Ehealth April 2018

volume 13 / issue 04 / APRIL 2018 / ` 100 / US $10 / ISSN 0973-8959

SPECIAL ARTICLES Health Transformation in Madhya Pradesh

Jayati Singh

Assistant Collector Barwani, Madhya Pradesh

Estonian Collaboration for Healthcare

Ankit Bahl

Advisor-Trade and Investment Embassy of Estonia

SPECIAL INTERVIEWS

Dr P Siva Kumar CEO Trivitron Healthcare

Rajiv Nath

Forum Coordinator AiMeD

Madan Krishnan Managing Director India Medtronic

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April 2018 | Volume 13 | Issue 04

COVER STORY

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special articles 14 ‘Technology Must Benefit Lower Strata of Life’

Tech-driven

Jayati Singh Assistant Collector, Barwani Government of Madhya Pradesh

22

Industry Empowering Healthcare Sector

‘Estonia Delivers Healthcare with Digital Solutions’ Ankit Bahl Advisor-Trade and Investment Embassy of Estonia

industry perspective 12 Dr P Siva Kumar CEO,

Trivitron Healthcare Pvt Ltd and Member,

Association of Indian Medical Device Industry (AiMeD) 16 Rajiv Nath

Forum Coordinator,

Association of Indian Medical Device Industry (AiMeD) 26 Mala Vazirani

Director

Transasia Bio-Medicals Limited

Dr Sandeep Chatrath Regional CEO, Apollo Hospitals, Andhra Pradesh and Telangana

18 Madan Krishnan

Managing Director India Medtronic

44 Boost Domestic Manufacturing for Affordable Healthcare

24 Dr Sahil Sahotra

Head – Operations

Para Homecare, a unit of Truehome Healthcare & Technologies Pvt Ltd

48 Dr KD Nayar

Chief Consultant Infertility and IVF of Akanksha IVF Centre

IVF – A Light at the End of Tunnel for Childless

Health InsuranceA Panacea for Healthy Life

technology Perspective

36 Gauri Agarwal

Director

Seeds of Innocence

special focus

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28

38 Dr Shivani Sachdev Gour

SCI IVF International Hospital 40 mCURA Smart OPD – For a Hassle-free Medical Treatment

interview 32 Dr Bipeenchandra Bhamre

Cardio-Thoracic Surgeon, Sir H N Reliance Foundation Hospital and Research Centre

Editorial Medical Device Industry Reviving Indian Healthcare As the Indian healthcare is on the cusp of transformation, medical devices are contributing the most. Technological advancement and innovations have buoyed healthcare industry to travel the extra mile, facilitating efforts to reach out to the people living on the margins of society.

Experts opine that three Ds -- doctors, devices and drugs -- are required to provide best clinical outcome to an individual. Though all three are important to achieve the big goal of universal healthcare, it is the medical device that plays a key role.

Carrying forward the rich legacy of promoting ICT and innovations to another level, our magazine’s latest issue focuses on various facets of medical devices and how technology is playing a role in it.

Our cover story “Tech-driven Medical Device Industry Empowering Healthcare Sector” talks about how medical devices are proving to be a big boon by providing quality patient care.

It talks about how medical technology has evolved by leaps and bounds providing a right thrust to surgical processes and treatment procedures, how technologically sound diagnostic equipment facilitates whole diagnostic process.

We are featuring special articles on ‘Health Transformation in Madhya Pradesh’, ‘Estonian Collaboration for Healthcare’ and ‘Health Insurance a Panacea for Healthy Life’.

Besides, we have special interviews of industry experts including Rajiv Nath, Forum Coordinator of AiMeD and Dr P Siva Kumar, CEO, Trivitron Healthcare Pvt Ltd, and Mala Vazirani, Director, Transasia Bio-Medicals Ltd. We also have interview of Madan Krishnan, Managing Director, India Medtronic which has been at the forefront of innovation and it offers some innovative technologies which contribute in the diagnosis and imaging space.

Giving an impetus to In Vitro Fertilisation (IVF), we have carried a few articles and interviews on this most discussed subject of society. It talks about how IVF technology or treatment has helped despondent couples to attain parenthood.

With such a variety of special interviews, features and articles, we hope to draw an invaluable feedback of our esteemed readers.

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

cover story

Tech-driven

Industry Empowering Healthcare Sector Looking at the speed at which India is taking long strides in the healthcare landscape at large, one derives a great sense of satisfaction that the nation is benefitting from factors like medical devices and modern technology, writes Mukul Kumar Mishra of Elets News Network (ENN).

T

he Indian healthcare sector is on the cusp of transformation due to a range of factors including technological advancements and high demand of quality and cost-effective medical facilities.

There is a belief that the quality of any healthcare delivery system depends upon three Ds -- Doctors, Drugs and Devices. All three are utmost important and needed to achieve the aim of providing healthcare to all.

Neeraj Lal, Vice President and Cluster Head — Bangalore and Karnataka Region, Rainbow Children’s Hospitals says, “Medical technology is an integral part of the entire healthcare. For decades now,

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with advancement of technology and increasing sophistication of medical devices, the industry has played a major role in bringing down the incidence of disease and improving the overall healthcare system across the globe.”

“Medical devices” encompass any instrument, apparatus and appliance which are used for the diagnosis, prevention, monitoring, and treatment of any disease or malfunction within the body. The medical devices are the sunshine segment of the healthcare ecosystem which makes whole process of diagnosis quick, accurate and an easy task.

“Medical technology has evolved by leaps and bounds providing a

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India is counted among the top 20 global medical devices market and is the fourth largest medical devices market in Asia.

more efficient management of ICUs and healthcare outcomes in private hospitals,” said Pushpa Vijayaraghavan, Director, Sathguru Management Consultants.

“Today, medical devices can provide enhanced patient care in remote areas through telemedicine and teleradiology. Advanced equipment technologies such as artificial intelligence and robotics

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provide higher levels of precision thus increasing the success rate and improving overall quality of care,” Lal said.

“Technologies such as virtual reality and augmented reality can also be used to simulate real time healthcare environment to provide training to physicians, technicians, and doctors thus eliminating the need for presence of actual equipment for training purposes,” he added.

As India’s population is on the rise, the country needs a very efficient imaging technology to screen and diagnose patients. Not only that, the growing non-communicable disease among citizens of urban cities is another challenge which makes healthcare providers think about catering people with high-tech medical devices.

Non-Communicable Diseases (NCDs), such as cancer account for 60 per cent of all deaths in India.

The data presents an alarming picture revealing that 68 per cent of cancer patients in India die before five years of diagnosis. In addition, changing lifestyle and food habits also make people vulnerable to NonCommunicable Diseases (NCDs), which are typically treated or ameliorated with medical devices.

“Healthcare providers are now focusing on patient care and enhancing clinical outcomes by adopting state of the art digital technology and advanced medical processes. Embracing and adopting technical advancements at an equipment and procedural level can help elevate clinical outcomes like never before while making it effective, affordable and accessible,” said Dr Dilpreet Brar, Founder, CEO & MD, medECUBE Healthcare. According to him, some recent developments in the field of medical science with respect to equipment and technologies specific to radiology are: • New probes (radiopharmaceuticals) are becoming available to

eHEALTH Magazine

april 2018

cover story

right thrust to surgical processes and treatment procedures. With new advanced technologies, doctors and surgeons can be more accurate, right from early diagnosis to attaining desired outcomes during procedures and surgeries,” says Madan Krishnan, Managing Director, India Medtronic, a company which deals in medical technology solutions.

Diagnostic equipment is used in medical imaging, a process of creating visual representations of the interior of a body for clinical analysis. Medical imaging is being done with the purpose to reveal internal structures which ultimately help doctors to examine and diagnose the medical condition of a patient.

“Connected care, digitisation, miniaturisation and indigenous innovation in medical technologies are trends that have potential to push boundaries of healthcare delivery in India. Digitisation and connected care are creating possibilities of

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cover story

in India concept and building medical device parks, etc, have also given push to this industry.

diagnose cancer, Alzheimer’s etc.

• Molecular imaging can be used to make targetted cancer therapies more effective • GE and Siemens recently launched their next generation CT machines for Cardiac applications • Siemens launched Magnetom Vida MRI at RSNA in Chicago in November 2017. This MRI can adapt to anatomical and physiological characteristics of patients Dr Vivek Chail from icliniq.com says, there are many developments taking place in the area of patient outreach and delivery of healthcare. “ There is AI assisted robotic surgery which is helping many patients and doctors perform precision surgeries and reducing the risks involved, with better outcomes. In artificial Intelligence-assisted robotic surgery, an experienced surgeon controls a robotic device and surgery is performed with greater precision and accuracy. This is a benefit in critical areas of medicine like brain and spine surgery where a high degree of accuracy is needed,” he added.

Growth Diagnostic equipment market comprises of organisations which are involved in the manufacturing and marketing of equipment such as

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computed tomography (CT) scanners, magnetic resonance imaging systems (MRI), X-rays, nuclear imaging (SPECT/PET), mammography devices, cardiovascular monitoring and diagnostic devices, ultrasound devices, and accessories.

Digitisation and the proliferation of IoT-enabled devices present a great opportunity for growth in India.

According to the Government’s Make In India website, the medical devices industry in India is presently valued at $ 5.2 billion and contributes 4-5 per cent to the $ 96.7 billion Indian health care industry.

Currently, India has about 750–800 medical device manufacturers in the country, with an average investment of Rs 170–200 million and an average turnover of Rs 450–500 million.

According to industry estimates, the medical devices market will grow to $50 billion by 2025. At present, India is counted among the top 20 global medical devices market and is the fourth largest medical devices market in Asia after Japan, China and South Korea.

The growth of medical device market is attributed to many factors including burgeoning middle class, improved healthcare infrastructure, increased healthcare spending, etc. In addition, the Government’s initiatives like bringing 100 per cent FDI, Make

Challenges Despite huge potential due to high demand of quality diagnostics services, the Indian medical device market faces several challenges.

Foremost among them is country’s reliability on imported devices for addressing domestic demand.

More than 70 per cent of medical equipment sold in the country are is imported. In addition, lack of compliance standards and coherent policy framework are also jeopardising growth of Indian device industry. Through Make in India concept and Medical Devices Rules 2017, the Government has tried to boost domestic manufacturing market; nonetheless these steps are not sufficient to do away all the obstacles of the domestic market.

Experts believe that in India, pseudo manufacturing flourishes as manufacturers are turning into importers for their brands. Other countries like US, China encourage domestic players to make indigenous products. Domestic players demand the Government should increase the basic customs duty on medical devices in the range of 5-15 per cent to promote domestic manufacturing.

India needs to implement ‘Make in India’ in its true sense and for that a framework of policies along with strategic roadmap is need of the hour.

“While medical technologies can redefine possibilities and push boundaries, impact on outcomes entirely depends on widespread adoption by public and private stakeholders in healthcare delivery.

Majority of the impressive devices indigenously developed are lurking on the sidelines for lack of market maturity and adoption pathways,” says Pushpa Vijayaraghavan, Director, Sathguru Management Consultants.

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Industry Perspective

Indigenous Manufacturers Competing for Excellence Tech-driven medical devices have been playing a pivotal role in driving Indian healthcare to reach the last mile. Due to rising demand of quality diagnostic services coupled with latest innovations, the industry is growing by leaps and bounds, says Dr P Siva Kumar, CEO, Trivitron Healthcare Pvt Ltd and Member of Association of Indian Medical Device Industry (AiMeD) in conversation with Elets News Network (ENN).

Dr P Siva Kumar

CEO, Trivitron Healthcare Pvt Ltd and Member, Association of Indian Medical Device Industry (AiMeD)

Q

How medical devices equipped with latest technology are playing an instrumental role in providing comprehensive healthcare delivery?

In the healthcare delivery system, medical devices play a significant role in identifying/diagnosing the disease which facilitate the medical fraternity to provide comprehensive solution to the patient to overcome the diseases.

Apart from the individual getting best treatment, it also plays a crucial role in reducing the disease burden of a community, State or the country.

In brief, the medical devices are used for the following purposes across the spectrum of healthcare delivery: • Diagnosis, prevention, monitoring, treatment, or alleviation of disease; • Investigation, replacement, or modification of the anatomy or of a

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physiological process; • Control of conception; on the human body by pharmacological, immunological, or metabolic means Unfortunately, medical devices in India are still dominated by the multinational overseas players and we are hugely dependent on import.

Q

Tell us about the market opportunity and scope of medical equipment segment which is considered a sunshine sector of healthcare ecosystem.

Medical devices industry is highly innovative and technology-driven and thus, constantly changes the face of

healthcare in the areas of diagnosis, treatment and delivery. While in India the perception is that there is very low level of market share of indigenous manufacturers of the Rs 65,000-70,000 crore market of medical devices with 70-90 per cent import dependency.

It is self-reliant in consumables and disposables and has more import dependency on medical equipment and electronics. There are some exceptions to the rule being challenged bravely by some entrepreneurs in the medical technology space.

It is indicative of the huge potential for the industry to Make in India and plays a larger role in Indian healthcare space.

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Industry Perspective

We have Transasia as a successful Indian manufacturer and an Indian MNC in the IVD (In Vitro Diagnostics) and highly automated Analyser space, Trivitron as a successful diversified Medical electronics and equipment manufacturer in Diagnostics and Imaging, Allengers, Cura, Skanray and Allengers in imaging - X-Rays and Ultrasound, Allengers and Involution in Cath Labs, Robonik and Accurex in Lab Analysers, Perfint in medical electronics, Prognosys in Linear Accelerators and Imaging, Mitra in video endoscopy, Appasamy and Forus in Opthomology, Phoenix and Zeus in neonatal care who are challenging the market dominators GE, Philips, Siemens, Olympus etc.

The world’s eyes are on India and the Government of India has woken up to the huge potential of growth offered by the medical equipment and the medical electronic sector. Ministry of Electronics and Information Technology (Meity) is now treating this as a focus sunrise sector and has been in consultation with AiMeD and other stakeholders to replicate the success of the Cellular Phone industry.

On realising the huge opportunities offered by medical devices sector, the Chief Minister of Andhra Pradesh, Dr Chandrababu Naidu, has initiated the rapid development of the Andhra Medtech Zone (AMTZ) at Vishakapatnam under the able leadership of Dr Jitendra Sharma who was serving as his healthcare advisor.

An interdependent ecosystem is being created in AMTZ focussing on medical electronics with common manufacturing facilities of an X-Ray Tube manufacturing plant, an Electromagnetic Radiation Test house, a rapid prototyping Centre and tool room, head display and supply chain of downstream manufacturing of Plastic Molded components, silicon rubber key pad components, SMT PCBs etc. Not to be left behind, the Chief Minister of Telangana, K

Medical devices industry is highly innovative and technology driven constantly changing the face of healthcare in the areas of diagnosis, treatment and delivery.

Chandrashekhar Rao has initiated rapid development of a Med Tech Park at Hyderabad.

Q

Shed some light over the challenges plaguing this medical equipment segment. What the Government should do to encourage domestic market of medical devices?

The Per capita spending on healthcare in India is significantly lower than in China or Russia

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The Indian healthcare system is inadequate, inefficient and unevenly distributed focusing mostly in the urban geographies.

There are Zero patient safety regulations unlike US FDA or CE of Europe acting as a Non Tariff barrier. Only some radiation safety regulations by AERB. Non-alignment of regulatory systems with global standards and lack of quality product testing infrastructure are hindering the progress of this sector. Babies get burnt by low quality Chinese incubators but still only 23 categories of medical disposables and implants only are covered under CDSCO under the Drugs and Cosmetics Act which is a misfit for medical electronics and equipment as it’s designed for Pharmaceuticals.

The Sector’s under development is stunted by poor attention by policy makers to addressing complete lack of Tariff protection with custom duties at Zero to a maximum of 7.5%.

There are rampant imports of low cost preowned second equipment being permitted in name of affordable access Indian manufacturers are discriminated against and kept out of the tender bidding process by asking for compliance to mandatory qualifications requirements like US FDA regulatory approval.

eHEALTH Magazine

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Special article

‘Technology Must Benefit Lower Strata of Life’ There is a need for technology to be taken to the people of lower strata of life in terms of healthcare initiatives, according to Jayati Singh, Assistant Collector, Barwani, Government of Madhya Pradesh, reports Mukul Kumar Mishra of Elets News Network (ENN).

Jayati Singh

Assistant Collector, Barwani Government of Madhya Pradesh

D

uring Elets Healthcare and Wellness Summit held in New Delhi recently, Jayati Singh, the Assistant Collector of Barwani, spoke at length on various aspects related to healthcare in her region.

Talking about the challenges of taking healthcare to the last-mile in the State, she said: “Topographically, our terrain is mix. We have flat terrain which is a very prosperous area of Barwani, a district of Madhya Pradesh, and we have undulated terrain which lacks on developmental parameters. This is the area where delivery of healthcare service or rather delivery of any services is a big challenge. As a civil servant, we try and make efforts to reach out to the last person in the area.”

Stating about the peculiarity of the delivery of healthcare being a challenge because of the terrain,

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she said: “We have a majority of tribal population in Barwani. These tribal people have unique settlement pattern. These people settle on hilltop, one house on one hilltop and another house on another hilltop. We have to cover a huge distance for delivery of any service.”

Health service seeking behaviour among people also seems very passive as people don’t actively demand services. As a result of which, delivery suffers.

Stating that in Barwani, human resource (HR) issue is also a major problem due to difficult terrain, she said: “In order to improve effectiveness as well as efficiency of a service, we did major change in logistics of the entire way in which the healthcare is delivered to the people especially to the last-mile people. ” “We accumulated the resources, primarily the HR resources, across the district. We made a mobile team.

In a mobile team, we have health workers known as ANM. Then we have ASHA workers (Accredited Social Health Activist) who deals with malnutrition and overall developmental parameters. We coupled them with local population who are a local subject market expert of the area.”

“We had this team which moved on feet on the particular day to cover all the areas, including all the houses and all the individuals. They provided health services; they provided immunisation to the expected mother as well as the child. Apart from this, ASHA workers worked on malnutrition which is a major challenge in the tribal area.”

Stating how an ASHA worker would bring the list of kids suffering from MAM (Moderate Acute Malnutrition) and SAMs (Severe Acute Malnutrition), she said: “After their identification, we would move them to the district headquarter or the block headquarter depending the state of the child.”

ASHA workers would carry common medicines for common ailments like fever and cough too.

This area has the “propensity of tuberculosis as well”.

So, these separate services would take different set of people to deliver to different beneficiaries at different rate of efficiency. “We combined them in one team and delivered it to people.

This was a very difficult experiment because of the terrain.”

Singh said: “In our experiment, we used boats; we used another means to reach out the people who have been left behind. As a result the

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particular process in a certain way, it gets better through creativity or ingenuity that for me, would be the innovative way of doing it.”

“In this particular context we have desperate people providing services on everyday basis to certain set of people. We were pooling those people to provide them resources, to provide them motivation, and they managed to achieve a target. This is application component of innovation,” Singh added.

Second component is human resource. “We had a set of ANM who went outside their market. They had defined spheres of responsibilities.

They engaged and supported us in every rounds of immunisation.

They went out of the way and worked so hard for the benefit of the local people.”

Third component and most important is intended benefit. In this case, “We had a significant positive benefit not only for the individual but for the entire society as well; not for this generation, but for coming generation as well”.

Jayati Singh said that there are “particular areas and particular aspects” which I suggest to take up which would help in healthcare delivery of services to the last person.

“We need to change the way the consumers use health. There has to be ease of use. We are talking about daily wage worker who has to go to PHC (Primary Health Centre) on one particular day, from there they move to CHC (Community health centre) and may be to district hospital.”

“There need to be vertical and horizontal integration in this sphere so that he can be benefitted. There has to be a change in perception in which he perceives health. It has to be linked with behavior. He has to pro-actively come and seek health.”

Talking about technology, Singh said, “It is a major game-changer in healthcare. We are linking various data. We have ASHA workers in

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There has to be a change in perception in which one perceives health. It has to be linked with behavior. One has to pro-actively come and seek health.

Special article

immunisation percentage increased to 100 per cent from 40-50 per cent.

We were able to identify 70 kids who were suffering from acute SAM and malnutrition.”

One of the most positive changes of this whole initiative is that “there has been an improvement in health seeking behaviour among people”.

This experiment was carried out in three rounds starting from November. So “when our team went in November, people generally were passive; not willing to engage. But when the next time we went around, people would pro-actively seek information about family planning or some counseling inputs. This has been a huge plus for us,” she added.

Revealing that immunisation has been a huge success in the area and the impact has been “positive”, the Assistant Collector said: “We have extended immunisation programme in other forest areas and other blocks.

Overall the immunisation programme has benefitted people the most.”

On convergence of policy, she said, “In Pati area, convergence has brought about huge benefit. We had converged with Deen Dayal Upadhya Gram Jyoti Yojna which is a scheme that brings in electricity to left out hemlets and to the individual people who have been not given electricity till now.

“It has brought about positive change in health seeking behaviour of the people. With electricity came mobile. And, the mobile brought wider exposure. Exposure ushered in more engagement of people with the Government as a whole for their health and for other nutritional aspect of the family.”

While talking about innovation she said that there are three components of innovation. There is no barrier or no qualifier as to how normal an idea might be especially from grass-root innovation perspective.

“We think that if I am doing a

villages who actually connect the health data of a child and an expected mother. Then we try to share this data with ANM who provides the delivery services. We are working on improving the institutional difficulties.”

The senior official said: “We are trying to have pro-active approach so that there is a particular alert when a lady is going in a labour room. Same information passes on to PHC which receives the lady and carry on the operation. He wants to get her profile, her indicator and then they should go to PHC and they should realise whether this lady is anemic; whether she should come to PHC or she should set out to CHC for better care.

This is a major game-changer.”

For a policy making, Singh stated that it can’t be 100 per cent effective as well as 100 per cent efficient.

“There has to be compromise between these two. There has to be a horizontal integration. We have different providers providing different facilities, but we would want to have a horizontal integration of different stakeholders combined so that efficiency gets improved. Similarly, for chronic diseases, we need to have vertical integration,” she said while talking about need for improvement of efficiency.

eHEALTH Magazine

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15

Industry Perspective

Preferential Pricing Needed to Boost Medical Devices Market The Indian Medical Device industry holds immense potential contributing to the growth of healthcare ecosystem. There are number of factors responsible for jeopardising this vertical’s growth. Preferential Market Access is need of the hour to buoy domestic industry, says Rajiv Nath, Forum Coordinator, Association of Indian Medical Device Industry (AiMeD), in conversation with Elets News Network (ENN).

Rajiv Nath

Forum Coordinator, Association of Indian Medical Device Industry (AiMeD)

Q

AiMeD recently expressed disappointment over the draft Medical Devices Preferential Market Access (PMA) Policy issued

by DoP. What needs to be done on this front?

Many countries use Preferential Market Access as a policy measure to accelerate domestic manufacturing.

The USA has a ‘Buy American’ policy and keeps out low priced imports from participating in the public healthcare procurement process unless they are signatory to TAA - Trade Agreement Act. Similarly, China , Malaysia , Indonesia, South Africa, Jordan , Uganda etc have preferential pricing to give competitive advantage to their domestic manufacturers and

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incentivise overseas manufacturers to put local factories to retain market shares.

The recently announced draft guidelines of Department of Pharma were found to be highly disappointing. The Draft PMA policy in its present form does not provide preferential pricing to Indian manufacturers, no incentives on maintaining and improving quality, indigenous development and no redressal/penal provisions against use of exclusionary 3rd country regulatory approval mandatory clauses e.g. US FDA. It doesn’t provide any corpus for ensuring no late payments by the Government. Such a corpus would be necessary to ward off any adverse impact on a company in case of delayed payments by the Government.

We regret to say that following suggestions made by us to give encouragement and boost domestic manufacturers over imports have not been considered e.g.

• Preferential Pricing for Domestic

Manufacturers based on World Bank norms • Preference for ICMED / ISO Certified Manufacturers to boost quality • Preference for Design India Certified Manufacturers to boost indigenous development • Timely payment against Government Supplies • Penal provision against Hospitals that keep exclusionary compliance Clause of USFDA Certification as 3rd Country Regulatory approval The Prime Minister wants to boost Make in India with ‘Buy in India’ and DIPP provided a Preferential Purchase order with a 20 per cent margin of preference for domestic manufacturers. However, this margin of preference is not preferential pricing of 20 per cent as is the case in some countries like China which give 15-25 per cent price preference and others like Malaysia, Jordan, Uganda, Indonesia etc give 15 per cent.

DIPP order only allows Indian

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domestic producers to add capacity.

Sadly, an opportunity to boost Make in India Medical Devices is being lost.

We can match prices of any country other than China as it has no global market economies but a subsidised state sponsored eco system. How can we compete with low priced imports from china with non- remunerative, nonsustainable pricing unless the Indian Government has supportive policies?

India needs to follow the UN system of procurement based on sustainable costs and not based on L1 lowest pricing that motivates some manufacturers to cut corners in regard to quality and service delivery of product and give poor image to Brand India.

By denying preferential pricing to Indian manufacturers, the draft policy guidelines can be said to be bordering on encouraging ‘pseudo manufacturing’. It is sad that genuine concerns and suggestions of Domestic Medical Device Manufacturers are being repeatedly sidelined.

Q

Tell us something significant about the existing policy framework related to medical equipment segment.

To boost manufacturing of medical

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The Prime Minister wants to boost Make in India with ‘Buy in India’ and DIPP provided a Preferential Purchase order with a 20 per cent margin of preference for domestic manufacturers.

Industry Perspective

bidders to match the L1 Lowest price bid of a foreign manufacturer (read Chinese) if his bid was within 20 per cent range.

The USA which uses a non -tariff barrier that only countries recognised in their Trade Agreement Act are allowed to sell to the US Government Institutions and countries like India, China and South Africa etc are even unable to bid. Whereas the DoP PMA guidelines has no Penal Action or disciplinary actions like not allowing access to Finance to procure medical devices where tenders use exclusionary mandatory Clauses of compliance e.g. Regulatory Approval

by US FDA (and CE) to keep out Indian manufacturers from bidding in their own country tenders .

The option to match L1 Lowest price of a Chinese product is not a preference to an Indian manufacturer – it’s only an option and this will hardly incentivise Indian manufacturing. Compare this to other countries like Indonesia, China, Malaysia, Jordan, Uganda etc. that give 15 per cent or higher price preference to manufacturers who produce in their country.

This has motivated importers to shift manufacturing base to these countries to retain market share and given competitive advantage to

equipment and electronics in India, there needs to be an urgent enforcement of the MoEF order restricting imports of pre-owned second equipment of over three years at least till we have a robust regulations to ensure Calibration and Patient Safety compliances .

This needs to be followed by raising tariff to 15-20 per cent as done for Consumer Electronics including mobile phones followed by a 7.510 per cent tariff on components to enable development of a manufacturing ecosystem.

Until we can have a separate medical device regulations law, the Government can initially make compliance to IS: 13485 mandatory under BIS law and rules to safeguard patients and act as a non-tariff barrier. Meanwhile encourage manufacturers to seek voluntary QA ICMED certification from QCI - NABCB accredited Certification bodies.

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technology perspective 18

India Medtronic – Innovating for Improved Patient Outcomes Medtronic has been at the forefront of innovation and we have evolved our products through continuous technological innovation in all aspects of their design, materials & delivery mechanism in the areas of heart, brain, spine, etc, says Madan Krishnan, Managing Director, India Medtronic, in conversation with Elets News Network (ENN).

Q

Tell us about emerging trends in medical imaging and diagnostics market in India.

Over the years, new medical developments and techniques have changed the face of healthcare.

Medical technology has evolved by leaps and bounds, providing a right thrust to surgical processes and treatment procedures. With new advanced technologies, doctors and surgeons can be more accurate right from early and correct diagnosis to attaining desired outcomes during procedures and surgeries.

Medtronic has been at the forefront of innovation and we have evolved our products through continuous technological innovation in all aspects of their design, materials & delivery mechanism in the areas of heart, brain, spine, etc.

Over the years, through innovation in our technologies, we have developed products that meet the needs of patients and caregivers as well as the needs of physicians with simpler and quicker procedures.

In today’s operating room, imaging is a vital tool for the surgical team striving for the best patient outcomes.

Medtronic offers some innovative technologies which contribute in the

april 2018

diagnosis and imaging space: • Reveal LINQ Insertable Cardiac Monitor (ICM) is the smallest implantable cardiac monitoring device designed to help physicians quickly and accurately diagnose irregular heartbeats. While, significantly smaller, the device is part of a powerful system that allows physicians to continuously and wirelessly monitor a patient’s heart for up to three years. It is mostly suitable for patients who experience symptoms such as dizziness, palpitation, fainting and chest pain that may suggest a cardiac arrhythmia and for patients at increased risk for cardiac arrhythmias.

• Another innovative technology in both digital imaging and the diagnostic market is the PILLCAM™ SB 3 CAPSULE. Capsule endoscopy is a breakthrough technology. The vitamin-sized, disposable capsule that has a camera, has been designed for the small bowel and the colon. Once the capsule is ingested, patients can return to most of their daily activities as the capsule naturally passes through the digestive system,

Madan Krishnan

Managing Director, India Medtronic

wirelessly transmitting more than 50,000 images of the small bowel to a receiver worn by the patient.

Physicians can review the footage at a later time to identify potential abnormalities.

• The newly launched StealthStation™ S8 system demonstrates Medtronic’s continued commitment to innovation and contributes to the transformation of how neurosurgeons treat spine disorders. It brings an advanced solution to neurosurgeons by helping them make critical decisions and enhancing the OR environment. It enables doctors to precisely track the location of surgical instruments throughout a procedure. The StealthStation™ S8 system introduces the most advanced version of Stealth

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Q

How do you ensure that your systems and processes are designed to deliver quality healthcare at affordable cost?

We focus on three key strategic priorities that help improve the continuum of care, specifically for chronic disease – all while developing new partnerships with those who are committed to transforming care.

• Therapy Innovation: Providing a spectrum of offerings aimed at

improving both economic and patient outcomes.

• Globalisation: Adapting our thinking to address access challenges in both developed and developing countries.

• Economic value: Thinking more holistically about the care continuum, and how we can lead the creation of value-based healthcare solutions.

Quality has been an integral part of our Mission since co-founder Earl Bakken penned it in 1960. With lives at stake, we at Medtronic take our responsibility for quality very seriously. To us, that means: • Approaching quality holistically – not just with products, but in everything we do • Having comprehensive, closedloop processes across the entire product lifecycle • Being proactive – to prevent and uncover issues early • Being collaborative – working with physicians who are closest to our products and processes • Being transparent – sharing our expectations and performance

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and with all our stakeholders, and raising awareness of potential issues early

Q

How are your policies geared towards collaborating with governments to bring efficiency in the public health delivery system?

Healthcare world over is a complex subject and cannot be addressed alone by one entity. That’s where we need partnership from all the stakeholders i.e. government, hospitals, doctors, patients and the industry.

Medtronic is committed to Indian market with its large footprint in India since 1979. Medtronic has already set up two global R&D centers and one world-class global IT center in India. Public Private Partnership (PPP) can bring fundamental changes in the treatment of various non-communicable diseases as the challenge in the treatment of patient starts from awareness and diagnosis point of view.

The PPP model can address the early-stage challenges and can actually do a fantastic job in the holistic care from a patient point of

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technology perspective

technology — a combination of hardware, software, tracking algorithms, image data merging, and specialised instruments to help guide during surgical procedures.

• O-arm® Imaging System is designed specifically for use by surgeons in standard operating rooms and yields high-quality imaging for intra-operative purposes. Images are displayed on the large, 30” digital, flat screen of the O-arm® System Mobile View Station (MVS), providing the surgical team with excellent visibility from the operative field.

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view. We are keen to partner with state governments in improving access to affordable, innovative and high-quality healthcare, in line with the National Health Policy.

Q

Tell us about your India centric innovations that may help the industry expand its reach.

At Medtronic, we are championing value-based healthcare that helps developing and deploying products, services, and integrated solutions to improve care and reduce costs. Medtronic is committed to address India’s challenges for increasing access to affordable, high-quality healthcare. Medtronic is more than 35 years old in India and the journey has been strong and steady. We have truly revolutionised the healthcare scenario through our innovative products, services and solutions.

The growth opportunity for Medtronic in India is vast, but to seize it, we must focus clearly on making our innovative devices accessible to a larger section of Indian society. Some of the examples of our market appropriate innovations to address the challenges of awareness, accessibility and affordability are: • Launched in Sep 2010, HHFA works with local hospitals and physicians to remove barriers to patient access to heart rhythm and vascular treatments. The

april 2018

programme works to continually evaluate and improve the entire cardiac patient care pathway, and it has worked to resolve issues associated with patient awareness and screening, referral connections between general physicians and specialists, and counselling and financing options for patients who need financing assistance to access therapy options. Currently present in over 30 cities in partnership with over 120 hospitals.

• Shruti, an innovative ear care programme to deliver awareness, screening, diagnosis and treatment for the underserved. Shruti is currently operational across seven self-funded cities including Delhi, Gurgaon, Faridabad, Hyderabad, Aurangabad, Jaipur, Chennai, Raipur, Amritsar and Dhaka (Bangladesh). As of February 2017, through community health workers, the programme has screened more than 3,00,000 people.

• Medtronic Academia engages with MD physicians through therapy awareness workshops, diagnostic summits, Continuous Medical Education, and Round-Table Meetings to enhance diagnosis and patient management to improve quality of care. India Medtronic has trained more than 16,000 doctors across various specialties over the last 3 years and trained

Medtronic has been at the forefront of innovation and we have evolved our products through continuous technological innovation in all aspects of their design, materials & delivery mechanism in the areas of heart, brain and spine

over 6,000 doctors on cardiac and vascular therapies in the last five years—covering 200 hospitals and 100 cities. We also have two Therapy and Procedure Training Centers (TPTC) in Mumbai, and Dhaka and a Medtronic Innovation Center (MIC) in Mumbai that hosts these training programs.

• MedEx is a web-based electronic portal that enables Interventional Cardiologists with knowledge, skill set and guidance to perform complex interventions. The treating cardiologist uploads the patient details including the angiogram report on the portal and other complex case details and queries. Intimation is triggered to one of the members of the panel of experts who have registered themselves on MEDEX portal. These experts can be from different parts of India. On the portal, the expert reviews the case and provides a structured report alongwith their recommendations and answers within 48 hours.

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Special article

‘Estonia Delivers Healthcare with Digital Solutions’ From creating digital identification to online health record, Estonia has revolutionised healthcare delivery. People don’t need to carry a prescription slip for medicine here as they are issued digital prescriptions, accessible to anyone from anywhere, according to Ankit Bahl, Advisor-Trade and Investment, Embassy of Estonia, reports Mukul Kumar Mishra of Elets News Network (ENN).

D

uring Elets Healthcare and Wellness Summit held in New Delhi recently, Ankit Bahl, Advisor-Trade and Investment, Embassy of Estonia, shared an insightful speech on digital healthcare solutions in Estonia.

Sharing an anecdote of digital prescriptions in Estonia, he said, “When I entered one of the pharmacies in Estonia, I saw nobody was showing doctor’s prescription to

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pharmacists. People were carrying the digital identification. By just carrying the identification, people were getting the drugs.”

“I was told that Estonian doctors issue digital prescriptions that are then sent to medical prescription centres. The centres database then give access to all pharmacies across Estonia. You don’t need to go to any particular pharmacy. One can go to any pharmacy.”

Ankit Bahl

Advisor-Trade and Investment Embassy of Estonia

Stating that Estonia is a country which believes in harnessing technology for the benefit of people, he said: “Today more than 20 million health documents, case summaries, referrals, vaccinations, dental information, medical images and over 250 million events are stored in Health Information centre which we have developed.”

“Estonia is small yet smart and efficient country. It is a part of EU, which has been a flag bearer of IT solutions since as early as 1990 with key focus sectors being cyber security, Smart City solutions, promoting e lifestyle.”

Talking about innovative practices adopted by the Estonian Government, Bahl said, “We

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Special article

are motivating and promoting a paperless Government. Estnoia being the first country in the world which actually implements internet voting as earliest in 2005. Try to open out almost 3,000 online Government services to the people to actually access the database and access their centres.”

Throwing light on upcoming projects for improving healthcare delivery he said, “We are learning about genome bank and genome centre which has almost collected about 52,000 individual gene pool data.”

“It has been able to deliver personalised medicine where genome and health data collected by the healthcare information system will combine in order to provide a specific diagnosis and specific treatment to the people.”

“This not only creates an efficient network of data collection but also creates a possibility of right diagnosis, prognosis and an appropriate treatment for the people.

Today Estonian bio-bank is available to global companies who want to test

Estonia has been a flag-bearer of IT solutions since as early as 1990 with key focus sectors being cyber security, smart city solutions, promoting e lifestyle.

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and do research and development in the area of gene pool development.”

Elaborating how digital solutions have facilitated things in Estonia, he said, “Each person in Estonia has his or her own online e health history and that can be tracked from anywhere in the world. The national health information system creates a data from different service providers creating a common record for each patient. This gives doctors an easy way to use patients’ electronic record.”

“They can just access all records with one digital identity card like our Aadhaar card. It has all the information either on your smart phone or in the app which you can access the information from,” he further stated.

“With eAmbulance innovation solutions, within a matter of seconds all your digital identification will be available online. Before you even reach hospital, all your information will be sent to the doctors and general practitioners who will be treating you in past.”

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technology perspective

Para Homecare – Creating Automated Healthcare Solutions We use technology to match the client needs with the suitable care giver or healthcare provider by using automated solutions.

These are performed using logics built or written in our software to match the preference fields between the patient and the caregiver, says Dr Sahil Sahotra, Head – Operations, Para Homecare, a unit of Truehome Healthcare & Technologies Pvt Ltd, in conversation with Elets News Network (ENN).

Dr Sahil Sahotra

Head – Operations, Para Homecare, a unit of Truehome Healthcare & Technologies Pvt. Ltd

Q

Give us an overview of Para Homecare.

Healthcare has been core indicator of any country’s’ economic growth.

The average spend from GDP indicates the welfare and well-being of the nation. The increase in healthcare developments has improved the longevity of life for the individual and family to manage quality. As the Indian families today become more and more engaged and the need for improving the quality of life increases day-by-day, the demand for a support system that can care for our loved ones rises. The next important thing is someone to maintain a quality life which can further enhance the quantity.

As the families are becoming smaller, there is always a dearth of caring hands for the dependent parent/ uncle/aunt/child/ wife/ husband etc.

Para Homecare not only shares the

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burden but also removes the guilt of not being able to care for someone who is such an important part of an individual’s life.

The market demand for domiciliary care has steadily increased and flown into the healthcare sector, while carving its own course.

In today’s world, the decreasing amount of time and increasing pressure with individuals due to their tasks, jobs, children, travel etc. and an increase in urbanisation leads to a very challenging situation wherein the younger generations often find themselves lost to care for a loved one. We, at Para Homecare, understand this urge and expanded our portfolio of making available the support, with empathy in our hearts and compassion as our key to deliver service.

Today, life is found in the simplest of comforts such as sleeping in your own bed, drinking in your favourite cup, independence to perform different tasks etc. These can contribute towards a better and successful outcome in a treatment plan. Earlier, this help was a distant vision and majorly available at hospitals or professional institutes.

Today, we live in a time where Para Homecare delivers all the care required

at home. The range of services extends from general care to highly specialised, customised services delivered at the doorstep.

The core thought and vision of Para Homecare is contributed by eminent professionals who participate in the society as doctors, philanthropists, IIMs graduates who bring along a wide range of experience and expertise to design and formulate the fundamentals of overall management and vision. These are further executed by a strong and dedicated backend team of doctors, nurses, physiotherapists, trainers and other functionaries who continuously guide and preserve the sanctity of care with professionalism delivered at different fronts.

Q

How have you been evolved in terms of latest technology and innovations thereby enhancing overall patient care?

Today, technology is the lifeline of any business and the availability of a stronger IT infrastructure helps us evolve as a unique and well defined organisation.

In today’s scenario, IT platform participates as the face of a business allowing the customer to interact,

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Q

You provide a range of services including Assistive Care Service (ACS) and Skilled Nursing Care.

Shed some light over these.

With a strong database of more than 3500 professionally trained caregivers, nurses, physiotherapists, doctors, allied health professionals etc. The staff hired are some of the most dedicated, skilled and devoted caregivers who provide a level of expertise and commitment to their patients’ well-being. This has mainly been due to the high standards of hiring policies, continuous expert training, regular feedback from our clients and trainers and careful coordination with identification and monitoring of KPIs. The base or the identified credential to be achieved being that we should be able to provide the staff or the caregiver that you can trust and treat as a member.

Para Homecare today has been able

Our wide range of experience has led us to understand that any need/ requirement however small or big is a priority for the family in that situation. While we believe every situation is different, we ensure and assure that we can fulfil that need.

to achieve a wide experience of performing more than 4000 visits per month. These visits are not restricted to Delhi-NCR but have extended to different states and currently experienced in more than 11 cities within India. With the introduction of more and more technology and availability of portable medical equipment and advanced monitoring services it helped us support families by providing equipment care support at home, diagnostics, physiotherapists with equipment at home and much more on offer. Some of the core credentials also include assisting in setup of ICU care, breathing support with trained technician to deliver and install the equipment.

Q

Tell us about ‘Diagnostics at home’ service. How does this work?

As we discuss homecare and the various aspects it covers, it is of utmost importance that a patient is provided a complete healthcare package which eases the burden of life and provides a one-stop solution to all healthcare needs.

We, at Para Homecare, ensure

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that the patient is catered for in all aspects one of them being diagnostics.

Again, owing to the developments in technology and techniques of sample collection and testing. A lot of the basic tests and little advanced pathological tests can be performed at the comfort of home without the patient or family being engaged in the hassle of moving back and forth to hospitals or diagnostic centres.

In today’s scenario, the ease has been incorporated from collection of samples done in sterile, compliant containers and reports being offered online through e-mails.

technology perspective

approach, gather information etc. required before availing a service. The mechanisms today assist and support the customer in viewing the nature of services, availability of the staff to fulfil the need, support system available, reviews etc. before the customer decides to avail the services offered. In our line of work, it is of extreme importance that we understand the right needs and provide as per the demand.

We use technology to match the client needs with the suitable care giver or healthcare provider by using automated solutions. These are performed using logics built or written in our software to match the preference fields between the patient and the caregiver.

Additionally, we also use technology to monitor and ensure high level of professionalism in the delivery of care which is maintained at all levels. It furthers enables us to communicate, follow up and perform cross functionalities & aggregate various other services through our platform such as ambulances, diagnostics, medicines etc.

Q

Homecare service is the evolving vertical of the healthcare sector.

Many hospitals have also started this service to cash on patients’ demand. What distinguishes you from other stakeholders of the field?

As a vision and growth parameter of the industry there also is a need of more and more trained dedicated professionals who would want to participate in this field with passion.

Additionally, we also require some form of regulatory body with mechanism which can control the abuse and make accountable for agencies and establishments who jeopardise the overall health of the patient by deploying untrained and non-reliable staff with no established link to a registered or regulated organisation.

As this missing link is the key to maintain and share the everincreasing burden on our clinical establishments and hospitals, as if the patients are ensured proper care and nursing at home it can reduce the burden both on the family and on the treating physicians and allied health professionals.

Our wide range of experience has led us to understand that any need/ requirement however small or big is a priority for the family in that situation.

While we believe every situation is different, we ensure and assure that we can fulfil that need.

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Industry Perspective

Transasia – Ensuring Diagnosis of Disease Affordable beyond Metros As technology has made diagnosis of disease accurate, faster, affordable, Indian companies like Transasia Bio-Medicals Ltd., have reached out beyond metro cities and equipped labs with sophisticated blood testing devices even in rural areas, says Mala Vazirani, Director, Transasia Bio-Medicals Limited, in an interview with Elets News Network (ENN).

Mala Vazirani

Director Transasia Bio-Medicals Limited

Q

How medical devices equipped with latest technology are playing an instrumental role in providing comprehensive healthcare delivery?

Members of Association of Indian Manufacturers of Medical Devices (AiMeD), who are all domestic manufacturers and exporters of e-share a common philosophy of being the “building blocks” of India’s fragile healthcare delivery system. In that spirit, we have taken some bold strides despite the absence of a helpful government policy. Our members know that India needs accurate, affordable and timely healthcare and are engaged in manufacturing high quality medical products of all from syringes and needles, stents and implants to high tech robotic diagnostic equipments with cuttingedge technology that helps them sell in overseas markets.

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As technology has made diagnosis of disease accurate, faster, affordable, Indian companies like Transasia BioMedicals Ltd., have reached out beyond metro cities and equipped labs with sophisticated blood testing devices even in rural areas thereby enabling accurate early diagnosis of disease at an affordable cost across the country, the same is true of radiological investigations, like x-rays and sonography. The data from the tests empowers doctors, sitting in remote medical centers to make accurate diagnosis and rapidly start correct treatment for patients, for patients suffering from number of life threatening conditions like Malaria, for which drugs are easily available thereby saving many lives. For more complex treatments, patients still have to travel to larger towns and cities where the qualified doctors, surgeons work out of well equipped government or private hospitals.

Q

Tell us about the market opportunity and scope of medical equipment segment considered a sunshine sector of healthcare ecosystem.

The Medical Device Industry has the capability to become a growth engine for the economy create jobs, raise GDP and become a net Foreign Exchange Earner larger than Info Tech. Globally, exports of Medical Devices contribute trillions of dollars to economies of the USA, EU, China and Japan.

Less than 20 percent of Indians, Pakistanis, Bangladeshis, Afghans, Nepalis, South Americans, Egyptians and Africans as yet have access to effective medical services, 80 percent do not have access to any meaningful or effective modern medical services.

To understand the size of the opportunity, one needs to know that the country has a huge 70 percent import dependency in this sector while just serving 20 percent of the population. Whereas for the Indian economy, with lakhs of educated unemployed, a robust Indian Medical Device Industry would serve not just India but also the world at large. By encouraging the manufacture of import substitutes, we would be giving a huge boost to the economy, thereby, creating lakhs of jobs, giving employment and livelhood to millions if we were able to take advantage of this huge market opportunity.

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Shed light on the challenges plaguing this medical equipment segment. What the Government should do to encourage domestic market of medical devices?

The Government has to work on removing all the impediments of earlier policies and practices that were put in place, shockingly to discourage Indian manufacturers and favour importers. Currently, the Imported Medical Devices under chapter 90 (HSN 90278090) are importable at zero basic customs duty, the components (HSN 90330000) required by domestic manufacturers to manufacture the same in India are charged 7.5 percent basic customs duty, while the fully finished Imported Medical Device is exempted from being cleared with Zero basic customs duty, thereby penalising any effort to make in India. The Government has to reverse the discriminatory inverted customs duty tariff against the Indian manufacturers and impose basic customs duties on Medical Equipment and products that are made in India to create a level paying field for Indian Manufacturers.

They have to ensure that no Indian fanufacturer is disqualified from participating in any Tender. They have to increase the EMD on Imported goods significantly over that of Indian Manufacturers to facilitate domestic industry. The Government and nodal agencies can simply nullifying any Tender whatsoever where there is no Indian Manufacturer Participating, or disqualified before Technical and Commercial bids are opened who are disqualified on false and flimsy pretext before Technical evaluation and Price Comparisons due to excessive technical specifications and discriminatory criteria such as certification by foreign bodies like European CE and US FDA Approvals.

They have to abolish discrimination against Indian made products, by blocking their participation in Government Tenders

To understand the size of the opportunity, one needs to know that the country has a huge 70 percent import dependency in this sector while just serving 20 percent of the population.

by employing discriminatory eligibility criteria including Certification by foreign FDA;s like US FDA and European CE mark.

There has to be more focus on implementation, monitoring of compliance of Tenders and swift redressal. As yet they are still to dismantle fully do away with ambiguity and discretionary powers to procuring committees for products funded by Government of India or State Governments and ensure the implementation of the Buy India Policy

by Ministry of Commerce, Ministry of Health and Family Welfare, Ministry of MSME so as to fuel the transformation of India into a Global Medical Decice Provider, akin to the success of the IT sector.

Q

AiMeD recently expressed disappointment over the draft Medical Devices Preferential Market Access (PMA) Policy issued

by DoP. What needs to be done?

Firstly, it is to be emphasised that only AiMeD represents the true voice of Indian manufacturers, as all our members are manufacturing firms owned and operated and headquarted in India. There is a lot coming from pseudo Indian associations that are in reality made up of MNCs and importers, whose effective control,

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management and headquarters are overseas but have been enjoying the free and protected access to Indian Market, especially lucrative government and private contracts due to the shackles of inverted duty structure and discriminatory Tender terms in Government Tenders to favour importers.

They are making a lot of noise as it appears that in future they may not gain such favourable access and preferential treatment and so are at work to cause confusion and gain support in government circles and misguide the general public about policy matters misrepresenting themselves to be the voice of “Indian” Industry, when they are foreign MNC’s operating in India.

AiMeD has made recommendations to the Government particularly the Department of Pharmaceuticals and Ministry of Health and Family Welfare, Ministry of Commerce, Planning Commission etc. What we are awaiting isbthe specific details from the nodal Ministry of Health and Family Welfare, the rules based on policy initiatives taken by the Cabinet Committee to give the impetus like the Prefrential Procurement Policy.

We require clear rules free of ambiguity and discretion that are easy to follow and implement by the procuring authorities who should be held accountable for proper implementation on the and outcomes on the ground. Value of Government orders going to Indian Manufacturers must increase substantially, and be measured at close intervals and so must the share in procurement in all sectors.

When there is a clear Buy India Policy, and Preferential Procurement form Local Manufacturers, why should the local manufacturer be burdened with providing so many documents to prove he is manufacturing when the government officials already can access all information about the importer and imported goods through government tax portals for customs duty and IGST on imports.

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Industry Perspective

Q

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Special focus

IVF – A Light at the End of Tunnel for Childless India has come a long way since first ‘test tube’ baby Harsha Chawda was born in 1986. Lots of innovations and technological advancements have taken place since then, enhancing the scope for unhesitatingly utilising IVF techniques, writes Mukul Mishra for Elets news Network (ENN).

T

he landscape of healthcare ecosystem is expanding like never before, with technologies and innovations playing a strategic role in fostering change towards better health outcomes.

Modern techniques and latest medical equipments have made such things possible which were previously assumed to be nearly impossible.

In vitro fertilisation (IVF) is one of such technique which has been instrumental in bringing back the lost smile on the face of millions of couples worldwide by bestowing them parenthood.

“India has a large number of couples who require assistance to conceive. According to the ICMR

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Publication, approximately 1.8 million couples in the country need infertility treatment,” said Dr Shivani Sachdev Gour, SCI IVF International Hospital.

IVF is a form of Assisted Reproductive Technologies (ARTs), others being Intrauterine Insemination (IUI), Intracytoplasmic Sperm Injection (ICSI) and Frozen Embryo Transfer (FET), which help biologically infertile women to conceive.

This artificial treatment process is turning out to be a big boon for all those couples who are faced with various kinds of medical problems and find it difficult to have a child of their own.

Today there are treatment options

and “having a baby is no longer an unfulfilled desire. Even though the emotional distress still lingers but hope is sparked by IVF”, said Dr K D Nayar, Chief Consultant Infertility, Akanksha IVF Centre.

“With time there is increasing trend in infertility and so in acceptance of treatment for the same. Now, more and more couples are accepting assisted reproduction techniques and enjoying the feeling of parenthood,” Nayar added.

How Does IVF Work?

It’s a modern artificial infertility treatment process. In this, eggs extracted from a prospective mother’s ovary are fused with the donor’s sperms in a specialised laboratory.

The four-to-five step process takes place in the supervision of a team of expert embryologists.

In this treatment, doctors first stop natural menstrual cycle of a woman by giving her specific dose of medicine. This is followed by superovulation process where ovaries are

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The market has picked up steam in recent years due to the rising prevalence of infertility and related conditions and the rising disposable income of consumers.

PRP (Platelet-rich Plasma) The technique is used for patients with recurrent implantation failures and IVF failures because of the thin endometrium. PRP helps to naturally heal tissues and improves the quality and thickness of the endometrium.

IVM (In Vitro Maturation) This procedure is used to help women with conditions like a polycystic ovarian disease to have children.

Growing Market of IVF Lots of innovations and technological advancements have occurred since first ‘test tube’ baby Harsha Chawda was born in 1986. It opened a hug market for IVF technique.

According to the Research and Markets, the world market for IVF and IVF products will grow to $12.5 billion till 2022. The Indian market of IVF is also growing by leaps and bounds. As per Allied Market Research (AMR), the In Vitro Fertilisation (IVF) services market in India is projected to reach $775.9 million by 2022.

Special focus

activated to produce more healthy eggs. After that both eggs and sperms are fused in the laboratory in artificial condition and finally the resultant embryos are transferred back into the woman’s uterus.

“Originally this process of fertilisation takes place in the fallopian tube of a woman. This is called in vivo fertilisation. After fertilisation, an embryo is formed which grows for four days in the fallopian tube and then it is transported through fallopian tube into the uterus or the womb where it grows into full-term baby in nine months,” Dr Gour said.

“In IVF, this process takes place in a small dish outside the human body and embryos are transferred directly into the womb or the uterus thus bypassing the fallopian tube.

It’s important to know that not all embryos grow into a child. Some stop developing at an early stage and the pregnancy does not continue and this is one of the major reasons why multiple embryos are transferred into the uterus in the IVF process”, Dr Gour added.

Causes of Infertility There are many factors including busy lifestyle in cities, late marriages and delayed pregnancy, decline in egg and sperm quality, which contribute to rising rates of infertility. In addition, pollution, smoking habit, mobile

Innovations in Infertility Market Intra-Uterine Insemination (IUI) It is one of the simplest forms of Assisted Reproductive Technology.

Here the semen is collected from the male partner and is prepared in the lab and then inserted into the uterine cavity at the time of ovulation to facilitate fertilisation.

Intracytoplasmic Sperm Injection (ICSI) This treatment process is used when problem arises due to male infertility factor. In ICSI, it involves an embryologist selecting a single sperm, removing the tail and then injecting it into the egg with the help of a micromanipulator. The resulting embryo is later transferred to the uterus for implantation.

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Special focus

phone use and stress also increase pregnancy related issues.

“The market has picked up steam in recent years due to rising prevalence of infertility and related conditions and the rising disposable income of consumers.

The increasing social acceptance of assisted reproductive technology has also aided the global market for the same, which is likely to exhibit rapid progress in the coming years,” Nayar said.

Gauri Agarwal, Director, Seeds of Innocence, says more and more couple are availing IVF treatment to attain parenthood. The reason being that people are now aware about this latest technology and its high success rate.

“Couples in the cities are much aware of this treatment due to easy access to fertility clinics. The assurance and success rates of good IVF clinics tempt couple to opt for their services,” Agarwal said.

In India women are often blamed

for not bearing child but the truth of the matter is infertility can affect men and women alike. “Literacy has helped the couples to understand that infertility is not related to women only, but it affects the male in equal percentage and hence men are also coming up for the treatment and opting IVF,” Agarwal further stated.

According to Dr Rajalaxmi Walavalkar, Consultant, IVF and Reproductive Surgery, Cocoon Fertility, the IVF market in India is a very fast growing market.

“There is a need for increased awareness in the population, both about infertility and about the availability of treatments and a need to de-stigmatise infertility.”

Shivani Sachdev Gour, SCI IVF International Hospital, believes that medical tourism in the country for fertility treatment is also on the rise due to latest innovations on this front.

“India has foreign trained highly skilled doctors to provide best IVF treatment. Here, fertility treatments

Today there are treatment options and having a baby is no longer an unfulfilled desire.

Even though the emotional distress still lingers but hope is sparked by IVF

are available at very competitive prices and that is why many more people visit the country to access the facility,” Gaur stated.

Challenges Despite IVF playing a pivotal role by bringing a bundle of joy to dejected couple, this modern treatment technique has many challenges associated with it. In rural parts of India, couples don’t seek medical advice despite facing ignominy of infertility for years.

In addition, the IVF treatment is also considered as emotionally stressful and financially demanding.

“Coping with the emotional challenges of infertility can be difficult for couples. Infertility is a social problem affected by various factors like accessibility, availability and knowledge. More stressful is the task of decision-making in seeking fertility treatment,” Nayar said.

“The high cost of IVF treatment not covered under any insurance policy also creates problem. The financial status of people at large is a great hindrance in treatment,” Agarwal said.

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Interview

India Needs Organised Efforts to Tackle Illnesses The standard of patient care, technology in India is at par with global standards. We have big hospitals with latest technology and our doctors are respected for intelligence, clinical accuracy and patient care. We need to organise efforts to fight against illness.

This is rapidly happening since last decade, says Dr Bipeenchandra Bhamre, Cardio-Thoracic Surgeon, Sir H N Reliance Foundation Hospital and Research Centre, in conversation with Mukul Kumar Mishra of Elets News Network (ENN).

Q

Having covered a long distance since training days at Texas Heart Institute, Houston, USA, how do you look at all these years today as a cardiac surgeon?

It’s been very exciting journey as a cardiac surgeon so far. When you are passionate about the work you do, it always yields best results. When I returned to Mumbai, it was a new beginning. Coming back was a challenge and it takes hard work and dedication, daily meeting new people, making them understand what I do, why I do and the results we can give.

Heart surgery is such a demanding speciality, it’s been satisfying four years in Mumbai. We are able to give 99.2% results for complex heart surgeries we do daily.

Q

Is cardiac arrest technically different from heart attack?

What preliminary precautionary measures need to be taken if someone faces such a situation?

In cardiac arrest the heart stops pumping the oxygen rich blood into body. There is a complete pump failure. In this condition, patient becomes unconscious and needs emergency measures on the spot to start the heartbeat. Like what

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we call CPR (cardio pulmonary resuscitation). The patient should be lying on floor and one person should call emergency team in nearby hospital. Other person starts compressing chest mechanically by using hands. This is a part of resuscitation. If you are in public place like shopping mall, airport, railway station, etc and you come across unconscious patient, he may be having cardiac arrest. At such places there are facilities for defibritaion machines, which help in regularisation of heart rhythm, in common language, shock to the heart.

Heart attack means that the heart muscle is not getting enough blood supply. That’s why we get severe chest pain. In this condition, patient needs to get to the nearby hospital for further treatment. If you have tablet aspirin at home, you can take one tablet. Probably, you need coronary angiography as early as possible.

Q

Tell us about minimally invasive cardiac surgery.

What distinguishes it from the traditional methods of cardiac surgery?

Minimally invasive cardiac surgery is a speciality of cardiac surgery in

Dr Bipeenchandra Bhamre

Cardio-Thoracic Surgeon, Sir H N Reliance Foundation Hospital and Research Centre

which we can perform the heart operations through smaller incisions with rapid recovery. We can do Coronary Artery Bypass Grafting (CABG) though left side of the chest, heart valve repair or replacement through right side of the chest without the need to cut the breast bone which is in the centre of the chest. The basic principles of cardiac surgery are followed to complete repair, safety of patient. Like in traditional open bypass surgery, I use bilateral internal mammary artery which remain patent after 20 to 25 years of surgery. During minimally invasive surgery. the basic surgical principles of revascularisation are followed with minimal incisions.

Nowadays, we can use Robot for doing cardiac surgeries in highly selected patients. Typically, traditional cardiac surgery patient completely

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interview

recovers in six to eight weeks. In minimally invasive cardiac surgery, patient recovers in two weeks.Â

Q

What are the latest technological advancements in the cardiac field which will prove to be a boon to patients and overall improve healthcare delivery in coming days?

On one hand, we have improved knowledge and care of cardiac patients. On the other hand, we have latest gadgets to serve patients. There are suture less valves available in India where we can replace heart valves through smaller incisions. Some of the valves are replaced through catheters in femoral arteries, known as TAVI/TAVR. This technology is available in highly selective patients.

There is a lot of development in the heart failure treatment with newer left ventricular assist devices in which we can increase the function of failing heart by fitting a small motor pump inside the body. These small pumps work well for few years. I have used these machines in couple of patients in last few months in Mumbai. There has been a lot of experiments in last decade in North America for these left ventricular assist devices. Then for H1N1 patients, who are otherwise with no hope on ventilator, we can offer them ECMO, extracorporeal mechanical oxygenator and give them chance to survive. Overall cardiac surgery is going through very exciting new developments. Cardiac surgeons have always been at the forefront of innovation.

Q

How do you rate the Indian healthcare sector against global standards in terms of innovations, technology and patient care?

The standard of patient care, technology in India is at par with global standards. The thing that we lack is organised sector. We have big hospitals with latest technology and

our doctors are respected all over the world for their intelligence and clinical accuracy and patient care.

We need to organise our efforts to fight against illness. This is rapidly happening in last decade.

By following things like control of diabetes and high blood pressure and cholesterol by regular medications.

Completely avoiding tobacco products, limiting alcohol use, eating proper food, doing regular exercise and getting adequate sleep, one can avoid coronary artery disease.

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Q

Indians are pre-disposed to heart disease, why is it so?

This is a myth. If you see the statistics in the west and in India, the incidence of heart diseases are almost same as per coronary artery disease is concerned. Of course the severity of the heart disease is more because Indians will have more diffuse coronary artery disease than their western counterparts. Our coronary arteries are smaller than western patients so we need more care during bypass surgery. Overall, if you follow few simple things, like control of diabetes and high blood pressure and cholesterol by taking regular medications, completely avoiding tobacco products, limiting alcohol use, eating proper food, doing regular exercise and getting adequate sleep, you can avoid coronary artery disease.

eHEALTH Magazine

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Special article

Health Insurance-

A Panacea for Healthy Life Amidst changing lifestyle, food habits and rising noncommunicable diseases across country, wellness should be the prime focus. People should go for annual health checkups and invest in various health insurance schemes which is need of the hour, according to Dr Sandeep Chatrath, Regional CEO, Apollo Hospitals, Andhra Pradesh and Telangana, reports Mukul Kumar Mishra of Elets News Network (ENN).

S

peaking during Elets’ Healthcare and Wellness Summit held in New Delhi recently, Chatrath shared Apollo’s vision for creating quality healthcare solution across country.

Talking about the rich legacy of Apollo Healthcare, he said, “Apollo is always at the forefront of technological revolution. It is in genes of Apollo. Nearly three decades of running with 67 hospitals and operation.”

While talking about role of technology in fostering healthcare, he said, “We always believe that the technology is game changer in today’s time. Apollo hospital has 100 telemedicine centres which are running across the country. The challenge in our country is that our country lives in rural masses while doctors and hospitals are more concentrated in cities and metros.

This huge divide of rural and urban and disparity in the healthcare are addressed through the telemedicine.”

“Telemedicine is best solution in today’s time to cater to the health needs of rural masses where 70 per

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cent of our population lives.”

Talking about AskApollo he said, “Apollo has a single window digital platform AskApollo. It has revolutionised the healthcare delivery including virtual consults and appointment systems. This AskApollo solution, a single window digital platform of Apollo helps a lot in connecting doctors to the people in rural areas.”

“We have a telemedicine centre in Himalaya too where it is very difficult to reach by roads. That sort of connectivity which we achieved through telemedicine and AskApollo helps in healthcare delivery.”

“The latest healthcare opinion, consultations to the people living in far flung areas is need of the hour. Apollo runs 300 ambulance services all over the country. We have 1,066 as emergency helpline.

These are all GPS enabled ambulance services. Apollo has been running e ambulance initiative since last 5 years,” he said.

Underlining the need of ambulance services in rural area, he said, “Ambulance should not be just a

Dr Sandeep Chatrath

Regional CEO Apollo Hospitals, Andhra Pradesh and Telangana

transport vehicle only. In rural areas we find ambulances but they are not having properly equipment which a modern ambulance should have.

Apollo is working very closely as PPP with State Governments under their guardianship, mentorship so that we can bridges in this gap.”

“We spend Rs 50 lakhs on one ambulance. GPS connected ambulance is a full-fledged hospital on wheel. The GPS connectivity makes healthcare services available in shortest period of time. We have a single window helpline so that transportation of ambulance can be facilitated as emergency and acute care is utmost important.”

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Special article

Emphasising on the need of robust healthcare services to cater emergency cases, he said, “Classically, there are four healthcare emergencies. First is heart attack followed by brain attack, poisoning and trauma. Pre-dominantly 85-90 per cent of our emergencies are centred around these four areas.

Through a robust emergency and accidental emergency system we have been able to bridge lots of gap in these.”

While sharing views about wellness concept which is need of the hour, he said, “Wellness is pivotal to healthcare in today’s time. The reason being India is at tsunami of non-communicable diseases (NCDs). We have unfortunately highest incidence of heart patients in world, highest incidence of diabetes in world, highest incidence of cancers in the world. In all these three verticals, India is the word’s capital of diseases.”

Appealing people to invest money on health insurance, he said, “Today is the era of Roti, Kapda, Makaan and insurance. Invest in your health insurance. It makes huge impact when we come on affordability of healthcare. Entire

family gets covered in Rs 15,000 for a lot of diseases. Our country has around 30 per cent of penetration of insurance at present.”

He said annual health checkup should be a priority. “Annual health check up is another important area.

We can fight the tsunami of NCDs only if we invest in wellness. If one goes for annual health check up, a lot of diseases get diagnosed at early

Apollo is working very closely with Government of India especially on partnership with PMO. On 9th of every month, we have free checkup programme for pregnant women.

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stages. The challenge in our country is that we come across diseases in tertiary stage. At that stage when it has already progressed to a late stage and it has become irreversible.”

Pledging to provide quality and cost-efficient health services to people across country, he said, “Apollo does countrywide seven lakh health checkups every year. This year we are targeting two billion health checkups. We have personalised and customised 30 different type of health checkups based on age, sex, risk factors in the family. We are also running healthy heart programme across country.”

“In community approach, the Apollo is working very closely with the Government of India especially on partnership with PMO. On 9th of every month we are having free checkup programme for pregnant females across length and breadth of country. This programme occurs across 70 odd hospitals of Apollo group. Without charging any money, we are engaged in detecting and diagnosing early stages of mother diseases. We save not only mother’s life but child’s life too. Apollo is working towards creating a healthy India.”

eHEALTH Magazine

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Industry Perspective

Seeds of Innocence Brings Ease in Infertility Treatment Seeds of Innocence has taken the initiative to provide IVF treatment on installments with zero interest rate and this has come up as a boon for those who cannot afford to pay full amount in one go, says Gauri Agarwal, Director, Seeds of Innocence in conversation with Elets News Network (ENN).

Gauri Agarwal

Director, Seeds of Innocence

Q

Appropriate diagnosis, treatment and counselling are some of the key elements for IVF and surrogacy. How do you ensure quality of the treatment while maintaining regulatory terms?

Diagnosis, counselling and treatment are the key factors to any medical treatment. At Seeds of Innocence, we are very particular to counsel the patients by understanding their infertility cause, going through the previous investigations and then finally diagnosing the protocol.

Our team of expert screens the patient in detail by interacting with both the partners about their marital, menstrual and medical history. They are then referred to the fertility expert for further evaluation.

The doctor explains the cause of infertility and provides the treatment

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best-suited to them. After getting the consent from the patient, he or she is advised some investigations and on the basis of which the protocol is given.

Surrogacy needs much more counseling and it is difficult for a woman to bear the agony of not being able to carry her own baby.

The Seeds of Innocence focuses on quality service rather than quantity and to ensure it exchanges its protocol with University of Gent, Belgium in complex cases. SOI is well-known for trustworthy quality care as each and every case is dealt with great passion by the fertility specialist. Seeds of Innocence is the first IVF center in North India to have its own genetic lab which enhances the success rate up to nearly 80 per cent and ensures healthy generations.

Q

Infertility issue is one of the sensitive subjects majorly in conservative society. Being a solution provider in this segment, what steps have been undertaken by you to create affordability and awareness about the treatment?

Infertility is often misunderstood in the Indian society and majority of the people take it as a curse or superstition suggested by the local occultists in the rural areas. The biggest challenge is to

change their mindsets and let them understand the basics.

Seeds of Innocence is incessantly working on this aspect since its inception. It organises free consultation camps in the rural areas to impart knowledge about the problem and the treatment.

Couples feel shy in talking about this sensitive issue and they don’t open up easily. For this, we have a good team of psychological counsellors who, through their expertise, get to know about their social and mental stigma and suggest them the appropriate protocol.

Seeds of Innocence is actively participating in running OPDs, providing free check-ups in the rural areas by regularly sending its team of doctors. Local newspapers and social media campaign also contribute in spreading awareness. Most of the fertility treatment expense is paid out of the pocket and SOI considers this factor too. EMI facility is available for these patients where they can go for the treatment with ease of paying in installments.

Q

What are the main reasons for increased IVF treatments among patients? Highlight the success rate of IVF and IUI treatments in India.

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Infertility is often misunderstood in the Indian society and majority takes it as a curse or superstition suggested by the local occultists in the rural areas.

Industry Perspective

Infertility has become a very common problem nowadays. Many factors contribute to it i.e busy lifestyle, late marriages, increased use of mobiles and laptops, pollution, pesticides and malfunction of the reproductive system of one or both the partners.

Couples in the cities are much aware of this treatment due to easy access to fertility clinics. In the rural areas, print and digital media have stepped in with great boom and are spreading awareness on a large scale.

Various camp activities organised by the fertility clinics attract the public at large to come and get information about the available treatment options.

The assurance and success rates of good IVF clinics tempt them to opt their services.

Seeds of Innocence has taken the initiative to provide IVF treatment on installments with zero interest rate and this has come up as a boon to those who cannot pay the entire amount in one go. Literacy has helped the couples to understand that infertility is not related to women only, but it affects the male in equal percentage and

hence men are also coming up for the treatment and opting IVF. The success rate of IVF lies between 44-48% and of IUI is somewhere 1015%, however, with PGS it could be increased up to 78-80%.

Q

What are the challenges and opportunities for Indian IVF market?

Every noble cause has its own challenges and opportunities and Seeds of Innocence believes that opportunity lies amongst challenges and solution could be best found amongst problems. India is a vast market for fertility business and equally loaded with ample of opportunities. Many people from interiors of tier II cities are still under the dark clouds and the lack of knowledge is ruining their lives.

They are too influenced with the local baba. Sometimes it becomes a tedious task to make them understand the treatment options.

The high cost of IVF treatment not covered under any insurance policy also creates problem. The financial status of people at large is a great hinderance in treatment.

The tailor-made pricing and cost to be paid in easy interest free installment could encourage the couples consider the full ramifications of IVF treatment.

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Increased success rate by opting PGS is also one of the leading factors to encourage the infertile couples to go for IVF treatment.

Q

What are your expansion plans?

Have you also collaborated to enhance IVF treatment facilities in the country?

Expansion is good for the health of any organisation as it leads to spearhead technological integration for array of services. The availability of quality services in every nook and corner of the world enhances patient relations and reduces critical wait times. Our organised, methodical and decisive-thinking has led Seeds of Innocence to expand in tier-II and tier-III cities with optimal treatment pricing and par excellence services.

The deprived generation in small towns and cities will soon experience our diligent and result-oriented services. Within a short span of three years, we have grown to five centers in Delhi/NCR. We are striving to deliver million dollar smiles across the world.

We are internationally collaborated with University of Gent, Belgium and our genetic center is also collaborated with Gendia University, Belgium for academic exchange and quality control.

eHEALTH Magazine

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technology perspective

IVF: Cutting Edge Technology Creating Families IVF or in vitro fertilisation is a process by which the eggs or the oocytes of the woman are fertilised by the sperm of male partner outside the human body in a laboratory. Though commonly called ‘a test tube baby’, the eggs are actually fertilised in a small dish, says Dr Shivani Sachdev Gour, SCI IVF International Hospital, in conversation with Elets News Network (ENN).

Dr Shivani Sachdev Gour SCI IVF International Hospital

Q

Give us an overview of SCI IV International, which caters to people by providing state-of-theart technologies.

SCI IVF was started in 2009 and since then it has conducted over 13,000 IVF procedures. It has helped thousands of couples and individuals in India and over 55 countries of the world to become parents.

We provide state-of-the-art technology and offer individualised protocols for fertility treatment.

Our staff is very sensitive to the needs of our patients and we provide service with care and compassion which is highly appreciated in the numerous thank you notes that we have received.

Q

Tell us about your services i.e IVF/ICSI and other infertility treatment. How do these work?

IVF or in vitro fertilisation is a process by which the eggs or the oocytes of the

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woman are fertilised by the sperm of male partner outside the human body in a laboratory. Though it is commonly called a test tube baby, the eggs are actually fertilised in a small dish.

Originally this process of fertilisation takes place in the fallopian tube of a woman. This is called in vivo fertilisation. After fertilisation, an embryo is formed which grows for four days in the fallopian tube and then it is transported through fallopian tube into the uterus or the womb where it grows into full-term baby in nine months.

In IVF, this process takes place in a small dish outside the human body and embryos are transferred directly into the womb or the uterus thus bypassing the fallopian tube.

It’s important to know that not all embryos grow into a child. Some stop developing at an early stage and the pregnancy does not continue and this is one of the major reasons why multiple embryos are transferred into the uterus in the IVF process.

The services that we provide include testing for ovarian reserve and sperm function; DNA fragmentation studies; sonosalpingography; follicular monitoring; testing for immune factors in infertility; IUI; IVF; ICSI; PICSI; Embryo biopsy and Pre-implantation genetic screening or PGS/ PGD; Laser assisted hatching;

Spindle view technology for imaging the egg; Egg freezing; embryo freezing; sperm freezing; vitrification; Donor gametes and Surrogacy.

Q

What is Clinical embryology?

Shed light over Laser Assisted Hatching, a technique which improves pregnancy rates.

An embryologist is the person who works in the laboratory to handle the gametes -- the sperm and the egg. The work involves testing the gametes for fertility. Embryologist does the actual fertilisation of the egg by the sperm by IVF or ICSI technique. Sperm preparation by various techniques like swim up and density gradient; doing sperm function tests when indicated and testing the sperm for vitality are a part of the process. Cryopreservation of the eggs, sperm and embryos and maintaining records, quality control and quality assessment in the laboratory are also a major part of their work profile.

Clinical embryology involves a further specialisation in which the individual also meets and consults with the patients instead of only working in the laboratory. Exploring various treatment options with them and walking them through what is actually involved in the treatment process.

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IVF technique is boon for childless couples and single parents. What are the factors which drive IVF market in India?

India has a large number of couples who require assistance to conceive. According to the ICMR Publication, approximately 1.8 million couples in the country need infertility treatment. The ICMR study puts the incidence of infertility in India at approximately 4 per cent which is lower than approx 10 per cent seen in western countries.

Today, at approx 1.2 to 1.5 lakh IVF cycles a year, India performs only approx 90 cycles per million population compared with 3,000 per million population in Israel, 1,500 in Australia, 500 in the US and 220 in Egypt.

Varying reports put the Assisted Reproductive Technology (ART) market in India to be worth at $1 billion (Rs 5,000 crore) in the next 1-2 years and predicted to cross Rs 10,000 crore mark by 2018.

In 2012, global IVF market had a value of $9.3 billion which is projected to cross $21.6 billion by the end of 2020.

A worldwide decline in sperm parameters, late marriages and delayed pregnancy, decline in egg quality are the major determinants affecting pregnancy.

In addition, environmental factors like pollution, pesticide use,

India has foreign trained highly skilled doctors to provide best IVF treatment. Here, fertility treatments are available at very competitive prices.

mobile phone use or stress may play a role contributing to rising rates of infertility.

Along with this, increasing availability of advanced fertility treatment and third party reproduction like donated gametes and surrogacy offer more options to couples unable to conceive by other means such a conventional IVF. Increased availability with even smaller towns and semi-rural areas having new fertility centres, plus scientific advances leading to a range of treatment options to treat infertility are readily available in India.

These include medications for ovulation induction, endoscopic surgery to correct or minimise anatomical and medical conditions, and the assisted reproductive

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technologies, including IUI, IVF, ICSI (intra cytoplasmic sperm injection) and many more.

India has foreign-trained highly skilled doctors to provide best IVF treatment. Here, fertility treatments are available at a very competitive prices and that is why many more people visit the country to access the facility.

Patient awareness camps that are being regularly conducted by corporate and medical institutes along with success story of celebrities have given acceptance to this modern technique and have raised its profile.

Medical tourism in the country for fertility treatment is also rising.

technology perspective

Q

Q

Lifestyle induced disorders, such as obesity and smoking are the main reasons for the high infertility rates among women. What are your suggestions to them?

It has been shown in numerous studies that obesity and smoking have a close relationship with infertility.

In certain conditions like polycystic ovarian syndrome or PCOS even a 5 per cent reduction in weight can help some women to rectify the underlying hormonal disorder and restore ovulation which help the woman conceive naturally without any medication.

Obesity has been found to be associated with infertility via many mechanisms, including an increased risk of ovulatory disorders; oxidative stress; increase in miscarriage rates.

Obesity in men has been linked to reduced sperm quality and oligoasthenoteratospermia; erectile dysfunction and reduced fertility.

Smoking has been found to be directly toxic to the gametes; both the eggs and sperm and has been linked to premature ageing of the eggs or premature menopause and reduction in quality of the sperm and its motility.

It increases the risk of miscarriage.

Both men and women are strongly advised to give up smoking for the sake of their family.

eHEALTH Magazine

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technology perspective 40

mCURA Smart OPD – For a Hassle-free Medical Treatment In a bid to address the usual challenges of patients at Hospital OPDs & Clinics, mCURA has come up with a solution -- mCURA Smart OPD -- to resolve the perennial problems without a fuss.

T

he mCURA Smart OPD is India’s First Integrated Mobility Platform, which ensures minimum counter visits, calculates wait time at each counter and provides e-prescriptions.

As is usually observed, the long multiple queues, overcrowding and waiting time at Hospital OPDs and clinics leads to patient frustration and discomfort.

To resolve these issues, the healthcare sector has realised the need of technology which can smoothen the work flow, offering a comfortable visit to the patients.

Under the pioneering initiative of mCURA, the heath-tech company, India’s first Integrated mobility platform, SMART OPD has been installed at hospitals and clinics in India.

This technology enables patients to bypass long queues at registration and billing counters, labs, pharmacies and doctor chambers which completely eliminates the necessity of spending valuable time waiting at the hospitals.

Through this technology, the patients can have ready information on their mobile phones or tablets

april 2018

located outside each consultation cabins on the inflow and outflow of other patients, providing comfort to the patients.

At the registration counter, patients are given NFC based “ TAP & PAY “ CARD (Registration + cash card) and are prompted to download patient app, which stores all the medical records, medical bills/payment transactions, checks doctor’s availability, real time token broadcaster which helps doctors as well as patients at investigation/

diagnostic counters and pharmacy.

For non-smart phone users the “Tap & Pay” Card has the capability to access records/ bills / payments/ book appointments from the tabs or devices installed outside every doctor’s chamber and at all investigation counters.

The patients can use their “Tap

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technology perspective

& Pay” cash card to pay for hospital services easily without waiting in any queue from any of these counters.

Simply, recharge it and tap the card at the counter to pay for doctor fees, investigation bills and medicine delivery. It also instantly calculates wait times and provides required information between various lab tests recommended by the doctor.

According to Madhubala Radhakrishnan, Founder and President of mCURA, “Labs, Pharmacy, doctors and even patients are integrated fully into the IT Infrastructure through mobile devices. This helps facilitate faster filling of prescription, reduction in misreading of doctors’ handwriting, lowered waiting time for test results and automatic medicine intake reminders to patients. By automating everything, redundancy can be avoided and manpower can be optimised.

“This technology will also help the patients who need a family member to take care of them at the billing counters, labs and pharmacy. This will help and ensure smooth entry, consultation and exit of the aged persons as there is no need of cash management at the billing counters.

The patient is only needed to carry the SMART OPD card to experience the smooth flow at the hospitals and clinics,” adds Radhakrishnan.

Recognising the fact that doctors using technology at the point of care is a big challenge, mCURA also provides Clinical Information Executive who is equipped with smart devices to support doctors for quickly entering patient prescriptions digitally. This also helps preserving doctor-patient relationship as the doctor would only be listening to the patient’s problems, without diverting his/her attention on computers.

Besides, catering to medical records in chronological order through single view case-sheet, it helps doctors to review and enter their current findings immediately.

Delivering customizable predefined templates for common ailments frequently seen in OPDs, it reduces doctors’ time per patient visit and helps improve patient intakes.

Moreover, by storing lab views of wounds and comparing it across time frames, doctors can measure treatment progressions/regressions. mCURA Smart OPD is installed at Sir Ganga Ram Hospital in Delhi and KIMS Hospitals in Hyderabad.

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SMART OPD enables patients to bypass long queues at registration and billing counters, labs, pharmacies and doctor chambers which completely eliminates the necessity of spending valuable time waiting at the hospitals”

eHEALTH Magazine

april 2018

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News Highlights

The Latest from Health World Manipal Hospitals acquires Fortis Healthcare Fortis Healthcare’s Board has approved the demerger of its hospitals business to Manipal Hospital Enterprises and given nod to selling of its 20 percent stake in SRL to Manipal Hospitals.

Now, as a result, the resultant entity Manipal Hospitals will be a publicly traded company listed on National Stock Exchange (NSE) and the Bombay Stock Exchange (BSE). The rest part of Fortis Healthcare will be an investment holding company with 36.6 percent stake in SRL. Reacting to the development, Bhavdeep Singh, Fortis Healthcare CEO said, as an organisation “we are thrilled with this transaction as it enables us to take the next bold step into our future”.

“Much has transpired over the past 12-18 months at Fortis and in the healthcare industry at large; it’s now time to get back to working with our doctors and nurses to saving and enriching lives.”

“We believe Manipal has built a terrific franchise and team and the coming together of our two organisations will be transformational for the healthcare industry,” Singh said.

Dr Ranjan Pai, Chairman of Manipal said the companies make a compelling strategic fit in terms of complementary geographies, clinical strengths as well as a shared commitment to providing outstanding patient care.

Medanta organises International Liver Symposium The Medanta Institute of Liver Transplantation and Regenerative Medicine recently organised the 4th International Liver Symposium (ILS) where healthcare experts shared their viewpoint on various aspect of liver diseases.

Liver cancer is the second largest cancer killer in India. 30 per cent of the Indian adult population has fatty liver. Cuttingedge treatment options and surgeries specific to these issues were presented in the symposium.

The event organised at Leela Ambience, Gurugram saw participation from experts from across the world. The world’s leading experts and academicians deliberated on Hepatology, Liver Surgery and Transplantation at three-day symposium which was based on the theme of “Debates in Liver Diseases and Transplantation“.

“The International Liver Symposium is a convergence of the leading minds, techniques, and innovations for Gastroenterologists, Hepatologists, Liver Surgeons, Anaesthetists, Intensivists, Paediatricians, Interventional Radiologists and Researchers, globally. The incidence of liver disease has risen and liver medicine

and surgery have seen phenomenal rise over the last decade.

At the Medanta Liver Transplant Institute, we run the world’s second largest living donor liver transplant program, performing more than 250 transplants annually.

Our team has an experience of almost 2800 liver transplants. ILS reflects our commitment to the currency of knowledge and harnessing it to deliver the best globally benchmarked treatments,” Dr A S Soin, Chairman, Medanta Institute of Liver Transplantation and Regenerative Medicine said.

Apollo Hospitals Join Hands With UK College to Train Radiologists The Apollo Hospitals has partnered with the Royal College of Radiologists to help address the shortage of skilled radiologists in UK and India. Through the collaboration, Apollo Radiology International (ARI), a specialty division of the Apollo Group, will provide opportunities to Indian Radiologists to work for fixed terms in the UK. These jobs will help in providing experience and exposure to contemporary clinical developments in the field of radiology.

As part of the collaboration, eligible Indian radiologists will work and train in the NHS partner hospitals for a three year period.

The jobs will involve providing a general radiology service to the UK hospital and at the same time getting subspeciality training in their area of interest. At the end of the three year period the Radiologists will come back to India and exercise their enhanced skills for the benefit of Indian patients and improve the quality and delivery of health services.

Commenting on the collaboration, Sangita Reddy, Joint Managing Director, Apollo HospitalsGroup said, “We are delighted to have partnered with the Royal College of Radiologists and Health Education England to enhance multifold the availability of trained radiologists in the NHS and Indian health system.

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news highlights

Prices of 869 formulations to go up by 3.44 per cent, says NPPA The Government has announced that the prices of 869 formulations including antibiotics, cancer and cardiovascular disease treatment drugs and two types of coronary stents will go up by 3.44 per cent.

The development follows a price revision as per annual wholesale Price Index (WPI), the drug pricing regulator, NPPA said in separate notifications on Monday.

Once the new price comes into effect, bare metal stents will cost Rs 7,923 while drug eluting stents (DES), including metallic DES and bioresorbable vascular scaffold / biodegradable stents will cost Rs 28,849.

The National Pharmaceutical Pricing Authority (NPPA) revised prices of 859 scheduled formulations, which included antibiotics such as combination of Amoxicillin (A) and Clavulanic acid (B) used in treatment of bacterial infections; docetaxel that is used to treat variety of cancers and atorvastatin, a cholesterol lowering drug which is also used for prevention cardiovascular diseases.

Scientists Discover New Human Organ ‘Interstitium’ In a landmark discovery the US scientists have identified a new organ in human beings consisting of a network of fluid-filled compartments that act like shock absorbers. This previously undiscovered organ which has been dubbed as ‘interstitium’ by the researchers protects tissues of vital organs from tearing.

Newly discovered organ, one of the largest in the body can be found beneath the surface of the skin. It also remains present in tissue layers lining the gut, lungs, blood vessels, and muscles.

The findings which was published in the journal Scientific Reports, has implications for the function of all organs and most tissues. Researchers from the New York University in the US showed that layers of the body long thought to be dense, connective tissues are instead interconnected, fluid-filled compartments.

This series of spaces, supported by a meshwork of strong (collagen) and flexible (elastin) connective tissue proteins, may act like shock absorbers that keep tissues from tearing as organs, muscles, and vessels squeeze, pump, and pulse as part of daily function.

The scientists believe that ‘interstitium’ may help them in understanding how cancer spreads within the body.

Google honours Anandi Gopal Joshi, India’s first lady doctor Search engine Google on Saturday celebrated the 153rd birth anniversary of Anandi Gopal Joshi, India’s first lady doctor with its Doodle.

Google’s doodle shows her holding a degree with stethoscope hanging around her neck.

Born on March 31, 1865, Joshi was the first woman of Indian origin to study and graduate with a two-year diploma in medicine in the United States. She earned her medical degree from the Women’s Medical College of Pennsylvania, now known as Drexel University College of Medicine.

Due to family pressure, she was married at the age of nine with Gopalrao Joshi, a widower almost 20 years older than her. But the marriage proved to be a biggest turning point of her life. Gopalrao Joshi not only supported her in all endeavours but also encouraged her to continue education. He also renamed India’s first lady doctor who was born with the name Yamuna as ‘Anandi’.

“In 1886, a young doctor stepped off a ship from America, eager to take up the role of physician in charge of the female ward at Kolhapur’s Albert Edward Hospital. Not only was she India’s first female doctor, but she was only 19 years old at the time. Her name was Anandi Gopal Joshi, and her story is one of courage and perseverance,” Google writes in its blog.

“Joshi’s young life was tragically cut short when she died of tuberculosis before her 22nd birthday. However, her legacy and the path she paved for generations of women continues today. Interestingly, even a crater on Venus is named after her!” the blog further adds.

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Industry Perspective 44

Boost Domestic Manufacturing for Affordable Healthcare

H

ailing the Narendra Modi Government’s measures to control prices of medicines and some devices like coronary stents etc. over the last two years, AiMeD has urged for taking policy decisions to boost domestic manufacturing and make healthcare affordable in India.

AiMeD, the umbrella Association of Indian Manufacturers of Medical Devices, covers all types of Medical Devices including consumables, disposables, equipments, instruments, electronics, diagnostics and implants.

There is need to understand that price control or MRP capping is important. But it is a small step in making healthcare affordable in the long-run, according to AiMED. “There is an urgent need for an integrated and calibrated development policy to put ‘Make In India’ initiative in medical devices sector in top gear and reduce high import dependency on foreign made devices in order to promote indigenous manufacturing of drugs and devices which would go a long way in making healthcare affordable,” said Rajiv Nath, Forum Coordinator, (AIMED) Association of Indian Medical Device Industry.

The government, as a first step, may consider granting tax / duty incentives and Price Preference in public procurement among other things to protect and promote domestic manufacturing, it has been suggested.

Simultaneously, price control measures should be undertaken. As of now, only coronary stents and some orthopaedic devices are being considered. But, the list needs to be expanded to include more devices.

april 2018

In a communiqué, AiMeD has suggested some price control measures that could be undertaken such as: • Tax Based Measures Government should introduce an Innovative Tax Structure of stalling Artificial Inflation of MRP e.g.1% GST Cess on MRP to have a disincentive to importers and manufacture from labelling device with excessive MRP. • Consider this option for Devices not notified as Drugs.

• Trade Margin Rationalisation: AiMeD has proposed to DoP to fix the trade margin to a maximum of 50-100% (depending upon value) between import landed price / Ex Fcy price and MRP. If DoP accepts our formula, after consulting with AHPi and IMA it will provide tremendous savings to consumers as MRP will be substantially reduced.

• MRP Capping, the least favourved option in case the above two options prove non-effective

Stating Make in India of medical devices is suffering and following MTAI recommended formula will put Indian manufacturing at a further competitive disadvantage, AiMED says the Government needs to take policy decisions to give strategic advantage to domestic manufacturing, said an official of AiMeD release.

China can Inspire There is a scope for India to learn from neighbour China who succeeded to drive FDI into manufacturing by manoeuvres of Preferential Market Access, Non Tariff Margins and punishing boldly errant companies doing unethical marketing.

AiMeD welcomes FDI in

manufacturing by overseas manufacturers but not in import based pseudo manufacturing of these importer/ overseas manufacturer lobbies, claiming to be Indian Industry.

Private healthcare providers have been profiteering from Medical Products Margins to cross subsidise easily comparable procedure costs to inflate overall treatment costs, leading to very high out- of- pocket cost of healthcare. At 60%, India’s out-ofpocket expenditure on health is one of the highest in the world and has led to many bankruptcies.

“Isn’t imports a trading activity so if we talk about Rationalisation of Trade Margins it has to include Imports , you can’t have importers having over 200% Margin as was indicated in NPPA report on Catheters & Guidewires and the whole supply chain have only a 3550% Trade Margin!” asked Nath, the Forum Coordinator of AiMeD. Stating that everyone in a supply chain has intermediate costs and value addition, Nath asked so what value addition importers are doing and the question is what’s a rational margin for them? “Why those intermediate costs like R&D are not part of the Import landed price? Is it to avoid custom duties?”

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New Arrivals Make water clean, safe to drink with pod+ Access to good health is all about ensuring quality healthcare services to a person anytime, anywhere. A British start-up, nkd has recently introduced pod+ which has a has provision to filter impurities including bacteria, viruses in the water.

Pod+ has capacity to clean water even it is bottled from the dirtiest lakes, rivers or ponds.

As you drink, the state-of-the-art technology, from the NASA space programme, immediately filters out up to 99.9 per cent of bacteria, viruses, heavy metals, chemicals and pharmaceuticals.

The pod shaped water bottle is impact resistant and leak proof while the fully attached cap protects the mouthpiece from exposure to dirt or germs. With nkd, you don’t just ensure good health for yourself and your loved ones but also for the underprivileged. It provides clean and safe drinking water to the people in need in developing countries.

IHHC sets-up first ICU simulation lab IHHC, India’s premier home healthcare service provider becomes the first home healthcare company to set up a dedicated ICU simulation lab at their Bangalore facility. This state of the art Simulation Lab will offer hands-on training modules and help nursing staff improve the quality of medical and health care services to homes.

The ICU simulation lab has state of the art equipment designed to recreate real life scenarios with the help of patient simulators, digitalised video, bedside computer charting, electronic supply, static mannequins that deliver a powerful hands-on training to the nursing staff.

Speaking on the occasion, V Thiagarajan, Founder & CEO of IHHC said, ‘Being a market pioneer and a leader in the home health care services, the need for including critical care at homes is on the raise with patients preferring to move out of the ICU faster, this calls for a highly trained and disciplined nursing staff who can deliver the same level of critical care at patient’s home. We have always invested ahead of the curve and this is yet another initiative to deliver world class critical care health service at homes in India”.

With this, IHHC will be launching their Critical Care at home services which often necessitates the use of complex Tracheotomy and Ventilator equipment for different medical conditions ranging from Ortho, Neurological, Transplant care, Cardio care, Post operative care, where, highly trained nursing staff can be deployed to take care of a range of critical medical care services at the patients home.

Scientists develop low-cost tool to detect bacteria in food, water Scientists have developed a new, low cost tool to detect bacteria in food or water samples.

The bacteria-detecting chip which has been developed by the researchers at University of Massachusetts could be helpful to the chefs using fresh fruits and vegetables.

“Most people around the world cook their vegetables before eating, but here in the U.S. more and more people like to eat these foods raw. This gave us the idea that a quick test that can be done at home would be a good idea,” Food scientist Lili He said.

“Microbial contamination is an important research topic right now. It has been a problem for a long time, but it is now the number one concern for food safety in the US,” She further stated.

The scientists designed a sensitive and reliable bacteria-detecting chip that can test whether foods, including fresh spinach or apple juice, carry a bacterial load.

A light microscope is used for optical detection with the chip, which also relies on 3-mercaptophenylboronic acid (3-MBPA)—which scientists dubbed a “capture molecule”—to attract and bind any bacteria.

The chip, used with a light microscope for optical detection, relies on what He calls a “capture molecule,” 3-mercaptophenylboronic acid (3-MBPA) that attracts and binds to any bacteria. The chemical detection method relies on silver nanoparticles. The techniques are now in the patenting process.

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Industry Perspective 48

Akanksha IVF – A Ray of Hope for Parenthood High prevalence of infertility among people, lifestyle changes, increased awareness and acceptance of In vitro fertilisation (IVF) have driven the adoption of latest assisted reproductive techniques (ART) among patients. Dr KD Nayar, Chief Consultant Infertility and IVF of Akanksha IVF Centre, speaks about the latest emerging technologies for IVF treatment in an interview with Elets News Network (ENN).

Q

Tell us about various assisted reproductive techniques available at Akanksha IVF Centre.

Whether it is cause within the male or the female partner or an unknown cause, you would find solutions to any infertility related problem at Akanksha IVF. We have all highend facilities available for assisted reproductive techniques which includes: Intrauterine Insemination (IUI) In IUI, the semen is collected from the partner and is prepared in the lab and then inserted into the uterine cavity at the time of ovulation to facilitate fertilisation.

In Vitro Fertilisation (IVF) In IVF the egg and the sperm are extracted and allowed to fertilise under lab conditions in a petri dish, post which the embryos are transferred to the uterus.

Intracytoplasmic Sperm Injection (ICSI) In ICSI, fertilisation is achieved by injecting a single sperm into the egg with the help of a micromanipulator.

The resulting embryo is later transferred to the uterus for implantation.

Frozen Embryo Transfer (FET) This procedure involves embryos that are frozen in a previous cycle and can

april 2018

be thawed and transferred in another cycle. Success rates for FET are better than fresh embryo transfers.

To help create ease in pregnancy procedure, we offer advanced reproductive techniques which includes: Blastocyst Transfer Embryos are cultured in a lab until they reach the blastocyst stage (day 5), post which, best quality blastocysts are transferred into the uterus for implantation. This process ensures that only best quality embryos are transferred, which results in better success rates.

Cryopreservation of Sperms and Oocytes This is especially useful for couples planning to postpone pregnancy or undergoing cancer treatment, wherein, the sperms or oocytes are extracted and frozen for later use.

Male Infertility Treatment At Akanksha, we provide solutions for male infertility problems like erectile dysfunction, ejaculatory problems, varicocele, low sperm count, azoospermia, oligospermia, etc., using surgical techniques such as Percutaneous Epididymal Sperm Aspiration (PESA), Testicular Sperm Aspiration (TESA) as well as through medical management.

Time lapse monitoring

Dr KD Nayar

Chief Consultant Infertility and IVF of Akanksha IVF Centre

Time lapse monitoring provides additional information about embryo development and therefore may aid embryo selection.

Embryo glue It is one of the sensitive as well as critical procedures in IVF treatment.

EmbryoGlue is a medium developed exclusively for embryo transfer and the only existing product with a proven implantation-enhancing effect.

• Third Party reproduction • Donor embryo • Donor oocyte • Donor sperm • Surrogacy Laparoscopy and hysteroscopy At Akanksha, we are devoted to help patient accomplish their objective of taking a baby home. In their first appointment, we assess them entirely to choose which style of treatment would be best suited for them. A detailed medical and surgical (past and present) history of the couple is taken followed by medical examination and best infertility unit evaluation.

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Q

Nowadays, assisted conception technology is practiced widely.

Being a solution provider in this segment, what kind of key technologies and clinical practices are

The increasing social acceptance of assisted reproductive technology has also aided the global market for the same, which is likely to exhibit rapid progress in the coming years.

adopted by you for efficient, safe and affordable delivery of the service?

Achieving one of the best success rates, we use latest techniques that could help improvise them each day.

We strive to offer services which aim to satisfy and meet all the criteria of a good fertility clinic. With total transparency policy, we keep the couple updated about each procedure like how the patient is responding, test results and complications if any.

Having a team of in-house staff, we provide services and treatments at a clinic providing patients with enhanced facilities irrespective of the cost of the treatment. We have experienced tertiary care IVF center; routine and advanced ART procedures done under one roof; world class Embryology Lab; affordable IVF packages; transparent reporting and detailed summary and ethical and patient-centered care unit.

Q

Such treatments are emotionally stressful and financially demanding for patients. Share your opinion.

It can be very hard for a woman when she learns that she cannot have a baby.

Coping with the emotional challenges of infertility can be difficult for couples.

Apart from medical problem, infertility is also a social problem affected by various factors like accessibility, availability and knowledge. In India, Infertility is not insurance covered so service seeking is comparatively difficult for lower socio-economic class.

More stressful is the task of decision-making in seeking fertility treatment. When they embark on assisted reproductive treatment (ART), they may experience many different

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emotions, from joy and excitement to grief and disappointment.

Fortunately, today there are treatment options and having a baby is no longer an unfulfilled desire.

Even though the emotional distress still lingers but hope is sparked by IVF. Fertility consultants understand the emotional aspects surrounding fertility treatment and infertility and ensure that they handle their patients’ sentiments delicately.

Industry Perspective

We request a semen analysis as part of baseline investigation and evaluate the tubes if necessary in the female partner as part of our preliminary investigation. Baseline hormonal profile (FSH, LH, Thyroid profile, Prolactin, AMH etc.) is also evaluated if required.

The results of the evaluation and analysis decide the most appropriate strategy and nature of the treatment to be undertaken. There are many fertility-enhancing procedures that might enable them to achieve a pregnancy and a decision is taken following the first assessment.

Q

Does IVF, IUI, ICSI and other solutions pose any challenges in India? And, to what extent such treatments are now acceptable in the country?

Initially, it was difficult to convince couples to undergo IUI, IVF, ICSI due to financial, religious and social issues in India. Infertility is no more a social taboo. With time there is increasing trend in infertility and so in the acceptance of treatment for the same. Now, more and more couples are accepting assisted reproduction techniques and enjoying the feeling of parenthood.

Q

What is the market scope for various assisted reproductive techniques in India?

The market has picked up steam in recent years due to the rising prevalence of infertility and related conditions and the rising disposable income of consumers, which is allowing an increasing number to obtain medical solutions.

The increasing social acceptance of assisted reproductive technology has also aided the global market for the same, which is likely to exhibit rapid progress in the coming years.

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