eHealth July 2015

Asia’s premier Monthly Magazine on ICT in Education Volume 10

Issue 7

July 2015

PRESIDENT: Dr M P Narayanan EDITOR-IN-CHIEF: Dr Ravi Gupta EDITORIAL TEAM HEALTH Senior Assistant Editor: Garima Pant Senior Correspondent: Anshuman Ojha Correspondent: Romiya Das EDUCATION Senior Assistant Editor: Garima Pant Assistant Editor: Bhawna Satsangi GOVRNANCE Senior Assistant Editor: Nirmal Anshu Ranjan Assistant Editor: Kartik Sharma, Rachita Jha Senior Correspondent: Souvik Goswami Correspondent: Poulami Chakraborty, Gautam Debroy Junior Correspondent: Sneha Mejari Trainee Sub-Editor: Akanki Sharma SALES & MARKETING TEAM: eHealth Deputy General Manager: Siddharth Varma, Mobile: +91-8860651646 Assistant General Manager: Ragini Shrivastava, Mobile: +91-8860651650 National Sales Manager: Fahim Haq, Mobile: +91-8860651632 Project Manager: Seema Gupta, Mobile: +91-8860651643 Manager: Sapna Choudhary, Mobile: +91-9910998066 SUBSCRIPTION & CIRCULATION TEAM Manager Subscriptions: +91-8860635832; subscription@elets.in DESIGN TEAM Creative Head: Pramod Gupta Deputy Art Director: Om Prakash Thakur, Gopal Thakur Senior Web Designer: Shyam Kishore WEB DEVELOPMENT & IT INFRASTRUCTURE Team Lead-Web Development: Ishvinder Singh Senior Executive – IT: Zuber Ahmed Executive – Information Management: Khabirul Islam EVENT TEAM Manager: Gagandeep Kapani ADMINISTRATION Head Administration: Archana Jaiswal EDITORIAL & MARKETING CORRESPONDENCE

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July / 2015 ehealth.eletsonline.com

Contents

JuLY 2015 | VOLUME - 10 | ISSUE - 07

Cover Story

Rajasthan: The Hub of Innovations in Healthcare The Rajasthan Government has efficiently made a benchmark to provide comprehensive healthcare services to the people of the state

Focus â&#x20AC;&#x201C; Healthcare IT

Ushering in Change: Innovation Unleashed To improve care, companies should leverage IT to create patient-centric healthcare systems that can improve response times, reduce human error, save costs, and impact the quality of life

ExCLUSIVE Interview 14

Taking Healthcare to the Last Mile Rajendra Singh Rathore, Medical, Health & Family Welfare Minister of Rajasthan

July / 2015 ehealth.eletsonline.com

Technology of PPP â&#x20AC;&#x201C; Recipe for Success in Healthcare Mukesh Sharma, Principal Secretary, Medical, Health & Family Welfare and Medical Education, Government of Rajasthan

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Unrivalled clinical chemistry testing Acetaminophen Acetic Acid Acid phosphatase Adiponectin Albumin Aldolase Alkaline Phosphatase Alpha-1 Acid Glycoprotein Alpha-1 Antitrypsin ALT ALT (GPT) Ammonia Amphetamines Amylase Apolipoprotein A-1 Apolipoprotein AII Apolipoprotein B Apolipoprotein CII Apolipoprotein CIII Apolipoprotein E ASO AST (GOT) Barbiturates

Benzodiazepines Beta-2 Microglobulin Bile Acids Bilirubin (Direct & Total) Calcium Canine CRP Cannabinoids Carbamazepine Ceruloplasmin Chloride (Non-Direct) Cholesterol Cholinesterase Cholinesterase (Butyryl) CK-MB CK-NAC CO2 Total Cocaine metabolite Complement Component 3 Complement Component 4 Copper Creatinine (Jaffe) Creatinine Enzymatic CRP

CRP Full Range (0.3-160mg/l) CRP High Sensitivity Cystatin C Digoxin Ecstasy EDDP Ethanol Ferritin Fructosamine G-6-PDH Gamma GT Gentamicin GLDH Glucose Glucose/Fructose Glutamate Glutamine Glutathione Peroxidase Glutathione Reductase Glycerol Haptoglobin HbA1c/Hb HDL Cholesterol (Direct)

H-FABP Homocysteine Hydroxybutyrate (Ranbut) IgA IgE IgG IgM Iron Lactate LAP LDH LDL Cholesterol (Direct) Lipase Lipoprotein (a) Lithium L-Lactic Acid Magnesium Malic Acid Methadone Microalbumin Myoglobin NEFA Opiates

Pancreatic Amylase Phenobarbitol Phenytoin Phosphorus Potassium (Non-Direct) Rheumatoid Factor Salicylate sLDL Sodium (Non-Direct) Superoxide Dismutase Theophyline TIBC Total Antioxidant Status Total Protein Transferrin Transthyretin (Prealbumin) Triglycerides TxB Cardio Urea Uric Acid Urinary Protein Valproic Acid Zinc

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Delivering optimum healthcare in Rajasthan

PP Mathur, Chief Engineer, Medical and Health Department, Government of Rajasthan

Technologies will Improve Accessibility Atul Umak, Assistant General Manager–IT, Dr. L H Hiranandani Hospital, Mumbai

Cloud Computing - A Game Changer

U K Ananthapadmanabhan, Group President, Rainbow Hospitals, Hyderabad

INDUSTRY SPEAK

Naveen Jain ExCLUSIVE Interview

Inching towards Digital Hospitals

Vivek Saxena, National Manager – PACS, Fujifilm India Private Limited

Connected Healthcare through Smart Medical Devices Dr Karthik Anantharaman, Chief Marketing Officer, BPL Medical Technologies Pvt. Ltd.

Healthcare in Rajasthan: On an Upward Trajectory

Hospital Information System Latest Emerging Solutions

Naveen Jain, Mission Director & Special Secretary National Health Mission, Department of Medical, Health & Family Welfare, Government of Rajasthan

Transforming Healthcare through Innovations

Sunil Wadhwani, Founding Donor, WISH Foundation and Co-Founder and Ex-Chairman of IGATE Corporation

Scaling up Healthcare Innovations

Soumitro Ghosh, Chief Executive Officer, WISH Foundation

India Blossoms as Medical Tourism Hub

Promoting Wellness Care

Sridharan Mani, Director and CEO, American Megatrends India Pvt. Ltd.

Sanjay Kumar Jain, Director, Akhil Systems

Moving towards Transformation

Ensuring Inclusivity and Access

Lux Rao, Country Leader – HP Future Cities and CTO Technology Services, HP India Sales

Shekhar Agrawal, Senior Vice President, Vodafone India Limited

Dr S B Jhawar, Managing Director, Apex Hospitals, Jaipur

Mukhyamantri Nishulk Dawa Yojana (MNDY)

Dr Sudhir Kumar Sharma, Managing Director, Rajasthan Medical Services Corporation

Enhancing Healthcare Practices with PPP

Yogesh Joshi, Chief Operating Officer, Metro MAS Heart Care & Multispecialty Hospital, Jaipur

Ushering Life through Science

Providing Affordable Cancer

Jon Mowles, Life Science Sector Specialist, UK Trade & Investment (UKTI)

Care

Dr (Maj. Gen.) S C Pareek, Medical Director, Bhagwan Mahaveer Cancer Hospital & Research Centre (BMCHRC)

July / 2015 ehealth.eletsonline.com

Shekhar Agrawal

editorial

Reaching out The crumbling public healthcare sector in the country has been a point of concern for long and has been the primary driving force behind the growth of the private healthcare facilities and services in the country. According to the recent NSS health survey, over 70% of rural and urban Indians get themselves treated at private sector facilities. The lack of physical and human infrastructure in rural healthcare has been the stumbling block in the growth of the public healthcare facilities in the country, leaving patients no choice but to opt for increasing out-of-pocket expenses while seeking out private healthcare services. The paucity of funds with the public sector has been a worrying factor, a point we have highlighted in our previous issues as well. Statistics reveal that India has just spent 1.3 per cent of its GDP in 2013 on public healthcare as compared to some of Indiaâ&#x20AC;&#x2122;s BRICS peers that spend much moreâ&#x20AC;&#x201D;Brazil and China spent 4.7% and 3.1% of their GDP respectively. There is a growing need to make affordable healthcare facilities reach out to the masses. And in our bid to facilitate this initiative, the Healthcare Summit at Rajasthan will look to deliberate, discuss and provide a knowledge sharing platform with active participation from the healthcare fraternity from many states of the country and the healthcare corporate sector. With over 50 healthcare experts from a crosssection of the society present and discussions ranging on PPP for public health to best healthcare practices in India, the summit will also look at the key healthcare initiatives in Rajasthan that have set a benchmark to follow. Why Rajasthan gains such importance in the healthcare sector is because of the proactive nature of the state government in implementing healthcare reforms and reaching out to the poorest of the poor. In some of the recent noteworthy initiatives in the state, Some of Primary Health Centres (PHCs) in Rajasthan will now run in the Public-Private Partnership (PPP) mode. The move would be undertaken in phases, and in the first phase, 90 out of 2,082 PHCs would be handed over to be run in the PPP mode. Also, the Rajasthan government will distribute free sanitary napkins to adolescent girls in the state in the age group 13-19 years studying in class 6 to 12 under Rajasthan Kishori Swasthya Evum Swachhata Karyakram. The state has provided landmark and inspiring models to follow for the other states as well. Its ASHA Soft initiative, an online system which facilitates the user to capture beneficiary wise details of services given by ASHA to the community, online payment of ASHA to their bank accounts and generate various kinds of reports to monitor the progress of the programme has inspired many other states. Other noteworthy initiatives include e-Aushadhi, a web based application which deals with the management of stock of various drugs, sutures and surgical items required by different district drug warehouses of Rajasthan state. The state also has an Integrated System for Monitoring of PCPNDT Act (IMPACT) Software that provides online surveillance system of government for prevention of sex determination to save girl child. The web based Software IMPACT was launched on October 1, 2012 by the Medical Health & Family welfare department. With the thread of IT swing all the initiatives together, our special July issue brings forth the significant contribution and impact IT has made in the healthcare sector and the avenues it has opened for the industry. We hope you find the articles and stories as interesting as we found them while compiling this special issue.

Dr Ravi Gupta ravi.gupta@elets.in july / 2015 ehealth.eletsonline.com

Exclusive Interview

Taking Healthcare to the Last Mile It is the priority of the state government to enable the reach of the local and global healthcare discoveries and initiatives to the people of Rajasthan , says Medical, Health & Family Welfare Minister of Rajasthan, Rajendra Singh Rathore in conversation with Kartik Sharma of Elets News Network (ENN) 10

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Exclusive Interview

What are the challenges for the healthcare sector in the state of Rajasthan? Our government has been in power for the last 18 months and I have been the stateâ&#x20AC;&#x2122;s Medical, Health & Family Welfare Minister previously as well. I am aware of the healthcare priorities of the state of Rajasthan, but more challenges have surfaced with changing times. Today swine flu, dengue, ebola and cancer have become common diseases and it has become important to tackle them along with the traditional healthcare necessities in the state. We see the paucity of doctors in the health sector as a major issue and have taken a number of steps to deal with it. Rajasthan is geographically the largest state of India with a varying population density, which makes it quite challenging to create an effective healthcare mechanism. It is the priority of the state government to enable the reach of the local and global healthcare discoveries to the people of Rajasthan. It is also a challenge to make the national health programmes reach out to the right beneficiaries.

What steps are you undertaking to strengthen the healthcare services in the rural areas of Rajasthan? A number of important budgetary announcements were made by Honourable Chief Minister in the budget to strengthen health services in the rural sector. Development of primary health centres on the PPP model, to increase participation of the private sector in investigative services, and to strengthen the ASHAâ&#x20AC;&#x2122;s more will be the primary focus of the state. Also, we have implemented programmes to reduce the maternal mortality rate and malnutrition in the state that include initiatives like celebrating Safe Motherhood Day (izlqfr fu;kstu fnol) and to encourage safe pregnancy through

these initiatives. We have plans to use community based techniques to remove malnutrition from the state and for this we have taken support from organisations of international repute along with the Rajasthan Government to show us the way.

There was an intense investigation campaign (Saghan Nirikshan Abhiyaan) that was carried out for the healthcare services in Rajasthan last year. What are your views on such investigations that keep on happening on a regular basis? What made the campaign unique was that all the findings of the investigations were compiled using information technology and uploaded on a website. Then weaknesses of every institute were identified individually using software and the ones that could be rectified easily were improved through an available fund.

Development of primary health centres on the PPP model, to increase participation of the private sector in investigative services, and to strengthen the ASHAâ&#x20AC;&#x2122;s more will be the primary focus of the state. A follow-up campaign was initiated in February this year, which helped in removing most of the shortcomings. A proposal is being formulated that will help the concerned department get the funds from the state government to provide budgetary support to weed out the remaining shortcomings. Any further budgetary allocations will be taken care of in a proposed time

frame. The entire campaign feedback is taken through video conferencing for analysis. We announced the third round of investigation campaign on April 23, 2015.

Though the government in Rajasthan is implementing programmes quite well, shortage of medical staff is a big roadblock. Could you please elaborate on the measures taken by the state government to tackle this issue? We are trying our best to deal with the issue of shortage of medical staff in Rajasthan. I have been appealing to the doctors in every possible public platform to serve the poor and certain policy measures undertaken by us are giving us good results too. We began with walk-in interviews and I am happy to tell you that in the last few months, because of this initiative, we have been able to bring in 400 doctors. To tackle the absence of super specialists, we are trying to implement a far reaching initiative under which officers of the state health department are being trained in important subjects. This course began in February 2015 and has 270 medical practitioners undergoing training in ten subjects. To inspire medical staff in high priority districts and tribal districts, hard duty allowance is being provided since November 2014, which has been beneficial. Rajasthan has relatively lesser number of medical colleges, thus, it is important that in the coming times we open more medical colleges and train more doctors. The efforts are on in the state on a war-footing. Along with these steps, we will also be able to pass on benefits of health insurance through private players to the people of Rajasthan.

The National Child Healthcare Programme Rashtriya Bal Swasthya Karyakram (RBSK) in Rajasthan has been giving

july / 2015 ehealth.eletsonline.com

Exclusive Interview

good results. What will be your strategy for the initiative for the year 2015-16? The National Child Healthcare Programme was announced in the year 2013-14. Butnot much work was done during the previous government rule.. However, in the year 2015-16,

with heart problems, children with cuts on their tongue-lips, hearing disabilities, blindness by birth were successfully operated upon. This year too we will try and screen children for other diseases and make healthcare services reach out to the children who are yet to get these services.

We set an example for the country to follow in the year 2014-15 when we linked the online payments of 40,000 ASHA workers directly to their bank accounts

under this scheme, through 250 mobile health squads, almost 22 lakh children were provided medical examination and after investigating 30 different diseases, almost one lakh children were marked for having one ailment or the other. The real task is not just to identify the ailment but also provide the right treatment. For this, the village children were taken to the nearest hospital using the ambulance network and further to the district hospital if need be. Children were provided ‘on the spot’ treatment by putting up 200 health camps while the ones with even serious ailments are being taken to medical colleges and private medical institutes for treatment. Therefore, many children

July / 2015 ehealth.eletsonline.com

Rajasthan has come up as a frontrunner state that has used IT to improve healthcare services. What are the new avenues that the government is exploring in this field in the coming times? We had set an example for the country to follow in the year 2014-15 when we linked the online payments of 40,000 ASHA workers directly to their bank accounts. It was a difficult task but we did it in record time. This initiative gained much popularity and we still have other states coming to have a look at this initiative. Seeing the success of this programme, Honourable Chief Minister has directed the department to transfer the benefits of the safe motherhood intervention received under the organised pregnancy

programme and also of the Shubh Lakshmi Yojana directly to their bank accounts. I am happy to share that all the necessary arrangements have been made in this regard and very soon we will be competent enough to be able to transfer benefits under both the schemes in a transparent manner. We have been using information technology to track ambulances and have been taking penalties from the service providers in case of any service lapse. Work has already been started to track the equipment of 3,000 hospitals under the ‘E-Upkaran Scheme’. Voice messaging service is also being used to follow-up on malnutrition treatment centres and also on the children being discharged from the Sick Newborn Care Unit (SNCU).

Hospital Protection Force is a unique and noble initiative of yours. Could you tell us about the specialties of this project? Scheme of providing free medicine and check-ups is adding a lot of pressure on the medical institutes in the tertiary region. We are also seeing an increase in the number of cases where family members of patients have been clashing and physically assaulting the medical staff. It is imperative to build up the confidence of the medical staff and also provide them a secure environment. My department had a clear consultation with the state Home Department and has started this initiative in the prominent medical colleges and hospitals in Rajasthan, which includes Sawai Man Singh Hospital of Jaipur. Based on the feedback of this programme, we will further think of increasing the outreach of this initiative.

Exclusive Interview

Technology of PPP â&#x20AC;&#x201C; Recipe for Success in Healthcare In order to overcome the problems such as malnutrition, lack of infrastructure and health coverage, the government has entered into various MoUs, says Mukesh Sharma, Principal Secretary, Medical, Health & Family Welfare and Medical Education, Government of Rajasthan in conversation with Kartik Sharma of Elets News Network (ENN) 14

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Exclusive Interview

What are the challenges in the health sector in Rajasthan at present? Rajasthan is facing many challenges in healthcare sector. Rajasthan is geographically the largest state of India and it has many disadvantages also as it has large desert, tribal, hilly and remote areas. Population is scattered, so reaching to every village and cluster is the biggest challenge for the healthcare sector. Although, we are making concerted efforts to overcome this problem, shortage of doctors is a cause of concern for the Government of Rajasthan. Many innovative ideas have been tried recently. Apart from this, getting experts for super specialty in healthcare services is also becoming a problem because of which we are not able to make trauma centres functional.

PPP in healthcare in Rajasthan is becoming a role model. How do you look at it? Public-Private-Partnership (PPP) is a keyword these days in the state and central governments, several departments are using PPP as a panacea for many problems. We often see that entrepreneurship and management elements are normally not present in the required quantity in the government set up, therefore, to bring these elements into the public services, PPP seems to be a very viable model. We have invited PPP in many fields in our budget announcement 2015-16, Hoâ&#x20AC;&#x2122;nable Chief Minister has announced many PPP initiatives in the healthcare sector. In our district hospitals, many facilities are required to be provided through PPP in which some diagnostics and some super-speciality services will be offered to the patients by inviting open offers from corporate sector, private hospitals and groups.

What are the new innovations which have been used to overcome the problem of shortage of doctors and specialists?

As I have mentioned that the paucity of doctors is the biggest challenge for Rajasthan but in the last one year many steps have been taken by the government to overcome this problem. The Medical, Health & Family Welfare Department has invited many MBBS doctors for a one-year-long PG course in which some super specialities have been defined. By imparting this one-year training on the doctors, we can operate our trauma centres and various other facilities effectively. Secondly, walk-ininterviews have been allowed by the government to allow MBBS doctors to contact the district administration. The district administration along with Chief Medical Health Officer can take a direct interview to recruit doctors fulfilling the basic criteria. We have also proposed a hard area allowance like in tribal districts or ten high-priority districts as rated by the Government of India, doctors are being given incentives ranging from `6,000-25,000.

Please tell us about integrated ambulance system and its operations? Integrated Ambulance System (IAS) is a very innovative idea, which has been announced by Hoâ&#x20AC;&#x2122;nable Chief Minister in her budget announcement of 2015-16. There are multiple ambulance systems in any state. In Rajasthan, we have 108 service, which is run by GVK Emergency Management and Research Institute (EMRI) where a call is attended when there is a need of medical attention or fire or police. Then 104 is a state run facility where Janani Express vans or ambulances are run by Chief Medical Health Officers and the funding is done by Government of India. There are base ambulances financed by the state government entirely whose capital and running costs both are borne by the state government independently. In IAS, we have combined all the three types of ambulances along with the helpline, which is a medical advisory service. The RPF has been made in such a way that the service provider will run

all the ambulances and the helpline and an integrated system would come in place to empower total medical system and give more avenues to the people for availing mobile medical units.

What are the benefits of recent MoUs signed between Rajasthan Government and Tata Trusts, Global Alliance for Improved Nutrition (GAIN) and WHO? Rajasthan is facing many problems like malnutrition, universal health coverage because of huge population and lack of required infrastructure to deal with such problems. In order to overcome these problems, the government has entered into agreements with UNICEF and GAIN. GAIN will be executing agency with our medical machinery. In March, we had signed an agreement with Tata Trust and Antara Foundation where they will try best practices and suggest how healthcare services should work in entire Rajasthan. In the first phase, they have chosen Sirohi and Jhalawar districts and if their experiment proves to be good, then it would be emulated in the entire state in the coming years. We have also entered into MoU with the WHO to learn how we can implement the Universal Healthcare Coverage (UHC) elements in Rajasthan.

How you think SMS Hospital can be made an ideal destination for super speciality needs? Sawai Man Singh (SMS) Hospital is one of the largest hospitals in India. We are getting huge footfall from Uttar Pradesh, Delhi, Haryana and Uttarakhand as we are providing free medicine to a larger number of patients. It is a huge challenge to meet peopleâ&#x20AC;&#x2122;s expectations and the massive crowd. Now, we are also trying some new experiments like organ transplant and our doctors are getting trained to launch organ transplant services. We would also set-up Hospital Security Force to look into a scuffle between hospital staff and patients.

july / 2015 ehealth.eletsonline.com

Exclusive Interview

Healthcare in Rajasthan: On an Upward Trajectory It has been found that we are able to identify the women who are in the zone of high-risk pregnancy. However, we need to do certain things to make the pregnancy comfortable in a coordinated manner, says Naveen Jain, Mission Director, National Health Mission & Special Secretary, Department of Medical, Health & Family Welfare, Government of Rajasthan in conversation with Kartik Sharma of Elets News Network (ENN) 16

July / 2015 ehealth.eletsonline.com

Exclusive Interview

What are the initiatives taken by Rajasthan government to uplift healthcare scenario in the state? Government of India has instructed all the state governments to make online payments to the beneficiaries of various schemes including “Janani Suraksha Yojana” (JSY). In JSY, an amount is paid to the pregnant woman if she delivers her child in a government facility. In rural areas, the amount is `1,400 while in an urban area it is `1,000. Earlier we were paying these incentives by cross cheques but now the Centre has asked all the states to increase transparency by using viable tools. In Rajasthan, we are working on “Online JSY” and “Subhalaxmi Payment Module” (SPM). Along with JSY, if there is a birth of a girl, additional `2,100 instalment is given at the time of birth. So in Rajasthan, we are making two payments when there is a birth of a girl, one is JSY and other is SPM. Our online payment module will take care of both payments. We will be paying both payments into the bank account of a mother who is giving birth to a child. In case, if she gives a birth to a boy, the government will give the JSY amount to her. We have also modified our system in such a way that her bank account details and Aadhaar number is captured when she turns up for her antenatal care. Normally, a pregnant woman should come for four antenatal care checkups and when she comes, we asked her to provide us with her bank account details so that we can deposit the incentive amount into her account directly.

Please throw some light on the Rashtriya Bal Swasthya Karyakram (RBSK) scheme? The RBSK was unveiled in Rajasthan in six districts in June and then extended to 20 districts in November. The Centre has sponsored the scheme under the National Health Mission (NHM), a team has been constituted which goes to schools and Aganwadis. Health of all the students in the schools and Aganwadis

is screened by AYUSH (Ayurveda,Yoga and Naturapathy, Unani, Siddha and Homeopathy) doctors based on 30 health parameters and then if any child is found having health related problems, then we refer him or her to the next higher facility. We have been able to screen around 22 lakh children in Rajasthan and 1.26 lakh of them were referred to the higher facilities. We are treating children for even very grave illness like congenital heart disease. We have a tie up with certain hospitals and also government medical colleges also extending support to us. Many companies like Mayur, HJL and other NGOs have helped us in making available the vehicles bring the ill children to the district hospitals and medical colleges.

ASHA Soft has been one of the key eInitiatives in the state. Please tell us more about it? ASHA Soft has been a very successful application for Rajasthan in the last seven months since it was unveiled. It was dreamt that all the ASHAs of Rajasthan would be paid online into their bank accounts once they fill an ASHA claim form. We have able to sustain the programme very well as we took some very good decisions in the last seven months. Now we are also suggesting other states that how a transparent payment system can lead to very good data. ASHA workers are now happy that they are receiving payments directly into their bank accounts without any hiccups. We are contemplating that some ASHAs should be given tablets while a mobile app can be developed to experiment whether they can do certain things for which they need not come to primary health centres again and again. Once the Internet facility is available at their villages, we can get crucial data from their houses.

Rajasthan is infamous for its high Maternal Mortality Rate (MMR). What are the key steps taken by Government of Rajasthan to

reduce MMR? In Rajasthan, our maternal mortality rate is near about 244 per lakh life birth and it is quite very high compared to other states. Although in 1997-1998 it was more than 500 and in last 15 to 17 years, the ratio has gone down by more than half and still we need to do a lot. This year, government has taken up a very ambitious program called Kushal Mangal Karyakram. It is for the management of high-risk pregnancies. It has been found that we are able to identify the women who are in the zone of high-risk pregnancy. But we need to do certain things to make the pregnancy comfortable in the coordinated manner. In this program, we will provide a telephone call facility, where our 104 helpline people will call the identified women enquiring their well being and they would be provided with ambulance and if she demands an ASHA worker to escort her to delivery point, it would be given to her. We shall be making a small software which will track the pregnancies of these women and also will ensure that delivery is done is comfortable manner.

How eUpkaran Software helps government in inventory management? A provision of equipment and diagnostics at a healthcare facility is very important to provide efficient health services to the general public. It is felt that sometimes the equipment are not used and they remain packed in the boxes and sometimes these equipment once dysfunctional, in charges do not get the issue rectified. eUpkaran will create centralised inventory management system. Thankfully in the year 20152016, Government of India has promised that if a state creates a system, they will give finance to repair the dysfunctional equipment. Our projects have already made the software and we are mapping all the equipment from 34 districts and soon we shall be training all the staff which is concerned with working of this equipment.

july / 2015 ehealth.eletsonline.com

5th

Come, be a part of 5th World

21-22 August 2015, Hotel Le Meridian, New Delhi

Skilling Youth, Skilling India

Education Summit to Meet, Discuss & Disseminate Knowledge

Confirmed Speakers@Wes 2015

Government Speakers Dr. Daljit Singh Madan Mohan Mittal Cheema Hon’ble Minister Hon’ble Minister of School Technical Education Education, Govt. of Punjab Government of Punjab

Higher Education Speakers

School Education Speakers

Priyanka Bhatkoti Principal Maxfort School New Delhi

Dr. Satbir Bedi Joint Secretary MHRD

Dr. G. Immanuel Chairman CISCE

C Roul Principal Secretary School Education, Government of Punjab

Shri. M.V.V. Prasada Rao Director (VE & E) CBSE

Subrat Sahoo Secretary, Department of School Education Government of Chhattisgarh

Prof. G.S.N. Raju Vice Chancellor Andhra University

Prof. Dr. K. Lal Kishore Vice Chancellor JNTU, Anantpur

Dr. Prafulla Agnihotri Prof. V.S.S. Kumar Dr. Kavita A. Sharma Dr. Devinder Dayal Prof. Uday B. Desai Singh Sandhu Director Vice Chancellor President Director Vice Chancellor IIM Tiruchirappalli JNTU South Asian University IIT Hyderabad Kurukshetra University Kakinada

Sudha Goyal Director Scottish High International School, Gurgaon

Dr Vandana Lulla Director Podar Group of International Schools School

Anirudh Gupta CEO DCM Group of Schools, Ferozpur

Hazel Siromoni Managing Director Maple Bear

Anita Malhotra Principal, Lotus Valley International School Gurgaon

Kalpana Mohan Shanti Krishnamurthy Principal, Vidyashilp Principal, Chinmaya Academy, Bangalore International Residential Gurgaon School, Coimbatore

Kavita C Das Principal St John’s High School Chandigarh

Kavita Sanghvi Principal MET Rishikul Vidyalaya Mumbai

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Dr Indu Khetarpal Principal Salwan Public School New Delhi

Lakshmi Kumar Director The Orchid School Pune

Pramod Sharma Aditi Mukherjee Director cum Principal Principal Genesis Global School GEMS Akademia Noida International School, Kolkata

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World Education Conference: The conference would be a unique platform for sharing of knowledge, challenges, ideas and best practices among the stakeholders in the domain of education. Bureaucrats, tecnocrats, academicians, industry personnel and civil society members along with education experts, senior leaders and management teams of various schools, foreign education representatives , practitioners, business leaders would all benefit through the thought provoking sessions, workshops and round table discussions etc. The conference would have three parallel tracks: School Education Track

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Healthcare Infrastructure

Delivering Optimum Healthcare in Rajasthan The state of Rajasthan requires optimum infrastructure for efficient healthcare service. The state’s infrastructure development in healthcare has been the top most priority of the government, shares PP Mathur, Chief Engineer, Medical and Health Department, Government of Rajasthan, with Elets News Network (ENN) The overall goal of the health sector in Rajasthan is to improve the health and nutritional status of the population, in particular the vulnerable groups. The infrastructure development projects would contribute to this goal by achieving some broad objectives. The state government also aims to enhance the effectiveness and quality of health services at the primary and secondary levels through institutional development and increase access and equity in health care service delivery with particular focus to the underserved sections. We also target the poor, particularly women, scheduled castes and scheduled tribes (SCs/ STs), most of whom reside in remote rural areas, inaccessible hilly terrain and in desert regions. The objective of the project will be achieved only through strengthening institutional capacity and improved health management systems; extending and renovating health care facilities at district and sub-district levels.

Major initiatives under NABARD/RIDF:  Upgradation of 25 PHC to CHC with total cost of `7465.00 lakh through NABARD loan under RIDF XX has been taken up, out of which 7 nos CHC have been already completed.  The construction of 100 new PHC with total cost of `12,690.00 lakh through NABARD loan under RIDF XX has been taken up, out of which 37 PHC have been completed.  Sanction has been issued for construction of 3,000 sub-health centers, which are being taken up in phased manner. In the first phase, work has been awarded for 919 sub centers to be constructed through suitable technology with a sanctioned cost of `24,813.00 lakh. These sub-centers are targeted to be complete in six months period.  Dharamshala at district level (14 at `100 lakh each) and at CHC level (263 at `50 lakh each) have been sanctioned for the benefit of the patients. In Dharamshala, 13 district hospitals and 147 CHC have been already completed.  In 2015, a Detailed Project Report (DPR) for NABARD loan has been submitted for construction of three new CHC, 20 upgraded CHC, 114 new PHC and 339 new SHC.

Major achievements in National Health Mission (NHM)  During the year 2011-12 - 40 CHC, 66 PHC, 320 SHC, 5 ANMTC & 130 Residential Quarters at CHC’s & PHC’s were constructed with total cost of `7620.65 lakh.  During the year 2012-13 - 28 CHC, 42 PHC, 86 SHC, 14 JSY Ward 3 ANMTC and 66 Residential Quarters at CHC’s & PHC’s. were constructed with total cost of `6925.79 lakh. While in the year 2013-14, it was 18,420.63 lakh. During the year, the main constructed works were eight CHC, 24 PHC, 47 SHC, 266 Residential Quarter at CHC’s & PHC’s 1 Swasthya Bhawan & 73 JSY Ward.  The year 2014-15 saw the coming up of three CHC, six PHC & 2 SHC, residential quarters at 10 district hospitals, 9 CHC, 103 PHC’s & 64 SHC’s, six places and 50 Bedded JSY Ward, 17 Nos 20 Bedded JSY Ward, 11 Nos 50 Bedded MCH Units were constructed with total cost of `23,611.00lakh.  During the current year 2015-16 expenditure up to May 2015 was `3,985.00 lakh and the primary completed tasks inlcude 1 Nos Bedded MCH, One 50 Bedded MCH, 11 50 Bedded JSY Wards, 76 Nos 20 Bedded JSY Wards. Presently 21 of 100 Bedded MCH Units, 3 Nos 50 Beddd MCH Units, 15 ANMTC & GNMTC Units, 15 BCMO Office 4 Swasthya Bhawan, 4 PHC Building,7 places CHC qtrs., 84 Nos PHC Quarters, 95 SHC are operational.  Up-gradation of 82 city dispensaries located in urban areas has been taken up with a cost of `10.00 lakh each and work has been completed in 42 health centres so far.  Sanction has been issued for 88 nos new Urban PHCs with a cost of `75 lakh each. Work will be in progress as soon as there is availability of land.

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Cover Story

Rajasthan: The Hub of Innovations in Healthcare The Rajasthan Government has efficiently made a benchmark to provide comprehensive healthcare services to the people of the state. Kartik Sharma and Romiya Das of Elets News Network (ENN) explore Rajasthanâ&#x20AC;&#x2122;s active adoption and implementation of the latest technology for the betterment of the state healthcare services.

ajasthan is the largest Indian state constituting 10.4 per cent of geographical area of the country and accounting for 5.67 per cent of the population of India. The geographic vastness makes it a colossal task to provide proper healthcare delivery to both rural and urban population. But, with the implementation of various progressive initiatives and schemes, the state government has escalated the health index of the people. The Government is

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working in Public-Private-Partnership (PPP) to provide proper healthcare delivery to improve health conditions of women and child, and also improving the nutrition status. Recently, the government decided to hand over all the Primary Health Centres (PHCs) to private players to strengthen the health services in rural areas by giving approval to run all the 2,084 health centres under PPP. The state government has implemented various schemes to

bring down the Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), providing universal access to public health services, prevention and control of communicable and noncommunicable diseases etc. Under the maternal health interventions, there is a reduction of 144 points in MMR from 388 [Sample Registration System (SRS), 2004-06] to 244 (SRS, 2011-13) in Rajasthan and rise in the institutional delivery from 30 per cent in FY 2005 to 78.0 per cent in year 2012 (as Annual

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Health Survey, 2012). Schemes such as the Janani Shishu Suraksha Yojana (JSSY) launched on 12 September 2011 entitles all pregnant women free deliveries including caesarian section with zero out of pocket expenses, accessing public health institutions. As the neonate mortality contributes approximately 75 per cent of IMR, therefore this group of children are provided free of cost facility for investigations, treatment, medicines and any referral facility from home to facility and back home facility. The benefits of these schemes have been well-documented and results are seen in the improvement of healthcare services amongst women and children in the state. In FY 2014-15, 11,90,738 pregnant women were provided free medicines, 9,72,194 pregnant women were benefitted with free lab tests, 8,82,333 availed free hot food, free referral transport from home to health availed by 7,09,658 pregnant women, 61,303 pregnant women availed free blood transfusion facility; 2,02,343 sick infants received free medicine, 1,09,651 received free lab tests, 25,693 and 40, 298 women received free referral transport from home to health facility and health facility to home, 4, 065 sick neonates availed free blood transfusion facility. Under the scheme of Janani Suraksha Yojna (JSY) 13.50 lakh institutional deliveries were conducted against the target of 17.86 lakh (75.58 per cent) as per FY 2014-15 and 11.28 lakh deliveries conducted at public institutions and JSY accredited private intuitions providing benefit to 10.87 lakh (96.38 per cent) mothers in the state. Talking about the child health interventions, the state has brought down the IMR from 63 (SRS, 2008) to 47 (SRS, 2013) which depicts a reduction of 14 points in the IMR. At district and medical colleges level, 12 bedded Special Newborn Care Units (SNCU) were established to provide curative services to neonates. At present, 36 FBNCs are operational

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in Rajasthan. In FY 2014-15, around 61,570 children were treated in these units. Rajasthan is the first state to establish SNCUs at all district hospitals. For the management of severely acute malnourished children 40 Malnutrition Treatment Corners (MTCs) are established at the level of district hospitals, medical colleges and identified sub-district hospitals. 51 MTCs have been operationalised at CHCs against target of 100. At CHCs level, 140 Newborn Stabilization Units are functional in the state, whereas at community level Home Based Natal Care (HBNC) scheme provides for immediate postnatal care and essential newborn care to all newborns up to the age of 42 days. AHAs are being trained and incentivised to provide special care to preterm and newborns. They are also being trained in identification of illness, appropriate care and referral through home visits. 42,638 ASHA-Sahyogini are trained in 6th and 7th modules after selection. Under the HBNC programme home visits are given to 6.11 lakh beneficiaries. To protect the overall child health, the state government initiated Rashtriya Bal Swasthya Karyakaram (RBSK) scheme under which all the children of Anganwadi Centres (0-6 yrs) and school going children up to 18 years will be screened for four Dâ&#x20AC;&#x2122;sDefects at birth, Diseases, Deficiencies,

Developmental delays and Disabilities (30 identified illnesses) through dedicated Mobile Health Team. If a child is screened with any identified 30 diseases, he would be given free referral and follow-up, and surgical treatment if required. At present the scheme is initiated at divisional head quarter districts (Ajmer, Bharatpur, Bikaner, Kota, Jodhpur, Jaipur-I, Jaipur-II and Udaipur) and nine high priority districts and three tribal districts (Banswara, Baran, Barmer, Bundi, Dholpur, Dungarpur, Jaisalmer, Jalore, Karoli, Rajsamand, Pratapgargh and Sirohi) from 14th November 2014. Around 250 Mobile Medical Teams are constituted in these 20 districts. Till March 2015, 21.04 lakh children were screened, 1.16 lakh children were referred to higher health facilities and 41,457 were treated. The Rajasthan government also initiated Rashtriya Kishore Swasthya Karyakram (RKSK) to address the health of adolescents. To strengthen the emergency referral transport services the Rajasthan government incorporated â&#x20AC;&#x2DC;108â&#x20AC;&#x2122; toll free ambulance yojana which is a free emergency response services to the people of Rajasthan started in September 2008. A present, 741 ambulances are working in 249 blocks of 33 districts in entire state. In FY 201415, 7,58,970 medical, 18,193 police, 42 fire cases and 2,04,619 pregnant

Innovation

UNDP- NIPI Innovations The Norway-India Partnership Initiative (NIPI) is a bilateral partnership between the Government of Norway and Government of India, with the intention to contribute to the achievement of the MDG-4. Innovations under Phase II (2013-17) HBNC+ as an innovation extends the home-based continuum to children up to 1 year of age. It promotes optimal infant care healthy practices like growth monitoring, appropriate infant feeding, hand washing, full immunisation, prophylactic iron supplementation, and improved ORS use in addition to appropriate play and communication by mother for early childhood development. This is achieved through adequate skill building, incentivisation and supportive supervision. Sick New-born Care Unit Plus (SNCU+) is an extension of the facility based care. The intervention extends the continuum of care for sick new-borns to their homes after they are discharged from SNCU. SNCU+ involves home visits by ASHAs and/or ANMs in order to ensure compliance with discharge

instructions, promote early child development and Kangaroo Mother Care (which includes skin to skin contact, warmth and exclusive breastfeeding). If danger signs are detected, then new-borns are referred back to the appropriate facility. This is achieved through appropriate training and provision of guidelines to ANMs and ASHAs and by establishing a supportive supervision mechanism to efficiently track and follow up the sick newborns discharged from SNCUs.

State and District Newborn Resource Centers Service providers located at SNCUs and at sub-district level newborn care facilities require constant mentoring support to improve their skills and thus the quality of care. A State Newborn Resource Center has been established in consultation with state NHM. The unit provides technical support through mentoring visits conducted by experts. In addition, quality of newborn care at primary and secondary level of the public health system is being improved by establishing and making functional SNCU-Teaching & Training Centre (TTC) at the District level. SNCUTTC conducts mentoring visits to NBCC and NBSU and provides â&#x20AC;&#x2DC;hands onâ&#x20AC;&#x2122; mentoring support and supportive supervision as required.

Improving quality of care for children in District Hospitals NIPI Phase II Geographical Areas

District

Hospital

assessment

conducted by MOHFW & UNDP newborn project in 4 EAG states shows that children are inappropriately treated for common childhood illnesses including diarrhoea, respiratory problems, fever and malnutrition. Lack of triage and assessment delayed treatment of paediatric emergencies, inadequate equipment, incomplete knowledge of treatment guidelines and insufficient monitoring of paediatric inpatients lead to reduced quality of care. As a result, more caregivers may seek care outside public health facilities and end up with high OOP expenses or delay seeking care or not seek care at all. The main objective of this innovation is to bring about functional and quality improvement of emergency and inpatient paediatric care in district hospitals. The important components shall include development of operational guidelines for paediatric emergency and inpatient care, operationalising paediatric emergency services, reorganisation of paediatric wards, introducing standard patient record formats, appropriate training of doctors and nurses, and data management. A practical approach for improving quality will be undertaken to achieve an acceptable standard of quality of care to address the most common paediatric conditions and make services more responsive to the needs of the children referred to the district hospitals.

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Cover Story

women were provided services through ‘108’ ambulances. Another helpline toll free ‘104’ medical advice service was declared in budget announcement 2011-12 and was launched on 16th January, 2012 in the state. “104 toll free medical advice service is not only a new initiative under NHM, but it is a unique service which is being provided for the first time to the citizens of Rajasthan. It is a medical helpline which provides medical advice, counseling, information directory services and many more health related information”, says Priyanka Kapoor, Consultant Intersectoral Convergence. The scope of service is also enhanced with addition of dispatch of 104 Janani Express vehicles, complaint registration related to sex selection, information related to malnutrition etc. Till March 2015, 18.79 lakh calls were given services under this scheme since its launch. In addition, this service is also being used for registering complaints for illegal determination of sex, medical counseling of tobacco users and imparting information of malnutrition.

Reaching Out There are many areas in the State, especially the tribal, the desert and inaccessible areas where basic healthcare infrastructure is not up to the reach of poor especially women and children. To overcome this problem, Rajiv Gandhi Rural Mobile Medical Unit (MMU) was launched in May 2008 throughout the state. There are two vehicles in each MMU comprising of a staff vehicle and a diagnostic van which contains modern instruments and equipments such as ECG machines etc. Out of 52 MMUs proposed to be deployed, at least one for each district and two or more for the desert, tribal and border districts 49 units have been made fully functional with both staff vehicles and diagnostic vehicles. During FY 2014-15, 26,322 camps were held and 12,42,775 patients were treated.

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Addressing the declining sex ratio provides the online form F for center the government launched the Mukhaya registered to report to appropriate auMantri Shubh Laxmi Yojna scheme on thority. Form F of every woman whose April 1, 2013 in entire State to promote sonography test is conducted is being girl child birth and to reduce maternal reported online by every centre. All mortality ratio. Under this scheme, an sonography centres in the state have incentive of Rs 2,100 is given to mother been enrolled with the Medical, Health on delivery at government and private & Family Welfare department and deaccredited health institutions other tails are available in the software. It than JSY incentive. Amount of Rs provides online surveillance system of 2,100 is given after one year of age on complete immunization of the girl child and Rs 3,100 is given after five years of age at the time of admission in school. Thus, a woman can get monitory benefit of Rs 7,300 for her girl child in addition to JSY benefitted of Rs 1,400 in rural and Rs 1,000 in urban areas. Around 4,91,219 girls benefitted in FY 2014-15 under Tokens of Appreciation: Government of India has also recognised continuous this scheme. efforts of Rajasthan in the healthcare sector The government will also be distributing free sanitary napkins government for prevention of sex deto about 20 lakh adolescent girls of termination to save girl child. The web the age group 13-19 years, studying based Software IMPACT was launched in class six to 12th standard under on October 1, 2012 by the Medical Rajasthan Kishori Swasthya Evum Health & Family Welfare department. Swachhata Karyakram in the state. ASHA Soft is an online system which facilitates the health department, to capture beneficiary eInitiatives wise details of services given by In the last few years Information ASHA to the community. It also Technology in health sector has been a provides online payment of ASHA to major focus of healthcare industry and their bank accounts and calculation is bound to continue as the industry of total incentive given will be in strives to automate medical records, accordance with the actual health improve electronic reporting, simplify services provided, which will help daily work flows and increase cost in strengthening of monitoring and savings by streamlining work efforts. management of physical & financial Therefore IT is a promising tool in progress. Under National Health healthcare that can provide new ways Mission, Rajasthan, the responsibility to healthcare providers to collect, for preparing ASHA Soft has been store, retrieve and transfer information assigned to NIC unit of Rajasthan electronically. In this regard, National State for the cooperation of which Health Mission has taken up few ASHA Soft Core Group has been e-initiatives and implemented them constituted under the directions of successfully. Mission Director, which is working Integrated System for Monitoring on the progress of this software with of PCPNDT Act (IMPACT) Software

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the coordination of NIC. Till date the profiles of all the working ASHAs have been prepared along with the work plan. e-Aushadhi is a web-based application which deals with the management of stock of various drugs, sutures and surgical items required by different district drug warehouses of Rajasthan. e-Aushadhi helps in ascertaining the needs of various district drug warehouses such that all the required materials, drugs are constantly available to be supplied to the user district drug warehouses without delay. This includes classification or categorisation of items, codification of items, etc. The prime objective of a District Drug Warehouse is to supply drugs to the various medical institutes that are associated with the given district drug warehouse. Pregnancy, Child Tracking & Health Services Management System (PCTS) is a online software used as an effective planning and management tool by Medical, Health & Family Welfare department, Government of Rajasthan. The system maintains online data of more than 13,000 government health institutions in the state. This software helps in tracking of pregnant women for better health surveillance; it is a useful tool for improving institutional delivery. It also helps in tracking BPL and JSY cases. Arogya Online Project is an e-Health initiative to automate the hospitals in the state to improve the patient care. It is an electronic management of health information to deliver safer, more efficient, better quality healthcare to the citizens of the state. This initiative facilitates the transition of paper-based clinical record keeping to electronic means for better information exchange. It is designed to provide the highest level of flexibility and operational efficiency for a hospital. The â&#x20AC;&#x2DC;Arogya Onlineâ&#x20AC;&#x2122; streamlines work-flows operations, resource utilisation and management to improve hospital administration,

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enhances the quality of patient care, creates platform for information exchange, end to end supply chain management within the system, unique modular design structure of application to enhance operational flexibility, the system performs complex tasks like investigation billing, bed management, and various other related activities. Saghan Nirikshan Abhiyaan is an designed institution-wise check list to identify the gaps in the health services at the health institution. This initiative gives access to information anywhere and anytime, direct and effective monitoring of progress, better planning and decision making, identification of gaps in health facilities, infrastructure and also in identifying best health institutions. Computerized Human Resource Information System (CHRIS): It is an integrated streamlined system to keep the employee data. This secured webbased system which contains complete information of all contractual or permanent stall and can be managed. It also provides real time status of HR for instance vacant or filled positions etc. Other e-initiatives include Eligible Couple Tracking System (ECTS), Health Management Information System (HMIS), Rajasthan Janani Shishu Suraksha Yojna (RJSSY) Software, e-Shubhalaxmi Yojna. The government has also incorporated the use of M-app (Whatsapp) for better communication and effective governance. It has come as a ready solution for mode of communication with various cadres for getting various activities done such as sending circulars, replying to common grievances, calling for meeting or giving notice, sharing feedback on trainings and discussing logistic problems in

programmes etc. The Government of Rajasthan is aggressively promoting Medical and Healthcare sector, also offering an opportunity for the private sector to invest in medical and healthcare institutions (medical, dental and paramedical etc). In order to facilitate the establishment of quality health institutions within the framework of set standards and norms, the government seeks participation from the private sector for qualitative healthcare delivery. The state has the potential of extending its tourism into medical tourism with its RIPS (Rajasthan Investment Promotion Scheme)-2014, offering concessions and tax benefits for such investments. The state government aims to develop complementary and alternative medicine centres, super specialty healthcare institutions to ensure qualitative delivery of healthcare at pocket-friendly cost. The government also promotes development of centres of excellence for medical care, investment of private sector in medical healthcare institutions and support units (diagnostic centres, blood banks and paramedical training institutions), and promotion of medical tourism. With all these initiatives in place, healthcare system in Rajasthan has set an example for other states to follow.

For conference updates please visit: http://smartcity.eletsonline.com/2015/

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Transforming Healthcare through Innovations I wanted to find a way to channel two personal passions – innovation and healthcare – in a way that would help underserved families in India and other developing countries, says Sunil Wadhwani, Founding Donor, WISH Foundation and Co-Founder and Ex-Chairman of IGATE Corporation, in conversation with Elets News Network (ENN) On Making Healthcare Accessible For much of India’s over 900 million Base of Pyramid (BoP) populations, living on or below the poverty line, basic healthcare is beyond their means. The public healthcare

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system has not been able to keep up, leaving little choice but to access costly private healthcare, pushing people deeper in to poverty. To address this, the government is drawing up its future healthcare plans under the broad principles

of the Universal Health Coverage (UHC). Innovations e.g. product based, process or technological, can play a very critical role in making this possible, as can public private partnerships (PPPs). To support the government

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initiative, the Wadhwani initiative for Sustainable Healthcare or WISH Foundation is working towards scaling up innovations to build an equitable healthcare system, making quality healthcare accessible to the underserved population in priority states. WISH Foundation and Department of Medical Health and Family Welfare, Government of Rajasthan through Memorandum of Understanding are implementing a five year project called SCALE Rajasthan. The project scales up healthcare innovations and brings in greater engagement between public and private sector to strengthen the primary healthcare and improve access to quality and affordable healthcare. The project responds to the healthcare challenges of shortages of human resources and functionality of the health facilities; geographical distances, gender imbalances and nutritional status of the poor and overall low health seeking behaviour of the people in the state.

On Making Healthcare Affordable Talking about devices, for instance, our pathology tests cost a thousand and more in serious cases. Rural underserved population group cannot afford that much of costs and might have to travel long distances could be as much as 50 km to reach the diagnostic labs, which would in turn increase their out of pocket expenses. They may also avoid visiting the labs unless and until it is a matter of death and life to them. Nowadays, there are lots of social enterprises which have come up with innovative devices. An average glucometer cost around `2,500 and each strip cost `25, now how many people can afford this in our country? These companies have come up with glucometer, which donâ&#x20AC;&#x2122;t cost more than `500 and each

strips cost `5. This is so affordable that can be given to ASHA worker when she is visiting for checking pregnant women and adolescence girls. Any pregnant women whose blood glucose is high can be categorised in the critical pregnancy case. Similarly, in our country anaemia is a major issue leading to high maternal mortality and infant mortality is due to malnutrition. So anaemia screener has come out and the cost per test is no more than `3. An ASHA worker or an A.N.M can carry it along with her itâ&#x20AC;&#x2122;s like a cell phone itâ&#x20AC;&#x2122;s a non-invasive procedure

institutions. The consortium comprising of government, private sector, technical and civil society organizations and social enterprises will bring skills and expertise at three levels: management and overall coordination, service delivery and technical expertise in the RMNCH+A strategy. We have partnership with various organisations such as World Bank, USAID, Sankalp Forum, FICCI and others. It is a combination of secondary research, organising grand challenges where innovators are invited. We have also taken

We have partnered with Government of Rajasthan to demonstrate the impact of low cost innovations and PPPs to improve primary healthcare delivery where the device scans the blood vessels and within a few seconds your haemoglobin noted. The device is IT enabled and results can be transmitted directly to the doctor and if the haemoglobin is less than seven and she is a pregnant woman immediately they can inform the ASHA worker or the ANM it is a critical pregnancy to put them through red channel. The early diagnosis becomes easier and cost effective, also this increases the chances of delivering a normal child grows by almost three to four times. Similarly, there is a urine analyser again portable IT enable device can do 10 to 12 tests and costs about `3 per test. WISH Foundation is creating a pipeline of these and many more innovations, which can help reach people at their doorsteps and reduce their expenditure on healthcare.

On PPPs to improve primary healthcare delivery By 2019, SCALE Rajasthan will bring on board collective strengths of the public and private sector

over primary health centres and we are bringing private sector players to manage dysfunctional primary health centres. So we are assisting the government to manage and operate 30 primary health centres and its 170 subcentres through the social sector partners. These PHCs are being operated per government norms, under government supervision and provide quality and free of cost services to the people. This will help the state address shortages of doctors and make currently dysfunctional PHCs into smart clinics over a period of time. We are working towards setting up state of art diagnostic labs at the district hospitals through private sector partnership, which will provide a number of additional diagnostic tests facilities at rates agreed by government. Our mission in next five year is to bring these and many more innovations which will help the poor in the village get services at their doorstep, reduce his expense of healthcare and also reduce the patient load on the district hospitals.

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Scaling up Healthcare Innovations Wadhwani Initiative for Sustainable Healthcare (WISH) Foundation focuses on scaling up innovations in the healthcare domain to strengthen the primary healthcare system, says Soumitro Ghosh, Chief Executive Officer, WISH Foundation in conversation with Elets News Network (ENN) What role does WISH Foundation play in strengthening the healthcare sector in Rajasthan and other states? Wadhwani Initiative for Sustainable Healthcare (WISH) focuses on scaling up high impact healthcare innovations in strengthening the primary healthcare delivery system in partnership with the state governments. Healthcare innovations include process innovations e.g. efficient and cost effective primary healthcare delivery models; device innovations e.g. compact, portable, low cost, high quality glucometer or non invasive anemia screener, no touch breast scanners etc.; as well as technology innovations like telemedicine, mobile health technology being used for supervising the frontline health workers or standardizing IEC or BCC messaging, or for monitoring and providing the supportive supervision by either the medical supervisor or Auxiliary Nurse Midwife (ANM) to the Accredited social health activists (ASHA) workers. In states such as Rajasthan, Madhya Pradesh, Uttar Pradesh access to quality healthcare is very poor due to acute shortage of skilled medical and non medical staff, sub optimal performance of primary health clinics, long distances and low density of population make physically monitoring difficult, erratic and costly.

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The use of variety of innovations like public private partnership to fill manpower gaps; outcome driven, efficient management of primary health clinics; use of innovative diagnostic devices by grass-root health workers at the door step; use of e-health, internet application, and mobile technology become highly beneficial in achieving desired health impact, making the public health system efficient and cost effective and reducing out-of-pocket expenditure on health for the economically weaker sections of the population.

How do you identify and incubate these innovations? We continuously look for these innovations and have partnered with various forums such as Millennium Alliance, TiE, Manthan, and Sankalp Forum besides working closely with The World Bank, USAID FICCI, BIRAC and many others. Within the public sector there are a lot of internal innovations that too. We systematically identify innovations from both private and public sectors and then manage a database that is available for public on our website. We choose the highest ranking innovations, potential to be scaled up faster than others and then take them to the government. With our focus on the economically weaker sections of the society and the underserved populations, it is the government

infrastructure which exists and operates in rural areas where a large proportion of the target audience lives. Hence, instead of reinventing or recreating parallel structures, we work with the government. We approach the state governments where we work as a foundation and through a long term Memorandum of Understanding (MoU) we chart out needs and priorities with the list of innovations and then match what fits the best. We have created a pipeline called SCALE in partnership with the state governments, which identifies, incubates and accelerates promising innovations and demonstrates their impact on ground within the government system with financial assistance from WISH for a period of up to two years. Different innovations require different approaches and time frame for demonstration. For example Primary Health Clinics (PHCs) and Sub Centers form the nucleus of our model. We have taken management and operations hand over of Primary Health Clinics (PHCs) and are making those PHCs functional by bringing reputed and experienced civil society organizations, philanthropy organizations and private not-forprofits to manage the clinics through a Public-Private-Partnership (PPP) for upto a period of two years. Currently we fund the expenses to demonstrate its efficacy with an understanding

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with the state governments that once proven successful, it starts reimbursing the PPP partners against agreed deliverables. With the PPP, we bring in players like Karuna Trust, Piramal Swasthya, and Ajeevika Bureau to run those PHCs. We also bring in organizations like SRL Diagnostics to provide state-of-the-art diagnostic services within the district hospitals and CHCs, some tests for free and others at an agreed rate with the government and the private players, substantially lower than the commercial market rates. Around each PHCs we deploy the innovations like point-of-care diagnostics and mobile health for use by trained ASHAs and ANMs; a foolproof patient referral system from PHCs to CHCs and DHs; HealthATMs at the sub centers offering 3-in-1 benefits of remote consultations by MBBS doctors through telemedicine, basic non invasive diagnostics and medicines through vending machines; portable diagnostic laboratories offering 76 essential tests right at the community level for early detection of diseases in a convenient and cost effective manner; electronic medical records (EMR) and integrated data analytics (IDA) for evidence-based decision making using tailor-made Dashboards for different levels of decision making e.g. state, district, block, facility and health worker. We also bring in the special state-related interventions. For instance, to reduce malnutrition we are working on several initiatives â&#x20AC;&#x201C; a) use of locally produced food supplement treatment for Severly Acute Malnutrition children (SAMs), b) wheat fortification for the rural mass in Rajasthan. We are working with Action for Hunger (ACF) who developed locally produced food supplement treatments for SAMs which improves nourishment level dramatically. We are scaling that up. Similarly while GAIN project successfully introduced fortified milk,

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oil and wheat in packaged forms. However packaged wheat is largely consumed in urban areas of the state. The rural population still depends on the local mills. We are working with various partners to bring micronutrients in sachet form and/or through devices that can be fitted with the mill, where the micronutrients can be mixed while grinding the wheat and made available to the entire family. These are different kinds of innovations that have already been plugged into the government system. And once the documentation is done the government takes over and scales it up across the district, our role changes as a facilitator. Our focus is to scale up innovations in healthcare area to strengthen the primary healthcare.

As you talked about malnutrition in Rajasthan, which is the core focus area you are looking at? And what are the other areas that WISH Foundation is focusing on at present? Besides RMNCH+A and communicable diseases, we see noncommunicable diseases (NCDs) as a major threat looming large that the primary healthcare system needs to address. We are introducing a number of low-cost devices that can early detect NCDs and thereby prevent the need for treatments. We have also introduced training programs for medical and non medical staff to develop capacity in managing NCDs. Rajasthan is extremely open and very supportive in pushing healthcare reforms. The state has the lowest doctor to population ratio, so the healthcare facility requires attention and the government is very supportive in initiating reforms.

How do the activities of the foundation stand today and what are the future initiatives? We are covering 13 high priority

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districts including Jaipur in consultation with the Health Ministry and the CMO â&#x20AC;&#x201C; all six districts in Udaipur division, all four districts of Kota division, Churu and Sawai Madhopur districts and Jaipurâ&#x20AC;&#x2122;s urban slums. Currently all the initiatives are being rolled out on ground. By middle of August they will all be fully operational. It is a five-year MoU, but our role evolves with the innovations getting scaled up within the government system. We take care of the bottlenecks and the operations that the government needs support and assistance for. For instance, over and above bringing ready to demonstrate innovations and funding them, we also work with design labs to design appropriate prototypes for different innovations. Present ATMs being urbanized needed a lot of redesigning to suit the rural requirements. We work with Indian School of Business (ISB), Hyderabad for designing the rural model. We also rework on the business models for some innovations like the HealthATM or Portable Labs which are highly operationintensive. Though very innovative and useful these may not be effectively operated by government staff. Hence we are using local entrepreneur development program in partnership with Rajasthan Skills & Livelihood Development Corporation (RSLDC) and local panchayats to test the effectiveness of these innovations where private ownership with public support could make the operations sustainable, benefitting the underserved population of the state.

The data provided by you says of the 114 health sectors PPPs in India, Rajasthan, Madhya Pradesh (MP) and Odisha account for eight percent. What is the reason behind this? PPPs have worked successfully in highways, airports, tertiary healthcare where there is high

revenue potential. This eight percent comes largely from the tertiary and diagnostic healthcare sectors. In Rajasthan, itâ&#x20AC;&#x2122;s for the first time that PPP is being tested in primary healthcare delivery. We believe it is possible to create success for PPPs in primary healthcare following a high volume-low margin business approach. There will always be a segment of population with no capacity to pay for healthcare, who will have to be offered free services, paid for by the government and other philanthropic initiatives. But with sustained efforts to provide quality healthcare at affordable prices, the bottom of the pyramid market is bound to develop and offer the opportunities to the private sector. It is still work in progress and we are learning while working with the government. We plan to visit six to seven states, with Rajasthan being the first one. Dialogues are in the final stages with Madhya Pradesh and Odisha. These are three priority states we have decided to focus for now.

Do you see this two per cent mandatory CSR mandate affecting the healthcare sector? Yes, two per cent is really a huge amount of resources. It is a good move but will take time. We are combining social venture funds, private CSR funds, multilateral agency grants and government funding to scale up innovations which in turn will address the healthcare challenges. We are creating those mechanisms and pipelines through which innovations can be adopted in the government system and there is accountability on both the public and the private sectors. We are committed to build the much needed healthcare ecosystem of funders, accelerators, innovators, providers and policy makers to make primary healthcare a viable business. We are confident in the coming 5-10 years we will see a sea change in the primary healthcare delivery.

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India Blossoms as Medical Tourism Hub Healthcare has been one of the slowest sectors to adapt and implement IT but definitely it is the future of healthcare industry, shares Dr S B Jhawar, Managing Director, Apex Hospitals, Jaipur with Kartik Sharma of Elets News Network (ENN) Tell us about the healthcare scenario and challenges in Rajasthan? Rajasthan is the largest state in India by area constituting 10.4 per cent of the total geographical area of India and it accounts for 5.67 per cent of the population of India. We have an acute shortage of hospital beds, only 0.9 beds per thousand populations against a global average of 2.9 beds per thousand populations is available here in India. Another big challenge in healthcare industry is getting skilled medical and paramedical manpower. Hospitals are struggling with continuously decreasing average revenue per occupied bed. Better economic policies like loans given to purchase new equipment on subsidy, taxation relief, and easy policies for conversion of land to the hospital can significantly change the healthcare delivery scenario. The government should take initiative like relaxation in rules of permission for medical, dental and nursing colleges and timely approval for MLC.

What are the healthcare facilities provided by Apex Hospital? Apex started functioning in 1994, since then it has emerged as fastest growing hospitals in Rajasthan. Apex Hospitals is a multispecialty chain of tertiary care hospitals in Malviya Nagar, Mansarovar and Suratgarh, with its

centre of excellence critical care, renal transplant, joint replacement, cardiology, neurosurgery, plastic and cosmetic surgery, and bariatric and metabolic surgery.

with a dedicated floor for international patients very soon.

What are your views on medical tourism in India? What initiatives has your hospital taken in medical tourism domain?

The implementation of advanced information systems is enabling great social and organisational changes. However, healthcare has been one of the slowest sectors to adapt and implement IT but definitely it is the future of the industry. The complexity of health organisations and their fragmented internal structure constrains their ability to adopt organisation-wide IT. This is further impacted upon by the relative immaturity of strategic health IT, which is complicated and unable to show quantifiable benefits. Both organisational and technological factors lead to the slow adoption of strategic IT.

Medical tourism in India is at the nascent stage of development and the driving factor is the availability of affordable standardised quality care. In India, patients are coming for cardiology, cardiothoracic surgery, fertility, bariatric surgery, cosmetic surgery and transplants. Rajasthan is a major tourist destination and located in the golden triangle, has a very good potential to attract medical tourist. We are treating the patients of various countries such as African countries, Gulf countries and the United Kingdom. We are the only hospital from Rajasthan, which had participated in Indian Medical Tourism Destination 2015 held at Dubai and Muscat, organised by FICCI. We are providing arrangements and solutions to the medical tourists starting from pick and drop from airport, hotel booking, local tourist places visit, food arrangements as per their needs, interpreter and also assist them in VISA process. We also focus that their cultural needs are also taken care of and we have plans of coming up

What is your opinion on the adoption of IT in healthcare industry?

What are your present operations in India and expansion plans? We are running two hospitals in Jaipur, a 200-beded NABH accredited multispecialty hospital in Malviya Nagar and another is in Mansarovar with 50-beded facilities. We have started another project of 100 bed hospital in Suratgarh and by the end of this year we will start operations there. Our vision is to have 15 more hospitals in North West region of Rajasthan and nearby states with 1250-beded capacity by 2020.

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Exclusive Interview

Mukhyamantri Nishulk Dava Yojana (MNDY) – An initiative by Rajasthan Government to enhance access to medicines Mukhyamantri Nishulk Dava Yojana (MNDY) has addressed equity and access to the healthcare for the people of Rajasthan. Dr Sudhir Kumar Sharma, Managing Director, Rajasthan Medical Services Corporation elaborates on MNDY in Conversation with Elets News Network (ENN) Please throw some light on Mukhyamantri Nishulk Dava Yojana (MNDY)? The Mukhyamantri Nishulk Dava Yojana (MNDY) was launched in the state of Rajasthan on October 2, 2011. This was in compliance to the budget announcement for the financial year 2011-12 which said that the Government would make available commonly used essential medicines free of cost to all patients visiting all government healthcare institutions with effect from 2nd October 2011. Another announcement was to establish a central procurement agency for procurement of medicines, surgical and suture items for the Medical & Health Department and Medical Education Department. Thus Rajasthan Medical Services Corporation (RMSC) was established in May 2011 under the Companies Act, 1956. The Corporation has its headquarters at Jaipur, with a set up of different sections to look after supply, logistics, procurement, quality, equipment procurement and maintenance, IT and finance issues. To advise RMSC on what to purchase and how to purchase, there is an outside body called the Technical Advisory Committee (TAC). This committee is chaired by the Managing Director and comprises of representation of subject experts from medical college

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“Free medicine scheme has dual benefits of delivering healthcare services and filling in the disparity gap at the same time” Dr Sudhir Kumar Sharma, Managing Director, RMSC hospitals, a representative from Finance Department, GoR, Rajasthan University of Health Sciences, Pharmacology experts and RMSC representatives. The TAC finalizes the Essential Drug List (EDL) in consultation with subject experts. Currently, the EDL has 612 drugs, 73 surgical and 77 suture items. For the implementation of the scheme, basic infrastructure was

set up at the level of institutions to facilitate drug distribution to the end users. At the district level, the District Drug Warehouses (DDWs) were strengthened in terms of infrastructure and manpower and today the corporation owns 34 DDWs and 6 Medical College Drug Warehouses. At the institutional level the Sub-stores were strengthened for the purpose of drug storage and based on the patient load of individual healthcare facility, the Drug Distribution Centres (DDCs) were set up for distribution of medicines to the patients. For a patient load of 150, one DDC was considered to be the norm. Pursuant to the launch of the scheme in view of the increased patient load, the institutions were directed to revisit the requirement of DDCs. For effective service delivery, the department recruited about 1400 pharmacists for management of DDCs in the year 2012 and this was augmented by deputation of Informatics Assistants in 2013 from DoIT for management of entries into the e-Aushadhi software. The development of the e-Aushadhi application as a complete supply chain management solution by C-DAC aided the headquarter and field level implementation of MNDY. It’s a complete inventory management solution for the medicines capturing all processes right from the forecasting of the annual demand to the issuance

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of supplies for distribution to patients. The application has been rolled out at more than 3500 institutions across the state. The e-Aushadi application has been acclaimed nationally and is under the nation-wide roll out for various other states in the country. Looking to the patient welfare centric nature of the scheme the quality mechanism has been inbuilt very strong in the corporation. Samples are received from the DDWs at the headquarters and sent to empanelled laboratories for quality test. The empanelled laboratories report online in the e-Aushadhi software, pursuant

Director, RMSC, I look forward to a bright future for the corporation and the scheme in times to come.

Are the commonly used essential medicines being distributed free of cost to only below poverty line (BPL) category people? No, we are providing commonly used essential generic medicines free of cost to all patients visiting all government healthcare institutions, irrespective of their financial status. The uniqueness of this scheme is that it is universal in nature and benefits

We have had our share of bottlenecks and challenges during the implementation because of the stateâ&#x20AC;&#x2122;s geographical vastness and the large number of institutions to which the medicines are shifted from the quarantine area to the main storage section to be issued to the institutions. We have had our share of bottlenecks and challenges during the implementation because of the Stateâ&#x20AC;&#x2122;s geographical vastness and the large number of institutions (more than 17,500) to be covered under the scheme. However, because of political and administrative willingness and a very strongly lead team at RMSC with a focused vision the scheme could be implemented successfully in a very short span of time. Over a period of three and half years, MNDY has achieved success with national and international recognition. The corporation has been visited by a number of other states to study the processes for replicability purpose as also by teams from number of development partners, NGOs and countries like Nepal and North Korea. The state has been represented at national and international forums for the schemeâ&#x20AC;&#x2122;s presentation by the then Managing Directors and other officials from the corporation. As Managing

extend to the entire population of the state. No card or identification of any sort is required to avail free medicines at public healthcare institutions in the state of Rajasthan. Although the supply chain is quite strong and medicines are being made available round the year, however, at times there are shortages and to cover that period, we have a provision of 10 per cent of the budget for local purchase by institutions.

Please mention the funds allocated for this scheme by the government? What are the major challenges you encountering? Since the inception of the scheme in the year 2011, the state government has been provisioning adequate budget every year to meet requirements under the scheme in the range of `280- 300 crore. The state has been receiving funds from NRHM in the range of `60 -150 crores as well; this aids the state ex-chequer and saves the state resources. Thus, as far as the availability of funds is concerned RMSC faces no bottlenecks on account

of funds for procurement of medicines under the scheme. The challenge of providing generic medicines free of cost to a large population of 7 crore was big and an uphill task; however RMSC could achieve the same with pre-defined guidelines, adherence to timelines and teamwork under expert leadership. Major challenges being encountered are management of increased OPD and IPD loads pursuant to launch of the scheme, the implementation resulted in huge footfall in numbers of patients visiting government healthcare institutions but the available infrastructure and manpower remains an issue of concern. There have been episodes of stock-outs of medicines on account of various reasons which have lead to breaks in supply chain and resulted in increased utilization of local purchase funds, the receipt of timely and validated annual demand from the medical departments has been an area of concern, this leads to shortages and expires at times. Rajasthan being a desert predominant area, temperatures in summer are often high; hence cold chain maintenance for heat sensitive drugs also is a critical issue in the supply chain. Then there are issues related to pilferage, breakage, deterioration, drugs becoming obsolete etc, leading to adverse media reports at times.

What are the parameters to select an agency to provide medicines to the Government? There are stringent procurement criteria and only a manufacturer or an importer can participate in the bid. The firm should have a turnover of more than `20 crore, it should not have been blacklisted anywhere across the country and should have a market standing of three years for that particular product. The firm should also mandatorily participate through e-procurement. Of late some changes have been made in the parameters to enhance the quality of drugs.

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Healthcare IT

echnology plays a vital role in delivery of healthcare services in India and in the treatment of patients for their return to normal life. Healthcare professionals rely on technologies for

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tests and investigations to aid their clinical decision making. Innovation in medical technology can therefore be crucial for the Indian healthcare system to improve access, enhance quality and reduce costs.

Innovation in medical technology was primarily led by the US with its strong ecosystem supportive of innovation. However, European countries as well as emerging economies like China, India and Brazil pose a strong challenge to

Healthcare IT

Market Trends

the leadership position of the US. According to PwC’s Global Innovation Survey, new digital entrants are more likely to: • Regard themselves as true innovation pioneers • Have derived a greater percentage of annual revenue from major new products and services launched during the past year • Implement business model innovation to create new services rather than a single product • Tap social media to support innovation and collaborate with competitors to deliver innovative products and services New entrants engaged in a Healthcare IT platform war for the consumer • The new Amazon Fire phone includes an array of sensors to enable new digital health applications

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• Apple HealthKit and app allows health and fitness apps to share their data • Qualcomm Life wireless health technology that aggregates and integrates patient data • Google Fit platform to manage the data from health and wellness apps, sensors and wearable devices • Intel home health gateway sold by the Intel-GE Care Innovations joint venture • Salesforce.com has partnered with Philips to build a connective digital healthcare site in the cloud • Samsung software integrates with mobile devices that allow users to track nutrition, exercise and weight

HIT Calling Healthcare Information Technology (HIT) has emerged as a lucrative solution for Indian healthcare industry. It has helped to improve the quality, safety, and efficiency of

healthcare delivery in a cost-effective manner. Healthcare IT allows healthcare providers to collect, store, retrieve, and transfer information electronically and also helps in sustaining point-of-care delivery at low costs and in less time. It is continuing to digitise the healthcare system and due to its various benefits, adoption of HIT solutions is on a continual rise. Some significant benefits include improved quality of care, enhanced administrative efficiency and financial benefits. Healthcare IT constitutes of two major segments, namely, providers and payers. The provider market for healthcare IT is the fastest-growing market with the highest revenue generated from the applications of clinical information systems, such as integrated solutions of EHR, HIS, LIS, CVIS, CDSS, Picture Archiving and Communications Systems (PACS), CPOE, and RIS. The global Healthcare IT market

Healthcare IT

was estimated at US$14.1 billion in 2013 and US$15.6 billion in 2014; the market is expected to grow with a compound annual growth rate (CAGR) of 4.8 percent over the next five years. Electronic health records (EHRs) accounted for the largest share of the market (61.5 percent) in 2013, followed by telemedicine (23 percent) and PACS (7.8 percent). Healthcare providers in India are expected to spend US $1.2 billion on IT products and services in 2015, an increase of seven per cent over 2014, according to Gartner, Inc. This forecast includes spending by healthcare providers (including hospitals, as well as ambulatory service and physicians practices) on internal services, software, IT services, data center, devices and telecom services. Internal services will achieve the highest growth rate amongst the spending categories with a 17 per cent increase in 2015, to reach US$ 297 million. Internal services refer to salaries and benefits paid to the information services staff of an organisation. The information services staff includes all company employees that plan, develop, implement and maintain information systems. Software spending will grow 6.2 percent, to reach US$ 103 million in 2015, up from US$ 97 million in 2014, led by growth in vertical specific software (Software applications that

Internal services will achieve the highest growth rate to reach US$ 297 million are unique to a vertical industry. These are stand-alone applications that are not modules or extensions of horizontal applications). Telemedicine is a fast-emerging sector in India. In 2012, the telemedicine market was valued at US$ 7.5 million, and it is expected to rise 20 per cent annually, to US$ 18.7 million by 2017. Telemedicine can bridge the rural-urban divide by extending low-cost consultation and diagnostic facilities to the remotest areas via high-speed Internet and telecommunications.

Indiaâ&#x20AC;&#x2122;s solid mobile technology infrastructure and the launch of 4G is expected to drive mobile health (mHealth) adoption. Currently, there are over 20 mhealth initiatives for spreading awareness of family planning and other ailments â&#x20AC;&#x201C; the industry is expected to reach US$ 0.6 billion by 2017. According to a report by PwC for the GSMA, mobile technology will play a significant role in the provision of healthcare services globally. It also predicts that the growth of the mHealth market will lead to a revenue opportunity worth US$ 0.6 billion for India and US$23 billion for the world by 2017. While the opportunity for mHealth services in India as well as globally is huge, for it to fall into place and become an effective tool of social inclusion, the government and the entire healthcare ecosystem will have to work together even as they compete on other fronts, so that the benefits percolate to the segment which most requires it. Favourable government policies and regulatory regimes will be crucial for scaling up mobile health.

Clouding IoT, Big Data Cloud computing has emerged as a silver-lining model for the healthcare IT industry. It enables the management and migration of huge amount of data, saves costs, offers anytime access from multiple mobile devices, provides high availability for large backup data storage, and

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Healthcare IT

is easy to use. Cloud computing is offered as a private, public, and hybrid cloud. Each model has its own advantages and disadvantages. However, in terms of security, public cloud computing services are preferred by the healthcare industry in order to be Health Insurance Portability and Accountability Act (HIPAA) compliant.

The Internet of Things (IoT) in healthcare encompasses heterogeneous computing and wireless communication systems, apps and devices that help patients and providers alike to monitor, track and store patientsâ&#x20AC;&#x2122; vital statistics or medical information. Examples of such systems are smart meters, RFID, wearable health monitoring sensors, and smart video cameras. Also, smart phones, intelligent vehicles, and robotics are considered to be the part of IoT. The global healthcare Internet of Things (IoT) market segment is poised to hit US$117 billion by 2020. The IoT enables health organisations to achieve superior technology interoperability, lift critical data from multiple sources in real-time, and a better decision-making capability. This trend is transforming healthcare sector, increasing its efficiency, lowering costs and providing avenues for better patient care. The IoT has already brought in

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significant changes in many areas of healthcare. It is rapidly changing the healthcare scenario by focusing on the way people, devices and apps are connected and interact with each other. IoT is coming out as the most promising information communications technology (ICT) solution which enables providers to improve healthcare outcomes and reduce healthcare costs by collecting, recording, analysing and sharing myriads of new data streams in real time and flawlessly. Moreover, as the widespread adoption of IoT grows, many of the inefficiencies in healthcare will be reduced. For example, sensors embedded in medical devices such as diagnostic equipment, drug dispensing systems, surgical robots, implantable devices, personal health and fitness sensors, etc., will perform data collections, measurements, and conduct tests digitally in no time which are currently administered and recorded manually. According to market researchers like Gartner and McKinsey, IoT will add US$1.9 trillion to the global economy by 2020, or it will have a potential impact of US$ 2.7 to US$ 6.2 trillion by 2025. The IoT revolution which has arrived in healthcare and medicine is making a strong impact on healthcare systems worldwide. New types of sensor technology, rapidly growing data analytics, and the new healthcare structures are formed due to the growing importance of IoT. The health IoT has a tremendous potential to create a more revolutionary archetype for healthcare industry if developed on a privacy and security model. In addition, it will have a major impact on health economy in the near future. According to ABI Research, by 2016, the sale of wearable wireless medical device will bloom and reach more than 100 million devices annually. Another report by IMS

Research, the research partner of Wearable Technologies, states that the devices which are wearable or are close to the body produce more realistic results. The market for wearable technologies in healthcare is expected to exceed by US$ 2.9 billion in 2016. There has been clinical evidence that the physiological data received from wireless devices has been a valuable contributor for managing or preventing chronic diseases and monitoring patients post hospitalisation. As a result, a growing number of medical devices are becoming wearable nowadays, including glucose monitors, ECG monitors, pulse oximeters, and blood pressure monitors and so on.

The Road Ahead The healthcare industry is laggard in comparison with other industries in implementing IT solutions. The industry is fragmented and this creates a barrier in the flow of information across each stage of the value chain, from the supplier to the end-users. Apart from this, the other challenges faced by healthcare providers and payers while implementing HCIT solutions are high cost of IT solutions, high maintenance and service expenses, growing concern over security, and shortage of healthcare IT professionals. To improve care, companies should leverage information technology (IT) to create patientcentric healthcare systems that can improve response times, reduce human error, save costs, and impact the quality of life. At the same time, the government should focus on establishing more medical colleges and training institutes to provide the requisite doctors, dentists, nurses and paramedics. The government also should invest in preventive and social medicine by promoting health education and preventive healthcare concepts.

Industry Speak

Inching towards Digital Hospitals Healthcare IT is playing a very important role in healthcare industry from the point, patient enters and till he leaves the hospital and even to extends to their referring physician for consultation, says Vivek Saxena, National Manager â&#x20AC;&#x201C; PACS, Fujifilm India Private Limited How do you perceive the Indian Health IT market?

What are the functional areas where Health IT can make a difference?

Indian healthcare is having a robust domestic demand and focussed approach on medical tourism along with government dedication to provide healthcare deliveries for better patient treatment and care, Indian Healthcare IT sector is booming in a big way.

What are your current operations in India and your expansion plans? FujiFilm India Medical has a strong presence in healthcare market. Our medical offering includes X-ray Films, CR, DR, Digital Mammography and Synapse. Synapse is our medical informatics product portfolio and our offering includes Synapse PACS, Synapse Clinical Workflow Manager (CWM) RIS, Synapse 3D, Synapse Mobility, Synapse VNA. Synapse product range have very unique feature, which enables multi-site hospitals and diagnostic centres to use the interconnected workflows and imaging needs. Teleradiology comes as a default component in our Synapse PACS and Synapse CWM RIS offering. I can very proudly share that our Synapse PACS rated 7th worldwide in KLAS 2013 ratings. We have 37 sites in India and growing like Sathy Sai Hospital, Bangalore (3 hospital connected), Sir Gangaram Hospital, New Delhi, Medall Healthcare, Chennai (30 centres across southern India with data centre) etc. Another feather to our offering under value PACS category is

iWeb Lite 3.0 Value PACS for those customers who want to go digital initially with minimal investment. It provides the flexibility to customer for storing the images locally, access images on site and remotely and do reporting on mobile devices and personal computers.

Is healthcare IT going to be a game changer in Indian healthcare industry? Information technology is always be the game changer in the all the leading Industries. Everyone understands the importance of IT solution and their benefits. Specifically if I talked about Indian healthcare industry, increasing number of patients, new diseases added every year, growing patient expectation on services, remote diagnosis and reporting trends, telemedicine and lot of other factors also are the some few drivers of the Health IT solution.

From small hospital to large chain of hospital, healthcare providers are looking forward to have a Health IT solution specially HIS, RIS and PACS. HIS is to manage the patient related workflows like registration, scheduling, billing etc. in the entire hospital. RIS manages the department workflow and PACS manages these thousands of patient images and distribute the images for diagnosis and reporting. Going digital is going to provide intangible benefits like workflow improvements, which in turn improve the overall efficiency of the system and more efficiency increases revenue. Tangible benefits are savings on direct cost like patient X-ray films, in spite giving paper image print outs or CD/ DVD to patients.

How do you see the Health IT evolving in the coming years? Vendor neutral archive is the next way forward where all the patientsâ&#x20AC;&#x2122; records DICOM images, Non DICOM images and other patient related documents are going to archive in the same solution. It is going to be vendor independent solution. Mobility solution and Cloud computing is also coming in a big way for different healthcare information system will be on the cloud to have a rule based access to doctors, physicians , referring physicians and even to patients also, hence providing ease and all information to patient on his fingertips.

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Industry Speak

Connected Healthcare through Smart Medical Devices Welcome to the World of Connected Healthcare! Revolutionise the way you treat patients through the advanced remote monitoring products, says Dr Karthik Anantharaman, Chief Marketing Officer, BPL Medical Technologies Pvt Ltd

n the current era of Internet of Things (IoT), the smart IoT technologies and products are available at each and every customer touch points in their daily life. BPL Medical Technologies has taken significant steps towards creating technologies that bridge the gap between the doctors and patients and elevate the quality of healthcare delivered to patients. For example, routine monitoring of health is a must for cardio-diabetic patients, but the effort it takes to seek appointments and travel to see the doctor for routine health monitoring is a deterrent. This is the primary cause because of which a significant percentage of patients with chronic disorders like cardio-diabetic conditions are lost to follow up. BPL LifePhone Plus BG, a homecare smart ECG solution with inbuilt glucometer, helps such cardiodiabetic patients that need monitoring to take 12 lead ECG and blood glucose measurements from the comfort of home or office and instantly share it with their doctor using a mobile phone app and seek consultation. The doctor can easily look at the ECG on his/her phone or computer and send back an instant consultation to the patient. The consultation fee for each consultation is collected through a payment gateway built into the app and credited to the account of

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the doctor/hospital. Doctors can also help walk-in patients use it/prescribe it for home-care thus making it easier to monitor the patient remotely. The technology also provides an option of having a backup doctor in case the primary doctor is not available. This novel hand held device can be used with an android smartphone and weighs only 70 grams. No gels and external electrodes would be required for measurement and hence zero running cost or maintenance cost for the doctor/hospital. A secure cloud-based

medical record storage system enables 24/7 access to medical records to both patients and doctors alike. BPL LifePhone Plus has been clinically validated at leading medical institutions such as Kasturba Medical College, Manipal and Narayana Health City, Bangalore. This technology will serve as a proven way to improve cardio-diabetic wellness at reduced cost through self-management and will facilitate hands-on prevention among hospitals, physicians, caregivers and patients. In ultrasound imaging, BPL- Alpinionâ&#x20AC;&#x2122;s E-CUBE range of Color Doppler systems provide a unique real-time ultrasound image sharing solution called CUBE View, which will elevate the quality of service that the doctors provide. CUBE View is worldâ&#x20AC;&#x2122;s first real-time ultrasound image sharing solution. Through wireless connection and CUBE View app, doctors can access live ultrasound images from their iPhone or iPad anywhere, anytime. This is a very useful solution that will make the doctors life easy and help them to provide better service to their patients.

Medical

www.bplmedicaltechnologies.com

Technologies

Increased Clinical Confidence, Excellent Workflow BPL Medical Technologies is committed to meet all your clinical needs with its E-Flo series anaesthesia workstation that offers best-in-class performance and the BPL ALPINION E-CUBE series color Doppler systems, which ensures confident and conclusive diagnosis

Woman & Child Care

Cardiology

Critical Care & Surgery

ECG

Patient Monitor

Foetal Doppler

Defibrillator

Syringe & Volumetric Pump

Foetal & Maternal

Anaesthesia

Colposcope

STS ECG Holter

Workstation

Monitor

Home Care

Imaging

Consumables & Accessories

Oxygen Concentrator

Color Doppler

Recording Papers

B/W Ultrasound

Gel & Disposable Electrodes

Mobile Healthcare

X-Ray

Solution

NiBP Cuffs

BP Monitor

Electrodes & Rubber Bulbs

Nebulizer

Probes & Extension Cables Patient Cables Respiratory Accessories

BMTPL:AIMS:CD/AW:07:15

BPL Medical Technologies Private Limited 11th KM, Bannerghatta Road, Arakere, Bengaluru â&#x20AC;&#x201C; 560 076. India Phone : (080) 2648 4350, 2648 4388, e-mail : sales.medical@bpl.in

Industry Speak

Promoting Wellness Care Our healthcare solutions put control of individual’s health with them, says Sridharan Mani, Director and CEO, American Megatrends India Pvt Ltd How do you perceive Indian health IT market? Indian health IT market is more focused on patient security, compliance and regulations. In fact more importance is given to documentation and patient safety and very much needed in sick care. The latest generation medical equipment with sophisticated system has supported physicians to diagnose and cure patients from critical and life threatening diseases. Technological advancements in video/ audio conferencing, picture archiving and communication systems (PACS) and healthcare information systems (HIS) have made significant inroads in providing better system for patient care. All the notable advancements made in IT are oriented towards sick care. We do believe that IT could play a much bigger role than this. IT should promote “Wellness” care. IT can make the shift from “sickness to wellness”. IT could help improve health and quality of life by providing real-time information of health status to the individuals. Advancements in IT should help individuals to lead a better and healthy lifestyle without any compromises made. It is just not important h o w long an

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individual lives but how healthy the individual lives and IT could play a significant role in it.

How can mobile health transform healthcare industry? Think of a minute, if your mobile can diagnose your health and advise you on what is going wrong and help you with the right guidance to take care of your health and avoid you from getting into a chronic condition or long term sickness. Think of a minute, if your mobile could scan the food and water and let you know whether it is good to consume or not. Think of a minute, if your mobile could let you know on lifestyle (diet and exercise) changes you need to make to live a life without comprise. What is said above is all happening with smart sensors being connected to mobile. Mobile health is transforming healthcare by help individuals to take control of their health. Mobile health is playing a major role in promoting “Wellness care”.

What is your take about mobility solutions in healthcare and how do you perceive its future especially in India? Mobile penetration in India is very high and it is across the country. Slowly smartphone penetration is also increasing. With government initiatives of fibre-connectivity across villages is going to help India digitally connected and aid digital revolution. Hence, connectivity and reach would become a mute issue. However, the last mile of collecting the right data and sharing with the quality care providers would become the need of the day. Definitely, mobility is the way to go and it is the inexpensive

way to provide quality healthcare. Today, a mobile comes with all the elements required for audio/visual communication and transmission. Companion portable devices like AMI B.O.L.T and AMI VitalsFit extends the value of the smartphone by taking the quality healthcare to doorsteps of the individuals. The health parameters are not only accurately collected but it is instantaneously transmitted to the caregiver for quality care.

What are your present operations in India and expansion plans? American Megatrends India (AMI) is one of the leaders in hightech engineering and computing innovations worldwide since 25+ years. AMI as a global organisation has more than 200 patents awarded on innovative engineering solutions and AMI products are shipping in more than 1/2 a billion of computers in the world today. AMI are specialty leaders in embedded services, BIOS customisation and porting, mobility solutions, IP SAN/NAS data storage solutions, infrastructure asset management, telematics solutions, knowledge management system, healthcare IT solutions, platform validation services and Android services. The estimated medical devices market in India is around US$ 3 billion and is growing at rate of 15 per cent annually. We are expecting a decent share of the market over the years. We are also partnering with key healthcare providers and many of our products would be integrated with their services and to be made available in the market.

Health Education

Effective Trainings, Better Healthcare Services State Institute of Health and Family Welfare (SIHFW) endeavours to yield optimum output with respect to state’s objective for providing quality healthcare services by effective training for better services. Elets News Network (ENN) finds out how they work in enhancing the services of healthcare domain. Please share a brief background about State Institute of Health and Family Welfare (SIHFW) at Jaipur. State Institute of Health and Family Welfare (SIHFW) was established in 1995 at Jaipur as an apex level autonomous institution under the aegis of health Department, Government of Rajasthan, with the aim of attainment of better quality of life of people through better healthcare delivery system supported by the Human Resource Development, research, consultancy and organisational development. The major clientele of SIHFW includes NHM, WHO, World Bank, UNICEF, UNFPA, NIPI, Save and children and many more department of the government.

What all training does SIHFW provide for improving healthcare services? Managerial Trainings- Foundation training for news recruited and professional development course for senior medical offers and training of SPMU and BPMU Staff Clinical Trainings- These trainings include Maternal Health training, child health and family planning. Community Process which includes ASHA induction and module 5, Asha module 6 & 7 (R1 and R2)

Please tell us about some recent studies made by SIHFW 1. Gap Analysis of ‘Mukhyamantri Shubhlaxmi Yojna’ in claim of second instalment 2. Independent monitoring Deworming activities for Rajashthan School and Anganwadi 3. District Eye Healthcare Facility Survey-District Banwara 4. Facility Assessment of PHCs and sub centres of 12 identified districts of Rajasthan 5. Community Assessment of Exercise for the RMNCH+A activities in 10 high priority districts of Rajasthan (ongoing) 6. Mapping on Ultrasound clinic and Assessment of Implementation of PCPNDT Act in Rajasthan(ongoing)

7. Compliance Assessment Survey Under COTPA 2003 in Kota Rajasthan (ongoing)

Which partnerships have been done by SIHFW UNICEF PartnershipThis includes strengthening of SNCU Data management in Rajasthan, improving maternal, newborn and child survival in the state though mentoring in 4 high priority districts and Social and Behaviour Change communication (SBCC) Strengthening. UNFPA Partnership- It includes partnership for strengthening RMNCH+A initiatives in 10 HPDs Save the Children Partnership NIPI Partnership

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Industry Speak

Hospital Information System -

Latest Emerging Solutions The market will evolve tremendously in upcoming years as healthcare providers are increasingly adopting corporate culture, which is fuelling demand for IT solutions in the healthcare industry, says Sanjay Kumar Jain, Director, Akhil Systems What is your view on Healthcare IT market in India vis-Ă -vis the global market? And how do you see the market evolving in next five years? Indian healthcare IT market is evolving at a very fast pace compared to global market. Using an integrated, holistic approach, which allows the healthcare organisations to remain flexible to the compliance and developments, has necessitated the requirement of information systems in healthcare sectors over the years. With more number of organisations moving towards better equipped healthcare institutes, technological advancements become an imperative need for such healthcare organisations in order to meet the increasing demand of the population. Our Miracle His provides an integrated solution with flexibility as per demand of the healthcare IT market worldwide. In next five years we can foresee the new technological advancement including mobile applications, electronic medical record (EMR), telemedicine, Cloud based systems etc. will become more in demands. The demand for advanced analytics tools will also be one of the key trends in the market. We expect the market will evolve tremendously in upcoming years as healthcare providers and institutions are increasingly adopting corporate culture, which is

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fuelling demand for IT solutions in the healthcare industry.

What according to you are the emerging trends in this particular sector and how do you see the Indian healthcare marketâ&#x20AC;&#x2122;s indulgence in adopting IT in healthcare? Web based Hospital Information System (HIS) is of the latest emerging solutions to manage hospital operations. It can be hosted on cloud. The benefit of web based HIS is that it allows the application to run on multiple servers and at various locations suitable for chains of hospitals, clinics, diagnostic centres and pharmacy chains. Currently in India the main focus of hospitals shifted to the web based solutions as it provides ease of a c c e s s and other technical advantages as well.

Electronic medical record has received more attention than any other over the past several years. Nowadays in India demand of EMR is increasing rapidly. Various renowned hospitals like Aster Medcity (Cochin), Shanti hospital (Bangalore), BLK Hospital (Delhi), etc. are using EHR developed by Akhil Systems and we handle enquires almost every day. Over the past several years, the omnipresence of smartphones, t a b l e t s and their applicati ons has been one of the biggest cultural shifts in the

Industry Speak

hospital setting, as well as society at large. Doctors nowadays preferring tablets for maintaining their patient records, it’s also being used for surgeries. Akhil Systems developed Miracle EMR mobile application recently for doctor’s use. Patient Portals is an online tool for patients is also one of the latest technologies now available in market. Through this patient can get online test results, access their

to the competition • Healthcare insurance market in India is growing like never before. As insurance penetrates the marketplace, there will be a financial motivation to collect all the data and mine it to create practice guidelines and achieve excellence • Corporatisation of hospitals is also a driving factor to adapt healthcare IT solutions • As India is one of the top medical

Through ‘Make in India’ initiative we can look forward for making quality and robust solution with cost effectiveness, which is a major concern. Also, especially through ‘Digital India’ initiative we can penetrate to tier II and tier III cities and rural areas as well with our web based/ cloud solutions clinical records, send appointment request etc. Akhil Systems is also providing Miracle patient portal.

What is driving the Indian healthcare IT market? There are several factors driving the Indian healthcare IT market: • Lowest market penetration in tier II and tier III cities, which covers a huge market in India. These markets are untapped due to low spending in IT infrastructure. But, now they are getting aware of the use and importance of IT, which is going to be a driving factor • Awareness of standardisation is also driving the market as hospitals are going for standard accreditations like NABH, NABL, JCI etc. The IT solutions make this task easy and accurate • Overall Indian healthcare industry is growing at fast pace and various new hospitals and healthcare institutes coming up in a big way. This increases the demand as most of the new hospitals go for the IT solutions to provide better care and stand up

tourism destination, hospitals looking for quality healthcare and robust IT solutions to provide best care to foreign patients

How do you see the ‘Make in India’ and ‘Digital India’ contributing to the growth of Healthcare IT industry? These initiatives are going to have huge impact on healthcare IT industry. There are numerous opportunities, in which foreign investor can invest. Through ‘Make in India’ initiative we can look forward for making quality and robust solution with cost effectiveness, which is a major concern. Also, especially through ‘Digital India’ initiative we can penetrate to tier II and tier III cities and rural areas as well with our web based/ cloud solutions.

What are the challenges presently faced by the Healthcare IT industry? The healthcare industry in India has various challenges due to inadequate infrastructure and a constrained healthcare delivery work process,

which intensify the complexity. Some of the key challenges in integrating IT into the Indian healthcare system include: • Lack of standards in healthcare IT due to varied functionality requirements in hospital to hospital • Lack of in-house IT domain knowledge • Integration and cost effectiveness • Reluctance of medical, nursing and other staff to adjust to change paper • More reliability on based systems • Lack of proper vendor support We have faced almost all of the above challenges in past two decades and we have tackled these challenges in very effective manner. For example we know there is lack of standardisation in healthcare IT but through our 20 years of experience we have almost included all the technical and functional requirements learning from the hospitals (especially in India) itself and above all our solution is so flexible that we can provide customisation as much as possible as per hospital requirement.

What are your present operations in India and expansion plans? For the past two decades we are working on single domain of healthcare only. Our headquarter is in New Delhi and we have presence of our HIS in18 states, 38 cities and covered almost all major metropolitan cities. We are planning to open offices in Mumbai, Kolkata and Bangalore soon. We have recently launched Akhil Health World a health portal for all which is our first business to consumer project. Apart from that we have presence in six countries including US, Dubai, Saudi Arabia, Nigeria, Bangladesh and Bahrain. We are also planning for expansion in international market as well.

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Industry Speak

Moving towards Transformation Ranging from devices to processes, healthcare modernisation will bring about a change in the way healthcare is practiced and delivered in the country, says Lux Rao, Country Leader - HP Future Cities and CTO - Technology Services, HP India Sales Indian market is experiencing great traction and is poised for transformation. Healthcare modernisation is beginning to happen in small pockets across the country and will gain momentum leading to significant transformation over the next 3-5 years. Ranging from devices to processes, healthcare modernisation will bring about a change in the way healthcare is practiced and delivered in the country.

What are your views on Healthcare IT market in India vis-à-vis the global market? And how do you see the market evolving in next five years? Roughly 75 per cent of India’s healthcare infrastructure— hospitals, clinics, medical personnel, and other healthcare resources—is concentrated in urban areas, putting it out of easy reach for all but 27 per cent of the population. Medicine and ICT are on a convergent path and we will soon see the benefits by way of quality, affordable healthcare services to more people living in the country’s resource-deprived locations. Access to affordable and quality healthcare is a fundamental requirement of every citizen and technology is sweeping the medicine world globally but will have a profound impact in India due to the inherent challenges of our legacy healthcare systems.

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What according to you are the emerging trends in this particular sector and how do you see the Indian healthcare market’s indulgence in adopting IT in Healthcare? India is fast emerging as a destination of repute for medical tourism. While much is said about the prowess of our medical community, the flip side is that the skill and talent is not ably supported by technology. Technology is the magic wand that will enable ubiquity and access to affordable healthcare to a billion Indians. We see the proliferation of M2M (mobile to mobile), IoT (Internetof-Thing) and wearable technology ably supporting the healthcare modernisation initiatives. Core medical technology is also going through a metamorphosis and will be well served by new technology such as M2M and IoT.

What is driving the Indian healthcare IT market? Healthcare modernisation initiatives

in government and private sector, rising awareness amongst rural populace about healthcare leading to Cloud (eHealth) and Mobility (mHealth) base initiatives, and increasing role of ICT in mainstream healthcare are some of the factors driving Indian healthcare IT market.

How do you see the ‘Make in India’ and ‘Digital India’ contributing to the growth of Healthcare IT industry? There is great potential for organisations to have point products and solutions that are designed for the Indian market. Last mile connectivity and robust Internet will ensure success of initiatives around telemedicine and remote diagnosis as also unifying patient databases for ubiquitous access. This is a great opportunity for Indian organisations to build products and solutions that can find markets outside India as well. HP eHC solution was completely designed bearing in mind Indian ethos and has spawned off a series of innovations around ICT enabled healthcare.

What are the challenges presently faced by the Healthcare IT industry? Legacy systems, closed / proprietary technologies, systems that are unable to scale due to archaic technologies, inter-operability and sluggish pace of adoption of pervasive technologies such as Cloud, mobility, and analytics are hampering patient experience and growth.

Industry Speak

Ensuring Inclusivity and Access We are excited to partner with the government for the progress of the country and improve the lives of millions of Indians, says Shekhar Agrawal, Senior Vice President, Vodafone India Limited

state government made providing better healthcare a key agenda and wanted to curb child and maternal mortality rates. The Health Department needed a strong telecom partner with assured connectivity for the execution of this plan; Vodafone was the preferred choice.

The Need The primary asks were monitoring the health requirements of women and children, connecting them to the Accredited Social Health Activist (ASHA), and delivering timely updates about health schedules and plans to all who needed it.

Vodafone’s Unique Proposition Vodafone helped the government gather verified data that gave a complete picture about individuals’ health, nutrition and education status. The project covered all to-be mothers and children of up to six years of age. Vodafone’s web-based application connected 80 per cent of the population to the Health Department and the ASHAs. To prevent being left out of the healthcare delivery system, irrespective of their location, pregnant women and children were given unique Health IDs. A customised SMS platform, with USSD features, improved communication between various departments responsible for healthcare delivery. ASHAs received automated messages with updates about individuals mapped to them, and were trained to communicate effectively using mobile phones.

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The Strategic Significance Vodafone, a leading enterprise and a key mobility player in India, helped the state move from numberbased reporting to individual reports. Pregnant women and children were provided appropriate healthcare support. As a result, the health of expectant mothers and new-borns improved. Today, four more children in every 1000 births survive to celebrate their first birthday. Vodafone is equipped to mobilise G2G and G2C initiatives to provide benefits and deliver outcomes for citizens, governments

We can help the government leverage mobile technology and be accessible to the citizens for health, education, employment, public safety, transportation, and financial and legal services and businesses. We can help the government leverage mobile technology and be accessible to the citizens for health, education, employment, public safety, transportation, and financial and legal services. Vodafone’s robust, cost-

effective, intelligent, round-theclock services meet the core agenda of mGovernance. We are excited to partner with the government for the progress of the country and improve the lives of millions of Indians.

Health Services

Soni Manipal Hospital, Jaipur

oni Manipal Hospital part of Indiaâ&#x20AC;&#x2122;s 3rd largest healthcare chainManipal Health Enterprises is one of the finest and largest hospital in Jaipur, Rajasthan. With a wide spectrum of healthcare delivery this hospital is the largest NABH & NABL accredited hospital in Rajasthan. The 280 bed Soni Manipal Hospital is at the helm of leading technological advancements in the medical sphere along with state-ofthe-art infrastructure and facilities intermixed perfectly with the finest medical minds in Rajasthan. This combination positions Soni Manipal as one of the premium healthcare delivery units in the entire state of Rajasthan. The hospital is equipped with the best in technology including 64 Slice CT, 1.5 T MRI and LINAC. With the largest number of ICU beds among all the public & private hospitals in the state, Soni Manipal Hospital is

the most preferred destination for all kinds of emergency treatments. The hospital is specialised in handling complicated cases which require multi-specialty and advanced critical care management. The complete 24 Hour support from NICU and intensive care facilities, blood bank and operation theatre, anesthesia and laboratory services along with world class maternity facilities makes the hospital one of the most preferred destinations in the region. From unique medical accomplishments like successfully completing a knee replacement surgery on a 100 year old patient breaking the previous record of 98 years to having the Best Pediatric Hemato-Oncology Department in Rajasthan it has churned medical milestones that have made it a very important medical destination in Rajasthan. The recent feather in the cap

happens to be the best paediatric and bone marrow transplant unit in the country. This new addition offers a world class infrastructure on the aforesaid department which was needed in the medical space of the country. This new initiative is poised to benefit lot of patients from the Uttar Pradesh, Madhya Pradesh, Bihar and Haryana. Soni Manipal Hospital is a part of Manipal Health Enterprises (MHE) which is among the largest hospital network in India serving over 2 million patients annually. MHE manages an aggregate of 5,200+ beds among 16 hospitals, over 13 locations across six states in India and one hospital in Klang, Malaysia. The network of hospitals covers all levels of delivery from primary to quaternary care. It has built a significant, committed clinical and healthcare skill pool of 2,000+ doctors and 6,000 nurses, paramedics and support staff. Its focus is to develop an affordable tertiary care multispecialty healthcare framework through its entire multispecialty delivery spectrum and further extend it to homecare. With its flagship quaternary care facility located in Bangalore, India, eight tertiary care, seven secondary care and two primary care clinics spread across India and abroad. Dedicated to its core values of â&#x20AC;&#x153;Clinical Excellence, Patient Centricity and Ethical Practicesâ&#x20AC;?, MHE delivers the highest standards of healthcare to its patients to around two million patients annually. Manipal Hospitals also happens to be the most respected and the most patient recommended hospital in India by consumer survey.

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Nutrition

Food Fortification In Rajasthan: Enriching Lives Improving nutrition through partnerships and innovations

ajasthan, one of Indian States, has a very high burden of micronutrient deficiency diseases such as anaemia, vitamin A deficiency, iodine deficiency disorders etc. These micronutrient deficiencies are prevalent across all socio-economic groups and affecting all age groups with high prevalence: 79.1 percent among children 6-35 months, 53.8 percent among ever-married women, and 61.7 percent among pregnant women. In addition, the occurrence of Neural Tube Defects due to folic acid deficiency is also very high (18per 1000 live births). Furthermore, Rajasthan also has a low coverage of vitamin A supplementation and poor compliance of iron folic acid (IFA) tablets amongst pregnant women.

Why Nutritional Deficiencies are Rampant Typical Indian diet has more cereals (providing energy) and very little pulses/legumes (promoting growth) and vegetables/fruits (preventing diseases). Common micronutrients deficient in our diets are Iron, Iodine, Folic Acid, and Vitamin A, B12, D. Absence of vitamins and minerals has serious consequences. Anaemia and Vitamin A deficiency are considered public health problems and Vitamin D deficiency is emerging as a big problem among all segments. Low reach of safe drinking water, poor sanitation and hygiene are also other factors that impact health and nutrition as these affect the nutrient absorption, lower the immunity, and

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thus add to the disease burden and high levels of malnutrition.

Why Fortify Staple Foods Food fortification is the process of adding micronutrients to food items offering an opportunity toward improving the micronutrient status of population. Fortification, especially of staples like wheat flour, oil, milk etc., is considered to be a good strategy to reduce dietary deficiencies. In Rajasthan, per capita consumption of wheat, milk and oil is higher than the average consumption in India hence these are good vehicles for fortification.

Advantages of Food Fortification Staple food fortification has several advantages:  It is a proven simple technology  It has a positive impact on health status  It is inexpensive as costs about 2 10 paisa per kg of food item  It improves national economic performance by improving the health status of people and hence their working capacity

GAIN Partnerships Supporting Large-scale Food Fortification GAIN considers food fortification as an appropriate medium-to-long term strategy to reduce the high burden of micronutrient malnutrition. Hence, GAIN in Rajasthan signed a Grant Agreement with Institute of Health Management Research (IIHMR), in 2011, for providing support to build the capacity of food processing industries like roller flour mills oil refineries, milk dairies and centralized kitchens cooking Mid-day Meals, facilitate quality assurance and control and support social marketing and communication and policy advocacy for scaling up food fortification. With all the efforts and advocacy, the GAIN-supported food fortification project in Rajasthan is progressing well. IIHMR University and GAIN have been actively engaging with Government, Food Industries, UN agencies, Civil Society Organizations and media for policy advocacy and positioning Food Fortification as a complementary strategy to reduce micronutrient malnutrition in the State.

A Partnership initiative of IIHMR University with support from GAIN – Global Alliance for Improved Nutrition

Nutrition

Staple Foods Fortified and Persons Reached in Rajasthan and Madhya Pradesh with Direct GAIN Support and Leveraged through Policy Advocacy Food vehicle Tonnage fortified Persons reached per annum (approx.) Wheat flour (with direct Project support) 360,000 5,000,000 Wheat flour (Provided / supported by the 1,560,000 21,500,000 State Govt.) Voluntary wheat flour by individual millers 300,000 4,150,000 Milk* (with direct Project support) 564,000 7,421,000 Oil (with direct Project support) 600,000 83,000,000 MDM and ICDS children reached through 1,100,000 the centralized kitchens (with direct Project support)* * In Rajasthan only

Specifically, IIHMR University, under the GAIN supported Project has actively engaged with the:  Food processing industries for their capacity building on Fortification.  Department of Food and Civil Supplies for mainstreaming fortified wheat flour in the Public Distribution System. Iron-spot testing kits were especially developed and provided to the Rajasthan State Food and Civil Supplies Corporation to undertake “Qualitative assessment of flour fortification” at the production level and also at the point of sale, i.e. Fair Price Shops.  Regulatory bodies at the State and National level to get the standards of fortified foods notified/minuted.  Commissioner, Food Safety, Rajasthan, to appraise the 7 State Food Laboratories and identify the “gaps” that need to be strengthened for accreditation by NABL. All Food Safety Officers and the Chief Medical Officers in the State were trained on significance of Food Fortification and undertaking regulatory monitoring.  Department dealing with MDM and trained all the Mastertrainers of Cooks-cum-helpers on good nutrition and safe cooking practices. Government of Rajasthan (GoR) is highly committed to improve nutritional status of the people. It is reflected in the pronouncements

of Hon’ble Chief Minister in budget speech 2015-16, as below:  Fortified wheat flour, fortified edible oil and Double Fortified Salt would be provided to all the persons covered under the National Food Security Act, through the Public Distribution System  Strengthening of the Food Safety laboratories in the State MDM Directorate also issued a guideline in September 2013 to all the schools to use fortified soyadal analogue and fortified oil for cooking the mid-day meals. In addition, GAIN is actively engaged with UNICEF and the GoR to:  Prepare the State’s strategy document: Rajasthan Nutrition Mission, wherein GAIN specifically contributed the strategy chapter on ‘Food Fortification as a Complementary Strategy to Reduce Micronutrient Malnutrition’  Develop a partnership proposal for “Community-based Management of Acute Malnutrition” (CMAM)  “Hon’ble Chief Minister has announced that the Government of Rajasthan will undertake rehabilitation of children suffering from Severe Acute Malnutrition (SAM) through the Communitybased programme entitled: Community-based Management of Acute Malnutrition (CMAM) in 10 high priority districts (HPD) and 3 Tribal districts, in a phased manner”

About Gain: Global Alliance For Improved Nutrition The Global Alliance for Improved Nutrition (GAIN) is a Swiss foundation headquartered in Geneva with a special international status granted by the Swiss government. GAIN was created in 2002 at a Special Session of the UN General Assembly on Children. It is an alliance driven by the vision of a world without malnutrition. GAIN’s approach is improving nutrition by building partnerships that enable innovations. It supports public-private partnerships to increase access to the missing nutrients in diets necessary for people, communities and economies to be stronger and healthier. It has a team of professionals located worldwide, which represents diverse sectors and backgrounds. In less than a decade, GAIN has been able to scale its operations by working in partnership with governments and international agencies, and through projects involving more national partners and civil society organizations in more than 40 countries, reaching an estimated 811 million people with nutritionally enhanced food products. About half of the beneficiaries are women and children. GAIN’s goal is to reach 1 billion people by 2015 with nutritious foods that have sustainable nutritional impact. GAIN has a Liaison Office in India since 2007. GAIN has supported projects on Staple Food Fortification, Mothers, Infant and Young Child Nutrition in Rajasthan, Madhya Pradesh, erstwhile Andhra Pradesh, Uttar Pradesh and Bihar. Besides this, GAIN is working at a National Level on the Salt Iodisation. GAIN adopts a multi-stakeholder approach to its work and its partners include National and State Government Ministries and Departments; BiLateral and Multi-Lateral Agencies, National and International NGOs/ Foundations working in India.

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Second Opinion

Technologies will Improve Accessibility The convergence of healthcare with upcoming technologies will play a major role in improving accessibility, says Atul Umak, Assistant General Manager â&#x20AC;&#x201C;IT, Dr. L H Hiranandani Hospital, Mumbai How do you perceive the Indian Health IT market? Healthcare Information Technology market in India is expected to reach 3-4 times from present market scenario in next 2-3 years mainly due to fast adoption of technology by stakeholders. Healthcare IT is a core component to achieve successful transformative shifts in healthcare. Growth in data, digitization trends in health information and electronic medical records, improvements in collaborative data exchange, workflows and mobility, and need for better financial management are the drivers, which are influencing the segment. Another driver for healthcare IT sector will cloud computing. Costeffective cloud-based solutions are expected to drive increased adoption of HMIS and EMRs. The various benefits can be derived like easy accessibility irrespective of geographical location, fast response in times of emergencies and patient convenience.

What are your current operations in India and your expansion plans? Currently, we are operating from Mumbai and coming up with 200 bed facility in Thane.

What are the emerging trends and new technologies? Technology will be a game changer in healthcare services in India. The private sector will be the major

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driving force behind technology adoption in the Indian healthcare segment. IT solutions will become an integral part of process management, patient care and the management information system (MIS) in hospitals for optimising costs and effectively manage operations. The convergence of healthcare with upcoming technologies such as cloud computing and wireless technologies will play a major role in improving accessibility. In coming years, there will be deployment of tools such as telemedicine, teleradiology, hospital information systems (HIS), hospital management information systems (HMIS), online or electronic medical records (EMR), mHelath products. To drive improved efficiencies, more hospitals are likely to seek automation for their workforce management, administration, finance, billing, patient records and pharmacies. Along with the growing popularity of digitisation in hospitals, market penetration of picture archiving and communication systems (PACS) is likely to increase further in the coming years.

What are the challenges and opportunities? There are some challenges like adoption of EMR/EMR, increased data demands, and data security. Adaption of EMR/HER is necessary for healthcare service provider to maintain patientâ&#x20AC;&#x2122;s health data for future use. This is challengeable as

most of EMR/HER systems are not so user friendly and not enough flexible to change to accommodate physician inputs. Another factor is availability of resources and training. Both clinicians and administrative managers needs data for making decisions and guide their planning. An enterprise data warehouse is a key to overcoming the current data challenges. Providers and payers will need to step up data security to avoid the type of Health Insurance Portability and Accountability Act (HIPAA) violations that can negatively impact an organisation. We have huge opportunities in the field of wearable tracking devices and patient-cantered Care. Wearable tracking devices to monitor physical activities, sleep patterns, calorie consumptions, and a whole lot more. This is an exciting new frontier with so much potential to improve patient care. Approach is to putting the patient at the centre of care. The goal is to improve patient satisfaction scores and engagement. But, this is new opportunity to look into ways to engage with patients outside of a traditional patient visit to hospital. For example, many providers havenâ&#x20AC;&#x2122;t yet tapped social media to build relationships with their patients. This will need to change, especially as patients begin to shop for healthcare by searching the Internet, looking for quality, facility, metrics and patient reviews, and comparing prices.

Exclusive Interview

Enhancing Healthcare Practices with PPP The Private-Public-Partnership (PPP) model in the healthcare industry will bridge the resource gap in infrastructure and bring in more innovation strategies in the healthcare industry, says Yogesh Joshi, Chief Operating Officer, Metro MAS Heart Care & Multispecialty Hospital, Jaipur in conversation with Romiya Das of Elets News Network (ENN) Tell us about the healthcare scenario and challenges in Rajasthan? The present scenario of the healthcare industry in Rajasthan is very exciting. Owing to the demand of specialised and quality healthcare facilities, the expansion of the healthcare sector in Rajasthan is happening at a rapid pace. This is a clear indication that the healthcare sector in Rajasthan is capable of providing economic growth and contributing in building the sector further. The growth can be gauged from the fact that people from neighbouring states are coming to Rajasthan for better and affordable treatment. With tourism already happening in Rajasthan, medical tourism is a way forward in the state. Backed with initiatives by government and private sectors, medical tourism has the potential to drive the healthcare industry. Apart from other issues, at present skill gap is the most challenging in Rajasthan.

What are the initiatives taken by Metro MAS in improving the delivery of healthcare services? We have got full time super specialist doctors and emergency department available round-the-clock to provide world class healthcare services. We provide free medical treatment to below poverty line (BPL) patients and medical treatment to government

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employee and pensioners at subsidised rate at par with the government rate.

Could you brief us about the PPP model taken up by your hospital? How successful are they? Do you think PPP is the right way forward? Metro MAS Hospital is the first of its kind PPP (Public-PrivatePartnership) hospital in joint sector with Government of Rajasthan on revenue sharing model. Metro group has invested to develop high quality infrastructure and modern equipment. Yes, PPP is the right way forward if the government and private sector working jointly, the mission related to â&#x20AC;&#x2DC;health to allâ&#x20AC;&#x2122; can be achieved.

What according to you are the measures needed by Private and Public sectors to improve healthcare in Rajasthan? The participation of private sector in healthcare infrastructure development is expected to bring innovation strategies, thereby quickly bridging the resource gap in infrastructure for healthcare. Apart from others, such as providing land at subsidised rate and building infrastructure, there are some areas where energies could be focused to extract workable solutions. Some measures include providing capital and operating expenses of the systems covered under the PPP

where possible, ensuring a noncompete policy within a predefined geographical limit, where the PPP facilities operate to guarantee growth and sustenance of the model. There has to be a single nodal point or office from the government end to address all issues faced by PPP project. There is an air of optimism surrounding PPPs in Rajasthan. Used judiciously and fitted to local circumstances, PPPs clearly have the potential to drastically change the healthcare landscape in Rajasthan. PPPs will survive only if the interests of all stakeholders are taken into account. The public sector has to lead by an example, and be willing to redefine itself and work with the private sector. The private sector too in turn be willing to work with the public sector to improve mutual cooperation and understanding.

Exclusive Interview

Ushering Life through Science Jon Mowles, Life Science Sector Specialist, UK Trade & Investment (UKTI) shares with Romiya Das of Elets News Network (ENN) the ICT components in the field of life sciences that drive the market What opportunities does United Kingdom offer to the Indian biotech, pharmaceuticals and life sciences companies? UK Trade & Investment (UKTI) has two parts to the investment side which helps the overseas companies to do business in the United Kingdom. And the other is the trade side which helps the UK organisations to internationalise. For any organisation, one of the primary things outside their own country is the market. In the life sciences sector, there is a huge market in the UK. In fact, of all prescriptions that are written in the UK, 50 per cent are generic drugs and half of them have Indian origin. Twenty five per cent of the drugs prescribed in the UK are having Indian origin, so UK is an extremely important market for Indian companies. There is also a great familiarity with the UK market for standard provisions. There is an ease of doing business here because the World Bank recognises the country as one of the top 10 countries in the world. Secondly there is a historical link between the UK and India. What also helps is that the UK corporation tax, at 20 per cent, is as low as any country in the G20. We now also have the patent cost, which implies that if you register a patent in the UK and when you have sales specifically related to that patent, the corporation tax is 10 per cent. Then there is the tax credit which includes

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that is an ongoing process as there is enormous amount of data and there are already millions of millions of records that are part of the CPRD.

How is the UK regulatory environment as compared to other European countries?

significant reduction in tax on the R&D undertaken in the UK.

How is UK harnessing big data for better healthcare? How do you think the data saved in the cloud is secured? One of the examples I can give with regard to use of big data is that we have National Health Service (NHS)â&#x20AC;&#x201D; one of the biggest organisations in the world which has a massive patients data. NHS has been around for over 60 years and we have information of the patients who are not only children which were born today, but also of their parents, grandparents and great grandparents and so on. There was a realisation some time back that we should try to make use of this data. We have Clinical Practice Research Datalink (CPRD) and did anonymise records that was kept by the NHS. But

UKâ&#x20AC;&#x2122;s regulatory organisation is known as Medicines and Healthcare Products Regulatory Agency (MHRA), which is soon going to ink an MoU this year with the Government of India. MHRA has always had acceptance in India, undertaking facility inspections to make sure that the manufacturing of the drugs is complying with the requirements of the MHRA. We have an European Medicines Agency (EMA), which covers entire Europe, to ensure harmony between all countries in Europe, making a drug registered for the UK, eligible to be sold in any of the other European countries.

When you talk about the Indian market of life sciences, are there any hurdles in the trade between UK and India in this sector? There are no hurdles in the trade between the two countries and I find a lot of interest in the Indian companies to do business in the UK and sell drugs into the UK market. A lot of companies already have facilities in the UK while a few of them are undertaking research and development here as well.Â

Viewpoint

108 the ‘Life Saviour’ of Rajasthan GVK EMRI was established with the objective of delivering comprehensive, emergency care service through a single toll-free number 108 (EMS), rendering quality pre-hospital care and transport of a patient to the appropriate healthcare facility.

VK EMRI (Emergency Management and Research Institute) is a pioneer in emergency management services in India. A not–for–profit organisation operating in PublicPrivate-Partnership (PPP) mode, GVK EMRI is the largest professional emergency service provider in India today. GVK EMRI was established with the objective of delivering comprehensive, emergency care service through a single toll-free number 108 (EMS), rendering quality pre-hospital care and transport of a patient to the appropriate healthcare facility. Every life saved by 108 is a reflection of the combined effort of a team of dedicated professionals. Thanks to their tireless efforts, today, 108 is a symbol of hope, trust and reassurance. GVK EMRI has in place, meticulously drawn processes that ensure speedy, effective pre-hospital care designed to save lives. A fourpronged approach: Sense–Reach– Care–Follow-Up is aimed at a holistic delivery of the most sophisticated emergency management services. With increased focus on research and analytics, GVK EMRI is now poised to enter the arena of protecting law and order in the society. From 108, 104, 102, 181, to 100, GVK EMRI has left no stone unturned to reach out to the needy. GVK EMRI is currently operational in 17 States including two Union Territories - Andhra Pradesh, Telangana, Gujarat, Uttarakhand, Goa, Tamil Nadu, Karnataka, Assam,

Meghalaya, Madhya Pradesh, Himachal Pradesh, Chhattisgarh, Uttar Pradesh, Rajasthan, Kerala, Dadra & Nagar Haveli and Daman & Diu. With a fleet of more than 9487+ Ambulances across the nation, we have responded to approx. 36.1 M emergencies and saved 1350,556 + lac lives. The launch of 108 Services in Rajasthan on 20 September 2008 heralds a new era of emergency medical care in the state. The service has revolutionised response to the people in distress and contributed to health index of the state directly. 108 Emergency Response Services run by GVK EMRI and Government of Rajasthan in PPP mode has become a symbol of faith reposed in the program for its response to any kind of emergency – be it medical, police or fire, 24X7 across entire state of Rajasthan. GVK EMRI has attended more than 10.26 lakh emergencies in last two years of operations in Rajasthan. 741 1-0-8 Ambulances cover more than seven crore population in 33 districts. Every day, 108 respond to over 1700 emergencies. 99 per cent of calls received on 108 are attended within three seconds, on par with global standards. GVK EMRI Rajasthan team comprises of a strong force of 3300 dedicated associates, responding to more than 45000 emergencies in a month. The service has directly contributed in the reduction of MMR/IMR in Rajasthan. Institutional deliveries have increased significantly over

“It is a matter of great pride for us for having served more than 10.26 lakh beneficiaries in Rajasthan. This PPP initiative of Government of Rajasthan and their continuous support to this service has benefitted the people of Rajasthan”, says K. Krishnam Raju, Director, GVK EMRI. last two years as 37 per cent of total emergencies handled by 108 comprises of pregnancy-related emergencies. Years of experience have increased the operational and management expertise in running the 108 program. Quality has gone up, costs have come down, the program has expanded, efficiency has increased, add on synergies have emerged, the number of services provided has increased and the ability of upstream and downstream health facilities to respond to the emergencies has also increased. Perceptions have changed in both the state and the centre, to seeing such investment as both affordable and essential.

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Innovation

√JanSwasthya

Technology enabled transformation of human potential for saving lives in most deprived settings with enhanced skills, scale and speed In this era of ever expanding technological advancement in India, an overwhelming number of mother and children still face the challenges of survival especially amongst tribal communities. Anaemia, low birth weight, malnutrition, diarrhoea, pneumonia, add on to this quest of survival further impeding opportunities to thrive in life Therefore, investments to ensure optimum health services delivery to each citizen through suitable initiatives are needed by the government to gain holistic development including the remotest belt.

anSwasthaya means public health. Any nation without healthy citizen, especially women and children, cannot grow to its full potential. Over the years, many interventions have been tested and found very useful for not only saving the lives of women and children, but also to make them grow to their fullest potential. The state and national governments have developed policies to provide these evidence based interventions even in the remotest area of the country, including Rajasthan. However, these services are mainly delivered by a government hired woman staff known as the Auxiliary Nurse Midwives (ANM) in the rural area. Delivering these interventions by an ANM is a difficult easy task in the complex ecosystem, cultural and traditional social fabric of the rural Rajasthan. There still remain multiple obstacles related to: Poor Inter personal counselling skills

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and sub optimal use of job aids which are often bulky and difficult to carry during home and community visits  Poor skills of ANM despite multiple trainings  Decision regarding the health of the women and children is either taken by the family or by societal elders who are rigid in their beliefs, fail to spot the importance of the required care. The delay makes the situation worse causing even death.  The ANM does manual updation of records which is a tedious process  Most of the preventive and promotive healthcare interventions depend on the communication between the family members and the ANM which often gets neglected due to weak skills of ANMs  Despite huge investment in setting up of monitoring mechanisms, it remains weak due to low quality and incomplete data √JanSwasthya is an android-based

application developed for National Health Mission Rajasthan, by an innovation hub set up at State Institute of Health and Family Welfare (SIHFW) with the technical support of UNICEF Rajasthan which has transformed the functioning as well as thoughts of the ANMs from number to quality. This was initiated with 15 ASHAs in one of the most deprived district Barmer and then advocated with the partners and district administration of various districts. In district Dungarpur ‘Save the Children’ is implementing through their resources where 60 ANM and 60 ASHA are using this application. In Pali, it started with 8 ANMs and now 120 ANMs are working. In Jhalawar district it was started at one PHC with 8 ANMs. The Chief Minister of Rajasthan witnessed the application being used by ANMs on at Jhalawar district and announced for the pilot in seven districts of Rajasthan in her budget speech.

Innovation

√JanSwasthya Application This is an android based application and includes the key interventions delivered by ANMs and ASHAs in the rural areas. 1. Improved Interactive Client Centric Communication to facilitate actions at the community and Family Level: It will facilitate decision at community and family level on the basis of information collected in analysis and preparing the automated key message to be communicated to the pregnant women, mothers of the young children and their family members. It also helps in better communication of messages which are auto-generated depending on the situation, providing a client centric communication and also use of Videos for communicating messages as a powerful tool 2. Enable ANM and Frontline functionaries to deliver lifesaving services with quality and improve Effectiveness The application covers key components of care during pregnancy, care after birth for mother and newborn, care of young children with monitoring and tracking of their growth. It helps in timely identification of deviation from normal progress during pregnancy and after child birth.. It also helps in tracking the growth of every child leading to timely identification of undernourished children. 3. Empower ANMs and Frontline functionaries in generating evidence based work plan and list of due beneficiaries: It generates the work plan and duelist for ANMs so that no woman and child are left. Most often

“ A dream has come true to deliver quality public health care services in an efficient and effective manner in the remotest area of Rajasthan” – Dr M L Jain, Director SIHFW ANMs forget to provide services to the eligible couple using family planning methods. This application automatically reminds both the user and ANMs regarding services to be provided for family planning to the eligible couples also tracking their preference towards contraceptive and its use. It keeps record of all eligible couples requiring any type of contraceptives. 4. Every Child Counts Denominator based tracking of every women and child in ANM or ASHAs area will help in counting and reaching to the most deprived and also track the left outs. 5. Transparent Performance-based monitoring Transparent performance based monitoring can contribute in keeping the staff motivated and also identifying underperformers. An automated star rating / grading system based on the denominator and achievements will be calculated, which can be seen both by the worker

and supervisors. 6. Simplified Reporting mechanism Form 6: Most of the time ANMs face difficulty in preparing form 6 report because the records collect the information on area basis, while reports need to be service based for that particular sub-centre unit. E Janswasthya addresses this by a form 6 which can be filled during MCHN Day (VHND) and auto compilation would generate a form 6, which can be submitted for digitisation at the PHC level. 7. Reminder to beneficiaries and service providers To improve coverage and continuous utilisation of key Maternal Newborn and Child Health interventions an automated SMS will be generated at the time of registration as well as two days prior to next due date. The initial results from the field confirm the robustness of the application as well as ease of use by lesser educated frontline functionaries who are successfully tracking 1500 pregnant women, 650 children and 32000 eligible couples. In phase one given the preliminary results, the Government of Rajasthan has prioritized the distribution of tablets to 1500 ANMs aimed at reaching 20000 pregnant women and 100000 children below 5 years. E Janswasthya is being considered for replication in other states by Govt of India. The Government of Chhattisgarh also showed interest in using this approach. Successful implementation of √Janswasthya by India would be a pioneering step towards delivering health services in remotest areas using technology aboard Digital India Platform.

july / 2015 ehealth.eletsonline.com

Exclusive Interview

Providing Affordable Cancer Care Our hospital treats 25 per cent patients belonging to economically weaker section and also imparts health education to prevent cancer, says Dr (Maj Gen) S C Pareek, Medical Director, Bhagwan Mahaveer Cancer Hospital & Research Centre (BMCHRC) in conversation with Romiya Das of Elets News Network (ENN) Tell us about the healthcare scenario in Rajasthan? The healthcare delivery system of Rajasthan includes hospitals (primary, secondary and tertiary care), PHCs, CHCs, maternity and child welfare centers, sub centers. However, any healthcare system can be successful if the elements such as finance, health work force, medicines, vaccines, diagnostics and infrastructures are available. There had been a shortage of health workforce, medicines and diagnostics in the rural Rajasthan. The availability of doctors and paramedical staff in rural area, preventive healthcare facilities are minimal, non-availability of medicines, inadequate health education facilities.

What healthcare facilities are provided at BMCHRC? BMCHRC is the only cancer hospital in Rajasthan that provides comprehensive cancer care to the people in the state as well as MP,

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UP, Haryana, Punjab, Uttarakhand etc. The management aims to make the hospital a comprehensive world class cancer treatment centre with cutting edge technology to provide affordable care with human touch to all sections of society irrespective of economic considerations.

What are the corporate social responsibilities BMCHRC has undertaken? BMCHRC has been entrusted some obligatory responsibilities to treat 25 per cent of cases (IPD & OPD separately) belonging to Economically Weaker Section (EWS) of the society and also patients referred by government hospital. The hospital has a separate counter for EWS. As part of CSR we are regularly conduct health camps in the remote areas of the state and also impart health education to prevent cancer. We have started two projects – ‘Donate a Life Project’ is for children aged 14 and under suffering from blood cancer are treated and the success rate of such treatments is more than 90 per cent. These are Acute Lymphoblastic Leukemia (ALL), Acute Promylocytic Leukemia (APML) and Hodgkin’s Lymphoma (HD). So far we have extended treatment to more than 27 (up to March 2015) children free of cost. ‘Early Detection of Breast & Cervix Cancer’ is aimed at providing an annual checkup for women aged 40 and above. The Pap smear and mammography tests are conducted on fourth Saturday of every month from 2-5 pm free of cost. So far, more than

86 women have been screened under this program.

What is your opinion in adaption of IT in healthcare industry? IT is a tool which can provide speed and quality in healthcare industry. Hospital information system has brought revolution in the delivery of healthcare facilities. IT has facilitated both healthcare providers and the receivers in patient care. However, this has to be taken as integral part of healthcare delivery system. Telemedicine can bring a revolution as even in the remote areas a doctor can consult the super specialist available in the capital. This can help in delivering almost same type of care which could have been provided as a tertiary care hospital.

Do you think PPP is the right way forward? Yes, I think Public-Private-Partnership (PPP) is the right way in providing healthcare facilities in the rural areas provided, the model has characteristics such as clearly specified, realistic and shared goals; clearly delineated and agreed roles and responsibilities; distinct benefits for all parties; the perception of transparency; active maintenance of the partnership; equality of participation; Meeting agreed obligations. The PPP in healthcare will result in to standardised services, affordable prices, quality assurance, government schemes for EWS can be implemented.

Second Opinion

Cloud Computing -

A Game Changer Indian healthcare providers must exploit the early entrant advantage otherwise countries like Thailand will overtake us in the years to come, says U K Ananthapadmanabhan, Group President, Rainbow Hospitals, Hyderabad

ndian healthcare industry traditionally has been a slow adopter of information technology when compared to other industries like banking, manufacturing, retail and education. Until last decade, healthcare providers’ primary focus has been on automation of back-office systems, reimbursement methods and regulatory compliance and accreditation requirements. IT budgets have been very low as they were not considered as a part of infrastructure and had to c o m p e t e with other priorities like radiology equipment

and hospital expansion. Today IT in a hospital has become as important as a stethoscope to a doctor. It is all pervasive and has become an inseparable part of any care provider, be it a doctor or a nurse.

Cloud Computing Cloud computing is transforming the way we are consuming technology. It should be better understood as the use of computing resources both hardware and software that are delivered as a service over a network. It can be Infrastructure as a Service (IaaS), or Platform as a Service (PaaS), or Software as a Service (SaaS). Deployment can be done in three different ways as Private, Public and Hybrid clouds combining two or more clouds (private or public) that remain unique entities but are bound together by technology that enables data and application portability.

Key Characteristics  Measured service: IT infrastructure and applications are delivered and consumed as a service over the network.  Rapid elasticity and homogeneity: Services operate consistently, Regardless of the underlying systems. Capacity and performance scale to meet demand and are invoiced by use. Multi-tenancy and resource  pooling: Services are shared across multiple organizations, allowing the same underlying systems and applications to meet the demands of a variety of interests, simultaneously and securely.  Location independence and ubiquitous network access: Applications, services, and data can be accessed through a wide range of connected devices (e.g., smart phones, laptops, and other mobile internet devices) at any time and any place using high band width connectivity.

Benefits Elasticity: Elastic (unlimited) public cloud scaling can handle traffic bursts. No need to our provision, cloud CPUs scale according to traffic. Conceptualising, architecting and deploying IT solutions in a healthcare setting do not need to be a long drawn-

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Second Opinion

out process. Solutions can be built quickly using cloud-based platforms that are already HIPAA compliant. For example, Rainbow hospitals group, Hyderabad moved all their applications in eight hospitals (800 inpatients 1000 outpatient a day) to the cloud within nine months. It gave real time access on a dashboard from any place and from any device be it a desktop, laptop, tablet or smartphone. This was the highlight of the recently launched IT transformational project titled “Rainbow Digital”. Rapid expansion IT resources was possible for existing healthcare facilities. In new healthcare facilities, IT resources like hardware, software was rolled out at very short notice as less as seven days. Low cost: Cloud computing empowers providers to only pay for what they need. It helps the hospitals and healthcare providers to use the applications, hardware, and services on a ‘pay per use’ model, which allows them to avoid heavy capital expenditure on buying and deploying expensive technology. Ease of Maintenance: IT expertise for in-house infrastructure maintenance is very difficult to obtain for healthcare institutions since IT personnel prefer to work for IT companies to IT departments in healthcare institutions. Therefore, many organisations have started to outsource the maintenance of inhouse IT infrastructure to agencies that have specialised knowledge on maintenance IT networks and desktops. The maintenance of infrastructure facilities like air conditioning, power, air-quality, and operating system for the hardware is shifted to the cloud service provider.

Risks and Challenges Cloud computing may not be the panacea for all the ills in the healthcare IT. Although most of the hardware, software and the specialised expertise available in the established data

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centres are superior to those are available on hospital premises. The touch and feel of the servers are not available for the IT personnel and the end-users, which sometimes seem to erode the confidence of the IT staff and the top management, on cloud based systems. IT managers of Indian hospitals have not still come to terms with huge impact of emerging cloud and mobile technologies. They need to unlearn and relearn and hone their software skills as winds of change are blowing very fast in their field. The Internet-of-Things (IoT), robotic technologies and virtual desk tops may become the order of the day in the next five years all being operated from the cloud. If they fail to see the

and it is not secure. On the contrary, the cloud can be as secure and convenient as data on their own premises provided they do enough planning, properly configure and manage their set ups well. In large hospital chains with number of units located geographically in distant places, managing data on premises is becoming very difficult and a unviable proposition in terms of availability, dependability and cost of IT expertise, hardware and software resources. It would be easier to protect the data in a central data centre with highly professional and specialised team rather than protecting the data servers in multiple and distant places.

The exponential growth of ICT technologies will open up great opportunities as well as challenges for Indian healthcare industry writing on the wall and come to terms with rapidly growing mobile and cloud technologies they may professionally fade away sooner than they expect. Although, cloud offers immense benefits in terms of costs, agility, efficiency and scalability, there are inherent risks like data centre vendor’s compliance of service level agreements (SLA), data security at data centres and also the reliability of the networks service providers. Many a times the escalation matrix in times of crisis seemed to be more on paper than in action and practice and during night times and holidays and the service delays can be very frustrating.

Security and Privacy There is no health insurance portability and accountability act (HIPPA) in India, but the indications are that the government is exploring process of putting up a regulatory framework in place. Most healthcare organisations pushback on cloud computing as they believe that their data is on an outside infrastructure

Conclusion India with its highly qualified and trained medical expertise, state-ofthe-art medical facilities and with its huge cost advantage is fast emerging as the medical tourism hub for the world. Domestic medical industry is also growing at about 15 per cent, much ahead of the GDP of the country. The exponential growth of ICT technologies will open up great opportunities as well as challenges for Indian healthcare industry. It is estimated that the cloud based technologies alone will offer about US$ 241 billion business by the year 2020 and India can surely benefit by it being the power house for the world in the IT sector. Our care providers, technologists and hospital promoters must learn to align their goals with emerging disruptive technologies being the power house for the world in the IT sector. Our care providers, must exploit the early entrant advantage otherwise countries like Thailand will overtake us in the years to come.