Ayushman Bharat the Gamechanger for Building New India

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Ayushman

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AUGUST 2018 | Volume 13 | Issue 08

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COVER STORY

Ayushman Bharat The Gamechanger for Building New India policymakers’ Perspective -MP

Hospital Perspective 22 Dr Sarman Singh Director

AIIMS Bhopal

30 Prof M V Padma Srivastava

12 Dr Pallavi Jain Govil

Principal Secretary, Public Health & Family Welfare Department, Government of Madhya Pradesh

14 Dhanaraju S

Director-Health Services, Mission Director, National Health Mission, and Managing Director-MPPHSCL, Government of Madhya Pradesh

Department of Neurology, Neurosciences Centre, AIIMS, Delhi

industry perspective 24 Rajiv Nath

Forum Coordinator of Association of Indian Medical Device Industry (AIMED)

28 Vivek Tiwari

Founder and CEO Medikabazaar.com

Dadra Nagar Haveli Perspective 16 Dr Tejaswi Naik

Director-Budget Government of Madhya Pradesh

26 S Krishna Chaitanya

Mission Director Nation Health Mission, Department of Health & Family Welfare, Dadra and Nagar Haveli

Technology Perspective Arunachal HEALTHCARE Perspective 20 Dr Kinny Singh

Mission Director, National Health Mission, Special Secretary, Health and Family Welfare Department Government of Arunachal Pradesh

32 Abhinav Krishna

Co-Founder & CEO OurHealthMate

36 Corporate Acquisitions/Appointments 37 Product Watch 38 Case Study 40 News Highlights

Editorial Ayushman Bharat – A Good News for Indian Healthcare Landscape Realising the nature of citizens’ demand for an affordable healthcare and the missing vital support from the government in this regard for decades, the Narendra Modi government has come up with the world’s largest medical insurance scheme to benefit people beyond caste and creed in India.

The cover story of the latest issue of eHealth magazine thus touches upon various aspects of Ayushman Bharat scheme, aiming to cover about 50 crore poor and vulnerable people. It explores how exactly it will benefit people, its vastness and key role in bringing the much-needed transformation in the healthcare scenario.

Titled “Ayushman Bharat-- The Gamechanger for Building New India” highlights how the Modi Government is determined to ensure that healthcare is accessible to one and all. It also talks about South India which is already working on various aspects of public healthcare quite comprehensively.

The magazine also carries insightful interviews of important policymakers including Dr Pallavi Jain Govil, Principal Secretary, Public Health & Family Welfare Department, Government of Madhya Pradesh, Dhanaraju S, Director-Health Services, Mission Director, National Health Mission, and Managing Director-MPPHSCL, Government of Madhya Pradesh, and Dr Tejaswi Naik, Director-Budget, Government of Madhya Pradesh.

Dhanaraju S, Director-Health Services, Mission Director, NHM, and Managing Director-MPPHSCL, Government of Madhya Pradesh, throws light upon various healthcare initiatives in the State. He also speaks about how the technology has been harnessed to benefit people of the State.

Dr Tejaswi Naik, Director-Budget, Government of Madhya Pradesh, in an interview says the urban planning needs to get aggressive to ensure scope for adequate physical exercise for our population.

We also have insightful interview of Dr Kinny Singh, Mission Director, National Health Mission, Special Secretary, Health and Family Welfare Department, Government of Arunachal Pradesh, who speaks about how the State has made a giant leap in healthcare delivery.

In another interview Prof M V Padma Srivastava, Department of Neurology, Neurosciences Centre, AIIMS Delhi, and Dr Sarman Singh, Director, AIIMS Bhopal, who talk about various facets of healthcare ecosystem.

Elets Technomedia is also organising “4th Annual Hsealthcare Summit” in Jaipur on 28 September. The conclave will discuss upon how to create a healthier world.

With such a bouquet of articles, interviews and stories, we hope this edition will evoke an invaluable response from our esteemed readers.

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

cover story

Ayushman Bharat The Gamechanger for Building New India If we had all the money in the world we wouldn’t need Ayushman Bharat - people could afford their own medical care, someone stated recently on social media. It narrated a collective agony so succinctly.

This medical insurance scheme holds huge significance perhaps for this very reason for public at large, especially in Bharat (the rural India), writes Sandeep Datta of Elets News Network (ENN).

P

opularly described as Ayushman Bharat, the Pradhan Mantri Jan Arogya Yojna (PMJAY), is Prime Minister Narendra Modi’s signature medical insurance scheme. It is reportedly set to be rolled out across the nation on September 23, two days ahead of the birth anniversary of Rashtriya Swayamsewak Sangh (RSS) ideologue Pandit Deen Dayal Upadhayaya.

A look at the way the Government machinery is promoting the universal healthcare scheme -- Ayushman Bharat, indicates there is a strong desire of Narendra Modi Government to ensure a sea change in terms of transforming the country’s healthcare scenario for all.

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The scheme reflects determination to provide succour to the poorest of the poor and the middle-class in terms of healthcare.

For many political pundits, the Ayushman Bharat may be a major move timed just ahead of the parliamentary and State assembly polls. For satirists, it may be just another political gimmick. But for a lot of commoners, it feels something what they longed for in the country.

With this national health protection scheme, the Modi Government aims to cover over 100 million poor and vulnerable families (approximately 50 crore beneficiaries). It will be done by providing an annual coverage of

up to 5 lakh rupees per family for secondary and tertiary care hospitalisation. It will subsume the ongoing centrally sponsored schemes - Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

Billed as the world’s biggest public healthcare programme, Ayushman Bharat, or the National Health Protection Mission (AB-NHPM), was announced in the 2018-19 Budget and approved by the Cabinet in March.

It is widely expected to vault over all other social welfare projects of the BJP-led National Democratic Alliance government, like Swachh Bharat, free LPG connections to the poorest families, electricity to all homes, and Jan Dhan bank accounts.

The Flip Side A section of the society opines Ayushman Bharat is very much required for people living in villages, towns, cities and States across India but not that much in South India.

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cover story

It is so because various healthcare schemes have been already existing and benefitting people in the South for a long time.

While appreciating the scheme, a section of the society looks at it with questioning eyes in terms of implementation challenges, that are to determine its success or failure.

Another section of society feels the Government must think of providing coverage for crop insurance and medical coverage reciprocal to land holding by increasing the annual land rent which will take care of farmers’ maladies.

Some others stress upon the absence of medicare scheme for the elderly retired people, as they simply cannot afford any costly medical insurance scheme as it is present with the insurance companies.

Can South India Inspire?

A look at the existing healthcare infrastructure and plethora of ongoing projects in various parts of the southern States, one can derive some inspiration about how much comprehensively these are expected to ensure healthcare for all.

Andhra Pradesh is one such example from South India. To develop a healthy State, the Nara Chandrababu Naidu-led TDP government has undertaken a slew of measures. These initiatives seek to offer quality medical facilities that are accessible and cost effective as well for all segments of society.

From ‘Arogya Raksha’ to ‘Chandranna Sanchara Chikitsa’

Haryana woman -- First Beneficiary of Ayushman Bharat scheme In August, Mausami, a Haryana woman turned first beneficiary of Modi government’s flagship healthcare programme, the Ayushman Bharat scheme.

On the Independence Day, she delivered a baby girl Karishma at the Kalpana Chawla Government Hospital in Haryana’s Karnal area through cesarean section.

Expressing her gratitude for the scheme, Mausami, who received a benefit of Rs 9,000, said, “The government will bear all medical expenses. This scheme is very good.”

The first claim also evoked a tweet from Harayana Chief Minister Manohar Lal Khattar @mlkhattar: “Heartening to see the first claim raised and paid under the Ayushman Bharat scheme, or the cesarean delivery of baby girl in Haryana.”

Also, the National Health Agency @AyushmanNHA tweeted: “First claim raised under #AyushmanBharat. A baby girl is born through caesarean section at Kalpana Chawla Hospital in Haryana. Claim of RS 9000 paid to the hospital

by Ayushman Bharat- Haryana. @AyushmanNHA welcomes the young angel!”

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or the ‘Feeder Ambulances (108 Bike) , the State government has implemented many programmes to improve overall health of the State.

PM’s Push to Expedite Ayushman Bharat scheme Giving a call to speed up pace on Ayushman Bharat, the Prime Minister recently expressed concern over seven Opposition-ruled States not signing up, asking seven States including Maharashtra, Rajasthan, Bihar and Sikkim to “make more efforts” to ensure the scheme is rolled out on time.

Prime Minister’s concern to speed up matters in seven States came in the wake of other States like Uttar Pradesh and Haryana already having started pilot runs of ‘Ayushman Bharat’ scheme.

He also expressed concern over seven States not signing the Memorandum of Understanding (MoU) with the Centre so far for rolling out the scheme. All these seven states are ruled by opposition parties, with Odisha refusing to sign the MoU and launching its own parallel health insurance scheme.

During a press conference held on August 28, the Union Health Ministry stated Delhi, Kerala, Tamil Nadu, Punjab and Karnataka were “likely” to come on board for MoUs while there was “no information” from Telangana and Odisha.

Developments on various fronts so far…

On September 6, The Karnataka

eHEALTH Magazine

august 2018

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cover story

government softened its initial stand with regard to implementing the Centre’s Ayushman Bharat national health protection scheme, and decided to blend it with State’s own Arogya Karnataka healthcare programme.

On September 7, in Jammu, the ambitious “Ayushman BharatPradhan Mantri Jan Arogya Yojana (AB-PMJAY)” meant to provide the poor and vulnerable families coverage for secondary and tertiary care hospitalisation was launched.

After inaugurating the pilot launch of the scheme, Deputy Commissioner Ramesh Kumar underlined the AB-PMJAY is aimed at providing portable coverage of Rs 5 lakh per family annually, and a beneficiary covered under the scheme would be allowed to avail cashless benefits from any public and private empanelled hospitals across the country.

Vision, Scope, and Significance -- Ayushman Bharat Scheme The government’s flagship health insurance scheme, Ayushman Bharat, is credit positive for insurance companies as it will aide in higher premium growth, a recent report said.

As per latest observation of international rating agency Moody’s “The launch of universal health coverage is credit positive for the country’s insurers because it will help grow health premiums and provide insurers with cross-selling and servicing opportunities.”

Prime Minister Modi, in his Independence Day speech from the ramparts of Red Fort, said the Ayushman Bharat-National Health Protection Mission (AB-NHBM) will be launched on September 25.

It is worth understanding that Ayushman Bharat - National Health Protection Mission will subsume the ongoing centrally sponsored schemes - Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

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Health insurance contributes around 23 percent of general insurance premiums and is one of insurers’ main drivers of growth, according to the report.

Understanding Ayushman Bharat -- Key Points • An annual cover of Rs 5 Lakhs per family for secondary and tertiary care • No money required to be paid by family for treatment in case of hospitalisation • Avail free treatment by visiting public or empanelled private hospitals across the country • Carry any prescribed ID to receive treatment at the hospital • All pre-existing conditions are covered from day one of the policy.

The benefit cover will include pre & post hospitalisation • No restriction on family size, age or gender • All members of eligible families as present in SECC database are automatically covered • The beneficiaries can avail benefits in both public and empanelled private facilities.

• The scheme’s benefits are portable across the country. A beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.

The Prime Minister Highlighting Ayushman Bharat on social media: 1 February, 2018 “Ayushman Bharat Yojana is a path breaking initiative to provide quality and affordable healthcare. It will benefit approximately 50 crore Indians. The scale of this scheme is unparalleled and it will bring a paradigm shift in our health sector.”

On 15 Feb, 2018 “Laid the foundation stone of the Academic Block of the Tomo Riba Institute of Health and Medical Science. Talked about Centre’s efforts to transform the health sector. Through Ayushman Bharat, India’s poor will get top quality and

affordable healthcare.”

On 12 March, 2018 “Ayushman Bharat is going to transform the health sector. It will provide top quality healthcare to the poor.”

PMO, on behalf of Narendra Modi, tweeted: 7 April, 2018 “I welcome the theme ‘Universal health coverage: everyone, everywhere’ that has been chosen by @WHO and others. It is the quest for #HealthForAll that inspired us to create Ayushman Bharat, the largest healthcare programme in the world.”

15 August, 2018 “Pradhan Mantri Jan Arogya Abhiyaan will be launched on 25th September this year. It is high time we ensure that the poor of India get access to good quality and affordable healthcare” “The healthcare initiatives of the Government of India will have a positive impact on 50 crore Indians.

It is essential to ensure that we free the poor of India from the clutches of poverty due to which they cannot afford healthcare” 23 August, 2018 “The coming of Pradhan Mantri Jan Arogya Yojana- Ayushman Bharat will transform the health sector and ensure the poor get top class healthcare and that too at affordable prices” Roadmap of Scheme’s Implementation: At the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (ABNHPMA) would be put in place.

States/ UTs would be advised to implement the scheme by a dedicated entity called State Health Agency

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Role of Nodal Agencies As per the Government’s plans at the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (ABNHPMA) would be put in place.

The States and Union Territories would be suggested to implement the scheme by a dedicated entity called State Health Agency (SHA). They can either use an existing Trust/ Society/ Not for Profit Company/ State Nodal Agency (SNA) or set up a new entity to implement the scheme.

The States and UTs will be authorised to decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.

Key Impact Ayushman Bharat - National Health Protection Mission will have major impact on reduction of Out of Pocket (OOP) expenditure on ground of: Increased benefit cover to nearly 40% of the population, (the poorest & the vulnerable) Covering almost all secondary and many tertiary hospitalisations (except a negative list) Coverage of 5 lakh for each family, (no restriction of family size) Expenditure Involved The expenditure incurred in premium payment will be shared between Central and State Governments in specified ratio as per Ministry of Finance guidelines in vogue.

Number of Beneficiaries Ayushman Bharat - National Health Protection Mission will target about 10.74 crore poor, deprived rural families and identified occupational category of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data covering both rural and urban.

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Ayushman Bharat - National Health Protection Mission will have major impact on reduction of Out of Pocket (OOP) expenditure on ground of Increased benefit cover to nearly 40% of the population, (the poorest & the vulnerable)

cover story

(SHA). They can either use an existing Trust/ Society/ Not for Profit Company/ State Nodal Agency (SNA) or set up a new entity to implement the scheme.

States/ UTs can decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.

STATES/DISTRICTS COVERED Ayushman Bharat - National Health Protection Mission will be rolled out across all States/UTs in all districts with an objective to cover all the targeted beneficiaries.

The Roadmap To Implementation As per the Government’s plans at the national level to manage, an Ayushman Bharat National Health Protection Mission Agency (ABNHPMA) would be put in place.

The States and Union Territories would be suggested to implement the scheme by a dedicated entity called State Health Agency (SHA). They can either use an existing Trust/ Society/ Not for Profit Company/ State Nodal Agency (SNA) or set up a new entity to implement the scheme.

States/ UTs will be authorised to decide to implement the scheme through an insurance company or directly through the Trust/ Society or use an integrated model.

On 23 September, Prime Minister Modi is all set to launch the Ayushman Bharat health scheme from Ranchi.

eHEALTH Magazine

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policymaker’s Perspective 12

‘MP’s e-Initiatives Building Robust Healthcare System e-Aushadhi initiative is one of the biggest initiatives in Madhya Pradesh, improvising our drug procurement system to get strengthened while making supply chain system far more efficient than it has been in the past, says Dr Pallavi Jain Govil, Principal Secretary, Public Health & Family Welfare Department, Government of Madhya Pradesh, in conversation with Divakar Mukherjee of Elets News Network (ENN).

Dr Pallavi Jain Govil

Principal Secretary, Public Health & Family Welfare Department, Government of Madhya Pradesh

Q

How do you perceive MP’s healthcare sector in terms of quality, cost efficiency and accessibility?

If we were to use an objective indicator, which is not our assessment, but a third party assessment, I will list a few of these, which will itself show various improvements MP has made by careful planning and execution of its health programme. For three years, we have been constantly getting the price for the least out of pocket expenditure for our patients. It shows that our medicines are reaching our patients and they are getting good quality services at our hospital.

In terms of quality, our maternal and under five mortality has been going down significantly. It shows our success is corroborated by data given

by Sample Registration System (SRS) Survey National Family Health Survey.

About accessibility, every healthcare facility in Madhya Pradesh has geospatial technique used for deciding areas bereft of a healthcare facility. It is

august 2018

accordingly planned and constructed.

This leads to better accessibility and cost efficiency. We have positioned our sub-health centers, primary healthcare centers in this manner so that nobody has to travel a long distance to get treated and for reaching far-flung areas, 108 ambulance service is used.

For upgradation of its health services, Madhya Pradesh is converting its primary health centers into health and wellness centers.

Q

What is the impact of ICT in the field of Medical Sciences? How is your department delivering healthcare solutions through technology in the State?

On ICT front, MP has taken many e-initiatives to make healthcare delivery more efficient. The Government has developed a tabletbased Anmol app, which records reproductive and child health (RCH) data of expecting mothers and newborns. It helps us in planning for immunisation and annual checkups. We are also using data analytics platform.

Our 108 Ambulance Service is also working on GPS (Global Positioning System) technology.

With a robust drug procurement system and most efficient supply chain, we have been able to cut down 60 percent of our extra expenses.

In a country like India, where

doctors and healthcare experts are catering to a large population, technology is a useful tool to facilitate things: • Usage of ICT for improved regulatory role of Govt (Nursing home/PCPNDT) and for transparent recruitments in the Department .

• Usage of ICT for improving access to high cost low volume procedures – SIAF and RBSK and finally Ayushmaan.

• Usage of ICT for Direct benefit Cashless transfer to beneficiaries – • Communitisation of health services – ASHA software

Q

Tell us about the reproductive and child health programmes in the State. Kindly elaborate about Mission Indradhanush, ‘Teeka Rath’, and eVIN programmes?

We have made significant progress on many health indices. Maternal and under five mortality rate has been going down significantly.

We have leveraged technology to identify children who are eligible for vaccination under Mission Indradhanush programme. After identification, it becomes easy for the team which visits to the houses directly to provide vaccination.

Teeka Rath has improved the visibility of vaccination services. eVIN has been recognised by

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Q the Government of India as the best technology programme in the Tirupati national health conclave. The whole supply chain of management, predicting supplies and ensuring quality, is being managed by eVIN.

Q

How are ANM workers contributing to improve patient care in rural areas?

Auxiliary Nurse Midwifery (ANM) stands for field workers. They are an important pillar of healthcare delivery system, contributing in listing families, verifying families and pre-marriage counseling etc. They are the first point of response and work closely in the coordination with anganwadi workers. They alert us in case of any disease outbreak and identify women who need extra care in the time of pregnancy.

This year about 2,000 ANMs have joined the system.

Here, I would also like to mention about Sambal Yojana where workers from unorganised sector are registered. Under the scheme, more than one-and-a-half crore workers are getting a sum of Rs 14,000 for different health checkups.

Q

Many a times people don’t have any idea about health programmes being carried out in their area. What kind of awareness programmes are being run to make people know about these schemes?

For making our health programmes more efficient, we have trained 220 doctors. We have plans to train 10,000 ANMs and 2,000 more doctors to attend people of the State

IEC (Information, Education & Communication) is a big component of our health programmes. Through the IEC division, we have been running informative programmes on primary health in which experts educate people about healthcare schemes being run by the State and how they can access them. We have Kilkari programme in which an expecting mother gets an SMS alert on her phone about follow checkups.

Our NIC (National information center) is very active on social media and using it to reach out the maximum number of people.

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Health is an ever-growing sector with huge employment generation opportunity. What efforts are being made to develop the sector in the State?

Healthcare sector has generated a lot of employment opportunities in our State. Apart from creating direct jobs, this sector is responsible for generating many indirect jobs as well i.e people are employed in data import, providing mobile technology services, affiliated pathology labs, driving ambulances, and many others.

The CPS course/ the Medical officers recruitment for remote areas (Archana Mishra)/ Paramdics/ investing in trainig/ career opportunities for nurses.

policymaker’s Perspective

Earlier, infertility used to be perceived as a curse in our society and women faced a lot of adverse pressure because of the same. Through a series of awareness programmes, we have successfully changed that perception and make people aware that it is just a disease and can be treated with care.

Q

How much fund has been received from the Centre and what more to be expected in near future?

We are receiving a good support from the Government in terms of capital.

Now with the onset of Ayushman Bharat programme, the State is expecting more money to revamp its healthcare system. We are also looking to invest heavily in the tertiary healthcare sector.

Q

What are the major areas you look forward to?

For making our health programmes more efficient, we have trained 220 doctors. We have plans to train 10,000 ANMs and 2,000 more doctors to serve people of the State.

In the coming years, we will focus on implementing Ayushman Bharat, as it can be the biggest gamechanger in the history of healthcare.

eHEALTH Magazine

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policymaker’s Perspective

E-Aushadhi Creating Robust Drug Procurement System in MP Madhya Pradesh is one of those States having lowest out-of-pocket healthcare expenditure. With MP-Aushadhi, EMMS (Equipment Management & Maintenance System), and eHospital, the State Government is trying its best to improve healthcare delivery system, says Dhanaraju S, Director-Health Services, Mission Director, National Health Mission, and Managing Director-MPPHSCL, Government of Madhya Pradesh, in conversation with Divakar Mukherjee of Elets News Network (ENN).

Q

Public Health Facilities are witnessing a significant increase in OPD (Out-Patient Department), IPD (Hospital In-patient care) and other general healthcare services in MP. How are you making quality diagnostic services more accessible?

In the last three to four years, figures of out-patient department (OPD) and in-patient department (IPD) have increased. It has almost doubled. As of now, through 1,600 health centers, PHCs (Primary Health Center), civil hospitals, we are catering around one lakh to 1.2 lakh out-patients in a day.

Our OPD figure is somewhere around 8,000 to 10,000. Despite handling this high volume of people, we always ensure quality of drugs and diagnostic services at all these facilities.

Q

Timely and effective healthcare system could reduce both direct costs and out-of-pocket expenditure? How is this model operating in Madhya Pradesh?

Madhya Pradesh is one of the

14

august 2018

States with lowest out-of-pocket expenditure. Quality drugs and diagnostic services are almost free and easily available at our health centers. Still, we are trying our best to improve the delivery system to make it more accessible. Given the socio-economic background of Madhya Pradesh, it is the responsibility of the State and health department to reduce the cost incurred by the patients.

Q

How difficult is it for MPAushadhi to manage the stock and requirement of various drugs and surgical items?

It is the biggest challenge to ensure the availability of drugs and other suture material at all the health centers. If you look at MP procurement model, it is different from other States’ procurement model. In most of the States drug procurement and logistic is managed by a centralised system. In MP, MPPHSCL finalises rate contracts through an online tender system.

Procurement is done decentralise by around 150 authorities. Payment

Dhanaraju S

Director-Health Services, Mission Director, National Health Mission, and Managing Director-MPPHSCL, Government of Madhya Pradesh

is also made by these authorities.

We are happy to share that our MPAushadhi system is one of the best running healthcare systems in the country.

As of now, we are handling drugs worth Rs 450 to Rs 500 crore. The entire thing is procured online and even payment is made online.

Though the system is working well, we are working to make it more efficient and robust.

Q

The Department of Health is providing healthcare services through 1,600 facilities, which is a big feat. What have been your strategies behind this?

The Department of Health ensures the availability of the drug at all the

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policymaker’s Perspective

health centers. The body also defines the list of essential drugs. There is a cell in MPPHSCL which monitors the stocks levels. If the stock level goes down, it passes on information immediately.

Q

MP has been one of the biggest proponents of ‘Digital India’ initiative. What digital initiatives have you taken in terms of ensuring ‘healthcare to all’ in the State?

There are three big things happening right now on this front, namely as— MP Aushadhi, EMMS (Equipment Maintenance and Monitoring System), and eHospital. eAushadhi is a platform to ensure the management of procurement system. It ensures the timing of the order, consignment, and payments.

It also imposes the penalty, if finding something wrong or delay in whole supply-chain management.

We have EMMS system in place to monitor the functionality of the biomedical equipment. Currently, we have 64,000 biomedical equipments

To monitor 35,000 biomedical equipments, we have a robust IT platform designed by CDAC which gives a realtime status of the functionality of equipment on the state level, district level, divisional level and block level

at 1,600 health facilities. Out of these, 35,000 equipments have been given to a third party contract for maintenance.

There are strict KPIs (key performance indicators) i.e within seven days of the complaint, the biomedical has to be functional.

In case, the equipment is highly critical and not functional beyond seven days, a penalty is imposed in that case. There is also a provision of penalty if calibration is not done in every quarter.

To monitor 35,000 biomedical equipments, we have a robust IT platform designed by Centre for Development of Advanced Computing (CDAC) which gives a real-time status of the functionality of equipment on the State, district, division and block level. The system calculates penalties as per in-built KPIs. We are pushing e-hospital IT platform in a big way. It is designed

by NIC and cloud-based system.

It has more than 15 modules.

As of now, we are rolling out six modules including managing inpatient department (IPD), out-patient department (OPD), causality, billing,

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lab information system, and EHR (Electronic health record). As of now, 45 out of 51 District Hospitals are already on- board.

Once the hospital is on board, we can capture the lab information system, discharge note, pharmacy, drug procurement system and maintain EHR (Electronic Health Record) of that particular hospital.

It would help citizens in visiting different departments. They don’t have to carry their health records every time. This would also help us to create health profiles and to understand illness patterns. September 15 onwards, our equipment will also be procured online.

Q

What are the upcoming health initiatives of the health department?

We will keep pushing e-hospital and try to bring 500 more hospitals on board. It will help us to capture 70,000 to 80,000 OPDs and 10,000 to 15,000 IPDs. Currently, we don’t have a robust HR management system, but our team is in talks to get it from Himachal Pradesh NIC (National Information Center).

eHEALTH Magazine

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15

Policymaker’s Perspective from MP 16

Smart Planning for Smart Cities Transforming Healthcare in Urban Landscape Our urban planning needs to get aggressive to ensure scope for adequate physical exercise for our population. From seamless transit, which ensures an adequate step count daily, to offices and buildings designed to avoid long term sitting, a vision needs to be set in place to prevent diseases like diabetes and obesity becoming an epidemic, says Dr Tejaswi Naik, Director-Budget, Government of Madhya Pradesh, in an exclusive interview to Souvik Goswami of Elets News Network (ENN).

Dr Tejaswi Naik

Director-Budget Government of Madhya Pradesh

Q

What is the mandate of your department?

We manage the finances of the State, keeping a tab on the income, expenditure, debt and liabilities while guiding the Government on fiscal matters and presenting the facts before the House as and when asked for.

Q

You have worked extensively in the health domain as the Collector of Barwani district.

What challenges have you observed to improve the State’s healthcare sector and how can these challenges be addressed?

Madhya Pradesh’s HDI/health parameters have shown a considerable jump in last few years.

But still, a Herculean effort, which is focused in nature, is required to correct the scenario which is historical, socio-economic as well as geographical in nature.

august 2018

It has been 10 years at least since the flagship schemes like NRHM, JNNURM, MGNREGS have been implemented. It is now time to do an impact assessment and do coursecorrection wherever required.

While implementing the schemes at the grassroots level, this gap was thoroughly felt, though one could also appreciate the huge stride ahead taken by these schemes.

It is here that one notices gap (the slips) between the cup and the lip. For, we have carried out the implementation part for the past few years, but still we are not there in the parameters where we wanted to be.

We may claim to have put on ground subcentres and ambulances and stuff on ground as per the norms, but are yet to achieve the actual figures that matter, let’s say, an acceptable rate of MMR, 100% institutional delivery and immunisation. And this is not the Health Department’s domain alone.

This final push requires a multidepartmental convergence.

Barwani was and remains to be one of the toughest areas to bring about a change as it is placed with one of the highest IMRs nationally, low immunisation levels, abysmal institutional delivery rate, equally

troubling malnutrition prevalence, compounded by the ritualistic seasonal migration and a tough terrain.

One should realise that one has to work incrementally and according to a plan if one has to bring about the change in the above parameters.

It can’t happen overnight. Morale building amongst the field staff and quick achievable targets were identified to start with as part of a larger plan. Immunisation saturation in an area where families were missing for half the year and each lived atop a hillock required innovation like Green Commando and a lot of back office planning.

The results have encouraged the district to be aggressive in the newly launched Aspirational district programme, which touches upon the achievement of all the above parameters but in a specific time frame.

Again, one has to bear in mind results don’t come overnight and efforts need to be built upon incrementally to reach there. Hence, aspirational programme gave the districts an opportunity to focus on key parameters and try and achieve them.

Thanks to the KPIs, it is now easy to reach out to even the last

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Q

How Madhya Pradesh’s healthcare sector is experiencing transformation, leveraging technology and innovation?

Madha Pradesh was a pioneer in having a statewide family database called Samagra. This was supposed to be helpful in pushing social sector schemes. In Barwani we used it to push health benefits to Sardar Sarovar affected families in a proactive manner.

During the period of rehabilitation, Green Commandos were deployed to check upon each individual across 70+ villages. The result was health data of 18,000+ case sheets.

This pilot showed us that when the same is implemented at the district level, with the help of technology, we can pre-empt many emergency situations i.e. likelihood of caesarian in a particular case and possibility of requirement of particular blood group.

Also, the seasonal migration which

was the root cause of most of the problems where the family missed out on almost all the social benefits by the State, could be checked if the family could be tracked to the final location where it relocates for labour and the same benefits extended there, from polio drops to scholarship to children. We tried a very basic version of this with our labourers in Gujarat, especially in bringing back the body in case of accidental deaths which otherwise would have caused loss of all earnings. This was done by maintaining village Samagra rosters where the family had to write down the destination and a contact number in case administration had to reach out in case of emergency. But the same could be done with a simple ERP at district level which maintains all data of a family including health data. The Government reaching out in real time becomes a reality then.

The same too can be used in cancer prevention which easily converts a middle class family to a below poverty line one, sapping them of all their life savings in the treatment of a member.

This happens in spite of Government schemes being available because of the flawed approach. The family avails the Government help mostly in the last or

The world has been witnessing an acute rise in the heights and weights of its population over the last 100 years.

With the benefits of improved health, it has also brought to fore the ‘hidden costs’ of the sameObesity, Diabetes and Respiratory disorders to name a few (not necessarily in that order). Culprit for the above is improved technology, mobility being the hero as well as the villain and our own worldview as to what is good for us and what is bad is equally at fault

Policymaker’s Perspective from MP

field personnel in the chain when talking about ORS or Zinc usage or importance of breastfeeding within an hour of birth.

But still a much more concerted effort is required to bring about that veritable change. This is where technology can be handy.

last but one stage when the prognosis is almost foregone and much money has already been expended. For better prognosis, diseases like cancer need to be pre- empted with aggressive, proactive screening of direct blood relatives of known patients and schemes extended to them. This is possible with the use of a database like Samagra where families with incidence of cancer can be marked up for probable cases. This will help in directing the Government resources where it actually matters in not just curing the individual but also in

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17

Policymaker’s Perspective from MP 18

preventing the economic collapse of the family.

Q

You have played an important role in Bhopal’s smart city journey, as Commissioner of Bhopal Municipal Corporation previously, and smart healthcare is an integral part of smart cities. In this context, how important is town planning considering importance of healthcare delivery in the urban ecosystem?

The world is witnessing an acute rise in the heights and weights of its population over the last 100 years.

With the benefits of improved health, it has also brought to fore the ‘hidden costs’ of the same -- obesity, diabetes and respiratory disorders to name a few (not necessarily in that order).

Culprit for the above is improved technology, mobility being the hero as well as the villain and our own worldview as to what is good for us and what is bad, is equally at fault.

Somebody, who may have watched the movie “Wall E” in 2008 with its obese technology-slave human characters, would have treated it entirely as a sci-fi movie. Not today.

For over the last 10 years, technology has made many parts of it look very much possible.

august 2018

With more than two-third of the population of the globe going to be in the urban setup by 2050 and half already living, urban planning becomes very critical. And to know that, it is the cities that has health problem as above mentioned in abounds, it becomes all the more important.

City planning has mostly been carcentric, rather bordering on car-philic/ car crazy over the last one century since the inception of automobiles on large scale. The blind assumption of car for everybody is at the centre of it which, as it turns out, is a very unsustainable model and wrong aspiration to cultivate. The whole of GenX and most of Millenials have been brought up on such dreams. The latter, mostly in absence of exposure to a seamless mass transit system, a major part of Millennial, live in the cities affording them a decent transit and last mile connectivity such as ‘Paid bike sharing’. Add to this the idea of a ‘Walkable city’ in place of a car-centric one, should be the holy grail when it comes down to negating effects of lack of exercise and long sitting hours.

Our urban planning needs to get aggressive in ensuring adequate exercise to our population. From

seamless transit, which ensures an adequate step count daily, to offices and buildings designed to avoid longterm sitting, a vision needs to be set in place to prevent diseases like diabetes and obesity becoming an epidemic.

Compulsory grounds and playcourts need to be encouraged in the city landscape, more than viewing them as a mere formality that they are now. Transiting for work can be checked through planned accommodation near place of work (the daily average commute in Pune and Bengaluru is minimum two hours). Technology can also ensure decentralisation of offices to tier-2 cities so that the ‘commute’ problem can be addressed.

In not going for the above, the opportunity cost is that of the mental health and its obvious effect on social health in general. From suicidal depression to aggressive mass shootings, one can trace the origins in the disturbance of the physical and mental well-being.

A ‘Happy city’ would be one which negates such possibilities with a vision in its urban planning. That is the change, I believe, we will have to look forward to, no matter how biblical it looks in practice.

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Arunachal HEALTHCARE Perspective 20

Dedicated Initiatives Improvising Healthcare Delivery in Arunachal With many initiatives including Mukhya Mantri Rogi Kalyan Kosh and a special flexi fund for districts, the State is embarking towards a better healthcare system. The State launched Chief Minister Arogya Arunachal Yojna before Ayushman Bharat. The academic session has also been started in the very first medical college of the State, says Dr Kinny Singh, Mission Director, National Health Mission, and Special Secretary, Health and Family Welfare Department, Government of Arunachal Pradesh, in conversation with Elets News Network (ENN).

Q

What steps have been taken to improve healthcare delivery across the State?

The State has launched Chief Minister Arogya Arunachal scheme which is an assurance based scheme covering all citizens of the State. It was launched before Centre’s Ayushman Bharat programme. The State Government has partnered with MD India (TPA) for smooth implementation of the scheme. Nine hospitals have already been empanelled across country.

Negotiations are going on with other big private hospitals as well.

Then there is Mukhya Mantri Rogi Kalyan Kosh where we provide flexible finances to districts to improve healthcare delivery. Rs 40

August 2018

crore have been earmarked to be decentralised to districts based on a calculated weightage criteria of OPD attendance, population and available health facilities. Districts can purchase emergency and life saving drugs, hire specialists and improve healthcare infrastructure from this flexi pool.

The Arunachal Government is also working towards implementation of tele radiology services and free diagnostics services in the State.

Q

MMUs are considered an effective tool in improvising rural healthcare delivery system. How many such units are functioning in the State?

To bring basic healthcare services

Dr Kinny Singh

Mission Director, National Health Mission, Special Secretary, Health and Family Welfare Department Government of Arunachal Pradesh

to the difficult / far-flung villages, mobile medical unit (MMUs) were introduced in 2007-08 in Arunachal Pradesh. Supported under National Rural Health Mission (NRHM), 16 MMUs (3 vehicles model) are running in 16 districts. They are equipped with diagnostics, drugs and required manpower to make people available medical facility on time.

The overall responsibility of operationalisation of MMUs in the districts rest with the District Health Society (DHS).

To provide maximum benefits through MMU, a fixed day and place approach is put in place. The schedule is made known to the people through IEC (Information, Education and Communication) through NGO / PRI / Clubs / Mahila Mandal / Self-help Group (SHG)/ Village Health and Sanitation Committee (VHSC).

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Q

Timely and effective healthcare system could reduce both direct cost and out-of-pocket expenditure. How is the model operating in the State?

The State has launched Chief Minister Arogya Arunachal Yojna on 15 August this year. It is a comprehensive healthcare insurance scheme where State provides an insurance coverage of four lakh rupees/year/family.

The State has also signed MoU

(Memorandum of Understanding) with Government of India for smooth implementation of Ayushman Bharat.

Q

How do you manage the supply, stock and requirement of various drugs and surgical items in remote areas?

The whole State is hilly and mountainous. The habitations are aligned to the natural topography adjusted to mountains, rivers etc.

There are few areas bordering Assam which are easily accessible.

Most of the districts of Arunachal Pradesh are remote areas. Currently, drugs and vaccines are being procured through the Central Procurement Board at State level. It is then supplied to districts where the drugs are received by District Health Society Board.

However, there is flexibility to districts for local purchasing of drugs for vertical programmes.

Soon, we are going to launch the online DVDMS (Drug and Vaccine Distribution Management System) to ensure uninterrupted supply of drugs and vaccines into the districts.

A comprehensive drug procurement policy is also underway.

Q

You have 52 PHCs providing round the clock healthcare services which is a big feat.

What have been your strategies on this front?

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Arunachal HEALTHCARE Perspective

PHC manpower is assured for health camps. It is fully assisted by members of the VHSC (including PRI member, AWW and ASHA) whenever there is a programme / Village Health Nutrition Day (VHND) / Health Mela organised through MMU. Local NGOs/ clubs / groups have been involved for community mobilisation and bringing the beneficiaries to the camps. Over the years, the performances of these units have not improved much. There are many issues because of which the expected outcome could not be achieved.

The poor road conditions in the mountainous / remote areas often limit the movement of the MMUs. In addition, lack of dedicated MMU team is also a big constrain. It is a fact that many districts are poorly staffed and taking out the team for outreach activities on a weekly basis is a big challenge.

We are going to launch the online DVDMS (Drug and Vaccine Distribution Management System) to ensure uninterrupted supply of drugs and vaccines into the districts. A comprehensive drug procurement policy is also underway

Priority of State Government is to place relevant / required manpower and to look into other requirements in these PHCs. Despite being operated in difficult and remote areas, the PHC are managed by dedicated technical manpower on 24 hour basis. Convergence with all vertical programmes have helped achieving this objective.

Regular monitoring and supportive supervision by the district health authorities ensure better output from these facilities.

Q

What digital initiatives have you taken in terms of ensuring healthcare to all in the State?

There are many initiatives including Health Management Information System (HMIS), Reproductive Child Health (RCH) portal, Drugs and Vaccine Distribution Management System (DVDMS) to be functional from September 2018, MeraAaspatal (to be implemented shortly), Mother and Child Tracking System (MCTS), Training Management Information System (TMIS), e-Hospital in one UPHC and 102 ERC.

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Hospital Perspective

‘Ensuring Best Medical Facilities Through Research, Innovations’ With its skilled doctors, nurses and paramedical staff, AIIMS Bhopal is serving people with best medical facilities.

The institute is doing exemplary work on research and innovations front to improve healthcare delivery system of the State, says Dr Sarman Singh, Director, AIIMS Bhopal, in conversation with Ritika Srivastava of Elets News Network (ENN).

Q

How is AIIMS Bhopal contributing towards augmenting healthcare delivery system across the State?

It was started with the establishment of AIIMS (All India Institute of Medical Sciences) Delhi in 1956 to serve as a nucleus for nurturing excellence in all aspects of healthcare. But later it was realised that the institute was overburdened and struggling to cope up the pressure coming from the States.

In 2004, it was decided to establish AIIMS in every State to augment existing healthcare delivery system.

In addition, the purpose of setting up AIIMS was to train faculty and staff by new conventions and to promote more research work to improve patient care.

AIIMS Bhopal has been doing the same. After AIIMS Delhi, AIIMS Bhopal has emerged as the closest competitor in terms of catering

Dr Sarman Singh

Director, AIIMS Bhopal

people with all types of diseases.

We are now shifting to referrals only. People suffering with rare diseases would be treated. AIIMS, Bhopal has required trained staff and equipment to provide quality medical facilities. In addition, we are also working on research and innovations, as no institute can sustain without meticulous research.

Q

In the present times, healthcare industry is being driven by digital initiatives. Can you share with us something about such initiatives at AIIMS Bhopal?

Digital health is a potent tool which facilitates healthcare delivery enabling people best medical facilities. It is a big challenge for each of us. We are trying to improve things on this front. An MoU has been signed between AIIMS Bhopal

22

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and Union Health Ministry in this regard. The institute is also working towards implementing Ayushman Bharat across the State and working to identify more families for the scheme.

We have best telemedicine department here, which comes into play in all three fields like teaching, research, and patient care. Through this technology, we can review and check the assignments of our medical students and teach them from anywhere.

On the research part, one can share things like medical experiment findings, protocols, and research reports through it. Telemedicine also enables teleradiology, through which doctors can review the reports of their patients from any location. Through this initiative, we are reaching out to even remote locations of Madhya Pradesh.

Q

What are your views on data security in healthcare?

As health data is vulnerable to theft, its security is very crucial.

Though we have partnered with many foreign institutes for data

security, still a lot needs to be done in terms of developing a data security system in India.

Q

How is AIIMS Bhopal working to improve the healthcare services?

We are creating a skilled workforce of doctors, nurses, paramedical and other staff to strengthen our healthcare services. The institute is also making its impact on quality research work.

AIIMS Bhopal is doing maximum research and breakthrough work to cure infectious diseases such as tuberculosis, Kala Ajar, and other diseases. To make patient care more efficient, we are also working on new areas.

Q

How is AIIMS Bhopal taking care of NCDs (Noncommunicable diseases)?

Today, NCDs are major killer diseases globally, including India.

Along with the Union Ministry of Health, the MP Government is also participating in different programmes like diabetes screening and stroke management

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Hospital Perspective

AIIMS Bhopal is doing a meticulous research, innovation and management to cure malnutrition cases, especially among children

and other NCDs. Unfortunately, the cases of malnutrition and genetic disorders in MP are highest in the country.

AIIMS Bhopal is doing a meticulous research, innovation, and management to cure malnutrition cases, especially among children. We also conducted a big workshop to identify the level of this problem last year. We have a dedicated body to look into this.

Q

Do you have any emergency services at your institute or any plans to introduce such services in near future?

It is very important to provide better patient care to people, irrespective of time constrain. Recently on August 1, we started an emergency service. It is getting a good response and we have saved many lives because of it.

It is a challenge for us, as we are facing a shortage of nurses and doctors. We are planning to recruit more staff including 700 nurses. We are also determined to start a trauma center to add more diseases in our treatment portfolio.

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Industry Perspective 24

Trade Margin Capping Needed to Make Healthcare Affordable for All The Government is expected to walk the fine line between making healthcare affordable and promoting Make in India or Make outside India, writes Rajiv Nath, Forum Coordinator of Association of Indian Medical Device Industry (AIMED) for Elets News Network (ENN).

D

omestic medical device industry hails Government’s move to rationalise and cap trade margins in medical devices to achieve the overall goal of affordable healthcare for all by making all critical and life saving medical devices available at affordable prices.

However, we suggest that the Government should tread the fine line carefully between affordability and boosting domestic manufacturing or suffocating domestic medical device industry and allowing importers to create artificial inflation.

If the Government plans to bring down prices of commonly used medical devices by capping the trade margin at 30 percent on the first point of sale as reported in media, then it is unrealistically low and won’t allow delivery to last mile.

It is pertinent that the Government brings down trade margins from irrational to rational level to reduce overall healthcare cost.

However, to lower it to irrationally low level may be disadvantageous to the patients and consumers.

Medical devices usually go through with different hands along the supply chain route from a distributor to a wholesaler to a retailer and a hospital before they reach a consumer in a distant village.

Each point in supply chain

august 2018

incurs various costs such as freight, inventory carrying, rental, salaries, marketing and sales overheads and service and statutory expenses of compliance and then there is also a need of net profit by a reseller.

The main aim of rationalisation of trade margins in medical devices should be to help consumers, allow rationalised profits for traders and retailers, create level playing field for domestic industry vis-à-vis foreign manufacturers.

There should be clear objectives for any policy intervention so as to avoid distress (to consumers), distrust (in industry) and disruption (to market).

To begin with, there seems to be confusion between Trade Margin which is based on sale price of product and Markup which is based on purchase price of products. These terms should be clearly defined to avoid any confusion among stakeholders. It is advisable to ensure consistency in use of terms and nomenclature or instead of realising its Make in India vision, the Government will end up encouraging Make Outside India.

The trade margin is the difference between the price at which the manufacturers (indigenous /overseas) sell to trade and the price to patients (maximum retail price). The issue of

Rajiv Nath

Forum Coordinator of Association of Indian Medical Device Industry (AIMED)

unreasonably high trade margins in medical devices has been adversely affecting both the industry as well as consumer interest and creating distrust for the Medical profession.

Association of Indian Manufacturers of Medical Devices (AIMED) has been asking for trade margin rationalisation and capping for last two-three years.

We are glad that finally the Government is moving in this direction.

For trade margin rationalisation, first point of sale by overseas and Indian manufacturers should be defined as the price by manufacturer, whether overseas or Indian, on which GST is initially paid.

In contrast, importers who are also traders, cunningly want first point of sale to be from their end to the distributors and not from

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Government to define the following: 1. First Point of Sale for Manufacturer is price on which GST is charged first time.

- On overseas Manufacturer GST is charged on import CIF landed price in BIE (Bill of Entry) - On Indigenous Mfr GST is charged on ex-factory price post discounts 2. Indigenous Mfrs need to be equated with overseas Mfrs and not with Importers.

This will help in creating a levelplaying field between goods entering India via imports or domestic production thus encouraging domestic manufacturing.

Also, there is transparent verifiable database linked to GST charged on invoice or bill of entry available with the Government and verifiable to implement and monitor this without

making it complex.

Everyone in a supply chain has intermediate costs and value addition.

It needs to be ascertained what value addition, if any, importers do and what’s a rational margin for them?.

The reason the importers state intermediate costs like R&D and clinical evaluation are not part of the import landed price which is basically to avoid custom duties.

They can’t avoid customs duty by lowering transfer prices and then seek to induce hospitals with higher MRP and higher trade margins.

This tactical marketing warfare has cost the consumers dearly and harmed ethical marketing. Thus, importers should be brought under the purview of trade margins.

The Government should cap trade margins of devices to 85 percent. This will help in reducing MRP of medical devices to less than half of current prices while not being unreasonably detrimental to traders and hospitals.

Additionally, manufacturers will be encouraged to attract clients on competitive features and hospitals will start buying on evaluating cost of purchase and quality, instead of margins to be made on higher MRP. It will result in a levelplaying field between imports and domestic products.

The Government should provide level playing field, if not a strategic advantage to domestic manufacturing while safeguarding consumers. Otherwise India will remain 7090% import dependent country

Industry Perspective

overseas manufacturers to them. It is to avoid coming into the trade margin regulation ambit.

So, if we talk about rationaliation of trade margins, it has to include imports. You can’t have importers having over 200 percent irrational margin as was indicated in NPPA report on Catheters & Guidewires and the rest of supply chain having only 35-50 percent trade margin.

The Government should provide level playing field, if not a strategic advantage to domestic manufacturing while safeguarding consumers. Otherwise, India will remain 70-90% import dependent country. Indian manufacturers seek preferential market access, tariff protection, price controls and strong deterrents like punishment to errant companies engaged in unethical marketing practices to boost domestic manufacturing.

This can be done in a calibrated manner through: • 1% GST cess on MRP as a taxbased disincentive • Capping trade margins to a rational level & • Price caps on few priority devices A pro-active policy formulation to regulate medical device differently than drugs, should permit free market dynamics to succeed and keep regulations simple, protecting consumers and incentivising make in India.

(Views expressed are a personal opinion.)

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DADRA AND NAGAR HAVELI PERSPECTIVE 26

Dadra and Nagar Haveli Leading Healthcare System in UTs The challenge before the Governments lies in bringing in innovations, moulding the technologies to reach maximum people who are still in the rural India. With the kind of efforts being put in all over the country accessible, affordable and quality healthcare to all citizens is round the corner, says S Krishna Chaitanya, Mission Director, Nation Health Mission, Department of Health & Family Welfare, Dadra and Nagar Haveli, in conversation with Elets News Network (ENN).

Q

How have you ensured affordable, accessible and quality healthcare delivery in Dadra & Nagar Haveli?

Dadra Nagar Haveli is a tribal majority Union Territory, with 52 percent of tribal population.

Specific interventions were done for ensuring affordable, accessible and quality healthcare delivery like: Strengthening of health infrastructure by a network of district hospital, sub district hospital, two Community Healthcare Centres (CHC), nine Primary Healthcare Centres (PHC) and 71 Sub Centres.

These are facilitating healthcare delivery in all villages of the Union Territory. In addition, mini SubCentres are also being establised to cover remote, inaccessible hamlets.

Strengthening of Rogi Kalyan Samiti at District Hospital and Sub District Hospital for ensuring decreased and nominal costs of high end services such as C T Scan, MRI, and laboratory investigations.

100 percent implementation of schemes such as Janani Shishu Suraksha Karyakaram (JSSK), Janani Suraksha Yojana (JSY) providing free of cost services to all Antenatal care

august 2018

(ANC), Prenatal care (PNC) mothers and children up to one year.

Prescription of generic medicines only in the healthcare facility.

Increase in the number of ambulances and schemes such as Peheli Savari and 108 services for emergency cases. We have recorded one of the best response times in emergency care.

Capacity building of employees with respect to quality monitoring processes such as Kayakalp and National Quality Assurance System (NQAS) with District Hospital being NQAS certified and Sub-District Hospital under certification process.

Empanelment of private hospitals under UT-run Sanjeevani Swasthya Bima Yojana as referral centers under the scheme for availing free of cost specialised surgeries. This scheme offers wider health insurance coverage in terms of packages and families covered than the SECC families covered in various schemes across the country.

Because of all the above initiatives, the Government Hospitals provide 90 percent of the health services in Union Territory of Dadra Nagar Haveli and the Union Territory has received

S Krishna Chaitanya

Mission Director, Nation Health Mission, Department of Health & Family Welfare, Dadra and Nagar Haveli

the award for least Out-of-Pocket expenditure for IPD and OPD services among the UTs.

Q

What kind of challenges do you face while implementing Government-run healthcare programmes in rural areas?

The literacy rate of the rural population is low. Hence, preventive knowledge and risk awareness of various diseases is low. Even after wide publicity and Information, Education and Communication (IEC), the issues of ignorance in terms of availing timely services is seen in rural population.

Some people in rural areas still seek help from traditional healers instead of availing the healthcare facilities.

Health professionals like super specialists do not opt to work in rural areas due to remoteness of territory

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Q

The union territory has seen an alarming rise in leprosy cases in recent years. It has highest proportion of childhood leprosy cases in India after Lakshadweep. What steps are being taken to improve situation?

The Union Territory has seen rise in leprosy cases due to efforts and commitment by team of health functionaries through quarterly surveys and intensive active case detection campaign.

We are determined to decrease the prevalence of leprosy which being a dormant disease is difficult to diagnose. The UT has implemented successful house-to-house survey and screening of families which initially led to increase in detection of cases. Over the years, the same has been managed by giving Rifampicin and now the prevalence has decreased from 6.77 in 2015-16 to 4.9 in 2017-18.

Due to massive industrialisation,

the Union Territory has a large number of migrant labour population.

The health administration is carrying out screening of all industrial labour to detect prevalence of leprosy.

In 2018-19, we are targeting to bring down the prevalence level to less than 3.5 and are confident that we will achieve the same.

Q

How do you analyse Indian healthcare system in terms of technology, innovations and delivery of services?

India has come far in terms of technological marvels such as healthcare information systems, picture archiving systems, laproscopic surgeries and technologies such as telemedicine. Telemedicine in rural areas ensures optimum management of post-operative cases availing follow up services by treating doctors without travelling to other cities indirectly cutting down the out-ofpocket expenditure. Still, there is scope in India for introduction of new technologies from other parts of the world for better healthcare facilities.

India has one of the largest public healthcare systems and is home to many innovations by Central

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India has come far in terms of technological marvels such as healthcare information systems, picture archiving systems, laproscopic surgeries and technologies such as telemedicine

government and State Governments in healthcare sector like National Health Mission, Save the Girl child scheme, 108 services through Public-Private Partnership, 104 helpline, radiological centres and dialysis centres through PPP, Paripakva Mata Niyojit Bal Yojana, Arogya Sri Scheme of health insurance and these innovations have helped in bettering the healthcare services in India.

The delivery of healthcare services in metropolitan centres of India is amongst the best and most affordable in the world contributing to medical tourism from all parts of the world.

On the other hand, the health services in semi-urban and rural areas of the country need to be improved and the access to these interiors of India  rests on government systems and a number of socio-economic factors also have to be addressed.

The challenge before the Governments lies in bringing the innovations, moulding the technologies to reach maximum number of population, still living in the rural India and with the efforts being put in all over the country accessible, affordable and quality healthcare to all citizens is round the corner.

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DADRA AND NAGAR HAVELI PERSPECTIVE

and difficult terrain and attrition rate is high even among those who join due to above mentioned disadvantages.

Access to technology such as internet facility is still a challenge in few hilly and forested areas. Scattered hamlets are sometime very difficult to access for repeated visits by health functionaries.

Prevalence of early marriage and the practice of live-in relationships at an early age noticed in few villages leads to increase in number of teenage pregnancies and this coupled with the malnutrition problem in rural areas is a challenge to reduce the rates of vital indicators like infant mortality rate etc.

The bank accounts of few beneficiaries in rural areas are dormant or inactive, the mobile numbers of few beneficiaries are different than those in the bank accounts or have gone inactive and hence it is difficult to disburse the benefits of various Government schemes in rural areas.

27

Industry Perspective

Best Practices for Operational Efficiency at Hospitals

O

perational efficiency is the capability to deliver cost-effective and quality products and services to the customers. In the case of healthcare, this translates to hospitals and medical establishments being able to provide the best healthcare services to their patients while optimising their operational costs.

Medikabazaar.com is a pioneering and leading B2B website for the online procurement of medical supplies. Being a leading solution provider across hospitals and medical establishments, we have gained a deep insight into the operations of these healthcare providers.

Based on this and our exposure in the global healthcare market, we recommend several best practices that hospitals and medical establishments can adopt to achieve operational efficiency.

Minimising cost of goods procured Medical supplies constitute one third of the total cost of operations (TCO) and is the second largest financial head for hospitals. In India, many medical establishments still have conventional procurement process for buying regularly required medical consumables. They have very little exposure to new and competitive product information. There is a significant lack of data needed for product procurement planning.

Thus, they end up deciding on wrong quantities, expensive products, excess or shortages in inventory etc. This leads to revenue leakages which affects healthcare delivery cost.

Nowadays, the internet has

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deeply penetrated into the personal consumption space. However, business organisations are still not gearing up to adopt Internet for improving their business processes.

The Internet is ubiquitous, transparent and an agile digital platform to facilitate business processes. Unlike conventional mode, information about the product, prices and brands are always updated on a digital platform. The convenience of selection offered by digital product catalogs is unmatched.

Imagine the power and flexibility that Internet provides to businesses.

By adopting online platform, hospitals and other medical establishments across India will have convenience of searching for products, comparing prices and alternatives, ordering products and getting them delivered at the doorstep. The conventional distribution network cannot reach out to remote areas.

Furthermore, hospitals can save procurement costs as they no longer need to waste time to contact multiple vendors, visit bigger markets for purchases, or block capital in warehousing huge quantity of medical consumables. To do away with this hassle, they usually get into annual contracts, which have its own limitations. Therefore, hospitals end up procuring supplies from numerous manufacturers and that too at disproportionate prices which result in high medical bills for patients.

Another widely and globally accepted practice for bringing savings in supplies is “Group purchasing organisations (GPO). GPOs are entities which assist healthcare establishments in managing their

Vivek Tiwari

Founder and CEO Medikabazaar.com

purchases. GPO aggregates the medical supply purchasing volumes of multiple hospitals and conducts negotiations with numerous suppliers on their behalf. This way, hospitals can procure quality supplies at reduced prices. In addition, healthcare providers also save on transaction costs as they don’t have to conduct multiple negotiations with different vendors, a task which is complicated and expensive.

Medikabazaar.com also acts as GPO for its key accounts.

Data analysis for efficient management: Data can have a significant impact on hospital management. There are multiple ways through which data can be used to achieve operational efficiency.

Hospital’s shift managers always face a problem of deciding how many staff members to allocate during a period of time. If there is over-staffing, it will result in high labour cost. In case of under-staffing, patient care will be

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utilise physician’s time effectively.

Outsourcing services: Hospitals can outsource subsidiary services like patient food, laundry, housekeeping and facility management.

This will help them to focus on their core expertise which is healthcare services and also bring in significant financial savings.

In a bid to provide quality medical service, hospitals have even started outsourcing clinical services like emergency room staffing and anesthesiology.

Hire specialist doctors to increase case volume: Hospitals should appoint doctors/ physicians who are specialised and popular in specific medical fields. This will increase patient flow leading to high profits. A specialist and popular doctor attracts a large number of patients in the healthcare facility.

Bring in Cost-Consciousness: Medical establishments should motivate physicians/doctors to be concerned about financial expenditures and total cost of ownership (TCO).

The physicians should be mindful of the cost of medical supplies, medical tests, and other healthcare operations. Doctors should do away with unnecessary medical tests. They

Continuous process improvement to make operations better and cost-effective should be the driving factor for any healthcare provider

Industry Perspective

adversely affected, which can lead to fatal consequences at times.

Using data to analyse and make informed decisions on staff allocation can lead to operational efficiency. Data on patient volume can be recorded and hospital staff can be appropriately allocated based on the same.

The data can also be used for flexible staffing for operating room (OR) nursing staff. OR managers can use the data to inspect arrival time of nursing staff for operations. If they arrive before-time consistently, flexible staffing can be implemented to avoid overtime expenses.

Data can also be used to track patient waiting time and consultation time, i.e. the amount of time doctors take in meeting patients and giving them medical advice. If the data shows that patients are waiting for long hours then specific measures such as increasing staff members who can assist physician, developing better-queuing systems by analysing exceptions in appointment schedule and slot vis-Ă -vis consultation time can be implemented.

To reduce long consultation time, doctors can make use of technological solutions such as appointment scheduling and allocating slots, Electronic Health Records (EHR), electronic prescription writing tools etc. All these help to plan well and

should also be encouraged to use high quality of medical equipments which are cost-effective. Equipment having Energy Star ratings should be used.

This will reduce the carbon footprint and positively impact the environment.

Add new services: Hospitals should expand their operations beyond their regular and core in-patient services. This will result in increased patient footfall and profits.

Some examples of additional services include annual health check programs for corporate employees, establishment of cancer and epilepsy support groups, lifestyle changes consultation, rehabilitation facilities etc.

Hospitals can also get into the business of home healthcare services, vitals scanning kiosks at malls, airports, virtual consultations and telemedicine, mobile healthcare services in remote locations etc.

However, medical establishments must conduct detailed analysis on profitability and return on investment (ROI) regarding any new services.

Continuous process improvement should be the driving factor to make operations better and costeffective. This will enable them to provide quality and affordable healthcare delivery.

(The writer, Vivek Tiwari, is Founder and CEO of Medikabazaar.com. Views expressed are a personal opinion.)

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august 2018

29

Hospital Perspective

Telestroke Facilities Key to Augment Healthcare Delivery in Rural Areas Telestroke facilities can make modern healthcare available and accessible to remote areas using information technology. It can serve to address the problems of both insufficient numbers of stroke specialists as well as the therapeutic time, says Prof M V Padma Srivastava, Department of Neurology, Neurosciences Centre, AIIMS Delhi, in conversation with Mukul Kumar Mishra of Elets News Network (ENN).

Prof M V Padma Srivastava

Department of Neurology, Neurosciences Centre, AIIMS Delhi

Q

How do you analyse the Indian healthcare delivery system in terms of quality, affordability and accessibility?

The challenges that we face include limited access, insufficient availability, sub-optimal or unknown quality of health services and high out-ofpocket expenditure. In addition, many Indian hospitals lack the necessary infrastructure and organisation requires triaging and treating patients with stroke quickly and efficiently. The clinical stroke services across the country, especially in public sector hospitals fare badly in terms of many aspects.

Existing treatment gaps in India: • Use of thrombolysis for stroke (a dismal 0.5 percent of all strokes receive thrombolysis) • 24/7 availability of stroke physicians • Interventional radiologist

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• Use of stroke care maps and implementation of stroke care pathways • Presence of a stroke unit and team • Sufficient community awareness programme which are essential key elements necessary to provide optimal stroke care to the community • Efficient public emergency ambulance system

Q

Stroke is among one of the leading causes of death in India including heart diseases and diabetes. Strokes are now happening more amongst the young populace. As an expert, how do you see this?

Stroke is the second commonest cause of death in India. According to the ICMR statistics, 1, 65, 000 strokes occur each year with nearly one stroke every 40 seconds and one stroke death every four minutes.

Amongst the stroke survivors, many are afflicted with serious, long-term disability. The 2006 annual economic costs of stroke in the USA were estimated at $57.9 billion. More than 64 percent of this sum consisted of direct healthcare expenses, the remaining $20.6 billion represented indirect costs including lost productivity due to morbidity and mortality. We do not have economic costs of stroke figures from India.

In 2010, the absolute number of people with first stroke was 16.9 million, stroke survivors 33 million,

stroke-related deaths 5.9 million, and disability-adjusted life year (DALY) lost 102 million. It had significantly increased since 1990 (68%, 84%, 26%, and 12% increase, respectively), with most of the burden (68.6% incident strokes, 52.2% prevalent strokes, 70.9% stroke deaths, and 77.7% disability-adjusted life year lost) in India.

As per the finding of Global Burden of Disease (GBD) 2010 stroke project, 5.2 million (31%) strokes were reported in children (aged <20 years old) and young and middleaged adults (20–64 years), to which children and young and middle-aged adults from developing countries such as India, contributed almost 74, 000 (89%) of the burden.

The stroke burden is greater in India more so among younger and middle-aged people.

It is imperative to immediately address the treatment gap and optimise stroke care in the country, especially in view of the impending epidemic of stroke burden in the Indian society.

Q

What can be done in golden hour by a family member to help stroke-hit patient before carrying him to nearby hospital?

Immediate recognition that it could be a stroke and react to it as an emergency situation by taking him to the nearest stroke ready hospital is what the care giver can do the best.

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Do you think awareness could play a major role on this front?

Awareness in terms of what is stroke, what are its causes, how to treat and its preventive measures, are of paramount importance in the public awareness module for major life threatening and life altering diseases.

Q

Telemedicine is an important advancement of technology to help patients in remote areas.

How do you view it in terms of stroke patient?

There is no well defined health infrastructure hierarchy in India for delivering care which leads to an increased burden on specialists and tertiary care facilities. Any national programme that is envisaged would require expertise with knowledge, skills and attitude.

Though clinicians play a crucial role, the stroke team would also require well equipped and swift ambulance services, swift access to radiology, trained paramedical and nursing personnel and rehabilitation facilities.

While the above aspects are mandatory, India has non-existent emergency medical services, lack of nationalised and prompt ambulance services, very few neurologists (1,800 neurologists for 1.2 billion populations) and an extremely skewed health infrastructure development including radiology services concentrated in urban areas where only 30 percent of total population resides.

The small number of neurologists means that most stroke care will have to be provided by other physicians and health care providers. These factors impede access to acute care and ongoing follow up for primary and secondary prevention.

Incorporating the physicians in the national umbrella of stroke programme will help tap their potential in the national fight-stroke program and will be able to generate

adequate work force. Because the physicians practice closer to the community, stroke care would reach closer to the general population.

Role of telestroke facilities in India: The objectives for which telemedicine has originated include: • Telemedicine can enhance citizen’s equality in the availability of various medical services and clinical health care, despite economic and geographic barriers • Save the time wasted by both providers and patients in traveling from one geographic location to another to avail services on time • Reduce costs of medical care

Q

How essential is “Telestroke” for India?

India is characterised by low penetration of healthcare services.

90 percent of tertiary and secondary healthcare facilities exist in cities and towns away from rural India.

Primary healthcare facilities for rural population are highly inadequate.

Despite current and several past initiatives by the Government and private sector agencies, the rural and remote areas continue to suffer from absence of quality healthcare.

Telestroke facilities through telemedicine seem to be the “promise” which has the potential to optimise stroke care across all strata bridging the economic and geographic barriers in the country.

Significant proportion of patients in remote locations could be successfully managed locally with advice/guidance from specialists / super specialists in the cities without having to travel to reach the specialists in person.

Telestroke facilities can make modern healthcare available and accessible to remote areas using information technology. Telestroke can also play a significant role in training medical personnel across the country. Telestroke can serve

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ASHA workers need to be empowered and to be given adequate incentives for their role as primary providers of care

Hospital Perspective

Q

to address the problems of both insufficient numbers of stroke specialists as well as to narrow therapeutic time for treatment with rTPA. Telestroke offers the promise to more consistently apply protocols and improve efficiency of stroke care.

In essence, it would allow patients in remote areas a chance to procure comprehensive stroke care. The establishment of telestroke facilities will allow overcoming limitations of stroke therapy prevalent today.

Q

Primary healthcare infrastructure still needs to be improved a lot to help such patients. What are your suggestions to improve things on this front?

Incorporating the basic healthcare and largely preventive strategies could improve things at primary level. These centers are manned essentially by healthcare workers (ASHA). They need to be empowered and also be given adequate incentives for their role as primary providers of care.

Q

How do you perceive Ayushman Bharat touted as biggest healthcare insurance scheme in the world?

Ayushman Bharat insurance scheme is an exemplary vision for optimising healthcare in the developing world.

India being the prototype. Even though it looks ambitious and daunting, I think it is achievable.

eHEALTH Magazine

august 2018

31

Technology Perspective

OurHealthMate Enabling People to Avail Better Patient Care OurHealthMate connects patients to healthcare providers with the cost-effective healthcare services. The platform gives people options to choose from more than 4.5 lakh medical services, says Abhinav Krishna, Co-Founder & CEO, OurHealthMate, in conversation with Elets News Network (ENN).

Q

What inspired launching of OurHealthMate?

The idea of OurHealthMate occurred when my father underwent a heart surgery in 2012 in India.

Since then I started looking into the healthcare landscape and found how our healthcare industry was different from the US and Singapore.

After interacting with people from diverse backgrounds we launched our product in the Indian market where people are generally reluctant to spend money on health checkups.

They find it a bit expensive.

Initially, we created a platform enabling people to generate a free medical bill before visiting hospital.

People can search from more than 4.5 lakh medical services and choose one as per their budget and proximity.

Q

Describe your business model and what is the role of data analytics in it?

OurHealthMate is using realtime data analytics to monitor and evaluate customised wellness programmes for employees. Every

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august 2018

corporate which works with us gets access to a corporate dashboard designed on business intelligence.

The corporate gets idea about employees’ spending on a specific treatment and customise. They can decide their budget about insurance plans for the employees accordingly.

This model is beneficial for both companies and employees, as it can help in the early detection of disease.

Moreover, the corporate can save their capital too.

People started using our portal from 2015 April onwards. We launched the product for corporates in June 2016.

Q

How is Indian healthcare delivery model different from others, especially developed countries?

In India, there is no such term as healthcare, it is all about disease care.

There is no system of regular health checkups as a result of which people at times end up with sudden trauma.

Most importantly, people don’t have any idea how much a regular health checkup costs.

Abhinav Krishna

Co-Founder & CEO, OurHealthMate

Q

In India, a significant number of people find health checkups a time-consuming affair? How is your model helping on this front?

We facilitate a meeting with the doctor. One doesn’t need to take a half-day leave for a simple health checkup. They can book their appointment online and make payment for the same.

When a bill is already paid, most of the people turn up on time for health checkup. Otherwise, they would lose 30 percent of their money. Out of six lakh appointments we have only six cancellations till now. It shows how much people value their money and time.

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Technology Perspective

Q

Do you have any expansion plan in near future?

Currently, we are focusing in India. We are planning to launch the product in the Philippines over the next 12 months.

The reason behind expanding our base in the Philippines is that most of the citizens speak English there.

The market dimensions are pretty much similar to India. Moreover, the Indian corporate clients that have presence in the Philippines, will be good prospects for us.

Q

What is the USP of your healthcare model?

OurHealthMate connects patients to healthcare providers with the cost-effective healthcare services.

By tapping big and small corporates together, we bring down the cost of health checkups. We arrange health checkups, combining big corporates

having large employee base with smaller corporates that have 50 to 100 employee strength.

It brings down the whole cost of checkups, as hospital always give discounts if people turn up in large numbers.

We facilitate a meeting with the doctor. One doesnâ&#x20AC;&#x2122;t need to take a halfday leave for a simple health checkup

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Q

As per reports, online medical data is vulnerable to theft.

What sort of advanced security measures have you undertaken for it?

OurHealthMate is fully HIPAA (Health Insurance Portability and Accountability Act) compliant. We have taken advanced security and encryption measures to ensure a safe and secure experience online.

In addition, we have legal agreements with the hospital to ensure the privacy of data from their end as well.

eHEALTH Magazine

august 2018

33

eHealth — Harnessing ICT and Innovation for the Betterment of Humankind

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Our conferences that include “Expo” and “Awards”, are held across India and in different parts of the world.

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Corporate update

Corporate Acquisitions/Appointments Radius Health appoints Chhaya Shah as senior Vice President Radius Health, a biopharmaceutical company, has appointed Chhaya Shah as senior Vice President of technical operations. The company which works in the area of innovative endocrine therapeutics in osteoporosis and oncology, made the official announcement recently.

“Ms Shah will help strengthen and expand our technical operations infrastructure, optimize our supply chain and ramp-up our manufacturing capabilities, supporting the development of our late-stage clinical pipeline to commercial readiness,” said Jesper Høiland, President and Chief Executive Officer of Radius.

Elaborating further about how the decision will buoy company to reach new height, Høiland said, “Chhaya’s more than 25 years of industry experience in supply chain, quality assurance, and manufacturing will be critical in guiding Radius through our operational and commercial transformation as we make significant progress with our two lead clinical assets, abaloparatide-patch and elacestrant.”

WestBridge consortium acquires Star Health

Carestream Health appoints David Westgate new President, CEO Carestream Health has appointed David C. Westgate new Chairman, President and CEO of the company.

With more than 6,000 employees worldwide and conducting business in nearly every country in the world, Carestream is an independent provider of medical imaging systems and healthcare IT solutions.

It also deals in X-ray imaging systems for non-destructive testing; and precision contract coating services for a wide range of industrial, medical, electronic and other applications.

“Our focus will be on delivering innovation that is life-changing— for patients, customers, employees, communities and other stakeholders— and we will grow our business for longterm success,” said Westgate.

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august 2018

A consortium of Rakesh Jhunjhunwala along with WestBridge Capital has acquired Chennai-based Star Health Insurance.

Though the deal amount has not been officially disclosed, reports say it is of Rs 6,500 crore. Rakesh Jhunjhunwala-led consortium outshined ICICI Lombard General Insurance which had placed a bid amount of about Rs 5,800 crore to acquire the Health insurance Company.

Sumir Chadha, co-founder & MD, WestBridge Capital, said, “We are really excited about Star Health, a dominant market leader in the retail health insurance industry. We believe the retail health insurance industry will continue to grow at a healthy pace in the coming decade, driven by increasing penetration. This aligns well with WestBridge’s investing philosophy and long-time horizon.”

Oscar Health raises $375 mn from Google’s Alphabet Google’s parent company, Alphabet, has invested $375 mn in Oscar Health. It will help the health insurer to expand to more markets and business segments, including Medicare Advantage in 2020.

The investment comes months after Oscar Health raised $165 mn in a funding round. Among the participants of that funding, CapitalG and Verily Life Sciences were financed by Alphabet.

Alphabet has now owned roughly 10 per cent of the privately held Oscar, which offers technology-driven services for individual consumers. Alphabet was “thrilled” to invest further to help Oscar in its next phase of growth, a company spokeswoman said.

Max Financial Services appoints Analjit Singh as non-executive Chairman

Max Financial Services has named its sponsor and founding shareholder Analjit Singh as non-executive chairman. He will take over from Naina Lal Kidwai.

The company houses the life insurance business of the $3 billion Max Group.

The appointment is in consultation with current Chairman Naina Lal Kidwai, said Singh. Kidwai will continue her role as an independent nonexecutive director of the company.

The group founder also ruled all rumors related to his plans to exit the venture of insurance venture.

“We are not going to exit the business. I will remain the single-largest principal sponsor,” he said.

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Product World health-tech solutions

Abbott India to launch over 100 pharmaceutical products Abbott India Ltd, a Mumbai-based pharmaceutical company, is planning to launch around 100 products over the next five years, as part of its effort to consolidate the company’s existing therapy areas and grow over-the-counter portfolio.

“Abbott plans to launch around 100 products over the next five years. Our focus remains on growing existing therapy areas such as gastroenterology, metabolics, vaccines, central nervous system and women’s health,” said the company’s Managing Director, Ambati Venu.

In total, our pharmaceutical business covers 90 percent of therapies in India so our goals are to increase the depth and breadth of the medicines we offer in these areas, ensure broader reach to people in India and continue to launch improved medicines that make it better or easier for people to get healthy,” said the managing director.

J Mitra launches iQuant – India’s first portable diagnostics solution

Google’s DeepMind to develop product to detect eye diseases DeepMind, an artificial intelligence company owned by Google, plans to develop a medical product.

It will help doctors to detect more than 50 sightthreatening conditions from a common type of eye scan.

The artificial intelligence software can detect signs of disease better than human doctors, according to a study published Monday in the scientific journal Nature Medicine.

The company and its partners in the research, London’s Moorfields Eye Hospital and the University College London Institute of Ophthalmology, said will go for clinical trials of the technology in 2019.

If proved successful, DeepMind will seek to create a regulator-approved product that Moorfields could roll out across the UK. This is the first time, DeepMind AI algorithm using machine learning has ended up in a healthcare product.

Earlier this year, Verily, an Alphabet-owned life sciences company, worked with AI experts from Google to develop an algorithm that could spot a range of cardiovascular issues from a different retinal image.

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J Mitra, India’s leading IVD (in-vitro diagnostic) manufacturing company, has launched India’s first portable diagnostic solution – the iQuant immunoassay analyzer in the Indian market.

The latest solution has been launched in collaboration with IIT Madras’ HTIC (Healthcare Technology Innovation Centre).

The portable solution is a state-of-the-art Fluorescence Immunoassay Analyzer for quantitative and qualitative determination of blood test parameter – that includes TSH (Thyroid Stimulating Hormone), T3 (Tri-iodo thyronine), T4 (Thyroxin), Vitamin D, Dengue NS1 Antigen, Dengue IgM, Dengue IgG and HbA1c test.

Beta-testing for the product had been going on for the past eight months. With this launch, various highly-active and sought-after diagnostic solutions will be available across the country and in the remotest of locations at the fraction of a cost.

It will be adding to the number of diagnostic solutions, which will be available as a software upgrade on the cloud.

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august 2018

37

Case Study 38

When Cross-Donation of Kidneys Gave New Lease of Life to Patients

D

octors of Pushpawati Singhania Hospital and Research Institute recently found themselves in a state of flux when three couples turned up to them for kidney transplant. The women requested doctors to transplant their kidneys to their husbands.

The doctors, however, had a tough time convincing the women that they won’t be able to do so as their kidneys were unsuitable for their respective husbands. Tests proved them incompatible for the transplants as blood groups of wives were not matching their husbands The doctors explained the situation to the couples and suggested them to cross-donate their kidneys to other three men. Once the couples gave consent, the transplants were carried out giving new lease of life to the men.

As per doctors, incompatible donor transplant costs more than double than in the case of compatible donors.

The families were unable to afford the high cost. Moreover, it doesn’t provide security of a long life to the recipient.

Conducting three concurrent transplant operations wasn’t an easy proposition. Dr Sajiv Saxena, Chairman, PSRI Institute of Renal Sciences, said “A major limiting factor in conducting kidney transplants in India is lack of adequate donor pool, the kidney swap programme not only makes more kidneys available, but also makes them available earlier than otherwise.”

Dr P P Singh, Director and head of kidney transplant surgery at PSRI, said five operation theaters were reserved for the marathon surgeries, which involved retrieving the kidneys from the donors and transplanting them into the three recipients.

august 2018

A challenging task · All three transplants had to be carried out on the same day · 5 operation theatres were run simultaneously for the purpose · 7 surgeons, six anesthetists, 18 staff nurses and 20 OT technicians worked for 15 hours, from 7 am to 10 pm to complete the task · Extra care was taken to ensure error-free surgery and outcome.

All three surgeries were successful

The hospital carried out the three transplants on 8 July, 2018. A team of Nephrologist headed by Dr Sanjiv Saxena and a another team of surgeon headed by Dr P P Singh, six anesthetists, 18 staff nurses and 20 OT technicians started the procedure around 7 am and wrapped up the operation around 10 pm.

One of the donors said that her husband was diagnosed with kidney failure in March. “We approached everyone. From the Chief Minister to PMO for financial assistance because my kidney was not compatible with my husband, eventually on doctor’s suggestion we swapped organs with

another couple.”

The second recipient said that he learnt about his falling kidney when he sought a medical certification to avail a work visa for Dubai. He couldn’t go through an incompatible transplant because his blood showed a high level of antibodies. I would have died if this transplant hadn’t taken place on time.

The third recipient was a government employee in Bihar. He had tried his luck to get a cadaver donor or a live donor but the exercise proved futile. “The hospital then told me to find my own match,” he said.

PSRI doctors claimed to keep a record of all potential donors (Swap transplant Registry) and turn down for incompatibility. If they come across a case where swapping is possible, they advise the two groups accordingly.

Dr Singh said that in a country like India, the expense involved in the antibody removal protocol in case of incompatible kidney transplants is very high. It involves risk of infections.

“Transplant centers should work towards a national kidney paired donation programme and frame a uniformly acceptable allocation policy to expand donor pools.”

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Latest from Health World ASHA, Anganwadi workers’ incentives hiked: PM

Andhra Pradesh–First state to launch auto disable syringes

Prime Minister Narendra Modi has announced doubling of routine incentives given to ASHA workers by the Government.

All ASHA workers and their helpers would also be provided free insurance cover under Pradhan Mantri Jeevan Jyoti Bima Yojana and Prime Minister Suraksha Bima Yojana.

The prime minister also announced significant increase in the honorarium given to Anganwadi workers. Those receiving Rs 3,000 so far would now receive Rs 4,500.

Similarly, those receiving Rs 2,200, would now get Rs 3,500.

The honorarium for Anganwadi helpers has also been increased from Rs 1,500 to Rs 2,250.

He also appreciated efforts and dedication of Accredited Social Health Activist (ASHA), Auxiliary Nurse Midwife (ANM) and Anganwadi workers for effective implementation of the Mission Indradhanush and for providing vaccination cover to over 3 lakh pregnant women and crores of children.

The prime minister was interacting with the team of three As- the ASHA worker, Anganwadi worker and ANM from across the country through video conferencing.

Andhra Pradesh has become first State in the country to launch AutoDisable Syringes for all clinical purposes. The Health Medical & Family Welfare Department, Government of Andhra Pradesh recently launched “AD Syringes for Patient Safety” at a conference at AP Secretariat, Amaravati.

India consumes over four billion syringes per year of which an INCLEN study done had found nearly 60 per cent as unsafe and 1/3 being reused.

Addressing the unsafe injection practices is an important public health agenda, especially in low and middle income countries

New AI model helps assess brain injury in patients Chinese researchers have built an artificial intelligence (AI) model with medical imaging which would be helpful in finding out brain injury among patients.

Severe brain injury can lead to disorders of consciousness (DOC), said researchers from the Chinese Academy of Sciences.

Some patients can recover from an acute brain injury, but others fall into chronic DOC, also known as a vegetative state. They cannot communicate or act consciously.

The model will accurately determine whether patients with severe brain damage might regain consciousness.

Researchers, including those from PLA Army General Hospital and General Hospital of Guangzhou Military Command, developed the AI model, which can make an assessment based on images of brain functional networks.

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august 2018

Delhi-based startup myUpchar raises $5 mn in series A funding

myUpchar, a local language health content app, has raised $5 mn funding, which will help it to further develop product and technology offering.

In an official statement on Tuesday, the Delhi based startup said that it received Series A funding from Nexus Venture Partners, Omidyar Network, and Shunwei Capital. myUpchar which claims to be accessed by more than 10 million people, partners with doctors to offer health content and translates it into 13 Indian languages across disciplines such as allopathy, ayurveda and homeopathy.

Health Ministry notifies new health warnings for tobacco products The Union Health Ministry has notified new sets of specified health warnings for all tobacco product packs.

The new rules have become applicable from 1 September onwards for all tobacco products manufactured or imported or packaged.

As per rules, the tobacco will feature a fresh set of 85 percent pictorial warnings.

“The Ministry of Health and Family Welfare, Government of India has notified new sets of specified health warnings for all tobacco product packs by making an amendment in the Cigarettes and other Tobacco Products (Packaging and Labeling) Rules and Cigarettes and other Tobacco Products (Packaging and Labeling) Second Amendment Rules, 2018,” an official statement said.

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The Pune Municipal Corporation (PMC) is set to introduce a maternity care van service. It will offer timely medical assistance in critical cases of pregnancy.

In the initial phase, two fullyequipped vehicles will be available on 24×7 support.

PMC’s standing committee and women and child welfare committee have already approved the proposal.

About Rs 20 lakh will be allotted from other works in the budget for the care vans.

“A provision should be made in the annual budget for the upkeep of the service. The special vehicles will be placed at Kamla Nehru hospital, Rajiv Gandhi Hospital and Kothrud hospital as per a schedule. The project will be expanded and each of the 17 maternity hospitals will have a van,” said standing committee chairman Yogesh Mulik.

IIT-Delhi, AIIMS join hands to set-up biomedical research park The Indian Institute of Technology-Delhi (IIT-D) and All India Institute of Medical Sciences (AIIMS) have joined hands to establish a Biomedical Research Park in Jhajjar, Haryana.

It is to start interdisciplinary research for a robust healthcare The agreement will include a joint Ph.D. supervision programme and provision for adjunct faculty for the two institutes.

20 projects have already been started. Their mandate extends to the development of a drug delivery system, Artificial Intelligence, machine learning, robotics, advanced material, etc, said B.R. Mehta, Dean, Research and Development, IIT-Delhi.

Centre issues advisory to States to ban e-cigarettes

In a bid to regulate online sale of medicines and provide patients accessibility to genuine drugs from authentic online portals, the Union Health Ministry has released draft rules on sale of drugs by e-pharmacies.

It states that registration would be mandatory and no person will be able to distribute or sell, stock, exhibit or offer for sale of drugs through e-pharmacy portal unless he registers the same.

“Any person who intends to conduct business of e-pharmacy shall apply for the grant of registration to the Central Licensing Authority in Form 18AA through the online portal of the Central Government,” the draft notification said.

Ayushman Bharat: UP Govt starts trial run across all districts Yogi Aditynath-led Uttar Pradesh Government has started a trial run to implement Ayushman Bharat Jan Arogya Yojna across the State.

State Health minister Sidharth Nath Singh recently formally launched the trial run from the governmentowned Balrampur Hospital, Lucknow. The trials were scheduled to continue till September 13 in all the districts of the State.

Speaking on the occasion, the Minister said the Centre’s most ambitious healthcare insurance scheme Ayushman Bharat would be launched on September 28 in Uttar Pradesh.

The scheme to be launched nationwide on September 23, would create over 2000 new jobs, besides imparting impetus to medical services.

94 dispensaries to become polyclinics in Delhi

To contain the harmful effect of e-cigarettes and other Electronic Nicotine Delivery Systems (ENDS), the Union Health Ministry has issued an advisory asking all States and Union Territories to not allow the manufacture, sale and advertisement of these products.

“It is evident that the Electronic Nicotine Delivery Systems (ENDS), including e-cigarettes, heat-not-burn devices, vape, e-sheesha, e-nicotine flavoured hookah, and the like devices or products available by whatsoever name, that enable nicotine delivery or its use, are a great health risk to public at large, especially to children, adolescents, pregnant women and women of reproductive age,” the advisory said.

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A total of 94 dispensaries are set to be turned into polyclinics in the national capital, as the Delhi Government has sanctioned over Rs 150 crore for the same.

The step has been taken in order to increase healthcare accessibility and affordability enabling people a better patient care.

“The Government has given administrative approval and expenditure sanction of Rs 168.58 crore to remodel 94 dispensaries into polyclinics across the national capital,” an official said.

In a written communication to Public Works Department’s Engineer-in-Chief Rakesh Kumar Agrawal, Director General of Health Services Kirti Bhushan said a committee will be constituted to monitor the work on regular basis.

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