to provide world-class and highly advance medical care to patient from India and abroad.

“Medical procedures in India are among the most affordable in the world, which is a combination of cost of devices and services. Any notification should be considered only if it can bring down the overall cost of treatment for the patient without denying them the options to avail the treatment of their choice. Additionally, such notifications significantly impact the ‘Make in India’ attractiveness of the country,” said Rahul Khosla, President, NATHEALTH.

Need for rational price control “Recently announced formation of a Medical Technology Assessment Board (MTAB) by the government would go a long way in standardising and regulating the stent quality in India and usher in the much needed transparency which would also enable pricing standardisation in a more rational manner,” said Anjan Bose, Secretary General, NATHEALTH. A Bajaj Allianz General Insurance spokesperson states that to benefit from price reduction and pass it on to end consumer, the government has instructed hospitals to mandatorily charge stents and mention it separately in the billing receipt in order to bring in transparency in stent pricing.

Appreciating this move, he spoke on the various initiatives taken by his organisation to interact with patients in this regard.

(Compiled by Sanjiv Das) sanjiv.das@expressindia.com

TRADE & TRENDS

School of Health System Studies,Tata Institute of Social Sciences organise third convocation 26 students received Post Graduate Diploma SCHOOL OF Health System Studies (SHSS), Tata Institute of Social Sciences (TISS) recently organised its third convocation of Executive PostGraduate Diploma in Hospital Administration (EPGDHA) at Library conference Hall, Main Campus, TISS in Mumbai. This year 26 students received their Post Graduate Diploma with Dr Geetanjali Nangai, Consultant Physiotherapist, receiving the best student award. Prof (Dr) S Natarajan, Chairman, Aditya Jyot Eye Hospital was the chief guest.

Prof Sundararaman, Dean

emphasised the role of TISS in bringing changes in the field of hospital and health administration over four decades. While delivering the convocation speech, Prof (Dr) S Natarajan stressed on the need to blend the teaching of Swami Vivekananda and practical knowledge to come up with creative leaders for healthcare industry. He emphasised to the graduating batch that through their continuous engagement with the alma mater, TISS graduates would be able to become torch bearers for hospital management and for the advancement of the nation and soci-

The ceremony ended with a ray of hope and joy that is sure to inspire the students and faculty of this institute in the years ahead

ety at large.

Throughout the programme, the sense of pride and achievement was visible among the students, the faculty and staff of the Institute. The convocation ceremony ended with a ray of hope and joy that is sure to inspire the students and faculty of this institute in the years ahead. The speeches by dignitaries were followed by vote of thanks by Prof M Mariappan, Chairperson, Centre for Hospital Management.

The students had felt that the course had contributed significantly to their learning and de-

veloping practical skills in the field of hospital administration.

However, it had also offered strong challenges to cope with while working and learning. Furthermore, few had mentioned that, “we knew it wasn’t going to be easy to cope up with the new environment and excel. This new start, however, helped us gain unique knowledge and experience that set us apart from our counterparts in other institutes.” The valedictorian emphasised that it was now the task of the graduated students as alumni to show professionalism in hospital administration.

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TRADE & TRENDS

Immunoturbidimetry reagents: Highest performance in protein testing Sachin Singh, Head: Strategic & Operational Marketing, DiaSys Diagnostic India, gives an insight on the characteristics of immunoturbidimetric assays, which have resulted in more reliable protein tests and reduced laboratory variances to help clinicians THE GROWING need of IVD testing arises due to increasing incidences of chronic and infectious diseases and growing geriatric population prone to immunological disorders.

Moreover, increased application of personalised medicines and widespread knowledge of rare diseases are boosting the growth of IVD market. Another such rise has been observed in testing specific proteins for infectious diseases, cardiac diseases, diabetes, autoimmune disorders, inflammatory markers and others.

Immunoturbidimetric methods have become the main technique for performing specific protein tests. The transition from nephelometry has been cautious but is increasing as laboratories enjoy the comparability and flexibility of immunoturbidimetry.

Immunoturbidimetric and nephelometric techniques measures turbidity of a sample to determine the level of analyses. It is also observed that specific proteins have traditionally been analysed using methodologies, such as immunonephelometry on specialised analysers. Although, immunonephelometry is a well-recognised and accepted methodology, it requires a specialised analyser that performs a limited menu of tests.

In addition, nephalometers are slow with expensive consumables cost and requires trained and experienced person to run the assay.

A variety of immunoturbidimetric assays are now available, and can be adapted to general purpose clinical chemistry analysers that are

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Albumin in Urine/CSF FS (Microalbumin)

One HbA1c FS

Antistreptolysin O FS

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Apolipoprotein A1 FS

Immunoglobulin E FS

Apolipoprotein B FS

Immunoglobulin G FS

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Complement C4 FS

LP(a) 21 FS

CRP FS

Myoglobin FS

CRP U-hs (Universal and high sensitive)

Prealbumin FS

Cystatin C FS

Rheumatoid Factor FS

D-Dimer FS

Transferrin FS

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Sachin Singh Head, Strategic & Operational Marketing, DiaSys Diagnostic India

A variety of immunoturbidimetric assays are now available, and can be adapted to general purpose clinical chemistry analysers that are ‘Open Systems’. Immunoturbidimetric assays have been improved considerably over time 'Open Systems.' Immunoturbidimetric assays have been improved considerably over time. These improvements include advances in antibody purification techniques, enhancements in instrument design, function and production of new reference materials based on global standardisation initiatives. Additional

practical advantages of immunoturbidimetric protein assays include random access analysis instead of batch testing, relatively rapid turnaround time, high volume testing capability, cost reduction through consolidation of testing on a single platform, elimination of stand alone specialised analysers, and time

and effort required to maintain them. Collectively, these characteristics of immunoturbidimetric assays have resulted in more reliable tests and reduced laboratory variances to help the clinicians.

DiaSys Diagnostic Systems immunoturbidimetric test portfolio offers more than 20 ready-to-use, stability optimised reagents for routine and special diagnostics with outstanding performance. DiaSys immunoturbidimetric tests are available in different vials and kit sizes for manual and automated use in various common clinical chemistry analysers. DiaSys reagents, in combination with DiaSys instruments, optimised applications, calibrators and quality control material form a harmonised system for highest laboratory demands.

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LIFE INSIGHT

Quality healthcare for women Dr Sujit Chatterjee, CEO, Dr LH Hiranandani Hospital, elaborates on the need to focus on women’s health to ensure that she maintains her pivotal position in the society

S

ir Winston Leonard Spencer-Churchill said “We make a living by what to get but we make a life by what we can give”.

This is a mindset of a mother who will give her all to make a life for her family.

We feel our society is based on equity, justice, social sensitivity and a culture of services in which we are all self reliant.

Our society will stand to crumble if the woman (or a mother) is removed from the equation.

It is only natural then that we need to focus on the women’s health to ensure that she maintains her pivotal position in society. If this asset is not strengthened in all its dimensions then the future of our country will not be vibrant socially, culturally or economically in the next decade.

India is on the world map of rocket technology in sending 103 satellites into the orbit by a single rocket, having solid fuel technology, a first-of-its-kind a world record. However, the team behind this initiative was a dedicated team of women scientists and technologists and the experts who worked on micro details to ensure a successful launch. The question really to be asked is what has this to do with women’s health? For those reading this article, I request you to imagine each of the many lady scientists who were the core to the project success being absent from critical meetings on account of health.

The programme may have failed.

Health disorders of woman has undergone a change. There is a shift from the communicable to the non-communicable disorders. The metros are witnessing manifold rise in women

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who have high blood pressure, major undiagnosed cardiac disorders, undiagnosed hypothyroidism, Vitamin D deficiency, osteoporosis, diabetes, psychological disorders and obesity.

While in the rural set up, it still is a communicable disease disorder and disorders related to child birth but with modernisation gradually seeping in hinterland there is a shift in the disease burden from the communicable to non communicable.

In the early decades, the woman’s role was basically to be at home, manage children and generally be the pivot and the person to absorb the emotional, physical, social and spiritual well being of the family. As era passed and the women has decided to step out and be recognised as a entity, she has only subjected herself to an additional pressure of work environment without relinquishing her role as a pivot for her family’s health. This has added a burden on her which she has gracefully taken in her stride. This does not mean that she does not feel the pressures that are manifold on her today as opposed to what her mother or grandmother may have faced. A study conducted at Dr LH Hiranandani Hospital indicated that women do have concerns about their health and the concerns related to some common disorders. In order of importance, their concerns start with anaemia, thyroid disorders, stress of travelling, diabetes and nutrition. It is very evident that it is a common disorder which is getting reflected as the concern that the working woman has today. All these disorders are mainly related to lifestyle and the pressures that can be contributory

to under performance or inability to perform because of the underlying ailments. All of them are treatable and an early diagnosis helps.

Also, there are various issues that could create work life imbalance such as planning a family. It seems that a careeroriented woman would prefer to start her family once well established at work. However, this may take time and hence the inclination to start a family may come at the mid to late 30s as opposed to yesteryear where woman generally conceived in mid 20s to late 20s. The fact that pregnancy (a normal physiological process) is postponed by a decade does not slow down the natural changes which occurred in women with age.

There is a decrease in fertility but with assisted reproductive techniques, delayed pregnancies are quite common. That again puts the patient in a ‘risk category,’ as physiological changes of pregnancy are better tolerated in the mid 20s than in the late 30s. There is also a rising incidence of lifestyle disorders for women in metros such as anxiety, panic attacks, depression and its re-

lated co- morbidities. The sheer physical exertion of travelling to and from work can also take a toll on health of the working women. Then there is a need to manage the family and also get ready for the next day’s travel.

Apart from the physical wear and tear, there is also mental pressure not only for travel but also at work. These can translate into issues which start cropping at house that might result not only in marital discord but panic attacks in women which can manifest in various ways and mimic acute disorders or result in depression which if not corrected may result in suicidal tendencies.

This is quite tragic.

For malignancy (cancer) while the incidence may not have increased in totality, however, breast cancer as an individual disease is more prevalent in metros and has overtaken the incidence of cervical cancer which erstwhile was the leading cancer amongst women in our country. Again there is a role of lifestyle disorder such as diet which is rich in saturated fats, delayed pregnancy, lack of breast feeding, excessive ingestion of junk food

DR SUJIT CHATTERJEE CEO, Dr LH Hiranandani hospital, Powai

have led to this transition. Also screening processes, vaccines, contraception by way of barrier contraception have contributed in good measure to the decrease in cervical cancer in the metros. Cervical cancer is now labelled as a preventive disease and breast cancer awareness has resulted in early reporting of breast lumps and as contributed to better outcomes but an apparent increase in incidence. Most doctors and hospitals are aware of such transformation and are fairly well geared up to attend to disorders which are commonly seen by afflicting ladies.

There has to be a reduction in maternal mortality and infant mortality rates by improving emergency services in the rural areas. This becomes the state issue, which needs to be addressed on a war footing.

Education while playing a role is not the most important factor in awareness and reduction in maternal and peri natal mortality rates. It is the availability of well equipped primary health centres that can give good ante natal care and also undertake emergency procedures as and when required will drastically reduce the maternal mortality and give very good peri natal outcomes.

India is poised to become the youngest nation in the world in the year 2020. But a healthy nation is what is the need of the hour. There are lot of initiatives that are being talked about as ‘Arogya Bharat’ by the year 2025. This will never happen if we do not wake up and improve quality of healthcare for a woman which translates to be the pivot in India’s march to become a super power.

REGD. WITH RNI NO. MAHENG/2007/22045, POSTAL REGD. NO. MCS/162/2016 – 18, PUBLISHED ON 8TH EVERY MONTH, POSTED ON 9TH, 10TH, 11TH EVERY MONTH, POSTED AT MUMBAI PATRIKA CHANNEL SORTING OFFICE, MUMBAI – 400001

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