Ehealth Magazine november 2017

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STHAN RAJA volume 12 / issue 11 / NOVEMBER 2017 / ` 75 / US $10 / ISSN 0973-8959

10 November 2017 | Jaipur

VasundhAra Raje Chief Minister of Rajasthan Smt VasundhAra Raje

Honâ&#x20AC;&#x2122;ble Chief Minister of Rajasthan

Kali Charan Saraf Minister for Medical, Health & Family Welfare Government of Rajasthan

Banshidhar Khandela

State Minister for Medical, Health & Family Welfare Government of Rajasthan

VEENU GUPTA Principal Secretary Department of Medical, Health & Family Welfare Government of Rajasthan

NAVEEN JAIN Secretary & Mission Director National Health Mission, Department of Medical, Health & Family Welfare Government of Rajasthan

RAJASTHAN on a Mission

to Save the Girl Child

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november 2017 | Volume 12 | Issue 11

industry perspective 60 Rajesh Mundra Founder and CEO Truworth Health 64 Rajesh Maurya Regional Vice President India and SAARC, Fortinet

COVER STORY

India’s War Against Non-Communicable Diseases

70 Dilip Patil Managing Partner Trivector Biomed LLP

Daughters are Precious

Learning is a Never Ending Process Yasmin Singh, Kathak exponent

Leader’s Perspective 18 Kali Charan Saraf Minister for Medical, Health and Family Welfare Government of Rajasthan 20 Banshidhar Khandela State Minister for Medical, Health and Family Welfare Government of Rajasthan

Policymaker’s perspective 22 Naveen Jain Secretary, Department of Medical, Health & Family Welfare, and Mission Director of National Health Mission Government of Rajasthan

state perspective 25 Dr Mohan Singh Mission Director National Health Mission, J&K 28 Vishal Chauhan Commissioner-cum-Secretary Health Care, Human Services and Family Welfare Department, Sikkim 30 Dr Gaurav Dahiya Mission Director, National Health Mission, Gujarat 48 Monica Priyadarshini Special Secretary, Health and Family Welfare Department of A&N Island Administration 68 Keshvendra Kumar Mission Director National Health Mission, Kerala

Norway-India Partnership 50 Dr Harish Kumar Project Director Norway India Partnership Initiative (NIPI) Newborn Project

NGO perspective 58 Apoorva Krishnakant Pathak Trustee, VCGTH 76 Dr Bulbul Sood India Country Director, Jhpiego

HOSPITAL perspective 72 Joy Chakraborty Chief Operating Officer P D Hinduja Hospital 74 Inder Davalur Group CIO KIMS Hospitals, Secunderabad

special feature

Revisiting India’s Child Sex Ratio Mystery

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Editorial Safeguarding Girl Child For A Secured Future of Society The Rajasthan Government had chosen 2nd Healthcare Summit Rajasthan last year as a platform to launch the ‘Daughters are Precious’ campaign. Since then, a lot of water has flowed under the bridge. Today, the negative connotation linked with the girl child has given way to a positive environment. They can now hope to survive the society’s regressive approach. But whatever has been achieved so far has not been without its own set of challenges. To challenge the set norms successfully, the State of Rajasthan is all geared up. Under the leadership of Chief Minister Vasundhara Raje, the State is undertaking long strides to make the State ‘safer’, especially, for the fairer sex. This is indeed a turning point in Rajasthan’s social upheavel to fight against the social evils that have far deeper implications than we can think of. Keeping this in mind, the 3rd Annual Healthcare Summit Rajasthan being organised in partnership with Elets Technomedia, has again made the cause of girl children its prime focus area, allowing healthcare stalwarts and stakeholders to come together to find a common ground and take this revolution forward. The cover story in the eHealth magazine’s November issue -- ‘India’s War Against Non-Communicable Diseases’ -- is a fair attempt by us to discuss how the growing burden of NCDs has prompted the Government and the health industry to act in urgency to address the issue. The story touches on the various advancements, innovations and infrastructural developments taking place to contain the NCD treat, but how challenges like scarcity of doctors, inadequate medicines, lack of awareness and knowledge need to be addressed to create a common front against NCDs. The 3rd Annual Healthcare Summit Rajasthan’s special issue of eHealth magazine carries a special story, Revisiting India’s Child Sex Ratio Mystery, which dwells deep into how this social issue appears to have been caused by various reasons, including the culture and the place of living of the people -- whether it is rural or tribal areas of the country or urban areas. It also touches upon some hard facts and tries to reach the root cause of sex determination and female feoticide in the country. This issue also contains interviews of Kali Charan Saraf, Minister for Medical, Health and Family Welfare, Rajasthan; Banshidhar Khandela, State Minister for Medical, Health and Family Welfare, Rajasthan; Naveen Jain, Secretary, Department of Medical, Health and Family Welfare, and Mission Director of National Health Mission-Rajasthan; and Mission Directors of NHMs from the states of Gujarat, Kerala and Jammu & Kashmir. We hope the useful insights given by them on the developments transforming the health sector in their respective States would give our readers an edge to stay ahead of the curve. Looking forward to our readers’ feedback.

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

Narendra Modi Honâ&#x20AC;&#x2122;ble Prime Minister of India

Kalyan Singh Honâ&#x20AC;&#x2122;ble Governer Rajasthan

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COVER STORY

India’s War Against Non-Communicable Diseases The modern-day healthcare industry has adopted various advancements to enhance its offerings, be it innovation, high-tech Infrastructure or quality healthcare. But challenges like scarcity of doctors, inadequate medicines, unawareness and lack of knowledge of emerging diseases are still major issues to be addressed, writes Rajbala of Elets News Network (ENN).

n the last decade, the advancements being witnessed in our day-to-day lifestyle have also brought significant changes in the disease patterns of people. There is a belief that it has turned not just a national but global health threat, leading to non-communicable diseases (NCDs). The NCDs which involve cardiovascular diseases (CVDs), chronic diseases, cancer, diabetes, etc have become a big challenge these days. It needs to be addressed immediately, specifically in rural India where a large segment is constrained in many ways due to limited awareness. “Quality of health services,

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infrastructure, trained HR and development of transparent healthcare system will be given a major push for which the government has already initiated various programmes” says Gaurav Dahiya, Managing Director, National Health Mission, Gujarat. In the modern era, the role of ICT in the field of medical science is immense, says Vishal Chauhan, Commissioner-cumSecretary Healthcare, Human Services and Family Welfare Department, Government of Sikkim. “ In Sikkim, we are utilising ICT for timely reporting and monitoring of health programmes through Health Management Information System (HMIS) under

eHEALTH Magazine

National Health Mission.” Moreover, NCDs affect individuals over a long period of time causing a financial challenge as well. An estimated 40 million people die annually due to a NCD, which amounts to 70% of all global deaths, and 17 million people die before the age of 70, according to the World Health Organisation, which adds that NCDs are increasing significantly in low- and middle-income countries: 87% of premature deaths occur in low- and middle-income countries. Together, cardiovascular diseases (CVDs), cancer, respiratory diseases and diabetes mellitus account for 81% of all deaths in NCDs. It is expected that the global burden of NCDs will

ehealth.eletsonline.com | november 2017

cover story

increase by 17% by 2025. Motivation, appreciation and incentives are the three key mantras that can bring major or drastic changes in any project, says Joy Chakraborty, Chief Operating Officer, P D Hinduja Hospital, adding: “The same applies for creating a culture of innovation in our country. Indian brains have time and again proved themselves being most innovative in various fields, irrespective of the place where they are in the world.” According to a Global Burden of Disease study, the cardiovascular disease has been one of the foremost NCD killers in 2015, with more than 400 million individuals living with CVD and nearly 18 million CVD deaths worldwide. Risk Factors of NCDs Underlying socioeconomic, cultural, political and environmental determinants like globalisation, unplanned urbanisation leads to common modifiable risk factors like unhealthy diet, physical inactivity and tobacco use and unmodifiable risk factors like age and heredity. Intermediate risk factors like raised blood pressure, high blood glucose, abnormal blood lipids and obesity increases the risk of NCDs such as heart diseases, stroke, cancer,

november 2017 | ehealth.eletsonline.com

chronic respiratory diseases, mental health and diabetes. As mentioned, NCDs are caused largely by four modifiable risk factors: tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol. Interestingly, 80% of the premature CVD can be prevented through action against these four behavioural factors, according to reports released by WHO. In India, nearly 61% of deaths now happen due to emerging noncommunicable diseases and over 23% are at a risk of premature death, as per reports released by WHO.

Initiatives to Curb Non-Communicable Diseases (NCDs) The development of NCDs has led to a tensed atmosphere in different parts of the country. It has become extremely important to deal with it in an efficient as well as planned way while overcoming other challenges as well. The State Health Departments are presently running the National Programme for Prevention and Control of Cancer, Diabetes,

eHEALTH Magazine

Cardiovascular Diseases and Stroke (NPCDCS) programmes in their respective States. Under this, doorto-door screening of diseases like diabetes, HTN, common cancer and investigation and treatment of noncommunicable diseases is done for early detection of such diseases. The programme aims to cover 200 districts nationwide by 2018. In addition to that, the Central Government has also started schemes to set up cancer centres across the country. While 31 such hospitals have already been built under the programme, 49 more are in the pipeline by 2020, according to reports. Meanwhile, suspected cases of NCDs are investigated and, if required, a proper treatment is given from primary to tertiary level. The Central Government proposes its efforts by offering efficient technical as well as financial support through NPCDCS programmes. For close monitoring of programmes, the Government has implemented NCD cells at various levels to ensure proper implementation and supervision of the programme related to treatment, screening, availability of medicines, etc. To control NCDs at larger level, the State health departments are attempting to create a wider knowledge base in the community for early prevention, detection, referrals and treatment strategies through convergence with executed interventions of the National Rural Health Mission (NRHM), National Tobacco Control Programme (NTCP), and National Programme for Health Care of Elderly (NPHCE). According to Dr Mohan Singh, Mission Director, National Health Mission, Jammu and Kashmir, “To provide equitable and quality primary healthcare services to the urban population with a special focus on slum and vulnerable sections of

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Year

Premature Mortality from NCDs reduction

Essential NCD Medicines and technologies coverage

Drug therapy and counselling coverage

Diabetes/ Raised obesity blood increase pressure reduction

Salt/ sodium intake reduction

Physical inactivity reduction

Harmful use of alcohol reduction

2019-20

10%

60%

40%

10%

15%

20%

2022-23

20%

75%

45%

22%

25%

2030

28%

85%

55%

28%

32%

12%

the society, we seek to improve the health status by facilitating their access to quality primary healthcare.”

and risk factors by 2025, a mission approach is required for effective implementation of programmes.

Challenges In a bid to combat NCDs, there is need for our healthcare industry has to accelerate and empowered to overcome the challenges and lessen the increasing burden of NCDs in the country.

To-do list to prevent NCDs: • Banning smoking in public places is recommended to prevent smoking and to promote smoking cessation • Increased availability and types of school playground spaces and equipment for exercise activity and sports are recommended • Consideration of physical activity when planning new landscaping/ buildings or towns is recommended • Elimination of industrially produced trans fats is recommended. • Drink-driving countermeasures are recommended such as lowered blood alcohol concentration limits and “zero tolerance”, random breath testing and sobriety check points. • Measures to support and empower primary care to adopt effective approaches to prevent and reduce harmful use of alcohol are recommended • Awareness and enforcement of the programmes initiated

Digital Guidance Digital guidance or consultation is not fully functional in many parts of the country due to which a large chunk of public faces hardship. Online presence or consultation about NCDs and its long-term impact on health can help control the rising rate of NCD patients. Also, this could control the disease at primary level. With integrated management and strong monitoring system, healthcare services can be made accessible. Specialist Doctors Availability of specialist doctors is one of the major challenges in India. It means we still need to groom our healthcare industry despite of huge integration of technology. It is therefore recommended that the medical education in small or big institutions must be given a major push. Due attention is required for implementation of these programmes in remote areas and underprivileged population in the urban areas. For India, having committed to global indicators and goals to address NCDs

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Action Plan Population-based NCD screening is much needed to control disease at the initial level. Moreover, the Government has planned to integrate NCD screening software to track and maintain the patient’s data and execute further plans. Another major step, which

eHEALTH Magazine

is already being implemented, is counselling about this big threat which could burden the country socially as well as economically. The State governments have started providing counselling programmes in schools, colleges, rural and urban parts of the country. The government has ensured to enhance the medical education to overcome scarcity of doctors and clinicians at primary as well as tertiary level. In accordance to that, medical institutions have been set up, additional medical courses have been started, and internship programmes have been enhanced with additional healthcare courses. Major step of the Health Department is that it has already started providing door-todoor screenings, investigation and evaluation of the initiated programmes, and free of cost treatments to the patients. Conclusively There is a strong scientific guidance both for clinical practice and for decision makers to combat the growing global threat of noncommunicable diseases. A further reduction in the use of tobacco, supporting regular physical activity and healthy food choices and limiting the use of alcohol will have a significant impact on population health. It is time to join hands and create public awareness about NCDs towards realising the dream of ensuring a better healthcare system exists in the country.

ehealth.eletsonline.com | november 2017

cover story

Identified indicators related to SDGs targets and their projections/likely achievements (Premature Mortality)

Leaderâ&#x20AC;&#x2122;s Perspective

Boosting Healthcare Delivery for Healthy Rajasthan Premature mortality and illness due to NCDs present a growing health and development challenge. The cost for economies, health systems, households and individuals is already substantial, and is set to increase significantly if action is not taken to stem the rise of NCDs, says Kali Charan Saraf, Minister for Medical, Health and Family Welfare, Government of Rajasthan, in an interview with Kartik Sharma and Rajbala of Elets News Network (ENN).

Kali Charan Saraf

Minister for Medical, Health and Family Welfare, Government of Rajasthan

What are your priorities to improvise or boost Rajasthan healthcare system? I believe that healthcare must be a core priority of every State. With this thought, we always seek to implement and execute programmes which could boost quality healthcare delivery in the country. In order to provide treatment to the patients in remote areas, we have boosted telemedicine services across the State. To enhance telemedicine services, we have signed MoUs with various firms which could help in providing treatment and consultation to patients till last mile. Major hospitals and health centres across the State are being connected through telemedicine

november 2017 | ehealth.eletsonline.com

which provides consultation through video conferencing. Apart from this, we have started medical courses at colleges, institutions and Universities. With this step, we look forward to overcome the challenge of scarcity of medical professionals and doctors. In addition to that we have also started training centres to qualify doctors working at primary level. Thirdly, to deal with emerging diseases like cancer, diabetes, mental health, and other ones we have launched programmes like NCPDCs, etc. We are also strengthening the public service delivery infrastructure, particularly at primary as well as secondary levels. Our department has improved

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management capacity to organize health systems and services in public health

How big is the NonCommunicable Diseases challenge for the people of Rajasthan? Are we prepared to tackle it? Premature mortality and illness due to NCDs present a growing health and development challenge. The cost for economies, health systems, households and individuals is already substantial, and is set to increase significantly if action is not taken to stem the rise of NCDs. Lack of knowledge about the NCDs in major threat as people still take these diseases as a general issue when at

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What is your take on child sex ratio in Rajasthan? We accept that fact that Rajasthan has one of the lowest Girl Child Sex Ratio in the country due to female foeticide. The sex composition of the Indian population has so far been discussed within the prevailing understanding of the reasons behind a declining child sex ratio: The use of prenatal diagnostic techniques followed by

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sex-selective abortion, female child neglect and female infanticide. Attention needs to shift towards those families who, under the influence of the prevalent small family norm and son preference, stop producing children when one or two sons are born. Child sex ratio reflects both, pre-birth discrimination manifested through gender biased sex selection, and post birth discrimination against girls. Skewed sex ratios can have far-reaching adverse social consequences. As evidence from regions with sex ratio imbalances indicate, it could contribute to increased violence against women, trafficking, increase in practices such as polyandry and overall rise in crime and general social disorder. To ensure child sex ratio, various initiatives have been taken like implementation of laws concerning women and girls, review schemes for women, addressing trafficking issues, ensuring civil registration, enforcement of programmes, and promoting awareness programmes.

What you think has helped in improvising sex ratio at birth in Rajasthan? The Health Department of the State has taken various initiatives which

eHEALTH Magazine

Child sex ratio reflects both, prebirth discrimination manifested through gender biased sex selection, and post birth discrimination against girls. Skewed sex ratios can have far-reaching adverse social consequences.

led to improvement in sex ratio at birth in Rajasthan. Initiatives like community mobilisation, toll free complaint services, revamped informer scheme, and other enforcement programmes led to enhancement in sex ratio at birth. Additionally, we have integrated tracking devices in Sonographic machines, started red alert SMS system, established PCPNDT Bureau of Investigation, and deployed maximum technology innovations.

ehealth.eletsonline.com | november 2017

Leaderâ&#x20AC;&#x2122;s Perspective

initial stage. Scarcity of specialists at primary level is another danger to healthcare situation. But we are very aggressively working to control NCDs in the State by implementing various programmes. Likewise, we have started free screening at door steps to prevent disease at initial level and refer required treatment if needed. We have centralised the access to public health services for Womenâ&#x20AC;&#x2122;s health, Child health, water, hygiene, sanitation and nutrition. To keep hold on growing danger of NCDs we have created accessible integrated comprehensive primary healthcare. One of the major steps to tackle NCDs our Department is ensuring population stabilization, gender and demographic balance in the State.

Leaderâ&#x20AC;&#x2122;s Perspective

Transforming Health Landscape of Rajasthan The Health Department of Rajasthan has taken a lead in improving the quality of healthcare delivery across the State. Banshidhar Khandela, State Minister of Health and Family Welfare, Rajasthan, highlights the transformation of the health sector that has been set in motion as also the Governmentâ&#x20AC;&#x2122;s priorities and initiatives in bringing down maternal and child mortality and the growing burden of NCDs, in conversation with Kartik Sharma and Rajbala of Elets News Network (ENN).

Banshidhar Khandela

State Minister of Health and Family Welfare, Rajasthan

What are the new schemes introduced by the Government of Rajasthan to improve healthcare services in the State? The Government of Rajasthan has been working very hard for the last four years to improve the health of common people. Mission Parivar Vikas has been launched recently for improving the total fertility rate in Rajasthan, under which 14 districts have been targeted where total fertility rate is more than three. Secondly, Mission Indradhanush and Intensified Mission Indradhanush (IMI) have been introduced in Rajasthan for encouraging vaccination and immunisation of children to ensure positive health outcomes in the State. For improving maternal health

november 2017 | ehealth.eletsonline.com

and child health, many new initiatives, like the Chirayu programme, have been taken up. It has been executed in eight districts of Rajasthan where newborn mortality rate is very high. Moreover, initiatives like telemedicine, mobile dental van and many other initiatives have been introduced by the State Government.

How do you see rural healthcare sector performing in Rajasthan? Do you think the healthcare infrastructure in rural Rajasthan is satisfactory? I belong to a rural area in Sikar district. The one thing I have observed recently is that now people residing in rural areas are very satisfied with the healthcare

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infrastructure available there. Earlier, there used to be only a few centres with Auxiliary Nurse Midwives (ANMs) and doctors. But now every village in Rajasthan is connected to some sub centre or Primary Health Centre (PHC) or Community Health Centre (CHC). We have also made available free of cost many drugs and diagnostic facilities to the public. Our honourable Chief Minister has introduced Bhamashah Swasthya Bima Yojana, under which the entire treatment package is available to 67 per cent of the population free of cost if they hold a National Food Security Act (NFSA) card. So, looking at the current scenario I can say I am satisfied with the Government

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What are the major problems or challenges in the healthcare sector of Rajasthan? From geographical point of view, Rajasthan is the largest State in the country and we have many unapproachable areas. Therefore, in order to make health facilities accessible to all is one of the major challenges we have. Secondly, availability of sufficient number of doctors and super specialists is an issue. To deal with such issues the Government has taken various initiatives. To overcome the shortage of doctors and paramedical staff, we have started many courses in medical colleges. Likewise, we have initiated a 21-month course in medical colleges and tied up with the College of Physicians and Surgeons (CPS), Mumbai for starting similar kind of courses. Another major issue we have in the State is literacy. Firstly, our population has to be well aware about their health needs, like cleanliness to prevent diseases like dengue, swine flu and viral fever. For example, people residing in villages still avoid going to health facilities to take preventive measures. But with our awareness programmes, changes can be seen happening and if we keep on

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promoting and maintaining health literacy in rural areas the challenge of health illiteracy can be met.

What is your take on status of PC & PNDT Act of Rajasthan? Our Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) cell is doing a wonderful job. The team has not only controlled female foeticide and sex determination in Rajasthan, but with the support of IPC and CrPc provisions and in collaboration with State teams of neighbouring States, has acted against unregistered centres or registered centres involved in illegal act in six other States. States like Punjab, Haryana, Uttar Pradesh, Delhi, Gujarat, and MP have been also covered by PCPNDT team. I believe such initiatives will improve child sex ratio. Female foeticide has become a subject of discussion these days. The interesting fact is that in rural areas people are changing their mindset and realising the importance of daughters. People have started educating their girl children, supporting them in their career and making them equal shareholders in property. These improvements in societal mindset will result in reduction of female foeticide and will improve child sex ratio.

In rural areas, school children majorly suffer from dental problems. What major steps

eHEALTH Magazine

Earlier, there used to be only a few centres with Auxiliary Nurse Midwives (ANMs) and doctors. But now every village in Rajasthan is connected to some sub centre or Primary Health Centre (PHC) or Community Health Centre (CHC). We have also made available free of cost many drugs and diagnostic facilities to the public.

have been taken in this context in Rajasthan? True, we can observe the children suffering from dental problems in rural schools in villages. Surprisingly, even parents do not take dental problems seriously unless their children are in deep pain. To eradicate this issue, our government has introduced dental mobile vans which provide dental care services in all districts majorly to school children. Many new dentists have been deputed and dental chairs as well as dental treatments have been made available at CHC level. We have also implemented an oral health programme in the State and I am sure that these measures will improve the overall health status in the State.

ehealth.eletsonline.com | november 2017

Leaderâ&#x20AC;&#x2122;s Perspective

health system in Rajasthan.

POLICYMAKERâ&#x20AC;&#x2122;S perspective

Awareness and Enforcement Key Drivers of PC & PNDT Act Daughters are precious and the Rajasthan Government has left no stone unturned for the cause of girl child. Naveen Jain, Secretary, Department of Medical, Health & Family Welfare, and Mission Director of National Health Mission, Government of Rajasthan, shares his views on various initiatives taken up under the Pre-Conception and Pre-natal Diagnostic Techniques (PC & PNDT) Act in the State in conversation with Kartik Sharma and Rajbala of Elets News Network (ENN).

Naveen Jain

Secretary, Department of Medical, Health & Family Welfare, and Mission Director of National Health Mission, Government of Rajasthan

Why Pre-Conception and Prenatal Diagnostic Techniques (PC & PNDT) Act is important in the context of Rajasthan? The PC & PNDT Act was implemented in 1994 and its rules were framed in 1996, and gradually some amendments were made in early 2003 and 2004. But the implementation of the Act had always been questionable. Rajasthan is infamous for female foeticide. Our child sex ratio, which is computed for 0 to 6 years of age group, has been falling continuously since 1981. It was 954

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in 1981 which fell down to 888 in 2011 census. The implementation of PC & PNDT Act is very important for Rajasthan because of the suspicion that many registered centres are engaged in illegal activities, or some unregistered people with unregistered machines are also involved in this sex determination business. Therefore, implementation has become more important so that by 2021 we can have a respectable child sex ratio. Falling child sex ratio or lower sex ratio will have many social implications which could later result

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in social imbalance. Hence, taking a serious view of the onslaught of sex-selective discriminatory practices which could have social as well as other impacts, it is very important to implement the Act in its letter and spirit.

Which initiatives Rajasthan has undertaken in recent years to implement PC & PNDT Act? The Rajasthan Government has taken many initiatives under the National Health Mission and has its own PCPNDT cell to implement the Act. The PCPNDT cell of Rajasthan

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What are the specific initiatives undertaken by Rajasthan to stop sex determination as well as sex selective abortion? Active trackers have been installed on all the sonographic machines and from 2015 it has become mandatory to install GPS also on all sonographic machines which are capable of sex determination. Secondly, a very strict monitoring is done over these machines to keep active trackers working efficiently. Thirdly, the PC & PNDT Bureau of Investigation has been constituted by the Rajasthan Government and now, this government has equipped this bureau with competent persons. The bureau is headed by the Secretary Medical and Health for Rajasthan, while an Additional SP and many officers from the circle inspector and SHO cadre have been provided on deputation by the Police Department. Moreover, this bureau has

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Declining trend of Tobacco Use Prevalence in Rajasthan State 70 60 50 40

Male Tobacco Prevelance Female Tobacco Prelevalce

30 20 12.9 10 0

7.8

2005-06 NFHS 3

6.3 2010 GATS-I

2015-16 NFHS 4

The Government of Rajasthan is working on National Tobacco Control Programme (NTCP), which is currently being implemented in all 34 districts of the State. A state-level coordination committee has been constituted in order to ensure that coordinated efforts are made by all key departments including home, medical and health, finance, agriculture, rural development, Panchayati Raj, law, education, forest and environment. All our districts have the mechanism of reviewing the progress of tobacco control under the District Collector quarterly. Various campaigns have been initiated which aim at deterring the demand, creating awareness and assisting to quit. We have started developing all our Anganwari Centres into tobacco free area. Sale of tobacco products within 100 wards of these institutions is prohibited. Also, all healthcare and educational institutions in Rajasthan State are being made into tobacco free areas. Elaborate guidelines and a reporting mechanism have been established to ensure effective compliance. Due to these rigorous efforts tobacco control is now taking priority within the ambit of public health. Rajasthan is the first State in the country that has made it mandatory for tobacco sellers to restrain from displaying tobacco products at the point of sale. Another drive includes enforcement of key provisions of Cigarette and other Tobacco Product Act, 2003; Rajasthan State has set up enforcement mechanism in all Districts up to Block level, total 2.39 lac challan were done. Tobacco cessation centres are made operational in 16 districts in which 12,282 tobacco users were counselled during 2016-17. Besides this, toll free Quitline (PAHAL) was made operational through 104 (medical advice service) and 108 (emergency helpline) for providing cessation help to tobacco users wishing to quit.

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POLICYMAKERâ&#x20AC;&#x2122;S perspective

has been most active in the last few years and many strict measures have been taken by it. The Honorable High Court of Rajasthan has issued many directions on which the State Government has been working very hard. As a result, the implementation of PCPNDT Act has improved considerably over these years. Firstly, all sonographic machines have been connected to an active tracker which is a mechanism to look into the activities undertaken at the registered centres. It acts as a deterrent against the misuse of sonographic machine. Now, GPS machines are also installed on sonographic machines in Rajasthan after 2015. In this way, directions of High Court as well as many decisions by the Government and strict enforcement by the PCPNDT cell have improved the overall sex ratio at birth which will finally lead to a better child sex ratio in 2021.

POLICYMAKERâ&#x20AC;&#x2122;S perspective

been made capable by adding Additional Director Prosecution and medical experts. It has done many operations successfully. In addition to that, the informer scheme has been made more attractive by announcing a reward of Rs 2.5 lakh for a successful decoy operation. The informer is given Rs 1 lakh and the pregnant women, who acts as the decoy, is also given a reward of Rs 1 lakh. If any person assists in the operation he or she is given a reward of Rs 50,000. In this way, the informer scheme has become very successful. Many information against illegal sex determination are coming to the bureau and based on that decoy operations are conducted. In all these years, the judiciary has been very much helpful and as a result people who have been caught red handed are kept in jail for longer period. Constant follow-ups during the trial has improved conviction rate as well. All these initiatives jointly have helped create a better environment for the birth of girl child in the State.

Do you think enforcement is enough for implementing PC & PNDT? No, we think that enforcement is the starting point. You have to enforce the Act of the land for sending out a clear message. But this is also true that enforcement alone is not enough because female foeticide is a social

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problem. We have to change the mindset of the society to encourage the birth of girl child. Last year, our PC & PNDT cell in Rajasthan started an awareness programme known as â&#x20AC;&#x153;Betiyan Anmol Hainâ&#x20AC;? or daughters are precious, during the 2nd Annual Healthcare Summit Rajasthan organised in association with Elets Technomedia. Enforcement and awareness are going hand in hand, and as a result we are getting tremendous response from the society. The enforcement alone cannot break the demand from the society to prefer only male children, as also awareness alone will not motivate people to have female children. Therefore both awareness and enforcement have to go hand in hand.

What steps Rajasthan has taken for the control of tobacco use? Every third adult person in Rajasthan State is using tobacco in one form or the other. The varied indigenous range of tobacco products locally available is adding more complexity to the tobacco control issue. But due to strict tobacco control measures and awareness drive taken up at the State, district and subdistrict level use of tobacco among adult population in Rajasthan State is declining constantly.

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the informer scheme has become very successful. Many information against illegal sex determination are coming to the bureau and based on that decoy operations are conducted. In all these years, the judiciary has been very much helpful and as a result people who have been caught red handed are kept in jail for longer period. Constant follow-ups during the trial has improved conviction rate as well.

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The healthcare industry in J&K has experienced a proliferation of innovations aimed at enhancing life expectancy, quality of life, diagnostic and treatment options, as well as the efficiency and cost effectiveness of the healthcare system, says Dr Mohan Singh, Mission Director, National Health Mission, J&K, in an interaction with Rajbala of Elets News Network (ENN).

Dr Mohan Singh

Mission Director National Health Mission, J&K

Share with us the initiatives undertaken to improve the health system and the health status of the people in the State. To provide equitable and quality primary healthcare services to the urban population with special focus on slum and vulnerable sections of the society, we seek to improve the health status by facilitating their access to quality primary healthcare. • Some of our initiatives include reduction in infant mortality rate – early Neonatal Mortality Rate has dipped from 22 to 18, Neonatal Mortality Rate has declined from 26 to 20 and under 5 Mortality Rate reduced from 35 to 28. • Our efforts also led to an increase in Institutional Deliveries. As per

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National Family Health Survey (NFHS), institutional deliveries have increased from 52.2 per cent in 2005-06 (NFHS 3) to 85.7 per cent in 2015-16 (NFHS 4). • We have achieved improvement in Full Immunisation. As per National Family Health Survey (NFHS), full immunisation in children has increased from 52.2 per cent in 2005-06 (NFHS 3) to 85.7 per cent in 2015-16 (NFHS 4). • Free Drug Policy - Free Drug Policy has been implemented in the State where under identified free drugs are being provided to the patients accessing District Hospitals, CHCs, PHCs and Sub Centers. • Critical Care Ambulances –

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As many as 23 critical care ambulances have been procured for deployment to the district hospitals to meet the requirement of accidental and emergency cases. These ambulances are well equipped to provide the Advance Life Support/Basic Life Support services to the accidental cases as well as sick patients requiring referral out of the state. • Bridge Course in Community Health - Under Universal Health Coverage, the Bridge Course in Community Health has been rolled out by the State. 2 District Hospitals in each of the division have been selected as Programme Study Centres. 50 candidates selected for undergoing the

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State Perspective

J&K Improving Health Status via Primary Healthcare

State Perspective

Bridge Course in Community Health for nurses. Ministry of Health & Family Welfare, GoI has introduced a new concept of “Health & Wellness Centres” whereby, the existing Sub Centres will be transformed to serve as first point of care for comprehensive primary health care closer to the community which will include screening for Non-Communicable Diseases like Hypertension, Diabetes and Cancer. • The Nurses trained for Bridge Course in Community Health shall be deployed in the selected Sub Centres to work as middle level health providers (Community Health Officers). • Pradhan Mantri Surakshit Maitritiva Abhiyan – It was launched in the State on 9th of June 2016, an initiative for detecting high risk pregnancies to reduce maternal morbidity and mortality in the State. Hot Cooked food is being provided to the pregnant woman during ANC check-ups (on 9th of every month) in convergence with the ICDS department. This initiative was started on 9th February, 2017 in the selected districts of the State.

Technology has been playing a vital role in improving the healthcare service delivery of the State.

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• With this initiative, State envisions to improve coverage and quality of absolute neutrophil count (ANC) among pregnant women and to promote inter-sectoral convergence among departments of same goals and interests. Box-- Pradhan Mantri National Dialysis Programme Request for Proposal (RFP) for Public Private Partnership (PPP) between State Government and service provider was floated but not a single bid was received. To provide benefits to patients suffering from Renal Diseases state has decided to implement this programme in the first instance in two districts of the state through State resources. 10 District Hospitals (5 in each of the division) have been identified for implementation of Pradhan Mantri National Dialysis Programme. • ‘Mother’s Absolute Affection’, a new initiative for promotion of breastfeeding has been launched in the State with an aim to reduce the neo-natal infections, mal-nutrition and reduction in Infant Mortality Rate. Training of Trainers (ToTs) has been completed in both the divisions and ASHAs are also being sensitized.

How integration of technology is supporting the monitoring and evaluation of the healthcare service delivery in J&K? Please share with us some technology initiatives. Technology has been playing a vital role in improving the healthcare service delivery of the State. We have launched the various portals for the monitoring and evaluation of healthcare delivery which involves web portal of NHM J&K, PCPNDT Portal, Human Resource Management Information System (HRMIS) Portal, Drugs and Vaccine

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Distribution Management System (DVDMS) –e Aushadi Portal. The webportal www.nhmjk.com provides the detail information to the public regarding the vision, mission and various activities of the health department including the details of the various schemes as well as the list of beneficiaries under JSY, JSSK, RBSK, etc is in the public domain. To monitor and evaluate the progress of implementation of PCPNDT act in the state, the State has launched the web portal which provides complete information regarding the Ultrasound Clinics, uploading of Form F, the activities being carried out in various districts for improving the sex ratio and Beti Bachao Beti Padao programme. The State has recently launched Human Resource Management Information System portal wherein the manpower of the state is being uploaded in the web portal to improve management and accountability of public health services. We have have introduced dedicated e Aushadi portal for management of drugs and Vaccines distribution system from procurement to end user. The state is using the various portals of Government namely HMIS, RCH, TMIS, Mera Aspataal etc

NCDs have become threat to life which needs to be controlled at fast pace. To reduce risk factors of NCDs among the people of the State, what steps are you implementing to prevent, manage and keep check on NCDs? Epidemiological Transition shows deaths from the four major NCDs –Cancer, CVD, Diabetes, and all respiratory diseases which accounts nearly 60% of all mortality The State has taken initiative for screening of 30 plus population for common Cancers (Breast, Cervix and Oral) and Non Communicable Diseases like Hypertension, Diabetes at CHC,

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Comprehensive Primary Health Care State is moving forward in implementation of Comprehensive Primary Health Care. 75 Health and Wellness centers are being established for providing comprehensive primary health care in first instance. These are going to be upgraded Sub Centres, wherein additional staff either GNM or Ayurvedic Doctor with six months training in Community Health (Bridge Course) will be posted as middle level health provider.

Partnerships are key to tackle global rise in NonCommunicable Diseases. Have you adopted any Partnership model to root out NCDs? And, what’s your opinion on government and private partnership in this regard. Given the complex nature of health systems and the diversity of needs

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and expectations from a large heterogeneous population belonging to various socio-economic and cultural groups, no single agency can satisfactorily address the health needs. Hence governments, corporate sectors, NGOs and other sectors of societies have to enter into mutually beneﬁcial partnership to serve the health needs of the poor and the lower income vulnerable population. These partnerships have to be well thought out, structured and open to independent assessment to ensure transparency and outcome. The State has entered into various partnerships after floating NIT for screening of Breast Cancers in the four districts of the state in first instance. The private partners will provide services in the four identified districts, wherein the screening of the women will be done for detection of breast cancer.

What have been your achievements? Unique Institutionalization of ASHA Support Structure in J&K State has been selected as the Best/ Replicable practice by the Ministry of Health & Family Welfare at the National Summit held on 29th of August 2016 to 31st August 2016 at Tirupati, Andhra Pradesh, and by the Govt. of Rajasthan during the 2nd Annual Healthcare Summit and Awards on 23rd September, 2016 at Jaipur, Rajasthan. • NHM, J&K has also received Best Practices/ Innovations award for Screening and Orientation of ASHAs and ANMs on Non –Communicable Diseases, by Ministry of Health & Family Welfare at the ‘National Summit on Good and Replicable Practices and Innovations in Public Healthcare Systems’ held on 6th to 8th July 2017 at Indore, Madhya Pradesh. • Kashmir Skills and Simulation Centre has been established at Regional Institute of Health

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The State has entered into various partnerships after floating NIT for screening of Breast Cancers in the four districts of the state in first instance.

& Family Welfare, Dhobiwan, Kashmir. This centre is first of its kind in the public sector across the country. The centre is deliberating immense increase in skills and expertise among the health personnel and shall be very relevant if this simulation centre is replicated across country. Health Personnel of Directorate of Health Services, Kashmir are being trained on regular basis on various training simulation modules. • All the trainings conducted on these mannequins and simulators are being continuously monitored and regular feedback from the trainees is being analysed. In addition, impact assessment studies are being regularly conducted in institutions where the trained staff is being deployed. Considering the feedback this institution and the skill based interventions are providing huge dividends to the Department. • This simulation lab has also bagged an award by Ministry of Health & Family Welfare at the ‘National Summit on Good and Replicable Practices and Innovations in Public Healthcare Systems’ held on 6th to 8th July 2017 at Indore, Madhya Pradesh.

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State Perspective

PHC and Sub Centre level. 4 Districts of the State viz. Udhampur, Doda, Anantnag and Kupwara have been selected on pilot basis. State Trainers for ANMs and ASHAs have been trained by NHSRC and District Trainers are trained at the State level. The District level trainings are completed and ASHA’s are trained to roll out population enumeration – creating a family folder/health record. State is using the services of dedicated staff of RBSK and RKSK programmes for dissemination of information regarding risk factors of common NCDs and the measures thereof in the adolescents and general population. Similarly the staff of National Tobacco Control Programme (NTCP) is providing IEC and BCC activity and dedicated Tobacco Cessation Centers have been made functional. Leh District has been notified as Tobacco Free District in the state.

State Perspective

Innovating to Make Sikkim NCD-free The Health Department is concerned about increasing number of Non Communicable Diseases (NCD) in the state and under the state flagship programme CATCH each individual is screened for all the diseases including NCDs, says Vishal Chauhan, Commissioner-cumSecretary Health Care, Human Services and Family Welfare Department, Sikkim, in an interview with Ritika Srivastava of Elets News Netowork (ENN).

Vishal Chauhan

Commissioner-cum-Secretary Health Care, Human Services and Family Welfare Department, Sikkim

How is your Department working towards providing best health services to the people of Sikkim? The Department of Health Care, Human Services and Family Welfare Department of the State is always endeavouring for strengthening the primary, secondary and tertiary level care in the right direction in terms of its infrastructure, man power and community participation. The State is one of the good performing state with Infant Mortality Rate (IMR) of 16 per/1000 live births, Institutional Delivery 98.4 per cent (HMIS 201617) and Immunisation coverage of 95 per cent (HMIS 2016-17). The Department is providing free essential drugs and diagnostics in all public

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health facilities. In addition, the Government of Sikkim has launched the state flagship programme called Chief Minsterâ&#x20AC;&#x2122;s Comprehensive Annual and Total Check-up for Healthy Sikkim (CATCH) in 2010 under our visionary and dynamic leader Shri Pawan Chamling, Honâ&#x20AC;&#x2122;ble Chief Minister of Sikkim. This is a programme to provide a comprehensive annual and total health check-up to all the citizens for appropriate intervention individually and collectively to make the Sikkim healthiest state in the country. Till date, the first phase of the programme has been over and we are now implementing second

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phase of the programme. Under this programme, health card is issued with the unique identification number to all the citizens of the state and the planning is to use it for providing healthcare services in future.

What is the impact of ICT in the field of medical science, how is your Department delivering healthcare solutions through technology in the state? In the modern era, the role of ICT in the field of medical science is immense. In Sikkim, we are utilising ICT for timely reporting and monitoring of health programmes through Health Management Information System (HMIS) under

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Please update us in the recent scheme being undertaken to deal with the Non Communicable Diseases? The Department is concerned about increasing number of Non Communicable Diseases (NCD) in the state and under the state flagship programme CATCH each individual is screened for all the diseases including NCDs like hypertension, diabetes, cancers, strokes, etc. The State has implemented National Programme for Cancer, Diabetes, Cardiovascular and Strokes (NPCDCS) under the NHM. The population based screening of NCDs has already been started since this year.

What actions has your Department initiated under PCPNDT Act? The PCPNDT act is being implemented in the state of Sikkim since 1996. The statutory bodies as per the Act are in place and functional. Regular meetings of the Advisory Committee of the State and district level are being conducted. The State inspection and monitoring committee is also formed to monitor the diagnostic centres on a regular basis. The Department is organising various IEC activities in all the

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districts of state. A video spot on PCPNDT awareness is also developed as a part of IEC activities. The Department has also developed website on PC & PNDT Act which was launched on 7th April 2016 by Honâ&#x20AC;&#x2122;ble Chief Minster of Sikkim (www.sikkimpndt.org). The child sex ratio of the State is 957 (Census 2011).

State Perspective

National Health Mission. It is being used for tracking of pregnant mothers and infants through RCH portal. The Department is now in a process to utilising health card under CATCH programme. We have also implemented Public Finance Management System (PFMS) for making transparency in transaction under NHM. The Direct Benefit Transfer (DBT) to the beneficiaries is also in place. We are in a process to implementing Drugs and vaccine Distribution Managements System (DVDMS) for better stores management in the state.

How your Department plans to improve the healthcare system of Sikkim in the coming years? The Department is planning to improve the public healthcare through transforming Primary Health Sub-Centres (PHSCs) into health and wellness centre for providing comprehensive public health services in the phase manner. The Department is also planning to strengthen all the CHC and district hospitals in terms of its infrastructure, manpower, equipment and other facilities. The CATCH programme would be strengthened and the health card generated under this programme would be linked to the hospital based treatment in near future. The tertiary health care would be enhanced by operationalisation of the up-coming 1,150 bedded multi speciality hospital situated at Socheygang, Gangtok and the Department is also considering to have Government medical college in order to produce specialised manpower so as to overcome the issues of human resource. The Department is also providing high priority in containing the tuberculosis programme in the State. In addition to RNTCP a separate state specific programme is also planning to be considered in near future. As an alternative to modern medicine, AYUSH is also given a high priority in the State. A 10-bedded AYUSH hospital is functional in the state capital. A 50-bedded AYUSH hospital is under construction at west district and a Sowa Rigpa Teaching Institute is coming up at Gangtok.

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The Department is concerned about increasing number of Non-Communicable Diseases (NCD) in the state and under the state flagship programme CATCH each individual is screened for all the diseases including NCDs like hypertension, diabetes, cancers, strokes, etc.

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State Perspective

Vision NHM Gujarat Creating Healthcare System for All

To provide primary, secondary and tertiary healthcare at the door steps of the people in Gujarat, the State National Health Mission has implemented considerable innovative programmes, says Dr Gaurav Dahiya, Mission Director, National Health Mission, Gujarat in an interview with Rajbala of Elets News Network (ENN).

Dr Gaurav Dahiya

Mission Director, National Health Mission, Gujarat

Please share the latest initiatives undertaken by the National Health Mission, Gujarat? Under the Government of Indiaâ&#x20AC;&#x2122;s flagship National Health Mission (NHM) programme, NHM Gujarat aims to provide accessible, affordable, and quality healthcare to the people of the State. We are majorly focussed on key issues like immunisation, maternal and child health, noncommunicable diseases, mental health, etc. We ensure building and providing quality healthcare infrastructure with an objective to improve health indicators of the State. In addition to that, we continuously keep check and do assessment of infrastructure, HR and all implemented programmes to facilitate access to quality healthcare

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services within the State. With such initiatives, we are moving towards accomplishing Sustainable Development Goal 3 (SDG 3), which relates to ensuring healthy lives and promoting well-being for all at all ages. In this context, we are committed to develop from Millennium Development Goals (MDGs) to Sustainable Development Goals (SDG) for building a healthy Gujarat. Secondly, to strengthen the quality healthcare services in the State we focus on providing trainings to enhance the practical skill-building in real-world clinical scenarios. We believe that it is vital to raise the bar of compassion in medical trainings. Moreover, we have initiated strict and regular monitoring of programmes executed in the State. This initiative plays an important role

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in successful execution of various programmes. With proper monitoring and evaluation of programmes, we seek to establish transparent healthcare services in the State.

Which schemes and programmes have been implemented by you to target Non-Communicable Diseases and implement Pre-Conception and PreNatal Diagnostic Techniques (PC & PNDT) Act in the State?Â To control the Non-Communicable Diseases, under NHM, the National Programme for Prevention and Control of Diabetes, Cancer, Cardiovascular Disease and Stroke (NPCDCS) has been implemented in all 33 districts of Gujarat. Over 18 lakh people have been screened for diabetes and hypertension and

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Tell us about the health and medical care facilities created in the State by NHM Gujarat? In the last five years, the infrastructure of Health Department developed keeping in view the rural health statistics. In 2012, there were 7,274 sub centres which have now increased to 9,206. There were 1,193 Primary Healthcare Centers (PHC) in 2012 which have now

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increased to 1,489, while the number of Community Healthcare Centres (CHC) was increased from to 298 to 363. Presently, the State has 143 blood banks, 42 dialysis units, 20 trauma centres, 145 Mobile Health and Mobile Medical Units functional in the State.

What actions have been taken by the Health Department to create adequate educational facilities for medical and paramedical manpower in the State of Gujarat? During my tenure as Mission Director, NHM Gujarat was awarded the first award for Outdoor Patient Department (OPD) services and the third award for Indoor Patient Department services (IPD) among all states by the Ministry of Health, Government of India. In order to cater to the healthcare needs of the country, India needs a large number of doctors and there lies a tremendous scope for establishing new medical institutes to create world-class doctors and clinical practitioners. So, moving one step ahead, we have developed numerous medical education institutions in Gujarat. A total of 23 medical colleges are functional in the State, including five private ones and one trust-run. As many as seven more medical colleges will be developed in near future. The State has 105 institutions for Auxiliary Nurse Midwife (ANM), 112 for General

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During my tenure as Mission Director, NHM Gujarat was awarded the first award for Outdoor Patient Department (OPD) services and the third award for Indoor Patient Department services (IPD) among all states by the Ministry of Health, Government of India.

Nursing and Midwifery (GNM) and 64 offering B.Sc in Nursing. Nursing institutions have been set up to provide training to paramedical manpower. Diplomate of National Board (DNB) courses are going to be introduced in as many as six centres, these are: Nadiyad, Mahesana, Navsari, Vadodara, Mental Hospital Ahmedabad and Vadodara.

What are the future plans to improve healthcare delivery in the State? We are aggressively working to develop healthcare delivery system in the State and take it to a new level. Our major focus is on mother and child health, mental health and countering Non-Communicable Diseases (NCDs). Quality of health services, infrastructure, trained HR and development of transparent healthcare system will be given major push and for which we have already initiated various programmes.

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State Perspective

Non-Communicable Disease clinics have been started in 19 districts of the State. In addition to that, two more initiatives have been started to prevent NCDs, namely, ‘Diabetes Screening Abhiyan’ and ‘Breast Cancer and Cervical Cancer Screening Abhiyan’. We have initiated free of cost screening for breast cancer and cervical cancer in peripheral health centres and district hospital. To implement the provisions of PC & PNDT Act, the State has established a PCPNDT cell at State and district levels for effective monitoring and supervision of sex ratio. By June 2017, over 5,558 clinics and hospitals were registered under PC& PNDT Act. Under these initiatives, 205 court cases have been filed in lower courts against clinics and hospitals, 208 cases in the High court of Gujarat and six in the Supreme Court. Due to this initiative, we have achieved a total 18 convictions under the Act.

special feature

Revisiting India’s Child Sex Ratio Mystery With India facing a challenge to tackle decline in child sex ratio (CSR), the problem appears to have been caused by various reasons including the existing culture and people living in the rural and tribal areas of the country, writes Rajbala of Elets News Network (ENN).

SR reflects both, pre-birth and post-birth discrimination manifested through genderbased sex selection against girls. A look at Census reports offers a sad story. India’s Child Sex Ratio as per 2011 Census stood at 919, which is a decline from 927 as recorded in 2001 Census. Whereas the Sex Ratio in the country stood at 943 as per 2011 Census, a rise from 933 as recorded in 2001 Census.

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(Source: http://www.census2011.co.in/) To prevent falling number of girl child in the country, the Government of India has been actively trying to reverse the decline in child sex ratio by introducing the Pre-Conception and Pre-Natal Diagnostic Techniques (Prohibition of Sex selection) Act (PC & PNDT) in 1994. To ensure prohibition of sex selection, before or after conception, and for regulation of pre-natal diagnostic

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techniques to detect genetic, metabolic or sex-link disorders and to prevent the misuse for sex determination leading to female feoticide, the Act came into force across the country. We detest our daughters. This is the fate of a girl child. There is systematic killing of girls through sex-selected feticide. The girl child’s discrimination begins before birth in the form of female feticide. Sex selection has been argued as the consequence of technology.

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special feature

Our child sex ratio, which is computed for 0 to 6 years of age group, has been falling continuously since 1981. It was 954 in 1981 which fell down to 888 in 2011 census.

Community Mobilisation

“The implementation of PC & PNDT Act is very important for Rajasthan because of the suspicion that many registered centres are engaged in illegal activities, or some unregistered people with unregistered machines are also involved in this sex determination business,” says Naveen Jain, Mission Director, National Health Mission of Rajasthan.

The Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act 1994 has since been amended later. Amendments to the Act mainly cover to: 1. Bring the technique of pre-conception sex selection within the ambit of this Act so as to prevent the use of such technologies which significantly contribute to the declining sex ratio. 2. Bring the use of ultrasound machines within the purview of this Act more explicitly so as to curb their misuse for detection and disclosure of sex of the fetus. 3. Empower the Central Supervisory Board for monitoring the implementation of the Act. 4. Introduce State level Supervisory Board for monitoring and reviewing the implementation of the Act in States/UTs 5. Constitute a multi member State Appropriate Authority for better implementation and monitoring of the Act in the States 6. Make punishments prescribed under the Act more stringent so as to serve as a deterrent for minimizing violations of the Act 7. Empower the Appropriate Authorities with the powers of Civil Court for search, seizure and sealing the machines, equipment and records of the violators of law including sealing of premises and commissioning of witnesses 8. Making mandatory the maintenance of proper records in respect of the use of ultrasound machines and other equipment capable of detection of sex of fetus and also in respect of tests and procedures leading to preconception selection of sex 9. Regulate the sale of ultrasound machines only to the bodies registered under the Act.

Regulations for pre-natal diagnostics techniques: l Prohibition of sex selection l Prohibition on sale of ultrasound machine l Regulation of pre-natal diagnostic techniques l Written consent of pregnant woman and prohibition of communicating the sex of foetus l Determination of sex prohibited Analysis of Pre-Conception And PreNatal Diagnostic Techniques Act: In Hindu mythology and religious texts, there have been examples of Saints giving blessings saying “Shat Putravati Bhava’ (May you have 100 sons!). It gives an impression how much birth of boys than girls has been given importance since olden times, indicating sanction of religion, tradition and culture. Even family elders still bless newly-wedded couples with words that imply: “May you bear many sons.” The above stated things give credence to the concern that biases or inclination for male-child have been existing in the social and cultural system of the country for centuries. It wouldn’t be an exaggeration to view it as one of the reasons of biases against the girl child and female foeticide. Today, technology provides

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l Toll-free Services l Daughters empowerment initiatives l Informer schemes l Setting up PC&PNDT Cell l Integrating technology l Installation of active trackers l Awareness Programmes

sophisticated methods of sex selection. At some places, some people have put up advertisements with crude messages: “Spend only Rs 500 now, save Rs 5, 00,000 (on dowry) later!” The Pre-Natal Diagnostic Techniques Act provides for the regulation of the use of prenatal diagnostic techniques for the purpose of detecting genetic or metabolic disorders, chromosomal abnormalities or certain congenital malformations or sex-linked disorders and for the prevention of misuse of such techniques for the purpose of prenatal sex determination leading to female foeticide and for matters connected therewith or incidental thereto. There is a section of society which feels except for certain conditions, no individual or genetic counseling

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center or genetic laboratory or genetic clinic shall conduct or allow the conduct in its facility of pre-natal diagnostic techniques including ultrasonography for determining the sex of the foetus; and “no person conducting prenatal diagnostic procedures shall communicate to the pregnant women concerned or her relatives the sex of the foetus by words, signs or in any other manner.” The Act provides for the constitution of a Central Supervisory Board (CSB) whose function is mainly advisory and for the appointment of an Appropriate Authorities (AAs) in States and Union Territories to enforce the law and penalize defaulters and Advisory Committee/s (ACs) to aid and advise the AAs.

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State Perspective

The Big Innovations to Make MP Healthy

Madhya Pradesh’s Health Department has come up with many innovations in public health to achieve its aim of creating a healthy State with emphasis on quality, Information Technology and Government policies that are tailored to improve healthcare delivery system, writes Divakar Mukherjee of Elets News Network (ENN).

ot just a big budget, but also the intent and innovations play a vital role in improving any sector in a developing state. Keeping in view this vision, Madhya Pradesh’s Health Department is dedicated to improving its services and reach by introducing many projects. Shri Sai Vishwanathan, MD NHM, Madhya Pradesh, says, “Our focus is to strengthen the health service delivery system in the state especially in villages and in urban slums.” And to make the State healthy, the department has taken many innovative measures. Some of these measures include: E-Aushdhi E-Aushdhi is one of such innovations that has streamlined the Supply Chain Management functions beginning

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from placement of orders to payment, including quality control, which had been a major area of concern. MP Health Corporation, which was established in year 2014-15, launched budget-based MP-Aushdhi IT system with Procure to Pay (P2P) function, generation of online indents, issue and receipts have been incorporated and graphical user interface made simplified. The project has resulted into increased efficiency and improved availability of drugs and consumables across all health facilities in the state and turnaround time of P2P has been reduced by approximately 90 per cent. As MP-Aushdhi ensured timely payment and automation of processes, the corporation expects increased competition, improved quality and reduction in prices of

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drugs and consumables. An initiative of the Madhya Pradesh government is focused on the women and by organising checkup camps in villages, the Health department is taking medical services to their doorstep. Mahila Swasthya Shivir Women Health Checkup Camps – Mahila Swasthya Shivir underlines the Madhya Pradesh government’s commitment towards wellbeing of women of all age groups. According to a National Family Health Survey conducted in the year 2015-16, shows high prevalence of hypertension (7.9 per cent) and diabetes (7.2 per cent) in women of reproductive age group. Madhya Pradesh Government’s Department of Public Health and

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State Perspective

Family Welfare and Department of Women and Child Development had come together to initiate these exclusive women health check-up camps three years ago. These camps extended a wide range of healthcare services to women of all age groups. Women of premenopausal and geriatric age group suffer from gynaecological problems like abnormal uterine bleeding, prolapse uterus etc. and they do not access to health facilities. Infertility is also a cause of immense mental agony and trauma for the couples who are desirous of children. In these camps, antenatal check-up by MBBS/AYUSH doctors for timely identification and management of complications and conduct screening of women for communicable and noncommunicable diseases and ensure timely treatment. In April-May 2017, the checkup camps were organised in 44,974 village in which about 20,50,000 women were examined including 3,60,000 pregnant women and 5,10,000 adolescent girls. As many as 800 anemic women were given blood transfusion and 13000 women were administered iron sucrose. Management of 5,497

november 2017 | ehealth.eletsonline.com

infertile couple has been initiated in District hospitals. Mental Health Programme The Madhya Pradesh Government is not only focusing on wellbeing of physical health of people but also on the mental health, an area which had been long ignored across the country by public healthcare establishments. As per World Health Organisation, it is estimated that by 2020, depression, the most common mental disorder, will be the second leading cause of disability worldwide and at present 10 per cent of global population suffers from some of mental illness. A policy decision was taken to run Mental Health Programme in all 51 districts of Madhya Pradesh. Under which, one medical officer and two staff nurses were trained in common psychiatric disorders from each District Hospital. Mannkaksh programme was launched to provide basic mental health care services to persons suffering from mental ailments. Under it, more than 20,000 patients suffering from mental ailments were given treatment and counselling in 2016-17. The medicines suggested by Government of India for mental

eHEALTH Magazine

The Madhya Pradesh Government is not only focusing on wellbeing of physical health of people but also on the mental health, an area which had been long ignored across the country by public healthcare establishments.

illness have been included in Essential Drug List. Dialysis is a lifesaving process, although costly, for the patients suffering with severe kidney diseases. The process is also, usually, not available in small towns and the patients have to go to big cities for its administration. To bring it to the reach of poor and make it affordable, the government of Madhya Pradesh launched dialysis scheme, a flagship programme of Department of Public Health and Family Welfare, in all its 51 district hospitals. Launched on 26 January 2016, it made Madhya Pradesh the first state in the country to start dialysis facility at district hospital-level. The dialysis services are being provided free of cost to all Below Poverty Line patients and others get the service at nominal charge of Rs 500 per session including all consumables and Medicines. At present, 1,467 patients are registered for dialysis and 91,322 dialysis sessions have been completed. The scheme is now being replicated in other states of the country.

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Office: 412-787-9211 E-mail: swadhwani@swat-capital.com

Sunil Wadhwani Managing Partner, SWAT Capital LLC

unil Wadhwani is co founder and the former Chairman and Chief Executive Officer (CEO) of IGATE Corporation, which provides a broad range of Information Technology services. With over 34,000 employees in four continents, IGATE has been ranked among the world’s leading consulting firms. In July 2015, IGATE was sold to Capgemini of France. Under Sunil’s leadership as CEO, the Company was listed four times in Inc. Magazine’s ranking of the fastestgrowing companies in the United States. It was also named among the “Top 100 Hot Growth” companies by Business Week and placed among the “Technology Fast 50” by Deloitte and Touche. In addition to IGATE, Sunil is the CoFounder and Chairman of the Board of Mastech Corporation, a provider of high-value information technology services and solutions. Mastech is a publicly-traded company with over 800 employees. Sunil is an active angel investor. He

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has invested in over 30 early-stage technology companies and has served on the Boards of several of these ventures. These companies are in a variety of sectors including healthcare, life sciences, software, IT services, social media and financial services. Sunil has written articles for a variety of publications including Datamation, Systems Integrator and Reader’s Digest, and has been quoted in publications such as Business Week, the Wall Street Journal, Information Week and Investors Business Daily. Sunil established the WISH Foundation in India in 2014. WISH has developed a unique PPPdriven, innovation-led model for transforming the primary healthcare system in the lowest income areas in India and other developing countries. This approach brings together the government, private sector partners, and the most promising healthcare innovators. WISH is currently managing over 200 health centres for economically weaker sections of India. The model was implemented in Rajasthan, Delhi, and Assam where

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the outcomes have been remarkable. WISH is in discussions with Governments of Uttar Pradesh and Madhya Pradesh to expand the model to these States most underserved urban and rural areas. Sunil serves or served as a Trustee or Director of the following institutions: l Carnegie-Mellon University l George Washington University l The US Federal Reserve Bank (Pittsburgh Branch) l United Way Worldwide l UPMC Health System l Allegheny Conference on Community Development l Pittsburgh Cultural Trust Sunil is a distinguished alumnus of the Indian Institute of Technology and has a Master’s degree from CarnegieMellon University.

ehealth.eletsonline.com | november 2017

innovations

A Leader in His Own Right

innovations

Transforming Sub-centres into Health & Wellness Centres

healthy infrastructure is a key determinant of health and wellbeing of an individual. The use of technology has transformed things in modern period to the extent that it is called as era of information and technology. The power of information has been realised so effectively that if it reaches timely to the patient and service provider, both can act efficiently and more vigilantly. The health infrastructure now-a-days depends largely on technology for diagnosis, treatment and care. The technology has spread its roots to break the geographical barriers created by man like rural and urban. Learning shows that in three tier health system at primary, secondary and tertiary level, the primary health needs more focus and investment to reduce burden on next level of health institutions. Also, when we talk about primary health, we are more concerned with the preventive and primitive aspect and basic clinical services to maintain good health. Primary health management, begins from Sub Centre (SC) level, is the first check post of health seeker. The health seeking behaviour can be substantially improved if SCs are more empowered to provide primary treatment. To achieve this objective, the Lords Education and Health Society (LEHS) through its flagship programme WISH has made a remarkable initiative of transforming

november 2017 | ehealth.eletsonline.com

Sub Centres into Health and Wellness Centres, which also is in line with one of the thrust areas of National Health Policy 2017 (NHP 2017). NHP 2017 defines Health and Wellness Centre as â&#x20AC;&#x153;the facilities which start providing the larger package of comprehensive primary health careâ&#x20AC;?.

eHEALTH Magazine

The way it is envisaged by LEHS/ WISH is diagrammatically shown in the picture, where key elements of healthy service delivery are brought under one umbrella. National Health Mission too has planned to strengthen sub centres as

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innovations Health & Wellness Centers (H&WCs) for implementing public health programmes better and to enable comprehensive primary health care service delivery, including disease prevention and health promotion. The policy expresses the specific need of providing healthcare in the farflung corners of the country through upgraded sub centers by converting them into Health & Wellness Centres. The initiative of LEHS/WISH will paved the way to transform 1,50,000 health sub centres of the country into a true “Health and Wellness Centres”.

Responding primary health care needs through sub centres The sub centre is the peripheral outpost and the first hope of healthcare for the remote population. It fulfills the basic primary and quality health care needs of the families surviving in difficult circumstances in the remote areas. The centres are usually manned by

november 2017 | ehealth.eletsonline.com

an Auxiliary Nurse Midwife (ANM) whose focus is on primitive and preventive healthcare services, and to act as a referral to the Primary Healthcare Center (PHC) for curative services. But the optimum utilisation of SCs in meeting out their key objective to strengthen primary health is hindered due to factors like poor infrastructure, weak monitoring and supportive supervision, lack of manpower, and geographical barriers. The underutilisation of SCs has also affected the health seeking behaviour of rural population negatively. They either refrains from seeking healthcare services, or resort to alternate solutions which includes unskilled practitioners (quacks, etc.) and when treatments fail, they travel to cities and private healthcare facilities for better quality of care, which leads to over-burdened hospitals, and unaffordable out-ofpocket expenses. Thus, the need to reinvigorate the

eHEALTH Magazine

The sub centre is the peripheral outpost and the first hope of healthcare for the remote population. It fulfills the basic primary and quality health care needs of the families surviving in difficult circumstances in the remote areas. The centres are usually manned by an Auxiliary Nurse Midwife (ANM) whose focus is on primitive and preventive healthcare services.

sub-centres is evident and it can be done by transforming them into well-equipped centres and upscaling as per Indian Public Health Standards (IPHS). SCs as “Health & Wellness Centers” can provide basic medical services to a cluster of population of 5,000 to 15,000 people in rural, sub-urban and urban setup. These establishments will act as a provider of holistic healthcare services package in a single visit and help in taking care of 80% of the healthcare needs with zero cost to the patient and with holistic package of services. Based on this vision, WISH has designed a state-of-the-art solution for addressing the primary healthcare needs in such areas of the country.

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innovations WISH has already been pioneering in showcasing Health & Wellness Centres in Rajasthan.

Health & Wellness Centre

Briefing the Concept

l Neonatal and infant health

The WISH concept of Health & Wellness Centre is based on IPHS. In operative terms, it means that the Health & Wellness Centre should address the preventive, primitive, curative and rehabilitative healthcare needs of the population in its catchment area. The use of technology and innovation are the game changer of rural primary health of Indiathrough Sub-Center.

l l l l l l l l

List of Services to be provided at

november 2017 | ehealth.eletsonline.com

l Pregnancy care and maternal

health services

services Child health Chronic communicable diseases Non-communicable diseases Management of mental illness Dental care Eye care Geriatric care Emergency medicine

The Experience and Learning LEHS/WISH has started H&W Centre at Subcentre Kundali Nadi of Bhadoti PHC at Sawaimadhopur

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and Subcentre Bhajneri at Dugari PHC of Bundi district. These two SCs were selected after analysing the OPD installations on the key parameters like physical condition of SC, feasibility of high speed internet connection, patient load, investment requirement etc. The identified SCs buildings were strengthened to ensure safety of Swasthya ATM. The competent GNM was recruited to manage the H&W centre. In emergency the GNM also support ANM in community mobilisation and service delivery activities. The analysed data of 609 clients at two H&W Centres during the period (July to Sept 2017) shows that about

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innovations

57% male and 43% females have been benefited so far. One of the highlight of the analysis is that about 30% of the beneficiaries are of age 60 years and above. About 30% of these beneficiaries belong to 70 - 90 years. It proves the significance of H&W Centre in not only strengthening primary health care but also the geriatric care because access to healthcare is a challenge for elderly population, particularly in rural areas.

Features of Health & Wellness Centre Model: l l r r l l r r r r

A Typical Model (Rajasthan)

Health & Wellness Centre Patient Registration Doctor Consultation Doctor Consultation Medicine

r r

LEHS/WISH has started H&W Centre at Subcentre Kundali Nadi of Bhadoti PHC at Sawaimadhopur and Subcentre Bhajneri at Dugari PHC of Bundi district. These two SCs were selected after analysing the OPD installations on the key parameters like physical condition of SC, feasibility of high speed internet connection, patient load, investment requirement etc.

Dispensing

l Electronic Health Records (EHR)

Proposed Outcomes

l Improved availability and

accessibility

l Improved health-seeking

behaviour

l Improved community outreach l Reduced out-of-pocket expenses l Increased knowledge and

awareness

l Improved referral and reduced

burden on PHCs/CHCs

enabling evidence based decision making; l WISH to provide technical support for knowledge management and monitoring and evaluation; l Implementation support to transform 5 sub-centres each in 8 EAG states over a period of 4 years;

l Well-aligned to the National

Health & Wellness Centre – Advanced

Health & Wellness Centre - Basic

l Nutrition Supplementation and

Health Policy - NHP 2017

l Round the clock provision of l

l l

november 2017 | ehealth.eletsonline.com

9:00 AM – 5:00 PM services: Human Resource (as per the IPHS-2011 norms – Type 3 SC): Two ANMs One Multipurpose Health Worker (MPW) Drugs, equipment, consumables as per the standard IPHS guidelines Additional unique feature of Swasthya ATM: Tele-consultation by the medical doctor Basic diagnostics Automated medicine vending Digital prescription (with doctor digital signature and his/her registration number) Provision of Electronic Health Records (EHR) enabling evidence based decision making; Referral mechanism (use of 104/108 services) Apart from basic diagnostics, 15 tests can be ensured using PHC or nearby CHC’s Lab technician; ANM/GNM can collect the samples and send to PHC for the tests Use of Point of Care innovative devices for NCD Screening (Diabetes, Hypertension, Cancer)

primary healthcare services; Availability of a doctor through telemedicine, 1 ANM and 1 GNM to provide healthcare services; Provision of essential drugs through medicine vending machines; Basic Diagnostic care; NCD Screening (Diabetes, Hypertension, Cancer etc.) using innovative screening devices;

eHEALTH Magazine

l l

Diet Counselling for adolescent girls and pregnant females; Mental Health Counselling for pregnant females; Disability Care for Visually impaired, mobility impaired people in rural areas; Geriatric Care; m-ECG, m-Partograph etc.

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State Perspective

Innovating to Improve Quality of Life in

Andaman & Nicobar Islands The Health & Family Welfare Department of Andaman and Nicobar Administration has taken up several innovative projects like Air Subsidy Scheme, ANISHI health insurance scheme and e-Hospital solutions to improve the quality of healthcare on the islands, says Monica Priyadarshini, Special Secretary, Health and Family Welfare Department of the island administration, in an interview with Ritika Srivastava of Elets News Nertwork (ENN).

Monica

Priyadarshini

Special Secretary, Health and Family Welfare Department of A&N Island Administration

Brief us about your department’s objective for ensuring affordable quality healthcare services in Andaman and Nicobar Islands? It is a unique feature of these islands that all health facilities are provided free of cost including treatment, investigation, medicines and diet. Only in the case of nursing homes and special wards nominal rates are levied as room charges. Unlike mainland, all PHCs in the Islands have 10-15 bedded inpatient facilities, with X-ray, laboratory, diet for inpatients, ambulance and cold chain facilities. All CHCs are 70-bedded facilities with OT, X-Ray, laboratory, ECG, ambulance and other facilities. The department’s main objective is to provide ‘health for all’.

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Which new healthcare services have introduced by your department for the welfare of the citizen? The services introduced by our department include Air Subsidy Scheme, which has been formulated to facilitate stretcher patients, who need air evacuation to mainland for super-specialised treatment. The patient need to pay only for one seat and the administration pays the rest of the amount for the remaining ones. Under the ‘Dulari’ Scheme for girl child, all the girl children of permanent domicile of Andaman and Nicobar Islands born on or after January 26, 2013 get cash benefits. We also have the Andaman and Nicobar Islands Scheme for Health

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Insurance (ANISHI). The ANI administration decided to launch its own health Insurance Scheme to provide better healthcare to the persons belonging to the BPL category, Government pensioners settled in the Islands with their dependent family members and permanent residents of these Islands with family income up to or below Rs 3 lakh per annum. The ANISHI Scheme provides cashless treatment up to Rs 5 lakh per patients per illness which include indoor and outdoor treatments in mainland.

What digital initiation have taken by you to improve health delivery in Andaman and Nicobar Islands?

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How innovation like telemedicine are impacting people in your state? The telemedicine facility of GB Pant Hospital was started in the year 2003 with the support of ISRO. The network is connected to the various super specialty hospitals at mainland

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@ehealthonline

where ISRO network is available. The VSAT connectivity and the telemedicine equipment required was provided by the ISRO. The facility was formally inaugurated in the year 2003 and it was used regularly by the doctors of GB Pant Hospital. Presently the GB Pant Hospital is equipped with MRI, CT scan and Digital X-Ray Machine all these hospital modalities are DICOM ready. So the patient data can be fetched from the consol of these machines and can sent to any Super-Speciality hospital for tele-consultation as and when required through telemedicine network. To enable the patient data grabbing and sending to SuperSpecialty hospital at mainland requires a PAC server installed at the telemedicine centre of GB Pant Hospital along with LAN connectivity with various sections. Moreover, considering the topography of Andaman and Nicobar Islands the telemedicine services should be expanded to all the remote islands to deliver quality health care services to the far-flung islands for the general public as well as tribal people.

Along with Communicable diseases, non-communicable diseases too pose a big challenge for the healthcare system how your department is addressing this dual challenge? We are planning to establish a noncommunicable diseases cell is these Island. National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) has already been implemented in the Islands and NCD clinics operate here on a weekly basis. For Communicable Disease Active Diseases Surveillance, we carry out various National programmes like IDSP, NVBCDP, etc, throughout the islands.

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What are your department’s goals for improving the healthcare system of the islands in the next five years? The department’s goals include providing curative, preventive, rehabilitative and supportive healthcare services to the community; ensuring availability of quality healthcare on equitable, accessible and affordable basis across islands and communities with special focus on hard to reach areas. We aims to achieve 100 per cent institutional deliveries; reduce Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR); raise child sex ratio in the 0–6 year age group; improve and sustain the standards of antenatal, pre-natal and post-natal care; improve infant and young child feeding practices and provide immunisation against vaccine preventable diseases. One of the important goals of the department is to prevent and reduce burden of communicable and non-communicable diseases¸ put emphasis on hygiene, sanitation and preventive healthcare. An established comprehensive primary healthcare delivery system and well-functioning linkages with secondary and tertiary care health delivery system is a prerequisite for a quality healthcare system. Irrespective of the size of population, all inhabited islands need to have basic healthcare facilities by overcoming the challenge of shortage of trained manpower. Therefore, we are working towards establishing new health institutions in different parts of these islands as per requirement, guidelines and local needs; up-gradation of PHCs/CHCs in outlying areas, wherever necessary; ensuring regular supply of drugs, vaccines, delivery of good quality health and family planning services and strengthening AYUSH facilities in the islands.

ehealth.eletsonline.com | november 2017

State Perspective

The e-Hospital solution (Hospital Information and Management System) from NIC has been implemented at the GB Pant Hospital here. The solution streamlines all the hospital processes across all departments and modalities. Unique patient identifiers are assigned using the system. AADHAAR linking of patient registration is helping to check duplicate registration identifiers. All the admission and discharges are being done centrally. It is helping in 100 per cent accountability of the hospital services being utilised by patients. The authentic hospital statistics is aiding us in planning and improving hospital facilities. The interconnected HIS is helping us reduce drug misuse as the dispensing pharmacist is aware of when any drug was dispensed to a patient. The upgradation of IT backbone at GBPH has also been undertaken by us, which includes development of a robust Local Area Network (LAN) with at least 1 Gigabit bandwidth for each node. The interconnecting uplinks are of 10 Gigabits. The entire new infrastructure is based on open source software and operating systems thereby saving lakhs of rupees. We have also implemented a Microbiology Reporting and Information System. It has allowed analysis of database of over 20,000 microbiology cases over a period of two year. Some other initiatives include Medical Records and ICD Coding System, Staff Intranet portal and a Digital Signage solution.

Norway-India Partnership

Innovating to Improve Paediatric Care in Hospitals Norway India Partnership Initiative (NIPI) established in 2006 provides catalytic, strategic and innovative support to the National Health Mission for accelerating mortality reduction in new-born child and related maternal health, writes Dr Harish Kumar, Project Director, Norway India Partnership Initiative (NIPI) Newborn Project, for Elets News Network (ENN).

Dr Harish Kumar

Project Director, Norway India Partnership Initiative (NIPI) Newborn Project

acility-based emergency and inpatient care can bring down mortality in children who are seriously ill and those who are referred to hospital in time. Under the National Health Mission, district hospitals have been positioned in the continuum of care as the referral health facilities, because these are the most important units in a district with regards to provision of specialist care. An ‘Assessment of quality of Care for Children in District Hospitals in India’, conducted in 2014 across four states of Rajasthan, Bihar, Madhya Pradesh and Odisha showed that none of the 13 district hospitals covered had a system for triage and emergency care for sick children.

november 2017 | ehealth.eletsonline.com

Precious time was lost during transfer of children to paediatric ward for treatment initiation. There were no specific guidelines for operationalisation of paediatric care facilities. The staff was not trained in emergency care or in triage, supervision was not in place in the five district hospitals. Moreover, the laboratory services were slow to provide results or did not provide services 24 hours. There was no observation area or high dependency area for the sickest children and resulted in delays of transferring children to the wards and initiating care. It emerged from the report that strengthening emergency paediatric care was as a priority area for intervention.

eHEALTH Magazine

Strengthening paediatric care under Norway India Partnership Initiative Norway India Partnership Initiative (NIPI) established in 2006 provides catalytic, strategic and innovative support to the National Health Mission for accelerating mortality reduction in new-born child and related maternal health. The approach used by NIPI is to try out innovations and implement them in the ‘incubator or demonstration’ mode in some key identified areas before offering them for the country wide scale up. Implementation process A comprehensive approach was undertaken in the five district hospitals with the following key steps:

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a) Establishment of National or State Technical Advisory Group for strengthening paediatric care b) Development of Operational Guidelines c) Gap Support funding for structural adaptations d) Establishment of Resource Centre Paediatric Emergency Model e) Sharing implementation results g) Scale up Model established at Alwar There was a visible gap in the paediatric emergency services at the District Hospital Alwar. The paediatric emergency cases were being attended at the emergency services located in the district hospital campus which is about a kilometre away. Precious time was being lost during transfer of children from General hospital emergency to paediatric wards located in the maternal and child health section across the road leading to child mortalities. In order to address these gaps, ETAT initiated in October, 2015 at MCH wing of the District Hospital Alwar. A ward space (12 metres X 6 metres) located at the entrance of newly constructed MCH wing was

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identified for ETAT. The civil work for minor changes and partitioning was carried out with NIPI support. The Triage Section, High Dependency Unit (HDU) and Diarrhoea Treatment Unit (DTU) were established. Most essential equipment and drugs required for ETAT and HDU were received from state NHM. The ETAT protocols are prominently displayed for standard treatment as per the diagnosis. Three Medical Officers (Paed.) and 4 Nursing staff of District Hospital were imparted three days training of ETAT at Kalawati Sharan Hospital, New Delhi during year 2015. One nursing incharge and three staff nurses trained in ETAT/FIMNCI module are deputed to work at ETAT. One paediatrician on rotation basis has been posted during day hours at ETAT (non-OPD hours). All emergency and priority cases during OPD hours are triaged by ETAT staff and treated immediately at ETAT while sick children during non-OPD hours are treated at ETAT with focus on children presenting with emergency signs. Separate patient case sheet, reporting formats and ETAT registers are being used for proper documentation.

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With the establishment of ETAT, the patients are being triaged using the following categories: • Those with emergency signs requiring immediate emergency treatment. • Those with PRIORITY SIGNS, indicating that they should be given priority in the queue, so that they can rapidly be assessed and treated without delay. • Those who have no emergency or priority signs and therefore are NON-URGENT cases. Impact of ETAT operationalisation The lag time in treating the severely sick children were reduced resulting in possible reduction of mortality of severely sick children. During year 2016 (Jan-Dec 2016); 12,931 children were treated at ETAT including 1246 children presented with emergency signs and 920 children with priority signs. During year 2017 (Jan-Sept 2017); 16,104 children were treated at ETAT including 1070 children presented with emergency signs and 1029 children with priority signs. 1,555 children in year 2016 and 1981 children in year 2017 (upto Sept 17) were investigated in ETAT itself. Implementation results across five centres in four states: Across five sites in India, a total of 27,723were children attended of which 3,252 (12%) presented with emergency signs and 4,229 (15%) presented with priority signs. Scale up: The state of Madhya Pradesh has scaled up in 42 district hospitals with state budgets. Similarly, the state of Odisha is strengthening paediatric care in its five health facilities. The state of Bihar is scaling up in two health facilities. The catalytic model started under NIPI is now setting the agenda for strengthening paediatric care services across the country.

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Learning is a Never Ending Process Chhattisgarh is a tribal state and has many tribal dance forms of its own. It is part of the rich tribal culture. In a way, the folk dance of Chhattisgarh has an influence over Raigad Kathak, says Kathak exponent and a symbol of women power Yasmin Singh, in an interview with Susmriti Sahu of Elets News Network (ENN).

Yasmin Singh

Kathak exponent

Tell us about your journey as a Kathak ensemble. What motivated you to carry on? Kathak is an Indian classical dance form and I started training in it at the age of 10 when I was in Indore during my father’s posting there. I was studying in a convent school and my Kathak Guru used to come visit our school to impart training to us. That was when I started learning performing art as a hobby. It went on for few years and my hobby took a backseat when I started pursuing higher education. I was focusing more on my career. I did my post graduation in history followed by M Phil and B.Ed. When I started working as a lecturer in college, I continued practicing Kathak because it was my passion. Although I was practicing the art form regularly at home as a hobby,

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the formal education was missing. After working for few years as a lecturer in college, I got incline towards social work and therefore decided to do my Masters in Social Work from Mysore University. Following this, I started working in the developmental sector from 2004 onwards. Presently I am working in ‘Swachh Bharat Abhiyaan.’ In 2004, I came to Chhattisgarh and got an opportunity to start my formal education in Kathak from Indira Kala Sangeet Vishwavidyalaya in Khairagarh, which is close to State capital Raipur and has affiliated college there. I took admission in first year and started formal education in Kathak. It took me eight long years to complete my formal education in the classical performing art. At the same time, I started

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inviting and visiting certain Gurus of Lucknow Gharana and Raigarh Gharana to start learning Kathak under the ‘Guru Shishya Parampara.’ So, the institutional learning along with traditional learning went on hand in hand. I believe that learning is a never ending process and it continues till date. So, after training hard till 2009 my Guru thought that I was ready for a stage performance and that’s how my journey as a performing artist began in May 2009. I used to read a lot of books when I was pursuing institutional learning. Reading more and more about Raigad Kathak helped me turn my hobby into passion. I realised that Raigad Gharana was unique when I learnt about its finer nuances. The school introduced a lot of

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What do you think needs to be done in Chhattisgarh for the growth of this traditional art forms? Chhattisgarh is a tribal state and has many tribal dance forms of its own. It is part of the rich tribal culture. In fact, Maharaja Chakradhar Singh learnt Kathak from Gurus of Lucknow Gharana and Banaras Gharana. Achchan Maharaj ji, father of Birju Maharaj ji, who is the leading exponent of the Lucknow Gharana of Kathak dance, lived in Chhattisgarh for 10 years. So, the king not only learnt the art form himself but also

encouraged the local tribal dancers to learn the art from the masters. In a way, the folk dance of Chhattisgarh has an influence over Raigad Kathak. Art and culture needs to be patrnonised for their promotion. In olden days it was kings and influential people of the society who used to play this role and now t is the Government which does that. We need a robust environment in which the support of government should go hand in hand with social appreciation.Â

What do you think is your major achievement as a Kartik artiste? I think my major achievement

My message would be that women were created by the nature to bestow a balance. If this evil practice of female foeticideÂ is not stopped immediately, it will create imbalance in our society.

as an artiste is that I am still able to practice this art form. I feel that practice is the most satisfying thing for an artiste and performing on stage or getting fame is an entirely different aspect. I am fortunate to have received right training, which for me is a major achievement.

What is your message for a State like Rajasthan, which is struggling to contain a high rate of female foeticide? My message would be that women were created by the nature to bestow a balance. If this evil practice of female foeticideÂ is not stopped immediately, it will create imbalance in our society. If you play with nature, it will never forgive you. So it should be stopped immediately.

What is your message for the Government of Rajasthan who have taken an initiative to celebrate girl child? My good wishes are with the Rajasthan Government for taking up this initiative. I am very happy to learn that the Government is organising such events. I wish that this initiative involves the general public to make it a grand success.

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Daughters are Precious

innovations in Kathak from 1925-30 under the patronage of local king Chakradhar Singh, who passed away when he was only 40 years old. His creations, contributions and the volumes of books he wrote did not survive for long. I am still trying to understand his contributions through research. All this is adding to my passion for Kathak. So this has been my journey so far.

NGO Perspective

V Can Give Them Hope Saving Smiles Resolved to bring smiles on the faces of those who are without hope, voluntary organisation V Can Give Them Hope (VCGTH) is working tirelessly to make a difference in the society, writes Apoorva Krishnakant Pathak, Trustee, VCGTH, calling for actions on issues that need to be addressed for common good.

Can Give Them Hope (VCGTH) is a voluntary organisation set up by wives of Indian Administrative Service (IAS) and Indian Police Service (IPS) officers with an objective to provide help to helpless and hope to hopeless through small and meaningful interventions. The voluntary organisation organises its own resources to carry out its welfare activities and does not depend on donations from outside to achieve its

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Dr Rekha Singh, Founder and Mrs Apoorva Singh, Trustee of VCGTH at one of the social activities organised by the organisation.

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novel goals. Initially, a newspaper headline disturbed the founders as many people were admitted in Jaipuria Hospital after consuming polluted water. So, as a first step VCGTH decided to help admitted patients by providing them some useful material and by spreading awareness among them.

As any festival is incomplete without sharing its joy and happiness with others, VCGTH as a team celebrated few festivals like Diwali and Christmas with them. The organisation believes in being someone’s Santa who can bring happiness and smile on their faces.

Thereafter, the voluntary organisation decided to informally adopt paediatric ward of the same hospital as the founders believed that children are the most sensitive section of our society and they become very vulnerable when they are in hospital. So, few interventions to share their pain and to make them bit happy and cheerful were made by VCGTH in the form of redoing the interiors of the wards by cleaning, painting and by putting new curtains.

Recently, this voluntary group organised a second blood donation camp. A bilateral platform named as ‘Muktangan’ is also running successfully which is a platform for haves and haven’t where they can share the joy, warmth and happiness by giving and receiving things they want. VCGTH believes that God has showered his blessings on us by making us women because a women can become mother of her own child as well as mother of all those underprivileged and helpless people who are in control of their destiny.

A special toy zone, playing zone, a small library with few magazines and books were set up and computer, LED screens were installed in the ward so that children can feel good.

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“It is believed that you give very little when you give from your possessions in true spirit you give something when you give it from and within yourself.” Hence, VCGTH’s next target was to donate blood with a message that giving blood to someone is something which neither tears of any mother nor wishes of well wishers can give at the time of emergency. To encourage others, the organisation looked for some eminent faces to spread the message in the society that if a Secretary, Chief Minister or a Collector of any district can give blood then why can’t you?

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NGO Perspective

As the next project, VCGTH took makeover of gynaecology ward by changing its interior and installing a sanitary pad vending machine. General awareness seminars for the sensitization towards mensturation cycle are conducted for rural and urban poor girls regularly. December 1 is observed as the World AIDS Day. To celebrate the day, a creative platform was recently presented by the organisation for the HIV positive children who were abandoned. A very attractive wall full of messages was painted by the volunteers in order to spread awareness regarding HIV.

Industry Perspective

Truworth

Reinventing Employee Health Benefits Model Truworth, in partnership with leading health insurance companies, has designed structured and outcome driven health benefits plans for the employers that has been proven to check the growth in insurance costs and improve the wellbeing of the employees, says Rajesh Mundra, Founder and CEO of Truworth Health, in an interview with Elets News Network (ENN).

Rajesh Mundra Founder and CEO Truworth Health

Tell us about Truworthâ&#x20AC;&#x2122;s market solutions. Truworth provides multiple health and wellness technology solutions for population health management. Our flagship solution for workplace wellness has been used by over 150 corporates and has reached to more than one million employees over a period of five years. Truworth also provides telehealth solutions for biometric screenings of NCDs and is launching a mobile enabled solution for universal health screening of NCDs by National Health Mission. This solution is multilingual and can be easily used by health workers like those associated with Accredited Social Health Activist (ASHA) programme and Auxiliary Nurse Midwives (ANMs). The solution uses Bluetooth-

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enabled 2 in 1 device for the measurement of blood sugar and blood pressure and the cost of the device and sugar strip is low and very competitive. This solution can easily replace the current manual method without any additional costs and can bring tremendous cost efficiency, speed and transparency in the implementation. Apart from this, Truworth also provides solutions for practice management, telehealth consultations and chronic disease management.

Employer wellness programmes have grown rapidly in recent years with the interest in making an impact on employeesâ&#x20AC;&#x2122; health. How does Truworth ensure delivery ofÂ successful programmes?

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Tell us about the programmes introduced? Truworth Wellness is reinventing the employee health benefits model by integrating technology into every aspect of health and benefits including management and delivery. Truworth, in partnership with leading health insurance companies, has designed structured and outcome driven health benefits plans for the employers that has been proven to check the growth in insurance costs and improve the wellbeing of the employees. Truworth Wellness engagement platform motivates the employees to remain healthy and happy enabling deviated lifestyle modifications through a gamified and socialised approach that is rewarding and incentivising. The technology

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Pioneering the Fastest,Transparent & Optimized Solutions for NHM Project

UNIVERSAL HEALTH SCREENING OF NCDS

Industry Perspective

platform also brings the entire health and wellness benefits ecosystem under one roof bringing in convenience and enabling better management and delivery of health benefits. Truworth Wellness data and analytics platform enables continuous, real-time monitoring to prevent hospital admissions, reduce avoidable spending, and identify and better manage chronic diseases.

Biometric health screenings are increasing in popularity and are being implemented by an increasing number of employers. What are the goals, overarching considerations and methods to execute biometric screenings and how can that help in improving healthcare conditions of users? This is the most important aspect for reducing the healthcare burden of the population and should be mandatorily adopted by the Employers becoming a part of the employee appraisal. Currently, the adoption rate of biometric screenings at corporate population is less than 50 per cent and with the growing incidence of stress and sedentary lifestyle this number needs to go up. Every employee should undergo minimum NCD screening twice a year and full preventive check-up

once a year. The NCD screenings can be easily adopted onsite using telehealth solutions that are very user, friendly. Post the assessment of the population, the employers can initiate the wellness programmes targeting the population. The structured outcome-oriented programmes of Truworth Wellness had demonstrated the decrease in the healthcare claims and costs when run over a period of three years and we have case studies to show that.

What are the key government initiatives to ensure the sectorâ&#x20AC;&#x2122;s growth? One of the key initiatives that the Government should take is to increase the tax exemption limits for health insurance plans that includes wellness and preventive health checks. The IRDA should also recognise the specialised Wellness Companies as important part of the health insurance eco-system. The Government is one of the largest employers and provides free healthcare and should adopt the structured outcome oriented wellness programme that can reduce the heathcare burden on the finances and the resources of the government.

Truworth is soon going to launch specialised wellness plans with insurance in partnership with leading health insurance companies. Truworth Wellness also plans to extend the marketing reach for its platform to the other geographies such as MENA, APAC and USA.

Please give us a brief overview of the emerging trends in the wellness sector. One of the most significant emerging trends is the increased focus of insurance companies on the wellness and making it a part of the policy. Insurance companies are now rewarding the members by reduction of premium if the member is adopting the accepted wellness behaviour and maintain the healthy vitals.

What are your future expansion plans? Truworth is soon going to launch specialised wellness plans with insurance in partnership with leading health insurance companies. We shall soon be launching our solution for NHMâ&#x20AC;&#x2122;s Universal Health Screening project and first pilot is expected to be rolled out very soon. Truworth Wellness also plans to extend the marketing reach for its platform to the other geographies such as MENA, APAC and USA.

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Ipas Development Foundation Ipas Development Foundation (IDF) is dedicated to preventing and managing unwanted pregnancies. At IDF we believe that no woman should have to risk her life or her health because she lacks reproductive health care, and every woman must have the opportunity to manage her fertility. IDF is a not-for-profit company registered under section 25 of The Companies Act 1956 and is the local partner organization in India for Ipas. From pilot projects in three districts in 2003 we now have a program that spans 12 states1. Our focus areas have expanded over the years and now include:  TRAINING of eligible providers in clinical and counselling skills for comprehensive abortion care and comprehensive IDF’s coverage in India contraceptive care  PROVIDING TECHNICAL ASSISTANCE to the national and state governments to bring about increased commitment to the sexual and reproductive health of women  Working with COMMUNITIES to expand their knowledge of reproductive health  RESEARCHING the impact of unsafe abortion and documenting best abortion care practices and policies  WORKING TO ENSURE YOUTH ACCESS to comprehensive reproductive health services and information, including contraception and safe abortion care  BUILDING STATE-LEVEL CAPACITIES to ensure sustained advancement of the CAC agenda IDF has a highly professional and Key highlights of our work so far: system oriented work culture adept at  8,450 doctors trained as comprehensive abortion scale up of programs in collaboration care providers with the government sector. IDF's CAC  2,388 health service providers trained to offer training program received the high-quality contraceptive care International Organization for  More than 1 million women, including young Standardization (ISO) certification of women, served through IDF’s interventions – 9001:2015. more than 50% of these women were poor Further, as a testament of IDF’s hightrust, high-performance work culture; in 2017 we have been identified as one of the 10 best NGOs in India to work for by Great Place to Work® institute, a global management consulting and research firm.

Assam, Bihar, Chhattisgarh, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Meghalaya, Odisha, Rajasthan, Uttar Pradesh and West Bengal

Industry Perspective

Ensuring Security of Internet of Medical Things Stolen healthcare databases can be used for financial fraud outside the healthcare industry and if the victimsâ&#x20AC;&#x2122; health insurance information is gathered, criminals can sell the information for even more money on black markets, says Rajesh Maurya, Regional Vice President, India and SAARC, Fortinet, in an interview with Arpit Gupta of Elets News Network (ENN).

Rajesh

Maurya

Regional Vice President India and SAARC, Fortinet

Why cybercriminals consider medical data far more valuable than credit card fraud or other online scams? The value of any stolen record is based on its ability to be replaced. For example, credit cards are easy to replace. It simply involves a phone call to the card issuer and a trip to the bank to get a new one. Patient records and other human data, however, are difficult if not impossible to replace. Electronic health records (EHRs) are especially attractive targets for hackers owing to the sensitive information of a large number of people they contain. The patient data they hold can be used for financial gains. Some recent reports show that stolen healthcare databases are being sold on the deep web for as much as $500,000. This information can be used for

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financial fraud outside the healthcare industry and if the victimsâ&#x20AC;&#x2122; health insurance information is gathered, criminals can sell the information for even more money on black markets. In fact, one medicare number in the US can reportedly sell for nearly $500 on todayâ&#x20AC;&#x2122;s black market (up to 10 times the amount of a credit card number). Health insurance information can be leveraged for medical fraud, and arms criminals with the information needed to access free medical care. Lastly, stolen medical data can go undetected for much longer period than something like a credit card, which is often disclosed within days of a breach.

How Internet of Medical Things (IoMT) be made less vulnerable from attacks by hackers?

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Cyber-attacks will continue to be a threat for healthcare providers, and likely in greater volumes going forward. The resulting overall downtime, incident response and legal fees, as well as long-term reputational damage can cost hospitals millions and keep them from providing high-quality care to patients. The best course of action is to ensure every hospital has a robust, integrated security strategy that includes: Maintain Good Network Hygiene Ensure security posture is up-todate with prevention and detection measures as well as develop and maintain good network hygiene, which includes systematic patching and updating of vulnerable systems, and replacing outdated technologies that are no longer supported.

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Industry Perspective

Implement Internal Segmentation Firewall (ISFW) CSIOs in healthcare organisations need to implement internal segmentation firewalls (ISFWs) as the landscape of networks is wide, open and flat. ISFWs operate inside the network instead of at the edge, allowing healthcare organizations to intelligently segment networks between patients, administrators, healthcare professionals and guests. ISFW can also identify types of devices – for example, between a patient information system and a life-saving heart monitor or infusion pump. It can then prioritize interconnected medical devices that need the highest degrees of protection and monitoring, and inspect and monitor all traffic moving between segments, all without impacting performance. Establish a Dedicated Team A dedicated team should be put in place to uncover the latest threat intelligence so that real-time threat and mitigation updates can be made expeditiously, before cybercriminals take advantage of any weaknesses in connected IoT devices or the critical services they provide.

What are the challenges for Healthcare IT security teams to contain possible cyber-attacks on connected medical devices in healthcare facilities? The biggest challenge for leading healthcare providers is around new attack surfaces. It’s not just the existing challenge of protecting healthcare records. That’s obviously still a primary issue due to the value of patient data and its inability to be easily erased or changed. However, as we move into 2018, healthcare organizations need to protect critical, connected networks, like those within the ICU. Data monitors, insulin and other medicinal pumps, and pacemakers all run on these networks. In these cases,

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the endpoint becomes the human life, not a PC. When it comes to protecting that endpoint, healthcare providers are faced with an extremely tough challenge because security is always seen as an inhibitor. If you put a security measure in place to block an attack and it inadvertently blocks things it shouldn’t, it could cause a denial of service and lead to grave consequences. This challenge extends outside the healthcare industry as well, since automakers and critical infrastructure industries face the same issue.

How can Fortinet help healthcare organisations to deal with such cyber-attacks? To fight today’s sophisticated threats, healthcare organizations must adopt an integrated security strategy that uses multiple technologies, and threat intelligence applied across the attack cycle and throughout the healthcare system. The Fortinet Security Fabric integrates security for the endpoint, access layer, network, applications, data center, content, and cloud into a cooperative solution that can be managed, analyzed, and orchestrated through a unified management interface. It intelligently and transparently segments the customer’s network, from IoT to the Cloud, to provide advanced protection against sophisticated threats The security fabric framework addresses three fundamental requirements to meet today’s advanced networking and security requirements: • Integration – security and network tools need to work together as a single system to enhance visibility and correlate and share threat intelligence. • Synchronisation – a security architecture needs to work as a unified system to enable single

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pane of glass management and analysis, and to enable a coordinated response to threats through such things as isolating affected devices, updating rules, and removing malware. • Automation – in order for security solutions to adapt to dynamically changing network configurations, and respond in real time to detected threats, security measures and countermeasures need to be applied automatically.

How do you see health organisations in India adopting themselves by taking concrete steps today to mitigate impact of future attacks on their connected systems? Fortinet works with leading healthcare service providers in India and I would say that they’re on the right track in terms of staffing and intent. When looking at the specific problems, is healthcare on the right track when it comes to protecting medical records? I would say they are. When it comes to protecting patients, however, I’d have to say there’s still much more work to be done. This is a problem with IoT and for most medical device manufacturers is that network security is not a priority. We’re going to see many more automated attacks being launched in 2018 that can penetrate healthcare organizations by moving from corporate networks into critical care networks. Healthcare needs to start building trusted intelligence into its automated defense solutions because it’s a primed attack surface. Few individuals can’t win this battle alone. The healthcare industry needs a threat information sharing network in place. Relevant intelligence for healthcare needs to be collaboratively shared between organizations and vendors to protect their networks in India.

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State Perspective

NHM Kerala Innovating

for Quality Life

The State Health Department has initiated the NonCommunicable Disease control programme in all the health units ranging from district hospitals to sub centres. Under the programme, medicines are given free of cost as per the protocol prepared. Training has been given to the entire health staff on management of NCD, says Keshvendra Kumar, Mission Director, National Health Mission, Kerala, in an interview with Poulami Chakraborty of Elets News Network (ENN).

Keshvendra Kumar

Mission Director National Health Mission, Kerala

Would you apprise us of the various initiatives that Kerala has been taking to ensure optimum and best healthcare for the citizens? The State has been implementing various programmes for ensuring best health care for citizens. Some of the programmes include: • Aardram – A patient-friendly transformation of OP services to ensure quality of care; to provide quality service delivery through all major service delivery points of the hospitals and healthcare institutions and to add specialty and super specialty facilities in district and taluk level hospitals; to develop Primary Health Centres into Family Health Centres capable of meeting the healthcare needs of all members of the family by themselves or

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through referral linkage and addressing the preventive; promotive and rehabilitative healthcare interventions of the local community; to improve case management in hospitals by ensuring protocol or guidelinebased case management and monitoring quality of service provided; ensuring primary lab facilities in all healthcare Institutions. • Palliative care project implemented with the help of local self government. • Hridyam project – A project through which treatment of infants and small children with Congenital Heart Disease is taken care of. • KASH – Kerala Accrediation Standards for Health – A quality

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initiative to gradually accredit all health care institutions to a given set of standards. • Safe Kit - A kit provided to all health institutions which contains all materials for proper collection of evidences , preservation and transportation of medicol-legal evidence in sexual assault cases. This is a 13 step pre packed kit and which is hopeful that evidence collection will be complete and scientific and that will lead to higher conviction rates. This is expected to be a major deterrent to sexual crimes in the society. • Anu Yatra – a comprehensive approach for disability management – Ensuring early intervention units, ensuring rehabilitative services, newborn screening.

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What measures has the State Health Department taken to ensure minimal interference of Non-Communicable Diseases (NCDs)? The State Health Department has initiated the Non-Communicable Disease control programme in all the health units ranging from district hospitals to sub centres. NCD primary screening is now functional in 100 district hospitals or Government hospitals, 232 Community Health Centres (CHCs), 835 Primary Health Centres (PHCs) and 5,400 sub-centres and over 1.32 crore people have already been screened. Medicines are given free of cost as per the protocol prepared. Training has been given to the entire health staff on management of NCD. Stroke clinics, COPD clinics and day care chemotherapy clinics were setup in all districts. Diabetic retinopathy clinics and Diabetic foot clinics are in the final process of implementation. NPCDCS programme was extended to the entire state using the existing staff strength. CCU and Geriatric clinics have been setup in 5 districts and staff including doctors were posted to support the NCD programme. Special itiatives like mobile NCD clinic (Care on Wheels and Waves), programme

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for school children (Leap) programme for police (Shape) and work place intervention were also implemented as a part of the programme.

Which latest initiatives has the State Health Department taken to control tobacco consumption in the state? Also apprise us of the results? Under the National Tobacco Control Programme (NTCP), awareness on harmful effect of tobacco was disseminated through IEC, short films and training programmes for various sections of the society. Gutka was banned in the state and E-cigarettes were also banned in the state. Kerala was declared 100 per cent tobacco advertisement free at point of sale and with 100 per cent compliance of section 4 and 6 at educational institutions. Unified head of account for Cigarettes and Other Tobacco Products Act (COTPA) fine collection was also initiated to pool the revenue under COTPA.

What major technological intervention and integration has been made in the state health department for implementing best healthcare services in the state? E-Health programme – digitally storing of health records – which ensures comprehensive health database of all the citizens in the

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State, is made and integrated with the healthcare system which will help in web based appointments, easy referrals to higher level institutions, easy access of patient medical history during each consultation, etc.

Any major initiatives and integration in technology been taken by the State Health Department to ensure curbing of PCP & NDT? Mapping of all Pre-Natal Diagnostic Technique (PNDT) units in the districts is nearing completion.

Would you share with us of any major challenges that the Health Department faces? The challenges being faced by the department include: • Shortage of specialist • Poor supply chain for medicines and logistics • Inadequate staff pattern • Re-emergence of vaccine preventable diseases like Diphtheria • Increase in prevalence of noncommunicable diseases like hyper tension, Diabetes, Coronary Artery diseases, cerebro vascular accidents, etc

Please share with us any major plans the health department of the state is having in pipeline for the coming days. The major programmes of the Health Department in the pipeline include: • AARDRAM – It is an initiative taken up by the Government in a mission mode to restructure and revamp the public health system to make Government hospitals more patient-friendly and efficient, delivering optimum level of care. • Strengthening of Secondary Care Hospitals – It will include decentralisation of speciality services and providing secondary palliative care in Community Health Centres.

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State Perspective

• Karunya Pharmacy – providing essential medicines for the general public at a lower cost.

Industry Perspective

Ensuring Clean Air for Disease - Free Hospitals Hospital Acquired Infections (HAIs) are amongst the top five causes of death. More deaths than road accidents, breast cancer, AIDS and armed conflicts occur due to HAIs, says Dilip Patil, Managing Partner, Trivector Biomed LLP, in an interview with Elets News Network (ENN).

Dilip Patil Managing Partner Trivector Biomed LLP

From In Vitro Fertilisation (IVF) and sperm banks, what led you to diversify into Healthcare Associated Infection (HAI) control? After working in the field of infertility management for more than two decades, my wife Sangeeta and I wanted to explore something which was more challenging and had potential to touch more lives. Observing a few of our acquaintances and family members succumbing to healthcare associated infections, we realised that this problem is much bigger and decided to focus on Airborne Infection Control.

What is an airborne infection? Infectious viruses, bacteria, fungi, molds, Volatile Organic Compounds (VOCs) are all around

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us in the air in the form of droplet nuclei. Most of them stay in the air for a longer duration and tend to settle on the surfaces and create contact points. Most of these airborne microbes are so small that they cannot be filtered. They need to be killed. There are seasonal outbreaks of viral or bacterial infections like Swine Flu, MERS and other respiratory illnesses. Tuberculosis (TB) is the biggest airborne killer along with other respiratory illnesses.

How big is the problem of airborne infection? Hospital Acquired Infections (HAIs) are amongst the top five causes of death. More deaths than road accidents, breast cancer, AIDS and armed conflicts occur due to HAIs.

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In developed countries like America, about 100,000 people die every year due to HAIs which costs additional healthcare burden of about $40 billion annually (source: CDC, America). Most bacteria have developed resistance to commonly used antibiotics leading to higher doses and more expenses. This is the case more or less in all developed countries. In Asian and African countries, the problem is more severe and thousands are getting affected and being killed silently. Immune-compromised patients like those in isolation rooms, pulmonology wards, ICCUs, dialysis units, neonatal and paediatric ICUs, burns units, organ transplants, asthma patients and homecare patients are more vulnerable to airborne pathogens.

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71 How can airborne infection be controlled? Atmospheric cold plasma, also known as the ‘fourth state of matter,’ is most effective and safe sterilising agent being used for healthcare appliances. If the same plasma technology was to be applied to the air, the problem of airborne infection could be minimised. Novaerus, an Irish company, has developed the cold plasma air sterilisation technology which destroys the DNA of the viruses and bacteria in the air and converts them into neutral constituents of natural air. It is the latest breakthrough which is validated by NASA research lab in California. This technology is being tried and tested in various healthcare establishments with great results. This compact and absolutely maintenance free system requires no maintenance or consumables and consumes electricity equivalent to a laptop charger. There is no need to shift the patient or staff; no time-consuming pre and post procedure rituals to be followed, just plug and play and the continuous protection stars from the next moment. It effectively eradicates up to 99.9 per cent viruses, bacteria, fungi, molds and eliminates odours and VOCs improving quality of life for patients and healthcare staff and saves precious lives.

How is the Novaerus solution different from other currently available solutions? All available solutions (HEPA Filters, Ionisers, UV Lights, Ozone, Hydrogen Peroxide, Vapour Generators, Fumigators etc , including existing sterility protocol) are decades old to trap or kill viruses. They have inherent limitations and are mostly combination of multiple sub-optimal technologies, making it cumbersome and expensive to maintain. We have reached the point of diminishing returns with no new technology available in decades.

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Plasma is known to be the most effective sterilising agent for medical devices and Novaerus has uniquely used cold atmospheric plasma for sterilisation of air with patented Dielectric Barrier Discharge (DBD Plasma) technology. Everything happens inside the box and only cleanest air comes out of the device, which is safe for human consumption.

Where was the Novaerus solution designed, used and tested? Novaerus Plasma Air Sterilisation System was designed in the UK and manufactured in Ireland. It is being used by numerous healthcare facilities in Europe and America with great benefits to the patients and healthcare staff. NASA laboratory has validated effectiveness of this technology by publishing a white paper on it. Various independent clinics and laboratories, including in India have conducted clinical trials and studies using Novaerus technology and the papers are available online. We have conducted pilot studies on MTB and Acinitobacter, and this technology has been proven to effectively kill all bacteria and viruses including TB bacteria in the air. Novaerus products are CE, UL marked and are manufactured under ISO certified factories.

How do you measure or monitor the effectiveness of Novaerus technology? There is no visible indicator of reduction in viruses and bacteria except for taking air-samples and culturing it before and after installation of Novaerus units. The reduced CFUs (Colony Forming Units) is the good measure. However, the effective reduction in odour or measurement of level of VOCs (Volatile Organic Compounds), particles in the air is another way to measure the air quality. Novaerus has developed a smart air quality cloud-based platform with sensors, GSM router, etc, which

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allows the users not just to monitor the air quality remotely, but it also communicates with Novaerus unit to act more efficiently based on the level of impurities in the air.

Has Novaerus solution been implemented in India? Novaerus technology has been brought to India through Trivector Biomed LLP and demonstrated and clinical trial conducted at different healthcare establishments across India with overwhelming results. Jaslok Hospital in Mumbai was the first hospital in India which installed three units in their IVF department in 2015.

What is the size and how much area does Novaerus sterilise? Novaerus units come in three compact sizes. NV200 which is effective for an area up to 200 sq ft (with 10 ft ceiling height) is of the size of the shoebox or a portable speaker, while NV-800 is surface or wall mounting type, size of a 21 inch LCD monitor which is effective up to area of 500 sq ft. NV-1000 is a portable floor unit which is designed to clean the air in quickest time and covers up to 2,000 sq ft area.

What are your future plans to establish and implement this wonderful technology to control airborne infections? In tune with the ‘Swachh Bharat Mission’, our goal is to reach all healthcare establishments where there could be a problem of HAIs. We have a dream of offering this technology to municipal, governmental and rural hospitals where it is needed the most. We are open to work with health missions, NGOs and appoint channel partners specialising in different areas. We are also enhancing our sales and marketing team across India. Our vision is to see infection-free hospitals by installing Novaerus technology where it matters the most.

ehealth.eletsonline.com | november 2017

Industry Perspective

Hospital Perspective

Innovations to Scale-up Healthcare Industry By supporting the scale and impact of promising innovations, healthcare industry can easily address health challenges across the country majorly in rural parts of the country. But, fact of the matter is that industry can be strengthened only by supporting the correct planning, piloting, and evaluation of innovations adopted in new settings. Joy Chakraborty, Chief Operating Officer, P D Hinduja Hospital, highlights the effective implementation of technology in healthcare in conversation with Rajbala of Elets News Network (ENN).

Joy Chakraborty Chief Operating Officer P D Hinduja Hospital

What is the need for implementing an effective system of production in healthcare? With the ‘Make in India’ campaign, the need to implement an effective system of production in healthcare is an ideal match. Typically, the major components of healthcare delivery systems are medical devices, medical technologies, medicines and the caregivers. The major hassle is to get the return on huge revenue invested in the devices and technologies that are imported from abroad to India for care delivery. Import duty, customs duty, fluctuating foreign currency exchange rate always makes the landing cost of the product too high.

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This can be reduced to minimum by producing the same on Indian land. While ensuring that the cost is reduced drastically, the quality also needs to be kept in mind and the same needs to be maintained as the imported ones. At the same time we need to keep in mind “Quality” has been a forte for India. A good example of which is many Indian Pharma companies are selling their drugs in the western world at much economical rates and with an approval from their FDA’s or respective bodies for quality. Thus, a country whose healthcare sector is expected to register CAGR of 22.9 per cent during 2015 -20 to US $280 billion certainly needs to harp on an effective system of production in

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Healthcare within INDIA to ensure that the cost of delivery is low for the people of our country and a good health statics is maintained in the country

Would you apprise us on the exponential growth of innovation in healthcare in India and how far it will take India’s healthcare industry? The Indian brains have always created a mark across the globe in any field, be it, Information Technology, Engineering, R&D and many more. Within the past two decades, the Indian Healthcare industry has seen many innovations from the price, quality and new technology or research perspective. The pharma

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What is the need for building a culture of innovation in the country? Motivation, appreciation and incentives are the three key mantras that can bring major or drastic changes in any project. The same applies for creating a culture of

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Innovation in our country. As mentioned earlier, Indian brains have time and again proved themselves being most innovative in various fields, irrespective of the place where they are in the world.

What is the relevance of PPP model in the Indian healthcare industry? In a country like India, were yet, the maximum population lives in the rural areas, PPP is an ideal healthcare delivery model. With PPP the good hospitals can create a nexus of their hospitals in tier 1, tier 2 and tier 3 cities as well as villages with the help of infrastructure, policy and cost support from the government to treat patients. This will help reduce cost of care and also increase accessibility of care to the people of India even at the rural area thus making the country’s healthcare status much improved in comparison to now.

How PD Hinduja has adopted, integrated and implemented technology in its healthcare offerings, equipment and services? P D Hinduja Hospital right from its inception has been as early adopter technology and quality process. Technology wise the hospital has been the first in India to do NAT blood

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A country whose healthcare sector is expected to register CAGR of 22.9 per cent during 201520 to $280 billion certainly needs to harp on an effective system of production in healthcare to ensure that the cost of delivery is low for the people of our country and a good health statics is maintained in the country.

testing, first in SAARC countries to have a CAP accredited laboratory. In 80’s it was the first hospital to launch Gamma Knife. The latest additions are the digital broad band MRI with Ambient Themes, Linear Accelerator for Radiation Therapy to onco patients, The Linear Accelerator also has dedicated prone breast frame, which is the first in India and is the safest as well as precise in treating breast cancer. Besides medical technology, our hospital has also used technology in non medical areas to provide better patient experience. Some of these include on line appointment booking and payments, payments via kiosk at our hospital, tab based patient feedback system and on line patient complaint management system.

ehealth.eletsonline.com | november 2017

Hospital Perspective

companies from the west have manufacturing units in India that not only produce medicines, but also do drug R&D at various stages for them. The shift of medical tourism to India is also a byproduct of innovation called economical or reduced cost of care for the western world in India. AYUSH has also contributed to a large extent to the innovation in health care industry by India. Who knew that Yoga which is native to Indian’s would be marked on global calendar and there would be a day called International Yoga Day. Innovations by India, in terms of production, research, technology or alternative medicines have made FDI’s also see a huge potential in the Indian market and facilities compelled them to set up production in India and can make India as one of the most advanced health care providing countries in the world in future.

Hospital Perspective

How Connected Continuum of Care is Transforming Healthcare? By 2028, both software-enabled devices and wireless technology will catapult the level and quality of healthcare as a true 24x7x365 for the majority of our population remotely and in real time, says Inder Davalur, Group CIO, KIMS Hospitals, Secunderabad, in an interview with Elets News Network (ENN).

Inder Davalur Group CIO KIMS Hospitals, Secunderabad

There are a number of technology trends emerging each day in the marketplace. How does KIMS Hospitals integrate technology to enhance its capabilities to provide trustworthy and secure healthcare services for patients? One of the thumb rules KIMS adopts when it comes to healthcare services to patients is the value it adds to the patient experience. Every technology is measured against this yardstick before it is considered for implementation. For instance, the patient waiting time for services such as physician consultation, specimen collection in lab, waiting for a wheelchair etc., have a greater impact on the patients’ experiences, KIMS is more interested in technology solutions that may not, at first, blush

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appear sexy but deeply meaningful to the patient. When it comes to technology, the approach and evaluation criteria matter more than the trendiness of the technology. For instance, IoT use cases are aplenty; however, how they serve the needs of a patient, the security offered by the solution, the sustainability and scalability are bigger considerations.

Advances in digital technologies will create enormous new possibilities and opportunities for the healthcare industry. How will that impact the Indian healthcare industry and economy of the country? India has had the fortune of being able to leapfrog versions and

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sometimes, even generations of evolution in technology. Cellular technology is a prime example. While the West had to contend with each ‘G’ in the cellular universe, India had the fortune of advancing with each passing generation rather instantly. The Internet has been a tremendous boon for deploying technologies in India and our economy, for the first time, is remotely agrarian. Internet of Healthcare Things (IoHT) will be a dominant beneficiary of this in India. The required brainpower and the economy of manufacturing these things is nowhere in abundance as it is in India – second only to China. The thinking trends and the passion that several entrepreneurs have, when it comes to better healthcare through technology,

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How integration of innovations in healthcare delivery in hospitals has improved and to what extent? While hospitals are talking about incorporating innovations into their operations and delivery of healthcare, there is a gap that exists in how they budget for these initiatives. This is not a criticism of the founders or the Boards of large hospital groups but an honest observation of what is keeping us from attaining greater gains when it comes to absorbing and integrating the innovations. Although the rate of absorption is slower than one would prefer to see, the uplifting news is the acceleration in the acceptance of new technology and innovations in novel ways in the healthcare delivery by several pioneering and established groups across the nation.

What are the big drivers of Healthcare transformation? (KIMS Hospital perspective) Have you adopted PPP model and, if yes, please brief. KIMS has not ventured into the PPP world as of yet. If a meaningful one makes its presence felt, KIMS would weigh its merits for sure. The greatest drivers of healthcare transformation are its founders. KIMS initiated its first-ever CIO role for its group with digital transformation at its core. This is evident in the support and thrust it has demonstrated

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in the course that I have set for KIMS for the next three years. Objectively speaking, the digital projects that are well underway at KIMS are primarily aimed at enhancing patient experiences and monitoring and reducing costs that will help to keep prices down which will, in turn, benefit the patients.

Technology has always played a crucial role in healthcare innovation, and this may be no different in the future. However, the pace and focus of technology-enabled innovation is likely to change. What is your say on that? Acceleration is the inevitable rule of the game. Whether it is processor speeds, computing densities, storage capabilities, or form factor of software driven hardware, we are witnessing blazing velocity in the acceleration of technology and its capabilities. Given this inevitability, healthcare will face increasing pressure from those who seek its services to quicken its pace and keep up with the other verticals. There is also likely to be a significant shift in the spending patterns of hospitals when it comes to technology. This will mostly come from the monitoring and diagnostic devices becoming more and more software-driven. The need to provide a common shared platform for disparate devices that will feed huge volumes of data will be imperative. Software applications will have to share data and be able to ‘talk’ to each other. Throw in AI (Artificial Intelligence) and hardcore analytics, one can expect to see the blurring of the lines between medical devices and traditional software platforms currently known as EMR (Electronic Medical Record) and HIS (Hospital Information Systems).

Despite innovations and integration of technology in healthcare industry, it has failed to provide healthcare facilities

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There is also likely to be a significant shift in the spending patterns of hospitals when it comes to technology.

as well as services full fledgedly? Can we overcome that and what initiatives has KIMS hospital taken to provide services to the last mile? Doctors, the custodians of patients and patient care, will continue to be the biggest challenge. I do not say it in a derogatory sense. It is simply a challenge in terms of how technology gallops while the “physician culture” trots along at a wait-and-see pace. The software development tools and stacks at the disposal of today’s programmer are mind-blowing in comparison to the days of characterbased programming and huge bulky unwieldy proprietary databases. Today’s advancement is only slowed by our culture. A human is other human’s primary obstacle. The clinical community also has reservations in embracing technology as a friend in the diagnostic and outcomes evaluation when it comes to patient care. KIMS is no different when it comes to such challenges. However, with an eye to digital transformation and increasingly improving patient experiences, KIMS is making a compelling case to its clinician community that data and technology are its friends. Because which doctor or nurse does not want her or his patient to get well soon and walk out of the hospital!

ehealth.eletsonline.com | november 2017

Hospital Perspective

is testament to what the future for Indian healthcare landscape will look like in a decade. The possibility of a 3C – ‘Connected Continuum of Care’ is my phrase that I coined to better describe the landscape – is very real and happening as we speak. Both software-enabled devices and wireless technology will catapult the level and quality of healthcare as a true 24x7x365 for the majority of our population remotely and in real time. This is my “what will happen to healthcare in 2028?” prediction.

NGO Perspective

Committed to Save Lives, Improve Health and Transform Future In the state of Rajasthan, Jhpiego was initially brought in to support the government’s efforts to expand access to postpartum family planning, which has led to Rajasthan being one of the first states in India to introduce Postpartum Intrauterine Contraceptive Device (PPICUD) services at the sub-district level facilities, says Dr Bulbul Sood, India Country Director, Jhpiego, in an interview with Elets News Network (ENN).

Dr Bulbul Sood

India Country Director Jhpiego

Please tell us about Jhpiego and the work it does with various governments to improve healthcare delivery. Jhpiego is a non-profit global health leader and a Johns Hopkins University affiliate that works for saving lives, improving health and transforming future of citizens. We partner with governments, health experts and local communities to nurture skills and develop systems that guarantee a healthier future for women and families.

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Jhpiego translates the best science and practices into moments of care that can mean the difference between life and death for women and families. The moment a woman gives birth; the moment a midwife helps a newborn to breath; the moment a nurse screens for cervical cancer with a simple vinegar swab; the moment a community health worker tests a man for HIV and reports he is HIV free. Through our partnerships, we are revolutionising healthcare for the world’s most disadvantaged

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and vulnerable people.

How has been Jhpiego’s journey in India so far?

Jhpiego’s journey in India began in the 1980s, collaborating with the Ministry of Health and Family Welfare, Government of India, to strengthen reproductive health services. Beginning in 1992, Jhpiego was named a key partner in a five-year project, funded by the US Agency for International Development, to strengthen

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Jhpiego opened its India office in 2009 and has been closely collaborating with Ministry of Health and Family Welfare, Government of India, at the national and state level, providing technical assistance in the areas of strengthening FP services, human resources for health (HRH) and improving the quality of MNH care.

How is Jhpiego helping private healthcare providers to improve their service delivery?

In a country where a large proportion of healthcare is provided by the private sector, Jhpiego’s work also includes working with and strengthening India’s private sector health institutions. Similarly, with more than 90% of India’s nursing students come from the private sector nursing institutions, Jhpiego’s work has expanded to strengthening private sector pre-service education.

What are the other areas of public health in which Jhpiego India works?

Jhpiego India also works in the field of non-communicable diseases, especially gestational diabetes mellitus. Jhpiego hosts the technical support units for family planning and adolescent health for the Ministry of Health and Family Welfare.

What has been Jhpiego’s experience of working in Rajasthan? How have you been

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aiding the government in improving public health delivery in the State? In the state of Rajasthan, we have a long history of collaboration and success. Jhpiego was initially brought in to support the government’s efforts to expand access to postpartum family planning, which has led to Rajasthan being one of the first states in India to introduce Postpartum Intrauterine Contraceptive Device (PPIUCD) services at the sub-district level facilities. Since then, we have helped build the capacity of more than 100 master trainers in PPIUCD insertion and more than 1,300 providers, resulting into counselling and serving around 40,000 women in Rajasthan. In maternal and newborn health, we’ve implemented the immensely successful WHO Safe Childbirth Checklist programme at 101 facilities across seven districts in the state, resulting in an almost 11% reduction in perinatal mortality in these facilities. The insights gained from the programme guided the development of the national initiative to improve the quality of maternal and newborn healthcare called “Dakshata”, which is now being implemented in 20 districts in Rajasthan and in the coming year it will be extended to seven more. Jhpiego is incredibly proud to have worked with the Indian Nursing Council and Government of India in their national initiative to strengthen the nursing profession in the country, including Rajasthan. With the support of the government, I am so proud of what we have been able to achieve in the State. Jhpiego has helped improve the quality of nursing education in 41 out of 48 public sector nursing schools in Rajasthan. We built the capacity of faculty and service providers in clinical standardisation and strengthening

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of training infrastructure using skills lab, IT labs and libraries. We developed standardised teaching materials and e-learning content for interactive teaching and learning. We are very fortunate to have played a role in improving the quality of health services for women and families in Rajasthan, as quality is the absolute bedrock of all Jhpiego programmes.

What strategy you adopt to ensure success of Jhpiego’s programmes?

In Rajasthan and in other States across the country, Jhpiego follows a system’s approach to its programme design and implementation. A 360-degree comprehensive advocacy strategy speaks not only with policy makers, programme managers but also with professional associations, using data to advocate for change. Jhpiego works to develop the system’s capacity to provide quality services by developing training sites, training state level master trainers from within the system and by creating an enabling environment at the facilities through on-site mentoring support. Material developed by Jhpiego— learning resource packages, job-aids, IEC materials etc. has been adopted by the government and is being utilised throughout the country. Jhpiego also works to strengthen the system’s capacity to record, report and analyse data for decision making. Quality was and continues to be the cornerstone of every programme that Jhpiego designs and implements. Jhpiego believes that successful, sustainable programmes can be achieved only through solid partnerships. It is grateful to the national and state governments for their leadership and to all its generous donors for their trust in realising the vision of preventing the needless deaths of women and families.

ehealth.eletsonline.com | november 2017

NGO Perspective

reproductive health services in the largest state (in terms of population) in India, Uttar Pradesh. Since 2006, Jhpiego has worked closely with the Ministry of Health and Family Welfare, Government of India, to improve access to high-quality reproductive health, Family Planning (FP) and Maternal and Newborn Health (MNH) services.

India-UK Healthcare Perspective

UK Seeking to Foster Global Healthcare Partnerships Healthcare UK, is a joint initiative of the Department for International Trade (DIT), the Department of Health (DH) and NHS England, supports partnerships in areas like education and training, clinical services, digital health, infrastructure and health systems development of healthcare provision, Geoff Wain, Deputy High Commissioner, British Deputy High Commission, shares his insights on India-UK collaboration to develop healthcare ecosystem, in an interview with Rajbala of Elets News Network (ENN).

Geoff Wain

Deputy High Commissioner British Deputy High Commission

Give an overview about the British High Commission in India. We enhance the India-UK relationship so that it is stronger, wider, and deeper, generating more jobs, more growth and more security for our two nations. The UK-India relationship is founded on a broad range of mutual interests. We work closely together on issues as diverse as education and research, energy security and climate change, security and defence and broader international relations.

How UK government can collaborate with the Indian Government to improve its healthcare ecosystem? The UK government is committed to working with the Indian government and the State governments in achieving universal healthcare, training and education for the staff that are required to improve healthcare delivery which involves common challenges such as anti-microbial resistance.

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We have a specific MoU that lays out this collaboration with the UK department of health. A number of British companies are active in India, for example, Diabetacare providing online and direct clinical care and the BMJ that provides education and easy to access good practice guidelines to Indian doctors. The UK has significant expertise in developing new and efficient healthcare facilities, designing top quality clinical services, training the whole range of healthcare staff and in providing systems to capture and use patient data to improve efficiency and improve the quality of care.

There are lots of startups who are active in Healthcare Spectrum. The Government of India has also started Start-up India programme to boost start-ups in the country, how do you view the British Healthcare startups scope in it? The UK has some of the most innovative startups operating in

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healthcare. Many are keen to find partners and customers in India which is why we are bringing companies on trade missions this month and next February to meet potential customers. There are vast opportunities for the UK and India to form closer partnerships in the healthcare sector, where the UK is a world leader. UK has an unmatched combination of clinical, technological and academic expertise which can be explored by setting-up such start-ups.

Tell us about the Health Systems development done yet. Share the upcoming plans. A good example is the Indo UK Institutes for Health Systems development where the National Health Services (NHS) and private companies are partnering with this massive programme for 11 medicities and many clinics in India. This brings the UKâ&#x20AC;&#x2122;s expertise in managing a whole system to India across primary, secondary and tertiary care.

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